Socioeconomic pattern of breastfeeding in sub-Saharan Africa: an individual participant data meta-analysis of six longitudinal cohorts
Background Breastfeeding rates in sub-Saharan Africa (SSA) are declining, and at the current rate, only four African countries will meet the WHO’s 2030 exclusive breastfeeding target. We examined the association between maternal socioeconomic status (SES) and breastfeeding practices in SSA.Methods S...
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BMJ Publishing Group
2025-06-01
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| Series: | BMJ Public Health |
| Online Access: | https://bmjpublichealth.bmj.com/content/3/1/e001298.full |
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| author | Alison Price Clara Calvert Suzanne Filteau Laura Oakley Judith R Glynn Albert Dube Milly Marston Ronald Makanga Shamsudeen Mohammed Emily L Webb Joseph O Mugisha |
| author_facet | Alison Price Clara Calvert Suzanne Filteau Laura Oakley Judith R Glynn Albert Dube Milly Marston Ronald Makanga Shamsudeen Mohammed Emily L Webb Joseph O Mugisha |
| author_sort | Alison Price |
| collection | DOAJ |
| description | Background Breastfeeding rates in sub-Saharan Africa (SSA) are declining, and at the current rate, only four African countries will meet the WHO’s 2030 exclusive breastfeeding target. We examined the association between maternal socioeconomic status (SES) and breastfeeding practices in SSA.Methods Six cohorts in Ethiopia, Malawi, Uganda and Zambia, with 11 863 participants, were analysed. Data for the cohorts were collected between 2000 and 2021, covering births from 2000 to 2019. SES exposures were maternal education and household income. Breastfeeding outcomes included ever breastfed, early initiation of breastfeeding (Ethiopia only), exclusive breastfeeding for ≥4 months or ≥6 months, and continued breastfeeding for ≥1 year. Risk ratios from multivariable Poisson regression models for individual cohorts were pooled in a random-effects meta-analysis to assess the effects of SES on breastfeeding, adjusting for confounders.Results Meta-analysis found no evidence of a difference in ever breastfeeding between mothers with secondary or tertiary education and those with primary/no education. Mothers with secondary education (adjusted risk ratio (aRR)=1.11, 95% CI=1.01 to 1.21) and those from middle-wealth households (aRR=1.12, 95% CI=1.01 to 1.24) were more likely to initiate breastfeeding early than those with primary/no education or low household wealth, but there was no evidence of association in the tertiary education and higher-wealth groups. The association between maternal education and exclusive breastfeeding for ≥4 months and ≥6 months varied across cohorts, with no evidence of association in most cohorts. Overall, household wealth was not associated with exclusive breastfeeding for ≥4 months or ≥6 months. The meta-analysis showed no evidence of association between household wealth and breastfeeding for ≥1 year, but mothers with tertiary education were less likely (aRR=0.93, 95% CI=0.88 to 0.99) to breastfeed for ≥1 year than those with primary or no education.Conclusion We observed no clear socioeconomic pattern in breastfeeding, contrasting with patterns observed in high-income countries. |
| format | Article |
| id | doaj-art-ff9389c79d9e4f0184fac150d5fbd169 |
| institution | OA Journals |
| issn | 2753-4294 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Public Health |
| spelling | doaj-art-ff9389c79d9e4f0184fac150d5fbd1692025-08-20T02:37:34ZengBMJ Publishing GroupBMJ Public Health2753-42942025-06-013110.1136/bmjph-2024-001298Socioeconomic pattern of breastfeeding in sub-Saharan Africa: an individual participant data meta-analysis of six longitudinal cohortsAlison Price0Clara Calvert1Suzanne Filteau2Laura Oakley3Judith R Glynn4Albert Dube5Milly Marston6Ronald Makanga7Shamsudeen Mohammed8Emily L Webb9Joseph O Mugisha101 PICU, Royal Belfast Hospital for Sick Children, Belfast, UKPublic Health Scotland, Edinburgh, UK1 Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UKDepartment of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UKDepartment