Breast-feeding patterns in a rural village in Giza, Egypt.

In a longitudinal study of infant feeding in rural Giza, Egypt, we found that 68.8% of the recruited mothers initiated early suckling of colostrum, but only 51.2% of the infants were exclusively breast-fed in the first week. Solid foods were introduced much earlier than at the recommended age of 4 to 6 months. Sixty percent of the mothers who participated in the study considered breast-feeding plus regular or irregular complementary feeding to be exclusive breast-feeding.     

Growth pattern of exclusively breast-fed infants during the first six months of life in Ile-Ife,Osun State,Nigeria

Several studies to determine the growth pattern of exclusively breast fed infants have provided varying conclusions as to the sufficiency of breast milk alone to support adequate growth for the first six months of life. Disagreement exists concerning the optimal timing of introduction of complementary foods to exclusively breast fed infants. This prospective study thus examined the adequacy of breast milk alone to support normal growth during the first six months of life in our environment. The overall objective was to propose a scientifically sound national recommendation on the appropriate timing for the introduction of complementary feeding in Nigeria. Three hundred and fifty-two mother/infant pairs were serially recruited into the study; all babies were aged 14 days or less and weighed 2.5 kg and above. Three hundred and forty-five (98%) were successfully followed up till the infants were six months old. By six months, 264 (76.5%) were exclusively breast-fed, while 81 (23.5%) had commenced complementary feeding. Growth curves of exclusively breast-fed infants showed increasing weight from birth to six months. Although the 50th percentile birth weight for both boys and girls were the same (3.2 kg), boys gained weight faster than the girls from the age of one month to six months and were heavier at six months. Additionally, the 50th percentile curves of these infants (both genders) for the first six months were above the 50th percentile curve of the World Health Organisation and National Centre for Health Statistics (WHO/NCHS) reference currently used on our national "road to health" (growth monitoring) cards. It was concluded that exclusive breast-feeding supported adequate growth during the first six months of life for most of the children studied and that our national recommendation that infants be introduced to complementary feeding at six months is appropriate.     

Infant feeding patterns during the first year of life in Denmark: Factors associated with the discontinuation of breast-feeding

We prospectively studied 500 infants born consecutively in a university-affiliated community hospital in Copenhagen, Denmark, over the first 12 months of life using a detailed monthly mailed questionnaire (overall response RATE = 73%) which focused on feeding practices and illnesses. Seventy-seven percent of respondents breast-fed their infants at 1 month of life compared to 19% at 12 months of life. Analysis of breast-feeding behavior using survival analysis showed that 50% of the mothers who breast-fed since the first month of their infant's life were still breast-feeding at 7 months of life. Also, there was a greater than two-fold increase in the rate of discontinuation of breast-feeding for infants in daycare compared to infants not attending daycare (RR = 2.08, 95% CI = 1.43, 3.01). Discontinuation of breast-feeding was not significantly associated with the number of children in the family or with social class.

These results give insight into infant feeding patterns in a developed country and suggest that: (1) breast-feeding is the dominant method of feeding during the infant's first year of life, and (2) the rate of discontinuation of breast-feeding is increased by the entry of these infants into daycare.     

Poor compliance with appropriate feeding practices in children under 2 y in Mexico

We evaluated breast-feeding and complementary feeding practices in Mexico, using data from a national probabilistic survey carried out in 17,716 households, with regional and urban-rural representation. Mothers of children <2 y old (n = 3,191) reported duration of breast-feeding and the ages of usual introduction of 7 food groups. The Kaplan-Meier method was used to estimate the median time of feeding events. Practices were analyzed by categories of ethnicity, housing condition, and place of residence (geographic region and degree of urbanization). We found that 86% of infants at 1 mo and 39% at 11 mo were breast-fed, whereas 60% at 1 mo and 8% at 6 mo were exclusively breast-fed. Early introduction (<6 mo) of water, nonhuman milk, nonnutritive liquids, and fruits and vegetables was reported for all categories studied. Also, early introduction of nutritive liquids, cereals and legumes, and animal foods other than milk occurred in all categories except rural areas and the indigenous population. Late introduction of solid foods was documented in large proportions of infants in rural areas and in poor families. Poorer, unemployed, and indigenous women, and those bearing males, had a significantly higher probability of feeding their infants as recommended by the WHO. Feeding practices were unrelated to attained growth when the influence of economic and social factors was considered. Results indicate the need to implement actions for the promotion of exclusive breast-feeding during the first 6 mo and of timely introduction of complementary foods thereafter.     

