Assess changes in exclusive breastfeeding (EBF) among Zambian infants aged 0 to 5 months from 2013–2014 to 2024 and examine variation across selected subgroups.
Approach:
Design and data: Repeated cross-sectional analysis of nationally representative Zambia Demographic and Health Survey data from 2013–2014, 2018, and 2024; 3,078 youngest living infants aged 0 to 5 months were included.
Measure and analysis: EBF meant receiving only breast milk in the preceding 24 hours. Survey-weighted estimates and regression models assessed prevalence and trends; Bonferroni correction was applied to 33 exploratory subgroup comparisons.
Key Findings:
Weighted EBF prevalence declined from 72.4% in 2013–2014 to 65.5% in 2024, an absolute change of −6.9 percentage points (95% CI, −11.6 to −2.3; P for trend = .004).
After correction for multiple comparisons, significant declines were observed among mothers aged 20 to 29 years (−11.6 percentage points), residents of Southern Province (−28.5 percentage points), and women with home deliveries (−26.2 percentage points); each …
Other subgroup trends with nominal P values below .05 did not remain statistically significant after Bonferroni correction.
Interpretation:
The authors report an overall decline in EBF between the 2013–2014 and 2024 survey cycles, with the largest statistically significant subgroup declines among mothers aged 20 to 29 years, Southern Province residents, and women with home deliveries.
Limitations:
The 24-hour recall measure may overestimate EBF maintained continuously from birth.
Only three survey cycles were available, limiting assessment of annual and short-term trends.
Exploratory subgroup analyses require cautious interpretation because of multiple comparisons and smaller subgroup sample sizes.
Conclusion:
The authors call for continued monitoring and renewed programmatic attention to breastfeeding promotion and support in Zambia.
