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Background  Breastfeeding is one of the components of Primary Health Care in Ethiopia. In Ethiopia a wide range of harmful infant feeding practices has been documented despite the implementation of infant and young child feeding guidelines. However, there is no well documented study of women’s perception of breastfeeding patterns and factors associated with delayed initiation of breastfeeding (with timely initiation of breastfeeding being within the first hour) in rural communities of Arba Minch Zuria.    Methods  A community-based cross-sectional study was carried out in Arba Minch Zuria from January to February, 2012. Quantitative data were collected from a sample of 383 respondents supplemented by qualitative data generated using in-depth interviews of 10 key informants. A multivariate logistic regression analysis was used to identify the predictors of delayed initiation of breastfeeding practices. Qualitative data were analyzed using thematic frameworks.    Results  In the rural communities of Arba Minch Zuria almost all mothers (98.2%) have ever breastfed their children. More than three-fourth (89%) of mothers provided colostrum to their infants while others discarded the first milk until the white milk was produced. A large number of mothers (42.8%) started breastfeeding one hour after childbirth. Delayed initiation of breastfeeding was positively associated with lack of maternal education (AOR 1.91; 95% CI 1.02, 3.44). Maternal knowledge about the duration of exclusive breastfeeding (AOR 0.39; 95% CI 0.15, 0.93), attending a primary health education (AOR 0.74; 95% 0.15, 0.98) and health personnel support for women at delivery time (AOR 0.52; 95% CI 0.21, 0.58) were inversely associated with delayed initiation of breastfeeding practices.    Conclusions  A large number of mothers (42.8%) were short of the national and global recommendations about breastfeeding initiation. Therefore, sustained health and community based nutritional education is recommended for pregnant and lactating mothers to promote optimal breastfeeding for the initiation of breastfeeding practices using health extension workers and local community resource people as key actors.

Women’s perception and risk factors for delayed initiation of breastfeeding in Arba Minch Zuria, Southern Ethiopia