Development and Pilot Testing of a Comprehensive and Culturally-sensitive Infant Feeding Structured Questionnaire: A Cross-sectional Design

Development and Pilot Testing of a Comprehensive and Culturally-sensitive Infant Feeding Structured Questionnaire: A Cross-sectional Design | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Development and Pilot Testing of a Comprehensive and Culturally-sensitive Infant Feeding Structured Questionnaire: A Cross-sectional Design Basma Al Yazeedi, Salma Al Yazeedi, Omar Al Omari, Badriya Alhatali, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4038672/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Feb, 2025 Read the published version in BMC Public Health → Version 1 posted 4 You are reading this latest preprint version Abstract Background: Infant feeding tools available in the literature lack comprehensiveness and inclusiveness to infants of different ages. This study aimed to pilot test a newly developed infant feeding structured questionnaire. Methods: This study utilized a cross-sectional design. The structured questionnaire developed had two main sections; the first section included questions relative to sociodemographic characteristics, birth and clinical history, and infant food history in the first year. The second section incorporated a 22-item design to stipulate a comprehensive description of infant feeding practices (IFP) and Infant Feeding Beliefs (IFB). A convenient sampling technique was used to collect data from six health centers located in Muscat and Al-Sharqia North. The infant feeding practices and beliefs variables were dichotomized to either meeting the recommendations (1) or not meeting the recommendations (0), based on the WHO guidelines Results: The data analysis encompassed a cohort of 203 participants. Most mothers aged between 26 and 35 years (58.6%). Among the mothers, 67% practiced exclusive breastfeeding in the first six months, 89.2% were breastfeeding in the first year, and 44.9% initiated infant formula feeding at six months of age or later. Moreover, 64% of the mothers introduced solid food (e.g., rice, vegetables, fruits) at six months, while (87.2%) started feeding meat, chicken, or fish at six months. For feeding egg white, fresh milk, and bee honey, 43.4%, 84.7%, and 78.4%, respectively, met the recommendation of waiting until the child ages 12 months. The mean IFP score was 8.09 (SD 1.75), while the mean IFB score was slightly higher (m=8.90, SD= 1.45). The Pearson correlation analysis signified a positive relationship between IFP and IFB (r=0.53, p<0.001). Mothers who received infant feeding counseling had higher IFP scores compared to the mothers who did not. Additionally, mothers with at least a baccalaureate degree and a family income of at least 1000 OMR had better IFB recommendation scores (p < 0.05). Conclusions: Data generated from the newly developed infant feeding practices and beliefs questionnaire shall assist in determining the risks associated with multiple nutrition-related morbidities in children, thus promising a valid and feasible mean for a comprehensive infant feeding assessment. Feeding Infant Complementary Breast Feeding Questionnaire Background Nutrition is the key element regulating children’s growth, particularly during infancy. During this phase, the energy requirements are the utmost due to heightened metabolic activity aligning with rapid growth [ 1 ]. Simultaneously, the infant’s digestive system is at its most vulnerable stage where unintentional feeding inaccuracies can result in serious health complications including allergies, eczema, iron-deficiency anemia, rickets, obesity, respiratory illnesses and infant botulism, among many others [ 2 ]. The 2022 statistical data from the Oman Ministry of Health reported that among children younger than five years, 10.2% had iron deficiency, 10.6% had vitamin D deficiency, 11.2% were underweight, and 4.2% were having overweight or obesity [ 3 ]. Health organizations, including esteemed entities such as the World Health Organization (WHO) and the Center for Disease Control (CDC), have set comprehensive infant feeding guidelines and recommendations. These recommendations vary between the first and second six months of infant’s age, aligning with the dynamic developmental alteration that dictate the nutritional needs and digestive capabilities of the growing infant. The infant’s digestive system in the first six months of age is merely capable of processing human milk or modified milk, which comprises all the essential nutrients the body needs. The advantages of exclusive breastfeeding surpass the modified milk across biological, psychosocial, and cognitive domains [ 4 ], thus supporting the endorsement of exclusive breastfeeding during the initial six months. At the age of six months, the gradual incorporation of solid food should commence, marking a stage when the body has acquired sufficient mechanical and physiological capabilities such as enhanced digestive enzymes, increased stomach capacity, enhanced sitting skills, development of teeth, and improved jaw function [ 5 , 6 ]. Limited breastfeeding experiences during infancy have been linked to reduced immunity and obesogenic eating behaviors [ 7 ]. Exposing the infant to a variety of food options during the second six months of life is essential for accepting and meeting the nutritional demands at a later stage of life [ 8 ]. However, early introduction of solid food has been found to increase the incidence of eczema, allergies, and respiratory infection, as well as obesity [ 9 – 11 ]. At the same time, food items such as honey, unmodified milk and egg whites, are refrained until the infants’ first birthday due to their association with identified health risks [ 12 ]. Bee honey, for instance, has been demonstrated to be associated with infant botulism when introduced before the age of one year [ 13 ]. The imposition of safe and healthy infant feeding practices places a considerable amount of pressure upon parents. Health care providers share that burden as they are the main source of parent’s awareness and support. Consequently, regular assessment of infant feeding practices emerges as an imperative undertaking, serving as a foundational strategy for the early identification of nutritional risks and potential concerns. A review of the regional literature indicates a suboptimal level of adherence to the infant feeding recommendations and stresses the need for immediate measures to promote children’s healthy nutrition [ 14 ]. A Saudi study examined the infant feeding practices among mothers of infants aged between 4 to 12 months through an electronic mothers' feeding practices semi-structured questionnaire and found that only 5.3% of infants exclusively breastfeed in the first six months and 64.3% were introduced to complementary food before the age of six months [ 15 ]. In a population-based survey conducted in the United Arab Emirates, 26% of infants had exclusive breastfeeding in the first six months and 19% started complementary feeding before the age of six months [ 16 ]. Data from the Oman National Nutrition Survey (ONNS) conducted in 2017 indicated that less than a third of the mothers (29%) were exclusively breastfeeding their infants in the first six months of age [ 17 ]. Complementary food including juice, yogurt, soup and porridge were introduced to infants younger than six months with percentages ranging from 6–13%[ 17 ]. Without undermining the significance of data presented by the above studies, data about the infant feeding practices from the Middle East and Northern Africa (MENA) region is fragmented and lacks inclusiveness. Simultaneously, Arabic women living the Western countries convey needs related to culturally sensitive infant feeding services [ 18 ]. Nevertheless, infant feeding tools available in the literature lack comprehensiveness and inclusiveness to infants of different ages. The ONNS screening tool, adapted from the WHO’s STEP wise approach, focuses on the initiation of breastfeeding, exclusive breastfeeding in the first six months, and acceptable diet scores for infants aged 6 to 24 months. The acceptable diet score is calculated based on the diet diversity (number of food groups) and frequency indices in the previous 24 hours [ 19 ]. Thus, providing a snapshot of the infant feeding practices. However, it lacks specifications related to the timing of introducing certain food items, which guide healthcare providers in estimating the associated health risks. Researchers from the United States (US) assessed the infant feeding practices through the Complementary Feeding Utility Index (CFUI). The CFUI standards evaluated the exposure to iron-rich cereal, energy-dense nutrient-poor foods, teas/broths, vegetables, fruits, sugary drinks, and breastfeeding duration. The results indicated a suboptimal intake of fruits and vegetables, increased sugary drinks, and reduced duration of breastfeeding [ 20 ]. Despite the significance of the results extracted, it lacked specifications related to the timing of introducing the food items. Available tools put more attention on breastfeeding practices and initiation of complementary feeding in general, where they fall short in providing specifications about certain early or late infant feeding practices that are known to link with specific risks. For example, feeding infants bee honey before the age of 12 months is a common practice in the Middle East. Hence, no questionnaire has assessed the phenomenon adequately. That led to blurriness in the estimated risks for infant botulism. Thus, there is an urgent need for a rigorous, comprehensive and culturally sensitive infant feeding assessment tool. To fill the gap and contribute to estimating the infant feeding risks, this study pilot tested a newly developed infant feeding structured questionnaire that aims to provide a comprehensive description of infant feeding practices and beliefs, adherence to infant feeding recommendations, and maternal factors associated with adherence to infant feeding recommendations. Methods Study Design This study utilized a cross-sectional design to pilot test the newly developed Infant Feeding Practices and Beliefs (IFPB) structured questionnaire. The choice of a cross-sectional design, well-recognized for its ability to promptly gather comprehensive data, was deemed optimal for assessing the feasibility of the newly developed tool. Furthermore, considering the data collection nature involving the history of infant feeding practices in the first year, this study design was expected to closely resemble real-world scenarios, enhancing the tool's relevance and applicability to the intended population[ 21 ]. Tool Development Process The process of developing the IFPB tool encompassed several sequential stages aimed at ensuring its validity and applicability to the intended purpose. The initial stage involved conceptualizing the tool's objectives and delineating the target population. Extensive planning was undertaken, including a comprehensive literature review, consultations with experts, and the establishment of specific tool variables. In the second stage, the authors generated a pool of potential items in alignment with the predefined objectives and drafted the first version of the tool in English. The drafted tool underwent rigorous assessment by experts in the child health and child nutrition fields (infant botulism, pediatric infection disease, infant feeding, and academic professors in child health) to evaluate its content validity. Revisions were then made based on the experts’ feedback to enhance the tool's content and relevance. Items then were translated into Arabic by three bilingual experts in child health. The third stage of the study integrated items with face validity, involving a cohort of six Omani mothers. This step aimed to ascertain the clarity and applicability of the terminology employed, ensuring alignment with cultural common understanding. Through this process, the research sought to enhance the relevance and comprehension of the utilized terms within the specific cultural context of Omani mothers. This step resulted in minor revisions of the instrument which was deemed using suitable terms for the specific context of Omani mothers. The last stage involved pilot testing of the tool to assess the feasibility and initial performance of the tool. Item Generation and Refinement The assessment tool developed has two main sections; the first section included questions relative to sociodemographic characteristics (#11), birth and clinical history (#11), and infant food history in the first year (#12). The second section incorporated a 22-item design to stipulate a comprehensive description of infant feeding practices (#11) and beliefs (#11). The items were designed to identify feeding practices that pose health risks to infants and warrant intervention. First Section Sociodemographic data. The demographics section included items about the geographical location, child's age and gender, mother's age, parental education status, number of children and family income. These items are treated as predictors of infant feeding practices and beliefs. Infant birth and clinical history. The infant birth and clinical history section asked about the child's birth weight, status, and mode of birth. Also, we asked about the history of neonatal intensive care unit admission, antibiotic intake, constipation, food allergy, and other questions related to neuromuscular problems during the first year of age. Some items including constipation and food allergy may be used as outcomes of feeding practices and beliefs. Infant food history. The infant food history part included general items such as the type of infant formula and solid food the child was having during the first year of age. The other two questions assessed the infant's feeding level of awareness. Also, we were asking about details relative to bee honey feeding. Details included the number of times bee honey was introduced, who introduced it, how it was introduced, the type of honey that was introduced, rationales for introducing the honey, feeling pressure to introduce honey from surroundings, and whether honey was introduced to the other children. Second Section Infant feeding practices (IFP). The infant feeding practices section asked about breastfeeding practices during the first six months and first year of life. The remaining questions asked about the age of initiating different food items including infant formula, solid food, animal protein (meat, chicken, fish), fresh juice, yoghurt, egg white, non-modified milk, and bee honey. Additionally, there was a question about applying honey to a cracked nipple before breastfeeding the child. Infant feeding beliefs (IFB) . Questions under the infant feeding beliefs section were the same questions in the infant feeding practices section but were modified to ask about the beliefs. For example, a question in the feeding practices section asks “I have breastfed my baby exclusively in the first six months of life.”, in the feeding beliefs section it was modified to “I believe it is better for my baby to have exclusive breastfeeding in the first six months of age.”