Random-effects modelling of timely initiation of breastfeeding in Tanzania: What predicts the practice?

To determine individual and community-level predictors associated with timely initiation of breastfeeding among women in Tanzania.

Analytical cross-sectional study.

This was an analytical cross-sectional study that used the 2022 Tanzania Demographic and Health Survey, which was conducted across all regions of Tanzania.

Data from 4308 women were included.

The outcome variable was timely initiation of breastfeeding, defined as starting breastfeeding within the first hour after birth, coded as 1 if timely and 0 otherwise. Mixed-effects generalised linear model (family- Binomial and link-logit) approach was used to account for the hierarchical structure of the data. Four models were constructed to assess individual and community-level predictors. Adjusted prevalence ratios (APRs) with 95% CIs were reported.

Women aged 25-34 years were significantly more likely to initiate breastfeeding within 1 hour (APR=1.40; 95% CI 1.18 to 1.65). Vaginal delivery was strongly associated with the timely initiation of breastfeeding (TIBF) (APR=10.13; 95% CI 7.84 to 13.09), whereas home delivery (APR=0.29; 95% CI 0.24 to 0.36) was negatively associated with TIBF. Multiparity (APR=1.22; 95% CI 1.04 to 1.43) increased the likelihood of TIBF. Women in the richest wealth category were less likely to practise TIBF (APR=0.70; 95% CI 0.51 to 0.96). Approximately 12.3% of the variation in TIBF was explained by cluster-level differences.

Both individual and community-level factors influence TIBF in Tanzania, highlighting the need for strong communication between mothers and healthcare providers to consistently promote its importance across all ages and wealth groups.