What is the impact of gender of new-born, antenatal care and postnatal care on breastfeeding practices in Ethiopia? A systematic review and meta-analysis
ObjectiveThe aim of this systematic review and meta-analysis was to investigate the association of gender of new-born, antenatal care (ANC) and postnatal care (PNC) with timely initiation of breastfeeding (TIBF) and exclusive breastfeeding (EBF) practice in Ethiopia.\n\nDesignSystematic review and meta-analysis\n\nMethodsPubMed, EMBASE, CINAHL, WHO Global Health Library, Web of Science and SCOPUS databases systematically searched and complemented by manual searches to retrieve all available literature. Newcastle-Ottawa Scale (NOS) was used for quality assessment of included studies. Eggers regression test at p-value threshold [≤] 0.01 was used to examine publication bias. Cochrans Q X2 test, {tau}2, and I2 statistics were used to test heterogeneity, estimate amount of total/residual heterogeneity and measure variability attributed to heterogeneity respectively. A meta-analysis using a weighted inverse variance random-effects model was performed. The trend of evidence over time was evaluated by performing a cumulative meta-analysis. Furthermore, mixed-effects meta-regression analysis was done to identify possible sources of heterogeneity.\n\nResultsOf 523 articles retrieved, 17 studies (N = 26,146 mothers) on TIBF and 27 studies (N = 17,819 mothers) on EBF were included in the final analysis. ANC (OR = 2.24, 95% CI 1.65 -3.04, p <0.001, I2 = 90.9%), PNC (OR = 1.86, 95% CI 1.41 - 2.47, p <0.001, I2 = 63.4%) and gender of new-born (OR = 1.31, 95% CI 1.01 - 1.68, p = 0.04, I2 = 81.7%) significantly associated with EBF. In addition, ANC (OR = 1.70, 95% CI 1.10 - 2.65, p = 0.02, I2 = 93.1%) was significantly associated with TIBF but not gender of new-born (OR = 1.02, 95% CI 0.86 -1.21, p = 0.82, I2 = 66.2%).\n\nConclusionsIn line with our hypothesis, gender of new-born, ANC and PNC significantly associated with EBF. Likewise, ANC significantly associated with TIBF. Optimal care during pregnancy and after birth is important to ensure adequate breastfeeding. This meta-analysis study provided evidence on breastfeeding practices and its associated factors in Ethiopian context, which can be useful for cross-country and cross-cultural comparison and for breastfeeding improvement initiative in Ethiopia.\n\nProtocol registration and publicationCRD42017056768 and 10.1136/BMJOPEN-2017-017437\n\nStrengths and limitations of this studyO_LIThis systematic review and meta-analysis was conducted based on the registered and published protocol.\nC_LIO_LISince it is the first study in Ethiopia, the information could be helpful for future researchers, public health practitioners, and healthcare policymakers.\nC_LIO_LIAlmost all included studies were observational which may hinder causality inference.\nC_LIO_LIPerhaps the results may not be nationally representative given that studies from some regions are lacking.\nC_LIO_LIBased on the conventional methods of the heterogeneity test, a few analyses suffer from high between-study variation.\nC_LI