Mekonen Enyew Getaneh
Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Ital J Pediatr. 2025 Jan 23;51(1):12. doi: 10.1186/s13052-025-01856-5.
Under-five mortality and malnutrition are more common in many low- and middle-income countries, highlighting the grave consequences of improper nutrition for children. Infants that continue to be exclusively breastfed after six months are considered to be engaging in prolonged exclusive breastfeeding. Children with prolonged exclusive breastfeeding are more susceptible to anemia, atopic dermatitis, and food allergies. There is no evidence on the pooled prevalence and determinants of prolonged exclusive breastfeeding in sub-Saharan Africa. Therefore, this study is intended to determine the prevalence and associated factors of prolonged exclusive breastfeeding among children aged 6 to 23 months in sub-Saharan African countries.
Data from the recent demographic and health surveys of 21 countries in sub-Saharan Africa conducted between 2015 and 2022 were used. A total weighted sample of 63,172 mother-child pairs was included in the current study. Multilevel mixed-effects logistic regression was used to determine the factors associated with the outcome variable. Intra-class correlation coefficient, likelihood ratio test, median odds ratio, and deviance (-2LLR) values were used for model comparison and fitness. Finally, variables with a p-value < 0.05 and an adjusted odds ratio with a 95% confidence interval were declared statistically significant.
The pooled prevalence of prolonged exclusive breastfeeding among children aged 6-23 months in sub-Saharan Africa was 17.32% (95% CI: 17.03%, 17.62%). Factors like child age [AOR = 4.39; 95% CI (4.17, 4.62)], wealth index [AOR = 1.15; 95% CI (1.07, 1.23)], maternal educational level [AOR = 1.56; 95% CI (1.36, 1.78)], marital status of the mother [AOR = 1.11; 95% CI (1.04, 1.19)], media exposure [AOR = 1.11; 95% CI (1.06, 1.17)], place of delivery [AOR = 0.82; 95% CI (0.78, 0.87)], postnatal checkup [AOR = 1.43; 95% CI (1.36, 1.51)], drinking water source [AOR = 1.06; 95% CI (1.01, 1.11)], sanitation facility [AOR = 1.15; 95% CI (1.10, 1.21)], antenatal care attendance [AOR = 1.27; 95% CI (1.16, 1.39)], community literacy [AOR = 1.08; 95% CI (1.02, 1.15)], and community media exposure [AOR = 1.06; 95% CI (1.01, 1.13)] were significantly associated with prolonged exclusive breastfeeding.
Nearly one out of five children aged 6-23 months in sub-Saharan Africa had prolonged exclusive breastfeeding. Both individual- and community-level factors were significantly associated with prolonged exclusive breastfeeding. Policymakers could find it very important to support maternal education, poverty reduction, media exposure, maternal healthcare services, and complementary feeding hygiene practices in order to encourage the timely initiation of complementary feeding.
在许多低收入和中等收入国家，五岁以下儿童死亡率和营养不良现象更为常见，这凸显了儿童营养不当带来的严重后果。六个月后仍纯母乳喂养的婴儿被视为持续纯母乳喂养。持续纯母乳喂养的儿童更容易患贫血、特应性皮炎和食物过敏。目前尚无关于撒哈拉以南非洲地区持续纯母乳喂养的综合患病率及其决定因素的证据。因此，本研究旨在确定撒哈拉以南非洲国家6至23个月儿童持续纯母乳喂养的患病率及相关因素。
使用了2015年至2022年期间对撒哈拉以南非洲21个国家进行的最新人口与健康调查数据。本研究纳入了总共63172对母婴的加权样本。采用多水平混合效应逻辑回归来确定与结果变量相关的因素。使用组内相关系数、似然比检验、中位数优势比和偏差（-2LLR）值进行模型比较和拟合优度检验。最后，p值<0.05且调整后的优势比及其95%置信区间的变量被判定具有统计学意义。
撒哈拉以南非洲6至23个月儿童持续纯母乳喂养的综合患病率为17.32%（95%置信区间：17.03%，17.62%）。诸如儿童年龄[AOR = 4.39；95%置信区间（4.17，4.62）]、财富指数[AOR = 1.15；95%置信区间（1.07，1.23）]、母亲教育水平[AOR = 1.56；95%置信区间（1.36，1.78）]、母亲婚姻状况[AOR = 1.11；95%置信区间（1.04，1.19）]、媒体接触[AOR = 1.11；95%置信区间（1.06，1.17）]、分娩地点[AOR = 0.82；95%置信区间（0.78，0.87）]、产后检查[AOR = 1.43；95%置信区间（1.36，1.51）]、饮用水源[AOR = 1.06；95%置信区间（1.01，1.11）]、卫生设施[AOR = 1.15；95%置信区间（1.10，1.21）]、产前检查[AOR = 1.27；95%置信区间（1.16，1.39）]、社区识字率[AOR = 1.08；95%置信区间（1.02，1.15）]以及社区媒体接触[AOR = 1.06；95%置信区间（1.01，1.13）]等因素与持续纯母乳喂养显著相关。
撒哈拉以南非洲近五分之一的6至23个月儿童存在持续纯母乳喂养的情况。个人层面和社区层面的因素均与持续纯母乳喂养显著相关。政策制定者可能会发现，支持母亲教育、减贫、媒体接触、孕产妇医疗服务以及辅食喂养卫生习惯对于鼓励及时开始添加辅食非常重要。
