Prevalence, Safety Evidence, and Determinants of Medicine Use during Breastfeeding among Women in Kampala, Uganda

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Limited research has been undertaken on medication practices during lactation, especially in low-resource settings like Uganda. The study aimed to investigate the prevalence of medicine use, evidence about safety, and factors that influence medicine use among breastfeeding women in Kampala, Uganda. Methods We conducted a cross-sectional study using a structured questionnaire in six healthcare clinics in Kampala, Uganda, from September 2023 to January 2024 among breastfeeding women. We enrolled breastfeeding women aged 18 and older. We used modified Poisson regression to identify factors associated with medication use. We evaluated medication safety during breastfeeding and Relative Infant Dose (RID) using Hale’s Lactation Risk Category, the LactMed database, and the WHO Anatomic Therapeutic Chemical (ATC) classification system. Medicines with a RID > 10% were flagged as potentially giving higher infant exposure. Results Of the 294 enrolled breastfeeding women, 168 (57.1%) practiced exclusive breastfeeding. A total of 232 women (78.9%) had used medicines in the preceding six months, and 98 (67.3%) of women reported obtaining medicines without prescriptions. Medicine use was significantly more common among women with younger infants (adjusted prevalence ratio [aPR] = 1.4; 95% CI: 1.1–1.6), higher educational attainment (aPR = 1.3; 95% CI: 1.1–1.4), and those without chronic health conditions (aPR = 1.1; 95% CI: 1.1–1.3). Antibiotics were the most frequently used class of medicines, with amoxicillin and ampicillin/cloxacillin reported by 112 women (38.1%). Metronidazole, an antimicrobial agent, was also commonly used, reported by 137 women (46.6%), raising concerns due to its potential for high infant exposure (estimated between 11–24%). Analgesic use was also high, particularly paracetamol, used by 183 women (74.5%). Overall, 61.0% of medicines used were classified as compatible with breastfeeding, 35.4% as probably compatible, and 2.6% as possibly hazardous. Medicines requiring cautious use included frusemide, cyproheptadine, metronidazole, phenylpropanolamine, acetaminophen combined with caffeine, and griseofulvin owing to risks of significant infant exposure, potential interference with lactation, or limited safety data. In contrast, dihydroartemisinin/piperaquine phosphate, artemether/lumefantrine, cefixime, pyrazinamide, and ethambutol were frequently used and considered acceptable during lactation. However, it is important to note that controlled studies assessing their safety specifically in breastfeeding women are lacking. Conclusion Breastfeeding women frequently used medicines, many of which were self-prescribed, including some that necessitate careful consideration due to safety concerns. Findings underscore the need for targeted education on safe medicines practices to support women's informed decision-making, conduct pharmacokinetics studies in breast milk, and impact on lactation. Breastfeeding lactation medication safety evidence relative infant dose Figures Figure 1 Figure 2 Figure 3 Introduction Breastfeeding is one of the most effective practices for promoting child health and survival. The World Health Organization (WHO) and United Nations Children's Fund (UNICEF) guidelines advise initiating breastfeeding within the first hour after birth, followed by exclusive breastfeeding for the first six months ( 1 , 2 ) while continued breastfeeding with complementary foods is recommended for up to two years and beyond ( 1 ). In Uganda, exclusive breastfeeding rates for the first 6 months range from 40–67%, although they vary by region ( 3 – 5 ). However, as breastfeeding mothers frequently encounter health problems that may necessitate medication, such as postpartum pain, infections, and chronic conditions, they must make informed decisions about safe medication use to avoid potential adverse effects on their infants. Various factors, including healthcare access, education, cultural beliefs, and individual health status, can affect mothers' medication choices. Medicine use can substantially influence breastfeeding patterns and duration ( 6 ), as certain drugs may interfere with milk production, composition, or flow. Specifically, drugs such as diphenhydramine, pseudoephedrine, haloperidol, and furosemide have been shown to impact milk synthesis and secretion, potentially leading to reduced breastfeeding efficacy or, in some cases, cessation of breastfeeding ( 7 ). Moreover, there exists a substantial gap in the literature concerning the safety of drugs used during lactation ( 8 ). While some medications are considered compatible with breastfeeding, limited evidence is available to assess the risks associated with many commonly used drugs. It is important to note that in Uganda, medications that typically require a prescription in many parts of the world, such as antibiotics, diazepam, amitriptyline, and codeine, can be purchased over the counter. This practice may pose potential risks, including improper use, lack of professional guidance, and increased likelihood of adverse effects or antimicrobial resistance ( 9 ). Similarly, breastfeeding women may resort to self-medication practices, obtaining medications without prescriptions or professional guidance, despite the increasing awareness of the benefits of breastfeeding. The topic of safe medication use among breastfeeding women remains under-researched, particularly in low- and middle-income countries (LMIC) like Uganda. Studies in other populations have shown that commonly used medications among breastfeeding women include analgesics, antibiotics, and