Factors contributing to inadequate exclusive breastfeeding among children 0-6 months in developing countries. A review

Mohamedkhalid Hared Derow; Phyllis Waruguru

doi:10.18535/ijmsci/v12i.12.01

Abstract

Exclusive breastfeeding for the first six months of life is essential for optimal infant health and development, yet its practice remains inadequate in many developing countries. Appropriate exclusive breastfeeding practices are important in reducing the incidence of malnutrition and improving the health and growth outcome of children. However, a few children receive exclusive breastfeeding hence low prevalence of exclusive breastfeeding practices in developing countries. The objective of this review is to review and integrate findings from different studies to determine factors contributing to inadequate exclusive breastfeeding practices of children aged 0-6 months in developing countries. A literature search on factors contributing to inadequate exclusive breastfeeding practices in developing countries was undertaken in PubMed, Cochrane, Elsevier, PLOS One, EMBASE and web of science to identify relevant studies between 2015 and 2025. Twenty-nine studies were initially retrieved, with ten studies that met the study inclusion criteria chosen for data synthesis. Factors found to contribute to the inadequate exclusive breastfeeding were: age and gender of the child, occupation of the mother, age of the mother, education level of the mother, marital status of the mother, mode of delivery, family size, antenatal visits, place of residence, household income, and exclusive breastfeeding intention during pregnancy. Exclusive breastfeeding practices for children 0-6 months are influenced by multifaceted factors that should be considered when developing strategies to improve nutrition and prevent diseases associated with poor nutrition, thus boosting children's chances of survival.

