Effect of gender of new-born, antenatal care and postnatal care on breastfeeding practices in Ethiopia: Evidence from systematic review and meta-analysis of national studies

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’s regression test at p-value threshold ≤ 0.01 was used to examine publication bias. Cochran’s 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 <0.001, I 2 = 90.9%), PNC (OR = 1.86, 95% CI 1.41 - 2.47, p <0.001, I 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 Strengths and limitations of this study This systematic review and meta-analysis was conducted based on the registered and published protocol. Since it is the first study in Ethiopia, the information could be helpful for future researchers, public health practitioners, and healthcare policymakers. Almost all included studies were observational which may hinder causality inference. Perhaps the results may not be nationally representative given that studies from some regions are lacking. Based on the conventional methods of the heterogeneity test, a few analyses suffer from high between-study variation.