Abstract
BACKGROUND: Exclusive breastfeeding is a crucial public health intervention with significant benefits for infants and maternal health. In Sierra Leone, despite national efforts to promote exclusive breastfeeding, prevalence remains suboptimal. Understanding the factors influencing exclusive breastfeeding practices among children aged 0-5 months is essential for developing effective interventions to increase exclusive breastfeeding rates. This study examined the sociodemographic, and healthcare-related factors associated with exclusive breastfeeding in Sierra Leone. METHODS: Data from the 2019 Sierra Leone Demographic and Health Survey was used for the study. A mixed-effect multilevel binary logistic regression models was fitted to examine the factors associated with exclusive breastfeeding in Sierra Leone. The results were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI) and intra-cluster correlation coefficients. RESULTS: The prevalence of exclusive breastfeeding among children aged 0-5 months was 54.1% (95% CI 50.2, 57.9) in Sierra Leone. Children aged 2-3 months (aOR 0.30; 95% CI: 0.20, 0.45) and 4-5 months (aOR 0.08; 95% CI: 0.05, 0.13) had lower odds of exclusive breastfeeding than those aged 0-1 months. Children of mothers with a history of skilled birth attendance (aOR 0.55; 95% CI: 0.32, 0.96) had lower odds of exclusive breastfeeding than those without skilled birth attendance. Children of mothers in rural areas (aOR 1.62; 95% CI: 1.03, 2.55) had higher odds for exclusive breastfeeding than those in urban areas. CONCLUSION: The findings suggest a need for targeted interventions to improve exclusive breastfeeding rates, particularly for infants aged 2-5 months, where the odds are significantly lower. There is also a critical need to enhance postnatal care and education for mothers, especially those with skilled birth attendance, to ensure they receive adequate support for breastfeeding practices. Furthermore, leveraging the strengths observed in rural areas could inform community-based strategies that promote exclusive breastfeeding, highlighting the importance of culturally sensitive approaches that address the unique challenges faced by urban mothers.