Association of Breastfeeding and Early Childhood Caries: A Systematic Review and Meta-Analysis.

Early childhood caries (ECC) is a growing public health concern worldwide. Although numerous systematic reviews have been published regarding the association between breastfeeding and early childhood caries (ECC), the results remain inconclusive and equivocal. This systematic review synthesises the evidence on the association between breastfeeding and ECC. Five electronic databases and backward citation chasing were performed from inception until May 2023. A total of 31 studies (22 cohort studies and 9 case-control studies) were included in this review. The meta-analysis of the case-control studies showed statistically significant fewer dental caries in children who were breastfed for < 6 months compared to those who were breastfed for ≥6 months (OR = 0.53, 95% CI 0.41-0.67, p < 0.001). There was a statistically significant difference in dental caries between children who were breastfed for <12 months and those who were breastfed for ≥12 months (RR = 0.65, 95% CI 0.50-0.86, p < 0.002). Similarly, there was a statistically significant difference in dental caries in children who were breastfed for < 18 months compared to those who were breastfed for ≥18 months (RR = 0.41, 95% CI 0.18-0.92, p = 0.030). Nocturnal breastfeeding increases the risk of ECC compared with no nocturnal breastfeeding (RR = 2.35, 95% CI 1.42-3.89, p < 0.001). The findings suggest breastfeeding for more than 12 months and nocturnal breastfeeding increase the risk of ECC.

Perceptions and Practices of Oral Health Care Professionals in Preventing and Managing Childhood Obesity.

In this study, we aimed to explore the perceptions of oral health care professionals (OHCPs) on childhood overweight and obesity screening and management in oral health settings in the Greater Sydney region in New South Wales, Australia. OHCPs involved in the Healthy Smiles Healthy Kids (HSHK) birth cohort study were purposively selected for this nested qualitative study. A sample of 15 OHCPs completed the face-to-face interviews, and thematic analysis was undertaken to identify and analyse the contextual patterns and themes. Three major themes emerged: (1) obesity prevention and management in dental practice; (2) barriers and enablers to obesity prevention and management in dental settings; and (3) the role of oral health professionals in promoting healthy weight status. This study found that OHCPs are well-positioned and supportive in undertaking obesity screening and management in their routine clinical practice. However, their practices are limited due to barriers such as time constraints, limited knowledge, and limited referral pathways. Strategies including capacity building of OHCPs, development of appropriate training programs and resources, and identification of a clear specialist referral pathway are needed to address the current barriers. This study provides an insight into opportunities for the oral health workforce in promoting healthy weight status among children.

Early life and socio-economic determinants of dietary trajectories in infancy and early childhood - results from the HSHK birth cohort study.

BACKGROUND: Early childhood is a period when dietary behaviours are established. This study aimed to examine the longitudinal intake of core and discretionary foods and identify early life and socio-economic factors influencing those intakes. METHODS: Mother-infant dyads (n = 934) from the Healthy Smiles Healthy Kids study, an ongoing birth cohort study, were interviewed. The information on 'weekly frequency of core and discretionary foods intake' using a food frequency questionnaire was collected at 4 months, 8 months, 1 year, 2 years and 3 years age points. Group-based trajectory modelling analyses were performed to identify diet trajectories for 'core' and 'discretionary' foods respectively. A multinomial logistic regression was performed to identify the maternal and child-related predictors of resulting trajectories. RESULTS: The intake of core and discretionary foods each showed distinct quadratic (n = 3) trajectories with age. Overall, core foods intake increased rapidly in the first year of life, followed by a decline after age two, whereas discretionary foods intake increased steadily across the five age points. Multiparity (Relative Risk (RR): 0.46, 95%CI: 0.27-0.77), non-English speaking ethnicity of mother (RR: 0.66, 95%CI: 0.47-0.91) and having a single mother (RR: 0.40, 95%CI: 0.18-0.85) were associated with low trajectories of core foods intake whereas older maternal age (RR: 1.05, 95%CI: 1.01-1.08) and longer breastfeeding duration (RR: 1.02, 95%CI: 1.00-1.03) were associated with higher trajectories of core foods intake. Also, multiparity (RR 2.63, 95%CI: 1.47-4.70), low maternal education (RR 3.01, 95%CI: 1.61-5.65), and socio-economic disadvantage (RR 2.69, 95%CI: 1.31-5.55) were associated with high trajectories of discretionary foods intake. Conversely, longer duration of breastfeeding (RR 0.99, 95%CI: 0.97-0.99), and timely introduction of complementary foods (RR 0.30, 95%CI: 0.15-0.61) had a protective effect against high discretionary foods consumption in infancy and early childhood. CONCLUSION: Children's frequency of discretionary foods intake increases markedly as they transition from infancy to preschool age, and the trajectories of intake established during early childhood are strongly influenced by socio-demographic factors and infant feeding choices. Hence, there is a need for targeted strategies to improve nutrition in early childhood and ultimately prevent the incidence of chronic diseases in children.

