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Background: Exclusive breastfeeding (EBF) is defined as feeding infants only breast milk of the mother or a wet nurse for the first six months, without additional food or liquids except the oral rehydration solution or drops/syrups of vitamins, minerals or medicines. The working status of women in developed countries adversely affects the EBF rates, which calls for an assessment in rapidly developing countries like India. Therefore, the primary aim of the present study is to determine the prevalence of EBF using the data from the National Family Health Surveys (NFHS 3, 4, 5) conducted between 2005 and 06, 2015-16 and 2019-21 to estimate the likelihood EBF according to mothers' employment status., Methods: We did a secondary data analysis of the cross-sectional surveys. Exclusive breastfeeding was the primary dependent variable and defined as the percentage of youngest children under six months exclusively breastfed per last 24 h. The employment status of the mother was the primary independent variable and was coded dichotomously (yes/no). Chi-square analysis assessed the association of EBF with the outcome variable of interest. A multi-level modelling approach has been used for portioning variation in the prevalence of exclusive breastfeeding at different geographical levels., Results: From NFHS rounds 3 to 5, the overall prevalence of exclusive breastfeeding was 47.45%, 54.85%, and 64.01% respectively. On segregating the women as per their employment status, the prevalence among employed women was 51.1%, 51.1%, and 60.3%, while in unemployed women the prevalence was 45.9%, 54.8%, and 67.3% respectively. The odds of practising EBF in NFHS-5 doubled since NFHS-3 (Adjusted Odds Ratio: 2; 95% Confidence Interval: 1.08, 3.67). Employed mothers had a significantly lower odds ratio (0.94, 0.91, 0.98) of practising exclusive breastfeeding. The likelihood increased when mothers were exposed to media, had normal BMI, and visited health centres > 4 times during pregnancy. The likelihood decreased in older mothers, birth of infant in a health facility, female gender of the child, and late initiation of breastfeeding., Conclusions: The lower prevalence of exclusive breastfeeding among working mothers calls for an urgent need to improve policies around maternity benefits at workplaces., Competing Interests: Declarations. Ethics approval and consent to participate: Being a secondary data analysis of datasets available in the public domain, ethical approvals were not deemed necessary. All methods were carried out in accordance with relevant guidelines and regulations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Human breast milk, a naturally balanced source of infant nutrition, promotes optimal growth and health when exclusively fed for 6 months. Exclusive breastfeeding reduces common childhood infections, provides protection against some chronic illnesses, and contributes to achieving several Sustainable Development Goals. Despite its benefits, only 58% of Ethiopian women practice it, and the associated education-related inequality is not well documented. Thus, this study aims to quantify and decompose the education-related inequality in exclusive breastfeeding practice among Ethiopian mothers., Methods: A total of 1,504 weighted samples were studied using a Performance Monitoring for Action Ethiopia longitudinal panel survey dataset (2021-2023). Wagstaff normalized concentration index and its concentration curve were used to assess education-related inequality in exclusive breastfeeding practice. Wagstaff decomposition analysis was performed to decompose the concentration index and identify factors contributing to the observed education-related inequality. Significance was declared at p -value <0.05., Results: The overall prevalence of exclusive breastfeeding among Ethiopian women was 57.29% (95% CI: 54.79, 59.80%), with a greater concentration found among women with lower levels of education. This indicates an inequality that favors less educated women (pro-less educated inequality), as demonstrated by the Wagstaff normalized concentration index of -0.058 (95% CI: -0.113, -0.002). Factors that made a significant contribution to the observed education-related inequality in exclusive breastfeeding practice were residence (18.80%), region (29.31%), place of birth (-7.38%), and the wantedness status of the indexed pregnancy (82.58%). The indexed pregnancy's wantedness was made a more elastic (elasticity = 0.282) contribution., Conclusion: The study identified a small yet significant education-related inequality in exclusive breastfeeding, favoring less educated women. Hence, emphasis should be placed not only on educating women but also on healthy habits that they can leave behind when they learn. Residence, region, place of birth, and indexed pregnancy's wantedness significantly contributed to the observed education-related inequality. The elasticity value for each factor suggests that policy changes addressing these factors could readily reduce the observed inequality., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Dessie, Zemene, Gebeyehu, Anley, Anteneh, Moges, Chanie, Tsega, Belete, Alemayehu and Kebede.)

In recent years, significant progress has been made in treatment access for women living with HIV (WLHIV). For example, option B+, which requires that all pregnant persons who test positive for HIV start on antiretroviral treatment, has been instrumental in reducing the risk of vertical transmission. For birthing individuals who have a low HIV viral load, there is a minimized risk of vertical transmission during breastfeeding. However, an alarming rate of WLHIV in South Africa disengage from care during postpartum. Given that work is intricately linked to individuals' socioeconomic status, and thus health outcomes, and their health-seeking ability, it is important to explore the role of work in decisions that impact HIV-related care for the dyad postpartum. Semi-structured interviews were conducted with 26 women living with HIV at 6-8 weeks postpartum in Cape Town, South Africa. A secondary qualitative data analysis was conducted following thematic content analysis. Three themes were identified, spanning participants' financial considerations, navigating childcare needs, and considerations for exclusive breastfeeding. For many participants, there was often a conflict between returning to work, childcare, and the decision whether or not to breastfeed-in addition to their HIV care. This conflict between participants' commitments suggests an increased pressure that WLHIV may face postpartum, which could impact their ability to remain engaged in their healthcare and adherent to medication. Although exclusive breastfeeding is an important recommendation for the baby's health outcomes; there is a need for structural support for WLHIV as they navigate work re-entry during postpartum., Competing Interests: Declarations. Competing Interests: The authors have no competing interests to declare., (© 2024. The Author(s).)

Background: The World Health Organization (WHO) aims to achieve a 50% rate of exclusive breastfeeding (EBF) during the first six months of life by 2025. Continuing breastfeeding up to six months is determined by an individual woman's choice and the availability of breastfeeding-friendly environments., Methods: In this multicenter prospective longitudinal study, we identified breastfeeding-friendly environmental factors that were associated with breastfeeding practices from days 1-5 to six months postpartum. Breastfeeding-friendly environmental factors were assessed using structured questionnaires for mothers who gave birth under a Baby-Friendly Hospital Initiative (BFHI). We evaluated uptake of breastfeeding by asking mothers if they used the indicated practices, as well as their perceived level of acceptance of breastfeeding among their live-in family members and their perceived availability of lactation rooms in public settings. From 2012 to 2016, we recruited 1,870 women at 1-5 days postpartum from obstetrics medical facilities in Taiwan and followed their breastfeeding status at one, two, four, and six months postpartum. The definition of EBF was that the infant had received only breast milk since birth, with no supplemental infant formula. We categorized breastfeeding practices into two groups: continuing EBF and non-continuing EBF at six months. We used logistic regression models to identify factors associated with continuing EBF at six months postpartum., Results: The prevalence of EBF and non-EBF at six months postpartum was 30.9% and 69.1%, respectively. The logistic regression analysis revealed that above university-level education, multiparity, and vaginal delivery were positively associated with continuing EBF. The Ten Step Baby-Friendly Hospital Initiative practices, perceived acceptance of breastfeeding in live-in families, and perceived availability of lactation rooms in public settings, were associated with a higher likelihood of continuing EBF. Postpartum women who returned to work at or after two months postpartum were more likely to report non-continuing EBF than women who did not return to work., Conclusion: Those who promote public health should advocate for breastfeeding-friendly practices, including the adoption of breastfeeding-friendly measures in public and workplace settings and providing increased support for breastfeeding mothers during and after hospitalization., Competing Interests: Declarations. Ethics approval and consent to participate: The study protocol was approved by the Medical Research Ethical Foundation’s Joint Institutional Review Board (09-S-008). All participants provided informed consent. Consent for publication: Consent to publish is not required. Conflicts of interest: All authors are without conflicts of interest, including specific financial interests, relationships, and affiliations relevant to the subject of their manuscript., (© 2024. The Author(s).)

Exclusive breastfeeding (EBF) means giving only breast milk to babies 0-6 month without giving any drinks or food, except medicines and vitamins. Only 44% of babies received EBF worldwide in 2020. Meanwhile, in 2025, the target for achieving EBF is 50%. The research aim is to analyze the determinant of the success of EBF for the first-time mother. Database search via Google Scholar, Pubmed, Web of Science, Science Direct, Scopus, and Pro Quest for articles published since 2020-2022. Search keywords influencing factors, determinants, exclusive breastfeeding, first-time mothers. We found 19 articles but only 6 articles were suitable with the inclusion critrria. From the researches findings that the importance factors influence EBF practice are self-efficacy, social support, culture, relationships between parents, happiness in breastfeeding, and social environment. It is recommended that tracing activities be part of increasing the success of EBF practices for first-time mothers., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2024.)