. Another example is a question in the feeding practices section as follows; “I have started feeding my baby yogurt at the age...” was modified to “I believe it is better for my baby to start feeding yogurt at age…” in the feeding beliefs section. Content Validity A panel of six experts in child health assessed the relevance of items to infant feeding practices and beliefs constructs. The panel consisted of two child health professors, two infant botulism experts, one pediatric infection disease consultant, and one infant feeding specialist. The item content validity index (I- CVI) ranged from 0.67 to 1, indicating good content validity. Face Validity Six Omani mothers were interviewed to assess the questionnaire's face validity. They conveyed acceptable clarity and relevance of the items to the infant feeding practices and beliefs constructs. Minor modifications to enhance clarity were made. Participants The study comprised 203 mothers. The mothers were recruited from the immunization clinics in the primary health centers located in two primary Omani governorates, Muscat and Al-Sharqia North. The inclusion criteria of participants encompassed mothers of infants aged between 12 to 36 months, of Omani nationality, at least 18 years old, and possessing proficiency in reading and writing in Arabic. The exclusion criteria were mothers exhibiting cognitive impairments impacting their comprehension of questionnaire items, those who had previously completed the questionnaire for another infant, or those with infants requiring severe nutritional interventions such as tube feeding or stringent protein intake restrictions. Data Collection A convenient sampling technique was used to collect data from six health centers, four in Muscat and two in Al-Sharqia North. Two trained research assistants (RAs) attended the health centers and performed an eligibility screening on the mothers bringing their infants for vaccination. Eligible mothers were invited to participate and provided the study information sheet and consent form. Mothers who signed the consent form were then handed the assessment tool. The RAs were available to clarify any questions from the mothers and to collect the filled questionnaire back from the mothers. Ethical Considerations Ethical approval to conduct this study was granted by two entities. The study was ethically approved by the Research and Ethics Committee at the College of Nursing, Sultan Qaboos University (CON/IG/2022/9). In addition, ethical approval was obtained from the Health Studies and Research Approval Committee at the Ministry of Health (MOH/CSR/23/26906). A study information sheet including the risks and benefits of participating in the study was included on the questionnaire’s first page. Before signing the consent form, mothers were allowed to ask questions and their questions were elaborately answered. No identifying information such as name, date of birth, or medical record number was asked to maintain participants’ anonymity and confidentiality. The collected data were stored in a locked cabinet inside a locked office. Electronic data were saved in a password-protected computer, and the research team had the sole access to the data. Data Analysis Data were entered into SPSS program version 23. Before data analysis, data were checked and cleaned by two authors. Descriptive analysis including frequency, percentages, mean, median, standard deviations and range were used to describe infant feeding practices and beliefs. The description of infant feeding practices and beliefs were presented in individual percentages. Then, these percentages were merged based on whether the selected practices or beliefs were meeting the WHO infant feeding recommendations or not. Next, the infant feeding practices and beliefs variables were dichotomized to either meeting the recommendations or not meeting the recommendations, based on the WHO guidelines, to assess the mothers’ adherence to the recommendations. Practices or beliefs meeting the recommendations were scored as 1 and the ones not meeting the recommendations were scored as 0. Frequency and percentages were used to describe the adherence to infant feeding recommendations. Then, a total score was calculated for infant feeding practices and infant feeding beliefs, and Pearson’s correlation was used to assess the relationship between infant feeding practices and beliefs. Additionally, inferential statistics including an Independent t-test was applied to assess the relationship between adherence to infant feeding recommendations and certain mothers’ characteristics including age, educational level, family income, geographical location, and history of receiving infant feeding counseling. Results Description of Participants Mothers Characteristics The data analysis encompassed a cohort of 203 participants. Most mothers aged between 26 and 35 years (58.6%). A notable proportion of these mothers, accounting for (42%), possessed at least a baccalaureate degree, and the majority (68%) had less than four children. Financially, (59%) of the families reported a monthly income of less than 1000 Omani Rial (OMR). As per their infants, the majority were female (52.2%) and aged between 12 and 17 months (38.4%) during the time of data collection. The majority of the mothers received infant feeding awareness from a health facility (66%). Furthermore, (39.4%) rated their level of knowledge regarding infant feeding as high. The mothers’ sociodemographic data are detailed in Table 1 . Table 1 Characteristics of the Sample (N = 203). Mother-related variables N % Child-related variables N % Child age (months) Birth status 12–17 78 38.4 Full-term 175 86.2 18–23 65 32.0 Post-term 13 6.4 24–30 43 21.2 Premature 15 7.4 > 30 17 8.4 Birth mode Child gender Vaginal‎/vacuum/forceps 153 75.4 Male 97 47.8 Cesarean 50 24.6 Female 106 52.2 NICU admission Mother's age (years) No 188 92.6 18–25 24 11.8 Yes 15 7.4 26–35 119 58.6 Antibiotic administration 36–45 60 29.6 No 134 66.0 Mother education level Yes 69 34.0 High school or less 83 40.9 History of constipation Diploma‎/high diploma 35 17.2 No 101 49.8 Baccalaureate or higher 85 41.9 Rarely 50 24.6 Monthly income (OMR) Sometimes 40 19.7 Less than 500 35 17.2 Frequently 12 5.9 500 – less than1000 84 41.4 History of muscle weakness 1000 – less than 2000 63 31.0 No 200 98.5 2000 or more 21 10.3 Yes 3 1.5 Mothers received infant feeding counseling History of neurological disease No 134 66.0 No 202 99.5 Yes 69 34.0 Yes 1 .5 Mother’s knowledge of healthy infant feeding History of food allergy High 80 39.4 No 193 95.1 Moderate 117 57.6 Yes 10 4.9 Minimal 6 3.0 Infants Characteristics The statistical analysis of pertinent to infants’ characteristics revealed a mean birth weight of 2.82 kg (SD 0.45) and a mean current weight of 9.78 kg (SD 1.49) among the study participants. The majority of infants, constituting (86.2%) were born full-term, and a significant proportion, accounting for (75.4%), underwent vaginal deliveries. Regarding constipation, (19.7%) of the infants were reported to occasionally experience constipation, while (5.9%) exhibited frequent occurrences of constipation during the initial year of life. However, most children had no history of neonatal intensive care unit admission (92.6%), antibiotics administration (66.0%), muscle weakness (98.5%), neurological disorders (99.5%), or food allergy (95.1%). See Table 1 for more details. Description of Infant Feeding Practices and Beliefs Most mothers (98%) believed that exclusive breastfeeding in the first six months is better for their infants, while only 67% adhered to this practice (answered mostly or always). For breastfeeding in the first year, 89.2% met the recommendation, although 96.5% had positive beliefs about it. Regarding the time of initiating infant formula feeding (six months or later), 44.9% met the recommendation, and 78.8% believed it. Moreover, 64% of the mothers adhered to the recommendation of introducing solid food at six months, and slightly more mothers (76.8%) believed that it is healthy to introduce solid food at six months of age. Also, most mothers (98%) believed it is healthier to start meat, chicken, or fish feeding at six months, which is congruent with the recommendations. However, 87.2% of the mothers met that recommendation. For egg white feeding, almost a similar percentage of mothers met (43.4%) and believed (43.3%) the recommendation of starting at the age of 12 months. A similar alignment was observed for fresh milk, with 84.7% of mothers adhering to the recommendation and 82.3% expressing belief in initiating fresh milk consumption at the age of 12 months. Likewise, for bee honey feeding, 78.4% of the mothers adhered to the recommended initiation at 12 months, while 82.8% believed it. Moreover, a significant majority, accounting for 72.4% believed it was unhealthy to apply honey to the cracked nipple before feeding the infant, and even higher percentage, specifically 97.5% refrained from practicing this behavior. Further illustrations of infant feeding practices and beliefs are available in Table 2 . Table 2 Description of Infant Feeding Practices and Beliefs and their Adherence to the Recommendations. Practices N (%) Recommendations %* Beliefs N (%) Recommendations%* Exclusive breastfeeding in the first six months Exclusive breastfeeding in the first six months is better for the baby never 10(4.9) strongly disagree 1(0.5) rarely 24(11.8) disagree 3(1.5) sometimes 33(16.3) agree 76(37.4) 98.0 mostly 65(32.0) 67.0 strongly agree 123(60.6) always 71(35.0) Breastfed through the first year of life Breastfeeding through the first year of life is beneficial for the baby no 22 (10.8) strongly disagree 4(2.0) yes 181(89.2) 89.2 disagree 3(1.5) agree 91(44.8) 96.5 strongly agree 105(51.7) Started feeding infant formula I believe it is better to start feeding infant formula <= 6 months 112(55.2) 6 months 44(21.7) 44.9 6–11 months 82(40.4) 78.8 not started yet 47(23.2) >=12 months 78(38.4) Started feeding solid food I believe it is better to start feeding solid food <=4 months 7 (3.4) =6 months 130(64.0) 64.0 >=6 months 156(76.8) 76.8 not started yet 1(0.5) Started feeding meat, chicken, fish I believe it is better to start feeding meat, chicken, fish <=4 months 1(0.5) =6 months 177(87.2) 87.2 >=6 months 199(98.0) 98.0 not started yet 11(5.4) Started feeding 100% fresh juice I believe it is better to start feeding 100% fresh juice < 6 months 30(14.8) =12 months 49(24.1) >=12 months 77(37.9) not started yet 14(6.9) Started feeding yogurt I believe it is better to start feeding yogurt < 6 months 38(18.7) =12 months 25(12.3) >=12 months 41(20.2) not started yet 2(1.0) Started feeding egg white I believe it is better to start feeding egg white < 6 months 16(7.9) =12 months 55(27.1) 43.4 >=12 months 88(43.3) 43.3 not started yet 33(16.3) Started feeding fresh milk I believe it is better to start feeding fresh milk < 6 months 6(3.0) =12 months 96(47.3) 84.7 >=12 months 167(82.3) 82.3 not started yet 76(37.4) Started feeding bee honey I believe it is better to start feeding bee honey < 6 months 13(6.4) =12 months 101(49.8) 78.4 >=12 months 168(82.8) 82.8 not started yet 58(28.6) Applied bee honey to cracked nipple It is fine to apply bee honey to cracked nipples no 198(97.5) 97.5 strongly disagree 69(34.0) 72.4 yes 5(2.5) disagree 78(38.4) agree 55(27.1) strongly agree 1(0.5) * Proportion of mothers adhering to the infant feeding recommendations. When responses were dichotomized to the meeting (1) or not meeting the recommendations (0), IFP scores ranged from 3 to 11, while the IFB scores were between 4 and 11, considering 11 is the maximum and 0 is the minimum. The mean IFP score was 8.09 (SD 1.75) and the median was 8.00, indicating good data distribution. The mean IFB score was slightly higher (m = 8.90, SD = 1.45), with a median equal to 9. The Pearson correlation analysis signified a positive relationship between IFP and IFB, with a correlation coefficient of 0.53 (p < 0.001). Details are presented in Table 3 . Table 3 Mean, Median, Range and Pearson Correlation of IFP and IFB Recommendation Scores Mean (SD) Median Range r p IFP 8.09 (1.748) 8.00 3–11 .528 < 0.01 IFB 8.90 (1.447) 9.00 4–11 Maternal Factors Associating with Adherence to Infant Feeding Recommendations Maternal characteristics including age, geographical location, educational level, family income, and history of infant feeding counseling were assessed against the IFP and IFB scores using independent t-tests. Data analysis showed a significant relationship between IFP recommendation scores and a history of infant