antipyretics, regarded as generally safe due to their low levels of transfer to breast milk and low percentage of the dose prescribed to the mother that is received by the infant known as the Relative Infant Doses (RIDs) ( 10 , 11 ). Studies have highlighted that self-medication practices are prevalent among breastfeeding mothers, especially in settings with limited access to healthcare, where women may obtain medications informally without prescriptions. In these settings, many medications requiring a prescription in other countries are available over the counter ( 12 , 13 ). The lack of context-specific research on medication use among breastfeeding women in Uganda presents a significant gap in developing targeted interventions and educational resources that can support safe medication practices among breastfeeding women. Given these considerations, this study aims to investigate the influences of medication use among breastfeeding mothers, as well as evaluate the safety of medicines commonly used during breastfeeding. Materials and methods Study design and setting In this cross-sectional study, we investigated the prevalence of medicines use, safety evidence, and factors associated with medication use in breastfeeding women. The study was conducted in six Urban healthcare clinics in Kampala Uganda; which included the Infectious Diseases Institute (IDI) and Kampala City Council Authority (KCCA) IDI-affiliated clinics that provide free maternal child health services, immunization, treatment for persons with HIV, and outpatient and in-patient services. The IDI is a research institution affiliated with the College of Health Sciences, Makerere University that supports over 200,000 People Living with HIV through the Health Systems Strengthening Programme. The KCCA healthcare facilities serve a population of over half a million people. Patient and Public Involvement Each questionnaire was subjected to user testing by peer mothers affiliated with sexual and reproductive health clinics to assess its content, length, and usability, specifically among breastfeeding women. Peer mothers played a vital role in providing emotional support, educating breastfeeding women about medication safety, facilitating study participation, promoting adherence to study protocols, and fostering community engagement to ensure the success of the study. Throughout the study, ongoing engagement was maintained through regular meetings with Community Advisory Board (CAB) members and peer mothers to monitor the study's progress. The roles of community members, peer mothers, and the CAB have previously been shown to bridge the gap between researchers and the community, offering valuable advice from a community perspective ( 14 , 15 ).These sessions provided a platform for feedback on study implementation. The questionnaires were also reviewed by the authors (LA, CW, RK) and multiple revisions were made to integrate user feedback. Eligibility and recruitment We included breastfeeding women aged 18 years and older who had finished breastfeeding in the past three months, and whose infants were twelve months or younger. The age group for infants was chosen because they rely heavily on breast milk for nutrition, and medication taken by the mother can be transferred to the infant through breast milk. Women with children more than twelve months of age were excluded from the study. We used systematic random sampling to recruit participants from September to January 2024. The sampling interval of approaching every fifth potential eligible woman was used based on the average attendance at the maternal and child health (MCH) clinic. To ensure fairness and minimize selection bias, the first potential woman was randomly chosen through a lottery drawing method. Subsequently, every 5th woman was selected in accordance with the predetermined interval. A sample size of 294 participants was required for enrollment based on the assumption that 80% of women use medicines while breastfeeding. ( 16 ). Data collection procedures The survey questionnaire was developed based on insights from a comprehensive literature review and previously published surveys ( 1 , 2 ). It was administered face-to-face to potential participants, and a series of structured questions were designed to be completed within 40 minutes. The research assistants translated the survey questions into the participants' preferred language, which was mainly Luganda due to the study setting in central Uganda. The questionnaire gathered information on demographic characteristics (e.g., maternal age, education level, and parity and child’s age), types of medicines used, and breastfeeding practices. Breastfeeding was defined broadly to include all practices incorporating breast milk, such as exclusive breastfeeding (EBF), complementary breastfeeding (CBF), and expressed breast milk feeding. Medicines were defined as all prescribed and non-prescribed medicines, including oral contraceptives and herbs. Participants were categorized into four groups: ( 1 ) currently using medication while breastfeeding, ( 2 ) previously used medication while breastfeeding, ( 3 ) not using any medication while breastfeeding, and ( 4 ) discontinued breastfeeding while on medication. The availability of safety information for medicines and the Relative Infant Dose (RID) was evaluated according to the LactMed database, Hales Lactation Risk Category, and the World Health Organization (WHO) Anatomic Therapeutic Chemical (ATC) classification system ( 17 , 18 ). Statistical analysis Descriptive statistics were used to summarize participants’ characteristics with frequencies and percentages. The prevalence of medication use during breastfeeding was defined as the proportion of participants who were actively using