Factors influencing Exclusive Breastfeeding in Sub-Saharan Africa: A Multilevel Analysis of Demographic and Health Survey

Background Exclusive breastfeeding (EBF) is the feeding practice where infants are exclusively fed with breastmilk without anything else for the first 6 months of life. Despite its benefits to both the mother and child, the low prevalence of EBF is an alarming public health concern in SSA leading to the highest child mortality attributable to inappropriate EBF practice. 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 26 SSA countries from 2010 to 2023. A total of 296,966 women aged 15–49 years, who were currently breastfeeding or had breastfed their children within the five years prior to the survey were included in the study. Pearson’s chi-square and multilevel logistic regression test 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 in SSA was 7.5%, with the highest EBF prevalence recorded in Ethiopia (17.3%) and Rwanda (15.8%). The multi-level logistic regression analysis revealed that the odds of EBF reduces as women age (Women aged 20–24 [AOR: 0.731, 95% CI: 0.636–0.840], and 45–49 [AOR: 0.432, 95% CI: 0.357–0.522] compared to those aged 15–19 years. Richer (AOR: 0.922, 95% CI: 0.877–0.973) and richest (AOR: 0.869, 95% CI: 0.803–0.936) wealth quintiles had significantly lower odds of EBF compared to those in the poorest wealth quintile. Conclusion This study identified key factors associated with the low prevalence of EBF in SSA. Therefore, the study highlights the need for targeted interventions to improve EBF rates in SSA, considering the diverse factors influencing these practices.