Determinants of Early Exclusive Breastfeeding among Ethiopian Infants: Cross-sectional Analysis from the Performance Monitoring for Action Data 2016 Open Access

Donoho, Nastassia (Spring 2021)

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Introduction: Breastfeeding is a cost-effective child survival intervention that provides optimal nutrition for child health and development. Identifying the factors associated with EBF during the first six weeks of a child’s life is vital to increasing overall exclusive breastfeeding rates. Additionally, understanding the association between infant illness and early exclusive breastfeeding practices provides insight into how to address barriers to early exclusive breastfeeding to improve infant survival.

Methodology: There were 333 mother-infant pairs identified as part of the Maternal and Newborn Health Survey from the Performance and Monitoring for Action project in Ethiopia. The objective of this study is to understand the determinants of exclusive breastfeeding in Ethiopia among infants at six weeks.  Univariate and bivariate descriptive analysis was done in R to develop a multivariate logistic regression model on the mother’s age, education status, wealth index, religion, antenatal care provider, and infant’s health status.

Results: Exclusive breastfeeding was its highest at the seven-day time point at 88%, then dipped to 71% at six weeks, and finally dropped down to 16% at six months. At seven days to six weeks post-deliver (AOR=0.43, 95%CI=0.22-0.80), infant illness was associated with a 57% decrease in exclusive breastfeeding at six weeks. On the other hand, Muslim women (AOR=4.09, 95% CI=1.49013.39) or who saw a skilled antenatal care provider (AOR=3.61, 95%CI=1.63-8.16) during pregnancy were significantly more likely to exclusive breastfeed their infant at six weeks. At all three time points, if the infant is sick, the odds of being EBF are significantly decreased: at seven days (OR=0.32, 95% CI=0.14-0.65), at six weeks (OR=0.29, 95% CI=0.17-0.49), and six months (OR=0.41, 95% CI= 0.20-0.72).

Discussion: Early exclusive breastfeeding practices remain suboptimal in Ethiopia. Expanding access to skilled antenatal care (ANC) providers may help improve EBF in this context. Further work on targeting EBF support and counseling for feeding during illness may be merited. Our findings may help inform other programs and policies to support breastfeeding in Ethiopia.


Table of Contents

Table of Contents

Chapter 1: Introduction.. 1

Terms & Definitions. 2

Acronyms. 4

Chapter 2: Literature Review... 5

Overview.. 5

Neonatal Mortality. 5

Sepsis. 6

Prematurity. 6

Low Birth Weight 6

Hypothermia. 6

Breastfeeding. 7

Figure 1: 47 Breastmilk Components. 8

Exclusive Breastfeeding. 8

Breastfeeding in Ethiopia. 9

Figure 2:1 10 Steps to Successful Breastfeeding. 12

Gaps. 13

Chapter 3: Methods. 14

Figure3: Map of Ethiopia. 14

Figure 4: Methodology of Study. 15

Variables. 16

Outcome Variables. 16

Exposure Variables. 17

Participants. 18

Chapter 4: Results. 19

Table 1: Descriptive Demographics of 2016-2017 Ethiopian Maternal and Newborn Survey from Performance Monitoring for Action Survey. 19

Table 2: Infant Feeding Demographics of 2016-2017 Ethiopian Maternal and Newborn Survey from Performance Monitoring for Action Survey. 19

Figure 5: Infant Breastfeeding Practices. 20

Figure 6: Non-exclusive Breastfeeding Liquids. 21

Table 3: Bivariate Odds of Exclusive Breastfeeding at seven days, six weeks, and six months of 2016-2017 Ethiopian Maternal and Newborn Survey from Performance Monitoring for Action Survey. 23

Table 4: Determinants of EBF* Among Ethiopian Infants at; 7-days, 6-weeks, and 6-months 2016-2017 PMA.. 24

Chapter 5: Discussion and Conclusion.. 26

Strengths. 29

Limitations. 29

Chapter 6: Public Health Implications and Recommendations. 31

Appendix.. 36

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