ArticleFrontiers in nutrition2026
Socio-demographic and community-level determinants of delayed breastfeeding initiation in Borama, Somalia: a multilevel mixed-effects analysis.
Article in Frontiers in nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Timely initiation of breastfeeding is a proven life-saving intervention for reducing neonatal morbidity and mortality. Despite global advocacy, adherence in fragile health systems remains critically low. This study assesses the magnitude and multi-level epidemiological predictors of delayed breastfeeding initiation among postnatal mothers in Borama, Somalia. Methods: An institution-based cross-sectional study was conducted among 392 postnatal mothers (aged 15-49 years) recruited via systematic random sampling at the Sheekh Osman Center for Community Health. Data were gathered using a pre-tested, structured interviewer-administered questionnaire. Delayed breastfeeding initiation was defined as initiating suckling more than 30 min postpartum. Participants were nested within 14 recognized municipal neighborhood clusters in Borama. To account for community-level clustering, a four-step hierarchical multilevel mixed-effects logistic regression was performed. Fixed effects were expressed as Adjusted Odds Ratios (aOR) with 95% Confidence Intervals (CI), and random effects were quantified using the Intraclass Correlation Coefficient (ICC). Results: The magnitude of delayed breastfeeding initiation was 40.8% (95% CI: 35.9-45.8%; Conclusion: Over four in ten mothers experienced delayed breastfeeding initiation. Gaps in antenatal counseling, lack of maternal formal education, and neighborhood-level clustering are primary drivers of delayed initiation. Health authorities must implement facility-based Baby-Friendly Hospital Initiative protocols and intensify antenatal lactation counseling.
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