Timely initiation of breastfeeding is feeding of breast milk within one hour of birth, however, three in five babies were not breastfed in the first hour of birth globally. There is evidence that cesarean section is the major constraint for this low prevalence, but the impact of cesarean section on timely initiation of breastfeeding in Ethiopia is limited. Therefore, this meta-analysis aimed to provide evidence for policy makers, health professionals and program implementers. This systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Electronic bibliographic databases such as PubMed/Medline, EMBASE, PsycINFO, CINHAL, Scopus, Google Scholar, Science Direct and Cochrane Library were used to search relevant studies and was conducted up to February 2021. Random effects model meta-analysis was applied to estimate the pooled impact of cesarean section on timely initiation of breastfeeding with 95% confidence intervals (CI). I2 statistical test and, funnel plot and Egger’s test were used to check heterogeneity and publication bias across included studies respectively. According to meta-analysis of 17 studies, the pooled estimate of timely initiation of breastfeeding among women who had cesarean section in Ethiopia was 40.1% (95% CI 33.29, 46.92). The meta-analysis of 29,919 study participants showed that cesarean section was associated with a 79% lower odds of timely initiation of breastfeeding compared with vaginal birth (OR 0.21; 95% CI 0.16, 0.28). In Ethiopia, almost only one-third of mothers who gave birth by cesarean section initiate breastfeeding within one hour of birth, much lower than the pooled prevalence among general population. Special health promotion, intervention and healthcare provider support during immediate or early skin to skin contact, and having focused breastfeeding guidelines for post-operative patient and trained health professionals should be considered for mothers who give birth through cesarean section.

中文翻译：

---

剖宫产对埃塞俄比亚及时开始母乳喂养的影响：系统评价和荟萃分析

及时开始母乳喂养是在出生后一小时内母乳喂养，然而，全球五分之三的婴儿在出生后第一小时内没有进行母乳喂养。有证据表明剖宫产是这种低流行率的主要制约因素，但剖宫产对埃塞俄比亚及时开始母乳喂养的影响是有限的。因此，这项荟萃分析旨在为政策制定者、卫生专业人员和计划实施者提供证据。本系统评价遵循系统评价的首选报告项目和 Meta 分析指南。使用 PubMed/Medline、EMBASE、PsycINFO、CINHAL、Scopus、Google Scholar、Science Direct 和 Cochrane Library 等电子书目数据库来搜索相关研究，并进行到 2021 年 2 月。应用随机效应模型荟萃分析以 95% 置信区间 (CI) 估计剖宫产对及时开始母乳喂养的综合影响。I2 统计检验、漏斗图和 Egger 检验分别用于检查纳入研究的异质性和发表偏倚。根据对 17 项研究的荟萃分析，埃塞俄比亚剖宫产妇女及时开始母乳喂养的汇总估计值为 40.1% (95% CI 33.29, 46.92)。对 29,919 名研究参与者的荟萃分析表明，与阴道分娩相比，剖宫产与及时开始母乳喂养的几率降低了 79%（OR 0.21；95% CI 0.16, 0.28）。在埃塞俄比亚，几乎只有三分之一的剖宫产母亲在出生后一小时内开始母乳喂养，远低于一般人群的汇总流行率。对于通过剖宫产分娩的母亲，应考虑在立即或早期皮肤接触期间提供特殊的健康促进、干预和医疗保健提供者支持，并为术后患者和训练有素的卫生专业人员制定重点母乳喂养指南。