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

Objective: The 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. Design: Systematic review and meta-analysis Methods: PubMed, 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. Egger regression test at p-value threshold ≤ 0.01 was used to examine publication bias. Cochran Q X 2 test, τ 2 , and I 2 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. Results: Of 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 2 = 90.9%), PNC (OR = 1.86, 95% CI 1.41 - 2.47, p 2 = 63.4%) and gender of new-born (OR = 1.31, 95% CI 1.01 - 1.68, p = 0.04, I 2 = 81.7%) significantly associated with EBF. In addition, ANC (OR = 1.70, 95% CI 1.10 - 2.65, p = 0.02, I 2 = 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, I 2 = 66.2%). Conclusions: In 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. Protocol registration and publication: CRD42017056768 and 10.1136/BMJOPEN-2017-017437