Socioecological predictors of breastfeeding practices in rural eastern Ethiopia

Authors: MAGALHAES, MARINA - University Of Florida; OJEDA, AMANDA - University Of Florida; MECHLOWITZ, KARAH - University Of Florida; BRITTAIN, KAITLIN - University Of Florida; DANIEL, JENNA - Emory University; ROBA, KEDIR - Ethiopia Haramaya University; HASSEN, JEMAL - Ethiopia Haramaya University; MANARY, MARK - Children'S Nutrition Research Center (CNRC); GEBREYES, WONDWOSSEN - The Ohio State University; HAVELAAR, ARIE - University Of Florida; MCKUNE, SARAH - University Of Florida

Submitted to: International Breastfeeding Journal
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/11/2022
Publication Date: 12/28/2022
Citation: Magalhaes, M., Ojeda, A., Mechlowitz, K., Brittain, K., Daniel, J., Roba, K.T., Hassen, J.Y., Manary, M.J., Gebreyes, W.A., Havelaar, A.H., McKune, S.L. 2022. Socioecological predictors of breastfeeding practices in rural eastern Ethiopia. International Breastfeeding Journal. 17. Article 93. https://doi.org/10.1186/s13006-022-00531-3.
DOI: https://doi.org/10.1186/s13006-022-00531-3

Interpretive Summary: Over 800,000 newborn deaths each year are because of not following ideal breastfeeding practices. A questionnaire was distributed in Eastern Ethiopia to explore factors guiding breastfeeding practices. Many mothers in Eastern Ethiopia reported giving their children fluids before they began breastfeeding and few mothers only breastfeed their children (with no other fluids or food), both of which may be clinically noteworthy considering high rates of undernutrition in this region.

Technical Abstract: Estimates by the World Health Organization indicate that over 800,000 global neonatal deaths each year are attributed to deviations from recommended best practices in infant feeding. Identifying factors promoting ideal breastfeeding practices may facilitate efforts to decrease neonatal and infant death rates and progress towards achieving the Sustainable Development Goals set for 2030. Though numerous studies have identified the benefits of breastfeeding in reducing the risk of childhood undernutrition, infection and illness, and mortality in low- and middleincome countries, no studies have explored predictors of breastfeeding practices in rural eastern Ethiopia, where undernutrition is widespread. The aim of this study is to examine predictors of infant feeding practices in Haramaya, Ethiopia, using a multi-level conceptual framework. This study uses data collected from household questionnaires during the Campylobacter Genomics and Environmental Enteric Dysfunction (CAGED) project among 102 households in the Haramaya woreda, Eastern Hararghe Zone, Eastern Ethiopia, and investigates factors influencing breastfeeding practices: early initiation, prelacteal feeding, and untimely complementary feeding. Nearly half (47.9%) of infants in this study were non-exclusively breastfed (n = 96). Generalized liner mixed effects models of breastfeeding practices revealed that prelacteal feeding may be a common practice in the region (43.9%, n = 98) and characterized by gender differences (p = .03). No factors evaluated were statistically significantly predictive of early initiation and untimely complementary feeding (82% and 14%, respectively). Severely food insecure mothers had more than 72% lower odds of early breastfeeding initiation, and participants who self-reported as being illiterate had 1.53 times greater odds of untimely complementary feeding (95% CI, [0.30,7.69]) followed by male children having 1.45 greater odds of being untimely complementary fed compared to female (95% CI,[0.40,5.37]). This study found high rates of prelacteal feeding and low prevalence of exclusive breastfeeding, with girls more likely to be exclusively breastfed. While no predictors evaluated in this multi-level framework were associated with prevalence of early initiation or complementary feeding, rates may be clinically meaningful in a region burdened by undernutrition. Findings raise questions about gendered breastfeeding norms, the under-examined role of khat consumption on infant feeding, and the complex factors that affect breastfeeding practices in this region. This information may be used to guide future research questions and inform intervention strategies.