Individual level and community level factors affecting exclusive breast feeding among infants under-six months in
Shambel Aychew Tsegaw1, Yeshimebet Ali Dawed2, Erkihun Tadesse Amsalu3
1Department of Public health, Dessie Health science college, Dessie, Ethiopia.
Insights
Exclusive breastfeeding (EBF) is crucial for infant health. This study identified individual factors like infant age and wealth, and community factors like postnatal visits, influencing EBF rates in Ethiopia. Interventions should address both levels for better infant outcomes.
Area of Science:
- Public Health
- Pediatrics
- Demography
Background:
- Exclusive breastfeeding (EBF) for the first six months is optimal for infant health, preventing issues into adulthood.
- Previous research on EBF determinants often focused on individual factors in limited geographic areas.
- Understanding both individual and community-level factors is vital for effective EBF promotion strategies.
Purpose of the Study:
- To identify individual and community-level determinants of exclusive breastfeeding (EBF) in Ethiopia.
- To inform the design of targeted strategies to reduce infant mortality and morbidity through improved infant feeding practices.
Main Methods:
- Secondary data analysis of the 2016 Ethiopian Demographic and Health Survey (EDHS).
- Included 1185 infants under six months of age.
- Employed multilevel logistic regression to analyze individual and community-level factors associated with EBF.
Main Results:
- Individual factors associated with EBF included infant age (4-5 months), female sex, comorbidities, household wealth, and antenatal care visits.
- Community-level factors included region, postnatal visit rates, and maternal employment.
- Multilevel analysis indicated that 46.8% of EBF variation was explained by combined individual and community factors, with significant community-level variation.
Conclusions:
- Both individual and community-level factors significantly influence exclusive breastfeeding practices in Ethiopia.
- Recommendations include promoting antenatal and postnatal care, with special attention to infants with comorbidities and those in pastoralist regions.
Background:
Exclusive breastfeeding (EBF) is the safest and healthiest option of feeding among infants in the first 6 months throughout the world. Thus, promotion of EBF is essential to prevent complex infant health problems even at the adulthood level. But majority of previous studies focused on individual level determinants of EBF by using basic regression models in localized areas. This study aims to identify individual level and community level determinants of EBF which would be helpful to design appropriate strategies in reducing infant mortality and morbidity.
Methods:
It is a secondary data analysis using the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total of 1185 infants under 6 months of age were included in the analysis. Multilevel logistic regression model was employed to investigate factors significantly associated with EBF among under-six month's infants in Ethiopia. Adjusted odds ratio (AOR) with 95% confidence interval (CI) was used to measure the association of variables whereas Intra cluster correlation (ICC), median odds ratio (MOR), and proportional change in variance (PCV) were used to measure random effects (variation).
Result:
In multilevel logistic regression; 4-5 months age infant (AOR = 0.04, 95%CI:0.02-0.07), female infants (AOR = 2.51, 95%CI:1.61-3.91), infant comorbidities (AOR = 0.35, 95%CI: 0.21-0.57), household wealth index (AOR = 10.34, 95%CI: 3.14-34.03) and antenatal care (AOR = 2.25, 95%CI:1.32-3.82) were determinants of EBF at individual level. Whereas, contextual region (AOR = 0.30, 95% CI: 0.10-0.87), community level of postnatal visit (AOR = 2.77, 95% CI: 1.26-6.58) and community level of maternal employment (AOR = 2.8, 95% CI: 1.21-6.47) were determinants of EBF at community level. The full model showed up with higher PCV; that is, 46.8% of variation of exclusive breastfeeding was explained by the combined factors at the individual and community levels. Similarly, it showed that the variation in EBF across communities remained statistically significant (ICC = 8.77% and variance = 0.32 with P < 0.001). The MOR at final model indicates there was significant cluster difference for EBF indicating the heterogeneity was explained by both individual and community level factors.
Conclusion And Recommendation:
Our study showed that both individual and community level determinants were significantly associated with EBF practice. Based on our findings it is strongly recommended to promote and enhance antenatal and postnatal care services utilization of mothers and more emphasis should be given for infants with comorbid conditions and those who live in the pastoralist regions.
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