Determinants of Exclusive Breastfeeding among Low Birthweight Infants in Ethiopia: A Survey-Based Analysis from the Saving Little Lives – Kangaroo Mother Care Program, 2021 Open Access

Rogers, Hannah Paige (Spring 2022)

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Introduction: About 50% of all under-5 mortality occurs during the neonatal period (0-28 days of life). Early and exclusive breastfeeding (EBF) promotion is a cost-effective child survival intervention that provides optimal nutrition for child health and development. By understanding the determinants of EBF at 28 days, future programs and improved policies supporting EBF practices can be developed to improve infant survival. 

Objective: The objective of this study is to predict EBF at 28 days among Ethiopia infants using infant, maternal, contextual, socioeconomic, and early feeding variables. 

Methods: A total of 501 mother-infant dyads were enrolled in Kangaroo Mother Care in Amhara, Ethiopia. Data collection occurred from June 2018 to May 2019 through surveys delivered to a cohort of mothers, fathers, and caregivers of low birthweight infants at discharge, 7-days post-discharge, and 28-days of life. Logistic regression was conducted to evaluate the infant, maternal, contextual, socioeconomic, and early infant feeding determinants of EBF at 28 days of life. Crude and adjusted prevalence odds ratios (cPOR and aPOR, respectively) were estimated using SAS version 9.4. 

Results: The prevalence of EBF was highest at 7-days post-discharge, then dropped to 74% at 28-days postpartum. Multivariate logistic regression showed that infant being a twin or triplet (aPOR 0.64, 95% CI 0.42, 0.98), and mother being a farmer (aPOR 0.57, 95% CI 0.39, 0.85), or having a caesarian or assisted delivery (aPOR 0.50, 95% CI 0.31, 0.80) significantly predicted decreased prevalence odds of EBF at 28 days. 

Discussion: Results from our analysis revealed that early EBF practices in Amhara, Ethiopia falls short of Sustainable Development Goal 3.2 which calls for at least 90% of women to practice EBF for at least 6 months. Improving EBF support for mothers of multiples, working mothers, and mothers who had a caesarian or assisted delivery may improve EBF prevalence and infant survival in Ethiopia. Future studies should examine additional factors that can impact EBF in larger samples and in other regions of Ethiopia. 

Table of Contents

Table of Contents

ACRONYMS ..........Page 8

CHAPTER I ...........Page 9

CHAPTER II ..........Page 12

CHAPTER III .........Page 22

CHAPTER IV .........Page 28

CHAPTER V ..........Page 32

FIGURES ...............Page 45

TABLES .................Page 47

APPENDIX ............Page 52

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