Breast-, complementary and bottle-feeding practices in Kenya: stagnant trends were experienced from 1998 to 2009

Spatial variations and determinants of bottle feeding among children aged 0-23 months in Ethiopia in 2019: A spatial and multi-level analysis

BACKGROUND

Bottle feeding should be avoided since it interferes with optimal breastfeeding and it causes diarrheal-related morbidity and mortality. Despite the WHO's recommendation that children to avoid bottle feeding, it is still widely practiced in developing countries including our country, Ethiopia. Therefore, this study aimed to assess the spatial variations, and determinants of bottle feeding among children aged 0-23 months using the recent demographic and health survey data for Ethiopia.

METHODS

A secondary data analysis was conducted using the 2019 Ethiopian mini demographic and health survey data. The total weighted sample of 2067 children aged 0-23 months was included in this study. Spatial analysis was done to identify the hotspot areas of bottle feeding among children in Ethiopia. Multivariable multilevel logistic regression was used to identify predictors of bottle feeding. The spatial analysis was done using ArcGIS 10.7 and Sat Scan 9.6 software.

RESULT

The prevalence of bottle feeding among children aged 0-23 months was 21.52% with 95% CI(19.80%, 23.34%). Age of the child from 6-11 months, and 12-23 months age, having secondary and above education [AOR = 2.09; 95%CI; 1.31, 3.32], being from middle and rich household [AOR = 2.14; 95%CI; 1.37, 3.34] and [AOR = 2.30; 95%CI; 1.46, 3.63], and twin birth [AOR = 8.06; 95%CI; 2.87, 22.58] were significant predictors of bottle feeding. Hotspot areas of bottle feeding were observed in Addis Ababa, Dire Dawa, Harari, and Afar regions of Ethiopia.

CONCLUSION

Bottle feeding practice was found to be spatially clustered in Ethiopia. Education, wealth index, parity, and child's age were significant predictors of bottle feeding. Hotspot areas of bottle feeding were observed in Addis Ababa, Dire Dawa, Harari, and Afar regions. Special attention should be directed towards mothers residing in hotspot areas, educated mothers, mothers of multiple births, and mothers from rich households through community education programs focused on child feeding practices to reduce the practice of bottle-feeding in Ethiopia.

Multilevel modeling analysis of bottle feeding and its determinants among children 0-23 months in East Africa: evidence from recent DHS data (2015-2022)

BACKGROUND

Despite breastfeeding recommendations, the prevalence and length of breast milk feeding in developing nations is rapidly decreasing, with bottle feeding taking its place. This reduces the effectiveness of breastfeeding and is associated with diarrheal disease mortality and morbidity. The purpose of this study was to determine the prevalence, distribution, and determinants of bottle feeding among under-two-year-old children in the region.

METHODS

The ten East African countries' Demographic and Health Surveys (DHS) recent data from 2015 to 2022 was used. The data were weighted using sample weights for probability sampling and nonresponse. The study used 43,150 weighted children. A multi-level logistic regression model was used, and P - values of ≤ 0.2 and < 0.05 were used to declare candidate variables in the binary, and multivariable to declare significant variables, respectively.

RESULTS

The prevalence of bottle feeding among children under-two-years-old in East Africa was 10.08% (95% CI 9.79, 10.36), ranging from 4.04% (95% CI 3.56, 4.53) in Tanzania to 33.40% (95% CI 32.72, 34.08) in Kenya. High antenatal care communities (AOR 1.22; 95% CI 1.11, 1.35), mothers aged 25-34 years (AOR 1.17; 95% CI 1.06, 1.28), high wealth index communities (AOR 1.12; 95% CI 1.02,1.25), women who had at least one types mass media exposure (AOR 1.64; 95% CI 1.53, 1.77), women from communities with high level mass media exposure (AOR 1.36; 95% CI 1.23, 1.52), given first birth after teenage years (AOR 1.17; 95% CI 1.09, 1.26), having more than one health visit in the year (AOR 1.37; 95% CI 1.27,1.47), multiple children (AOR 1.46; 95% CI 1.22, 1.75) were associated with higher rates of bottle feeding. Whereas a primary education (AOR 0.51; 95% CI 0.47, 0.54), having 3-5 living children (AOR 0.86; 95% CI 0.79, 0.95), a rural setting (AOR 0.53; 95% CI 0.49, 0.58), and a long distance from health facilities (AOR 0.84; 95% CI, 0.78, 0.91) were associated with lower rates of bottle feeding.

