Determinants of early initiation of breastfeeding in Côte d'Ivoire: a hospital-based study.

Background: Early initiation of breastfeeding (EIBF), defined as putting the newborn to the breast within the first hour of life, is a cost-effective and evidence-based intervention to reduce neonatal morbidity and mortality. In Côte d'Ivoire, EIBF coverage remains suboptimal despite international recommendations.

Methods: We conducted a cross-sectional analytical study from June to July 2022 at Abobo Houphouët-Boigny Regional Hospital in Abidjan. A total of 320 mother-infant dyads were consecutively enrolled. Data were collected using structured questionnaires and medical records. Associations between independent variables and EIBF were first explored using chi-square or Fisher's exact tests. Variables with p < 0.20 were included in a multivariate logistic regression model. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported.

Results: The prevalence of EIBF was 61%. In bivariate analysis, maternal age < 20 years, maternal education, religion, unplanned pregnancy, vaginal delivery, and a 5-minute Apgar score ≥ 7 were significantly associated with EIBF. In the multivariate model, two independent predictors remained significant: higher maternal education increased the likelihood of EIBF (aOR = 2.20; 95% CI: 1.37-3.93; p = 0.005), whereas cesarean delivery markedly reduced it compared with vaginal delivery (aOR = 0.08; 95% CI: 0.04-0.14; p < 0.001).

Conclusions: Although the prevalence of EIBF in this hospital was higher than the national estimate, it remains below international targets. Maternal education and mode of delivery are key determinants. Strengthening prenatal counseling and adapting post-cesarean protocols to promote immediate skin-to-skin contact are essential to increase EIBF coverage in Côte d'Ivoire.