Keywords

Inadequate exclusive breastfeedingbreastfeeding rateexclusive breastfeeding EBF

References

Awoke, S., & Mulatu, B. (2021). Determinants of exclusive breastfeeding practice among mothers in Sheka Zone, Southwest Ethiopia: A cross-sectional study. Public Health in Practice, 2, 100108. https://doi.org/10.1016/j.puhip.2021.100108DOI ↗Google Scholar ↗
Dede, K. S., & Bras, H. (2020). Exclusive breastfeeding patterns in Tanzania: Do individual, household, or community factors matter? International Breastfeeding Journal, 15(1), 32. https://doi.org/10.1186/s13006-020-00279-8DOI ↗Google Scholar ↗
Giang, N., Duy, T., Vuong, L., Ngoc, T., Pham, T., Duc, M., Le, D., Nga, T., Hieu, M., Vi, T., Triet, M., Thach, T., Truc, B., & Huy, T. (2023). Prevalence of exclusive breastfeeding for the first six months of an infant’s life and associated factors in a low–middle income country. International Breastfeeding Journal, 18(1), 47. https://doi.org/10.1186/s13006-023-00585-xDOI ↗Google Scholar ↗
Kassa, T., Meshesha, B., Haji, Y., & Ebrahim, J. (2016). Appropriate complementary feeding practices and associated factors among mothers of children age 6–23 months in Southern Ethiopia, 2015. BMC Pediatrics, 16(131), 1–10.Google Scholar ↗
Koffi, I., Essis, E. M. L., Bamba, I., Assi, K. R., Konan, L. L., & Aka, J. (2023). Factors associated with exclusive breastfeeding of children under six months of age in Cote d’Ivoire. International Breastfeeding Journal, 18(1), 43. https://doi.org/10.1186/s13006-023-00573-1DOI ↗Google Scholar ↗
Mbuyi, E., Nkongolo, B.-K., & Musema, G. (2023). Factors associated with low adherence to exclusive breastfeeding in the Dibaya health zone, Democratic Republic of Congo. Journal of Global Health Economics and Policy, 3, e2023015. https://doi.org/10.52872/001c.123579DOI ↗Google Scholar ↗
Mekebo, G. G., Argawu, A. S., Likassa, H. T., Ayele, W., Wake, S. K., Bedada, D., Hailu, B., Senbeto, T., Bedane, K., Lulu, K., Daraje, S., Lemesa, R., Aga, G., Alemayehu, E., Kefale, B., Bechera, T., Tadesse, G., Galdassa, A., Olani, J., … Diriba, G. (2022). Factors influencing exclusive breastfeeding practice among under-six months infants in Ethiopia. BMC Pregnancy and Childbirth, 22, 630. https://doi.org/10.1186/s12884-022-04955-xDOI ↗Google Scholar ↗
Mekonen, E. G., Zegeye, A. F., & Workneh, B. S. (2024). Complementary feeding practices and associated factors among mothers of children aged 6 to 23 months in Sub-saharan African countries: A multilevel analysis of the recent demographic and health survey. BMC Public Health, 24(1), 115. https://doi.org/10.1186/s12889-023-17629-wDOI ↗Google Scholar ↗
Mohammed, S., Yakubu, I., Fuseini, A.-G., Abdulai, A.-M., & Yakubu, Y. H. (2023). Systematic review and meta-analysis of the prevalence and determinants of exclusive breastfeeding in the first six months of life in Ghana. BMC Public Health, 23(1), 920. https://doi.org/10.1186/s12889-023-15758-wDOI ↗Google Scholar ↗
Moshi, F. V., Akyoo, E. E., & Seif, S. A. (2021). Prevalence and Predictor of Exclusive Breastfeeding among Mothers of 0 to 6 months Infants from Pastoralists and Hunters’ Community in Tanzania; A Community Based Cross-Sectional Study. The East African Health Research Journal, 5(1), 82–90. https://doi.org/10.24248/eahrj.v5i1.654DOI ↗Google Scholar ↗
Nabunya, P., Mubeezi, R., & Awor, P. (2020). Prevalence of exclusive breastfeeding among mothers in the informal sector, Kampala Uganda. PLOS ONE, 15(9), e0239062. https://doi.org/10.1371/journal.pone.0239062DOI ↗Google Scholar ↗
Olasinde, Y., Ibrahim, O., Idowu, A., Odeyemi, A., Olasinde, A., Agelebe, E., Ogunlaja, O., & Gbadero, D. (2021). Determinants of Exclusive Breastfeeding Practices Among Mothers of Infants Less Than Six Months Attending an Immunization Clinic in Southwestern Nigeria. Cureus, 13(6), e15975. https://doi.org/10.7759/cureus.15975DOI ↗Google Scholar ↗
Rahman, M. A., Khan, M. N., Akter, S., Rahman, A., Alam, M. M., Khan, M. A., & Rahman, M. M. (2020). Determinants of exclusive breastfeeding practice in Bangladesh: Evidence from nationally representative survey data. PLOS ONE, 15(7), e0236080. https://doi.org/10.1371/journal.pone.0236080DOI ↗Google Scholar ↗
Salim, Y. M., & Stones, W. (2020). Determinants of exclusive breastfeeding in infants of six months and below in Malawi: A cross sectional study. BMC Pregnancy and Childbirth, 20(1), 472. https://doi.org/10.1186/s12884-020-03160-yDOI ↗Google Scholar ↗
Shi, H., Yang, Y., Yin, X., Li, J., Fang, J., & Wang, X. (2021). Determinants of exclusive breastfeeding for the first six months in China: A cross-sectional study. International Breastfeeding Journal, 16(1), 40. https://doi.org/10.1186/s13006-021-00388-yDOI ↗Google Scholar ↗
Shirima, R., Greiner, T., Kylberg, E., & Gebre-Medhin, M. (2021). Exclusive breast-feeding is rarely practised in rural and urban Morogoro, Tanzania. Public Health Nutrition, 4(2), 147–154. https://doi.org/10.1079/PHN200057DOI ↗Google Scholar ↗
Singh, B. K., Khatri, R. B., Sahani, S. K., & Khanal, V. (2024). Determinants of exclusive breastfeeding among infants under six months in Nepal: Multilevel analysis of nationally representative household survey data. BMC Public Health, 24, 2456. https://doi.org/10.1186/s12889-024-19963-zDOI ↗Google Scholar ↗
Tulelo, P. M., & Mulaudzi, F. M. (2021). Indigenous neonatal feeding and bathing practices of caregivers in Vhembe District, Limpopo province. Health SA Gesondheid, 26, 1632. https://doi.org/10.4102/hsag.v26i0.1632DOI ↗Google Scholar ↗
UNICEF. (2023a). Global breastfeeding scorecard 2023. https://www.unicef.org/media/150586/file/Global-breastfeeding-scorecard-2023.pdfGoogle Scholar ↗
UNICEF. (2023b). Global UNICEF Global Databases: Infant and Young Child Feeding: Exclusive breastfeeding. UNICEF. https://data.unicef.org/wp-content/uploads/2023/12/UNICEF_Expanded_Global_Databases_ExclusiveBF_2023.xlsxGoogle Scholar ↗
WHO. (2023). Infant and young child feeding. https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feedingGoogle Scholar ↗
WHO. (2024). Exclusive breastfeeding: Celebrating successes and accelerating progress by 2030. https://www.who.int/news-room/events/detail/2024/11/20/default-calendar/exclusive-breastfeeding-celebrating-successes-and-accelerating-progress-by-2030Google Scholar ↗
WHO, & UNICEF. (2009). Baby-Friendly Hospital Initiative. WHO and UNICEF. https://www.unicef.org/documents/baby-friendly-hospital-initiativeGoogle Scholar ↗

