背景:建议避免奶瓶喂养,因为它会干扰最佳的哺乳行为,很难保持清洁,是病原体传播的重要途径。然而,目前正在向短期母乳喂养转变,发达国家和发展中国家都引入了奶瓶喂养。在撒哈拉以南非洲,没有解决奶瓶喂养做法及其个人和社区一级的决定因素。因此,这项研究旨在填补这一空白,并评估23个月以下儿童母亲的奶瓶喂养率和相关因素.
方法:使用了2015年至2022年对撒哈拉以南非洲20个国家进行的近期人口和健康调查数据。本研究包括86,619对母子对的总加权样本。使用多水平混合效应逻辑回归来确定与结果变量相关的因素。类内相关系数,似然比检验,中位数赔率比,和偏差(-2LLR)值用于模型比较和适应度。最后,p值<0.05的变量和95%置信区间的调整后比值比被宣布为有统计学意义.
结果:撒哈拉以南非洲0至23个月儿童的母亲中,奶瓶喂养的总体汇总患病率为13.74%(95%CI:13.51%,13.97%)。产妇年龄等因素[AOR=1.09;95%CI(1.04,1.14)],教育状况[AOR=2.83;95%CI(2.58,3.10)],婚姻状况[AOR=1.16;95%CI(1.09,1.24)],产妇职业[AOR=0.76;95%CI(0.73,0.79)],培养基暴露[AOR=0.80;95%CI(0.76,0.85)],财富指数[AOR=1.21;95%CI(1.15,1.29)],户主性别[AOR=1.17;95%CI(1.12,1.24)],家庭规模[AOR=1.06;95%CI(1.01,1.12)],5岁以下儿童的数量[AOR=1.11;95%CI(1.04,1.19)],交货地点[AOR=1.06;95%CI(1.00,1.12)],交货方式[AOR=1.41;95%CI(1.31,1.52)],母乳喂养咨询[AOR=0.88;95%CI(0.84,0.92)],儿童年龄[AOR=1.65;95%CI(1.57,1.75)],和居住地[AOR=1.64;95%CI(1.56,1.72)]与奶瓶喂养方式显著相关.
结论:在撒哈拉以南非洲国家,年龄在0至23个月的儿童中,近七分之一接受了奶瓶喂养。年长的母亲,母亲的教育地位较高,未婚女性,最富有的家庭,非工作母亲,暴露于媒体,女户主家庭,大家庭规模,有一个五岁以下的孩子,送货上门,剖宫产,6-11个月的儿童,和城市居住与奶瓶喂养风险增加显著相关.建议母乳喂养促进计划针对年龄较大的母亲,受过教育,工作,富有,在家分娩,有一个大家庭,是通过剖腹产分娩的,有6-11个月的孩子,并居住在城市地区,以实现撒哈拉以南非洲地区奶瓶喂养率的显着下降。
BACKGROUND: Avoidance of bottle feeding is recommended as it interferes with optimal suckling behavior, is difficult to keep clean, and is an important route for the transmission of pathogens. However, there is a current shift towards breastfeeding for a short period and the introduction of bottle feeding in both the developed and developing worlds. Bottle-feeding practice and its individual- and community-level determinants are not addressed in sub-Saharan Africa. Therefore, this study aimed to fill this gap and assess the pooled prevalence and associated factors of bottle feeding among mothers of children less than 23 months of age.
METHODS: Data from the recent demographic and health surveys of 20 countries in sub-Saharan Africa conducted between 2015 and 2022 were used. A total weighted sample of 86,619 mother-child pairs was included in the current study. Multilevel mixed-effects logistic regression was used to determine the factors associated with the outcome variable. Intra-class correlation coefficient, likelihood ratio test, median odds ratio, and deviance (-2LLR) values were used for model comparison and fitness. Finally, variables with a p-value < 0.05 and an adjusted odds ratio with a 95% confidence interval were declared statistically significant.
RESULTS: The overall pooled prevalence of bottle feeding among mothers of children aged 0 to 23 months in sub-Saharan Africa was 13.74% (95% CI: 13.51%, 13.97%). Factors like maternal age [AOR = 1.09; 95% CI (1.04, 1.14)], educational status [AOR = 2.83; 95% CI (2.58, 3.10)], marital status [AOR = 1.16; 95% CI (1.09, 1.24)], maternal occupation [AOR = 0.76; 95% CI (0.73, 0.79)], media exposure [AOR = 0.80; 95% CI (0.76, 0.85)], wealth index [AOR = 1.21; 95% CI (1.15, 1.29)], sex of the household head [AOR = 1.17; 95% CI (1.12, 1.24)], family size [AOR = 1.06; 95% CI (1.01, 1.12)], number of under-five children [AOR = 1.11; 95% CI (1.04, 1.19)], place of delivery [AOR = 1.06; 95% CI (1.00, 1.12)], mode of delivery [AOR = 1.41; 95% CI (1.31, 1.52)], counseling on breastfeeding [AOR = 0.88; 95% CI (0.84, 0.92)], age of the child [AOR = 1.65; 95% CI (1.57, 1.75)], and residence [AOR = 1.64; 95% CI (1.56, 1.72)] were significantly associated with bottle-feeding practices.
CONCLUSIONS: Nearly one out of seven children aged 0 to 23 months received bottle feeding in sub-Saharan African countries. Older mothers, higher mothers\' educational status, unmarried women, richest families, non-working mothers, exposed to media, female-headed households, large family size, having one under-five children, home delivery, cesarean delivery, children aged 6-11 months, and urban residence were significantly associated with an increased risk of bottle feeding. Breastfeeding promotion programs are advised to target mothers who are older, educated, working, rich, gave birth at home, have a large family size, are delivered by cesarean section, have children aged 6-11 months, and reside in urban areas to achieve a significant decrease in bottle feeding rates in sub-Saharan Africa.