Factors influencing exclusive breastfeeding in Sub-Saharan Africa: analysis of demographic and health surveys

Munawar Harun Koray; James Njuguna Wanjiru; Johnson Socrates Kerkula; Theophile Dushimirimana; Sudue Epaphroditus Mieh; Tanya Curry; John Mugisha; Lucas K Kanu

doi:10.1186/s12889-025-23045-z

Factors influencing exclusive breastfeeding in Sub-Saharan Africa: analysis of demographic and health surveys

BMC Public Health. 2025 May 15;25(1):1790. doi: 10.1186/s12889-025-23045-z.

Authors

Munawar Harun Koray¹, James Njuguna Wanjiru², Johnson Socrates Kerkula³, Theophile Dushimirimana⁴, Sudue Epaphroditus Mieh⁵, Tanya Curry⁶, John Mugisha⁷, Lucas K Kanu^{8

7}

Affiliations

¹ Upper West Regional Health Directorate, Wa, Ghana. gbanglin@rocketmail.com.
² The Technical University of Kenya, Nairobi, Kenya.
³ African Methodist Episcopal University, Monrovia, Liberia.
⁴ Rugarama Health Centre, Kigali, Rwanda.
⁵ Rally Time Hospital, Grand Cess, Liberia.
⁶ National Public Health Institute of Liberia, Monrovia, Liberia.
⁷ Southern Medical University, Guangzhou, China.
⁸ University of Makeni (UNIMAK), Makeni, Sierra Leone.

Abstract

Background: Low rates of exclusive breastfeeding (EBF) contribute to high child mortality rates. This study aimed to identify the prevalence and factors influencing EBF in SSA using nationally representative data from the Demographic Health Survey program (DHS).

Methods: A cross-sectional study design using the most recent DHS data of 25 SSA countries from 2010 to 2023. A total of 17,431 women aged 15-49 years with infants below six months were included. Pearson's chi-square and multivariable logistic regression tests were used to test the association and predictors of EBF at a 95% confidence interval (CI) at a significance level of p ≤ 0.05.

Results: The pooled prevalence of EBF across 25 Sub-Saharan African countries was 49%, ranging from 83% in Burundi to 19% in Gabon. Multivariable logistic regression revealed that older infants aged 2-3 months (AOR = 0.511, 95% CI: 0.458-0.570) and 4-5 months (AOR = 0.176, 95% CI: 0.156-0.198) had significantly lower odds of EBF compared to newborns (0-1 month). Overweight infants (AOR = 0.800, 95% CI: 0.647-0.987) and those experiencing fever (AOR = 0.805, 95% CI: 0.704-0.921) or diarrhea (AOR = 0.799, 95% CI: 0.683-0.935) were also less likely to be exclusively breastfed. Mothers with higher education (AOR = 0.700, 95% CI: 0.516-0.948) had reduced EBF odds. Wealthier households demonstrated higher odds (middle: AOR = 1.411, 95% CI: 1.185-1.681; richer: AOR = 1.539, 95% CI: 1.254-1.889; richest: AOR = 1.455, 95% CI: 1.119-1.892). Rural, the East (AOR = 2.588, 95% CI: 2.162-3.099) or West Africa (AOR = 3.018, 95% CI: 2.464-3.697) significantly increased EBF odds compared to urban areas and Central Africa, respectively.

Conclusion: This study highlights key factors influencing EBF in 25 Sub-Saharan African countries. The findings provide complex interplay of individual and community factors influencing EBF. To improve EBF, targeted interventions should focus on: supporting mothers of older infants, integrating counseling into child health services, addressing wealth gaps, and implementing region-specific strategies. Strengthening health systems and community engagement is crucial to overcome barriers and promote equitable breastfeeding practices.

Keywords: Demographic health survey; Exclusive breastfeeding; Multilevel analysis; Predictors; sub-Saharan Africa.

MeSH terms

Adolescent
Adult
Africa South of the Sahara / epidemiology
Breast Feeding* / statistics & numerical data
Cross-Sectional Studies
Female
Health Surveys
Humans
Infant
Infant, Newborn
Middle Aged
Socioeconomic Factors
Young Adult