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Abstract：
BACKGROUND: Breastfeeding offers numerous benefits for infants, mothers, and the community, making it the best intervention for reducing infant mortality and morbidity. The World Health Organization (WHO) recommends initiating breastfeeding within one hour after birth and exclusively breastfeeding for the first six months. This study investigated the trend, spatio-temporal variation, and determinants of spatial clustering of early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) in Ethiopia from 2011 to 2019.
METHODS: Data from the Ethiopian Demographic and Health Survey (EDHS), which was conducted in 2011, 2016, and 2019, were analyzed utilizing a weighted sample of 10,616 children aged 0-23 years for EIBF and 2,881 children aged 0-5 months for EBF. Spatial autocorrelation analysis was used to measure whether EIBF and EBF were dispersed, clustered, or randomly distributed and Kriging interpolation was employed to predict the outcome variables in the unmeasured areas. Spatial scan statistics were used to identify spatial clusters with a high prevalence of cases. Both global and local regression modeling techniques were employed to examine the spatial relationships between the explanatory variables and the dependent variables.
RESULTS: The trend analysis revealed a notable increase in the prevalence of EIBF from 51.8% in 2011 to 71.9% in 2019. Similarly, the prevalence of EBF increased from 52.7% in 2011 to 58.9% in 2019. Spatial analysis demonstrated significant spatial variation in both EIBF and EBF throughout the country. Cold spots or clusters with a low prevalence of EIBF were observed consistently in the Tigray and Amhara regions, and significant cold spot areas of EBF were observed consistently in the Afar and Somali regions. Multiscale geographically weighted regression analysis revealed significant predictors of spatial variations in EIBF, including the religious affiliation of being a follower of the orthodox religion, parity of 1-2, absence of antenatal care visits, and delivery via cesarean section.
CONCLUSIONS: Despite the increase in both EIBF and EBF rates over time in Ethiopia, these rates still fall below the national target. To address this issue, the government should prioritize public health programs aimed at improving maternal healthcare service utilization and maternal education. It is essential to integrate facility-level services with community-level services to achieve optimal breastfeeding practices. Specifically, efforts should be made to promote breastfeeding among mothers who have delivered via cesarean section. Additionally, there should be a focus on encouraging antenatal care service utilization and adapting maternal healthcare services to accommodate the mobile lifestyle of pastoralist communities. These steps will contribute to enhancing breastfeeding practices and achieving better outcomes for maternal and child health.
METHODS: Data from the Ethiopian Demographic and Health Survey (EDHS), which was conducted in 2011, 2016, and 2019, were analyzed utilizing a weighted sample of 10,616 children aged 0-23 years for EIBF and 2,881 children aged 0-5 months for EBF. Spatial autocorrelation analysis was used to measure whether EIBF and EBF were dispersed, clustered, or randomly distributed and Kriging interpolation was employed to predict the outcome variables in the unmeasured areas. Spatial scan statistics were used to identify spatial clusters with a high prevalence of cases. Both global and local regression modeling techniques were employed to examine the spatial relationships between the explanatory variables and the dependent variables.
RESULTS: The trend analysis revealed a notable increase in the prevalence of EIBF from 51.8% in 2011 to 71.9% in 2019. Similarly, the prevalence of EBF increased from 52.7% in 2011 to 58.9% in 2019. Spatial analysis demonstrated significant spatial variation in both EIBF and EBF throughout the country. Cold spots or clusters with a low prevalence of EIBF were observed consistently in the Tigray and Amhara regions, and significant cold spot areas of EBF were observed consistently in the Afar and Somali regions. Multiscale geographically weighted regression analysis revealed significant predictors of spatial variations in EIBF, including the religious affiliation of being a follower of the orthodox religion, parity of 1-2, absence of antenatal care visits, and delivery via cesarean section.
CONCLUSIONS: Despite the increase in both EIBF and EBF rates over time in Ethiopia, these rates still fall below the national target. To address this issue, the government should prioritize public health programs aimed at improving maternal healthcare service utilization and maternal education. It is essential to integrate facility-level services with community-level services to achieve optimal breastfeeding practices. Specifically, efforts should be made to promote breastfeeding among mothers who have delivered via cesarean section. Additionally, there should be a focus on encouraging antenatal care service utilization and adapting maternal healthcare services to accommodate the mobile lifestyle of pastoralist communities. These steps will contribute to enhancing breastfeeding practices and achieving better outcomes for maternal and child health.