Impact of Dietary Trajectories on Obesity and Dental Caries in Preschool Children: Findings from the Healthy Smiles Healthy Kids Study.

This study examines the impact of longitudinal dietary trajectories on obesity and early childhood caries (ECC) in preschool children in Australia. Mother-infant dyads from the Healthy Smiles Healthy Kids study were interviewed at 4 and 8 months, and 1, 2, and 3 years of age. Children underwent anthropometric and oral health assessments between 3 and 4 years of age. Multivariable logistic regression and negative binomial regression analysis were performed for the prevalence of overweight and obesity, and the number of tooth surfaces with dental caries, respectively. The intake of core, discretionary, and sugary foods showed distinct quadratic (n = 3) trajectories with age. The prevalence of overweight or obesity was 10% (n = 72) and that of early childhood caries (ECC) was 33% (mean decayed, missing, and filled tooth surfaces (dmfs) score: 1.96). Children with the highest trajectories of discretionary foods intake were more likely to be overweight or obese (adjusted OR: 2.51, 95 %CI: 1.16-5.42). Continued breastfeeding beyond 12 months was associated with higher dmfs scores (adjusted IRR: 2.17, 95 %CI: 1.27-3.73). Highest socioeconomic disadvantage was the most significant determinant for overweight or obesity (adjusted OR: 2.86, 95 %CI: 1.11-7.34) and ECC (adjusted IRR: 2.71, 95 %CI: 1.48-4.97). Targeted health promotion interventions should be designed to prevent the incidence of two highly prevalent conditions in preschool children.

Determinants for early introduction of complementary foods in Australian infants: findings from the HSHK birth cohort study.

OBJECTIVE: The purpose of this study was to examine the timing of introduction of complementary (solid) foods among infants in South Western Sydney, Australia, and describe the maternal and infant characteristics associated with very early introduction of solids. METHODS: Mother-infant dyads (n = 1035) were recruited into the "Healthy Smiles Healthy Kids" study by Child and Family Health Nurses at the first post-natal home visit. Data collected via telephone interviews at 8, 17, 34 and 52 weeks postpartum included timing of introduction of solids and a variety of maternal and infant characteristics (n = 934). Multiple logistic regression was used to identify factors independently associated with the risk of introducing solids very early, which for the purpose of this study was defined as being before 17 weeks. RESULTS: The median age of introduction of solids was 22 weeks. In total, 13.6% (n = 127) of infants had received solids before 17 weeks and 76.9% (n = 719) before 26 weeks of age. The practice of introducing solids early decreased with older age of the mother. Compared to women < 25 years of age, those who were 35 years or older were 72% less likely to introduce solids very early (OR = 0.28, CI95 0.14-0.58). Single mothers had more than twice the odds of introducing solids before the age of 17 weeks compared to married women (OR = 2.35, CI95 1.33-4.16). Women who had returned to work between 6 to 12 months postpartum were 46% less likely to introduce solids very early compared with those who were not working at the child's first birthday (OR = 0.54, CI95 0.30-0.97). Women born in Vietnam and Indian sub-continent had lower odds of introducing solids very early compared to Australian born women (OR = 0.42, CI95 0.21-0.84 and OR = 0.30, CI95 0.12-0.79, respectively). Infants who were exclusively formula-fed at 4 weeks postpartum had more than twice the odds of receiving solids very early (OR = 2.34, CI95 1.49-3.66). CONCLUSIONS: Women who are younger, single mothers, those not working by the time of child's first birthday, those born in Australia, and those who exclusively formula-feed their babies at 4 weeks postpartum should be targeted for health promotion programs that aim to delay the introduction of solids in infants to the recommended time.

Predictors of Early Introduction of Core and Discretionary Foods in Australian Infants-Results from HSHK Birth Cohort Study.