of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK8 Malawi Epidemiological and Intervention Research Unit, Chilumba, MalawiPopulation Health, London School of Hygiene & Tropical Medicine Department of Population Health, London, UKNon-Communicable Disease Epidemiology, MRC/UVRI and LSHTM Research Unit, Entebbe, UgandaDepartment of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UKDepartment of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Public Health, London, UKNon-communicable diseases Theme, Medical Research Council/Uganda Virus Research Institute and LSHTM Uganda Research Unit, Entebbe, UgandaBackground Breastfeeding rates in sub-Saharan Africa (SSA) are declining, and at the current rate, only four African countries will meet the WHO’s 2030 exclusive breastfeeding target. We examined the association between maternal socioeconomic status (SES) and breastfeeding practices in SSA.Methods Six cohorts in Ethiopia, Malawi, Uganda and Zambia, with 11 863 participants, were analysed. Data for the cohorts were collected between 2000 and 2021, covering births from 2000 to 2019. SES exposures were maternal education and household income. Breastfeeding outcomes included ever breastfed, early initiation of breastfeeding (Ethiopia only), exclusive breastfeeding for ≥4 months or ≥6 months, and continued breastfeeding for ≥1 year. Risk ratios from multivariable Poisson regression models for individual cohorts were pooled in a random-effects meta-analysis to assess the effects of SES on breastfeeding, adjusting for confounders.Results Meta-analysis found no evidence of a difference in ever breastfeeding between mothers with secondary or tertiary education and those with primary/no education. Mothers with secondary education (adjusted risk ratio (aRR)=1.11, 95% CI=1.01 to 1.21) and those from middle-wealth households (aRR=1.12, 95% CI=1.01 to 1.24) were more likely to initiate breastfeeding early than those with primary/no education or low household wealth, but there was no evidence of association in the tertiary education and higher-wealth groups. The association between maternal education and exclusive breastfeeding for ≥4 months and ≥6 months varied across cohorts, with no evidence of association in most cohorts. Overall, household wealth was not associated with exclusive breastfeeding for ≥4 months or ≥6 months. The meta-analysis showed no evidence of association between household wealth and breastfeeding for ≥1 year, but mothers with tertiary education were less likely (aRR=0.93, 95% CI=0.88 to 0.99) to breastfeed for ≥1 year than those with primary or no education.Conclusion We observed no clear socioeconomic pattern in breastfeeding, contrasting with patterns observed in high-income countries.https://bmjpublichealth.bmj.com/content/3/1/e001298.full |
| spellingShingle | Alison Price Clara Calvert Suzanne Filteau Laura Oakley Judith R Glynn Albert Dube Milly Marston Ronald Makanga Shamsudeen Mohammed Emily L Webb Joseph O Mugisha Socioeconomic pattern of breastfeeding in sub-Saharan Africa: an individual participant data meta-analysis of six longitudinal cohorts BMJ Public Health |
| title | Socioeconomic pattern of breastfeeding in sub-Saharan Africa: an individual participant data meta-analysis of six longitudinal cohorts |
| title_full | Socioeconomic pattern of breastfeeding in sub-Saharan Africa: an individual participant data meta-analysis of six longitudinal cohorts |
| title_fullStr | Socioeconomic pattern of breastfeeding in sub-Saharan Africa: an individual participant data meta-analysis of six longitudinal cohorts |
| title_full_unstemmed | Socioeconomic pattern of breastfeeding in sub-Saharan Africa: an individual participant data meta-analysis of six longitudinal cohorts |
| title_short | Socioeconomic pattern of breastfeeding in sub-Saharan Africa: an individual participant data meta-analysis of six longitudinal cohorts |
| title_sort | socioeconomic pattern of breastfeeding in sub saharan africa an individual participant data meta analysis of six longitudinal cohorts |
| url | https://bmjpublichealth.bmj.com/content/3/1/e001298.full |
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