Variation of continued breastfeeding by age of the child among children aged 12-23 months: evidence from 21 sub-Saharan African countries.

Abstract

Background: Appropriate breastfeeding practices are recommended to decrease the burden of under-five mortality and its related costs in sub-Saharan Africa. Continued breastfeeding is associated with a reduced risk of child morbidity and mortality. There is no evidence on the pooled prevalence and determinants of continued breastfeeding conducted using the most recent indicators for assessing infant and young child feeding practices in 2021. Therefore, the findings of this study could help nutrition policymakers prioritize and implement specific interventions for breastfeeding continuation.

Methods: Data from the most recent demographic and health surveys, which were carried out between 2015 and 2022 in 21 sub-Saharan African countries, were used. The study comprised a weighted sample of 44,423 children between the ages of 12 and 23 months. Software for statistical analysis, STATA/SE version 14.0, was used to clean, recode, and analyze data. Utilizing multilevel mixed-effects logistic regression, the factors associated with the outcome variable were identified. Statistical significance was attained by variables having an adjusted odds ratio with a 95% confidence interval and a p-value < 0.05.

Results: The pooled prevalence of continued breastfeeding among children aged 12 to 23 months was 64.59% (95% CI: 64.15%, 65.04%). Factors like maternal age [AOR = 1.22; 95% CI (1.09, 1.38)], maternal educational level [AOR = 0.51; 95% CI (0.47, 0.55)], and paternal educational level [AOR = 0.79; 95% CI (0.73, 0.85)], marital status of the mother [AOR = 1.13; 95% CI (1.05, 1.22)], maternal working status [AOR = 1.32; 95% CI (1.25, 1.39)], wealth index [AOR = 0.82; 95% CI (0.77, 0.88)], parity [AOR = 1.09; 95% CI (1.00, 1.19)], place of delivery [AOR = 0.92; 95% CI (0.87, 0.98)], ANC visits [AOR = 1.27; 95% CI (1.15, 1.39)], mode of delivery [AOR = 0.81; 95% CI (0.73, 0.89)], twin status [AOR = 4.65; 95% CI (4.07, 5.31), age of the child [AOR = 9.59; 95% CI (9.03, 10.2)], sex of the child [AOR = 0.95; 95% CI (0.91, 0.99)], preceding birth interval [AOR = 1.28; 95% CI (1.20, 1.37)], residence [AOR = 0.74; 95% CI (0.70, 0.79)], and community level education [AOR = 0.90; 95% CI (0.85, 0.96)] were significantly associated with continued breastfeeding.

Conclusion: In the present study, nearly two-thirds of children aged 12 to 23 months in sub-Saharan African countries continued breastfeeding. Higher odds of continued breastfeeding were reported among older, educated, and married women; working mothers; wealthier households; grand multiparous women; home delivery; attending ANC visits; vaginal delivery; single birth; younger children; male children; long preceding birth interval; urban residence; and mothers from eastern Africa. Therefore, women's empowerment, improving maternal healthcare services, and giving special attention to unmarried and younger women, primiparous women, women with multiple births, mothers with female children, and mothers from rural areas are recommended.