摘要：
背景：母乳喂养为婴儿提供了许多好处，母亲们,和社区，使其成为降低婴儿死亡率和发病率的最佳干预措施。世界卫生组织（WHO）建议在出生后一小时内开始母乳喂养，并在头六个月内完全母乳喂养。这项研究调查了趋势，时空变化，以及2011年至2019年埃塞俄比亚早期开始母乳喂养（EIBF）和纯母乳喂养（EBF）的空间聚集性决定因素。
方法：来自埃塞俄比亚人口与健康调查（EDHS）的数据，这项研究于2011年、2016年和2019年进行,对10,616名0-23岁儿童的EIBF和2,881名0-5个月儿童的EBF进行了加权样本分析.空间自相关分析用于测量EIBF和EBF是否分散，集群，或随机分布，并采用克里格插值来预测未测量区域的结果变量。使用空间扫描统计数据来识别具有高患病率病例的空间集群。全局和局部回归建模技术均用于检查解释变量与因变量之间的空间关系。
结果：趋势分析显示，EIBF的患病率从2011年的51.8%显著上升至2019年的71.9%。同样，EBF的患病率从2011年的52.7%上升至2019年的58.9%。空间分析表明，全国EIBF和EBF的空间差异很大。在提格雷和阿姆哈拉地区一致观察到EIBF患病率低的冷点或集群，在阿法尔和索马里地区一直观察到重要的EBF冷区。多尺度地理加权回归分析揭示了EIBF空间变化的重要预测因子，包括作为东正教信徒的宗教信仰，1-2的平价，没有产前护理访问，和剖腹产。
结论：尽管埃塞俄比亚的EIBF和EBF比率随着时间的推移而增加，这些比率仍然低于国家目标。为了解决这个问题，政府应优先考虑旨在改善孕产妇保健服务利用率和孕产妇教育的公共卫生计划。必须将设施级别的服务与社区级别的服务相结合，以实现最佳的母乳喂养做法。具体来说,应努力促进通过剖宫产分娩的母亲的母乳喂养。此外,应重点鼓励利用产前保健服务，并调整孕产妇保健服务，以适应牧民社区的流动生活方式。这些步骤将有助于加强母乳喂养做法，并为母婴健康取得更好的成果。
方法：来自埃塞俄比亚人口与健康调查（EDHS）的数据，这项研究于2011年、2016年和2019年进行,对10,616名0-23岁儿童的EIBF和2,881名0-5个月儿童的EBF进行了加权样本分析.空间自相关分析用于测量EIBF和EBF是否分散，集群，或随机分布，并采用克里格插值来预测未测量区域的结果变量。使用空间扫描统计数据来识别具有高患病率病例的空间集群。全局和局部回归建模技术均用于检查解释变量与因变量之间的空间关系。
结果：趋势分析显示，EIBF的患病率从2011年的51.8%显著上升至2019年的71.9%。同样，EBF的患病率从2011年的52.7%上升至2019年的58.9%。空间分析表明，全国EIBF和EBF的空间差异很大。在提格雷和阿姆哈拉地区一致观察到EIBF患病率低的冷点或集群，在阿法尔和索马里地区一直观察到重要的EBF冷区。多尺度地理加权回归分析揭示了EIBF空间变化的重要预测因子，包括作为东正教信徒的宗教信仰，1-2的平价，没有产前护理访问，和剖腹产。
结论：尽管埃塞俄比亚的EIBF和EBF比率随着时间的推移而增加，这些比率仍然低于国家目标。为了解决这个问题，政府应优先考虑旨在改善孕产妇保健服务利用率和孕产妇教育的公共卫生计划。必须将设施级别的服务与社区级别的服务相结合，以实现最佳的母乳喂养做法。具体来说,应努力促进通过剖宫产分娩的母亲的母乳喂养。此外,应重点鼓励利用产前保健服务，并调整孕产妇保健服务，以适应牧民社区的流动生活方式。这些步骤将有助于加强母乳喂养做法，并为母婴健康取得更好的成果。
