The World Health Organization (WHO) recommends that newborns be placed in skin-to-skin contact with their mothers immediately after birth for at least one hour and that mothers be helped to recognize when their babies are ready to breastfeed. Helping mothers initiate breastfeeding during this sensitive period when both mothers and newborns are on alert is Step 4 of the Baby-Friendly Hospital Initiative (BFHI) [1] . Newborns who are breastfed within the first hour of life are much more likely to survive. A delay of just a few hours after birth can have fatal consequences. Skin-to-skin contact and breastfeeding stimulate the mother’s milk production, including colostrum, which is considered the newborn’s “first vaccine” because it is rich in nutrients and antibodies [2] . According to WHO, 78 million newborns—or three out of five—are not breastfed within an hour of birth, increasing their risk of death and disease and reducing their likelihood of being breastfed later [3] . Breastfeeding rates within an hour of birth are highest in Eastern and Southern Africa (65%) and lowest in Eastern Asia and the Pacific (32%) [4] . In Western and Central Africa, only 46% of newborns are breastfed within the first hour of life [4] . The WHO initiative aims for Western and Central Africa to achieve the global target of 50% exclusive breastfeeding by 2025. Côte d’Ivoire, a West African country, has an early breastfeeding rate of 43% [5] . This rate remains low compared to the WHO target. Despite these benefits, less than 40% of newborns in resource-limited settings are breastfed within one hour of birth [6] . To contribute to increasing the rate of adherence to early breastfeeding, it seemed appropriate to determine the factors that could influence its practice. The results of this study will be used to guide awareness strategies for women.

This was a cross-sectional study with a descriptive and analytical aim that took place over a period of six (06) months from January 1, 2022, to June 30, 2022. The study took place in the district of Abidjan in the delivery room of the Abobo Houphouët Boigny Regional Hospital Center. The sampling was based on a progressive constitutional model. The selection of women and their children was made in order of arrival at the facility throughout the survey period. The selected women came to the facility to give birth. Any woman who came to give birth and gave her oral consent was included in the study. The sample size was calculated from the following formula: n = t2 × p × q /d2. The non-early initiation of breastfeeding is the phenomenon to be studied. According to the Annual Report on the Health Situation of 2017 [5] , the prevalence of initiation of breastfeeding within one hour of birth was 43%.

To find our prevalence, we do 100 − 43 = 57 (57%). p = 0.57; t = 1.96 (for a significance level of 95%), t2 = (1.96)2 = 3.84; q = 1 − p or 1 − 0.57 = 0.43; d (precisions) = 10% or 0.1. n = (1.96)2 × 0.57 × (0.43/ 0.01) = 3.84 × 0.69 × 36 or n = 94. The minimum sample consisted of 94 mother-child couples.

The data were collected using a questionnaire by a previously trained doctor. The purpose of the study was clearly explained by the investigator to the women as well as the assurance of confidential management of the information collected. Participation in the study was free with the obtaining of informed consent from the parents based on a verbal agreement. The variables studied concerned the mothers: socio-professional characteristics (age, marital status, profession, ethnicity, place of residence, religion, lifestyle, stay in maternity), the newborns (reason for admission, maternity of origin, pregnancy monitoring, gestational age, measurements, trophicity, diagnosis during hospitalization, date of first breastfeeding, difficulties encountered by the mother in practicing breastfeeding, length of stay (days), evolution). The information collection technique was the direct face-to-face interview with each of the mothers surveyed. Data entry and analysis were done using Excel and XLSTAT software. Comparisons were made using the chi-square statistical test and Fisher’s exact test. To look for an association between the dependent variable, which is early breastfeeding, and a presumed risk factor, the Odds ratio and the 95% confidence interval were calculated. When the expected p-value was less than 0.05, it was considered significant. Multivariate analysis was performed using the logistic regression (binomial) method. For this analysis, variables that were significant in univariate analysis were selected and statistical tests giving p values less than 0.05 were considered significant.