feeding counseling (p < 0.05). Mothers who received infant feeding counseling at a healthcare facility had higher IFP scores compared to the mothers who did not, 8.46 (1.614) and 7.90 (1.79), respectively. Yet, the IFB score did not differ significantly between the mothers who received or not received infant feeding counseling (p > 0.05). On the other hand, mothers with higher educational levels (at least a baccalaureate degree) and family income (at least 1000 OMR) had better IFB recommendation scores (p 0.05). Results also showed a nearly significant difference in the IFB scores between mothers younger than 35 years and those aged 35 years or more (p = 0.53). Older mothers were having healthier beliefs about infant feeding, 9.20 (1.47) versus 8.77 (1.42). Nonetheless, there was no significant difference in the IFP score among older and younger mothers. Interestingly, neither the IFP nor IFB recommendation score had a significant relationship with the geographical location (p > 0.05), indicating similarities across Muscat and Sharqia North infant feeding practices and beliefs. Results are detailed in Table 4 . Table 4 Comparison of IFP and IFB Recommendation Scores Means Among Different Groups. IFP score IFB score M (SD) p-value* M (SD) p-value* Maternal Age 0.701 0.053 l8–34 8.06 (1.737) 8.77 (1.423) 35–45 8.17 (1.787) 9.20 (1.471) Geographical location 0.843 0.186 Muscat 8.07 (1.697) 8.79 (1.467) Sharqiya North 8.12 (1.833) 9.06 (1.408) Maternal Educational Level 0.328 0.019 < baccalaureate 7.99 (1.837) 8.69 (1.528) ≥ baccalaureate 8.24 (1.616) 9.18 (1.283) Family Income (OMR) 0.991 0.032 < 1000 8.09 (1.859) 8.71(1.427) ≥ 1000 8.10 (1.588) 9.15 (1.444) Health Counseling 0.030 0.179 Not received 7.90 (1.789) 8.80 (1.434) Received 8.46 (1.614) 9.09 (1.463) * Sig. (2-tailed) with equal variances assumed. OMR = Omani Riyals (currency). Discussion The present study investigated infant feeding practices and beliefs employing a newly developed comprehensive and culturally-sensitive structured questionnaire. In general, we found that the majority of the mothers were meeting the infant feeding recommendations. However, there remains a considerable division of mothers who did not, implying the importance of screening every mother’s infant feeding practices and beliefs for early identification of possible infant nutritional risks. The findings of this study revealed a notably higher degree of adherence to breastfeeding practices throughout the first year compared to exclusive breastfeeding within the initial six months. Hence, the reported exclusive breastfeeding rates show a better level of compliance compared to the previously reported data from Saudi Arabia, UAE and Oman, 5.3%, 26%, and 29%, respectively [ 15 – 17 ]. Additionally, the rate of breastfeeding throughout the first year reported in our study surpasses the level documented in the US., which was 23.8% [ 20 ]. The current study’s findings might indicate the positive outcomes of the baby-friendly movement initiative by the Omani health authorities in collaboration with WHO. In previous years, the Omani government adopted the baby-friendly initiative involving a breastfeeding policy that was strongly deployed in the health care facilities and capitalized through different means of campaigns [ 22 ]. The current statistics from this pilot study report an added improvement in breastfeeding practices. Moreover, large percentages of mothers in our study believed that exclusive breastfeeding and breastfeeding throughout the first year were healthier choices for their children, emphasizing a community-level awareness of the significance of breastfeeding [ 23 , 24 ]. On the other side, the rate of non-adherence to specific complementary feeding recommendations in our study (grains, fruits and vegetables, animal protein, yoghurt, 100% fresh juice, fresh milk, egg white, bee honey) ranged from 12.8% for the time of starting animal protein to 56.6% for the time of initiating egg white. Data from the other studies reflected lower non-adherence rates, most probably due to the non-inclusiveness of a comprehensive list of complementary food items. For instance, the previous ONNS questioned the time of initiating juice, yogurt, soup and porridge and the rate of non-adherence ranged from 6–13% [ 17 ]. Studies conducted in the UAE described that 19% of 28% of infants were introduced to complementary feeding before the age of six months [ 16 , 25 ]. The highest rate of introducing complementary food to infants younger than six months in the region was observed in Saudi Arabia with a rate reaching 64.3% [ 15 ]. This could indicate that mothers were relying on the old WHO recommendations stating to initiate complementary feeding at four months, especially since online was reported as the primary source of infant feeding information. It was noted that most studies describing the complementary feeding practices focused on describing the quality of complementary feeding by calculating specific indices (e.g. diversity, frequency, and acceptability) such as the Infant and Young Child Feeding and Complementary Feeding Utility Index (CFUI) rather than providing details relative to the time of introducing different types of food items. These results highlight the importance of promoting and supporting breastfeeding practices among mothers, particularly in the first six months of a child's life, to improve overall health outcomes [ 26 ]. Further research is needed to explore the factors that contribute to successful breastfeeding practices and to develop effective interventions to support mothers in this regard. Nevertheless, the rate of beliefs in our study was consistently higher than the actual practices, signifying the presence of certain barriers to healthy practices. The literature identified that mothers returning to work was a significant predictor of intention to continue breastfeeding [ 21 ]. Other common breastfeeding problems reported were pain and perceived inadequate breastmilk [ 27 ]. A qualitative study identified perceived challenges to breastfeeding including judgement from others for breastfeeding in the public or using a bottle, even with expressed breastmilk [ 28 ]. A Suadi study suggested that younger mothers' age and cesarean section mode of delivery were predictors of the early introduction of complementary feed [ 15 ]. While there is evidence that different social circumstances such as economic constraints and dependence on food purchasing as well as cultural beliefs could significantly influence the breastfeeding behaviors among mothers [ 29 ], the case in Oman might be slightly different. The majority of the participating mothers in the current study had a baccalaureate education or higher and reported an acceptable monthly income. This might explain the mothers’ need to prioritize early returning to work before healthy breastfeeding practices regardless of their knowledge, awareness, and beliefs. Therefore, policymakers and stakeholders are recommended to consider the working conditions and more or less “forced” absence of the mother when planning targeted interventions. Our study findings indicated that the provision of infant feeding counseling had a significant association with healthy infant feeding practices. Furthermore, higher education level and monthly income were correlated with healthier infant feeding beliefs. Accurate evidence in the literature supports our study findings stating that breastfeeding education sessions and high levels of education were significant factors associated with breastfeeding [ 28 ]. Our study also aligns with previous research conducted in Ethiopia, which found that limited breastfeeding counseling quadrupled the risks for introducing fluids or foods other than breastmilk before establishing regular breastfeeding [ 30 ]. Additionally, professional, partner, and family support, was related to higher rates of exclusive breastfeeding [ 28 ]. The results of our study and previous research highlight the importance of providing comprehensive breastfeeding education and support to mothers, particularly those with limited resources and education. Such interventions can help improve infant feeding practices and promote better health outcomes for infants. Descriptions collected through our newly developed questionnaire have helped clarify the type of complementary food that needs to be highlighted during infant feeding counseling. Moreover, it can capture the specific deviation from the recommended infant feeding practices that are known to be associated with several complications including the ones associated with limited breastfeeding and early introduction of infant formula (e.g., immunity, obesity), early introduction of complementary food (allergy, respiratory illnesses, and constipation), late introduction to animal protein (iron deficiency anemia), early introduction of 100% fresh juice (obesity and malnutrition), late introduction of yogurt (disturbed gut micropia), early introduction of egg white (food and skin allergy), early introduction of fresh milk (food allergy and iron deficiency anemia), and early introduction of bee honey (infant botulism) [ 31 , 32 ]. While this sample size might be relatively modest, it is in line with recommended guidelines for pilot studies, allowing for a preliminary evaluation of initial validation while considering the feasibility of a larger-scale study. Moreover, a revised version of the tool is needed incorporating the insights learned from this pilot study. Thus, further validation through larger-scale studies to establish its reliability and validity shall be considered. Conclusion A comprehensive assessment of infant feeding practices is fundamental for the early identification of nutrition-related risks. Data generated from the newly developed infant feeding practices and beliefs questionnaire shall assist in determining the risks associated with multiple nutrition-related morbidities in children, thus promising a valid and feasible mean for a comprehensive infant feeding assessment. List Of Abbreviations CDC Center for Disease Control and Infection CFUI Complementary Feeding Utility Index CON/IG College of Nursing/Internal Grant I- CVI Item Content Validity Index IFB Infant Feeding Beliefs IFP Infant Feeding Practices IFPB Infant Feeding Practices and Beliefs MOH/CSR Ministry of Health/ Center for Studies and Research MENA Middle East and Northern Africa OMR Omani Rial RAs Research Assistants SD Standard Deviation UAE United Arab Emirates US United States WHO World Health Organization Declarations Ethics approval and consent to participate The approval for the study was obtained from the Research and Ethics Committee at the College of Nursing, Sultan Qaboos University (CON/IG/2022/9). In addition, ethical approval was obtained from the Health Studies and Research Approval Committee at the Ministry of Health (MOH/CSR/23/26906). All the mothers who participated in this study provided written consent. Study methods were performed by the ethical guidelines and regulations for research among human subjects following the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analysed during the current study will be available from the Principal Investigator (BAY) upon reasonable request. Competing interests BAY is the primary developer of the IFPB structured questionnaire. The authors declare that they have no financial competing interests. Funding This study received funds from the Internal Grants of Sultan Qaboos University (REF.NO IG-CON-MCHH-23-04). Authors' contributions All authors contributed to the conceptualization and writing of this manuscript. BAY developed the overall structure of the questionnaire and conceptualized the study objectives and methodology. SAY and BAH facilitated the operation and implementation processes, while OAO and AK contributed to the analysis procedures. All authors revised the manuscript several times and approved the final version of the manuscript. Acknowledgements We would like to express our gratitude to the Deanship of Research at Sultan Qaboos University; Directorate General for Planning and Studies at the Ministry of Health; Directorate General for Health Services in Muscat at the Ministry of Health in Oman. We also appreciate the support of our partner healthcare agencies in Muscat and North Al-Sharqia. We thank the mothers who volunteered and participated in this study. References Hockenberry MJ, Wilson D. Wong's nursing care of infants and children. -E-book: Elsevier Health Sciences; 2018. Thompson AL. Evaluating the pathways linking complementary feeding practices to obesity in early life. Nutr Rev. 2020;78(Supplement2):13–24. Ministry of Health O. Annual Health Report. 2022. Couto GR, Dias V, de Jesus Oliveira I. Benefits of exclusive breastfeeding: An integrative review. Nurs Pract Today. 2020. Forde CG, McKinley MC, Woodside JV, Nugent AP. Nutritional considerations in children. Nutr oral health. 2021:3–15. Bakhrieva G, AGE CHARACTERISTICS OF, THE DIGESTIVE SYSTEM. Mod Sci Res. 2023;2(10):975–81. Yelverton CA, Geraghty AA, O’Brien EC, Killeen SL, Horan MK, Donnelly JM, et al. Breastfeeding and maternal eating behaviours are associated with child eating behaviours: Findings from the ROLO Kids Study. Eur J Clin Nutr. 2021;75(4):670–9. Dewey KG, Pannucci T, Casavale KO, Davis TA, Donovan SM, Kleinman RE, et al. Development of food pattern recommendations for infants and toddlers 6–24 months of age to support the Dietary Guidelines for Americans, 2020–2025. J Nutr. 2021;151(10):3113–24. Moroishi Y, Signes-Pastor AJ, Li Z, Cottingham KL, Jackson BP, Punshon T, et al. Infant infections, respiratory symptoms, and allergy in relation to timing of rice cereal introduction in a United States cohort. Sci Rep. 2022;12(1):4450. Waidyatillake N, Dharmage S, Allen K, Bowatte G, Boyle R, Burgess J, et al. Association between the age of solid food introduction and eczema: a systematic review and a meta-analysis. Clin Experimental Allergy. 