CONCLUSIONS

The overall prevalence of bottle feeding was moderate in East African countries. Improving the availability and accessibility of health facilities to mothers, utilizing maternal healthcare, and media exposure will contribute to a significant decrease in the inappropriate bottle feeding of children in East Africa.

Trends and associated factors of bottle-feeding in Turkey: dramatic change over the last three decades under the limited implemented code

The study aimed to examine the trends and associated factors of bottle-feeding among children aged 0-35 months. Data covering 11,205 mother-child pairs, from six recent Turkey Demographic and Health Surveys (TDHSs) were analyzed by using complex sample crosstabs and logistic regression. Bottle-feeding was on an upward trend from 33.0% to 51.5% from 1993 to 2013 and fell slightly 47.9% in 2018. Increasing trends of bottle-feeding were found in children aged 6-35 months, the East region, lower wealth index, maternal education under 5 years, Kurdish mothers, and the low antenatal care attendance. Multivariate analysis using data from TDHS-2018 showed that young maternal age, low birth weight and being 6-23 months of age were associated with higher rates of bottle-feeding. The prolonged bottle-feeding became widespread, and the bottle-feeding was common even in 35-month-old children. Interventions by the Government and stakeholders to minimize low rates of bottle-feeding should focus on high-risk groups.

Mapping regional variability of exclusive breastfeeding and its determinants at different infant's age in Tanzania

INTRODUCTION

Despite its numerous benefits, exclusive breastfeeding (EBF) remains an underutilized practice. Enhancing EBF uptake necessitates a focused approach targeting regions where its adoption is suboptimal. This study aimed to investigate regional disparities in EBF practices and identify determinants of EBF among infants aged 0-1, 2-3, and 4-5 months in Tanzania.

METHODS

This cross-sectional study utilized data from the 2015/16 Tanzania Demographic and Health Survey. A total of 1,015 infants aged 0-5 met the inclusion criteria, comprising 378 aged 0-1 month, 334 at 2-3 months, and 303 at 4-5 months. EBF practices were assessed using a 24-hour recall method. A generalized linear mixed model, with fixed covariates encompassing infant and maternal attributes and clusters for enumeration areas (EAs) and regions, was employed to estimate EBF proportions.

RESULTS

Regional disparities in EBF were evident among infants aged 0-1, 2-3, and 4-5 months, with decline in EBF proportions as an infant's age increases. This pattern was observed nationwide. Regional and EA factors influenced the EBF practices at 0-1 and 2-3 months, accounting for 17-40% of the variability at the regional level and 40-63% at the EA level. Literacy level among mothers had a significant impact on EBF practices at 2-3 months (e.g., women who could read whole sentences; AOR = 3.2, 95% CI 1.1,8.8).

CONCLUSION

Regional disparities in EBF proportions exist in Tanzania, and further studies are needed to understand their underlying causes. Targeted interventions should prioritize regions with lower EBF proportions. This study highlights the clustering of EBF practices at 0-1 and 2-3 months on both regional and EA levels. Conducting studies in smaller geographical areas may enhance our understanding of the enablers and barriers to EBF and guide interventions to promote recommended EBF practices.

