Determinants of exclusive breastfeeding practice among mothers with infants under six months in Ethiopia: A Multilevel Analysis of the 2019 Ethiopian Mini Demographic and Health Survey

Background: Exclusive breastfeeding (EBF) is defined as feeding infants only breast milk, be it directly from the breast or expressed, with no other foods or liquids except prescribed drops or syrups consisting of vitamins, mineral supplements, or medicine. However, the prevalence of exclusive breastfeeding in Ethiopia is lower than that internationally recommended. Most previous studies of EBF in Ethiopia focused on individual-level factors, covered limited geographic areas, used small sample sizes, and relied on binary logistic regression analysis of older datasets. The main objective of this study was to identify the determinants of EBF practice among Ethiopian mothers of infants under 6 months old.

Methods: The 2019 Ethiopian Mini Demographic Health Survey (2019 EMDHS), a recent nationwide community-based cross-sectional survey, was used as the primary source for this study. A multilevel logistic regression model was used to identify significantly associated individual and community-level factors with exclusive breastfeeding among infants under 6 months of age. An adjusted odds ratio (OR) with 95% confidence interval (CI) was used to measure the association of factors with EBF practice. Log-likelihood (LL), deviance, and Akaike information criterion (AIC) were used for model comparison.

Results: A total of 531 weighted infants under 6 months of age in Ethiopia were included in the study. The prevalence of exclusive breastfeeding practice was 83%. Mothers with higher education (AOR: 0.02; 95% CI: 0.001, 0.64) and infants from middle-class or wealthy family backgrounds (AOR: 5.34; 95% CI: 1.022, 27.85) were significantly associated with EBF practice among under-6-month-old infants. Rural residences (AOR: 0.08; 95% CI: 0.01, 0.99), pastoral regions (AOR: 0.03; 95% CI: 0.003, 0.18), and low community poverty level (AOR: 0.11; 95% CI: 0.018, 0.68) were also significantly associated with EBF practice among infants under 6 months old.

Conclusion: In this study, mothers’ educational level, wealth index, place of residence, contextual region, and community poverty level were significant factors affecting EBF practice among infants aged 6 months or less. Creating awareness about poverty and the value of EBF at the community level may help enhance exclusive breastfeeding practices.