背景:纯母乳喂养(EBF)的益处已被普遍记录,有证据表明对孩子的最佳成长有积极影响,发展,和生存。然而,在过去的25年里,尼泊尔的EBF做法一直在波动和下降。除了母亲和婴儿的个体因素,EBF实践受到多个社区层面因素的影响。了解这些因素对于设计母乳喂养促进计划以改善尼泊尔儿童的营养状况至关重要。这项研究调查了尼泊尔0-5个月小婴儿中EBF行为的个人和社区水平决定因素。
方法:我们使用了2022年尼泊尔人口与健康调查的数据集。540名0-5个月的婴儿在过去24小时内获得了有关EBF的信息。在尼泊尔0-5个月的婴儿中,使用多水平混合效应逻辑回归来确定与EBF相关的个人和社区水平因素。
结果:0-5个月婴儿的24小时EBF患病率为57.46%(95%置信区间(CI):52.18,62.57)。在个体水平上,婴儿年龄与EBF患病率呈负相关。与<1个月的婴儿相比,3个月大的婴儿(调整比值比(AOR):0.14,95%CI:0.05,0.40),四个月(AOR:0.11,95%CI:0.04,0.28),5个月(AOR:0.07,95%CI:0.03,0.20)接受EBF的可能性较小。在社区层面,社区级变量,如≥4次ANC访问覆盖率,孕产妇就业状况,贫困水平是通过将个体特征聚集在一个集群中来产生的,并使用四分位数分类为低(“<25%”),中等(25-75%),高(≥75%)。来自中等≥4次ANC访问(AOR:3.30,95%CI:1.65,6.57)和高≥4次ANC访问(AOR:2.70,95%CI:1.40,5.22)的母亲的EBF实践的几率高于那些来自低≥4次ANC访问覆盖率的社区。同样,孕产妇就业状况处于中度(AOR:2.67,95%CI:1.34,5.30)和高度(AOR:2.34,95%CI:1.10,4.99)的社区和中度贫困(AOR:2.20,95%CI:1.13,4.28)的社区与更高的EBF实践可能性相关.国家以下级别的差异很明显,蓝毗尼省的婴儿与Koshi省相比,EBF的几率较低(AOR:0.32,95%CI:0.13,0.77)。在这项研究中,在跨集群映射时,在母亲之间观察到大约9%的EBF实践变化。
结论:各种个人和社区水平的因素影响尼泊尔EBF的吸收,强调需要改进EBF计划的方法和策略。这项研究强调了社区层面因素的显著关联(≥4次ANC访问覆盖率,贫困水平,和产妇就业状况)与6个月以下婴儿的EBF。它揭示了整个集群中EBF大约9%的变异性。未来促进EBF的努力应集中在年龄较大的婴儿和贫困水平低,推荐的≥4次ANC访问覆盖率低的社区。此外,考虑到在本研究中观察到的社区之间的差异,可能需要针对特定环境进行此类努力的适应。
BACKGROUND: The benefits of exclusive breastfeeding (EBF) have been universally documented, with evidence of positive impacts on a child\'s optimal growth, development, and survival. However, EBF practices in Nepal have fluctuated and declined over the last 25 years. In addition to the individual factors of mothers and infants, EBF practices are affected by multiple community-level factors. Understanding these factors is essential for designing breastfeeding promotion programs to improve child nutritional status in Nepal. This study investigated the individual- and community-level determinants of EBF practices among young infants aged 0-5 months in Nepal.
METHODS: We used the dataset from the Nepal Demographic and Health Survey 2022. Information on EBF in the past 24 h was available for 540 infants aged 0-5 months. A multilevel mixed-effect logistic regression was used to identify individual- and community-level factors associated with EBF among infants aged 0-5 months in Nepal.
RESULTS: The 24-hour prevalence of EBF among infants aged 0-5 months was 57.46% (95% confidence interval (CI): 52.18, 62.57). The infant\'s age was inversely associated with EBF prevalence at the individual level. Compared with infants aged < 1 month, infants aged three months (adjusted odds ratio (AOR): 0.14, 95% CI: 0.05, 0.40), four months (AOR: 0.11, 95% CI: 0.04, 0.28), and five months (AOR: 0.07, 95% CI: 0.03, 0.20) were less likely to receive EBF. At the community level, community-level variables such as ≥ 4 ANC visits coverage, maternal employment status, and poverty level were generated by aggregating the individual characteristics in a cluster and were categorized using quartiles into low (\"< 25%\"), moderate (25-75%), and high (≥ 75%). Mothers from communities with moderate ≥ 4 ANC visits (AOR: 3.30, 95% CI: 1.65, 6.57) and high ≥ 4 ANC visits (AOR: 2.70, 95% CI: 1.40, 5.22) coverage had higher odds of EBF practices than did those from communities with low ≥ 4 ANC visits coverage. Similarly, communities with moderate (AOR: 2.67, 95% CI: 1.34, 5.30) and high (AOR: 2.34, 95% CI: 1.10, 4.99) levels of maternal employment status and moderate levels of poverty (AOR: 2.20, 95% CI: 1.13, 4.28) were associated with a higher likelihood of EBF practices. Subnational level variation was evident, with infants in Lumbini province having lower odds of EBF (AOR: 0.32, 95% CI: 0.13, 0.77) relative to Koshi province. Approximately 9% of the variation in EBF practices was observed among mothers while mapping across clusters in this study.
CONCLUSIONS: Various individual- and community-level factors influence the uptake of EBF in Nepal, underscoring the need to improve the approaches and strategies of EBF programs. This study highlighted the significant association of community-level factors (≥ 4 ANC visits coverage, poverty level, and maternal employment status) with EBF among infants under 6 months. It revealed approximately 9% variability in EBF across clusters. Future efforts to promote EBF should focus on older infants and communities with low poverty levels and low coverage of recommended ≥ 4 ANC visits. Furthermore, context-specific adaptation of such efforts might be required considering the variation observed between the communities in the present study.