Early introduction of complementary foods can have a detrimental impact on children's long-term health. This study examined the timing and determinants of early introduction of core and discretionary foods among infants in Sydney, Australia. Mothers (n = 1035) from an ongoing population-based birth cohort study were interviewed at 8, 17, 34 and 52 weeks postpartum. The outcome was 'age at which particular core and discretionary food items were first introduced'. Multivariable logistic regression models were used to investigate family and infant-related determinants of early introduction of core (<17 weeks of age) and discretionary foods (<52 weeks of age). Of the 934 mother-infant dyads interviewed, 12% (n = 113) of infants were introduced core foods before 17 weeks of age (median: 22). Mothers working part-time (adjusted odds ratio (OR): 3.42, 95% confidence interval (CI): 1.54-7.62) and those exclusively formula-feeding their babies at four-weeks postpartum (adjusted OR 3.26, 95% CI: 1.99-5.33) were most likely to introduce core foods early. Ninety-five percent (n = 858) of infants were introduced discretionary foods before 52 weeks of age (median: 28). Low socio-economic status was significantly associated with early introduction of discretionary foods (adjusted OR: 3.72, 95% CI: 1.17-11.78). Compliance with infant feeding guidelines related to core foods was better; however, discretionary foods were introduced early in most infants.

Obesity and dental caries in early childhood: a systematic review protocol.

OBJECTIVE: The objectives of this review are to examine whether overweight/obese children experience more dental caries compared with non-overweight/non-obese children, and to identify common risk factors associated with both conditions. INTRODUCTION: Systematic reviews have shown that any evidence on a link between overweight and/or obesity and dental caries remains inconclusive. This relationship has not been assessed for children under six years of age with primary dentition. Therefore, an updated systematic review of this topic is necessary as its findings will be important for young children, clinicians, researchers and policy makers. INCLUSION CRITERIA: Studies examining children under six years of age and with complete primary dentition at the time of dental caries assessment will be included. The exposure of interest is the overweight and/or obesity status of children under six years of age. The outcome is dental caries in children with complete primary dentition. There will be no restriction on setting, date or language. METHODS: MEDLINE, Web of Science, Cochrane Central Register of Controlled Trials, Embase, PsycINFO, ProQuest Central, Scopus, CINAHL, and Google Scholar will be searched for eligible studies. The electronic database search will be supplemented by OpenGrey and Grey Literature Report databases, ProQuest Dissertations and Theses Global, and the International Association for Dental Research conference websites. Two reviewers will independently screen and select studies, assess methodological quality and extract data. Meta-analysis will be performed, if possible, and the Grading of Recommendations Assessment Development and Evaluation (GRADE) Summary of Findings presented. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42018085292.

Obesity and dental caries in early childhood: A systematic review and meta-analyses.

Obesity and dental caries in children are significant health problems. The aims of this review are to identify whether children aged 6 years and younger with overweight and/or obesity have higher dental caries experience compared with children with normal weight and, secondly, to identify the common risk factors associated with both conditions. Medline, Embase, and seven other databases were systematically searched followed by lateral searches from reference lists, grey literature, theses, conference proceedings, and contacting field experts. Longitudinal observational studies addressing overweight and/or obesity and dental caries in children aged 6 years and younger were included. A random effects model meta-analyses were applied. Nine studies were included in this review. Children with overweight and obesity had a significantly higher dental caries experience compared with children with normal weight (n = 6). The pooled estimates showed that difference in caries experience between the two groups was statistically significant. Low levels of parental income and education were identified to be associated with both conditions in the sample population. Children with overweight and obesity are more vulnerable to dental caries. Low levels of parental income and education influence the relationship between the two conditions. However, the quality of evidence varied considerably; therefore, findings should be interpreted cautiously.

The Prevalence and Academic Impact of Dysmenorrhea in 21,573 Young Women: A Systematic Review and Meta-Analysis.

