Mekonen Enyew Getaneh
Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Nutr Metab (Lond). 2025 Apr 11;22(1):31. doi: 10.1186/s12986-025-00919-y.
Appropriate breastfeeding practices are recommended to decrease the burden of under-five mortality and its related costs in sub-Saharan Africa. Continued breastfeeding is associated with a reduced risk of child morbidity and mortality. There is no evidence on the pooled prevalence and determinants of continued breastfeeding conducted using the most recent indicators for assessing infant and young child feeding practices in 2021. Therefore, the findings of this study could help nutrition policymakers prioritize and implement specific interventions for breastfeeding continuation.
Data from the most recent demographic and health surveys, which were carried out between 2015 and 2022 in 21 sub-Saharan African countries, were used. The study comprised a weighted sample of 44,423 children between the ages of 12 and 23 months. Software for statistical analysis, STATA/SE version 14.0, was used to clean, recode, and analyze data. Utilizing multilevel mixed-effects logistic regression, the factors associated with the outcome variable were identified. Statistical significance was attained by variables having an adjusted odds ratio with a 95% confidence interval and a p-value < 0.05.
The pooled prevalence of continued breastfeeding among children aged 12 to 23 months was 64.59% (95% CI: 64.15%, 65.04%). Factors like maternal age [AOR = 1.22; 95% CI (1.09, 1.38)], maternal educational level [AOR = 0.51; 95% CI (0.47, 0.55)], and paternal educational level [AOR = 0.79; 95% CI (0.73, 0.85)], marital status of the mother [AOR = 1.13; 95% CI (1.05, 1.22)], maternal working status [AOR = 1.32; 95% CI (1.25, 1.39)], wealth index [AOR = 0.82; 95% CI (0.77, 0.88)], parity [AOR = 1.09; 95% CI (1.00, 1.19)], place of delivery [AOR = 0.92; 95% CI (0.87, 0.98)], ANC visits [AOR = 1.27; 95% CI (1.15, 1.39)], mode of delivery [AOR = 0.81; 95% CI (0.73, 0.89)], twin status [AOR = 4.65; 95% CI (4.07, 5.31), age of the child [AOR = 9.59; 95% CI (9.03, 10.2)], sex of the child [AOR = 0.95; 95% CI (0.91, 0.99)], preceding birth interval [AOR = 1.28; 95% CI (1.20, 1.37)], residence [AOR = 0.74; 95% CI (0.70, 0.79)], and community level education [AOR = 0.90; 95% CI (0.85, 0.96)] were significantly associated with continued breastfeeding.
In the present study, nearly two-thirds of children aged 12 to 23 months in sub-Saharan African countries continued breastfeeding. Higher odds of continued breastfeeding were reported among older, educated, and married women; working mothers; wealthier households; grand multiparous women; home delivery; attending ANC visits; vaginal delivery; single birth; younger children; male children; long preceding birth interval; urban residence; and mothers from eastern Africa. Therefore, women's empowerment, improving maternal healthcare services, and giving special attention to unmarried and younger women, primiparous women, women with multiple births, mothers with female children, and mothers from rural areas are recommended.
建议采取适当的母乳喂养方式，以减轻撒哈拉以南非洲地区五岁以下儿童死亡负担及其相关成本。持续母乳喂养与降低儿童发病和死亡风险相关。目前尚无使用2021年评估婴幼儿喂养方式的最新指标对持续母乳喂养的汇总患病率及其决定因素进行研究的证据。因此，本研究结果有助于营养政策制定者确定优先事项，并实施促进持续母乳喂养的具体干预措施。
使用了2015年至2022年期间在21个撒哈拉以南非洲国家开展的最新人口与健康调查数据。该研究包括44423名年龄在12至23个月之间儿童的加权样本。使用统计分析软件STATA/SE 14.0对数据进行清理、重新编码和分析。利用多水平混合效应逻辑回归，确定与结果变量相关的因素。变量的调整比值比具有95%置信区间且p值<0.05时具有统计学意义。
12至23个月儿童持续母乳喂养的汇总患病率为64.59%（95%CI：64.15%，65.04%）。母亲年龄[AOR = 1.22；95%CI（1.09，1.38）]、母亲教育水平[AOR = 0.51；95%CI（0.47，0.55）]、父亲教育水平[AOR = 0.79；95%CI（0.73，0.85）]、母亲婚姻状况[AOR = 1.13；95%CI（1.05，1.22）]、母亲工作状况[AOR = 1.32；95%CI（1.25，1.39）]、财富指数[AOR = 0.82；95%CI（0.77，0.88）]、产次[AOR = 1.09；95%CI（1.00，1.19）]、分娩地点[AOR = 0.92；95%CI（0.87，0.98）]、产前检查次数[AOR = 1.27；95%CI（1.15，1.39）]、分娩方式[AOR = 0.81；95%CI（0.73，0.89）]、双胞胎状况[AOR = 4.65；95%CI（4.07，5.31）]、儿童年龄[AOR = 9.59；95%CI（9.03，10.2）]、儿童性别[AOR = 0.95；95%CI（0.91，0.99）]、上次生育间隔[AOR = 1.28；95%CI（1.20，1.37）]、居住地[AOR = 0.74；95%CI（0.70，0.79）]以及社区教育水平[AOR = 0.90；95%CI（0.85，0.96）]等因素与持续母乳喂养显著相关。
在本研究中，撒哈拉以南非洲国家近三分之二的12至23个月儿童持续母乳喂养。年龄较大、受过教育、已婚的女性；职业母亲；较富裕家庭；多产妇女；在家分娩；接受产前检查；顺产；单胎；年龄较小的儿童；男性儿童；上次生育间隔较长；城市居住；以及来自东非的母亲持续母乳喂养的几率较高。因此，建议增强妇女权能，改善孕产妇保健服务，并特别关注未婚和年轻女性、初产妇、多胞胎母亲、育有女童的母亲以及农村地区的母亲。
