Minimum milk feeding frequency and its associated factors among non-breastfed children aged 6-23 months in sub-saharan Africa: a multilevel analysis of the recent demographic and health survey data.

Poor infant and child feeding practices, in combination with increased rates of infectious diseases, are the main immediate causes of malnutrition during the first two years of life. Non-breastfed children require milk and other dairy products, as they are rich sources of calcium and other nutrients. As far as our search is concerned, there is no evidence on the pooled magnitude and determinants of minimum milk feeding frequency among non-breastfed children in sub-Saharan Africa conducted using the most recent indicators for assessing infant and young child feeding practices published in 2021. Therefore, this study is intended to determine the magnitude and associated factors of minimum milk feeding frequency among non-breastfed children aged 6-23 months in sub-Saharan Africa using the most recent guideline and demographic and health survey dataset. Data from the most recent health and demographic surveys, which were carried out between 2015 and 2022 in 20 sub-Saharan African countries, were used. The study comprised a weighted sample consisting of 13,315 non-breastfed children between the ages of 6 and 23 months. STATA/SE version 14.0 statistical software was used to clean, recode, and analyze data that had been taken from DHS data sets. Utilizing multilevel mixed-effects logistic regression, the factors associated with the outcome variable were identified. Model comparison and fitness were assessed using deviance (-2LLR), likelihood ratio test, median odds ratio, and intra-class correlation coefficient. Finally, variables with a p-value < 0.05 and an adjusted odds ratio with a 95% confidence interval were declared statistically significant. The pooled magnitude of minimum milk feeding frequency among non-breastfed children aged 6-23 months in sub-Saharan African countries was 12.39% (95% CI: 11.85%, 12.97%). Factors like maternal educational level [AOR = 1.61; 95% CI (1.35, 1.91)], marital status of the mother [AOR = 0.77; 95% CI (0.67, 0.89)], maternal working status [AOR = 0.80; 95% CI (0.71, 0.91)], media exposure [AOR = 1.50; 95% CI (1.27, 1.77)], wealth index [AOR = 1.21; 95% CI (1.03, 1.42)], place of delivery [AOR = 1.45; 95% CI (1.22, 1.72)], ANC visit attended during pregnancy [AOR = 0.49; 95% CI (0.39, 0.62)], PNC checkup [AOR = 1.57; 95% CI (1.40, 1.76)], child's age [AOR = 0.70; 95% CI (0.53, 0.93)], and residence [AOR = 2.15; 95% CI (1.87, 2.46)] were significantly associated with minimum milk feeding frequency. In sub-Saharan Africa, the proportion of minimum milk feeding frequency among non-breastfed children aged between 6 and 23 months was low. The likelihood of minimum milk feeding frequency increases with high levels of education, unemployment, media exposure, rich wealth status, being unmarried, having a child born in a health facility, getting PNC checks, being between 6 and 8 months old, and living in an urban area. Hence, promoting women's education, increasing the economic status of the household, disseminating nutrition information through media, strengthening maternal health service utilization like health facility delivery and PNC services, and giving prior attention to mothers with older children and from rural areas are strongly recommended.

Mekonen EG ，Workneh BS ，Ali MS ，Gonete AT ，Alemu TG ，Tamir TT ，Tekeba B ，Techane MA ，Wassie M ，Kassie AT ，Zegeye AF ... -  《BMC PUBLIC HEALTH》

Bottle-feeding practice and its associated factors among mothers of children aged 0 to 23 months in sub-Saharan Africa: a multi-level analysis of demographic and health surveys (2015-2022).

Avoidance of bottle feeding is recommended as it interferes with optimal suckling behavior, is difficult to keep clean, and is an important route for the transmission of pathogens. However, there is a current shift towards breastfeeding for a short period and the introduction of bottle feeding in both the developed and developing worlds. Bottle-feeding practice and its individual- and community-level determinants are not addressed in sub-Saharan Africa. Therefore, this study aimed to fill this gap and assess the pooled prevalence and associated factors of bottle feeding among mothers of children less than 23 months of age. Data from the recent demographic and health surveys of 20 countries in sub-Saharan Africa conducted between 2015 and 2022 were used. A total weighted sample of 86,619 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 overall pooled prevalence of bottle feeding among mothers of children aged 0 to 23 months in sub-Saharan Africa was 13.74% (95% CI: 13.51%, 13.97%). Factors like maternal age [AOR = 1.09; 95% CI (1.04, 1.14)], educational status [AOR = 2.83; 95% CI (2.58, 3.10)], marital status [AOR = 1.16; 95% CI (1.09, 1.24)], maternal occupation [AOR = 0.76; 95% CI (0.73, 0.79)], media exposure [AOR = 0.80; 95% CI (0.76, 0.85)], wealth index [AOR = 1.21; 95% CI (1.15, 1.29)], sex of the household head [AOR = 1.17; 95% CI (1.12, 1.24)], family size [AOR = 1.06; 95% CI (1.01, 1.12)], number of under-five children [AOR = 1.11; 95% CI (1.04, 1.19)], place of delivery [AOR = 1.06; 95% CI (1.00, 1.12)], mode of delivery [AOR = 1.41; 95% CI (1.31, 1.52)], counseling on breastfeeding [AOR = 0.88; 95% CI (0.84, 0.92)], age of the child [AOR = 1.65; 95% CI (1.57, 1.75)], and residence [AOR = 1.64; 95% CI (1.56, 1.72)] were significantly associated with bottle-feeding practices. Nearly one out of seven children aged 0 to 23 months received bottle feeding in sub-Saharan African countries. Older mothers, higher mothers' educational status, unmarried women, richest families, non-working mothers, exposed to media, female-headed households, large family size, having one under-five children, home delivery, cesarean delivery, children aged 6-11 months, and urban residence were significantly associated with an increased risk of bottle feeding. Breastfeeding promotion programs are advised to target mothers who are older, educated, working, rich, gave birth at home, have a large family size, are delivered by cesarean section, have children aged 6-11 months, and reside in urban areas to achieve a significant decrease in bottle feeding rates in sub-Saharan Africa.