2018;48(8):1000–15. Papoutsou S, Savva SC, Hunsberger M, Jilani H, Michels N, Ahrens W, et al. Timing of solid food introduction and association with later childhood overweight and obesity: The IDEFICS study. Matern Child Nutr. 2018;14(1):e12471. Hollis JL, Collins CE, DeClerck F, Chai LK, McColl K, Demaio AR. Defining healthy and sustainable diets for infants, children and adolescents. Global Food Secur. 2020;27:100401. Harris R, Tchao C, Prystajecky N, Cutler J, Austin JW. A summary of surveillance, morbidity and microbiology of laboratory-confirmed cases of infant botulism in Canada, 1979–2019. Can Commun Dis Rep. 2021;47(78):322–8. Ibrahim C, Bookari K, Sacre Y, Hanna-Wakim L, Hoteit M. Breastfeeding Practices, Infant Formula Use, Complementary Feeding and Childhood Malnutrition: An Updated Overview of the Eastern Mediterranean Landscape. Nutrients. 2022;14(19):4201. Albar SA. Mothers’ feeding practices among infants (4–12 months) and associated factors: A cross-sectional study in Saudi Arabia. J Nutritional Sci. 2022;11:e83. Cheikh Ismail L, Al Dhaheri AS, Ibrahim S, Ali HI, Chokor FAZ, O’Neill LM, et al. Nutritional status and adequacy of feeding Practices in Infants and Toddlers 0-23.9 months living in the United Arab Emirates (UAE): findings from the feeding Infants and Toddlers Study (FITS) 2020. BMC Public Health. 2022;22(1):319. Al Maamari S, Al Shammakhi S, Alghamari I, Jabbour J, Al-Jawaldeh A. Young children feeding practices: An update from the sultanate of Oman. Children. 2021;8(9):818. Rehayem A, Taki S, Brown N, Denney-Wilson E. Infant feeding beliefs and practices of Arabic mothers in Australia. Women Birth. 2020;33(4):e391–9. Oman Ministry of Health. Oman National Nutrition Survey. 2017. Au LE, Gurzo K, Paolicelli C, Whaley SE, Weinfield NS, Ritchie LD. Diet Quality of US Infants and Toddlers 7–24 Months Old in the WIC Infant and Toddler Feeding Practices Study-2. J Nutr. 2018;148(11):1786–93. Wang X, Cheng Z, Cross-Sectional Studies. Strengths, Weaknesses, and Recommendations. Chest. 2020;158(1S):S65–71. Policy - Developing a Baby-Friendly Initiative in Oman to Improve Breastfeeding and Early Childhood Nutrition and Development - Phase 2 – Recommendations & Plan of Action: World Health Organization. 2016 [Available from: https://extranet.who.int/nutrition/gina/en/node/24474 . Ambassador-Brikins HO. Influence of Awareness Campaigns on Knowledge and Adoption of Six-Month Exclusive Breastfeeding in Lagos and Ogun States, Nigeria. KIU J Social Sci. 2020;6(3):181–91. Cajetan IO, Ikechukwu A, Williams EE. Influence of broadcast media campaigns on creating awareness on exclusive breastfeeding: A study of Owerri urban. Am J Humanit Social Sci Res. 2021;5(9):168–75. Taha Z, Garemo M, Nanda J. Complementary feeding practices among infants and young children in Abu Dhabi, United Arab Emirates. BMC Public Health. 2020;20:1–8. Pérez-Escamilla R, Tomori C, Hernández-Cordero S, Baker P, Barros AJ, Bégin F, et al. Breastfeeding: crucially important, but increasingly challenged in a market-driven world. Lancet. 2023;401(10375):472–85. Rozensztrauch A, Klaniewska M, Berghausen-Mazur M. Factors affecting the mother's choice of infant feeding method in Poland: a cross-sectional preliminary study in Poland. Ir J Med Sci. 2022;191(4):1735–43. Buckland C, Hector D, Kolt GS, Thepsourinthone J, Arora A. Experiences of young Australian mothers with infant feeding. BMC Pregnancy Childbirth. 2022;22(1):489. Chakona G. Social circumstances and cultural beliefs influence maternal nutrition, breastfeeding and child feeding practices in South Africa. Nutr J. 2020;19(1):1–15. Megersa N, Tariku EZ, Yesera G, Gutema B. Prevalence of prelacteal feeding and its associated factors among mothers of under-24-month-old children at Arba Minch Zuria District, Ethiopia: A cross-sectional study. South Afr J Child Health. 2021;15(2):112–7. Zhuang L, Chen H, Zhang S, Zhuang J, Li Q, Feng Z. Intestinal Microbiota in Early Life and Its Implications on Childhood Health. Genomics Proteom Bioinf. 2019;17(1):13–25. Henrick BM, Yao XD, Nasser L, Roozrogousheh A, Rosenthal KL. Breastfeeding Behaviors and the Innate Immune System of Human Milk: Working Together to Protect Infants against Inflammation, HIV-1, and Other Infections. Front Immunol. 2017;8:1631. Additional Declarations Competing interest reported. BAY is the primary developer of the IFPB structured questionnaire. The authors declare that they have no financial competing interests. Cite Share Download PDF Status: Published Journal Publication published 18 Feb, 2025 Read the published version in BMC Public Health → Version 1 posted Editorial decision: Revision requested 16 Mar, 2024 Editor assigned by journal 15 Mar, 2024 Submission checks completed at journal 15 Mar, 2024 First submitted to journal 08 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4038672","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":280282446,"identity":"f8ba2963-27cd-4768-9544-35c6b0eac0b9","order_by":0,"name":"Basma Al Yazeedi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYBACAzBZwSYH4bIRreUMnzGJWhjb5BIbiNZizn786YYfZ8zS57fnGDB8KDvMwC92AL8Wy54cs5s9FWm5G868MWCcce4wg+TsBAIOO5DDdoPnzLHcDRI5Bsy8bYcZDG4T0nL++bObf9v+p8vPAGr5S5SWGwlmt3nb2BIYbgC1MBKjxXLGG7PbMmfYDDeceVZwsOdcOg9Bv5jzpz+7+aaCTV6+PXnjgx9l1nL80gS0IIEEhgNAkodo9WAto2AUjIJRMAqwAgA4zkf3BCdQjwAAAABJRU5ErkJggg==","orcid":"","institution":"Sultan Qaboos University","correspondingAuthor":true,"prefix":"","firstName":"Basma","middleName":"Al","lastName":"Yazeedi","suffix":""},{"id":280282447,"identity":"91a5cbb8-fc17-44fa-ad7d-c7ef72940f41","order_by":1,"name":"Salma Al Yazeedi","email":"","orcid":"","institution":"Oman College of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Salma","middleName":"Al","lastName":"Yazeedi","suffix":""},{"id":280282450,"identity":"6228ceff-25c6-4d6d-9543-b80171478c55","order_by":2,"name":"Omar Al Omari","email":"","orcid":"","institution":"Sultan Qaboos University","correspondingAuthor":false,"prefix":"","firstName":"Omar","middleName":"Al","lastName":"Omari","suffix":""},{"id":280282452,"identity":"1eafac5d-285e-41b9-925a-ca83a083d487","order_by":3,"name":"Badriya Alhatali","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Badriya","middleName":"","lastName":"Alhatali","suffix":""},{"id":280282454,"identity":"d8ba7597-309a-4058-8c71-a43fc88a5c0b","order_by":4,"name":"Atika Khalaf","email":"","orcid":"","institution":"Kristianstad University","correspondingAuthor":false,"prefix":"","firstName":"Atika","middleName":"","lastName":"Khalaf","suffix":""}],"badges":[],"createdAt":"2024-03-08 07:32:37","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4038672/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4038672/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-025-21839-9","type":"published","date":"2025-02-18T15:57:37+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":77058290,"identity":"b3f0159e-5f6a-424a-a0a0-0ba51f3cf23d","added_by":"auto","created_at":"2025-02-24 16:57:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1972215,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4038672/v1/cbb434c0-72db-4c65-abf9-3e2dadcbb5e7.pdf"}],"financialInterests":"Competing interest reported. BAY is the primary developer of the IFPB structured questionnaire. The authors declare that they have no financial competing interests.","formattedTitle":"Development and Pilot Testing of a Comprehensive and Culturally-sensitive Infant Feeding Structured Questionnaire: A Cross-sectional Design","fulltext":[{"header":"Background","content":"\u003cp\u003eNutrition is the key element regulating children\u0026rsquo;s growth, particularly during infancy. During this phase, the energy requirements are the utmost due to heightened metabolic activity aligning with rapid growth [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Simultaneously, the infant\u0026rsquo;s digestive system is at its most vulnerable stage where unintentional feeding inaccuracies can result in serious health complications including allergies, eczema, iron-deficiency anemia, rickets, obesity, respiratory illnesses and infant botulism, among many others [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The 2022 statistical data from the Oman Ministry of Health reported that among children younger than five years, 10.2% had iron deficiency, 10.6% had vitamin D deficiency, 11.2% were underweight, and 4.2% were having overweight or obesity [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Health organizations, including esteemed entities such as the World Health Organization (WHO) and the Center for Disease Control (CDC), have set comprehensive infant feeding guidelines and recommendations. These recommendations vary between the first and second six months of infant\u0026rsquo;s age, aligning with the dynamic developmental alteration that dictate the nutritional needs and digestive capabilities of the growing infant. The infant\u0026rsquo;s digestive system in the first six months of age is merely capable of processing human milk or modified milk, which comprises all the essential nutrients the body needs. The advantages of exclusive breastfeeding surpass the modified milk across biological, psychosocial, and cognitive domains [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], thus supporting the endorsement of exclusive breastfeeding during the initial six months. At the age of six months, the gradual incorporation of solid food should commence, marking a stage when the body has acquired sufficient mechanical and physiological capabilities such as enhanced digestive enzymes, increased stomach capacity, enhanced sitting skills, development of teeth, and improved jaw function [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLimited breastfeeding experiences during infancy have been linked to reduced immunity and obesogenic eating behaviors [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Exposing the infant to a variety of food options during the second six months of life is essential for accepting and meeting the nutritional demands at a later stage of life [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, early introduction of solid food has been found to increase the incidence of eczema, allergies, and respiratory infection, as well as obesity [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. At the same time, food items such as honey, unmodified milk and egg whites, are refrained until the infants\u0026rsquo; first birthday due to their association with identified health risks [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Bee honey, for instance, has been demonstrated to be associated with infant botulism when introduced before the age of one year [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The imposition of safe and healthy infant feeding practices places a considerable amount of pressure upon parents. Health care providers share that burden as they are the main source of parent\u0026rsquo;s awareness and support. Consequently, regular assessment of infant feeding practices emerges as an imperative undertaking, serving as a foundational strategy for the early identification of nutritional risks and potential concerns.\u003c/p\u003e \u003cp\u003eA review of the regional literature indicates a suboptimal level of adherence to the infant feeding recommendations and stresses the need for immediate measures to promote children\u0026rsquo;s healthy nutrition [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. A Saudi study examined the infant feeding practices among mothers of infants aged between 4 to 12 months through an electronic mothers' feeding practices semi-structured questionnaire and found that only 5.3% of infants exclusively breastfeed in the first six months and 64.3% were introduced to complementary food before the age of six months [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In a population-based survey conducted in the United Arab Emirates, 26% of infants had exclusive breastfeeding in the first six months and 19% started complementary feeding before the age of six months [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Data from the Oman National Nutrition Survey (ONNS) conducted in 2017 indicated that less than a third of the mothers (29%) were exclusively breastfeeding their infants in the first six months of age [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Complementary food including juice, yogurt, soup and porridge were introduced to infants younger than six months with percentages ranging from 6\u0026ndash;13%[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWithout undermining the significance of data presented by the above studies, data about the infant feeding practices from the Middle East and Northern Africa (MENA) region is fragmented and lacks inclusiveness. Simultaneously, Arabic women living the Western countries convey needs related to culturally sensitive infant feeding services [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNevertheless, infant feeding tools available in the literature lack comprehensiveness and inclusiveness to infants of different ages. The ONNS screening tool, adapted from the WHO\u0026rsquo;s STEP wise approach, focuses on the initiation of breastfeeding, exclusive breastfeeding in the first six months, and acceptable diet scores for infants aged 6 to 24 months. The acceptable diet score is calculated based on the diet diversity (number of food groups) and frequency indices in the previous 24 hours [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Thus, providing a snapshot of the infant feeding practices. However, it lacks specifications related to the timing of introducing certain food items, which guide healthcare providers in estimating the associated health risks.