Premature complementary feeding is associated with poorer growth of vietnamese children

The objective of this longitudinal study was to investigate the association between the premature initiation of complementary feeding and physical growth of children. Four cohorts of newborn children were included, consisting of 90 infants born in 1981, 90 in 1982, 60 infants in 1983 and 60 in 1984. The weights and heights of children were measured monthly up to 1 y, then every 3 mo for y 2 and 3, and once every 6 mo in y 4. Information on feeding practices and diseases of the children was obtained by interviewing the mothers at each home visit. All but three children (98.6%) were breast-fed. Although 87.1% of the mothers breast-fed their children for at least 1 y, only 3.3% of the infants were breast-fed exclusively at the age of 4 mo. In the analyses of growth, care was taken to address the biases of reverse causality, regression to the mean and confounding. There was little association between feeding pattern at 15 d and growth in length in mo 1. However, partially breast-fed and weaned infants gained weight more slowly than those exclusively or predominantly breast-fed. From 1 to 3 mo, exclusively breast-fed infants grew more quickly in both weight and length, followed by predominantly breast-fed infants. From 3 to 6 mo, exclusively breast-fed infants gained more weight compared with the other groups, but there was a slight difference (P = 0.047) in length gain only between exclusively and partially breast-fed infants. In the older period (6-12 mo), exclusively and predominantly breast-fed infants grew in length more quickly than partially breast-fed and weaned groups. However, there was no difference in weight gain among groups. Morbidity from diarrhea and acute respiratory infections was significantly lower for the >/=3 mo exclusively breast-fed group (chi(2) and Fisher-Exact Test). Over nearly the whole age range from 1 mo to 4 y, Z-scores for all indices (weight-for-age, height-for-age and weight-for-height) of the children who received complementary food were significantly lower than those of children who were exclusively breast-fed for at least 3 mo (repeated measures ANOVA, adjusted for sex, family size, maternal education and family income). These results show a long-term deterioration of physical growth in infants who received premature complementary feeding and confirm the importance of exclusive breast-feeding for infants for at least 3 mo.     

The duration of breast-feeding. A longitudinal prospective study in Denmark.

A longitudinal prospective study was performed to investigate the total duration of breast-feeding. Three hundred and sixty-six mothers were followed-up until 3 years after delivery. At 1 month 93% were breast-feeding, at 3 months 73%, at 6 months 52%, at 1 year 20% and 1% breast-fed more than 3 years. Correlations were found between duration of breast-feeding and maternal age, education and social class. Mothers who had breast-fed an older child usually breast-fed the next child for a period of similar length. Solid food was most frequently introduced when the infants were 4 months old. At 6 months 4% were still exclusively breast-fed. Breast-feeding has become popular: only 1% did not want to breast-feed at all and 89% of mothers intended to breast-feed their children for 6 months or more. Even though the mothers now breast-feed longer than earlier, only 39% succeeded in breast-feeding for as long as or longer than they had intended.     

Impact of breast-feeding promotion on infant feeding in the Czech Republic

OBJECTIVES: To assess infant feeding practices, identify factors that influence the duration of exclusive breast-feeding, and evaluate the impact of the National Breastfeeding Promotion Programme in the Czech Republic. HYPOTHESIS: We predicted the positive effect of the program in terms of increased prevalence of breast-feeding at discharge from the hospital and 6 months later. DESIGN: Multicenter cross-sectional survey. Mothers were randomly selected and interviewed in maternity hospitals in 1998 and were reinterviewed 6 months later. SETTINGS: Nine maternity hospitals in 6 cities across the country and households. PARTICIPANTS: 1104 mothers who gave birth within the 38th to the 42nd week of pregnancy to a healthy child with a minimum birthweight 2500 g; 1019 mothers were reinterviewed 6 months later. Intervention: The National Breastfeeding Promotion Programme implemented since 1991. VARIABLES MEASURED: Breast-feeding rates at discharge from the hospital and 6 months later, participation in prenatal classes, strategies related to breast-feeding promotion in the hospital, and support following discharge. ANALYSIS: Epi Info 6, SPSS (analysis of variance, F test), chi2. RESULTS: On leaving the hospital, 93.5% of newborns were exclusively breast-fed. Six months later, 23.1% of infants were breast-fed exclusively and 29.9% of infants were breast-fed while receiving complementary food. Participation in prenatal classes, first suckling within 2 hours of birth, breast-feeding on demand in the hospital, exclusive breast-feeding on leaving the hospital, and the duration of breast-feeding recommended by a pediatrician were positively related to the duration of exclusive breast-feeding (P <.001). CONCLUSIONS AND IMPLICATIONS: Compared with national data from the last 2 decades, the data from this study proved the increasing rates of breast-feeding at discharge from the hospital and 6 months later. The findings indicate the effectiveness of the National Breastfeeding Promotion Programme. However, further implementation of breast-feeding promotion strategies in health facilities coordinated by the Ministry of Health is needed.     

