Prevalence of Breastfeeding Indicators in Middle East and North African Countries: A Meta-Analysis of National Health Surveys (2010- 2020)

Abstract

Introduction: Breastfeeding is the clinical gold standard for an infant's nourishment. Worldwide, less than one in two newly born infants are breastfed within the first hour of birth and only 44% of infants are exclusively breastfed. Despite the importance of breastfeeding, rates in the Middle East and North African (MENA) region are still not within the 2030 World Health Organization targets to reach 70% for early initiation of breastfeeding within the first hour (EIBF), 70% for exclusive breastfeeding under 6 months (EBF), and 80% for continued breastfeeding at one year (CBF). Aim: This study aims to estimate the overall prevalence of EIBF, EBF, and CBF for the MENA region by income level, delivery mode (cesarean section), baby-friendly hospital initiative (BFHI), survey period, and ethnicity. Methods: A meta-analysis was conducted using national estimates from the Multiple Indicator Cluster Survey and the Demographic Health Survey. Overall pooled prevalence estimates of EIBF, EBF, and CBF were calculated using a random-effects model. Forest plots were used to display results from individual studies and pooled analyses. Cochrane Q statistic (chi-square test) and I-squared statistics were used to assess heterogeneity among surveys. Subgroup analysis and meta-regression were conducted to investigate the effects of income levels, cesarean section, BFHI, survey period, and ethnicity on the prevalence of the breastfeeding indicators. Sensitivity analysis was performed to examine the effect of outliers. Results: A total of 12 national surveys were included in this meta-analysis. The overall pooled prevalence of EIBF was 42% (95% CI: 33%, 52%), EBF 32% (95% CI: 24%, 41%), and CBF 63% (95% CI: 53%, 73 %). Breastfeeding practices decreased as income levels increased, except for EIBF. As cesarean section rates increased to more than 10%, the prevalence of breastfeeding indicators decreased. Availability of BFHI enhanced the high rates of breastfeeding practices. EIBF was higher among Arab mothers, however, EBF and CBF were higher among non-Arab mothers. Breastfeeding indicators were higher among countries with survey period 2012-2015 than countries where data were collected after 2015; this result was statistically significant only for the CBF indicator (Meta-regression ?= -0.264; p <0.001). Conclusion: MENA region reported a lower overall prevalence of EIBF, EBF, and CBF as compared to the World Health Organization's targets by 2030. There is a need for effective collaboration efforts between different entities to conduct communitybased interventions that support optimal breastfeeding practices to achieve Sustainable Development Goals (SDGs) goals by 2030. More research is needed to explore the association of breastfeeding practices using modeling of individual data.