Background: Complementary feeding is a process starting at 6 months of age when breastfeeding alone cannot provide the nutrients infants require. Foods and liquids are started along with breastfeeding up to 24 months, while complementary foods are available either from a garden or local market appropriate to complement breast milk at 6 months to satisfy the nutritional needs of the infant. Infancy is from birth to 12 months of age, and the term young child is used when referring to infants and children from 12 months to 2 years of age. Infants and young children require a sufficient diet that includes all nutrients that support overall growth and development. Appropriate feeding practices are crucial during infancy and early childhood. In addition to breastfeeding, complementary feeding should be started on time, administered safely and appropriately, and in sufficient amounts with regularity, consistency, and a variety of foods to meet nutritional needs., Objectives: This work was designed to understand the perceptions and practices of infant and young child feeding among mothers with children under 2 years in the West Shewa Zone Toke Kutaye districts., Methods: The study was conducted from December 05 to December 30, 2023. Twenty-seven mothers with children under 2 years old participated. The study was a cross-sectional descriptive qualitative study that employed focus group discussions and in-depth interviews to gather perceptions, opinions, practices, beliefs, and experiences about infant and young child feeding. Before coding, texts were double-checked against audio files to ensure accuracy and consistency. Afan Oromo conducted verbatim transcriptions of the focus group discussions and in-depth interviews, transcribed into Microsoft Word 2010., Results: The study revealed that most infants were not initiated early into breastfeeding and were not exclusively breastfed because most mothers gave cow milk, especially after 2 months, when mothers returned to working on other activities. Most mothers begin complementary feeding at the age of 4 months., Conclusions: The responses of mothers from all age strata regarding factors that hinder appropriate infant and young child feeding show a lack of awareness about initiating early breastfeeding. Extreme work overload prevented the feeding of breast milk and preparation of a complementary diet as per protocol, low utilization of family planning, and a perceived shortage of food items to prepare a balanced diet for complementary feeding were factors that hindered appropriate infant and young child feeding. Concerned stakeholders should work to alleviate the extreme workload among mothers with children under 2 years old and reduce their lack of awareness by designing appropriate infant and young child feeding education; cooking demonstrations are strongly recommended., Competing Interests: Declaration of competing interest The authors declare the following financial interests and/or personal relationships that may be considered potential competing interests: Belete Feyera reports financial support provided by Ambo University. The other authors declare no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: This study aimed to understand why breastfeeding and exclusive breastfeeding rates substantially decrease shortly after birth among mothers in the USA. Specifically, we aimed to illuminate the impact of stressful life events and racial discrimination on mothers' breastfeeding behaviors and duration., Methods: We conducted a qualitative analysis of semi-structured telephone interviews with women (N = 66; 47 White, 16 Black, and 3 Hispanic) who gave birth between 2019 and 2021 in Ohio. Interviews were conducted between March 2022 and May 2022. Interviews were digitally recorded, transcribed verbatim, analyzed, coded, and organized into themes., Results: After thematic analysis of the data, five key themes were identified: (1) stress, (2) breastfeeding barriers, (3) policy and system change to support breastfeeding mothers, (4) racial discrimination, and (5) breastfeeding motivators. Our study found that the breastfeeding experience was both a positive bonding experience and a challenging practice, characterized by physical, mental, and sociocultural struggles., Conclusion for Practice: Addressing stress during pregnancy, equitable access to culturally sensitive lactation support, improved parental leave, and enhanced workplace breastfeeding regulations are essential to increasing breastfeeding duration among racially marginalized women., (© 2023. W. Montague Cobb-NMA Health Institute.)

Background: The birth of a preterm infant is considered a crisis for the mother and the family. Given the significance of breastfeeding for these high-risk infants, failure to initiate and maintain exclusive breastfeeding in this group of infants is a prevalent and serious problem. The aim of this research was to investigate the impact of Theory of Planned Behavior based intervention on breastfeeding patterns of the mothers with preterm infants: a randomized trial., Materials and Methods: This study is a field trial conducted in Isfahan, Iran in 2021-2022. It included 72 mothers of late preterm infants, divided into the intervention (n = 36) and control (n = 36) groups. The intervention group received four training sessions focused on breastfeeding patterns based on the Theory of Planned Behavior. Before, immediately after, and two and four months after the intervention, the constructs of the Theory of Planned Behavior related to breastfeeding patterns were assessed using a researcher-made questionnaire, and the infant's breastfeeding pattern was recorded. Statistical analysis was performed using SPSS version 19, g repeated measures ANCOVA, Bonferroni post hoc test, and chi-square test., Results: The results indicated that immediately after the intervention, as well as two and four months later, the mean scores for attitude (P < 0.001), subjective norms (P < 0.001), perceived behavioral control (P < 0.001), and behavioral intention (P < 0.001) were significantly higher in the intervention group than in the control group. Additionally, the results showed that, the rate of breastfeeding immediately, two months, and four months after the intervention was significantly higher in the intervention group than before the intervention (P < 0.001). However, in the control group, the rate of breastfeeding immediately, two months, and four months after the intervention was significantly lower than before the intervention (P < 0.001)., Conclusion: Interventions based on the Theory of Planned Behavior can improve exclusive breastfeeding in late preterm infants by changing the attitudes, subjective norms, perceived behavioral control and the behavioral intentions of the mothers of preterm infants., Trial Registration: "IRCTID: IRCT20210524051392N1", 13/06/2021., (© 2024. The Author(s).)

Background: Despite the many benefits of exclusive breastfeeding to infants and mothers, only 33% of Jamaican infants are exclusively breastfed up to the recommend six months. This study was conducted to identify factors affecting mothers' feeding choices focusing on barriers to exclusive breastfeeding of infants six weeks to less than six months old., Methods: A qualitative study consisting of four focus group discussion sessions was conducted among 22 mothers attending postnatal clinics in western Jamaica from May to August 2016. The transcripts were coded by three independent coders and content analysis conducted to generate themes., Results: Four themes were identified namely, perceived advantages of breastfeeding centered mainly on the benefits of breastfeeding for the infant and mother, perceived barriers of breastfeeding highlighting physical pain and fatigue, supplementing culturally acceptable complementary foods and herbal remedies, and cultural norms including perception of how breastfeeding affects a woman's body, societal sources of breastfeeding information, satiation of infants, and family and other support. Mothers overwhelmingly agreed that breastfeeding was inexpensive, allowed them to bond with their infants and was good for the overall health and intellectual development of the infants. They identified painful nipples, engorged breasts, lack of sleep, physical exhaustion and pressure to return to work as barriers to breastfeeding. Mothers named a number of complementary foods, such as pumpkin, carrots, potato, banana, and chocho (Chayote), that were culturally accepted for feeding infants in Jamaica and discussed herbs that were considered to aid in infants' nutrition and overall health. Other cultural factors that were noted to influence exclusive breastfeeding were mothers feeling that breastfeeding would help their bodies, especially their bellies, go back to their pre-maternity figure, sources of breastfeeding information in the society including the internet, belief that breast milk alone does not satisfy babies, and family and other support., Conclusion: Mothers in this study identified unique challenges to exclusive breastfeeding that if addressed, would help to increase exclusive breastfeeding so that the World Health Organization's exclusive breastfeeding recommendations can be achieved., (© 2024. The Author(s).)

Introduction: Initiation of breastfeeding right after birth and exclusive breastfeeding for the first 6 months of life is highly recommended. In this survey, we assessed the knowledge and practice of ever-married women towards early initiation of breastfeeding and exclusive breastfeeding in the Nuristan province of Afghanistan., Methods: In a cross-sectional household survey, we enrolled 640 ever-married 15-49 years women having a child aged 0-23 months in the Parun district of Nuristan province from September to October 2021. Using a standardized data collection form and face-to-face interview, we measured self-reported demographic characteristics and the study outcomes (awareness and practice towards the initiation of breastfeeding within an hour of birth and exclusive breastfeeding for the first 6 months of life). We analyzed the data using survey methods and used bivariate and multiple Poisson regression to assess the covariates of the study outcomes., Results: About 46.9% of ever-married women were 25-34 years old, 67.5% never attended school, 30.4% were unemployed, and 86.4% had < $60 monthly income. Overall, 56.8% (95% CI 52.9-60.6) of the women had correct knowledge of the early initiation of breastfeeding, and 51.4% (95% CI 47.5-55.3) initiated breastfeeding early for their last baby. Also, 85.9% (95% CI 82.9-88.4) of the women had correct knowledge of exclusive breastfeeding, but only 32.6% (95% CI 29.1-36.4) exclusively breastfed their last baby for 6 months after birth. After adjustment for covariates, women who were 45-49 years old (Adjusted Prevalence Ratio [APR] = 1.26), Divorced/Separated (APR 1.68), ever attended school (APR 1.39), monthly income > $115 (APR 1.50) were more likely to start early breastfeeding. Moreover, women who were Divorced/Separated (APR 3.53) were more likely to exclusively breastfeed their babies for 6 months after birth., Discussion: Only over half of the women were aware of and initiated early breastfeeding. Although most women knew about exclusive breastfeeding, less than one-third exclusively breast their babies for 6 months after birth. We found several contributing factors, such as age, marital status, education, and income that should be considered for targeted interventions., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Although digital educational resources are used worldwide to educate new parents, the impact of digital resources tailored specifically to women's needs on breastfeeding practices is not well explored., Aim: The study aimed to evaluate the effectiveness of using a women-centred Web-Based Breastfeeding Educational Resource (WEBBER) in increasing the rate of exclusive breastfeeding at one month after birth., Methods: A quasi-experimental study with before and after intervention was conducted in one metropolitan hospital in Saudi Arabia. Participants were primiparous women (n=290) aged 18 or above who intended to breastfeed. The intervention involved introducing the WEBBER to pregnant women and reinforcing its uses as a routine breastfeeding educational resource. Women's characteristics and infant feeding data were collected at one month after birth via an online survey., Findings: The rate of exclusive breastfeeding at one month postpartum among the women who received the WEBBER intervention was nearly three times higher compared to the women prior to the introduction of the intervention (66 % vs. 26 %, p-value <.001). Furthermore, other predictors of exclusive breastfeeding at one month were the mother being unemployed, the baby not receiving infant formula in the hospital, and the mother having postnatal intention to continue breastfeeding for 6 months or more., Discussion and Conclusion: Using WEBBER as a routine breastfeeding educational resource increased the rate of exclusive breastfeeding one month after birth. Embedding woman-centred digital resources into routine breastfeeding education is an effective intervention for women in Saudi Arabia., Competing Interests: Conflict of Interest None to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Breast milk is the first, highly valuable, and solely natural food recommended for infants in their first six months of life, which is critical for children's overall growth and development. Evidence suggests that exclusive breastfeeding differs by geographic area in Ethiopia. However, little is known regarding the geographic distribution of exclusive breastfeeding practice. Hence, this study aimed to assess exclusive breastfeeding practice, its geographic variation and associated factors among Ethiopian mothers., Method: The study used the 2019 Ethiopian mini demographic and health survey data. All living children born 0-23 months before the survey were included. Global Moran's I statistics on Arc-GIS and Getis Ord Gi* statistics was used to visualize the spatial pattern and hotspot and cold spot areas, respectively. Kulldorff SaTScan was used to show purely significant spatial clusters. The associated factors were identified using a multilevel mixed-effects logistic regression model. Statistically significant factors were reported using the AOR with a 95% CI and a p-value of < 5%., Result: The coverage of exclusive breastfeeding practice in Ethiopia was 56.05% (95% CI: 53.95%, 58.10%). The spatial pattern was non-random across the country's regions. Somalia, Gambela, Benshangul Gumuz, Dire Dawa, and Harari regions had low clustering of exclusive breastfeeding practices, whereas Amhara, Eastern SNNPR, and Central and Northern Oromia regions had high clustering. Children born through caesarean delivery [AOR = 0.36; 95% CI: 0.21, 0.63], initiated breastfeeding within the first 1 h [AOR = 0.55; 95% CI: 0.34, 0.90], after 1-24 h of delivery [AOR = 0.36; 95% CI: 0.24, 0.54], after a day [AOR = 0.04; 95% CI: 0.02, 0.08], and women residing in the pastoralist region [AOR = 0.22; 95% CI: 0.12, 0.39] or city administrations [AOR = 0.49; 95% CI: 0.27, 0.89] had lower odds of exclusive breastfeeding practice., Conclusion: Exclusive breastfeeding practice in Ethiopia remained low. The practice had a spatial variation across the country. Caesarean section delivery, late breastfeeding initiation, and region were statistically significant variables. Therefore, promoting timely initiation of breastfeeding and improving the utilization of maternal health services and designing special intervention strategy for women residing in city administrations and pastoralist regions of the country may increase the coverage of exclusive breastfeeding practice., (© 2024. The Author(s).)