Weaning practices and breast-feeding duration in Northern Thailand.

Current infant feeding guidelines recommend exclusive breast-feeding until the infant is about 4 months old to reduce the risks of early termination of breast-feeding, undernutrition and infection. In many societies, however, supplementary foods are given well before 4 months of age. The present paper describes weaning practices, factors associated with early supplementation and the effects of supplementation on duration of breast-feeding in a random sample of sixty northern Thai breast-fed infants studied prospectively from birth to 2 years of age. Composition of supplementary foods, energy and protein intake from supplements and changes in the supplementary diet with increasing infant age are also described. Rice-based foods were given from soon after birth; 81% of the sample had received supplements by 6 weeks of age. Early supplementary feeding was significantly associated with rural residence, large household size, maternal employment in agriculture and maternal age. Girls and infants with lower birth weights tended to be supplemented earlier. Despite early feeding of supplements, breast-feeding was prolonged, with median duration of 12 months. Early introduction of supplements and quantity of supplements consumed in the first 3 months were not associated with duration of breast-feeding. However, mothers who gave infant formula as the first supplementary food stopped breast-feeding slightly earlier, as did younger mothers living in households with more children.     

Mode of infant feeding and achieved growth in adolescence: early feeding patterns in relation to growth and body composition in adolescence.

OBJECTIVE: Feeding mode in infancy and differences in childhood growth have been studied in several longitudinal studies, but few studies have followed children up to adolescent age. There is evidence that formula-fed infants weigh more and are taller than their breast-fed counterparts, and indications that this difference may sustain. RESEARCH METHODS AND PROCEDURES: We have studied the relations between length of breast-feeding, growth, and body composition in a group of 781 representatively chosen adolescents. Data on feeding pattern in infancy and on weight and height from birth up to 18 years were collected. We studied the relation between high body mass index (BMI) (defined as < or =85th percentile) in adolescence and length of breast-feeding. RESULTS: Girls who were not breast-fed or breast-fed for less than 3 months had a significantly higher height curve than girls exclusively breast-fed for more then 3 months. There were tendencies towards higher values of adipose tissue measured by skinfolds in girls breast-fed for 3 months or less. Short duration of exclusive breast-feeding was associated with higher BMI (p<0.04). In a subgroup of 194 adolescents, body composition was measured with dual energy X-ray. Both boys and girls who were exclusively breast-fed for more than 3 months were leaner and showed a trend towards lower skinfold values. CONCLUSION: These results are important to include in the debate about optimal feeding in infancy. Regarding breast-feeding as a standard, our results imply that formula fed infants may be at risk for overfeeding, which might lead to overweight, even up to adolescent age.     

Do early infant feeding patterns relate to breast-feeding continuation and weight gain? Data from a longitudinal cohort study

OBJECTIVES: To describe the first-week feeding patterns for breast- vs bottle-fed babies, and their association with sustained breast-feeding and infant weight gain at 6 weeks. DESIGN: A longitudinal cohort study. SETTING: Feeding diaries were completed by mothers in an urban UK community shortly after birth; follow-up weight and feeding data were collected at routine health checks. SUBJECTS: Mothers of 923 full-term infants born during the recruiting period agreed to join the study. In all, 502 usable diaries were returned from 54% of the cohort. RESULTS: Breast-fed infants were fed more frequently (2.71 h between feeds) than bottle-fed infants (3.25 h between feeds) and mixed-fed infants (3.14 h between feeds) (P<0.001) in the first week of life, while duration of feeds was similar. Only exclusive breast-feeding in the first week (P<0.001) and maternal education (P=0.004) were related to continued breast-feeding at 6 weeks. Greater first-week feeding frequency (as measured by feed-to-feed interval, h) was associated with higher weight gain at 6 weeks for breast-feeders, but no analysed factors were associated with higher weight gain for bottle-feeders. CONCLUSIONS: This large-scale study of first-week feeding patterns sheds light on the important and complicated issues of breast-feeding continuation and infant weight gain, with implications for the feeding advice given to mothers. Supplementary bottle feeds were clearly associated with discontinued breast-feeding at 6 weeks. Over that period, higher weight gain was associated with more frequent feeding for breast-fed infants only. SPONSORSHIP: Henry Smith Charity, SPARKS, Child Growth Foundation.     

