Individual and community-level factors influencing optimal breastfeeding: A multilevel analysis from a national survey study in Ethiopia

Abstract

Background Optimal breastfeeding is critical for healthy growth. Despite this about 820,000 children and 20,000 women lost due to inappropriate breastfeeding each year globally. In Ethiopia, about 50,000 children lost related to malnutrition. Of these, about 18% of child death is contributed by poor breastfeeding habit. Many studies reported the individual-level factors; however, little is known about the determinants of breastfeeding at the hierarchical level. Therefore, this study aimed to identify factors associated with optimal breastfeeding among children age 0-5 month in Ethiopia using multilevel analysis.Methods A five-year representative survey study was conducted to assess the determinants of optimal breastfeeding among 1,087 children aged 0-5 months using the 2016 Ethiopian Demographic and Health Survey data (EDHS). Both bivariate and multivariable multilevel logistic regression analysis were done to identify significant explanatory variables. Fixed effect and random effect were done to estimate the association between the dependent and explanatory variable and to measure the variation explained by the higher level respectively.Results Among the total of 1,087 children, only 45.4% of optimally breastfed. Children aged 4-5 months (AOR =0.19; 95%CI: 0.12-0.27), children from richest wealth index (AOR=2.87; 95% CI: 1.53- 5.43), children born through cesarean section and residing in Afar region were found significantly associated with optimal breastfeeding. The random-effects showed that the variation between communities was statistically significant.Conclusion Both individual and community level factors play a significant role in shaping optimal breastfeeding. Future strategies and health interventions should target individual and community level factors that enhance optimal breastfeeding.