Prevalence of and factors associated with formula feeding among mothers with infants 0-6 months of age in Ethiopia: a systematic review and meta-analysis

Zenebe Abebe Gebreegziabher; Birhan Ewunu Semagn; Agmasie Damtew Walle; Werkneh Melkie Tilahun; Mahider Awoke Belay; Wubet Tazeb Wondie; Gezahagn Demsu Gedefaw; Tadesse Mamo Dejene; Fitsum Zekarias Mohammed

doi:10.1093/nutrit/nuae201

Prevalence of and factors associated with formula feeding among mothers with infants 0-6 months of age in Ethiopia: a systematic review and meta-analysis

Nutr Rev. 2025 Jan 11:nuae201. doi: 10.1093/nutrit/nuae201. Online ahead of print.

Authors

Zenebe Abebe Gebreegziabher¹, Birhan Ewunu Semagn², Agmasie Damtew Walle¹, Werkneh Melkie Tilahun³, Mahider Awoke Belay⁴, Wubet Tazeb Wondie⁵, Gezahagn Demsu Gedefaw⁶, Tadesse Mamo Dejene², Fitsum Zekarias Mohammed²

Affiliations

¹ Department of Epidemiology and Biostatistics, School of Public Health, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia.
² Department of Public Health, School of Public Health, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia.
³ Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
⁴ Department of Public Health, College of Medicine and Health Science, Injibara University, Injibara, Ethiopia.
⁵ Department of Pediatrics and Child Health Nursing, College of Medicine, and Health Science, Ambo University, Ambo, Ethiopia.
⁶ Department of Neonatal Health Nursing, School of Nursing, College of Medicine and Health Sciences, and Specialized Hospital, University of Gondar, Gondar, Ethiopia.

PMID: 39798154
DOI: 10.1093/nutrit/nuae201

Abstract

Context: Inconsistent results have been reported regarding the prevalence of and factors associated with formula feeding in Ethiopia.

Objective: This study aimed to determine the pooled prevalence of and factors associated with formula feeding among mothers with infants 0-6 months of age in Ethiopia.

Data sources: A comprehensive systematic search was conducted across 3 databases (PubMed, EMBASE, and ScienceDirect) and the Google Scholar search engine to identify relevant studies published up to April 2, 2024.

Data extraction: After assessing the quality of each study using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies, data were independently extracted by 2 authors using pre-designed forms in an Excel spreadsheet. Any disagreements were resolved through discussion and consultation with additional authors.

Data analysis: Statistical heterogeneity across studies was assessed using the I2 statistic. A random-effects meta-analysis was used to pool the proportions, due to high heterogeneity, while a fixed-effect meta-analysis was used to pool associated factors with low heterogeneity. A sensitivity analysis was performed to assess the potential impact of outlier studies on the overall estimates. Five studies, with a combined sample size of 2344 participants, were included. The pooled prevalence of formula feeding was 34.0% (95% CI: 23.0%, 44.0%). Factors significantly associated with formula feeding included cesarean delivery (POR [pooled odds ratio] = 4.72, 95% CI: 3.32, 6.71) compared with vaginal delivery, a positive attitude toward formula feeding (POR = 2.26, 95% CI: 1.45, 3.53) compared with a negative attitude, initiation of breastfeeding more than 1 hour after delivery (POR = 2.27, 95% CI: 1.25, 4.13) compared with initiation within 1 hour, and receiving information about formula feeding from friends or family (POR = 2.47, 95% CI: 1.46, 4.20) compared with receiving information from health-care professionals.

Conclusion: The prevalence of formula feeding in Ethiopia is significant. Cesarean delivery, a positive attitude toward formula feeding, late initiation of breastfeeding, and receiving formula feeding-related information from friends and family were positively associated with formula feeding. Given these findings, the authors recommend that public health interventions in Ethiopia target these key determinants to decrease the high prevalence of formula feeding practices observed in the country. Strategies addressing factors such as promoting vaginal delivery, improving attitudes toward breastfeeding, encouraging early breastfeeding initiation, and limiting the influence of social networks on formula-feeding decisions may be beneficial.

Keywords: Ethiopia; associated factors; formula feeding; infants; meta-analysis; systematic review.