[refR-1] Awoke, S., & Mulatu, B. (2021). Determinants of exclusive breastfeeding practice among mothers in Sheka Zone, Southwest Ethiopia: A cross-sectional study. Public Health in Practice, 2, 100108. https://doi.org/10.1016/j.puhip.2021.100108DOI ↗Google Scholar ↗

[refR-2] Dede, K. S., & Bras, H. (2020). Exclusive breastfeeding patterns in Tanzania: Do individual, household, or community factors matter? International Breastfeeding Journal, 15(1), 32. https://doi.org/10.1186/s13006-020-00279-8DOI ↗Google Scholar ↗

[refR-3] Giang, N., Duy, T., Vuong, L., Ngoc, T., Pham, T., Duc, M., Le, D., Nga, T., Hieu, M., Vi, T., Triet, M., Thach, T., Truc, B., & Huy, T. (2023). Prevalence of exclusive breastfeeding for the first six months of an infant’s life and associated factors in a low–middle income country. International Breastfeeding Journal, 18(1), 47. https://doi.org/10.1186/s13006-023-00585-xDOI ↗Google Scholar ↗

[refR-4] Kassa, T., Meshesha, B., Haji, Y., & Ebrahim, J. (2016). Appropriate complementary feeding practices and associated factors among mothers of children age 6–23 months in Southern Ethiopia, 2015. BMC Pediatrics, 16(131), 1–10.Google Scholar ↗

[refR-5] Koffi, I., Essis, E. M. L., Bamba, I., Assi, K. R., Konan, L. L., & Aka, J. (2023). Factors associated with exclusive breastfeeding of children under six months of age in Cote d’Ivoire. International Breastfeeding Journal, 18(1), 43. https://doi.org/10.1186/s13006-023-00573-1DOI ↗Google Scholar ↗

[refR-6] Mbuyi, E., Nkongolo, B.-K., & Musema, G. (2023). Factors associated with low adherence to exclusive breastfeeding in the Dibaya health zone, Democratic Republic of Congo. Journal of Global Health Economics and Policy, 3, e2023015. https://doi.org/10.52872/001c.123579DOI ↗Google Scholar ↗

[refR-7] Mekebo, G. G., Argawu, A. S., Likassa, H. T., Ayele, W., Wake, S. K., Bedada, D., Hailu, B., Senbeto, T., Bedane, K., Lulu, K., Daraje, S., Lemesa, R., Aga, G., Alemayehu, E., Kefale, B., Bechera, T., Tadesse, G., Galdassa, A., Olani, J., … Diriba, G. (2022). Factors influencing exclusive breastfeeding practice among under-six months infants in Ethiopia. BMC Pregnancy and Childbirth, 22, 630. https://doi.org/10.1186/s12884-022-04955-xDOI ↗Google Scholar ↗

[refR-8] Mekonen, E. G., Zegeye, A. F., & Workneh, B. S. (2024). Complementary feeding practices and associated factors among mothers of children aged 6 to 23 months in Sub-saharan African countries: A multilevel analysis of the recent demographic and health survey. BMC Public Health, 24(1), 115. https://doi.org/10.1186/s12889-023-17629-wDOI ↗Google Scholar ↗

[refR-9] Mohammed, S., Yakubu, I., Fuseini, A.-G., Abdulai, A.-M., & Yakubu, Y. H. (2023). Systematic review and meta-analysis of the prevalence and determinants of exclusive breastfeeding in the first six months of life in Ghana. BMC Public Health, 23(1), 920. https://doi.org/10.1186/s12889-023-15758-wDOI ↗Google Scholar ↗

