Zegeye Alebachew Ferede, Gebrehana Deresse Abebe, Bezabih Selamawit Abrha, Mengistu Seble Ayana, Adane Kassaw Chekole, Lakew Ayenew Molla
Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
BMC Health Serv Res. 2024 Dec 18;24(1):1577. doi: 10.1186/s12913-024-12064-y.
Inadequate access to services for breastfeeding counseling results in poor breastfeeding practices and adverse health consequences. Although poor access to breastfeeding counseling services is a major challenge, its magnitude and determinantes are not well studied in developing countries. Therefore, this study assessed the magnitude and determinants of poor access to breastfeeding counseling services among lactating mothers who had optimal antenatal care follow-up in Sub-Saharan Africa.
Data from the recent Demographic and Health Surveys, involving a total of 289,929 women, were used for analysis. The determinants of poor access to breastfeeding counseling services were examined using a multilevel mixed-effects logistic regression model. Significant factors associated with poor access to breastfeeding counseling services were declared significant at p-values < 0.05. The adjusted odds ratio and confidence interval were used to interpret the results. A model with the lowest deviance and highest log likelihood ratio was selected as the best-fit model.
In Sub-Saharan Africa, nearly one in two women with optimal antenatal care follow-up had poor access to breastfeeding counseling services. Maternal age (AOR = 1.18, 95% CI: 1.02, 1.38), maternal education (AOR = 1.128, 95% CI: 1.22, 1.35), distance to health facility (AOR = 1.17, 95% CI: 1.13, 1.21), media exposure (AOR = 1.12, 95% CI: 1.08, 1.17), wealth index (AOR = 1.05, 95% CI: 1.00, 1.10), place of delivery (AOR = 4.31, 95% CI: 4.11, 4.52), PNC (AOR = 3.92, 95% CI: 3.78, 4.07), mode of delivery (AOR = 1.88, 95% CI: 1.76, 2.02), birth interval (AOR = 1.12, 95% CI: 1.07, 1.17), residence (AOR = 1.14, 95% CI: 1.09, 1.18), community poverty (AOR = 1.09, 95% CI: 1.03, 1.15), community institutional delivery (AOR = 1.06, 95% CI: 1.01, 1.12), country category (AOR = 2.23, 95% CI: 2.10, 2.37), had higher odds of poor access to breastfeeding counseling services.
Poor access to breastfeeding counseling services among lactating mothers was found to be high. Both individual and community-level factors were determinants of poor access to breastfeeding counseling services. The Ministry of Health in Sub-Saharan Africa should give attention to those women who have not had a postnatal check-up and give birth at home while designing policies and strategies.
获得母乳喂养咨询服务的机会不足会导致不良的母乳喂养行为及不良健康后果。尽管获得母乳喂养咨询服务的机会不足是一项重大挑战，但在发展中国家，其严重程度和决定因素尚未得到充分研究。因此，本研究评估了撒哈拉以南非洲地区接受过最佳产前保健随访的哺乳期母亲中，获得母乳喂养咨询服务机会不足的严重程度及其决定因素。
使用近期人口与健康调查的数据进行分析，该调查共涉及289,929名女性。采用多级混合效应逻辑回归模型研究获得母乳喂养咨询服务机会不足的决定因素。与获得母乳喂养咨询服务机会不足相关的显著因素在p值<0.05时被判定为显著。采用调整后的优势比和置信区间来解释结果。选择偏差最小且对数似然比最高的模型作为最佳拟合模型。
在撒哈拉以南非洲地区，近二分之一接受过最佳产前保健随访的女性获得母乳喂养咨询服务的机会不足。产妇年龄（调整后的优势比[AOR]=1.18，95%置信区间[CI]：1.02，1.38）、产妇教育程度（AOR=1.128，95%CI：1.22，1.35）、到医疗机构的距离（AOR=1.17，95%CI：1.13，1.21）、媒体曝光度（AOR=1.12，95%CI：1.08，1.17）、财富指数（AOR=1.05，95%CI：1.00，1.10）、分娩地点（AOR=4.31，95%CI：4.11，4.52）、产后护理（AOR=3.92，95%CI：3.78，4.07）、分娩方式（AOR=1.88，95%CI：1.76，2.02）、生育间隔（AOR=1.12，95%CI：1.07，1.17）、居住地区（AOR=1.14，95%CI：1.09，1.18）、社区贫困程度（AOR=1.09，95%CI：1.03，1.15）、社区机构分娩情况（AOR=1.06，95%CI：1.01，1.12）、国家类别（AOR=2.23，95%CI：2.10，2.37），这些因素会增加获得母乳喂养咨询服务机会不足的几率。
发现哺乳期母亲获得母乳喂养咨询服务的机会不足情况很严重。个人和社区层面的因素都是获得母乳喂养咨询服务机会不足的决定因素。撒哈拉以南非洲地区的卫生部在制定政策和战略时，应关注那些未进行产后检查且在家分娩的女性。