不同喂养方式对0～24月龄婴幼儿生长速率、生长水平的影响

目的了解哈尔滨市婴幼儿喂养方式,建立前瞻性队列观察不同喂养方式对婴幼儿体格发育的纵向影响。方法随机抽取哈尔滨市2009年7月1日—2010年7月1日出生的婴儿593例,监测婴幼儿0～24月龄的体重、身长、头围、喂养情况、家庭基本信息等。测量次数：共测查20次,包括出生3 d内、1岁内每月1次、1～2岁每3月1次。结果 593例研究对象中,男性293例（49.41%）,女性300例（50.59%）;男、女婴在社会人口学特征分布上差异均无统计学意义（P〉0.05）。母乳喂养组267例（45.03%）,混合喂养组132例（22.26%）,人工喂养组194例（32.71%）。方差分析显示婴幼儿不同喂养方式对0～24月龄婴幼儿体重、身长、头围有不同影响。1月时体重均值人工喂养组〉混合喂养组〉母乳喂养组;7～24月龄体重均值母乳喂养组〉混合喂养组〉人工喂养组,3组均值经方差分析差异有统计学意义（P〈0.05）。对4～24月龄时身长有影响,7～24月龄体重均值母乳喂养组〉混合喂养组〉人工喂养组,差异有统计学意义（P〈0.05）。2月龄时头围均值人工喂养组〉混合喂养组〉母乳喂养组,差异有统计学意义（P〈0.05）;7月龄、9～24月龄时头围均值母乳喂养组〉混合喂养组〉人工喂养组,差异有统计学意义（P〈0.05）。结论母乳是婴幼儿生命早期最佳的天然食品,为婴幼儿提供了生命所需的必要营养物质,对婴幼儿生长速率增长有极大的促进作用。     

Breast-feeding among the urban poor in southern Brazil: reasons for termination in the first 6 months of life

A study of breast-feeding practices over the first 6 months of life among a cohort of urban poor infants in southern Brazil indicated that the median duration of breast-feeding was 18 weeks, and at 6 months 41% of the infants were still being breast-fed. The duration of breast-feeding was significantly associated with the following: the infant's sex, mother's colour, type of first feed, timing of the first breast-feed, breast-feeding regimen and frequency of breast-feeding at 1 month, and the use of hormonal contraceptives by the mother. The following were significant risk factors for early termination of breast-feeding: the infant's sex, type of first feed, use of supplementary feeds, frequency of breast-feeding, feeding regimen, weight-for-age, and weight-for-age after controlling for birth weight. Dissatisfaction with their infant's growth rate was the most frequent reason given by mothers for supplementing the diets of infants who were exclusively breast-fed in the first 3 months of life. Also, the mothers' perception that their milk output was inadequate was the most frequent reason expressed for stopping breast-feeding in the first 4 months. The roles of health services and family support in providing favourable conditions for increasing the duration of breast-feeding in the study population are discussed, as well as the possibility of bias being introduced into studies of the relationship between infant feeding and growth by the effect of the infant's rate of growth on the mother's decision to continue breast-feeding.     

Breast-feeding in the modern health sector in Indonesia: the mother's perspective

This paper presents findings of a study of postpartum women in major hospitals throughout Indonesia. The objective was to assess the mothers' practices and attitudes regarding several key aspects of breast-feeding and 'rooming-in'. The study found that most of the women breast-fed their babies, with many believing infants should be breast-fed for 18 months or longer. However, many mothers lacked information about ideal infant feeding patterns and were unaware of how to solve problems that may arise. Only 38% recognized the value of feeding colostrum, and many feared the effect of breast-feeding on breast shape. They often gave supplementary formula. Almost none understood the importance of frequent suckling in promoting milk production. Only 50% of infants were kept in the same hospital room with their mothers for 24 hr a day, or full rooming-in. Women who kept their infants in the nursery (39%) were generally younger, better educated, primiparous, or had non-normal deliveries. They knew little about rooming-in, and if given more information to allay their doubts, they might consider rooming-in as a viable and safe arrangement. The results of this study reinforce the importance of identifying the perceptions and the knowledge of women concerning breast-feeding and rooming-in, so that hospital administrator, and health professionals can design programs and provide environments that encourage women to breast-feed their infants in optimal ways.     