medicines at the time of recruitment into the study. A modified Poisson Regression model was fitted to identify factors associated with the prevalence of medicine use among breastfeeding women. Factors were selected for the adjusted model if p < 0.2 at the univariate level, as well as based on clinical significance. In the regression model, the association of medication use with the following factors was examined: maternal age, infant age, education level, employment status, marital status, alcohol intake, smoking, mode of delivery for the last baby, presence of a current non-chronic medical condition, chronic condition (non-HIV), and HIV status. Descriptive statistics were used to summarize medication categories, lactation risk, relative infant dose (RID), and breastfeeding recommendations for participants taking medication while breastfeeding. Percentages of medication use were calculated by dividing the number of participants who reported using each specific medication by the total sample size (N = 294) and multiplying the result by 100. The lactation risk assessments and drug categories were based on the Lactmed database and the WHO Anatomic Therapeutic Chemical (ATC) classification system. RID was used to assess potential exposure risks to infants, with values > 10% marked as higher exposure and flagged for additional precautionary recommendations. RID is calculated by dividing the infant’s dose via milk (in mg/kg/day) by the mother’s dose (in mg/kg/day) *100. A RID of 10% is a pragmatic cut-off that is less likely to be of concern to an infant’s well-being. Medications were classified as "L1-compatible (safest)," "L2-probably compatible," "L3-presumed compatible, L4-Possibly hazardous, and L5-Hazardous (contraindicated) according to the LactMed database and Hale medication and mothers milk ( 18 , 19 ). Recommendations provided reflect guidelines from published pharmacological safety databases and lactation risk assessments. We used a heat map to present the co-administration of medication medicines taken while breastfeeding visually. In contrast, a stacked bar graph was used to present risk categories for these medicines by drug classification. Results A total of 294 participants were enrolled in the study. The majority of women, 63.3% (186/294), were 25 years or older, 68.7% (202/294) had infants 6 months or younger, 66.0% (194/294) of participants had post-primary education, and 72.7% (194/294) were married. Two-thirds (65.0%, 191/294) did not use any form of contraception, while 35.0% (103/294) reported contraceptive use. The most frequently used method was Depo-Provera (injectable), 45.7% (48/105). 82.7% had spontaneous vaginal deliveries. HIV/AIDS was the most common chronic condition, 39.5% (116/294), as shown in Table 1 of the demographic characteristics. Prevalence of medicine use while breastfeeding The prevalence of medication use was 78.9%, while 8.2% had not taken any medicines while breastfeeding, and 12.9% of women stopped breastfeeding while on medications on clinical recommendation due to high HIV viral load ( Figure 1). Additionally, a total of 168 (57.1%) of women exclusively breastfed, while none of the women pumped or expressed breastmilk. The majority, 198 (67.3%) of women acquired medicines without a prescription, and 63 (21.4%) consumed herbal remedies, including bitter leaf, African basil, and desmodium, while breastfeeding,as detailed in Table 4 of the Supplementary material . Participants' characteristics associated with taking medicine while breastfeeding Women with infants aged six months or younger were significantly more likely to use medicines while breastfeeding compared to those with infants older than six months (adjusted prevalence ratio [aPR] = 1.4; 95% CI: 1.1–1.6). Additionally, women who attained education beyond the primary level were more likely to report medicine use during breastfeeding compared to those whose education ended at the primary level (aPR = 1.3; 95% CI: 1.1–1.4). Women with current acute medical conditions were 1.2 times more likely to take medications than those mothers without current acute medical conditions (aPR=1.1, 95%CI 1.1-1.3 ) as shown in Table 2 . Medicines consumed while breastfeeding Analgesics/antipyretics were highly used, representing 219(74.5%) of total medications. Antibiotics were widely used by 112 (38.1%), mostly amoxicillin and ampicillin/cloxacillin. Notably, metronidazole was consumed by 137 (46.6%) of women. A comprehensive heat map of all reported medicines used by participants is provided in Supplementary material, Figure 3, and Table 3. The map highlights significant variability in drug usage among breastfeeding mothers, with paracetamol, amoxicillin, and ibuprofen being the most frequently used medications. These medicines were co-administered, with paracetamol commonly paired with amoxicillin and ibuprofen to manage pain, fever, or inflammation during infections. In contrast, most other medicines showed minimal usage, suggesting limited prescription or accessibility. Evidence of the safety of medicines consumed while breastfeeding The majority of medications (61.04%) were classified as Level 1 (L1) - Compatible, indicating they are safe for breastfeeding, including commonly used medicines like antibiotics and analgesics. A smaller proportion were Level 3 (L3) - presumed compatible (Moderately safe) (20.78%), and Level 2 (L2) - probably compatible (safer) (15.58%). A few drugs (2.60%) were Level 4 (L4)-Possibly Hazardous, posing potential risks to infants. Reported adverse effects associated with these medications include dry mouth, constipation, urinary retention, and central nervous system depressant effects. Paracetamol was highly compatible with a low RID (0.1–0.2%), while acetaminophen/caffeine