Predictors of Exclusive Breastfeeding Among Infants Below Six Months: A Multilevel Analysis of Nigeria Demographic Health Survey

Abstract Background Exclusive breastfeeding (EBF) for the first six months of life is critical for infant health and maternal well-being, yet Nigeria’s EBF rates remain suboptimal at 23–28.7%, far below the WHO’s 2030 target of 70%. This study identifies individual and community-level predictors of EBF in Nigeria, using nationally representative data to inform targeted interventions. Methods A cross-sectional analysis of the 2018 Nigeria Demographic and Health Survey (NDHS), involving 1,232 infants under six months, was conducted. Multilevel logistic regression models assessed associations between EBF and maternal, child, and community factors. Hierarchical models (null, individual, community, and combined) were fitted, and measures of variation (ICC, PCV, MOR) and model fitness (AIC, BIC) were evaluated. Significance level was set at p-value ≤ 0.05 at 95% confidence interval. Results The prevalence of EBF varied significantly by infant age, maternal education, occupation, wealth index, media exposure, and regional disparities. EBF prevalence declined sharply with infant age (39.7% at 0–1 month vs. 19.9% at 4–5 months; p < 0.0001). Maternal age positively correlated with EBF, peaking at 4.4 times higher odds among mothers aged 40–44 (aOR = 4.37, 95% CI: 1.70–11.22). Sales/business occupations (aOR = 1.61, 95% CI: 1.10–2.33) and weekly radio exposure (aOR = 1.57, 95% CI: 1.00–2.48) increased EBF odds. Regional disparities were significant, with the North West (aOR = 0.43, 95% CI: 0.21–0.87) and South East (aOR = 0.42, 95% CI: 0.20–0.92) showing lower rates than the North Central region. Conclusions EBF in Nigeria is influenced by a complex interplay of individual, maternal, and community-level factors. Interventions should focus on supporting younger mothers, promoting workplace flexibility, and addressing regional disparities. Policy measures to increase maternal education and media exposure could further improve EBF rates across the country.