Introduction: Dysmenorrhea (period pain) and associated symptoms are very common in young women <25 years. This time corresponds with a significant stage in adolescents and young women's academic lives at both school and in higher education. Dysmenorrhea may cause absenteeism from class or result in reduced classroom concentration and performance. Owing to cultural and economic differences, any impact may vary by country. This systematic review and meta-analysis examines the prevalence of dysmenorrhea in young women and explores any impact it has on their academic performance and other school-related activities. Materials and Methods: A search in Medline, PsychINFO, EMBASE, and Cumulative Index to Nursing and Allied Health Literature was carried out in June 2018. Results: Thirty-eight studies including 21,573 young women were eligible and included in the meta-analysis. Twenty-three studies were from low-, lower middle-, or upper middle-income countries, and 15 studies were from high-income countries. The prevalence of dysmenorrhea was high 71.1% (N = 37, n = 20,813, 95% confidence interval [CI] 66.6-75.2) irrespective of the economic status of the country. Rates of dysmenorrhea were similar between students at school (N = 24, 72.5%, 95% CI 67.5-77.0) and at university (N = 7, 74.9%, 95% CI 62.9-84.0). Academic impact was significant, with 20.1% reporting absence from school or university due to dysmenorrhea (N = 19, n = 11,226, 95% CI 14.9-26.7) and 40.9% reporting classroom performance or concentration being negatively affected (N = 10, n = 5126, 95% CI 28.3-54.9). Conclusions: The prevalence of dysmenorrhea was high, irrespective of country, with dysmenorrhea having a significant negative impact on academic performance both at school and during higher education.

The role of oral health care professionals in preventing and managing obesity: A systematic review of current practices and perceived barriers.

INTRODUCTION: There is a growing interest to expand the role of oral health care professionals in obesity prevention and management. The aim of this systematic review was to synthesise the evidence on current practices of, and perceived barriers to, oral health care professionals' involvement in obesity screening and management. METHODS: Key search strings were developed and used in seven databases from inception through February 6, 2019. Data were screened against inclusion criteria, independently extracted, and quality appraised by two reviewers based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS: Ten studies were included in this review. The practices of oral health care professionals in relation to obesity assessment, counseling, and specialist referrals were found to be very limited. Oral health care professionals believed in their role to support patients for achieving weight-loss goals, however just over one-third were trained in anthropometry. Perceived barriers included lack of time, limited knowledge or training, patients' unwillingness to listen to oral health care professionals' advice, and lack of appropriate specialist referrals. CONCLUSION: Oral health care professionals are well-positioned and supportive in undertaking healthy weight interventions in their clinical practice; however, their practices are limited due to barriers such as lack of time, limited training and lack of referrals.

Determinants of early initiation of breastfeeding in Ethiopia: a population-based study using the 2016 demographic and health survey data.

BACKGROUND: Timely breastfeeding initiation is a simple but important measure that has protective effects on infants and mothers. This study aims to determine the predictors of early breastfeeding initiation among mothers residing in Ethiopia. METHODS: This study employed the 2016 Ethiopian Demographic and Health Survey data. A total of 5546 children born during the last 24 months at the time of survey were included for analysis from nine regional states and two city administration areas. Socio-demographic and socio-economic factors including individual, household and community-level factors were examined of their significance against the outcome variable of early initiation of breastfeeding using a mixed-effect logistic regression model. RESULTS: The proportion of infants who had timely initiation of breastfeeding was 74.3% (n = 3064). In the multivariate logistic regression analysis, mothers who delivered with assistance of one or more health professionals had 68% (AOR 1.68; 95% CI: 1.23, 2.29) higher odds of initiating timely breastfeeding. In addition, mothers delivering by a caesarean section had 86% reduced odds of early breastfeeding initiation (AOR 0.14; 95% CI: 0.09, 0.22) when compared to mothers who had vaginal delivery. In terms of socio-demographic factors, the odds of early breastfeeding initiation were more than two and half times higher particularly for mothers residing particularly in Oromiya (AOR 2.58; 95% CI: 1.84, 3.63) and Southern Nations Nationalities and Peoples (SNNP) (AOR 2.75; 95% CI: 1.86, 4.05). In addition, timely breastfeeding initiation was also significantly associated with wealth index with wealthier mothers having 43% higher odds compared to mothers of poorest households (AOR 1.43; 95% CI: 1.07, 1.92). Other factors such as age, gender and birth order of the infant also had significant associations with early breastfeeding initiation. CONCLUSION: Early breastfeeding initiation in Ethiopia is inextricably associated with various socio-demographic, biomedical, and socio-economic factors. The study findings can potentially inform mothers and the wider community on the benefits of timely breastfeeding initiation and policymakers and community leaders to target health promotional interventions and resources where needed.

A content analysis of Australian television advertising: focus on child and adolescent oral health.

