Spatial variations and determinants of bottle feeding among children aged 0–23 months in Ethiopia in 2019: A spatial and multi-level analysis

Background: Bottle feeding should be avoided since it interferes with optimal breastfeeding and it causes diarrheal-related morbidity and mortality. Despite the WHO’s recommendation that children to avoid bottle feeding, it is still widely practiced in developing countries including our country, Ethiopia. Therefore, this study aimed to assess the spatial variations, and determinants of bottle feeding among children aged 0–23 months using the recent demographic and health survey data for Ethiopia. Methods: A secondary data analysis was conducted using the 2019 Ethiopian mini demographic and health survey data. The total weighted sample of 2067 children aged 0–23 months was included in this study. Spatial analysis was done to identify the hotspot areas of bottle feeding among children in Ethiopia. Multivariable multilevel logistic regression was used to identify predictors of bottle feeding. The spatial analysis was done using ArcGIS 10.7 and Sat Scan 9.6 software. Result: The prevalence of bottle feeding among children aged 0–23 months was 21.52% with 95% CI(19.80%, 23.34%). Age of the child from 6–11 months, and 12–23 months age, having secondary and above education [AOR = 2.09; 95%CI; 1.31, 3.32], being from middle and rich household [AOR = 2.14; 95%CI; 1.37, 3.34] and [AOR = 2.30; 95%CI; 1.46, 3.63], and twin birth [AOR = 8.06; 95%CI; 2.87, 22.58] were significant predictors of bottle feeding. Hotspot areas of bottle feeding were observed in Addis Ababa, Dire Dawa, Harari, and Afar regions of Ethiopia. Conclusion: Bottle feeding practice was found to be spatially clustered in Ethiopia. Education, wealth index, parity, and child’s age were significant predictors of bottle feeding. Hotspot areas of bottle feeding were observed in Addis Ababa, Dire Dawa, Harari, and Afar regions. Special attention should be directed towards mothers residing in hotspot areas, educated mothers, mothers of multiple births, and mothers from rich households through community education programs focused on child feeding practices to reduce the practice of bottle-feeding in Ethiopia.