Exclusive breastfeeding is widely acknowledged as one of the most effective measures to enhance newborn survival rates, providing lasting benefits for children that extend beyond infancy into adulthood (4). In SSA, a large number of infant and child deaths occur, with 55–75% of these deaths in children under five being linked to poor breastfeeding practices (30). In this region, even though almost all mothers breastfeed, only a small percentage practice EBF for the first six months postpartum (31). This study assesses the prevalence and predictors of EBF in SSA. The analysis reveals that the prevalence of EBF in SSA is 7.5%, with a 95% confidence interval (CI) ranging from 6.3–8.8%. Among the countries studied, Ethiopia has the highest EBF prevalence at 17.3%, followed by Rwanda at 15.8%. In contrast, Chad has the lowest EBF prevalence at 2.9%.
These results indicate a significant heterogeneity among the countries, as shown by heterogeneity value of 99.32% and a p-value of less than 0.0001. This high heterogeneity value suggests a substantial variation in EBF prevalence rates across the different countries in the region. The significant heterogeneity implies that the differences in EBF prevalence are not due to random chance but are likely influenced by various country-specific factors, such as cultural practices, healthcare infrastructure, socioeconomic conditions, and policy implementations related to breastfeeding.
Previous studies found the prevalence of EBF in SSA to be 35%, which is lower compared to 39% in other low- and middle-income countries (30). Only 18 of 49 African countries are on track to meet the World Health Organization’s (WHO) Global Nutrition Targets, aiming to raise the rate to 50% by 2025 (32). As of 2019, 50.7% of infants aged 0 to 6 months are exclusively breastfed worldwide (33). In many SSA communities, traditional practices may include giving infants water, herbal teas, or other foods alongside breast milk, which may reduce EBF rates.
Logistic regression analysis revealed that as the women's age increases, the odds of EBF decrease. Women aged 20–24 had 27% lower odds, while those aged 45–49 had 48% lower odds of EBF compared to those aged 15–19. Our findings concur with a previous study in China, which presented evidence that younger mothers had more access to breastfeeding knowledge compared to older mothers (34). However, other studies found that middle-aged and older mothers are inclined to breastfeed their children exclusively (17, 19, 23, 35–37). This shows that as a mother’s age increases, the experience in child management also increases. Interestingly, younger mothers believe that long-term breastfeeding will affect their beauty and breast size leading to early weaning, thus, the early introduction of complementary food to their infants (19). This assertion is in contrast with our study findings.
The analysis indicates that shorter birth intervals are associated with a higher likelihood of EBF. Specifically, women with birth intervals of 8–24 months exhibit a 30.2% increased probability of practising EBF, and those with 25–35-month intervals have a 51.9% higher probability than those with 36–59-month intervals. Prior research consistently demonstrates a correlation between shorter birth intervals and higher rates of EBF (38). For instance, a study on birth spacing observed that women with shorter intervals between births often continue breastfeeding the younger child for extended periods, driven by the older sibling's ongoing nutritional needs and guidelines (38). The underlying reasons for this trend include sustained exposure to breastfeeding advocacy and education during subsequent pregnancies and breastfeeding periods. Moreover, mothers with shorter intervals might have more recent and reinforced knowledge about the benefits of EBF from previous healthcare interactions (39).
The study found that the place of residence mothers who dwell in rural areas were 16% more likely to breastfeed their children exclusively. Our findings are similar to the previous studies conducted in SSA (17, 40–42). This reason might be that mothers in urban areas are suitable to get jobs that may limit the time they spend with their infants. Also, they can easily access other options for infant feeding, like formulas, resulting in early weaning compared to rural mothers.
The analysis shows that the type of person assisting ANC significantly influences the odds of EBF practices. Assistance provided by nurses/midwives, other health workers, and TBAs/others is associated with higher odds of EBF compared to doctors. Mothers assisted by a nurse or midwife have 16.5% higher odds of practicing EBF than those assisted by a doctor. These results are consistent with studies done in Nigeria (43) and Malawi (44), where mothers who attended antenatal care, especially mothers assisted by nurses and midwives, were positively associated with EBF practices.
Those who received no antenatal care have 80.1% lower odds of EBF compared to those assisted by a doctor. The result is highly statistically significant, showing a strong negative association. This suggests that assistance during antenatal care can significantly influence EBF. Mothers who participate in these follow-up visits often have the chance to receive nutritional counselling and education on infant feeding, including the importance of EBF.
Strengths and Limitations
There was adequate statistical power because of the large dataset used in this study. The study's use of nationally representative data from 26 SSA nations' Demographic and Health Surveys improves the findings' generalizability. Regression models were rigorously examined in order to guarantee the reliability and validity of the study's analysis. Because of the cross-sectional nature of the research design, it is challenging to determine causal links. There is also a possibility of recall bias, as the data collection necessitated that the participant recall prior events.