BACKGROUND: Children's preferences for cariogenic foods and/or drinks has been proven to be associated with exposure to advertisements. This study aimed to assess and compare the proportion of cariogenic food and /or drink advertisements aired on three metropolitan Sydney commercial television channels at different broadcast times during school term and school holidays. METHODS: Three Sydney free-to-air television channels (Channels Seven, Nine, and Ten) were recorded between June 2016 and January 2017. Two weekdays and one weekend day were recorded for a week for each channel during the school term and school holidays, respectively. All channels were recorded from 0630 h until 2300 h. Food and/or drink advertisements were categorised according to the time they were aired and their sugar and acid content. For each channel, school holiday data was compared with school term data. Pearson chi-squared testing was used to determine the difference in advertisements rates across TV channels and broadcast times including school holidays and school term. RESULTS: The proportion of food and/or drink advertisements for all networks was less than 10% of all advertisements. Overall, Channel Ten had the most food and/or drink advertisements (39.74%) and Channel Seven had the lowest (28.60%). Channel Ten aired the largest proportion of food and/or drink advertisements (27.18%) during school term Channel Nine aired the highest number of food and/or drink adverts (15.50%) during school holidays. There were more food and/or drink advertisements during children's viewing hours compared to overlap, adult, and other viewing periods respectively, with Channel Ten airing the highest advertisements (15.72%) and Channel Seven airing the least (11.35%) food and/or drink advertisements. For all analyses, Pearson chi-square tests had a p-value < 0.001. CONCLUSION: Although the overall proportion of food and/or drink advertisements aired on Sydney television is low, the advertisements containing high sugar and /or acid were broadcasted more during children's viewing times than other times and during school term compared to school holidays.

Lessons learnt in recruiting disadvantaged families to a birth cohort study.

BACKGROUND: Dental decay in early childhood can be prevented by a model based on shared care utilising members of primary care team such as Child and Family Health Nurses (CFHNs) in health promotion and early intervention. The aims of this study were to identify the facilitators and barriers faced by CFHNs in recruiting research participants from disadvantaged backgrounds to a birth cohort study in South Western Sydney, Australia. METHODS: Child and Family Health Nurses recruited mothers-infants dyads (n = 1036) at the first post-natal home visit as part of Healthy Smiles Healthy Kids Study, an ongoing birth cohort study in South Western Sydney. The nurses (n = 19) were purposively selected and approached for a phone based in-depth semi-structured interview to identify the challenges faced by them during the recruitment process. Interviews were audio-recorded, subsequently transcribed verbatim and analysed by thematic analysis. RESULTS: The nurses found the early phase of parenting was an overwhelming stage for parents as they are pre-occupied with more immediate issues such as settling and feeding a newborn. They highlighted some key time-points such as during pregnancy and/or around the time of infant teething may be more appropriate for recruiting families to dental research projects. However, they found it easier to secure the family's attention by offering incentives, gifts and invitations for free oral health services. The use of web-based approaches and maintaining regular contact with the participants was deemed crucial for long-term research. Cultural and linguistic barriers were seen as an obstacle in recruiting ethnic minority populations and the need for cultural insiders in the research team was deemed important to resolve the challenges associated with conducting research with diverse cultures. Finally, nurses identified the importance of inter-professional collaboration to provide easier access to recruiting research participants. CONCLUSIONS: This study highlighted the need for multiple time-points and incentives to facilitate recruitment and retention of disadvantaged communities in longitudinal research. The need for cultural insiders and inter-professional collaboration in research team are important to improve research participation.

Adaptation of child oral health education leaflets for Arabic migrants in Australia: a qualitative study.

