Prevalence of and factors influencing early initiation and exclusive breastfeeding for first two days of life in the mountainous regions of Karnali, Nepal

Background Despite proven benefits of initiating breastfeeding within the first hour of birth and exclusive breastfeeding, many newborns across low- and middle-income countries do not receive timely or exclusive breastfeeding in the early neonatal period. Delayed initiation and the introduction of prelacteal feeds remain prevalent, influenced by a range of maternal, neonatal, and health system factors. Exclusive breastfeeding (EBF) for the first two days after birth was recently introduced as a new infant feeding indicator; however, its prevalence and associated factors remain less understood. This study aims to investigate the prevalence of and factors associated with early initiation of breastfeeding (EIBF) and EBF for the first two days after birth. Methods A community-based cross-sectional study was conducted using structured questionnaire among 423 randomly selected mothers of children aged 6–23 months in a remote mountainous region of Nepal. The prevalence was reported using frequency distribution, whereas associations were examined using Chi-square tests followed by multiple logistic regression. Results The prevalence of EIBF and EBF for the first two days were 84.4% and 83.9%, respectively. Infants had a higher likelihood of receiving EIBF when born in a health facility (Adjusted odds ratio (AOR): 13.2; 95% confidence interval (CI): 4.71, 37.3), and when their mothers received counselling to avoid artificial nipples and pacifiers (AOR: 3.60; 95% CI: 1.63, 7.96). Conversely, those born via caesarean delivery had a lesser likelihood (AOR: 0.30; 95% CI: 0.09, 0.98). The infants had higher likelihood of receiving EBF for the first two days when they had normal birthweight (AOR: 2.77; 95% CI: 1.48, 5.17), their mothers received counselling on exclusive breastfeeding during antenatal care (AOR: 1.90; 95% CI: 1.01, 3.57); but had a lesser likelihood when their mothers were employed in semi-formal sector (i.e. small businesses or labor) (AOR: 0.48; 95% CI: 0.25, 0.94). Conclusion Breastfeeding practices in remote Nepal remain suboptimal, particularly among the mothers who gave birth by caesarean section. Strengthening counselling, promoting institutional births, and creating supportive policies and practices for working mothers are essential to achieving optimal breastfeeding outcomes.