The global breastfeeding recommendation states that all infants should be put to the breast within one hour of birth, which is defined as timely initiation or early initiation of breastfeeding. Early initiation of breastfeeding is associated with reduced risk in infant illness and death. Understanding the determinants of delay in initiation of breastfeeding might spur health staff and policy makers to foster timely breastfeeding. We assessed the prevalence and determinants of delay in initiation of breastfeeding among mothers in Juba Teaching Hospital. The present study enrolled 806 mother-infant pairs within 24 hrs of birth in Juba Teaching Hospital in 2017. The mothers were interviewed about the time of initiation of breastfeeding, sociodemographic and birth characteristics. The independent variables associated with delay in initiation of breastfeeding were identified using multivariable logistic regression analysis. In the current study, 52% (418/806) of the mothers initiated breastfeeding later than one hour after birth. Birth by Caesarean section (Adjusted Odds Ratio [AOR] 41; 95% Confidence Interval [CI] 12.21, 138), discarding of colostrum (AOR 9.89; 95% CI 4.14, 23.62), unmarried mothers (AOR 3.76; 95% CI 1.53, 9.24), exposure to infant formula advertisement (AOR 1.82; 95% CI 1.09, 3.02) and no house ownership (AOR 1.52; 95% CI 1.11, 2.09) were independent factors associated with delay in initiation of breastfeeding. We found that more than half of the mothers delayed the initiation of breastfeeding. Therefore, we recommend training on best breastfeeding practices and counselling skills for health staff in Juba Teaching Hospital. Policy dialogue, with the relevant ministries and departments on the promotion and protection of early initiation of breastfeeding is crucial.

Background: Pre-lacteal feeding (PLF) is a barrier to optimal breastfeeding and increases the risk of diarrhoea and acute respiratory tract infections in infants.The prevalence and predictors of PLF are not well studied in South Sudan. Understanding the predictors of PLF is crucial in designing interventions to increase exclusive breastfeeding (EBF) rates. Objective: To assess the prevalence and factors associated with PLF in Jubek State, South Sudan. Method: This was a community based cross-sectional study of 810 mothers of children under two years of age in Jubek State, South Sudan. Mothers were interviewed in their homes using a semi-structured questionnaire to collect data on PLF, socio-demographic and birth characteristics. Multivariable analysis was used to identify factors independently associated with PLF. Results: A total of 426/810 (53 %), 95% confidence interval (CI) [48 %, 59 %] mothers had given pre-lacteal feeds to their infants. The commonest pre-lacteal feeds included glucose solution (54%), water (26%), and infant formula (14%). Having received antenatal breastfeeding counselling decreased the odds of PLF [adjusted odds ratio (AOR) 0.60; 95% CI (0.43, 0.82)]; while discarding of colostrum increased the use of pre-lacteal feeds [AOR 1.57; 95% CI (1.17, 2.11)]. Conclusion: The prevalence of PLF in South Sudan is high. Predictors of PLF included lack of breastfeeding counselling and discarding of colostrum. Infant feeding counselling should be given to all pregnant women in the health facilities and communities. The counselling should emphasize the health benefits of colostrum and discourage the practice of discarding it.

Background: Perinatal mortality in Uganda remains high at 38 deaths/1,000 births, an estimate greater than the every newborn action plan (ENAP) target of ≤24/1,000 births by 2030. To improve perinatal survival, there is a need to understand the persisting risk factors for death. Objective: We determined the incidence, risk factors, and causes of perinatal death in Lira district, Northern Uganda. Methods: This was a community-based prospective cohort study among pregnant women in Lira district, Northern Uganda. Female community volunteers identified pregnant women in each household who were recruited at ≥28 weeks of gestation and followed until 50 days postpartum. Information on perinatal survival was gathered from participants within 24 hours after childbirth and at 7 days postpartum. The cause of death was ascertained using verbal autopsies. We used generalized estimating equations of the Poisson family to determine the risk factors for perinatal death. Results: Of the 1,877 women enrolled, the majority were ≤30 years old (79.8%), married or cohabiting (91.3%), and had attained only a primary education (77.7%). There were 81 perinatal deaths among them, giving a perinatal mortality rate of 43/1,000 births [95% confidence interval (95% CI: 35, 53)], of these 37 were stillbirths (20 deaths/1,000 total births) and 44 were early neonatal deaths (23 deaths/1,000 live births). Birth asphyxia, respiratory failure, infections and intra-partum events were the major probable contributors to perinatal death. The risk factors for perinatal death were nulliparity at enrolment (adjusted IRR 2.7, [95% CI: 1.3, 5.6]) and maternal age >30 years (adjusted IRR 2.5, [95% CI: 1.1, 5.8]). Conclusion: The incidence of perinatal death in this region was higher than had previously been reported in Uganda. Risk factors for perinatal mortality were nulliparity and maternal age >30 years. Pregnant women in this region need improved access to care during pregnancy and childbirth.

