Early Initiation of Breastfeeding and Associated Factors in a Private Healthcare Facility in Port Harcourt, Nigeria: A Before-and-After PDSA Cycle Study

Abstract

Background: Early breastfeeding initiation ensures that the newborn receives the nutrients- and immunoglobulin-rich colostrum, reduces reliance on prelacteal feeds and promotes exclusive breastfeeding, protecting the child from infections and offering other health benefits that significantly decrease neonatal and infant morbidity and mortality. Aims: The present study evaluates the prevalence of early initiation of breastfeeding (EIBF) 2 years before and after a Quality Improvement Project (QIP) using the Plan-Do-Study-Act (PDSA) cycle, and assesses associated maternal and child factors. Study design – A retrospective hospital-based before and after a PDSA cycle study. Place and Duration of Study: the maternity ward of a 50-bedded private specialist hospital in Port Harcourt, Nigeria using data of mothers that delivered in the hospital over 4 years and their babies. Those that delivered from January 2020 to December 2021 were termed the ‘before QIP’ group and those from January 2023 to December 2024 the ‘after QIP’ group. Mothers who delivered in 2022, the year of the QIP and their babies were not included in the study Methodology: Details of the mothers and their babies were obtained from the hospital’s medical records. Data were summarized and analyzed, differences between the before and after QIP groups were assessed using the independent samples t-test, prevalence of EIBF in each study population was determined; and the difference between the two groups and categorical variables between EIBF and selected variables were assessed using the Chi-square test or Fisher’s Exact where appropriate. Results: Prevalence of EIBF improved significantly from 45.4% in the before to 90% in the after group.  (P-value < 0.001). Vaginal delivery was significantly associated with EIBF in the before group (P-value < 0.001) and multiparity in the after group (P-value = 0.03). Maternal age, education, utilization of antenatal services, socio-economic class and baby’s age and sex were not significantly associated with EIBF. Conclusion: The prevalence of EIBF significantly increased after a PDSA cycle and was sustained for up to 2 years, supporting its use to improve healthcare gaps. Lack of association of EIBF with most evaluated factors calls for further research into other factors not evaluated in this study.