Abstract
BACKGROUND AND AIMS: Delayed initiation of breastfeeding is associated with poor child development outcomes and increased risk of infant mortality, which remains a major public health challenge in low- and middle-income countries. Despite global and national efforts to promote optimal breastfeeding, early initiation remains suboptimal in much of Sub-Saharan Africa. This study examined the prevalence and factors associated with delayed initiation of breastfeeding in Tanzania. METHODS: We analyzed secondary data from the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey, a nationally representative cross-sectional survey. The study population comprised children under 24 months. The outcome variable was delayed breastfeeding initiation, defined as not initiating breastfeeding within 1 h of life. Weighted data were analyzed using multilevel mixed-effects logistic regression to identify associated factors. RESULTS: A total of 4478 children were included, with a mean (±SD) age of 11.5 ± 6.9 months. The prevalence of delayed initiation was 24.4%. Child-related factors included first (aPR = 1.32; 95% CI: 1.13-1.55) and second birth order (aPR = 1.21; 95% CI: 1.06-1.39). Maternal age 35-49 years was also associated (aPR = 1.16; 95% CI: 1.02-1.32). Health-related factors included absence of immediate skin-to-skin contact (aPR = 1.85; 95% CI: 1.64-2.09), cesarean delivery (aPR = 2.45; 95% CI: 2.17-2.78), lack of birth assistance (aPR = 1.63; 95% CI: 1.16-2.28), and assistance from non-skilled provider (aPR = 1.42; 95% CI: 1.09-1.84). Geographically, delayed initiation was more prevalent in Zanzibar (aPR = 1.62; 95% CI: 1.33-1.98) and less prevalent in the Southern zone (aPR = 0.54; 95% CI: 0.36-0.80). CONCLUSION: Nearly one in four newborns in Tanzania experience delayed breastfeeding initiation. Delayed initiation was associated with child, maternal, health-related, and geographical factors. Strengthening skin-to-skin contact, skilled birth attendance, cesarean support, counseling for first-time and older mothers, and addressing geographical disparities may improve early initiation and support progress toward Sustainable Development Goal target 3.2.