Background: The growth and development of infants during the first 1000 days of life are crucial for their health., Objectives: This study aims to assess the impact of maternal characteristics and infant feeding patterns on infant growth from birth to 18 months., Methods: Data were derived from the 2-year perspective Mother Infant Study Cohort (MISC) study which included six visits from the third trimester of pregnancy until 18 months postpartum. A convenient sample of 256 pregnant women aged 19-40 years was recruited from Sharjah, Dubai and Ajman in the United Arab Emirates., Results: Amongst mothers' characteristics, Arab nationality, pre-pregnancy overweight/obesity, higher gestational weight gain and lower physical activity were found to increase the likelihood of infants being overweight at 6, 12 and 18 months. Exclusive breastfeeding was positively correlated with reduced odds of the infant being overweight at 18 months (aOR = 0.31, 95% CI: 0.12-0.81). Breastfeeding for up to 6 months and the introduction of solid foods after 6 months was associated with reduced odds of the infant being overweight at 12 months old (aOR = 4, 95% CI: 1.1-14.6; aOR = 2.97, 95% CI: 1.09-8.08, respectively)., Conclusion: The findings spotlight the influence of maternal characteristics and infant feeding on infant growth. This asserts the need for evidence-based programmes targeting mothers to promote optimal feeding practices and foster healthy child growth., (© 2024 World Obesity Federation.)

Background: Ethiopia has committed to ending undernutrition by implementing nutrition intervention strategies, including promoting optimal feeding and care practices. To monitor and evaluate optimal infant feeding practices, it is crucial to have reliable and quality data on infant feeding indicators. Therefore, this study aimed to evaluate the extent to which breastfeeding mothers in Ethiopia have completed the continuum of age-appropriate infant feeding practices and the barriers they face., Methods: In this study, a sequential explanatory mixed method design was used. First, using datasets from performance monitoring for action (PMA) in Ethiopia, we estimated the level of the outcome and associated factors. In the quantitative (QUAN) analysis, 1755 mothers of infants were included to generate estimates. A generalized estimating equations logistic regression model was used to identify factors associated with the outcome by accounting for the clustering nature of the data by enumeration area. Then, a qualitative (QUAL) study was conducted with 14 mothers to explore their infant feeding practices using an in-depth interview guide and analyzed using a thematic approach. Results from both quantitative and qualitative data were integrated, described under the identified thematic areas, and interpreted concurrently., Results: This study showed that 13.96% (95% CI: 12.4 to 15.6%) of mothers practiced a complete continuum of age-appropriate infant feeding. Over 8% of mothers did not practice any optimal feeding. Nearly 47% of mothers practiced optimal breastfeeding, and one-fifth of mothers practiced optimal complementary feeding. Results from both quantitative and qualitative data showed that mothers' complete continuum of age-appropriate infant feeding practice was affected by their level of income, knowledge, and attitude towards optimal infant feeding, as well as by important others, including husbands, grandmothers, and health workers., Conclusion: The level of a complete continuum of age-appropriate infant feeding practice is low among breastfeeding mothers in Ethiopia. Mothers' optimal feeding practices in Ethiopia are affected by their level of knowledge and attitude towards infant feeding, income or access to food, and health workers or family members. Therefore, collaborative efforts are needed to strengthen mothers' education on the health benefits of optimal infant feeding and design and promote strategies to improve household income or access to diverse food., (© 2024. The Author(s).)

Background: This study focuses on the conceptualization and graphical characterization of Exclusive Breastfeeding Support Networks (EBSN) in Mexico., Methods: Through a sample design stratified by federal entity with state significance at 95%, a questionnaire was administered online via Microsoft Forms to a representative sample of 2989 women whose primiparity occurred in Mexico. The questionnaire primarily focused on sociodemographic data of the mothers and the structure of their EBSNs during primiparity., Results: In this work, EBSNs are defined as networks mainly composed of women, whose function is to share knowledge and experiences about breastfeeding, as well as to provide emotional and physical support to breastfeeding mothers, contributing to strengthening the emotional and caregiving bonds between mothers and their newborns., Conclusions: Sankey diagrams were employed for the characterization of EBSNs, revealing that the mother of the primipara is generally the main node, resulting in a network with greater flow and reach. Conversely, when the first node is not related to the primipara, the networks tend to be smaller and with less flow., (Copyright: © 2024 Permanyer.)

Background: Exclusive breastfeeding (BF) has the greatest potential impact on child mortality of any preventive intervention. Skin-to-skin contact (SSC) during the first hour of life is beneficial for initiating BF; however, routine separation of mother and infant is still common. This work aimed to demonstrate that SSC during the first hour of life is associated with a greater frequency and duration of exclusive BF., Methods: This is an observational case-control study. We reviewed the medical records of patients born between 2016 and 2022 classified as cases or controls based on the history of SSC in the first hour of life. Statistical analysis was performed using SPSS version 28., Results: We included 362 medical records, of which 200 (55.2%) had SSC and were considered cases; the 162 (44.8%) who did not have SSC were considered controls. Those who received SSC were more likely to receive exclusive BF at 3 (163 [81.5%] vs. 94 [58%], p < 0.001) and 6 months of age (147 [73.5%] vs. 83 [51.2%], p < 0.001)., Conclusions: Patients who received SSC in the first hour of life were more likely to receive exclusive BF at 3 and 6 months of age. Promoting and respecting this practice is essential to increase the possibility of a newborn to be exclusively breastfed for the first 6 months of life., (Copyright: © 2023 Permanyer.)

Objective: To find out actual statistics on breastfeeding in Spain, as well as sociocultural and perinatal factors that affect its initiation and maintenance., Design: Prospective, multicentre, longitudinal, nationwide study (XXX study). SITE: Primary care paediatricians' office., Participants: Cohort of newborns born between April 2017 and March 2018 in Spain who were followed up to two years of age in 8 visits., Main Measures: Rates of different types of breastfeeding were analysed at each visit and variables related to gestation, delivery, neonatal period, social, economic and biological variables were also analysed., Results: Initial sample of 1946 (50.1% male). 90.7% decided to initiate breastfeeding at birth. Exclusive breastfeeding (EBF) was 66.4% at 15days and 35.2% at 6months. Any type of breastfeeding (total breastfeeding [TBF]) at 6months was 61.7%. Median survival from TBF was 6.0months (95%CI: 6.0-6.1). Variables related to EBF at 15days: previous children, mother's level of education, absence of illness during pregnancy, no separation of mother and child at birth, no dummy use, no nipple problems, and time of decision to breastfeed. Variables related to longer duration of TBF: relationship of parents older than 5years, no dummy use, co-sleeping at one month of life, deciding to breastfeed before pregnancy, receiving information on breastfeeding during pregnancy and using support from associations., Conclusions: Early abandonment of breastfeeding is a major problem in Western societies. There are factors that can be worked on to improve outcomes., (Copyright © 2023 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: The World Health Organization (WHO) recommends exclusive breastfeeding (EBF) in infants for the first 6 months of life. This analysis aims to estimate the proportion of Indian infants exclusively breastfed for the first 6 months using the National Family Health Surveys (NFHS)-4 and 5, and further, determine factors associated with EBF practices., Methods: EBF for this analysis was defined as when infants received only breast milk and no complementary feeds (solid food, water, animal milk, baby formula, juice, and fortified food) in the last 24 h prior to the survey. The proportion of infants exclusively breastfed was plotted from birth to 6 months as per the age of children at the time of the survey, and this was computed for individual states, union territories, and overall, for India. Univariate and multivariable logistic regression analyses were performed to examine factors influencing EBF in Indian infants., Results: The proportion of Indian infants exclusively breastfed for 6 months was 31.3% (1280/4095; 95% CI 29.9, 32.7) and 43% (1657/3853; 95% CI 41.4, 44.6) as per the NFHS-4 and 5 surveys, respectively. In NFHS-5, infants of scheduled tribes (aOR 1.5; 95% CI 1.2, 1.9) and mothers who delivered at public health facilities (aOR 1.3; 95% CI 1.1, 1.5) showed an increased odds of being exclusively breastfed at 6 months of life compared to their counterparts. Further, infants of mothers aged < 20 years (aOR 0.5; 95% CI 0.4, 0.7), low birth weight infants (aOR 0.6; 95% CI 0.4, 0.8), and infants in whom breastfeeding was initiated one hour after birth (aOR 0.8; 95% CI 0.7, 0.9) showed a reduced odds of being exclusively breastfed at 6 months compared to their counterparts., Conclusions: The overall EBF practice showed an increasing trend in the NFHS-5 compared to the NFHS-4 survey. However, a vast gap remains unaddressed in the Indian setting with > 50% of the population still not exclusively breastfeeding their infants for the WHO recommended duration of first 6 months. Behavioral studies dissecting the complex interplay of factors influencing EBF within the heterogenous Indian population can help plan interventions to promote and scale-up EBF in Indian infants., (© 2023. The Author(s).)

