{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T08:35:45Z","timestamp":1765874145431,"version":"3.48.0"},"reference-count":36,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T00:00:00Z","timestamp":1735776000000},"content-version":"unspecified","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-009691"],"award-info":[{"award-number":["INV-009691"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-010320"],"award-info":[{"award-number":["INV-010320"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,12,6]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess the geographical equity in Ethiopian infants\u2019 exclusive breastfeeding at 5\u2009months and dietary diversity at 12 months and whether social factors explained the spatial inequities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Secondary analysis of a birth cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Analysis of data from the Ethiopian Performance Monitoring for Action panel study conducted from July 2020 to August 2021 in five regions (ie, Oromia, Amhara, Afar and Southern Nations, Nationalities and Peoples regions and the Addis Ababa City administration). We analysed geographical autocorrelation to assess geographical variations in exclusive breastfeeding and dietary diversity. Areas with higher and lower coverage of appropriate infant feeding outcomes were analysed using hotspot analyses. We performed geographically weighted regression to investigate whether sociodemographic factors explained the geographical feeding differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>1850 infants were prospectively followed from birth to 12 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Exclusive breastfeeding at 5\u2009months and minimum-level dietary diversity at 12 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixty-nine percent (95% CI 67 to 71) of infants were exclusively breastfed at 5\u2009months, while at 12 months, only 16% (95% CI 13 to 19) had complementary feeding from five or more food groups. There were geographical variations in the coverage of exclusive breastfeeding and minimum dietary diversity. Higher proportions of infants were exclusively breastfed at 5\u2009months in northern areas, and more 12-month-old infants in central parts of the country had complementary feeding from at least five food groups. Sociodemographic factors explained a quarter of the geographical variation in dietary diversity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Most Ethiopian infants were exclusively breastfed, which was in line with global recommendations but with some geographical differences. There was prominent geographical variation in dietary diversity, partly explained by social factors, but overall, very few 12-month-old infants were fed from at least five food groups. This low dietary quality could impair Ethiopian children\u2019s physical growth, development and health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-088762","type":"journal-article","created":{"date-parts":[[2025,1,3]],"date-time":"2025-01-03T01:35:51Z","timestamp":1735868151000},"page":"e088762","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Geographical equity in Ethiopian infant feeding practices: a secondary analysis of a birth cohort study"],"prefix":"10.1136","volume":"15","author":[{"given":"Amare","family":"Tariku","sequence":"first","affiliation":[{"name":"Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia"},{"name":"Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0710-7954","authenticated-orcid":false,"given":"Lars","family":"Persson","sequence":"additional","affiliation":[{"name":"Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK"},{"name":"Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanna","family":"Schellenberg","sequence":"additional","affiliation":[{"name":"Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4228-4334","authenticated-orcid":false,"given":"Tanya","family":"Marchant","sequence":"additional","affiliation":[{"name":"Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4984-893X","authenticated-orcid":false,"given":"Della","family":"Berhanu","sequence":"additional","affiliation":[{"name":"Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK"},{"name":"Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5910-3723","authenticated-orcid":false,"given":"Seblewengel","family":"Lemma","sequence":"additional","affiliation":[{"name":"Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK"},{"name":"Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9435-2135","authenticated-orcid":false,"given":"Atkure","family":"Defar","sequence":"additional","affiliation":[{"name":"Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK"},{"name":"Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6486-0531","authenticated-orcid":false,"given":"Theodros Getachew","family":"Zemedu","sequence":"additional","affiliation":[{"name":"Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0221-4101","authenticated-orcid":false,"given":"Zewditu Abdissa","family":"Denu","sequence":"additional","affiliation":[{"name":"Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia"},{"name":"Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7024-185X","authenticated-orcid":false,"given":"Tadesse Guadu","family":"Delele","sequence":"additional","affiliation":[{"name":"Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia"},{"name":"Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Solomon","family":"Shiferaw","sequence":"additional","affiliation":[{"name":"School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3734-7705","authenticated-orcid":false,"given":"Girum Taye","family":"Zeleke","sequence":"additional","affiliation":[{"name":"Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meseret","family":"Zelalem","sequence":"additional","affiliation":[{"name":"Maternal, Child & Adolescent Health Service Lead Executive Office, Ethiopia Ministry of Health, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kassahun Alemu","family":"Gelaye","sequence":"additional","affiliation":[{"name":"Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia"},{"name":"Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,1,2]]},"reference":[{"unstructured":"Assembly general: resolution adopted by the general assembly on 11 September 2015. 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Global breastfeeding scorecard 2023 rates of breastfeeding increase around the world through improved protection and support. 2023. Available: https:\/\/wwwuniceforg\/media\/150586\/file\/Global%20breastfeeding%20scorecard%202023pdf","key":"2025121600310513000_15.1.e088762.7"},{"key":"2025121600310513000_15.1.e088762.8","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1038\/s41591-019-0525-0","article-title":"Mapping exclusive breastfeeding in Africa between 2000 and 2017","volume":"25","author":"Bhattacharjee","year":"2019","journal-title":"Nat Med"},{"doi-asserted-by":"publisher","key":"2025121600310513000_15.1.e088762.9","DOI":"10.1186\/s12963-016-0112-2"},{"key":"2025121600310513000_15.1.e088762.10","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0275586","article-title":"Geographic variation and factors associated with under-five mortality in Ethiopia. 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Infant feeding practices in ethiopia: birth cohort study in five regions maternal & child nutrition. 2023.","key":"2025121600310513000_15.1.e088762.12"},{"key":"2025121600310513000_15.1.e088762.13","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0273793","article-title":"Modeling spatial determinants of initiation of breastfeeding in Ethiopia: A geographically weighted regression analysis","volume":"17","author":"Hailegebreal","year":"2022","journal-title":"PLoS One"},{"key":"2025121600310513000_15.1.e088762.14","doi-asserted-by":"crossref","DOI":"10.1186\/s40795-022-00573-0","article-title":"Spatial distribution of vitamin A rich foods intake and associated factors among children aged 6-23 months in Ethiopia: spatial and multilevel analysis of 2019 Ethiopian mini demographic and health survey","volume":"8","author":"Demsash","year":"2022","journal-title":"BMC Nutr"},{"key":"2025121600310513000_15.1.e088762.15","doi-asserted-by":"crossref","DOI":"10.12688\/gatesopenres.13161.1","article-title":"Protocol for PMA-Ethiopia: A new data source for cross-sectional and longitudinal data of reproductive, maternal, and newborn health","volume":"4","author":"Zimmerman","year":"2020","journal-title":"Gates Open Res"},{"unstructured":"Central Statistical Agency (CSA) [Ethiopia] and ICF . 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