\u003c/p\u003e \u003cp\u003eResearchers from the United States (US) assessed the infant feeding practices through the Complementary Feeding Utility Index (CFUI). The CFUI standards evaluated the exposure to iron-rich cereal, energy-dense nutrient-poor foods, teas/broths, vegetables, fruits, sugary drinks, and breastfeeding duration. The results indicated a suboptimal intake of fruits and vegetables, increased sugary drinks, and reduced duration of breastfeeding [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Despite the significance of the results extracted, it lacked specifications related to the timing of introducing the food items.\u003c/p\u003e \u003cp\u003eAvailable tools put more attention on breastfeeding practices and initiation of complementary feeding in general, where they fall short in providing specifications about certain early or late infant feeding practices that are known to link with specific risks. For example, feeding infants bee honey before the age of 12 months is a common practice in the Middle East. Hence, no questionnaire has assessed the phenomenon adequately. That led to blurriness in the estimated risks for infant botulism. Thus, there is an urgent need for a rigorous, comprehensive and culturally sensitive infant feeding assessment tool. To fill the gap and contribute to estimating the infant feeding risks, this study pilot tested a newly developed infant feeding structured questionnaire that aims to provide a comprehensive description of infant feeding practices and beliefs, adherence to infant feeding recommendations, and maternal factors associated with adherence to infant feeding recommendations.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis study utilized a cross-sectional design to pilot test the newly developed Infant Feeding Practices and Beliefs (IFPB) structured questionnaire. The choice of a cross-sectional design, well-recognized for its ability to promptly gather comprehensive data, was deemed optimal for assessing the feasibility of the newly developed tool. Furthermore, considering the data collection nature involving the history of infant feeding practices in the first year, this study design was expected to closely resemble real-world scenarios, enhancing the tool's relevance and applicability to the intended population[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003eTool Development Process\u003c/h2\u003e \u003cp\u003eThe process of developing the IFPB tool encompassed several sequential stages aimed at ensuring its validity and applicability to the intended purpose. The initial stage involved conceptualizing the tool's objectives and delineating the target population. Extensive planning was undertaken, including a comprehensive literature review, consultations with experts, and the establishment of specific tool variables.\u003c/p\u003e \u003cp\u003eIn the second stage, the authors generated a pool of potential items in alignment with the predefined objectives and drafted the first version of the tool in English. The drafted tool underwent rigorous assessment by experts in the child health and child nutrition fields (infant botulism, pediatric infection disease, infant feeding, and academic professors in child health) to evaluate its content validity. Revisions were then made based on the experts\u0026rsquo; feedback to enhance the tool's content and relevance. Items then were translated into Arabic by three bilingual experts in child health.\u003c/p\u003e \u003cp\u003eThe third stage of the study integrated items with face validity, involving a cohort of six Omani mothers. This step aimed to ascertain the clarity and applicability of the terminology employed, ensuring alignment with cultural common understanding. Through this process, the research sought to enhance the relevance and comprehension of the utilized terms within the specific cultural context of Omani mothers. This step resulted in minor revisions of the instrument which was deemed using suitable terms for the specific context of Omani mothers. The last stage involved pilot testing of the tool to assess the feasibility and initial performance of the tool.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eItem Generation and Refinement\u003c/h2\u003e \u003cp\u003eThe assessment tool developed has two main sections; the first section included questions relative to sociodemographic characteristics (#11), birth and clinical history (#11), and infant food history in the first year (#12). The second section incorporated a 22-item design to stipulate a comprehensive description of infant feeding practices (#11) and beliefs (#11). The items were designed to identify feeding practices that pose health risks to infants and warrant intervention.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eFirst Section\u003c/h2\u003e \u003cp\u003e \u003cb\u003eSociodemographic data.\u003c/b\u003e The demographics section included items about the geographical location, child's age and gender, mother's age, parental education status, number of children and family income. These items are treated as predictors of infant feeding practices and beliefs.\u003c/p\u003e \u003cp\u003e \u003cb\u003eInfant birth and clinical history.\u003c/b\u003e The infant birth and clinical history section asked about the child's birth weight, status, and mode of birth. Also, we asked about the history of neonatal intensive care unit admission, antibiotic intake, constipation, food allergy, and other questions related to neuromuscular problems during the first year of age. Some items including constipation and food allergy may be used as outcomes of feeding practices and beliefs.\u003c/p\u003e \u003cp\u003e \u003cb\u003eInfant food history.\u003c/b\u003e The infant food history part included general items such as the type of infant formula and solid food the child was having during the first year of age. The other two questions assessed the infant's feeding level of awareness. Also, we were asking about details relative to bee honey feeding. Details included the number of times bee honey was introduced, who introduced it, how it was introduced, the type of honey that was introduced, rationales for introducing the honey, feeling pressure to introduce honey from surroundings, and whether honey was introduced to the other children.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eSecond Section\u003c/h2\u003e \u003cp\u003e \u003cb\u003eInfant feeding practices (IFP).\u003c/b\u003e The infant feeding practices section asked about breastfeeding practices during the first six months and first year of life. The remaining questions asked about the age of initiating different food items including infant formula, solid food, animal protein (meat, chicken, fish), fresh juice, yoghurt, egg white, non-modified milk, and bee honey. Additionally, there was a question about applying honey to a cracked nipple before breastfeeding the child.\u003c/p\u003e \u003cp\u003e \u003cb\u003eInfant feeding beliefs (IFB)\u003c/b\u003e. Questions under the infant feeding beliefs section were the same questions in the infant feeding practices section but were modified to ask about the beliefs. For example, a question in the feeding practices section asks \u0026ldquo;I have breastfed my baby exclusively in the first six months of life.\u0026rdquo;, in the feeding beliefs section it was modified to \u0026ldquo;I believe it is better for my baby to have exclusive breastfeeding in the first six months of age.\u0026rdquo;. Another example is a question in the feeding practices section as follows; \u0026ldquo;I have started feeding my baby yogurt at the age...\u0026rdquo; was modified to \u0026ldquo;I believe it is better for my baby to start feeding yogurt at age\u0026hellip;\u0026rdquo; in the feeding beliefs section.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eContent Validity\u003c/h2\u003e \u003cp\u003eA panel of six experts in child health assessed the relevance of items to infant feeding practices and beliefs constructs. The panel consisted of two child health professors, two infant botulism experts, one pediatric infection disease consultant, and one infant feeding specialist. The item content validity index (I- CVI) ranged from 0.67 to 1, indicating good content validity.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eFace Validity\u003c/h3\u003e\n\u003cp\u003eSix Omani mothers were interviewed to assess the questionnaire's face validity. They conveyed acceptable clarity and relevance of the items to the infant feeding practices and beliefs constructs. Minor modifications to enhance clarity were made.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThe study comprised 203 mothers. The mothers were recruited from the immunization clinics in the primary health centers located in two primary Omani governorates, Muscat and Al-Sharqia North. The inclusion criteria of participants encompassed mothers of infants aged between 12 to 36 months, of Omani nationality, at least 18 years old, and possessing proficiency in reading and writing in Arabic. The exclusion criteria were mothers exhibiting cognitive impairments impacting their comprehension of questionnaire items, those who had previously completed the questionnaire for another infant, or those with infants requiring severe nutritional interventions such as tube feeding or stringent protein intake restrictions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003eA convenient sampling technique was used to collect data from six health centers, four in Muscat and two in Al-Sharqia North. Two trained research assistants (RAs) attended the health centers and performed an eligibility screening on the mothers bringing their infants for vaccination. Eligible mothers were invited to participate and provided the study information sheet and consent form. Mothers who signed the consent form were then handed the assessment tool. The RAs were available to clarify any questions from the mothers and to collect the filled questionnaire back from the mothers.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations\u003c/h2\u003e \u003cp\u003e Ethical approval to conduct this study was granted by two entities. The study was ethically approved by the Research and Ethics Committee at the College of Nursing, Sultan Qaboos University (CON/IG/2022/9). In addition, ethical approval was obtained from the Health Studies and Research Approval Committee at the Ministry of Health (MOH/CSR/23/26906).\u003c/p\u003e \u003cp\u003eA study information sheet including the risks and benefits of participating in the study was included on the questionnaire\u0026rsquo;s first page. Before signing the consent form, mothers were allowed to ask questions and their questions were elaborately answered. No identifying information such as name, date of birth, or medical record number was asked to maintain participants\u0026rsquo; anonymity and confidentiality. The collected data were stored in a locked cabinet inside a locked office. Electronic data were saved in a password-protected computer, and the research team had the sole access to the data.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData were entered into SPSS program version 23. Before data analysis, data were checked and cleaned by two authors. Descriptive analysis including frequency, percentages, mean, median, standard deviations and range were used to describe infant feeding practices and beliefs.\u003c/p\u003e \u003cp\u003eThe description of infant feeding practices and beliefs were presented in individual percentages. Then, these percentages were merged based on whether the selected practices or beliefs were meeting the WHO infant feeding recommendations or not. Next, the infant feeding practices and beliefs variables were dichotomized to either meeting the recommendations or not meeting the recommendations, based on the WHO guidelines, to assess the mothers\u0026rsquo; adherence to the recommendations. Practices or beliefs meeting the recommendations were scored as 1 and the ones not meeting the recommendations were scored as 0. Frequency and percentages were used to describe the adherence to infant feeding recommendations. Then, a total score was calculated for infant feeding practices and infant feeding beliefs, and Pearson\u0026rsquo;s correlation was used to assess the relationship between infant feeding practices and beliefs.\u003c/p\u003e \u003cp\u003eAdditionally, inferential statistics including an Independent t-test was applied to assess the relationship between adherence to infant feeding recommendations and certain mothers\u0026rsquo; characteristics including age, educational level, family income, geographical location, and history of receiving infant feeding counseling.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eDescription of Participants\u003c/h2\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003eMothers Characteristics\u003c/h2\u003e \u003cp\u003eThe data analysis encompassed a cohort of 203 participants. Most mothers aged between 26 and 35 years (58.6%). A notable proportion of these mothers, accounting for (42%), possessed at least a baccalaureate degree, and the majority (68%) had less than four children. Financially, (59%) of the families reported a monthly income of less than 1000 Omani Rial (OMR). As per their infants, the majority were female (52.2%) and aged between 12 and 17 months (38.4%) during the time of data collection. The majority of the mothers received infant feeding awareness from a health facility (66%). Furthermore, (39.4%) rated their level of knowledge regarding infant feeding as high. The mothers\u0026rsquo; sociodemographic data are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the Sample (N\u0026thinsp;=\u0026thinsp;203).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother-related variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChild-related variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild age (months)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBirth status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFull-term\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e86.