Proximal and distal factors predicting timely initiation of breastfeeding in Ethiopia: a systematic review and meta-analysis

Background: In Ethiopia, the current coverage of timely initiation of breast feeding (TIBF) has fallen short of the National Health Sector Transformation Plan 2016–2020, National Nutrition Program 2016-2020 and WHO global target. This calls for the need to assess relevant proximal and distal factors that affect the rate of TIBF in Ethiopia. Objective: The aim of this meta-analysis was to investigate the association between TIBF and educational status, household income, marital status, media exposure, and parity in Ethiopia. Methods: Databases used were PubMed, EMBASE, Web of Science, SCOPUS, CINAHL and WHO Global health library, and key terms were searched using interactive searching syntax. It was also supplemented by manual searching. Observational studies published between September 2000 and March 2019 were included. The methodological quality of studies was examined using the Newcastle-Ottawa Scale (NOS) for cross-sectional studies. Data were extracted using the Joanna Briggs Institute (JBI) data extraction tool. To obtain the pooled odds ratio (OR), extracted data were fitted in a random-effects meta-analysis model. Statistical heterogeneity was quantified using Cochran Q test, tau2, and I2 statistics. Additional analysis conducted includes Jackknife sensitivity analysis, cumulative meta-analysis, and meta-regression analysis. Results: Out of 553 studies retrieved, 25 studies fulfilled our inclusion criteria. Almost all studies were conducted on mothers with newborn less than 23 months. Maternal educational status (OR = 1.82; p