Trends of Exclusive Breastfeeding Practices and Its Determinants in Tanzania from 1999 to 2016

Introduction: The benefits of exclusive breastfeeding (EBF) are widely reported. However, it is crucial to examine potential disparities in EBF practices across different regions of a country. Our study uses Tanzania demographic and health survey data to report on the trends of EBF across regions from 1999 to 2016, the patterns of the practice based on geographical location and socioeconomic status, and explores its determinants across the years. Methods: Descriptive statistics were used to establish the trends of EBF by geographical location and wealth quintile. A generalized linear mixed model was developed to incorporate both infant and maternal attributes as fixed covariates while considering enumeration areas and regions as clusters. The fitted model facilitated the estimation of EBF proportions at a regional level and identified key determinants influencing EBF practices across the survey periods. Moreover, we designed breastfeeding maps, visually depicting the performance of different regions throughout the surveys. Results: Across the various survey rounds, a notable regional variation in EBF practices was observed, with coastal regions generally exhibiting lower adherence to the practice. There was a linear trend between EBF and geographical residence (p < 0.05) and socioeconomic standing (p < 0.05) across the survey periods. Rural-dwelling women and those from the least affluent backgrounds consistently showcased a higher proportion of EBF. The prevalence of EBF declined as infants aged (p < 0.001), a trend consistent across all survey waves. The associations between maternal attributes and EBF practices displayed temporal variations. Furthermore, a correlation between exclusive breastfeeding and attributes linked to both regional disparities and enumeration areas was observed. The intra-cluster correlation ranged from 18% to 41.5% at the regional level and from 40% to 58.5% at the enumeration area level. Conclusions: While Tanzania's progress in EBF practices is laudable, regional disparities persist, demanding targeted interventions. Sustaining achievements while addressing wealth-based disparities and the decline in EBF with infant age is vital. The study highlights the need for broad national strategies and localized investigations to understand and enhance EBF practices across different regions and socioeconomic contexts.

Breastfeeding counseling changes breastfeeding behavior of babies in coastal communities in the area of Mangara Bombang community health centers, Takalar regency

INTRODUCTION

Breastfeeding is the first step to forming children who are not only healthier but smarter, with a better emotional quotient (EQ) and spiritual quotient (SQ). Babies need physical closeness and warmth from their mother as much as optimal nourishment. Poor knowledge and attitudes towards exclusive breastfeeding can result from information that is not intensive and maximal, due to limited breastfeeding counseling staff. Other reasons include cultural factors, especially in coastal areas, such as the belief in prelacteal feeding before the first breastfeeding; the baby has then automatically not exclusively breastfed.

METHODS

This study used an intervention with a one-group pretest-posttest design. It aimed to analyze the role of breastfeeding counseling in increasing mothers' knowledge and attitudes regarding exclusive breastfeeding. The participants were pregnant women from the end of the second trimester to the third trimester, selected using stratified systematic random sampling.

RESULTS

Counseling had a significant effect on mothers' knowledge (p = 0.004) and attitude (p = 0.000) in changing the behavior of coastal communities towards giving exclusive breastfeeding (p = 0.03). Intensified counseling is recommended for pregnant women in the third trimester to realize exclusive breastfeeding.

CONCLUSIONS

A positive and significant effect of breastfeeding counseling was found on the level of knowledge, attitudes, and changes in the behavior of coastal communities in exclusive breastfeeding.

Spatial distribution and determinants of bottle feeding among children 0-23 months in Ethiopia: spatial and multi-level analysis based on 2016 EDHS

BACKGROUND

Bottle feeding is associated with diarrheal disease morbidity and mortality and risk of pyloric stenosis, especially in developing countries. Even though, World Health Organization (WHO) recommended avoiding bottle feeding among children, still higher magnitude was reported in developing countries. This study aimed to assess the spatial distribution and determinants of bottle feeding among children 0-23 months in Ethiopia.

METHODS

This study was conducted based on Ethiopian Demographic and Health Surveys data (EDHS). The data were weighted using sampling weight for probability sampling and non-response to restore the representativeness of the data and get valid statistical estimates. Then a total of 4,275 weighted samples of under two years children were used to investigate the study. The data were cleaned using MS excel and extracted and analyzed using STATA V.16 software. A multilevel binary logistic regression model was fitted. P-value < 0.05 was taken to declare statistical significance. A spatial analysis was done using ArcGIS and SaTScan software.

