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Background: UNICEF and WHO recommend that all children should be exclusively breastfed for the first 6 months of life as breastmilk contains all the nutrients an infant needs during this period. In Malawi, exclusive breastfeeding has been declining from 72% (2009), 70.2% (2014) and 61% in the most recent survey (2015-16). We aimed to determine factors associated with exclusive breastfeeding in Malawi. Methods: We used data from the Malawi Demographic and Health Survey (MDHS) 2015-2016. Survey records for 2059 mothers of children aged 6 months and below were identified and potential factors influencing infant feeding were examined. Logistic regression analysis was carried out to model determinants of exclusive breastfeeding (EBF). Results: EBF declined in proportion to the age of the infant. Significant associations with continuing EBF were age of the mother, ethnicity of the mother, sex of infant and number of siblings. Members of the Tumbuka (OR = 1.71, CI. 1.13-2.59) and Ngoni (OR = 2.05, CI. 1.38-3.05) communities were more likely to practice EBF. In addition, mothers with female babies (OR = 1.35, CI. 1.08-1.70) and those with 3-4 children (OR = 1.47, CI. 1.04-2.08) were more likely to engage in EBF. Conclusion: We identify important variations in EBF practices among population sub-groups in Malawi that need to be considered when framing health education messaging. Work is needed to assess the impact of more targeted messaging, whether delivered via ‘ten steps’ to successful breastfeeding under Baby Friendly Hospital Initiative (BFHI) programming or other health education and awareness campaigns to sensitize communities on implications of some cultural practices on the lives of babies. The potential role for mass media, targeted Health Surveillance Assistants’ (HSA) home visits and male involvement also require exploration.
We used data from the 2015–16 MDHS. The dependent variable was exclusive breastfeeding and the independent variables were the factors potentially affecting exclusive breastfeeding. We examined the influence of maternal determinants (age of mother, education of mother, religion of mother, employment status of mother, ethnicity of mother, region where mother resides, wealth index of mother and marital status), and infant determinants (sex of the baby, age of the baby and number of children born to the mother). These variables were assessed quantitatively to measure their significance in affecting exclusive breastfeeding. The study used the data set which involved information on women with infants of 6 months and below. This data set was used because the women would have provided the most current information about feeding status and on the determinants of exclusive breastfeeding. The MDHS was a nationally representative sample of 25,146 women aged 15–49 of whom 24,562 were interviewed during the survey, representing a response rate of 98%. The 2015–16 MDHS provides reliable estimates at the national and regional levels, for urban and rural areas, and for each of the 28 districts in Malawi. The survey methods are described in detail in the MDHS report [7]. After access to dataset was granted, the data were analyzed using statistical software (STATA Version 12 S/E) and bivariate tables generated. Logistic regression analysis was carried at two levels to identify factors associated with exclusive breastfeeding. Firstly, binary logistic regression analysis was carried out and variables with p-value < 0.05 were included in the final multivariable logistic regression analysis. Strength of association was measured using odds ratios and 95% confidence intervals. A p-value < 0.05 was set for statistical significance. MDHS used sample weights to ensure accurate representation of the proportion of women at national and regional levels. Therefore, in this analysis, only the weighted numbers are shown in the tables. The data used in this analysis were from woman’s questionnaire in which women with babies from 0 to 6 months were considered. A variable of exclusive breastfeeding was generated by considering those women who gave their children food other than breastmilk including water within the period of 6 months from birth of the child. Whether currently breastfeeding or not, a woman with child within age of 6 months and below was considered during the process of generating the variable of exclusive breastfeeding. Permission to use the secondary data was sought from the Demographic and Health Surveys (DHS) Program and a waiver of ethical review was granted by the College of Medicine Research Ethics Committee (COMREC).
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