This prospective cohort study was conducted to evaluate the association between women's satisfaction with breastfeeding at 1 month post-partum and the risk of exclusive breastfeeding (EBF) interruption before 6 months. 287 mother-infant dyads randomly selected from two maternity hospitals were followed from birth to 24 months of infant's age. Women's satisfaction with breastfeeding was assessed using the Maternal Breastfeeding Evaluation Scale (MBFES) at 1 month. The association between women's satisfaction with breastfeeding and risk of EBF interruption before 6 months was estimated using Cox proportional hazards model. Kaplan-Meier survival curves for EBF were compared between women with lower satisfaction with breastfeeding (MBFES score < median 124) and those with higher satisfaction (MBFES score ≥ 124). Median EBF duration in women with higher satisfaction was 120 days (95%CI 109-131), vs. 26 days (95%CI 19-33) in less satisfied women. Each additional point on MBFES promoted a reduction of 2.0% in the risk of EBF interruption. Among women with satisfaction scores < 124, the risk of EBF interruption was 86% higher when compared with those ≥ 124 (adjusted hazard ratio 1.86; 95%CI 1.41-2.46). Lower maternal satisfaction with breastfeeding in the first month post-partum is associated with a higher risk of EBF interruption before 6 months.

Introduction: Assessing how well a hospital adheres to the Ten Steps to Successful Breastfeeding is the key to outlining necessary modifications in mother breastfeeding support. This study aimed to assess Latinx mothers' perception of how well a hospital adheres to the Ten Steps to Successful Breastfeeding and its influence on exclusive breastfeeding (EBF) rates at hospital discharge. Methods: Secondary analysis of two longitudinal studies. The combined sample ( N  = 74) of Latinx pregnant women residing in the US. We modified, translated, and evaluated reliability of the Questionnaire for the Breastfeeding Mother (QBFM), which was applied to evaluate mothers' perception of how well a hospital adheres to the Ten Steps to Successful Breastfeeding. Results: The QBFM obtained a standardized KR-20 of 0.77. Mothers who EBF had higher scores of the QBFM than mothers who used formula during hospitalization. For each point that the QBFM score increased, the likelihood that the mother was EBF at discharge increased by 1.30 times. Conclusion: Mothers' perceptions of how well a hospital adheres to the Ten Steps to Successful Breastfeeding were the only significant variable associated with EBF at discharge. The QBFM Spanish version is a valuable instrument that can be used to obtain measurable outcomes and outlines necessary changes after implementing the Ten Steps to Successful Breastfeeding., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The exclusive breastfeeding rate in China remains significantly low. Numerous studies have identified the impact of maternal characteristics on exclusive breastfeeding; however, the correlation between primary family caregivers' characteristics, such as health and nutrition knowledge, and exclusive breastfeeding still lacks clarity. The aim of this study is to investigate the association between the health and nutrition knowledge of primary family caregivers and exclusive breastfeeding in rural China., Methods: In 2019, a cross-sectional study was conducted in two prefectures within the Qinba Mountains area, located in the southern region of Shaanxi province. Data on knowledge of health and nutrition, breastfeeding practices, breastfeeding family support, breastfeeding self-efficacy, and conflict frequency were collected via structured questionnaires from 372 caregiver-infant pairs. Infant feeding practices were assessed based on the caregivers' recall of the previous day (within the 24 h before the interview). The mother was interviewed first, followed by a brief questionnaire for the primary family caregiver, both conducted individually to minimize disruptions from other family members. Univariate and multivariate regression analyses were conducted to explore the correlation between knowledge of mothers and primary family caregivers and exclusive breastfeeding., Results: The exclusive breastfeeding rate for six-month-old infants in the sample was 15.7%. On average, mothers scored 4.6 (SD 1.4) for health and nutrition knowledge, while primary family caregivers scored 3.6 (SD 1.4). Both maternal (OR 1.48; 95% CI 1.16, 1.88) and primary family caregiver's (OR 1.34; 95% CI 1.05, 1.70) health and nutrition knowledge were significantly associated with exclusive breastfeeding. A positive correlation (OR 1.98; 95% CI 1.40, 2.80) existed between the average health and nutrition knowledge of the mother and primary family caregiver and exclusive breastfeeding. The primary family caregiver's health and nutrition knowledge was positively correlated with the practical family support perceived by the mother (OR 1.23; 95% CI 1.02, 1.49) and breastfeeding self-efficacy of the mother (β = 1.40; 95% CI 0.29, 2.50)., Conclusions: The characteristics of the primary family caregiver play a large role in exclusive breastfeeding. To promote exclusive breastfeeding, interventions should address the needs of the whole family instead of just mothers., (© 2023. The Author(s).)

Introduction: Despite its numerous benefits, exclusive breastfeeding (EBF) remains an underutilized practice. Enhancing EBF uptake necessitates a focused approach targeting regions where its adoption is suboptimal. This study aimed to investigate regional disparities in EBF practices and identify determinants of EBF among infants aged 0-1, 2-3, and 4-5 months in Tanzania., Methods: This cross-sectional study utilized data from the 2015/16 Tanzania Demographic and Health Survey. A total of 1,015 infants aged 0-5 met the inclusion criteria, comprising 378 aged 0-1 month, 334 at 2-3 months, and 303 at 4-5 months. EBF practices were assessed using a 24-hour recall method. A generalized linear mixed model, with fixed covariates encompassing infant and maternal attributes and clusters for enumeration areas (EAs) and regions, was employed to estimate EBF proportions., Results: Regional disparities in EBF were evident among infants aged 0-1, 2-3, and 4-5 months, with decline in EBF proportions as an infant's age increases. This pattern was observed nationwide. Regional and EA factors influenced the EBF practices at 0-1 and 2-3 months, accounting for 17-40% of the variability at the regional level and 40-63% at the EA level. Literacy level among mothers had a significant impact on EBF practices at 2-3 months (e.g., women who could read whole sentences; AOR = 3.2, 95% CI 1.1,8.8)., Conclusion: Regional disparities in EBF proportions exist in Tanzania, and further studies are needed to understand their underlying causes. Targeted interventions should prioritize regions with lower EBF proportions. This study highlights the clustering of EBF practices at 0-1 and 2-3 months on both regional and EA levels. Conducting studies in smaller geographical areas may enhance our understanding of the enablers and barriers to EBF and guide interventions to promote recommended EBF practices., (© 2023. The Author(s).)

Introduction : The benefits of exclusive breastfeeding (EBF) are widely reported. However, it is crucial to examine potential disparities in EBF practices across different regions of a country. Our study uses Tanzania demographic and health survey data to report on the trends of EBF across regions from 1999 to 2016, the patterns of the practice based on geographical location and socioeconomic status, and explores its determinants across the years. Methods : Descriptive statistics were used to establish the trends of EBF by geographical location and wealth quintile. A generalized linear mixed model was developed to incorporate both infant and maternal attributes as fixed covariates while considering enumeration areas and regions as clusters. The fitted model facilitated the estimation of EBF proportions at a regional level and identified key determinants influencing EBF practices across the survey periods. Moreover, we designed breastfeeding maps, visually depicting the performance of different regions throughout the surveys. Results : Across the various survey rounds, a notable regional variation in EBF practices was observed, with coastal regions generally exhibiting lower adherence to the practice. There was a linear trend between EBF and geographical residence ( p < 0.05) and socioeconomic standing ( p < 0.05) across the survey periods. Rural-dwelling women and those from the least affluent backgrounds consistently showcased a higher proportion of EBF. The prevalence of EBF declined as infants aged ( p < 0.001), a trend consistent across all survey waves. The associations between maternal attributes and EBF practices displayed temporal variations. Furthermore, a correlation between exclusive breastfeeding and attributes linked to both regional disparities and enumeration areas was observed. The intra-cluster correlation ranged from 18% to 41.5% at the regional level and from 40% to 58.5% at the enumeration area level. Conclusions : While Tanzania's progress in EBF practices is laudable, regional disparities persist, demanding targeted interventions. Sustaining achievements while addressing wealth-based disparities and the decline in EBF with infant age is vital. The study highlights the need for broad national strategies and localized investigations to understand and enhance EBF practices across different regions and socioeconomic contexts.

Aim: To explore why Croatian mothers request formula for their healthy, term newborn infants during the postnatal hospital stay., Methods: Four focus groups discussions were conducted with a total of 25 women who gave birth to healthy newborn infants, between May and June 2021 in Split, Croatia. A homogenous, non-random purposive sampling technique was used. The semi-structured interview schedule contained 15 open-ended questions. Reflexive thematic analysis was applied., Results: Three themes were generated. The first theme fear of hunger referred to the mothers' fears arising from difficulties in interpreting newborn infant behaviour and finding solace in giving formula. The second theme too little support-too late reflected participants' unrealised expectations of hospital staff. The third theme non-supportive communication addressed mother's need for empathy during the postpartum hospital stay., Conclusion: Croatian mothers want to breastfeed, but often feel unsupported in doing so in the maternity hospital setting. Antenatal education of expectant mothers and training of maternity staff in breastfeeding counselling, with a strong emphasis on communication skills, as well as employment of International Board Certified Lactation Consultants and/or volunteer breastfeeding counsellors, were perceived by participants as a way to decrease mothers' requests for formula for their healthy, newborn infants., (© 2023 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Objective: The aim of this study is to examine in-hospital exclusive breastfeeding (EBF) and its association with sociodemographic factors, medical factors, breastfeeding intentions, and health care system breastfeeding support. Materials and Methods: We conducted a retrospective cross-sectional study using medical records from 2015 to 2019 of healthy term infants without breastfeeding contraindications at a public teaching hospital serving a racially and ethnically diverse patient population. Using multivariable regression analysis, we examined the associations between in-hospital EBF and sociodemographic factors, medical factors, breastfeeding intentions, and health care system breastfeeding support (in-hospital breastfeeding education and lactation support). Results: The prevalence of in-hospital EBF was 29.0%. The statistically significant findings from our fully adjusted regression analysis include that there was a higher prevalence of in-hospital EBF among adult mothers (prevalence ratio [PR]: range 1.78-1.96), married mothers (PR: 1.35, 95% confidence interval [CI]: 1.23-1.44), and mothers who were White (PR: 1.41, 95% CI: 1.20-1.66, compared with Black). Factors associated with a lower prevalence of in-hospital EBF were maternal diabetes (PR: 0.82, 95% CI: 0.70-0.95), pre-eclampsia/eclampsia (PR: 0.82, 95% CI: 0.71-0.95), cesarean delivery (PR: 0.84, 95% CI: 0.77-0.92), neonatal hypoglycemia (PR: 0.46, 95% CI: 0.36-0.59), and intention in the prenatal period to formula feed only (PR: 0.15, 95% CI: 0.10-0.22). In-hospital lactation support was associated with higher prevalence of in-hospital EBF (PR: 1.24, 95% CI: 1.16-1.33). Conclusions: Prioritizing lactation support for Black mothers, adolescent mothers, those intending in the prenatal period to formula feed only, and mother-infant dyads with certain medical factors could improve in-hospital EBF.

