Contextual Influences on Breastfeeding Practices in Selected West African Countries

Abstract

Studies have examined the predictors of breastfeeding practices across countries in West Africa. However, these studies neither employed multilevel methodological approach nor conceptualized breastfeeding practices beyond the conventional categorisation. This study addresses this limitation by investigating contextual influence on breastfeeding practices in three selected West African countries. The study analysed data extracted from the Demographic Health Surveys in Sierra Leone SLDHS), Nigeria (2013 and Guinea (2012 GDHS. Information was extracted from a weighted sample size of 5,008 (SLDHS), 12,180 (NDHS) and 3,082 (GDHS) for fecund mothers aged 20-49 years who have had at least a child preceding the surveys. The outcome variable was breastfeeding and which was dichotomised into optimal and suboptimal breastfeeding. Optimal breastfeeding was coded into "1" if adhered to and "0" if otherwise. The explanatory variables were the contextual factors measured as the individual, household, and community levels. The multilevel mixed-effect logistic regression was applied using Stata 14. The fixed effect results showed that breastfeeding practice was significantly associated with contextual factors (p<0.05). Results of the random effects showed that community factors accounted for 38. 2%, 18.3% and 17.3% variation in adherence to optimal breastfeeding for mothers in Guinea, Nigeria and Sierra Leone respectively. Contextual factors are key predictors of optimal breastfeeding among women of reproductive age in Guinea, Nigeria and Sierra Leone.