Geographical equity in Ethiopian infant feeding practices: a secondary analysis of a birth cohort study

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Abstract
Objectives To assess the geographical equity in Ethiopian infants’ exclusive breastfeeding at 5 months and dietary diversity at 12 months and whether social factors explained the spatial inequities. Design Secondary analysis of a birth cohort study. Setting Analysis of data from the Ethiopian Performance Monitoring for Action panel study conducted from July 2020 to August 2021 in five regions (ie, Oromia, Amhara, Afar and Southern Nations, Nationalities and Peoples regions and the Addis Ababa City administration). We analysed geographical autocorrelation to assess geographical variations in exclusive breastfeeding and dietary diversity. Areas with higher and lower coverage of appropriate infant feeding outcomes were analysed using hotspot analyses. We performed geographically weighted regression to investigate whether sociodemographic factors explained the geographical feeding differences. Participants 1850 infants were prospectively followed from birth to 12 months. Outcome measures Exclusive breastfeeding at 5 months and minimum-level dietary diversity at 12 months. Results Sixty-nine percent (95% CI 67 to 71) of infants were exclusively breastfed at 5 months, while at 12 months, only 16% (95% CI 13 to 19) had complementary feeding from five or more food groups. There were geographical variations in the coverage of exclusive breastfeeding and minimum dietary diversity. Higher proportions of infants were exclusively breastfed at 5 months in northern areas, and more 12-month-old infants in central parts of the country had complementary feeding from at least five food groups. Sociodemographic factors explained a quarter of the geographical variation in dietary diversity. Conclusion Most Ethiopian infants were exclusively breastfed, which was in line with global recommendations but with some geographical differences. There was prominent geographical variation in dietary diversity, partly explained by social factors, but overall, very few 12-month-old infants were fed from at least five food groups. This low dietary quality could impair Ethiopian children’s physical growth, development and health.
Funding Information
  • Bill and Melinda Gates Foundation (INV-009691)
  • Bill and Melinda Gates Foundation (INV-010320)

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