Introduction: even though exclusive breastfeeding (EBF) for up to six months is recognised as essential infant care, it is still insufficiently practiced. The objective of this study was to identify predictors of EBF cessation in Thiès., Methods: this was a survival analysis of data collected using a cross-sectional procedure. Data collection took place from 2 nd December 2019 to 21 st January 2020. The study population consisted of mothers of children aged 6 to 12 months residing in Thiès and seen at the reference health centre of the Thiès Health District during infant vaccination sessions. The number of subjects was 400 mothers recruited using a systematic survey, with a sampling interval equal to two. Data were collected through a face-to-face interview. Predictive factors were identified using the Cox regression model. The adjusted hazard ratio (AHR) and its 95% confidence interval (95% CI) are calculated., Results: the average age of the mothers was 27.08 ± 6.34 years. The proportion of mothers who breastfed their child within one hour of birth was 29.25%. The proportion of those who practiced EBF was 41.50%. The incidence density of EBF cessation was 14 person-months per 100 breastfeeding mothers. The median duration of EBF was 5 months. Lack of advice on EBF during antenatal care (AHR=1.42; 95% CI =1.08-1.85), sources of information other than health professionals (AHR =1.51; 95% CI =1.05-2.19), late initiation of EBF, i.e. breastfeeding beyond 24 hours after birth (AHR =1.53; 95% CI =1.02-2.28) and low level of knowledge about EBF (AHR =1.46; 95% CI =1.11-1.92) were significantly associated with early termination of EBF., Conclusion: the promotion of EBF for up to six months will necessarily involve the promotion of prenatal consultations during which professionals should raise awareness among future mothers., Competing Interests: The authors declare no competing interests., (Copyright: Mouhamadou Faly Ba et al.)

Background: Sri Lanka is an upper-middle-income country with excellent health statistics. However, 2016 Demographic and Health Survey data have shown 82% and 64% of mothers exclusively breastfed infants aged 0-6 months and 4-5 months, respectively. The short duration of exclusive breastfeeding (EBF) has an impact on the growth and development of babies. Since no studies have been reported on EBF practices of the rural mothers in Jaffna District, an administrative district among 25 districts of Sri Lanka, this study aimed to assess the factors influencing the early cessation of EBF., Methods: For this community-based cross-sectional study, 338 mother-child pairs were selected from 2013-14. EBF was defined as children not receiving any food or drink, including complementary foods, formula milk or milk products except for medicines and vitamins or mineral drops, other than breast milk since birth. Socio-economic and demographic factors, the influence of the mode of delivery, and knowledge on EBF were obtained using an interviewer-administered questionnaire. The details of EBF and reasons for the cessation of breastfeeding before six months were obtained from a subgroup of mothers (n = 208). Multivariate analysis was performed to explore the correlates of breastfeeding., Results: In this study, 71.2% (95% CI 64.5, 77.2) had practiced EBF for six months. Early discontinuation of EBF was practiced by employed mothers (AOR 4.3; 95% CI 1.3, 13.9), mothers of low birth weight babies (AOR 3.6; 95% CI 1.6, 8.2) and those who experienced Cesarean section birth (AOR 2.9; 95% CI 1.2, 6.9). The EBF practiced by mothers of rural Jaffna was not associated with the gender of the babies, type of family, number of children in a family, religion of the household, knowledge on EBF, or family income., Conclusion: The prevalence of EBF up to six months was low in rural Jaffna, and it was influenced by employment, birthweight of the babies, and the mode of delivery. To enhance EBF, the Regional Directorate of Health Service, Jaffna, should take necessary action with policymakers to increase maternity leave for at least six months, reduce the Cesarean section rate, and provide nutritional support to pregnant mothers., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Despite benefits of exclusive breastfeeding (EBF) and its strategic place in the national guidelines for infant and young child feeding, its practice remains insufficient in Cote d'Ivoire. It is therefore important to identify its early stopping associated factors. We aimed to (i) assess the extent of children's exposure to exclusive breastfeeding and the associated explanatory factors for discontinuation before six months, and (ii) to profile non-exclusively breastfed children and interrelationships between these factors., Methods: A secondary analysis of data from the 2016 Cote d'Ivoire Fifth Multi Indicator Cluster Survey (MICS5) of 980 children under six months of age was conducted in this study. Data were analyzed using the actuarial method of survival hazard estimation combined with the Wilcoxon (Gehan) test, discrete time proportional hazards regression models, and Multiple Correspondence Analysis (MCA) to profile the children., Results: Maternal exposure to counseling session, age at delivery, and child sex were significantly associated with the likelihood of discontinuing exclusive breastfeeding before the first six months of life. Children deprived of EBF resided in urban areas, in high and very high economic welfare households. Their mothers had a secondary education or higher and had three or fewer children. Logistic analysis showed that health status and sex of the child were significantly associated (P < 0.001) with exclusive breastfeeding. An extremely important and rarely studied factor is that children who were sick in weeks prior to the survey were more likely to remain exclusive breastfeeding (adjusted OR 1.80; 95% Confidence Interval (CI) 1.452, 2.234). Girls are less likely to be exclusively breastfed than boys (adjusted OR 1.48; 95% CI 1.22, 1.798). Low standard of living was associated with early cessation of EBF (adjusted OR 2.15; CI 1.325, 3.499). The duration of the exclusive breastfeeding was significantly longer among mothers with high exposure to medical discourse (adjusted OR 0.74; CI 0.595, 0.91)., Conclusions: Improving the practice of exclusive breastfeeding in Cote d'Ivoire requires strengthening the capacities of health professionals in terms of advice and assistance to mothers for the practice of exclusive breastfeeding and its maintenance until six months of age, regardless of the health status and sex of the child., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Aim: We determined the prevalence and predictors of formula supplementation for healthy, term newborn infants in hospital., Methods: A cross-sectional study was conducted from 1 June to 21 October 2020 among Croatian women who gave birth to healthy newborn infants of ≥37 weeks gestation and birth weight of ≥2500 g at the University Hospital of Split, Croatia. The mothers completed a questionnaire on hospital infant feeding practices and breastfeeding self-efficacy. Multinomial logistic regression investigated associations between perinatal factors and formula supplementation., Results: We approached 392 mothers, and 355 (90.6%) were included: 286 (80.6%) said their newborn infant received formula in hospital and it was at their request in 173/286 (60.5%) of cases. The adjusted analyses identified factors associated with increased odd ratios (OR) and 95% confidence intervals (CI) for formula supplementation: no previous breastfeeding experience (OR 9.42, 95% CI 3.51-25.28), breastfeeding difficulties in hospital (OR 9.12, 95% CI 3.46-24.09) and older children who received formula during their birth hospitalisation (OR 11.51, 95% CI 4.4-30.1). Mothers were not routinely notified of the risks., Conclusion: An unacceptably high proportion of healthy newborn infants received formula in hospital., (© 2023 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Introduction: the World Health Organization (WHO) recommends immediate and exclusive breastfeeding in order to reduce malnutrition and neonatal mortality. The purpose of this study was to determine the prevalence of exclusive breastfeeding (EBF) and to identify its associated factors among mothers of children aged 6 to 12 months in Kaolack., Method: we conducted a cross-sectional descriptive and analytical study. The study was conducted from July 8 th , 2020 to February 8 th , 2021. Multivariate analysis was performed using the logistic regression model. The target population consisted of mothers of children aged 6 to 12 months residing in the city of Kaolack and met during vaccination sessions., Results: a total of 400 women were enrolled in the study. Among them, 51.8% practiced EBF according to the WHO recommendations. The average age of mothers was 27.42 years; 56.3% were housewives and 82.7% have done at least 4 antenatal care (ANC). Logistic regression showed an association between EBF and the following factors: age < 25 years (OR=2.03 CI 95% [1.23-3.36]), receiving advice on EBF during ANCs (OR=2.92 CI 95% [1.70-5.01]), receiving advice on EBF during postnatal care (PNC) (OR=4.33 CI 95% [2.51-7.45]), the permanent presence of mother with her baby (OR=3.97 CI 95% [1.99-7.91]), and a good knowledge of EBF (OR=4.54 CI 95% [1.96-10.51])., Conclusion: these modifiable factors can help improve the practice of EBF in the city of Kaolack., Competing Interests: Les auteurs ne déclarent aucun conflit d´intérêts., (Copyright: Boubacar Gueye et al.)

This study examined the demographic and sociocultural influences on the level of exclusive breastfeeding (EBF) practices in Enugu state. The major instrument for data collection was a uniform set of structured questionnaire and in-depth interviews with the husbands, grandmothers/mothers-in-law, health workers, women leaders, and traditional/community leaders. Data were analyzed using frequencies, percentages and chi-squared test. Qualitative data were analyzed with ATLAS.ti. The study established that the prevalence level of EBF practice was relatively low (27%) in all the local government areas in the state. The result also showed that several sociocultural factors affected EBF practice. Some of them were: influence of TBAs (91%); poor nutrition in family menu (82%); campaign/marketing of artificial feed (78.3%), unfavorable conditions in the work place (66.8%); belief that lack of water can kill a baby (64.6%) and influence of grandmothers/mothers-in-law (64.2%). The results further revealed that age, occupation, parity, and educational qualification of the mothers influences the level of EBF practice. The findings also revealed that majority of mothers practice mixed feeding in the name of EBF practice. It is suggested that more efforts are needed in giving proper and adequate education and skilled counseling on EBF practice and sociocultural factors associated with the practice.