This study has some limitations given the observational study design that does not allow to establish a causal relationship between the outcome and the independent variables. It aimed to determine the prevalence and factors associated with early initiation of breastfeeding. Early initiation of breastfeeding is important for both mother and child [7] - [9] . Early breastfeeding stimulates the release of prolactin, which contributes to milk production and oxytocin, responsible for milk ejection and stimulates uterine contraction after delivery [9] [10] . WHO guidelines recommend that the baby be placed “skin-to-skin” with the mother within the first half hour after delivery [1] . Ideally, the baby should be breastfed before any routine procedures (such as weighing, umbilical cord care and administration of medications). Early breastfeeding strengthens the emotional bond, increases the chances of breastfeeding success and generally prolongs the duration of breastfeeding. For early initiation of breastfeeding, guidelines indicate that the percentage of infants breastfed within one hour of birth is low, between 0 and 29%; average between 30% - 49%; good between 50% - 80%; and very good between 90% - 100% [10] . This study found that only 61% of babies were breastfed within one hour of birth. Therefore, the results of this study showed that the prevalence of early initiation of breastfeeding was good. Rates of early initiation of breastfeeding vary greatly across regions, from 35% in the Middle East and North Africa to 65% in East and Southern Africa [11] . The possible explanation for the observed difference in the prevalence of early initiation of breastfeeding between studies could be due to the methodological difference, variation in the sociodemographic characteristics of the infant and mother, as well as the economic and health situation. In West Africa it is 40% [11] . In this study, the frequency of early initiation of breastfeeding among pregnant women who gave birth vaginally was 89%. This method of delivery increased the possibility of early initiation of breastfeeding by 10.6 times. The same observation was made by Dun-Dery et al [12] [13] . Immediate skin-to-skin contact after birth facilitates early initiation of breastfeeding. Whatever the method of delivery, only the adoption of an appropriate policy and protocol by the center on breastfeeding can increase the frequency of early initiation of breastfeeding [14] . Multivariate analysis of factors associated with early breastfeeding found in this study were religion, mode of delivery, gender and APGAR score. Regarding religion, early breastfeeding was more marked among women of Muslim faith. Recruiting lay leaders to promote breastfeeding within religious communities may be particularly helpful because these leaders have considerable influence [15] . Vaginal delivery followed by immediate skin-to-skin contact after birth facilitates early initiation of breastfeeding. In this study 61% of women had practiced early initiation of breastfeeding. The same observation was made by Dun-Dery et al [16] [17] . On the other hand, cesarean delivery had a negative effect on early initiation of breastfeeding [18] [19] . But, whatever the method of delivery, only the adoption of an appropriate policy and protocol by the health structure on breastfeeding can increase the frequency of early initiation of breastfeeding [16] . This protocol could include receiving breastfeeding advice, breastfeeding support and the provision of spaces dedicated to breastfeeding by employers [20] - [22] . This study found that girls tended to be breastfed early than boys. According to a study conducted in sub-Saharan Africa, there is an inequality in the initiation of early breastfeeding of male children who were breastfed beyond the first hour of life [23] . Making the same observation in these sub-Saharan African countries shows that this is a real problem that requires public health attention. There may be several reasons why mothers breastfeed their male infants later after delivery compared to their female infants. Studies have shown that infants breastfed after one hour of life have a higher risk of mortality [24] . To reduce this inequality, programs that educate and encourage early breastfeeding should be promoted to mothers, regardless of the child’s sex.

The practice of early breastfeeding continues to be a problem in this secondary care structure, with only six out of ten newborns receiving breast milk within an hour of birth. Factors influencing its practice were religion, gender, APGAR and mode of delivery. The Ministry of Health, through the Directorate for the Coordination of the National Nutrition Program, should develop messages, communication strategies and coaching techniques adapted to young girls who are future mothers in the conduct of early breastfeeding, taking this factor into account. This would undoubtedly contribute to reducing infant morbidity and mortality in Côte d’Ivoire.