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.