School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia.
Department of Public Health, College of Medicine and Health Science, Samara University, Afar, Ethiopia.
BMC Public Health. 2024 Jul 27;24(1):2011. doi: 10.1186/s12889-024-19552-0.
Breastfeeding offers numerous benefits for infants, mothers, and the community, making it the best intervention for reducing infant mortality and morbidity. The World Health Organization (WHO) recommends initiating breastfeeding within one hour after birth and exclusively breastfeeding for the first six months. This study investigated the trend, spatio-temporal variation, and determinants of spatial clustering of early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) in Ethiopia from 2011 to 2019.
Data from the Ethiopian Demographic and Health Survey (EDHS), which was conducted in 2011, 2016, and 2019, were analyzed utilizing a weighted sample of 10,616 children aged 0-23 years for EIBF and 2,881 children aged 0-5 months for EBF. Spatial autocorrelation analysis was used to measure whether EIBF and EBF were dispersed, clustered, or randomly distributed and Kriging interpolation was employed to predict the outcome variables in the unmeasured areas. Spatial scan statistics were used to identify spatial clusters with a high prevalence of cases. Both global and local regression modeling techniques were employed to examine the spatial relationships between the explanatory variables and the dependent variables.
The trend analysis revealed a notable increase in the prevalence of EIBF from 51.8% in 2011 to 71.9% in 2019. Similarly, the prevalence of EBF increased from 52.7% in 2011 to 58.9% in 2019. Spatial analysis demonstrated significant spatial variation in both EIBF and EBF throughout the country. Cold spots or clusters with a low prevalence of EIBF were observed consistently in the Tigray and Amhara regions, and significant cold spot areas of EBF were observed consistently in the Afar and Somali regions. Multiscale geographically weighted regression analysis revealed significant predictors of spatial variations in EIBF, including the religious affiliation of being a follower of the orthodox religion, parity of 1-2, absence of antenatal care visits, and delivery via cesarean section.
Despite the increase in both EIBF and EBF rates over time in Ethiopia, these rates still fall below the national target. To address this issue, the government should prioritize public health programs aimed at improving maternal healthcare service utilization and maternal education. It is essential to integrate facility-level services with community-level services to achieve optimal breastfeeding practices. Specifically, efforts should be made to promote breastfeeding among mothers who have delivered via cesarean section. Additionally, there should be a focus on encouraging antenatal care service utilization and adapting maternal healthcare services to accommodate the mobile lifestyle of pastoralist communities. These steps will contribute to enhancing breastfeeding practices and achieving better outcomes for maternal and child health.
母乳喂养为婴儿、母亲和社区带来诸多益处，是降低婴儿死亡率和发病率的最佳干预措施。世界卫生组织（WHO）建议在婴儿出生后 1 小时内开始母乳喂养，并在最初的 6 个月内进行纯母乳喂养。本研究调查了 2011 年至 2019 年期间埃塞俄比亚早期启动母乳喂养（EIBF）和纯母乳喂养（EBF）的趋势、时空变化和空间聚类的决定因素。
利用 2011 年、2016 年和 2019 年埃塞俄比亚人口与健康调查（EDHS）的加权样本，对 10616 名 0-23 岁儿童的 EIBF 和 2881 名 0-5 个月儿童的 EBF 进行了分析。空间自相关分析用于测量 EIBF 和 EBF 是否分散、聚类或随机分布，Kriging 插值用于预测未测量区域的结果变量。空间扫描统计用于识别病例高发的空间聚类。采用全局和局部回归建模技术，研究了解释变量与因变量之间的空间关系。
趋势分析显示，EIBF 的流行率从 2011 年的 51.8%显著增加到 2019 年的 71.9%。同样，2011 年 EBF 的流行率为 52.7%，到 2019 年增加到 58.9%。空间分析表明，EIBF 和 EBF 在全国范围内都存在显著的空间变化。在提格雷和阿姆哈拉地区，EIBF 低流行率的冷点或聚类一直存在，而在阿法尔和索马里地区，EBF 低流行率的显著冷点区域一直存在。多尺度地理加权回归分析显示，EIBF 空间变化的显著预测因素包括正统宗教信仰、1-2 次生育、无产前护理和剖腹产分娩。
尽管埃塞俄比亚 EIBF 和 EBF 的比例随着时间的推移有所增加，但仍低于国家目标。为了解决这一问题，政府应优先考虑改善孕产妇医疗服务利用和孕产妇教育的公共卫生方案。将设施层面的服务与社区层面的服务相结合，以实现最佳的母乳喂养实践至关重要。具体来说，应努力促进剖腹产分娩后母乳喂养。此外，应鼓励利用产前护理服务，并调整孕产妇保健服务以适应牧民社区的流动生活方式。这些步骤将有助于提高母乳喂养实践，并为母婴健康带来更好的结果。