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost-term\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePremature\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eBirth mode\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChild gender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVaginal\u0026lrm;/vacuum/forceps\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e75.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCesarean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e24.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eNICU admission\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMother's age (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e92.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eAntibiotic administration\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e36\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e66.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMother education level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e34.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school or less\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eHistory of constipation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiploma\u0026lrm;/high diploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e49.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaccalaureate or higher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e24.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMonthly income (OMR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e19.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFrequently\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e500 \u0026ndash; less than1000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eHistory of muscle weakness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1000 \u0026ndash; less than 2000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e98.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2000 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMothers received infant feeding counseling\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eHistory of neurological disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e99.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMother\u0026rsquo;s knowledge of healthy infant feeding\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eHistory of food allergy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e95.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinimal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eInfants Characteristics\u003c/h2\u003e \u003cp\u003eThe statistical analysis of pertinent to infants\u0026rsquo; characteristics revealed a mean birth weight of 2.82 kg (SD 0.45) and a mean current weight of 9.78 kg (SD 1.49) among the study participants. The majority of infants, constituting (86.2%) were born full-term, and a significant proportion, accounting for (75.4%), underwent vaginal deliveries.\u003c/p\u003e \u003cp\u003eRegarding constipation, (19.7%) of the infants were reported to occasionally experience constipation, while (5.9%) exhibited frequent occurrences of constipation during the initial year of life. However, most children had no history of neonatal intensive care unit admission (92.6%), antibiotics administration (66.0%), muscle weakness (98.5%), neurological disorders (99.5%), or food allergy (95.1%). See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for more details.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eDescription of Infant Feeding Practices and Beliefs\u003c/h2\u003e \u003cp\u003eMost mothers (98%) believed that exclusive breastfeeding in the first six months is better for their infants, while only 67% adhered to this practice (answered mostly or always). For breastfeeding in the first year, 89.2% met the recommendation, although 96.5% had positive beliefs about it. Regarding the time of initiating infant formula feeding (six months or later), 44.9% met the recommendation, and 78.8% believed it. Moreover, 64% of the mothers adhered to the recommendation of introducing solid food at six months, and slightly more mothers (76.8%) believed that it is healthy to introduce solid food at six months of age. Also, most mothers (98%) believed it is healthier to start meat, chicken, or fish feeding at six months, which is congruent with the recommendations. However, 87.2% of the mothers met that recommendation.\u003c/p\u003e \u003cp\u003eFor egg white feeding, almost a similar percentage of mothers met (43.4%) and believed (43.3%) the recommendation of starting at the age of 12 months. A similar alignment was observed for fresh milk, with 84.7% of mothers adhering to the recommendation and 82.3% expressing belief in initiating fresh milk consumption at the age of 12 months.\u003c/p\u003e \u003cp\u003eLikewise, for bee honey feeding, 78.4% of the mothers adhered to the recommended initiation at 12 months, while 82.8% believed it. Moreover, a significant majority, accounting for 72.4% believed it was unhealthy to apply honey to the cracked nipple before feeding the infant, and even higher percentage, specifically 97.5% refrained from practicing this behavior. Further illustrations of infant feeding practices and beliefs are available in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescription of Infant Feeding Practices and Beliefs and their Adherence to the Recommendations.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractices\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRecommendations %*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBeliefs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRecommendations%*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eExclusive breastfeeding in the first six months\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003eExclusive breastfeeding in the first six months is better for the baby\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003estrongly disagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003erarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24(11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003edisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33(16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e76(37.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e98.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emostly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(32.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e67.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003estrongly agree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e123(60.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ealways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71(35.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBreastfed through the first year of life\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003eBreastfeeding through the first year of life is beneficial for the baby\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003estrongly disagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4(2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e181(89.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003edisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e91(44.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e96.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003estrongly agree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e105(51.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStarted feeding infant formula\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003eI believe it is better to start feeding infant formula\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;= 6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112(55.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43(21.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44(21.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e44.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u0026ndash;11 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e82(40.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e78.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enot started yet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47(23.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;=12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78(38.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStarted feeding solid food\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003eI believe it is better to start feeding solid food\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;=4 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;=4 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;5 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(32.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u0026ndash;5 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45(22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;=6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e130(64.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;=6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e156(76.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e76.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enot started yet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStarted feeding meat, chicken, fish\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003eI believe it is better to start feeding meat, chicken, fish\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;=4 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;=4 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;5 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14(6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u0026ndash;5 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4(2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;=6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e177(87.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;=6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e199(98.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e98.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enot started yet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStarted feeding 100% fresh juice\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003eI believe it is better to start feeding 100% fresh juice\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30(14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17(8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;11 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e110(54.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e85.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u0026ndash;11 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e109(53.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e91.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;=12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49(24.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;=12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e77(37.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enot started yet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14(6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStarted feeding yogurt\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003eI believe it is better to start feeding yogurt\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38(18.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22(10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;11 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e138(68.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u0026ndash;11 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e140(69.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e69.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;=12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25(12.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;=12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41(20.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enot started yet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStarted feeding egg white\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003eI believe it is better to start feeding egg white\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5(2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;11 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99(48.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u0026ndash;11 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e110(54.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;=12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55(27.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e43.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;=12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e88(43.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e43.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enot started yet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33(16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStarted feeding fresh milk\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003eI believe it is better to start feeding fresh milk\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4(2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;11 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25(12.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u0026ndash;11 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32(15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;=12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96(47.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e84.