Introduction: For infants, no one is as nutritious as breastmilk for the rest of their lives. It is a great guarantee for their future health, especially if they can exclusively breastfeed for the next few months, from the moment they are born until the end of the fifth month. Although breastfeeding rates are very low, there is no data record about it in the Gambia., Objective: This study aimed to assess the status of exclusive breastfeeding and its determinants among infants under six months of age in the Gambia., Methods: It is a secondary data analysis using the 2019-20 Gambia demographic and health survey data. A total of 897 weighted mother-infant paired samples were included in the study. A logistic regression analysis method was employed to declare factors significantly associated with exclusive breastfeeding among infants under six months of age in Gambia. Variables with a p-value of 0.2 were entered into multiple logistic regression analysis, and after controlling other confounding factors, an adjusted odds ratio of 95% CI was applied to identify associated variables., Results: Exclusive breastfeeding was found in 53.63% only among infants under six months of age. Being a rural resident (AOR = 2.14, 95% CI: 1.33, 3.41), reading a newspaper (AOR = 5.62, 95% CI: 1.32, 24.09), and being counseled on breastfeeding by a health professional (AOR = 1.36, 95% CI: 1.01, 1.82) are times more likely to practice exclusive breastfeeding, respectively. On the other hand, a child with a fever (AOR = 0.56, 95% CI: 0.37, 0.84), a child whose age is 2-3 months (AOR = 0.41, 95 CI: 0.28, 0.59), and a child whose age is 4-5 months (AOR = 0.11, 95% CI: 0.07, 0.16) is less likely to be fed exclusively than a 0-1-month-old child., Conclusion: Exclusive breastfeeding remains among the public health challenges in the Gambia. Strengthening health professionals' counseling techniques on breastfeeding and infant illnesses, promoting the pros of breastfeeding, and designing timely policies and interventions are urgently needed in the country., (© 2023. The Author(s).)

Objective: Exclusive breastfeeding has important benefits for both children and mothers. However, the proportion of exclusive breastfeeding is still not evenly distributed among regions, including in Indonesia. The purpose of this study was to analyze the practice of exclusive breastfeeding by region in Indonesia and its influencing factors., Study Design: This study was cross-sectional study., Methods: This study used secondary data from the Indonesia Demographic and Health Survey 2017. The total sample was 1621 respondents, which consisted of mothers whose last child was under six months old and was still alive; the mothers did not have twins and lived with their child. Data were analyzed by using Quantum GIS and binary logistic regression statistical tests., Results: This study shows that 51.6% of respondents gave exclusive breastfeeding in Indonesia. The highest proportion was in the Nusa Tenggara region (72.3%), whereas the lowest was in Kalimantan province (37.5%). Mothers who lived in the regions of Nusa Tenggara, Sulawesi, Java-Bali, and Sumatra had a higher chance of exclusive breastfeeding compared to those in the Kalimantan region. The factors associated with the exclusive breastfeeding vary widely across all regions, and the child's age is the only common factor associated with the exclusive breastfeeding in all regions, except Kalimantan., Conclusion: This study shows wide variation in regional proportions and determinants of exclusive breastfeeding in Indonesia. Therefore, appropriate policies and strategies are needed to increase equitable exclusive breastfeeding practices across all regions in Indonesia., (Copyright © 2023 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Exclusive breastfeeding is recommended for 6 months; however, many childbearing people wean their infants before 6 months. Psychosocial factors such as stress, social support and race are significant determinants of breastfeeding; however, few studies have longitudinally explored the effect of perceived stress and various forms of social support on exclusive breastfeeding. We used quantitative methodologies to examine exclusive breastfeeding, perceived stress and social support among 251 participants from the Postpartum Mothers Mobile Study. Participants between 18 and 44 years were recruited during pregnancy (irrespective of parity) and completed surveys in real-time via Ecological Momentary Assessment up to 12 months postpartum from December 2017 to August 2021. We measured perceived stress with the adapted Perceived Stress Scale and perceived social support with the Multi-dimensional Social Support Scale. Received social support was measured using a single question on breastfeeding support. We conducted a mixed-effects logistic regression to determine the effect of stress, race and social support on exclusive breastfeeding over 6 months. We examined the moderation effect of perceived social support and breastfeeding support in the relationship between perceived stress and exclusive breastfeeding. Black, compared with White, participants were less likely to breastfeed exclusively for 6 months. Participants who reported higher perceived stress were less likely to breastfeed exclusively for 6 months. Perceived social support moderated the relationship between perceived stress and exclusive breastfeeding (odds ratio: 0.01, 95% confidence interval: 0.001-0.072). However, breastfeeding support directly increased the likelihood of exclusive breastfeeding over 6 months. Perceived stress is negatively associated with exclusive breastfeeding. Birthing people who intend to breastfeed may benefit from perinatal support programs that include components to buffer stress., (© 2022 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

All mortality risk factors are higher in non-breastfed infants compared to infants under five months of age who receive Exclusive Breastfeeding (EBF). Examining the predicting role of maternal ideation in EBF practices can help to direct and strengthen the cooperation between multidisciplinary healthcare providers to formulate multidisciplinary breastfeeding enhancement strategies., Methods: This correlational cross-sectional study investigates the relationship between maternal ideation and EBF practice among Saudi nursing mothers at Maternal and Children's Hospital (MCH) in Najran, Saudi Arabia. The study incorporated 403 Saudi nursing mothers aged 6-12 months with healthy infants. The data collected using a questionnaire comprises demographic characteristics and obstetric history, the EBF Practice scale, and a maternal ideation scale. The data was collected from the beginning of November 2022 to the end of January 2023 and analyzed using I.B.M. version 22., Results: Breastfeeding initiation within one hour occurred among 85.1% of women, while 39.2% fed their newborn only colostrum during the first three days. EBF until six months was practiced by 40.9% of the participants day and night and on-demand (38.7%). Furthermore, 60.8% of the study participants had satisfactory overall EBF practices. The cognitive part of maternal ideation shows that 68.2% of the participants had adequate knowledge and 63.5% had positive beliefs regarding EBF practice. The maternal psychological ideation dimensions show that 81.4% had high EBF self-efficacy. The maternal social ideation dimensions showed that high injunctive and descriptive norms were present among 40.9% and 37.5%, respectively. In addition, healthcare providers (39.2%) had the most significant social influence, followed by husbands (30.5%). Binary logistic regression shows that the mother's age, occupation, and education are the significant demographic predictors of satisfactory EBF practices ( p < 0.05). All maternal ideation constructs were positive predictors of satisfactory EBF practices ( p < 0.05)., Conclusion: Maternal ideation constructs are positive predictors of satisfactory EBF practice and can be used to predict high-risk groups and plan for further intervention.

The World Health Organization (WHO) recommends that women exclusively breastfeed for the first six months and continue breastfeeding until two years of age. However, breastfeeding is declining, especially in developing countries. This study aims to describe breastfeeding habits and demographic factors influencing these practices in Jerusalem Governorate. Self-reporting questionnaires were sent to 481 mothers of preschoolers asking about the type of feeding used with their children, breastfeeding exclusively, bottle feeding, and a combination of both. Data were also collected about the duration of breastfeeding to classify women into those who adhered to the World Health Organization (WHO) recommendations and those who did not. We received 471 complete questionnaires. Two hundred and five mothers exclusively breastfed their children for 6 months or more (44.1%). Almost 11% ( n = 52) used bottle feeding exclusively, and 44.2% ( n = 208) combined both breastfeeding and bottle feeding. Having a full-time job increased the chance of not breastfeeding children (π 2 = 9.2, p = 0.002), and being a stay-at-mother increased the chance of exclusive breastfeeding (π 2 = 4.4, p = 0.044). In the final model, having a preterm baby and being a stay-at-home mother increased the odds of exclusively breastfeeding by 3.6 and 2.3, respectively. On the other hand, having a full-time job decreased the odds by 0.3. A mother's full-time employment was a determinant factor in abandoning exclusive breastfeeding before 6 months. Policies, regulations, and laws supporting the promotion of exclusive breastfeeding practices until 6 months in mothers as recommended by the WHO should be reinforced.

Background: WHO/UNICEF recommends that women in resource-poor developing countries- like the Gambia, should exclusively breastfeed their infants for the first six months of their lives because of its health benefits to both mother and infant. The study aimed to explore the cultural beliefs, attitudes, and perceptions of lactating mothers towards exclusive breastfeeding in The Gambia., Methods: This was a qualitative ethnographic study of culture-sharing groups of mothers with infants 4 to 6 months old. The study was conducted from July to October 2014 and data collection was done through a face-to-face, in-depth interview and moderate participant observation. The study recruited 22 breastfeeding mothers attending government health facilities in the Kanifing Municipality. The collected data were transcribed verbatim and analyzed through a constant comparison method generating six cultural themes, each with sub-themes., Results: Baby's welfare is traditionally based on the types of food mother's eat. To this end, mothers reportedly shunned eating green leafy vegetables, liquid and hot foods for their infants' wellbeing. Encounters such as weight loss, nipple inflammation, and backache, which mothers associated with hyper latching and sitting for prolonged breastfeeding, respectively, were among major undesirable physical effects revealed by the participants. Furthermore, the necessity of giving water to infants for their survival was illustrated as a barricade to exclusive breastfeeding practices. Likewise, the entrenched practice of giving charm water to instill the Islamic faith and shielding infants against evil spirits was another factor influencing exclusive breastfeeding practices. Finally, the belief that breast milk adequacy is based on breast size and nurturing men's physical strength by starting prelacteal feeds early in infancy also contributes to the meek exclusive breastfeeding rate among mothers., Conclusion: This study could be a gazette piece for effective policy making and enhance nurses' cultural sensitivity while caring for lactating mothers. Cultural meanings of health care behaviors in lactating mothers challenge universally applying guidelines of exclusive breastfeeding to all societies. The study findings could benefit healthcare providers in informing policies and designing culturally adaptive and acceptable community-based breastfeeding intervention programs in resource-limited settings., (© 2023. The Author(s).)

