Multidimensional factors predicting exclusive breastfeeding in Ethiopia: evidence from a meta-analysis of studies in the past 10 years

Background In Ethiopia, the prevalence of exclusive breastfeeding (EBF) is 60.1%, which is lower than the national Health Sector Transformation Plan 2016-2020, National Nutrition Program 2016–2020 and WHO global target. This may be attributed to multidimensional factors. Objective The aim of this meta-analysis was to investigate the association between EBF and educational status, household income, marital status, media exposure, and parity in Ethiopia. Methods Databases used were PubMed, EMBASE, Web of Science, SCOPUS, CINAHL and WHO Global health library, and key terms were searched using interactive searching syntax. It was also supplemented by manual searching. Observational studies published between September 2000 and March 2019 were included. The methodological quality of studies was examined using the Newcastle-Ottawa Scale (NOS) for cross-sectional studies. Data were extracted using the Joanna Briggs Institute (JBI) data extraction tool. To obtain the pooled odds ratio (OR), extracted data were fitted in a random-effects meta-analysis model. Statistical heterogeneity was quantified using Cochran’s Q test, τ 2 , and I 2 statistics. Additional analysis conducted includes Jackknife sensitivity analysis, cumulative meta-analysis, and meta-regression analysis. Results Out of 553 studies retrieved, 31 studies fulfilled our inclusion criteria. Almost all studies were conducted on mothers with newborn less than 23 months. Maternal educational status (OR = 1.39; p = 0.03; 95% CI = 1.03 - 1.89; I 2 = 86.11%), household income (OR = 1.27; p = 0.02; 95% CI = 1.05 - 1.55; I 2 = 60.9%) and marital status (OR = 1.39; p = 0.02; 95% CI = 1.05 - 1.83; I 2 = 76.96%) were found to be significantly associated with EBF. We also observed an inverse dose-response relationship of EBF with educational status and income. Significant association was not observed between EBF and parity, media exposure and paternal educational status. Conclusions In this meta-analysis, we depicted the relevant effect of maternal education, income, and marital status on EBF. Therefore, multifaceted, effective, and evidence-based efforts are needed to increase national breastfeeding rates in Ethiopia.