Knowledge of key decision makers and actors in newborn care is necessary to ensure that health interventions are targeted at the right people. This was a cross-sectional study carried out in Lira district, Northern Uganda. Multivariable logistic regression was used to determine factors associated with mothers being the key decision maker regarding where to give birth from and when to initiate breastfeeding. Fathers were the key decision makers on the place of birth (54.3%, n = 505) and on whether to seek care for a sick newborn child (47.7%, n = 92). Grandmothers most commonly bathed the baby immediately after birth (55.5%, n = 516), whereas mothers and health workers were common decision makers regarding breastfeeding initiation. Predictors for a mother being the key decision maker on the place of birth included: Mother having a secondary education (AOR 1.9: 95% C.I (1.0–3.6)) and mother being formally employed (AOR 2.0: 95% (1.5–2.9)). Mothers, fathers, grandmothers, health-workers, and traditional birth attendants were the most influential in the selected newborn care practices. Programs that aim to promote newborn care need to involve husbands, grandmothers, and health workers in addition to mothers.

South Sudan has a high maternal mortality ratio estimated at 800 deaths per 100,000 live births. Birth in health facilities with skilled attendants can lower this mortality. In this cross-sectional study, we determined the level and determinants of health facility utilization and skilled birth attendance in Jubek State, South Sudan. Mothers of children aged less than two years were interviewed in their homes. Multivariable regression analysis was performed to determine factors associated with health facility births. Only a quarter of the mothers had given birth at health facilities, 209/810 (25.8%; 95% CI 18.2–35.3) and 207/810 had a skilled birth attendant (defined as either nurse, midwife, clinical officer, or doctor). Factors positively associated with health facility births were four or more antenatal visits (adjusted odds ratio (AOR) 19; 95% CI 6.2, 61), secondary or higher education (AOR 7.9; 95% CI 3, 21), high socio-economic status (AOR 4.5; 95% CI 2.2, 9.4), and being primipara (AOR 2.9; 95% CI 1.5, 5.4). These findings highlight the need for efforts to increase health facility births in South Sudan.

Globally, suboptimal breastfeeding contributes to more than 800,000 child deaths annually. In South Sudan, few women breastfeed early. We assessed the effect of a Baby-Friendly Hospital Initiative training on early initiation of breastfeeding at Juba Teaching Hospital in South Sudan. We carried out the training for health workers after a baseline survey. We recruited 806 mothers both before and four to six months after training. We used a modified Poisson model to assess the effect of training. The prevalence of early initiation of breastfeeding increased from 48% (388/806) before to 91% (732/806) after training. Similarly, early initiation of breastfeeding increased from 3% (3/97) before to 60% (12/20) after training among women who delivered by caesarean section. About 8% (67/806) of mothers discarded colostrum before compared to 3% (24/806) after training. Further, 17% (134/806) of mothers used pre-lacteal feeds before compared to only 2% (15/806) after training. Regardless of the mode of birth, the intervention was effective in increasing early initiation of breastfeeding [adjusted prevalence ratio (APR) 1.69, 95% confidence interval CI (1.57-1.82)]. These findings suggest an urgent need to roll out the training to other hospitals in South Sudan. This will result in improved breastfeeding practices, maternal, and infant health.