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Review
. 2024 Oct 6:11:2333794X241288743.
doi: 10.1177/2333794X241288743. eCollection 2024.

Breastfeeding Practice in Tunisia: Combined Results of Multiple Indicator Cluster Surveys (2000-2018)

Mariem Nouira  1 , Nesrine Souayeh  2 , Mohamed Maatouk  3 , Hajer Nouira  4 , Anis Hasnaoui  5 , Sondess Arfa  6
Affiliations
Review

Breastfeeding Practice in Tunisia: Combined Results of Multiple Indicator Cluster Surveys (2000-2018)

Mariem Nouira et al. Glob Pediatr Health. .

Abstract

Introduction. Breastfeeding practices fall short of optimal levels globally, despite its known health benefits and World Health Organization endorsements. We aimed through this study to firstly estimate the global prevalence of principal indicators of breastfeeding practice in Tunisia. Secondly, we aimed to identify their associated factors and to assess the temporal trend of breastfeeding practice in Tunsia from 2000 to 2018. Methods. We extracted data from all available reports of Multiple Indicator Cluster Surveys (MICS) surveys conducted in Tunisia (MICS2000, 2006, 2012 and 2018) that were publicly available on the MICS UNICEF website prior to 2024. Results. Never breastfeeding prevalence was 4% (95% CI [3%-7%]) with a significant increase (P < 10-3) from 2000 (2.4%) to 2018(7.8%). The prevalence of early breastfeeding initiation was 56% (95% CI [20%-87%]) with a significant decrease(P < 10-3) from 2006(87.4%) to 2018(31.5%). The prevalence of exclusive breastfeeding was 15% (95% CI [5%-35%]) with a significant decrease(P < 10-3) from 2000(46.4%) to 2018(13.4%). The prevalence of predominant breastfeeding was 41% (95% CI [31%-51%]) with a significant decrease(P < 10-3) from 2000(50.5%) to 2018(30.4%). The prevalence of continued breastfeeding up to the age of 2 years was 19% (95% CI [16%-22%]) with no significant decrease from 2000 to 2018(P = .09). The mother educational level was significantly associated with early breastfeeding initiation, exclusive and predominant breastfeeding. A higher prevalence of exclusive breastfeeding was found among mothers from rural areas. Conclusions. Tunisia has been experiencing low rates of breastfeeding practice, with a concerning decline observed over the years. Addressing this issue effectively necessitates a comprehensive, multi-faceted approach that encompasses various aspects of society, healthcare, and policymaking.

Keywords: Tunisia; breastfeeding; exclusive breastfeeding; prevalence.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Forest plot of pooled prevalence of children who were never breastfed according to the MICS Tunisian surveys (2000-2006-2012-2018).
Figure 2.
Figure 2.
Forest plots of the pooled OR estimating the association between Never breastfeeding and: (A) Place of birth; (B) Mother Educational level; (C) Environment of residence; (D) Region of the country; (E) economic well-being level.
Figure 3.
Figure 3.
Forest plot of pooled prevalence of early breastfeeding initiation according to the MICS Tunisian surveys (2006-2012-2018).
Figure 4.
Figure 4.
Forest plots of the pooled OR estimating the association between early breastfeeding initiation and: (A) Place of birth; (B) Mother Educational level; (C) Environment of residence; (D) Region of the country; (E) economic well-being level.
Figure 5.
Figure 5.
Forest plot of pooled prevalence of exclusive breastfeeding during the first 6 months according to the MICS Tunisian surveys (2000-2006-2012-2018).
Figure 6.
Figure 6.
Forest plots of the pooled OR estimating the association between exclusive breastfeeding practice and: (A) Infant sex; (B) Mother Educational level; (C) Environment of residence; (D) Region of the country; (E) economic well-being level.
Figure 7.
Figure 7.
Forest plot of pooled prevalence of predominant breastfeeding during the first 6 months according to the MICS Tunisian surveys (2000-2006-2012-2018).
Figure 8.
Figure 8.
Forest plots of the pooled OR estimating the association between predominant breastfeeding practice and: (A) Infant sex; (B) Mother Educational level; (C) Environment of residence; (D) Region of the country; (E) economic well-being level.
Figure 9.
Figure 9.
Forest plot of pooled prevalence of continued breastfeeding up to the age of 2 years according to the MICS Tunisian surveys (2000-2006-2012-2018).
Figure 10.
Figure 10.
Forest plots of the pooled OR estimating the association between continued breastfeeding up to the age of 2 years and: (A) Infant sex; (B) Mother Educational level; (C) Environment of residence; (D) Region of the country; (E) economic well-being level.
Figure 11.
Figure 11.
Trend of prevalence of children who were never breastfed according to the MICS Tunisian surveys (2000-2006-2012-2018).
Figure 12.
Figure 12.
Trend of early initiation of breastfeeding according to the MICS Tunisian surveys (2006-2012-2018).
Figure 13.
Figure 13.
Trend of the prevalence of exclusive breastfeeding during the first 6 months according to the MICS Tunisian surveys (2000-2006-2012-2018).
Figure 14.
Figure 14.
Trend of the prevalence of predominant breastfeeding during the first 6 months according to the MICS Tunisian surveys (2000-2006-2012-2018).
Figure 15.
Figure 15.
Trend of the prevalence of continued breastfeeding up to the age of 2 years according to the MICS Tunisian surveys (2000-2006-2012-2018).
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