Mekonen EG 《BMC PUBLIC HEALTH》

Determinants of prolonged exclusive breastfeeding among children aged 6-23 months in 21 sub-saharan African countries: evidence from nationally representative data.

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.

Mekonen EG 《-》

Determinants of formula feeding among mothers with infants and young children in six Sub Sahara African countries: Multilevel analysis of data from demographic and health survey.

Formula feeding is providing infants with prepared formula as an alternative to or alongside breastfeeding. While breast milk is widely regarded as the optimal source of nutrition for infants, formula feeding is a common practice. The recommended approach is exclusive breastfeeding for the first six months, followed by the introduction of complementary foods after that period, which is crucial for child growth and development. Formal feeding has a negative impact on an infant's health, causing malnutrition and other illnesses. Therefore, this study was investigated to assess formula feeding and determinant factors among mothers with infants in six sub-Saharan African countries. A total weighted sample of 26,119 mothers with infants and young children less than two years was included in this study. The data were taken from a recent demographic and health survey in six sub-Sahara African countries. A multilevel, multivariable logistic regression model was used to identify the determinant factors associated with formula feeding. In the multivariable analysis, the adjusted odds ratio with a 95% CI was used to declare a statistically significant association with formula feeding among mothers with infants. In this study, the proportion of mothers with infants who use formula feeding was 17.1%. In multilevel logistic analysis (model III), the significant factors associated with formula feeding were the age of the mothers; 25-34 years (AOR = 1.3; 95% CI (1.2-1.41)), 35-49 years (AOR = 1.4; 95% CI (1.22-1.54)), multiple children (AOR = 1.4; 95% CI (1.23-1.77)), maternal educational status; secondary and higher (AOR = 2.4; 95% CI (2.11-2.66)), mother's employment status; (AOR = 1.24; 95% CI (1.14-1.5));, richer households (AOR = 1.2; 95% CI (1.10-1.36)), place of delivery (AOR = 2.1; 95% CI (1.83-2.44)), household media exposure (AOR = 1.5; 95% CI (1.3-1.68))place of residence (AOR = 1.97; 95% CI (1.79-2.17)), community illiteracy level (AOR = 1.17; 95% CI (1.02-1.34)), and community media exposure (AOR = 1.2; 95% CI (1.03-1.38)). Formula feeding among mothers with infants in Sub-Saharan Africa has emerged as a public health concern. The recommended approach is to promote exclusive breastfeeding for the first six months, followed by the introduction of complementary feeding after that period. Factors associated with formula feeding include older maternal age, secondary and higher education, delivery in health institutions, employment status, higher household income, twin births, urban residence, low community illiteracy rates, and increased community media exposure. Stakeholders and health policymakers should be focused on strategies to improve breast feeding and discourage infant formula feeding.

Ali MS ，Zegeye AF ，Workneh BS ，Zeleke GA ，Mekonen EG ，Aemro A ，Tekeba B ，Tamir TT ，Wassie M ，Terefe B ... -  《PLoS One》

Minimum meal frequency and associated factors among children aged 6-23 months in Sub-Saharan Africa: a multilevel analysis of the demographic and health survey data.

Worldwide, approximately half of all children are not provided the minimum meal frequency (MMF). Sub-Saharan Africa (SSA) had the lowest proportion of children aged 6-23 months who met the requirements of the complementary feeding indicators, including MMF. Ensuring adequate meal frequency poses a challenge in numerous developing countries, particularly in regions characterized by low household food security, such as SSA. Therefore, this study aimed to assess the pooled prevalence of MMF and its associated factors in SSA via the most recent demographic and health survey data. A total of 100,526 weighted samples from demographic and health survey datasets of 35 SSA countries were used. A multilevel Poisson regression model with robust variance was applied to identify factors associated with MMF, and the model with the lowest deviance was the best-fitted model. An adjusted prevalence ratio with a 95% confidence interval (CI) was reported, and variables with a p < 0.05 were considered statistically significant. The pooled prevalence of MMF among children aged 6-23 months in SSA was 38.47% (95% CI: 34.97-41.97), which ranged from 21.41% in Liberia to 63.98% in Madagascar. According to the subgroup analysis, the pooled magnitude of MMF in central, west, east, and southern Africa was 36.42, 35.46, 39.97, and 50.69%, respectively. Marital status, maternal education level, sex of household head, working status, wealth index, media exposure, age of the child, postnatal check-up, breastfeeding status, residence, and SSA regions were significantly associated with minimum meal frequency. Less than forty percent of infants and young children in SSA receive the minimum recommended meal frequency, which is relatively low. This presents a notable difficulty in efforts to prevent malnutrition and attain sustainable development goals related to health and nutrition on the continent. Therefore, priority should be given to empowering women, promoting breastfeeding and postnatal check-ups, targeting infants who just started complementary feeding, and spreading information through media.

Tebeje TM ，Abebe M ，Tesfaye SH ，Seboka BT ，Argaw GS ，Seifu BL ，Mare KU ，Aragaw FM ... -  《Frontiers in Public Health》