We aimed to study the impact of the COVID-19 pandemic on exclusive breastfeeding (EBF) rate and routine follow-up practices including immunization. A total of 62 neonates born to COVID-19 positive mothers and an equal number of neonates born to COVID-19 negative mothers were prospectively evaluated for EBF rate and routine neonatal follow-up practices including delay (>7 days) in routine immunization at 3 months follow-up. We further tried to compare the results across two epochs (epoch 1, March-June 2020 and epoch 2, July-November 2020). There was significantly lesser number of babies born to COVID-19 positive mothers on EBF at 3 months of age when compared with the control group (45.1% vs. 96.7%, p = 0.00) as well it was significantly lesser in epoch 1 when compared with epoch 2 (16% vs. 74%, p = 0.00). Further, a significantly higher number of babies born to COVID-19 positive mothers had their routine immunization delayed with no significant difference across the epochs. There was no significant difference in growth parameters between babies born to COVID-19 positive mother when compared with the control group as well as across the epochs. The COVID-19 pandemic has significantly disrupted the EBF rates as well as hampered the routine immunization practices among babies born to COVID-19 positive mothers. Although such practices got improved after the implementation of evidence-based national guidelines, but it is still much below when compared with those born to COVID-19 negative mother., (© The Author(s) [2023]. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Breast milk is irreplaceable for healthy development. In Mexico, by 2019, the prevalence of exclusive breastfeeding (EBF) was low and the use of breastmilk substitutes (BMSs) was high., Objective: The aim of this work was to evaluate the maternal and child characteristics related to breastfeeding (BF) duration and to the introduction of BMSs for residents of Mexico City (CdMX) and an agricultural town in Morelos., Methods: A cross-sectional study was conducted with 160 mother-child binomials (0-15 months of age) from the megacity CdMX and the agricultural town., Outcomes: EBF and total breastfeeding (TBF) duration, age of transition to BMSs, and the introduction of complementary feeding (CF) were assessed. Associations with maternal and infant factors were assessed using Cox models., Results: The prevalence of EBF in the joint samples at 5.9 months was 32.6% and 5.8% at 6 months. EBF was favored under the following conditions: living in CdMX, receiving prenatal care, no newborn hospitalization, and breastmilk provided as first food at birth. TBF was prolonged under the following conditions: older mother, female children, rooming-in care during puerperium, receiving BF upon discharge after birth, cohabiting with extended family, and having no siblings. The introduction of BMSs predominated under the following conditions: living in an agricultural town, BMSs given after birth before discharge, younger mother, worker mother, and lack of prenatal care. The early introduction of CF (before the fourth month) was 2% for CdMX and 14% for the agricultural town., Conclusions: The agricultural population had a higher risk of the premature interruption of EBF/TBF and the early introduction of BMSs and CF. Protective factors were family-friendly environments and being born in a baby-friendly hospital.

The status of breastfeeding practices remains unsatisfactory across China, but regional differences persist. However, disaggregated data for specific provinces are limited. This representative survey determined the status of breastfeeding and factors associated with breastfeeding practices in Shanghai. The questionnaire was designed in compliance with indicators for assessing infant and young child-feeding practices defined by the World Health Organization and the United Nations Children's Fund (UNICEF). A total of 2665 children aged two years and younger (0-730 days) were investigated, among whom 1677 were aged under six months. The early initiation of breastfeeding (EIBF) rate was 60.3%. Among children aged under six months, 43.4% were exclusively breastfed (EBF). The univariate regression analysis showed that the EBF rate was influenced by multiple factors, including individual, socioeconomic, workplace and employment, and health system. The subsequent multivariate analysis suggested that mothers with a higher rate of EBF shared the following characteristics: intention to breastfeed during pregnancy, breastfeeding knowledge, and higher satisfaction with support through the healthcare system after delivery. The rate of EBF in Shanghai is over 40%, and supporting breastfeeding requires measures at multiple levels, including individual attributes, women's work and employment conditions, breastfeeding knowledge, and health services.

Purpose: This systematic review aims to identify factors influencing exclusive breastfeeding (EBF) up to 6 months., Methods: The databases including PubMed, MEDLINE, CINAHL, Scopus, EMBASE, CNKI, and WANFANG were searched to retrieve studies. Quantitative research were extracted and the preferred reporting items for systematic reviews were followed. Critical appraisal checklists of Joanna Briggs Institute were used to evaluate the quality of the included studies., Findings: A total of 16 papers were eligible for this systematic review, comprising five cohort studies and 11 cross-sectional studies. Moderate to strong evidence supported that 6-month exclusive breastfeeding is affected by maternal working status, breastfeeding knowledge, delivery mode, parity, perception of insufficient human milk, mothers' infant feeding attitude, breastfeeding self-efficacy, and intention., Conclusions: Factors influencing EBF up to 6 months postpartum play a key role in promoting mothers' health and reducing diseases in their infants., Implications for Nursing Practice: Interventions based on related factors should be developed and taken into practice to assist mothers in exclusive breastfeeding for up to 6 months. Additional studies from different countries in different populations with high quality are needed to provide more reliable and richer findings., (© 2022 NANDA International, Inc.)

Breastfeeding (BF) initiation rates in French maternity units are among the lowest in Europe. After increasing for several years, they decreased between 2010 and 2016, although several maternal characteristics known to be positively associated with BF in France were more frequent. We aimed to (1) quantify adjusted trends in BF initiation rates between 2010 and 2016; (2) examine associations between BF initiation rates and newborn, maternal, maternity unit, and department-level characteristics. Using data from the 2010 (n = 12,224) and 2016 (n = 11,089) French National Perinatal Surveys, we analysed BF initiation (exclusive, mixed, and any) through a succession of six mixed-effect multinomial regression models, progressively adding adjustment covariates. Adjusted exclusive and any BF initiation rates decreased by 9.6 and 4.5 points, respectively, versus by 7.7 and 1.8 points, respectively, in the crude analysis. In both years, adjusted exclusive and any BF initiation rates were lowest in the following categories of mothers: low education level, single, high body mass index and multiple or premature births. Exclusive BF initiation decreased most in primiparous mothers, those with the lowest household income, mothers that had a vaginal delivery, women born in an African country and those who delivered in a maternity unit without Baby-Friendly Hospital Initiative designation. The 2010-2016 decrease in BF initiation rates in France cannot be explained by changes in mothers' characteristics; quite the opposite, adjustment increased its magnitude. Additional efforts should be put in place to understand why this decrease is particularly sharp in some subgroups of mothers., (© 2022 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Inequitable gender norms can contribute to rapid repeat pregnancies and adverse maternal health outcomes among adolescent girls and young women. This study examined associations between male partners' gender-equitable attitudes and behaviors and postpartum family planning (FP) and maternal and newborn health (MNH) outcomes among first-time mothers aged 15-24 in Kinshasa, Democratic Republic of the Congo. Participants were 1335 couples who were successfully interviewed in the Momentum project's 2018 baseline and 2020 endline surveys. Multivariable regression models were used to analyze predictors of postpartum FP discussion and use, shared MNH decision making, completion of the maternal health continuum of care, and exclusive breastfeeding. Male involvement in maternal health was significantly associated with FP discussion and shared decision making. Male partners' willingness to be involved in routine childcare and shared decision making were significant positive predictors of exclusive breastfeeding. Postpartum FP outcomes were shaped by the intersection of marital status and male partners' gender-equitable attitudes, intimate partner violence perpetration, and willingness to engage in routine childcare activities to constitute advantage for some outcomes and disadvantage for others. Interventions must use multiple measures to better understand how young mothers' health outcomes are shaped by their male partners' gender-related attitudes and behaviors.

Uncertainty concerning the associations between rooming-in and breastfeeding duration remains at postpartum care centers. This cross-sectional study investigated the associations between the rooming-in policy and continual exclusive breastfeeding among first-time mothers at a postpartum center. Of the 160 participants, only 12.5% ( n = 20) implemented full rooming-in. At 3-month follow-up, 85% ( n = 17) of those individuals were exclusively breastfeeding. At the same time point, no participant practicing partial rooming-in ( n = 140) was exclusively breastfeeding. The generalized estimating equation analysis indicated that full (24 h) rooming-in was statistically associated with continual exclusive breastfeeding 1 month postpartum (odds ratio (OR) = 0.90, p < 0.001) and 3 months postpartum (OR = 0.73, p < 0.001). Significant factors associated with a first-time mother's willingness to practice full rooming-in included vaginal delivery, a prenatal decision to practice breastfeeding, and undergoing prenatal classes on both rooming-in and breastfeeding. Success with continual exclusive breastfeeding in the postpartum period is dependent on full rooming-in. The findings serve as a reference for promoting exclusive breastfeeding for the first 6 months, as recommended by the World Health Organization.

Background: Early initiation of breastfeeding within the first hour of birth and exclusive breastfeeding (EBF) for the first six months of life are beneficial for child survival and long-term health. Yet breastfeeding rates remain sub-optimal in Northwestern Nigeria, and such practices are often influenced by complex psychosocial factors at cognitive, social and emotional levels. To understand these influences, we developed a set of breastfeeding-related ideational factors and quantitatively examined their relationship with early initiation of breastfeeding and EBF practices., Methods: A cross-sectional population-based survey was conducted in Kebbi, Sokoto, and Zamfara states from September-October 2019. A random sample of 3039 women with a child under-2 years was obtained. Respondents were asked about the two main outcomes, early initiation of breastfeeding and EBF, as well as breastfeeding-related ideations according to the Ideation Model of Strategic Communication and Behavior Change. Average marginal effects were estimated from mixed-effects logistic regression models adjusted for ideational and socio-demographic variables., Results: Among 3039 women with a child under 2 years of age, 42.1% (95% CI 35.1%, 49.4%) practiced early initiation of breastfeeding, while 37.5% (95% CI 29.8%, 46.0%) out of 721 infants aged 0-5 months were exclusively breastfed. Women who knew early initiation of breastfeeding was protective of newborn health had 7.9 percentage points (pp) [95% CI 3.9, 11.9] higher likelihood of early initiation of breastfeeding practice than those who did not know. Women who believed colostrum was harmful had 8.4 pp lower likelihood of early initiation of breastfeeding (95% CI -12.4, -4.3) and EBF (95% CI -15.7%, -1.0%) than those without that belief. We found higher likelihood of early initiation of breastfeeding (5.1 pp, 95% CI 0.8%, 9.4%) and EBF (13.3 pp, 95% CI 5.0%, 22.0%) among women who knew at least one benefit of breastfeeding compared to those who did not know. Knowing the timing for introducing complementary foods andself-efficacy to practice EBF were also significantly associated with EBF practices., Conclusion: Ideational metrics provide significant insights for SBC programs aiming to change and improve health behaviors, including breastfeeding practices, Various cognitive, emotional and social domains played a significant role in women's breastfeeding decisions. Maternal knowledge about the benefits of breastfeeding to the mother (cognitive), knowledge of the appropriate time to introduce complementary foods (cognitive), beliefs on colostrum (cognitive), self-efficacy to breastfeed (emotional) and perceived social norms (social) are among the most important ideations for SBC programs to target to increase early initiation of breastfeeding and EBF rates in northwestern Nigeria., (© 2022. The Author(s).)

