Abstract
Exclusive breastfeeding (EBF)—giving infants only breast-milk for the first 6 months of life—is a component of optimal breastfeeding practices effective in preventing child morbidity and mortality. EBF practices are known to vary by population and comparable subnational estimates of prevalence and progress across low- and middle-income countries (LMICs) are required for planning policy and interventions. Here we present a geospatial analysis of EBF prevalence estimates from 2000 to 2018 across 94 LMICs mapped to policy-relevant administrative units (for example, districts), quantify subnational inequalities and their changes over time, and estimate probabilities of meeting the World Health Organization’s Global Nutrition Target (WHO GNT) of ≥70% EBF prevalence by 2030. While six LMICs are projected to meet the WHO GNT of ≥70% EBF prevalence at a national scale, only three are predicted to meet the target in all their district-level units by 2030.
Highlights
Exclusive breastfeeding (EBF)—giving infants only breast-milk for the first 6 months of life—is a component of optimal breastfeeding practices effective in preventing child morbidity and mortality
The proportion of exclusively breastfed children remains low in many low- and middle-income countries (LMICs), where most child deaths attributed to suboptimal breastfeeding occur[12]
General increases in mean EBF prevalence occurred across LMICs over the study period, from 28.6% (95% uncertainty interval: 22.9–35.4%) in 2000 to 38.7% (28.3–49.9%) in 2018
Summary
Exclusive breastfeeding (EBF)—giving infants only breast-milk for the first 6 months of life—is a component of optimal breastfeeding practices effective in preventing child morbidity and mortality. We present a geospatial analysis of EBF prevalence estimates from 2000 to 2018 across 94 LMICs mapped to policy-relevant administrative units (for example, districts), quantify subnational inequalities and their changes over time, and estimate probabilities of meeting the World Health Organization’s Global Nutrition Target (WHO GNT) of ≥70% EBF prevalence by 2030. Building on our previous geospatial analysis of EBF prevalence in sub-Saharan Africa[14], we synthesized data from 349 geo-referenced household surveys from years 1998 to 2018 representing 302,435 infants under 6 months to produce annual 2000– 2018 subnational estimates for the proportion and absolute number of exclusively breastfed infants for 94 LMICs. We used 14 geographically distinct modelling regions which were determined on the basis of epidemiological homogeneity and geographical contiguity by the Global Burden of Disease (GBD) study[18] (Supplementary Table 4 and Supplementary Fig. 7). The full array of our model outputs—at various spatial levels and aggregations—is available through an online visualization tool (https://vizhub.healthdata.org/lbd/ebf), with additional results in the Supplementary Information
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