Exploring the determinants of exclusive breastfeeding among infants under six months in the Gambia using gambian demographic and health survey data of 2019-20

This study aimed to assess the status of exclusive breastfeeding practice among mothers who have children under the age of six months, and it declared that the overall practice of exclusive breastfeeding among under-six-month-old children in the Gambia remains low among mothers who have experienced EBF. The proportion of participants in this study was higher with studies conducted in Ghana 43.7% [30], Cameroon 45.2% [31], Kenya 33% [32], Malaysia 41.7% [33], Nigeria [34], and Gambia [25]. However it is lower than studies done in Ethiopia 57.3% [35], and India [36], and it is almost in agreement with a study done in Bangladesh 56% [37] Pakistan 53.6% [38], and a systematic review of east African countries 55.9% [11]. The empirical findings of this study may be less than those of the previous one due to national profiles of EBF experience, government policy, and closed follow-up on EBF, children’s health, and participants’ culture, attitude, knowledge, and education backgrounds concerning EBF. On the other hand, this study discovered a substantially greater prevalence of EBF, which could be due to several factors such as limiting confounding factors both at the individual and community levels, methods of recruiting participants, time variation, and other methodological difficulties. This could have influenced their prevalence findings.

The study at hand discovered that the age of a child was one predictor factor of exclusive breastfeeding after controlling other variables. Children whose ages are between 2 and 3 months and 4–5 months have a lower likelihood of being exposed during a stay at EBF than children aged 0–1 month. This figure is consistent with studies done in Ghana [30], Guinea [39], Ethiopia [40] and Canada [41]. This results in the fact that as children get closer to six months of age, they are less likely to take EBF alone. This is a matter of precaution and scientific acceptance. By the time they are six months old, it is common and expected for mothers to feed their babies on regular basis in addition to mothers’ milk.

The study also revealed that mothers from rural areas of the Gambia have more likelihood of feeding their children exclusively than participants living in urban areas. The figure of this study had in agreement with plenty of other studies done in various settings in the 13 economic communities of west African states (ECOWAS) countries [42]. The finding could be explained by mothers who are from rural areas, who might have no chance of accessing infant formula feeding due to the cost, and availability of it. Because those countryside participants might have a less powerful influence against their husbands/community on various issues both economic and political. On the other hand, those rural area residents might have faced knowledge and practice gaps to prepare infant formula or other complementary foods to feed their children. Last but not least there is a usual occasion that, when mothers provide infant formula or any other complementary foods to their children due to children’s digestive systems, children might have a probability of diarrhea and other unexpected health problems [31]. At this stage, those mothers might be perceived that the illness of the child is due to the complementary foods that they fed, and they will not provide any complementary foods then. On the contrary, mothers living in urban areas, on the other hand, are more likely to work outside the home, either in government or in private, so they may not have enough time to breastfeed their children, and the duration of maternity leave is a very short time, especially, in those ECOWAS countries, this remains a public challenge [17, 43]. For instance in Nigeria maternity leave duration is 16 weeks only [43], Ghana 12 weeks only [44]. Furthermore, these mothers are better off financially, so they have more money with access and availability to buy infant formula feeding and other complementary foods for their children and more self-determination [31, 40].

The other exciting variable was reading the newspaper. The study at hand depicted those mothers who read newspapers have more chance of being exclusive breast feeders to their children. The result could be justified by mothers who have read newspapers for at least a week and might receive much information about the advantage of EBF for both the child and the mother. This is because, first of all, these mothers are educated and probably have a better income. Alternatively, the benefits of breastfeeding may be exclusively covered in the newspaper. A time series study in the USA from 19,972 to 2000 showed that media exposure such as reading magazines has a great potential of changing the mind of mothers regarding EBF [45, 46], in Guinea [47], and in Ghana [48].

Participants who have received breastfeeding counseling from health providers have more experienced EBF than their counterparts. This study has the same findings as studies done in Ghan a[30], Gambia [25], and a systematic review report [49]. This scenario may be because health professionals may have more profound knowledge and positive attitude than many mothers think about the benefits and harms of breastfeeding. As a result, counseled mothers are determined to continue EBF giving their children the advice of health care providers to keep their children healthy, active and competitive in the schools and communities as they received from the professionals.

Mothers whose children had experienced fever have less chance of continuing EBF than their counterparts. This finding has shown that mothers have both knowledge and practice as well as attitude gap barriers by the time their children are under the weather by fever. These mothers are in a knowledge deficit and can give their children everything they accessed at home when their children become febrile. On the other side, those children might a greater chance of exposure to fever, while they are not put on EBF. Because studies showed that a lack of EBF increased the odds of dehydration, fever and diarrhea, and other infections [37, 38, 48]. However, if they were taken to a health institution, health providers would not only treat the fever but also give them scientific advice on how to maintain their exclusive breastfeeding instead of eating extra meals when they have such problems. Mothers might have a knowledge deficit that their milk has an antibody to the child.

This study’s use of a sizable sample size is one of its strengths. The likelihood of departures from the actual population declining as sample size rises also makes it more likely that it will be trustworthy for use by subsequent researchers. Additionally, the right statistical model that can consider the nature of the data was used. Although this study considered several significant response variables, we were unable to analyze study participants’ HIV status since there is no record of their HIV status for exclusive breastfeeding in The Gambia. Considering HIV status may therefore be necessary given the context. Certain variables or confounders, such as the HIV status of the study participants, are missed in the analysis because it is reliant on the information in the data set. Last but not least, future researchers may find it valuable to do additional primary research by using a variety of methods and designs to determine HIV status and other relevant characteristics of exclusive breastfeeding. The cross-sectional design of the study precludes concluding the causes of the relationships that were found, hence the present study should be regarded with caution. Moreover, because all of the data were self-reported, social desirability bias could have been introduced.