Background: The World Health Organization identifies exclusive breastfeeding as the gold standard for child nutrition. Breastfeeding provides many benefits to both the baby and the mother. First days after birth are crucial for breastfeeding and determining its further path. Unfortunately, very often it is also the time of facing the first breastfeeding problems. The aim of this study was to analyse selected factors influencing a mother's decision to breastfeed., Methods: This is a cross-sectional study conducted between March 2019 and November 2019 in selected Polish maternity wards. Data were collected through completion of author's questionnaire and a standardised questionnaire and the Multidimensional Perceived Social Support Scale and also through informal interviews with mothers. During statistical analysis, the chi-square test of independence and the Kolmogorov-Smirnov test as well as the non-parametric Mann-Whitney U test in addition to Fisher's exact test were performed., Results: The results showed that there is no correlation between the mode of delivery and the mother's choice of infant feeding method. Knowledge of the benefits of breastfeeding and received support affects the mother's decision on infant feeding method. The study also showed that the 83% of newborns were put to the breast within the first 2 h after birth. However, only 58% continued to be breastfed in the subsequent days. As many as 42% of the newborns were supplemented with formula despite early initiation of breastfeeding. Analyses showed that exclusive breastfeeding was more often chosen by mothers with higher education. And the most common breastfeeding problem reported by 62% of the respondents was perceived insufficient milk supply and also breastfeeding pain, reported in 48.5% mothers., Conclusions: It is extremely important to continually promote breastfeeding among women. The role of midwives is crucial in this regard, as they should encourage the initiation of breastfeeding, support mothers during the perinatal and postnatal periods, and increase their sense of competence and confidence in their ability to breastfeed. Accessible, professional, and empathetic support can help reduce the number of women supplementing with modified milk. Undoubtedly, the postpartum period is important for breastfeeding outcomes, but it is significant that breastfeeding education and promotion begin during pregnancy., (© 2021. The Author(s).)

Background: WHO and UNICEF (1990) have recommended EBF for six months, followed by an introduction of complementary foods at the age of six months with continued breastfeeding for the first 24 months or more. Exclusive breastfeeding (EBF) during the first 6 months of life reduces infant morbidity and mortality. According to Ethiopia Demographic Health Survey (DHS), only 58% of children were exclusively breastfed during the first 6 months of age., Objective: The study aimed to identify time to early cessation of EBF and associated factors among 6-12 months old children in Lanfuro Woreda, Silte Zone., Methods: A community-based cross-sectional study was conducted in Lanfuro Woreda, Silte Zone, from March to April 2017. A total of 636 mothers with 6-12 months old infants from ten randomly selected kebeles were included. Both quantitative and subjective information assortment techniques were utilized. The Kaplan-Meier curve with log-rank test was used to compare the survival difference by the selected covariates. Both bivariate (P < 0.25) and multivariable (P < 0.05) Cox Proportional Hazards model were fitted to identify factors predicting time to early cessation of EBF., Results: The median duration of exclusive breastfeeding was 6.22 months. The highest proportion of cessation of exclusive breastfeeding occurred during the first four to five months. Early cessation of exclusive breastfeeding was observed in 295 (48%). Place of residence (AHR: 1.6; 95% CI = 1.14-2.20), knowledge on EBF (AHR = 1.31; 95% CI = 1.02-1.68), type of delivery (AHR: 2.41; 95% CI = 2.24-3.68), pre-lacteal feeding (AHR = 1.8; 95% CI = 1.32-2.36) and household food insecurity (AHR = 5.02; 95% CI = 3.89-6.50) were significant independent factors which were associated with time to early cessation of exclusive breastfeeding., Conclusion and Recommendation: There are still sizable proportions of children not enjoying exclusive breastfeeding for the first full six months. Being an urban resident and coming from food-insecure households, giving birth by CS, having low knowledge on EBF, and giving pre-lacteal feeding were factors associated with time to early cessation of EBF. Multi-sectoral action should be taken for respective predictors of time to early cessation of EBF., Competing Interests: Declaration of competing interest The authors confirm that they have no competing interests., (Copyright © 2022 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Objectives: Exclusive breastfeeding is the ideal source of nutrition for the first 6 months of life. Although skin-to-skin contact (SSC) has been shown to be associated with greater rates of exclusive breastfeeding, the results are heterogeneous. SSC involves placing a naked infant on its mother's bare chest immediately after birth. We examined the association between SSC immediately after birth and exclusive breastfeeding at 4 months., Methods: A retrospective cohort of healthy, term, singleton infants who were liveborn from 2008 to 2019 was constructed from the Nova Scotia Atlee Perinatal Database. Our main outcome was exclusive breastfeeding at 4 months, available for a subset of the cohort through linkage to a primary care database (n=256). Our secondary outcome was exclusive breastfeeding at hospital discharge, available for the broader cohort (n=56,459). Odds ratios (OR) for the association between SSC and exclusive breastfeeding at 4 months were estimated from logistic regression models., Results: The odds of breastfeeding exclusively at 4 months were 4.14 (95% confidence interval (CI) 1.89-9.25) times greater among those who had SSC than among those who did not. The odds of breastfeeding exclusively at hospital discharge were 3.81 (95% CI 3.64-3.99) times greater among those who had SSC than among those who did not. The association between SSC and exclusive breastfeeding at hospital discharge was heterogeneous by birth year (OR 4.35, CI 4.07-4.65 in 2008-2011; OR 2.81, CI 2.57-3.07 in 2012-2015; OR 1.89, CI 1.63-2.10 in 2016-2019)., Conclusion: Skin-to-skin contact appears to be associated with greater odds of exclusive breastfeeding at discharge and 4 months postpartum. Early SSC should continue to be supported for breastfeeding promotion., (© 2022. The Author(s) under exclusive license to The Canadian Public Health Association.)

The present study determined whether behavioral economic demand analysis could characterize mothers' decision to exclusively breastfeed in the workplace. Females, aged between 18 and 50 who have given birth in the past three years, completed a novel demand task with hypothetical scenarios, in which they returned to work with a 2-month-old baby. Participants rated their likelihood of breastfeeding their baby at a workplace lactation room versus formula-feeding their baby at their desk. The distance to the lactation room ranged from 10 s to 60 min. This assessment was conducted with and without hypothetical financial incentives for 6-month exclusive breastfeeding. Primary dependent measures were demand intensity and change in demand elasticity, which could conceptually represent initiation and continuation of breastfeeding, respectively. Demand for breastfeeding was more intense and less elastic (i.e., more likely to initiate and continue breastfeeding) among mothers with an experience of 6-month exclusive breastfeeding and under the condition with the financial incentives. The novel demand task can potentially provide a useful behavioral marker for quantifying mothers' decision to initiate and continue exclusive breastfeeding in the workplace, informing workplace policy regarding lactation rooms, identifying risk for early cessation, and developing and individualizing an intervention to assist mothers to exclusively breastfeed in the workplace., (© 2022 Society for the Experimental Analysis of Behavior.)

Background: It is unclear if state laws supporting breastfeeding are associated with exclusive breastfeeding (EBF) practice among low-income mothers participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The main objectives of our study were to assess the relationship between such laws and EBF among WIC-participating mothers and to assess whether this association varied by employment status. We also assessed how mother's exposure to WIC breastfeeding consultation was associated with EBF., Methods: A cross-sectional study was conducted across seven WIC program locations (i.e., Georgia, Massachusetts, Nevada, Pennsylvania, Wisconsin, Wyoming, Chickasaw Nation) between July-August 2020. Data were collected using convenient sampling from each program location and surveys were administered electronically or on paper to WIC-participating mothers. We restricted our analysis to data from 1161 WIC-participating mothers with infants aged zero to five months old. Multivariable mixed models were used to estimate the relationship between our exposures of interest (i.e., number of laws supporting breastfeeding, employment-related breastfeeding laws, WIC breastfeeding consultation) and EBF, while controlling for potential confounders and accounting for clustering by program location. Effect modification by employment status was assessed on the additive and multiplicative scales., Results: Among WIC-participating mothers living in program locations with no employment-related breastfeeding laws, EBF was 26% less prevalent for employed mothers compared to unemployed mothers (adjusted prevalence ratios [aPR]: 0.74, 95% CI: 0.67,0.83). Among all mothers, a one-unit increase in laws supporting breastfeeding was not associated with EBF (aPR: 0.88, 95% CI: 0.71,1.10). However, among employed mothers, living in areas with more employment-related laws was associated with a higher prevalence of EBF (aPR: 1.43, 95% CI: 0.83, 2.44). Infants whose mothers received a WIC breastfeeding consultation had 33% higher prevalence of being exclusively breastfed compared to infants whose mothers did not receive a WIC breastfeeding consultation (aPR: 1.33, 95% CI: 1.05,1.70)., Conclusions: Infants whose WIC-participating mothers were employed, were less likely to be exclusively breastfed, but our effect modification analyses showed that laws supporting breastfeeding at the workplace may promote EBF among employed women. EBF was more prevalent among mothers who received a WIC breastfeeding consultation compared to those who did not receive such a consultation., (© 2022. The Author(s).)