Limited evidence exists on the complex relationship among interventions, early initiation of breastfeeding (EIBF), prelacteal feeding and exclusive breastfeeding (EBF). We examined whether early breastfeeding practices are associated with EBF and how much improving EIBF and non-prelacteal feeding contributes to increased prevalence of EBF. Survey data were collected in 2010 and 2014 as part of impact evaluations of Alive & Thrive (A&T) interventions to improve infant and young child feeding (IYCF) practices in Bangladesh, Vietnam and Ethiopia. Multivariable logistic regression analyses were used to examine effects of interventions and early breastfeeding practices on EBF. Structural equation modelling quantified the direct and indirect effects of interventions (via improving EIBF and non-prelacteal feeding) on EBF. Although breastfeeding is nearly universal in all three countries (≥98%), delayed initiation of breastfeeding is prevalent (>60%) and prelacteal feeding is common. EIBF alone was not associated with EBF, whereas non-prelacteal feeding was associated with 1.6-3.5 higher odds of EBF. Intervention exposure affected breastfeeding practices in all three countries; these impacts were amplified among those who practiced EIBF or non-prelacteal feeding [odds ratio (OR) = 11 and 27.5 in Bangladesh and 6.5 and 11.5 in Vietnam, respectively]. The paths through EIBF and non-prelacteal feeding explained 13%-18% of the effect of the interventions on EBF. Early breastfeeding practices influence EBF, but interventions aimed only at the initiation and early days of breastfeeding will be inadequate to promote EBF. Social and behaviour change interventions should simultaneously target EIBF, non-prelacteal feeding and EBF to support optimal breastfeeding practices.

中文翻译：

---

在孟加拉国、越南和埃塞俄比亚，早期母乳喂养实践有助于纯母乳喂养。

关于干预措施、早期开始母乳喂养 (EIBF)、乳前喂养和纯母乳喂养 (EBF) 之间复杂关系的证据有限。我们研究了早期母乳喂养实践是否与 EBF 相关，以及 EIBF 和非乳前喂养的改善在多大程度上有助于 EBF 的患病率增加。调查数据是在 2010 年和 2014 年收集的，作为 Alive & Thrive (A&T) 干预措施影响评估的一部分，以改善孟加拉国、越南和埃塞俄比亚的婴幼儿喂养 (IYCF) 实践。多变量逻辑回归分析用于检查干预措施和早期母乳喂养实践对 EBF 的影响。结构方程模型量化了干预措施（通过改善 EIBF 和非乳前喂养）对 EBF 的直接和间接影响。尽管母乳喂养在所有三个国家几乎普及（≥98%），但延迟开始母乳喂养很普遍（>60%），并且乳前喂养很常见。单独的 EIBF 与 EBF 无关，而非乳前喂养与 1.6-3.5 更高的 EBF 几率相关。干预暴露影响了所有三个国家的母乳喂养实践；这些影响在那些实行 EIBF 或非乳前喂养的人中被放大[比值比 (OR) 在孟加拉国分别为 11 和 27.5，在越南分别为 6.5 和 11.5]。通过 EIBF 和非乳前喂养的路径解释了干预对 EBF 影响的 13%-18%。早期母乳喂养实践会影响 EBF，但仅针对母乳喂养开始和早期的干预措施不足以促进 EBF。