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;=12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e167(82.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e82.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enot started yet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76(37.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStarted feeding bee honey\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003eI believe it is better to start feeding bee honey\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6(3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;11 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31(15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u0026ndash;11 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;=12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e101(49.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e78.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;=12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e168(82.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e82.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enot started yet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58(28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eApplied bee honey to cracked nipple\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003eIt is fine to apply bee honey to cracked nipples\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e198(97.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003estrongly disagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e69(34.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e72.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003edisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78(38.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55(27.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003estrongly agree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e* Proportion of mothers adhering to the infant feeding recommendations.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen responses were dichotomized to the meeting (1) or not meeting the recommendations (0), IFP scores ranged from 3 to 11, while the IFB scores were between 4 and 11, considering 11 is the maximum and 0 is the minimum. The mean IFP score was 8.09 (SD 1.75) and the median was 8.00, indicating good data distribution. The mean IFB score was slightly higher (m\u0026thinsp;=\u0026thinsp;8.90, SD\u0026thinsp;=\u0026thinsp;1.45), with a median equal to 9. The Pearson correlation analysis signified a positive relationship between IFP and IFB, with a correlation coefficient of 0.53 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Details are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean, Median, Range and Pearson Correlation of IFP and IFB Recommendation Scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIFP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.09 (1.748)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u0026ndash;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIFB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.90 (1.447)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u0026ndash;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eMaternal Factors Associating with Adherence to Infant Feeding Recommendations\u003c/h2\u003e \u003cp\u003eMaternal characteristics including age, geographical location, educational level, family income, and history of infant feeding counseling were assessed against the IFP and IFB scores using independent t-tests.\u003c/p\u003e \u003cp\u003eData analysis showed a significant relationship between IFP recommendation scores and a history of infant feeding counseling (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Mothers who received infant feeding counseling at a healthcare facility had higher IFP scores compared to the mothers who did not, 8.46 (1.614) and 7.90 (1.79), respectively. Yet, the IFB score did not differ significantly between the mothers who received or not received infant feeding counseling (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eOn the other hand, mothers with higher educational levels (at least a baccalaureate degree) and family income (at least 1000 OMR) had better IFB recommendation scores (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, there was no significant association between these factors and the IFP score (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eResults also showed a nearly significant difference in the IFB scores between mothers younger than 35 years and those aged 35 years or more (p\u0026thinsp;=\u0026thinsp;0.53). Older mothers were having healthier beliefs about infant feeding, 9.20 (1.47) versus 8.77 (1.42). Nonetheless, there was no significant difference in the IFP score among older and younger mothers.\u003c/p\u003e \u003cp\u003eInterestingly, neither the IFP nor IFB recommendation score had a significant relationship with the geographical location (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating similarities across Muscat and Sharqia North infant feeding practices and beliefs. Results are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of IFP and IFB Recommendation Scores Means Among Different Groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eIFP score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eIFB score\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eM (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaternal Age\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.701\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003el8\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.06 (1.737)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.77 (1.423)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.17 (1.787)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.20 (1.471)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGeographical location\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.843\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuscat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.07 (1.697)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.79 (1.467)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSharqiya North\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.12 (1.833)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.06 (1.408)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaternal Educational Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.328\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt; baccalaureate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.99 (1.837)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.69 (1.528)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003ebaccalaureate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.24 (1.616)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.18 (1.283)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily Income (OMR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.991\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.09 (1.859)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.71(1.427)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;1000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.10 (1.588)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.15 (1.444)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealth Counseling\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.179\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot received\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.90 (1.789)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.80 (1.434)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReceived\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.46 (1.614)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.09 (1.463)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e* Sig. (2-tailed) with equal variances assumed. OMR\u0026thinsp;=\u0026thinsp;Omani Riyals (currency).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study investigated infant feeding practices and beliefs employing a newly developed comprehensive and culturally-sensitive structured questionnaire. In general, we found that the majority of the mothers were meeting the infant feeding recommendations. However, there remains a considerable division of mothers who did not, implying the importance of screening every mother\u0026rsquo;s infant feeding practices and beliefs for early identification of possible infant nutritional risks.\u003c/p\u003e \u003cp\u003eThe findings of this study revealed a notably higher degree of adherence to breastfeeding practices throughout the first year compared to exclusive breastfeeding within the initial six months. Hence, the reported exclusive breastfeeding rates show a better level of compliance compared to the previously reported data from Saudi Arabia, UAE and Oman, 5.3%, 26%, and 29%, respectively [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Additionally, the rate of breastfeeding throughout the first year reported in our study surpasses the level documented in the US., which was 23.8% [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The current study\u0026rsquo;s findings might indicate the positive outcomes of the baby-friendly movement initiative by the Omani health authorities in collaboration with WHO. In previous years, the Omani government adopted the baby-friendly initiative involving a breastfeeding policy that was strongly deployed in the health care facilities and capitalized through different means of campaigns [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The current statistics from this pilot study report an added improvement in breastfeeding practices. Moreover, large percentages of mothers in our study believed that exclusive breastfeeding and breastfeeding throughout the first year were healthier choices for their children, emphasizing a community-level awareness of the significance of breastfeeding [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOn the other side, the rate of non-adherence to specific complementary feeding recommendations in our study (grains, fruits and vegetables, animal protein, yoghurt, 100% fresh juice, fresh milk, egg white, bee honey) ranged from 12.8% for the time of starting animal protein to 56.6% for the time of initiating egg white. Data from the other studies reflected lower non-adherence rates, most probably due to the non-inclusiveness of a comprehensive list of complementary food items. For instance, the previous ONNS questioned the time of initiating juice, yogurt, soup and porridge and the rate of non-adherence ranged from 6\u0026ndash;13% [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Studies conducted in the UAE described that 19% of 28% of infants were introduced to complementary feeding before the age of six months [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The highest rate of introducing complementary food to infants younger than six months in the region was observed in Saudi Arabia with a rate reaching 64.3% [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This could indicate that mothers were relying on the old WHO recommendations stating to initiate complementary feeding at four months, especially since online was reported as the primary source of infant feeding information. It was noted that most studies describing the complementary feeding practices focused on describing the quality of complementary feeding by calculating specific indices (e.g. diversity, frequency, and acceptability) such as the Infant and Young Child Feeding and Complementary Feeding Utility Index (CFUI) rather than providing details relative to the time of introducing different types of food items. These results highlight the importance of promoting and supporting breastfeeding practices among mothers, particularly in the first six months of a child's life, to improve overall health outcomes [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Further research is needed to explore the factors that contribute to successful breastfeeding practices and to develop effective interventions to support mothers in this regard.\u003c/p\u003e \u003cp\u003eNevertheless, the rate of beliefs in our study was consistently higher than the actual practices, signifying the presence of certain barriers to healthy practices. The literature identified that mothers returning to work was a significant predictor of intention to continue breastfeeding [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Other common breastfeeding problems reported were pain and perceived inadequate breastmilk [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. A qualitative study identified perceived challenges to breastfeeding including judgement from others for breastfeeding in the public or using a bottle, even with expressed breastmilk [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. A Suadi study suggested that younger mothers' age and cesarean section mode of delivery were predictors of the early introduction of complementary feed [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. While there is evidence that different social circumstances such as economic constraints and dependence on food purchasing as well as cultural beliefs could significantly influence the breastfeeding behaviors among mothers [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], the case in Oman might be slightly different. The majority of the participating mothers in the current study had a baccalaureate education or higher and reported an acceptable monthly income. This might explain the mothers\u0026rsquo; need to prioritize early returning to work before healthy breastfeeding practices regardless of their knowledge, awareness, and beliefs. Therefore, policymakers and stakeholders are recommended to consider the working conditions and more or less \u0026ldquo;forced\u0026rdquo; absence of the mother when planning targeted interventions.