Abstract / Summary
Abstract Background Breastfeeding is essential for optimal infant growth, health, and development, particularly during the first six months of life. Despite its well-established benefits, many infants in low-resource settings do not receive optimal breastfeeding. However, evidence on the cumulative incidence, determinants, and early health consequences of inadequate breastfeeding in Uganda remains limited. This study aimed to determine the incidence, risk factors, and adverse outcomes of inadequate breastfeeding among 10-week-old infants delivered at three health facilities in Bushenyi District, Western Uganda. Methods This multicenter prospective cohort study followed mother–infant pairs from birth to 10 weeks postpartum at three health facilities in Bushenyi District. Mother–infant pairs with live-born infants delivered at ≥ 28 weeks’ gestation were eligible for inclusion. Inadequate breastfeeding was defined as delayed initiation of breastfeeding (initiation more than one hour after birth) and/or non-exclusive breastfeeding during the 10-week follow-up period. A modified Poisson regression analysis was performed in SPSS version 26.0 to identify independent risk factors for inadequate breastfeeding. Results A total of 260 newborns were enrolled, of whom 12 were lost to follow-up. Among the remaining 248 infants, 55.8% were female, and 84.6% were born at term. By 10 weeks of follow-up, the cumulative incidence of inadequate breastfeeding was 56.0% (95% CI: 50.0%–62.1%). Early initiation of breastfeeding occurred in 79.2% of infants. Exclusive breastfeeding declined from 100% during the neonatal period to 83.7% at 6 weeks and 65.7% at 10 weeks. Independent predictors of inadequate breastfeeding included maternal education below tertiary level, preterm birth, low birth weight, firstborn status, and prolonged labour (all P < 0.05). Infants with inadequate breastfeeding had significantly higher rates of diarrhoea, respiratory tract infections, underweight, and wasting during follow-up. Conclusion More than half of infants experienced inadequate breastfeeding during the first 10 weeks of life. Maternal education below tertiary level, preterm birth, low birth weight, firstborn status, and prolonged labour were independent risk factors. Inadequate breastfeeding was associated with increased infectious morbidity and undernutrition during early infancy. Strengthening breastfeeding education and support throughout antenatal and postnatal care may improve breastfeeding practices and reduce adverse infant health outcomes. Routine nutritional assessment and targeted breastfeeding support should be prioritized for infants at risk of inadequate breastfeeding.