RESULTS

The prevalence of bottle feeding practice among under two years children in Ethiopia were 13.5% (95%CI: 11.16, 15.29) and ranges from the lowest 5.16% (95% CI: 3.28, 78.73) Amhara region to the highest 55.98% (95% CI: 47.98, 61.46) Addis Ababa region. Women with secondary and above education status [AOR=2.49; 95%CI; 1.66, 3.74], women from richest household [AOR=1.33; 95%CI; 1.01, 1.78], child 12-23 months age [AOR= 1.59; 95%CI; 1.23, 2.05], multiple birth [AOR=4.30; 95%CI; 1.88, 9.84], rural residence [AOR=0.49; 95%CI; 0.16, 0.82] and large central region [AOR= 0.15; 95%CI; 0.08, 0.27] have significantly associated with bottle feeding. Addis Ababa, Central Oromia, Dire Dewa, Somali and Harari regions were the hot spot areas for bottle feeding practice among under two years children.

CONCLUSION AND RECOMMENDATIONS

The prevalence of bottle feeding practices in Ethiopia is relatively moderate. Maternal education, wealth index, child age, multiple births, residence and region were significant predictors of bottle feeding. These findings highlight that, the Ministry of Health Ethiopia (MOH), policymakers, and other stakeholders had better give prior attention to preventable factors such as empowering women, enhancing household wealth status to decreasing bottle feeding practice in Ethiopia.

Role of clusters in exclusive breastfeeding practices in Tanzania: A secondary analysis study using demographic and health survey data (2015/2016)

BACKGROUND

While the benefits of exclusive breastfeeding are widely acknowledged, it continues to be a rare practice. Determinants of exclusive breastfeeding in Tanzania have been studied; however, the existence and contribution of regional variability to the practice have not been explored.

METHODS

Tanzania demographic and health survey data for 2015/2016 were used. Information on infants aged up to 6 months was abstracted. Exclusive breastfeeding was defined using a recall of feeding practices in the past 24 h. Enumeration areas and regions were treated as random effects. Models without random effects were compared with those that incorporated random effects using the Akaike information criterion. The determinants of exclusive breastfeeding were estimated using the generalized linear mixed model with enumeration areas nested within the region.

RESULTS

The generalized linear mixed model with an enumeration area nested within a region performed better than other models. The intra-cluster variability at region and enumeration area levels was 3.7 and 24.5%, respectively. The odds of practicing exclusive breastfeeding were lower for older and male infants, for mothers younger than 18, among mothers residing in urban areas, among those who were employed by a family member or someone else, those not assisted by a nurse/midwife, and those who were not counseled on exclusive breastfeeding within 2 days post-delivery. There was no statistical evidence of an association between exclusive breastfeeding practices and the frequency of listening to the radio and watching television. When mapping the proportion of exclusive breastfeeding, a variability of the practice is seen across regions.

CONCLUSION

There is room to improve the proportion of those who practice exclusive breastfeeding in Tanzania. Beyond individual and setting factors, this analysis shows that a quarter of the variability in exclusive breastfeeding practices is at the community level. Further studies may explore the causes of variabilities in regional and enumeration area and how it operates. Interventions to protect, promote, and support exclusive breastfeeding in Tanzania may target the environment that shapes the attitude toward exclusive breastfeeding in smaller geographical areas.

Intimate partner violence, breastfeeding, breastmilk substitutes and baby bottle use in the first year of life

This article aims to investigate the relationship between intimate partner physical violence (IPPV) and breastfeeding (BF), use of breastmilk substitutes (BMS) and bottle-feeding among children aged 12 to 15 months. This is a cross-sectional study with mothers in primary care facilities of the city of Rio de Janeiro. IPPV was identified by the Brazilian version of the Conflict Tactics Scales 1-Form R and feeding practices were identified by a 24-hour Dietary Recall. Associations were verified by logistic regression with odds ratio (OR) estimates and 95% confidence intervals. BF was offered to 58.5% of the children and BMS to 88.5%. Also, 70.5% of the children used a baby bottle. Physical violence was observed in 26.7% of couples. Households where couples physically abuse each other are more likely to not breastfeed (OR=2.14, p-value=0.030), to use breastmilk substitutes (OR=5.15, p-value=0.03) and bottle-feed (OR=2.71; p-value=0.01), when compared to households without physical violence. The results highlight the need to investigate intrafamily relationships in cases where inadequate breastfeeding practices are identified, and to enable health professionals to support families in conflict situations.

