Mohammed Shamsudeen, Calvert Clara, Webb Emily L, Glynn Judith R, Filteau Suzanne, Price Alison, Dube Albert, Mugisha Joseph O, Makanga Ronald, Marston Milly, Oakley Laura
Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
Usher Institute, The University of Edinburgh , Edinburgh, UK.
BMJ Public Health. 2025 Mar 18;3(1):e001298. doi: 10.1136/bmjph-2024-001298. eCollection 2025.
Breastfeeding rates in sub-Saharan Africa (SSA) are declining, and at the current rate, only four African countries will meet the WHO's 2030 exclusive breastfeeding target. We examined the association between maternal socioeconomic status (SES) and breastfeeding practices in SSA.
Six cohorts in Ethiopia, Malawi, Uganda and Zambia, with 11 863 participants, were analysed. Data for the cohorts were collected between 2000 and 2021, covering births from 2000 to 2019. SES exposures were maternal education and household income. Breastfeeding outcomes included ever breastfed, early initiation of breastfeeding (Ethiopia only), exclusive breastfeeding for ≥4 months or ≥6 months, and continued breastfeeding for ≥1 year. Risk ratios from multivariable Poisson regression models for individual cohorts were pooled in a random-effects meta-analysis to assess the effects of SES on breastfeeding, adjusting for confounders.
Meta-analysis found no evidence of a difference in ever breastfeeding between mothers with secondary or tertiary education and those with primary/no education. Mothers with secondary education (adjusted risk ratio (aRR)=1.11, 95% CI=1.01 to 1.21) and those from middle-wealth households (aRR=1.12, 95% CI=1.01 to 1.24) were more likely to initiate breastfeeding early than those with primary/no education or low household wealth, but there was no evidence of association in the tertiary education and higher-wealth groups. The association between maternal education and exclusive breastfeeding for ≥4 months and ≥6 months varied across cohorts, with no evidence of association in most cohorts. Overall, household wealth was not associated with exclusive breastfeeding for ≥4 months or ≥6 months. The meta-analysis showed no evidence of association between household wealth and breastfeeding for ≥1 year, but mothers with tertiary education were less likely (aRR=0.93, 95% CI=0.88 to 0.99) to breastfeed for ≥1 year than those with primary or no education.
We observed no clear socioeconomic pattern in breastfeeding, contrasting with patterns observed in high-income countries.
撒哈拉以南非洲地区（SSA）的母乳喂养率正在下降，按照目前的速度，只有四个非洲国家能够实现世界卫生组织2030年的纯母乳喂养目标。我们研究了SSA地区孕产妇社会经济地位（SES）与母乳喂养行为之间的关联。
对埃塞俄比亚、马拉维、乌干达和赞比亚的六个队列进行了分析，共有11863名参与者。这些队列的数据收集于2000年至2021年之间，涵盖了2000年至2019年的出生情况。SES暴露因素为孕产妇教育程度和家庭收入。母乳喂养结果包括曾经母乳喂养、早期开始母乳喂养（仅针对埃塞俄比亚）、纯母乳喂养≥4个月或≥6个月以及持续母乳喂养≥1年。对各个队列的多变量泊松回归模型得出的风险比进行随机效应荟萃分析，以评估SES对母乳喂养的影响，并对混杂因素进行调整。
荟萃分析未发现接受过中等或高等教育的母亲与接受过小学教育/未接受教育的母亲在曾经母乳喂养方面存在差异的证据。接受中等教育的母亲（调整后风险比（aRR）=1.11，95%置信区间（CI）=1.01至1.21）和中等财富家庭的母亲（aRR=1.12，95%CI=1.01至1.24）比接受小学教育/未接受教育或家庭财富低的母亲更有可能早期开始母乳喂养，但在高等教育和高财富群体中没有关联的证据。孕产妇教育程度与纯母乳喂养≥4个月和≥6个月之间的关联在不同队列中有所不同，大多数队列中没有关联的证据。总体而言，家庭财富与纯母乳喂养≥4个月或≥6个月无关。荟萃分析未发现家庭财富与母乳喂养≥1年之间存在关联的证据，但接受高等教育的母亲母乳喂养≥1年的可能性低于接受小学教育或未接受教育的母亲（aRR=0.93，95%CI=0.88至0.99）。
我们在母乳喂养方面未观察到明显的社会经济模式，这与高收入国家观察到的模式形成对比。