\u003c/p\u003e \u003cp\u003eOur study findings indicated that the provision of infant feeding counseling had a significant association with healthy infant feeding practices. Furthermore, higher education level and monthly income were correlated with healthier infant feeding beliefs. Accurate evidence in the literature supports our study findings stating that breastfeeding education sessions and high levels of education were significant factors associated with breastfeeding [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Our study also aligns with previous research conducted in Ethiopia, which found that limited breastfeeding counseling quadrupled the risks for introducing fluids or foods other than breastmilk before establishing regular breastfeeding [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Additionally, professional, partner, and family support, was related to higher rates of exclusive breastfeeding [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The results of our study and previous research highlight the importance of providing comprehensive breastfeeding education and support to mothers, particularly those with limited resources and education. Such interventions can help improve infant feeding practices and promote better health outcomes for infants.\u003c/p\u003e \u003cp\u003eDescriptions collected through our newly developed questionnaire have helped clarify the type of complementary food that needs to be highlighted during infant feeding counseling. Moreover, it can capture the specific deviation from the recommended infant feeding practices that are known to be associated with several complications including the ones associated with limited breastfeeding and early introduction of infant formula (e.g., immunity, obesity), early introduction of complementary food (allergy, respiratory illnesses, and constipation), late introduction to animal protein (iron deficiency anemia), early introduction of 100% fresh juice (obesity and malnutrition), late introduction of yogurt (disturbed gut micropia), early introduction of egg white (food and skin allergy), early introduction of fresh milk (food allergy and iron deficiency anemia), and early introduction of bee honey (infant botulism) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e While this sample size might be relatively modest, it is in line with recommended guidelines for pilot studies, allowing for a preliminary evaluation of initial validation while considering the feasibility of a larger-scale study. Moreover, a revised version of the tool is needed incorporating the insights learned from this pilot study. Thus, further validation through larger-scale studies to establish its reliability and validity shall be considered.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eA comprehensive assessment of infant feeding practices is fundamental for the early identification of nutrition-related risks. Data generated from the newly developed infant feeding practices and beliefs questionnaire shall assist in determining the risks associated with multiple nutrition-related morbidities in children, thus promising a valid and feasible mean for a comprehensive infant feeding assessment.\u003c/p\u003e"},{"header":"List Of Abbreviations","content":" \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCDC\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eCenter for Disease Control and Infection\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCFUI\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eComplementary Feeding Utility Index\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCON/IG\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eCollege of Nursing/Internal Grant\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eI- CVI\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eItem Content Validity Index\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eIFB\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eInfant Feeding Beliefs\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eIFP\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eInfant Feeding Practices\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eIFPB\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eInfant Feeding Practices and Beliefs\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMOH/CSR\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eMinistry of Health/ Center for Studies and Research\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMENA\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eMiddle East and Northern Africa\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eOMR\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eOmani Rial\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRAs\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eResearch Assistants\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSD\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eStandard Deviation\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eUAE\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eUnited Arab Emirates\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eUS\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eUnited States\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eWHO\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eWorld Health Organization\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe approval for the study was obtained from the Research and Ethics Committee at the College of Nursing, Sultan Qaboos University (CON/IG/2022/9). In addition, ethical approval was obtained from the Health Studies and Research Approval Committee at the Ministry of Health (MOH/CSR/23/26906). All the mothers who participated in this study provided written consent. Study methods were performed by the ethical guidelines and regulations for research among human subjects following the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study will be available from the Principal Investigator (BAY) upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBAY is the primary developer of the IFPB structured questionnaire. The authors declare that they have no financial competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received funds from the Internal Grants of Sultan Qaboos University (REF.NO\u0026nbsp;IG-CON-MCHH-23-04).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the conceptualization and writing of this manuscript. BAY developed the overall structure of the questionnaire and conceptualized the study objectives and methodology. SAY and BAH facilitated the operation and implementation processes, while OAO and AK contributed to the analysis procedures. All authors revised the manuscript several times and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our gratitude to the Deanship of Research at Sultan Qaboos University;\u003c/p\u003e\n\u003cp\u003eDirectorate General for Planning and Studies at the Ministry of Health; Directorate General for Health Services in Muscat at the Ministry of Health in Oman. We also appreciate the support of our partner healthcare agencies in Muscat and North Al-Sharqia. We thank the mothers who volunteered and participated in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHockenberry MJ, Wilson D. Wong's nursing care of infants and children. -E-book: Elsevier Health Sciences; 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThompson AL. Evaluating the pathways linking complementary feeding practices to obesity in early life. Nutr Rev. 2020;78(Supplement2):13\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinistry of Health O. Annual Health Report. 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCouto GR, Dias V, de Jesus Oliveira I. Benefits of exclusive breastfeeding: An integrative review. Nurs Pract Today. 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eForde CG, McKinley MC, Woodside JV, Nugent AP. Nutritional considerations in children. Nutr oral health. 2021:3\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBakhrieva G, AGE CHARACTERISTICS OF, THE DIGESTIVE SYSTEM. Mod Sci Res. 2023;2(10):975\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYelverton CA, Geraghty AA, O\u0026rsquo;Brien EC, Killeen SL, Horan MK, Donnelly JM, et al. 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Lancet. 2023;401(10375):472\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRozensztrauch A, Klaniewska M, Berghausen-Mazur M. Factors affecting the mother's choice of infant feeding method in Poland: a cross-sectional preliminary study in Poland. Ir J Med Sci. 2022;191(4):1735\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuckland C, Hector D, Kolt GS, Thepsourinthone J, Arora A. Experiences of young Australian mothers with infant feeding. BMC Pregnancy Childbirth. 2022;22(1):489.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChakona G. Social circumstances and cultural beliefs influence maternal nutrition, breastfeeding and child feeding practices in South Africa. Nutr J. 2020;19(1):1\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMegersa N, Tariku EZ, Yesera G, Gutema B. Prevalence of prelacteal feeding and its associated factors among mothers of under-24-month-old children at Arba Minch Zuria District, Ethiopia: A cross-sectional study. South Afr J Child Health. 2021;15(2):112\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhuang L, Chen H, Zhang S, Zhuang J, Li Q, Feng Z. Intestinal Microbiota in Early Life and Its Implications on Childhood Health. Genomics Proteom Bioinf. 2019;17(1):13\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHenrick BM, Yao XD, Nasser L, Roozrogousheh A, Rosenthal KL. Breastfeeding Behaviors and the Innate Immune System of Human Milk: Working Together to Protect Infants against Inflammation, HIV-1, and Other Infections. Front Immunol. 2017;8:1631.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Feeding, Infant, Complementary, Breast Feeding, Questionnaire","lastPublishedDoi":"10.21203/rs.3.rs-4038672/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4038672/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Infant feeding tools available in the literature lack comprehensiveness and inclusiveness to infants of different ages. This study aimed to pilot test a newly developed infant feeding structured questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This study utilized a cross-sectional design. The structured questionnaire developed had two main sections; the first section included questions relative to sociodemographic characteristics, birth and clinical history, and infant food history in the first year. The second section incorporated a 22-item design to stipulate a comprehensive description of infant feeding practices (IFP) and Infant Feeding Beliefs (IFB). A convenient sampling technique was used to collect data from six health centers located in Muscat and Al-Sharqia North. The infant feeding practices and beliefs variables were dichotomized to either meeting the recommendations (1) or not meeting the recommendations (0), based on the WHO guidelines\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The data analysis encompassed a cohort of 203 participants. Most mothers aged between 26 and 35 years (58.6%). Among the mothers, 67% practiced exclusive breastfeeding in the first six months, 89.2% were breastfeeding in the first year, and 44.9% initiated infant formula feeding at six months of age or later. Moreover, 64% of the mothers introduced solid food (e.g., rice, vegetables, fruits) at six months, while (87.2%) started feeding meat, chicken, or fish at six months. For feeding egg white, fresh milk, and bee honey, 43.4%, 84.7%, and 78.4%, respectively, met the recommendation of waiting until the child ages 12 months. The mean IFP score was 8.09 (SD 1.75), while the mean IFB score was slightly higher (m=8.90, SD= 1.45). The Pearson correlation analysis signified a positive relationship between IFP and IFB (r=0.53, p\u0026lt;0.001). Mothers who received infant feeding counseling had higher IFP scores compared to the mothers who did not. Additionally, mothers with at least a baccalaureate degree and a family income of at least 1000 OMR had better IFB recommendation scores (p \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Data generated from the newly developed infant feeding practices and beliefs questionnaire shall assist in determining the risks associated with multiple nutrition-related morbidities in children, thus promising a valid and feasible mean for a comprehensive infant feeding assessment.\u003c/p\u003e","manuscriptTitle":"Development and Pilot Testing of a Comprehensive and Culturally-sensitive Infant Feeding Structured Questionnaire: A Cross-sectional Design","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-19 09:34:14","doi":"10.21203/rs.3.rs-4038672/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-03-16T10:32:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-15T06:44:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-15T06:44:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2024-03-08T07:16:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b0dfaddf-fe4b-41e1-ab64-add0b97b8676","owner":[],"postedDate":"March 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-24T16:57:08+00:00","versionOfRecord":{"articleIdentity":"rs-4038672","link":"https://doi.org/10.1186/s12889-025-21839-9","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2025-02-18 15:57:37","publishedOnDateReadable":"February 18th, 2025"},"versionCreatedAt":"2024-03-19 09:34:14","video":"","vorDoi":"10.1186/s12889-025-21839-9","vorDoiUrl":"https://doi.org/10.1186/s12889-025-21839-9","workflowStages":[]},"version":"v1","identity":"rs-4038672","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4038672","identity":"rs-4038672","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}