Current findings and gaps in early initiation of breastfeeding practices in sub-Saharan African countries: A scoping review

Background Early initiation of breastfeeding (EIBF) plays an important role in reducing neonatal and infant mortality. Sub-Saharan African countries have high rates of neonatal and infant mortality, as well as a low prevalence of EIBF. By conducting a scoping review, we aimed to determine the gaps and current understandings of EIBF in Sub-Saharan Africa. Methods We conducted this scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Re-views (PRISMA-ScR) reporting guidelines, focusing on primary studies pub-lished from 2008 to 2021. We reviewed their titles and abstracts against the eligibility criteria, selecting the relevant ones to this study's criteria for a fur-ther full-text review. Results The identified determinants can be categorized into household, mater-nal, and health service characteristics. Regarding health service characteristics, many studies reported that cesarean section was strongly associated with the delayed initiation of breastfeeding. Institutional delivery and delivery by skilled birth attendants were also reported to be associated with the early initiation of breastfeeding. Others pointed out that place of residence and wealth index as two household characteristics that were strongly associated with EIBF, as well as maternal characteristics such as older maternal age and higher education status. Conclusions We found that only eleven studies on the early initiation of breast-feeding have been conducted in Central and West Africa. Household, maternal, and health service factors have been reported to be associated with the ear-ly initiation of breastfeeding across many countries. More studies are needed to fill the current geographic gaps and investigate determinants that have not been examined. Future research should also cover interventions that have been effective in improving EIBF for women after caesarean sections in sub-Saha-ran Africa. Interventions that promote institutional delivery and deliveries by skilled attendants have the potential to improve the practice.