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

Abstract

Background Optimal breastfeeding is critical for healthy growth of the child. Globally, 820,000 children and 20,000 women lost due to in appropriate breastfeeding each year. In Ethiopia, 50,000 children lost related to malnutrition with 18% were due to poor breastfeeding habit. Little is known on the determinants of breastfeeding with hierarchical level. Therefore, this study aimed to identify factors influencing optimal breastfeeding among children under six month in Ethiopia using a multilevel analysis. Methods The data of this study were obtained from Ethiopian Demographic and health survey conducted from January to June 2016. A total 1,087 children aged 0–5 months were selected using two stage stratified sampling technique. Multilevel logistic regression analysis was done to identify significant explanatory variables. Akaike information criteria were used to select the best model fit. Fixed effect was done to estimate the association between the outcome and explanatory variable and also random effect to measure the variation explained by the higher level. Result Among the total of 1,087 children, 45.4% were optimally breastfeed. Children from the richest wealth index (AOR = 2.87; 95% CI: 1.53–5.43) was positively associated with optimal breastfeeding but, children aged 4–5 months (AOR = 0.19; 95%CI: 0.12–0.27), children born through cesarean section (AOR = 0.18; 955 CI: 0.07–0.51) and residing in Afar region (AOR = 0.13; 95%CI: 0.02–0.92) were found inversely associated with optimal breastfeeding. The random-effects showed that the variation between communities was statistically significant. Conclusion Individual and community level factors play a significant role in shaping optimal breastfeeding. Future strategies and health interventions should be strengthen to target individual and community level factors that enhance optimal breastfeeding.

Multilevel Analysis of Urban–Rural Variations of Body Weights and Individual-Level Factors among Women of Childbearing Age in Nigeria and South Africa: A Cross-Sectional Survey

“…Moreover, in South Africa, our study findings showed that women of childbearing age who were underweight were more likely to belong to poorer wealth households, reside in the Northern Cape and Limpopo provinces, have height above average, be currently breastfeeding, and smoke cigarettes. These study findings are in line with other studies conducted in South Asian [ 49 , 51 , 52 ] and other African countries [ 39 , 40 , 59 ]. Studies have documented that the upturn in women’s employment is an important contributing factor to the direct causes of undernutrition such as feeding practices and ill health, and more distinct bases of undernutrition (such as income, food security, and education) have a greater prospect to improve women’s nutritional status [ 64 , 65 , 66 ].…”

“…The odds of being underweight among Nigerian women of childbearing age were increased by being self-employed, as well as being from the North east and North west geopolitical zones; breastfeeding was also significantly associated. This is consistent with other studies [ 27 , 28 , 29 , 59 ] and could be due to differences in educational status, food security, and access to information regarding nutrition education to address the prevalent underweight burden, especially among Nigerian women in rural grassroots communities. Moreover, in South Africa, our study findings showed that women of childbearing age who were underweight were more likely to belong to poorer wealth households, reside in the Northern Cape and Limpopo provinces, have height above average, be currently breastfeeding, and smoke cigarettes.…”

“…This is also consistent with other study reports in low- and middle-income countries [ 54 ]. This might be due to the fact that residing in rural areas is one of the determinant factors significantly associated with a high prevalence of underweight in this study and in other studies [ 58 , 59 , 60 , 61 ].…”

“…Thus, multiple factors are likely to contribute to the increased prevalence of overweight/obesity in urban populations, including the presence of modern communication facilities, increased availability of technology, easy access to energy-rich food, reduced levels of physical activity, and adoption of a sedentary lifestyle [ 57 , 58 ]. Studies revealed a higher prevalence of overweight and obesity among South African women of childbearing age compared with women from other African countries [ 43 , 59 , 60 ]; this may be as a result of nutritional and epidemiological shifts, which are determined by factors such as demographic variations, rising earnings, suburbanization, unhealthy lifestyles, and consumption of highly processed diets, which appear to be strong drivers of a prevailing overweight and obesity epidemic among women of childbearing age in South Africa.…”

“…Thus, weight loss or gain can be achieved during breastfeeding. Studies have shown that calories from fat cells stored in the body to produce milk are burned during breastfeeding [ 27 , 59 , 70 ]. Furthermore, weight can be gained during breastfeeding if nursing mothers do not adopt healthy choices of dietary intake with increasing calories, rather than the necessary macro- and micronutrients [ 63 , 70 ].…”