[refR-10] Moshi, F. V., Akyoo, E. E., & Seif, S. A. (2021). Prevalence and Predictor of Exclusive Breastfeeding among Mothers of 0 to 6 months Infants from Pastoralists and Hunters’ Community in Tanzania; A Community Based Cross-Sectional Study. The East African Health Research Journal, 5(1), 82–90. https://doi.org/10.24248/eahrj.v5i1.654DOI ↗Google Scholar ↗

[refR-11] Nabunya, P., Mubeezi, R., & Awor, P. (2020). Prevalence of exclusive breastfeeding among mothers in the informal sector, Kampala Uganda. PLOS ONE, 15(9), e0239062. https://doi.org/10.1371/journal.pone.0239062DOI ↗Google Scholar ↗

[refR-12] Olasinde, Y., Ibrahim, O., Idowu, A., Odeyemi, A., Olasinde, A., Agelebe, E., Ogunlaja, O., & Gbadero, D. (2021). Determinants of Exclusive Breastfeeding Practices Among Mothers of Infants Less Than Six Months Attending an Immunization Clinic in Southwestern Nigeria. Cureus, 13(6), e15975. https://doi.org/10.7759/cureus.15975DOI ↗Google Scholar ↗

[refR-13] Rahman, M. A., Khan, M. N., Akter, S., Rahman, A., Alam, M. M., Khan, M. A., & Rahman, M. M. (2020). Determinants of exclusive breastfeeding practice in Bangladesh: Evidence from nationally representative survey data. PLOS ONE, 15(7), e0236080. https://doi.org/10.1371/journal.pone.0236080DOI ↗Google Scholar ↗

[refR-14] Salim, Y. M., & Stones, W. (2020). Determinants of exclusive breastfeeding in infants of six months and below in Malawi: A cross sectional study. BMC Pregnancy and Childbirth, 20(1), 472. https://doi.org/10.1186/s12884-020-03160-yDOI ↗Google Scholar ↗

[refR-15] Shi, H., Yang, Y., Yin, X., Li, J., Fang, J., & Wang, X. (2021). Determinants of exclusive breastfeeding for the first six months in China: A cross-sectional study. International Breastfeeding Journal, 16(1), 40. https://doi.org/10.1186/s13006-021-00388-yDOI ↗Google Scholar ↗

[refR-16] Shirima, R., Greiner, T., Kylberg, E., & Gebre-Medhin, M. (2021). Exclusive breast-feeding is rarely practised in rural and urban Morogoro, Tanzania. Public Health Nutrition, 4(2), 147–154. https://doi.org/10.1079/PHN200057DOI ↗Google Scholar ↗

[refR-17] Singh, B. K., Khatri, R. B., Sahani, S. K., & Khanal, V. (2024). Determinants of exclusive breastfeeding among infants under six months in Nepal: Multilevel analysis of nationally representative household survey data. BMC Public Health, 24, 2456. https://doi.org/10.1186/s12889-024-19963-zDOI ↗Google Scholar ↗

[refR-18] Tulelo, P. M., & Mulaudzi, F. M. (2021). Indigenous neonatal feeding and bathing practices of caregivers in Vhembe District, Limpopo province. Health SA Gesondheid, 26, 1632. https://doi.org/10.4102/hsag.v26i0.1632DOI ↗Google Scholar ↗

[refR-19] UNICEF. (2023a). Global breastfeeding scorecard 2023. https://www.unicef.org/media/150586/file/Global-breastfeeding-scorecard-2023.pdfGoogle Scholar ↗

[refR-20] UNICEF. (2023b). Global UNICEF Global Databases: Infant and Young Child Feeding: Exclusive breastfeeding. UNICEF. https://data.unicef.org/wp-content/uploads/2023/12/UNICEF_Expanded_Global_Databases_ExclusiveBF_2023.xlsxGoogle Scholar ↗

[refR-21] WHO. (2023). Infant and young child feeding. https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feedingGoogle Scholar ↗

[refR-22] WHO. (2024). Exclusive breastfeeding: Celebrating successes and accelerating progress by 2030. https://www.who.int/news-room/events/detail/2024/11/20/default-calendar/exclusive-breastfeeding-celebrating-successes-and-accelerating-progress-by-2030Google Scholar ↗

[refR-23] WHO, & UNICEF. (2009). Baby-Friendly Hospital Initiative. WHO and UNICEF. https://www.unicef.org/documents/baby-friendly-hospital-initiativeGoogle Scholar ↗