COMPARISON OF BREASTFEEDING SELF-EFFICACY BETWEEN ADOLESCENT AND ADULT MOTHERS AT A MATERNITY HOSPITAL IN RIBEIRÃO PRETO, BRAZIL

ABSTRACT Objective: to measure and compare the breastfeeding self-efficacy between adolescents and adults mothers in the immediate postpartum. Method: is an observational, cross-sectional and comparative study, developed at a maternity hospital in Ribeirao Preto, Brazil. Data were collected between January and July 2014. The sample consisted of 306 adult mothers and 94 adolescent mothers. The breastfeeding self-efficacy scores were obtained using the Brazilian version of the Breastfeeding Self-Efficacy Scale. Student t-test was used to compare the values of breastfeeding self-efficacy between the groups of participants. We considered a 5% significance level (p=0.05). Results: most adolescents and adults mothers (54%) presented high levels of breastfeeding self-efficacy and there was no statistically significant difference between the scores of the two groups (p=0.3482) . Conclusion: health professionals need to be careful about breastfeeding self-efficacy in order to direct specific actions for each group of mothers (adolescents and adult mothers) to improve the breastfeeding rates.

Changes in Optimal Childcare Practices in Kenya: Insights from the 2003, 2008-9 and 2014 Demographic and Health Surveys

Objective(s)

Using nationally representative surveys conducted in Kenya, this study examined optimal health promoting childcare practices in 2003, 2008–9 and 2014. This was undertaken in the context of continuous child health promotion activities conducted by government and non-government organizations throughout Kenya. It was the aim of such activities to increase the prevalence of health promoting childcare practices; to what extent have there been changes in optimal childcare practices in Kenya during the 11-year period under study?

Methods

Cross-sectional data were obtained from the Kenya Demographic and Health Surveys conducted in 2003, 2008–9 and 2014. Women 15–49 years old with children 0–59 months were interviewed about a range of childcare practices. Logistic regression analysis was used to examine changes in, and correlates of, optimal childcare practices using the 2003, 2008–9 and 2014 data. Samples of 5949, 6079 and 20964 women interviewed in 2003, 2008–9 and 2014 respectively were used in the analysis.

Results

Between 2003 and 2014, there were increases in all health facility-based childcare practices with major increases observed in seeking medical treatment for diarrhoea and complete child vaccination. Mixed results were observed in home-based care where increases were noted in the use of insecticide treated bed nets, sanitary stool disposal and use of oral rehydration solutions, while decreases were observed in the prevalence of urging more fluid/food during diarrhoea and consumption of a minimum acceptable diet. Logit models showed that area of residence (region), household wealth, maternal education, parity, mother's age, child’s age and pregnancy history were significant determinants of optimal childcare practices across the three surveys.

Conclusions

The study observed variation in the uptake of the recommended optimal childcare practices in Kenya. National, regional and local child health promotion activities, coupled with changes in society and in living conditions between 2003 and 2014, could have influenced uptake of certain recommended childcare practices in Kenya. Decreases in the prevalence of children who were offered same/more fluid/food when they had diarrhea and children who consumed the minimum acceptable diet is alarming and perhaps a red flag to stakeholders who may have focused more on health facility-based care at the expense of home-based care. Concerted efforts are needed to address the consistent inequities in the uptake of the recommended childcare practices. Such efforts should be cognizant of the underlying factors that affect childcare in Kenya, herein defined as region, household wealth, maternal education, parity, mother's age, child’s age and pregnancy history.