Breast and complementary feeding practices in relation to morbidity and growth in Malawian infants

OBJECTIVES: The objective of this study was to compare growth, morbidity incidence and risk factors for undernutrition between infants receiving complementary feeding early, before 3 months of age, with those receiving complementary foods after 3 months in a poor rural Malawian community. METHODS: A cohort of babies was enrolled at birth for follow-up to 12 months of age. Weight, length, morbidity and feeding patterns were recorded at 4 weekly intervals from birth to 52 weeks. RESULTS: Mean age at introduction of water was 2.5 months (range 0-11.8), complementary foods 3.4 months (range, 1.0-10.7) and solids 4.5 months (range 1.2-13.8). Over 40% of infants had received complementary foods by 2 months and 65% by 3 months. The proportion of exclusively breast-fed infants, which included those receiving supplemental water, was 13% at 4 months, 6.3% at 5 months and 1.5% at 6 months. Infants with early complementary feeding had lower weight for age at 3 and 6 months (P<0.05), and at 9 months (P=0.07) and at 2 months they were approximately 200 g lighter. Early complementary feeding was significantly associated with increased risk for respiratory infection (P<0.05), and marginally increased risk for eye infection and episodes of malaria. Maternal illiteracy was associated with early complementary feeding (OR=2.1, 95% CI 1.3, 3.2), while later complementary feeding was associated with reduced infant morbidity and improved growth. CONCLUSION: Breast-feeding promotion programmes should target illiterate women. Greater emphasis is required to improve complementary feeding practices.     

Food choices to meet nutritional needs of breast-fed infants and toddlers on mixed diets

The primary focus of this review is considerations for complementary feedings to meet micronutrient needs of infants aged 6-24 mo who are continuing with breast-feeding and minimal or no formula. The World Health Organization recommends initiation of complementary feeding to breast-fed infants at approximately 6 mo of age. Whether complementary foods will meet nutrient needs will depend on the types of food selected. One criterion for the selection of complementary foods is that they be rich sources of zinc and iron because both of these essential micronutrients are critical for normal growth and development, and requirements are not met by exclusive breast-feeding after approximately 6 mo. For an exclusively breast-fed 7-mo-old infant, human milk provides approximately 0.5 mg of zinc, and a little over half of that is absorbed. Adding some cereal can increase zinc intake modestly but will fall short of providing the estimated physiologic requirement because adaptive mechanisms are inadequate to compensate for moderately low zinc intake. Maize, wheat, rice, and roots are also relatively low in zinc and have the added factor of a high phytate-to-zinc molar ratio, which makes the zinc less bioavailable. Meats and liver have greater zinc and iron concentrations than unfortified plant foods and have been shown to have good acceptance by 7-mo-old infants. In contrast to current practices in both developed and developing countries, meats should be considered as an early complementary food for breast-fed infants to provide essential micronutrients.     

伊犁察布查尔县婴儿代乳品、辅食添加现状及原因分析

目的 了解伊犁察布查尔地区6个月以内婴儿母乳喂养与辅食添加现状,分析影响婴儿过早添加辅食的可能因素。方法 队列研究方法,对伊犁察布察尔地区2008年出生的婴儿母亲进行问卷调查及产后6个月的逐月随访,样本量226例。结果 （1）婴儿出生时纯母乳喂养率是82.06%,3个月时纯母乳喂养率（72.81%）开始明显下降,4个月时纯母乳喂养率降到55.92%,6个月仅有43.09%的婴儿是纯母乳喂养。（2）婴儿1月、2月、3月、4月、6月时辅食添加率分别是16.4%、16.8%、20.8%、27.4%、41.6%,其中有27.4%的婴儿在4个月前已经开始添加了一种或一种以上的辅食,已添代乳品、水、水果蔬菜、谷类、蛋类的比例分别占62.9%、53.2%、27.4%、27.4%、35.5%;6个月时大部分婴儿未及时添加辅食,辅食添加率仅为41.6%,代乳品、水、水果蔬菜、谷类、蛋类的比例分别占77.7%、40.4%、42.6%、35.1%、57.4%。（3）代乳品添加中鲜牛奶的比例最高,4个月时已达82.1%,6个月时所占比例为84.9%。（4）婴儿辅食添加过旱的影响因素有：母亲年龄、孩子是否第一个、吸吮时间、孩子每天睡眠时间等。结论伊犁察布查尔地区纯母乳喂养率低;在辅食添加时间上存在较大的问题;加强少数民族母亲婴儿喂养知识的教育,重点在及时合理的添加辅食。     