BACKGROUND: The purpose of this study was to gain an in-depth understanding of Arabic-speaking mothers views on the usefulness of existing oral health education leaflets aimed at young children and also to record their views on the tailored versions of these leaflets. METHODS: This qualitative study was nested within a large ongoing birth cohort study in South Western Sydney, Australia. Arabic-speaking mothers (n = 19) with young children were purposively selected and approached for a semi-structured interview. Two original English leaflets giving advice on young children's oral health were sent to mother's prior to the interview. On the day of interview, mothers were given simplified-English and Arabic versions of both the leaflets and were asked to compare the three versions. Interviews were audio-recorded, subsequently transcribed verbatim and analysed by thematic analysis. Ethical approval was obtained from Human Research Ethics Committees of the former Sydney South West Area Health Service, University of Sydney and Western Sydney University. RESULTS: Mothers reported that simplified English together with the Arabic version of the leaflets were useful sources of information. Although many mothers favoured the simplified version over original English leaflets, the majority favoured the leaflets in Arabic. Ideally, a "dual Arabic - simplified English leaflet" was preferred. The understanding of key health messages was optimised through a simple layout and visual images. CONCLUSIONS: There is a need to tailor oral health education leaflets for Arabic-speaking migrants. Producers of dental leaflets should also consider a "dual Arabic - simplified English leaflet" to improve oral health knowledge of Arabic-speaking migrants. The use of simple layout and pictures assists Arabic-speaking migrants to understand the content of dental leaflets.

Factors Associated with Dental Caries in Primary Dentition in a Non-Fluoridated Rural Community of New South Wales, Australia.

Dental caries persists as one of the most prevalent chronic diseases among children worldwide. This study aims to determine factors that influence dental caries in primary dentition among primary school children residing in the rural non-fluoridated community of Lithgow, New South Wales, Australia. A total of 495 children aged 5-10 years old from all the six primary schools in Lithgow were approached to participate in a cross-sectional survey prior to implementation of water fluoridation in 2014. Following parental consent, children were clinically examined for caries in their primary teeth, and parents were requested to complete a questionnaire on previous fluoride exposure, diet and relevant socio-demographic characteristics that influence oral health. Multiple logistic regression analysis was employed to examine the independent risk factors of primary dentition caries. Overall, 51 percent of children had dental caries in one or more teeth. In the multiple logistic regression analysis, child's age (Adjusted Odd's Ratio (AOR) = 1.30, 95% CI: 1.14-1.49) and mother's extraction history (AOR = 2.05, 95% CI: 1.40-3.00) were significantly associated with caries experience in the child's primary teeth. In addition, each serve of chocolate consumption was associated with 52 percent higher odds (AOR = 1.52, 95% CI: 1.19-1.93) of primary dentition caries.

Determinants of breastfeeding initiation among mothers in Sydney, Australia: findings from a birth cohort study.

BACKGROUND: Breastfeeding has short-term and long-term benefits for both the infant and the mother. The objective of this study was to identify the incidence of breastfeeding initiation among women in South Western Sydney, and the factors associated with the initiation of breastfeeding. METHODS: Child and Family Health Nurses recruited mother-infant dyads (n = 1035) to the Healthy Smiles Healthy Kids birth study in South Western Sydney, an ethnically and socio-economically diverse area, at the first post-natal home visit. A sample of 935 women completed a structured, interviewer-administered questionnaire at 8 weeks. Multivariate logistic regression analysis was used to identify those factors independently associated with the initiation of breastfeeding. RESULTS: In total, 92% of women (n = 860) commenced breastfeeding in hospital. Women who completed a university degree were more likely to initiate breastfeeding compared to those who did not complete high school (AOR = 7.16, 95% CI 2.73, 18.79). Vietnamese women had lower odds of breastfeeding initiation compared to Australian born women (AOR = 0.34. 95% CI 0.13, 0.87). Women who had more than one child were less likely to breastfeed than those who had one child (AOR = 0.38, 95% CI 0.19, 0.79). Women who gave birth via a caesarean section were less likely to breastfeed their baby compared to those who had a vaginal delivery (AOR = 0.27, 95% CI 0.14, 0.52). Women who drank alcohol during pregnancy had 72% lower odds to breastfeed compared to those who did not drink alcohol during pregnancy (AOR = 0.28, 95% CI 0.11, 0.71). Women who reported that their partner preferred breastfeeding were more likely to initiate breastfeeding (AOR = 11.77, 95% CI 5.73, 24.15) and women who had chosen to breastfeed before pregnancy had more than 2.5 times the odds of breastfeeding their baby compared to those women who made their decision either during pregnancy or after labour (AOR = 2.80, 95% CI 1.31, 5.97). CONCLUSIONS: Women with lower levels of education, who consume alcohol during pregnancy, have more than one child, and make infant feeding decision after becoming pregnant, and those born in Vietnam should be targeted when implementing breastfeeding promotion programs. Further, women who deliver by caesarean section require additional breastfeeding support post-delivery and it is important to include fathers in breastfeeding related decisions and encourage them to participate in antenatal programs.