Socioecological predictors of breastfeeding practices in rural eastern Ethiopia

• Type of Material: Article
• Authors: Marina Magalhães, University of Florida, Gainesville; Amanda Ojeda, University of Florida, Gainesville; Karah Mechlowitz, University of Florida, Gainesville; Kaitlin Brittain, University of Florida, Gainesville; Jenna Daniel, Emory University; Kedir Teji Roba, Haramaya University; Jemal Yousuf Hassen, Haramaya University; Mark J Manary, Washington University; Wondwossen A Gebreyes, The Ohio State University; Arie H Havelaar, University of Florida, Gainesville; Sarah L McKune, University of Florida, Gainesville
• Language: English
• Date: 2022-12-28
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2022
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s13006-022-00531-3
• Title of Journal or Parent Work: International Breastfeeding Journal
• Volume: 17
• Grant/Funding Information: In addition, this work was partially supported by the University of Florida Graduate School.; This work was funded by the United States Agency for International Development (USAID) Bureau for Food Security under Agreement #AID-OAA-L-15–00003 as part of Feed the Future Innovation Lab for Livestock Systems, and by the Bill & Melinda Gates Foundation OPP#1175487.; Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission. Any opinions, findings, conclusions, or recommendations expressed here are those of the authors alone.
• Keywords: Infant feeding; Ethiopia; Maternal child health; Nutrition; Breastfeeding
• Research Categories: Biology, Microbiology; Health Sciences, Immunology; Health Sciences, Nursing

Abstract

Background Estimates by the World Health Organization indicate that over 800,000 global neonatal deaths each year are attributed to deviations from recommended best practices in infant feeding. Identifying factors promoting ideal breastfeeding practices may facilitate efforts to decrease neonatal and infant death rates and progress towards achieving the Sustainable Development Goals set for 2030. Though numerous studies have identified the benefits of breastfeeding in reducing the risk of childhood undernutrition, infection and illness, and mortality in low- and middle-income countries, no studies have explored predictors of breastfeeding practices in rural eastern Ethiopia, where undernutrition is widespread. The aim of this study is to examine predictors of infant feeding practices in Haramaya, Ethiopia, using a multi-level conceptual framework. Methods This study uses data collected from household questionnaires during the Campylobacter Genomics and Environmental Enteric Dysfunction (CAGED) project among 102 households in the Haramaya woreda, Eastern Hararghe Zone, Eastern Ethiopia, and investigates factors influencing breastfeeding practices: early initiation, prelacteal feeding, and untimely complementary feeding. Results Nearly half (47.9%) of infants in this study were non-exclusively breastfed (n = 96). Generalized liner mixed effects models of breastfeeding practices revealed that prelacteal feeding may be a common practice in the region (43.9%, n = 98) and characterized by gender differences (p = .03). No factors evaluated were statistically significantly predictive of early initiation and untimely complementary feeding (82% and 14%, respectively). Severely food insecure mothers had more than 72% lower odds of early breastfeeding initiation, and participants who self-reported as being illiterate had 1.53 times greater odds of untimely complementary feeding (95% CI, [0.30,7.69]) followed by male children having 1.45 greater odds of being untimely complementary fed compared to female (95% CI,[0.40,5.37]). Conclusions This study found high rates of prelacteal feeding and low prevalence of exclusive breastfeeding, with girls more likely to be exclusively breastfed. While no predictors evaluated in this multi-level framework were associated with prevalence of early initiation or complementary feeding, rates may be clinically meaningful in a region burdened by undernutrition. Findings raise questions about gendered breastfeeding norms, the under-examined role of khat consumption on infant feeding, and the complex factors that affect breastfeeding practices in this region. This information may be used to guide future research questions and inform intervention strategies.