Infant feeding and risk of severe diarrhoea in Basrah city, Iraq: a case-control study

A case-control study of the relationship between feeding mode and risk of hospitalized diarrhoea in infants (aged 2-11 months) in Basrah city was conducted between September 1983 and May 1984. A total of 597 cases were recruited from among infants admitted with diarrhoea to the major paediatric hospital in the city, while 723 controls were recruited from among healthy infants attending any of the seven maternal and child health clinics in Basrah. A variety of potentially confounding variables were controlled in the analysis. For infants aged 2-5 months, breast-feeding alone or breast-feeding plus food were the least risky feeding modes. Bottle-feeding was dangerous and bottle-feeding alone was associated with a risk of 55 among infants aged 2-3 months, and 37 among infants aged 4-5 months, relative to exclusive breast-feeding. For older infants (6-11 months), the risks of hospitalized diarrhoea were not significantly different among different partial breast-feeding modes, but non-breastfeeding was dangerous, especially exclusive bottle-feeding. Food intake was associated with a reduced risk of severe diarrhoea among bottle-fed infants but not with an increased risk among breast-fed infants. Among bottle-fed infants, no association was found between risk of severe diarrhoea and method of bottle-cleaning. Previous breast-feeding conferred no current protection.     

Incidence and duration of breast-feeding in Mexican-American infants, 1970-1982

The Mexican-American component of the Hispanic Health and Nutrition Examination Survey (HHANES-MA) was used to examine the breast-feeding behavior of 2402 infants born between 1970 and 1982. The proportion of infants ever breast-fed increased substantially in recent years. Weighted proportions were 30.7% for 1970-1974, 38.1% for 1975-1978, and 47.6% for 1979-1982. By use of logistic regression models, children born into households with a college-educated head were shown to be more likely to be breast-fed than were other children; breast-feeding was also positively associated with birth weight. Infants in households for which the preferred interview language was Spanish were more likely to be breast-fed than were infants living in households for which the interview was conducted in English. Analysis of the factors influencing the distribution of weaning times among infants was less definitive because reported weaning times are heaped on multiples of 3 mo. The gathering of current-status, or status quo, information on infant feeding is urged for data collection in future studies.     

Breast-feeding patterns, time to initiation, and mortality risk among newborns in southern Nepal

Initiation of breast-feeding within 1 h after birth has been associated with reduced neonatal mortality in a rural Ghanaian population. In South Asia, however, breast-feeding patterns and low birth weight rates differ and this relationship has not been quantified. Data were collected during a community-based randomized trial of the impact of topical chlorhexidine antisepsis interventions on neonatal mortality and morbidity in southern Nepal. In-home visits were conducted on d 1-4, 6, 8, 10, 12, 14, 21, and 28 to collect longitudinal information on timing of initiation and pattern of breast-feeding. Multivariable regression modeling was used to estimate the association between death and breast-feeding initiation time. Analysis was based on 22,838 breast-fed newborns surviving to 48 h. Within 1 h of birth, 3.4% of infants were breast-fed and 56.6% were breast-fed within 24 h of birth. Partially breast-fed infants (72.6%) were at higher mortality risk [relative risk (RR) = 1.77; 95% CI = 1.32-2.39] than those exclusively breast-fed. There was a trend (P = 0.03) toward higher mortality with increasing delay in breast-feeding initiation. Mortality was higher among late (> or = 24 h) compared with early (< 24 h) initiators (RR = 1.41; 95% CI = 1.08-1.86) after adjustment for low birth weight, preterm birth, and other covariates. Improvements in breast-feeding practices in this setting may reduce neonatal mortality substantially. Approximately 7.7 and 19.1% of all neonatal deaths may be avoided with universal initiation of breast-feeding within the first day or hour of life, respectively. Community-based breast-feeding promotion programs should remain a priority, with renewed emphasis on early initiation in addition to exclusiveness and duration of breast-feeding.