and metronidazole required cautious use or breastfeeding discontinuation due to higher RIDs. Most drug categories, such as antiretrovirals and antihistamines, were compatible, though anti-tuberculosis and anti-malaria drugs lacked sufficient data. Cyproheptadine and phenylpropanolamine were possibly hazardous due to their effects on lactation, while prednisolone and chlorpheniramine required timing adjustments to reduce infant exposure. Griseofulvin lacked adequate safety data., Table 3, S3 . The drug classes versus risk categories consumed by women are illustrated in Figure 2. Discussion This study revealed that more than 70% of the breastfeeding mothers attending six facilities in Kampala consumed medications, and more than 50% obtained drugs without prescriptions. Women with younger infants, higher education, or current acute conditions were more likely to use medications. Analgesics, particularly paracetamol, were the most commonly used medications among breastfeeding women, with high compatibility and low exposure to infants, although acetaminophen/caffeine required caution due to a higher exposure. Antibiotics, including amoxicillin and ampicillin/cloxacillin, were also widely used (38.1%) and showed low exposure to the infant through breastmilk, indicating safe compatibility. It is plausible that women with younger infants may exhibit higher medication use, potentially driven by increased exposure to infections during the postpartum period and the heightened vulnerability associated with factors that elevate the risk of infections during this time. Thus, mothers of younger infants may prioritize their health to maintain optimal care for their infants, leading to increased medication use. Similarly, higher education levels could have been linked to better access to healthcare information, which could raise awareness and acceptance of medication use when necessary. Also, the increasing health disparities based on education level are a significant social concern that may warrant targeted interventions, as noted by Goldman et al. ( 20 ). Our study revealed that more than half of the women (57.1%) exclusively breastfed without pumping or expressing milk. This rate of exclusive breastfeeding suggests moderate adherence to breastfeeding practices, which is essential for optimal infant nutrition and immune support. The results show decreasing rates of exclusive breastfeeding as mothers seek paid work, reducing the time available for exclusive breastfeeding. Similarly, Nabunya’s study revealed a prevalence of exclusive breastfeeding of 42.8% among mothers in the informal sector ( 3 ). However, the absence of milk expression could indicate limited awareness or access to pumping methods, which can help manage breastfeeding challenges, such as maintaining milk supply or balancing work demands. Encouraging safe and accessible milk expression options could enhance breastfeeding continuity for those who may face time constraints or work obligations. Additionally, 67.3% of participants obtained medications without prescriptions, raising concerns about self-medication practices and the potential risks of using non-prescribed medicines while breastfeeding. This behavior suggests a gap in access to healthcare or a reliance on informal health advice. Unregulated medication use may increase the risk of exposure to medicines that could transfer into breast milk at potentially harmful levels, and incorrect dosing, which can increase the risk of adverse effects and drug interactions ( 21 , 22 ). Furthermore, a notable portion of women (78.9%) reported recent medication use within the past six months, as observed in Nigeria, where over 95% of women consumed medicines while breastfeeding ( 23 ). In this study. 8.2% had never used medications while breastfeeding; however, while some breastfeeding women were comfortable using medicines when needed, a subset of 10% stopped breastfeeding while on antiretroviral therapy because of high viral load, which would increase the chances of HIV exposure to the infant, as recommended by the healthcare providers. Our findings indicate that analgesics, particularly paracetamol, are the most frequently used medications among breastfeeding women (74.5%). Paracetamol, with its high compatibility for breastfeeding, is commonly prescribed for pain and fever relief due to its well-documented safety profile and low relative infant dose, which minimizes risk to infants through breast milk exposure. This is consistent with other studies showing that analgesics and antipyretics are the most commonly used medications among breastfeeding women ( 24 , 25 ), making it one of the safest analgesics for breastfeeding mothers. However, formulations containing caffeine require cautious use due to their higher exposure to breastfed infants (7–18%), which could increase infant exposure to caffeine, potentially leading to irritability or sleep disturbances in infants ( 26 , 27 ). The extensive use of antibiotics, including amoxicillin and ampicillin/cloxacillin, also reflects a pattern of safe medication practices among breastfeeding women. These antibiotics are generally regarded as compatible with breastfeeding, and their low exposure to infants (0.5-1%) supports their safety profile, posing minimal risk of adverse effects to the infant. This is in line with studies from similar populations that show amoxicillin and cloxacillin were the most used antibiotics due to their safety profiles and effectiveness in treating maternal infections while minimizing infant exposure risks ( 28 , 29 ). This study reveals varying safety levels across drug categories for breastfeeding women. While most categories, such as antiretrovirals, antihistamines, corticosteroids, and supplements, are deemed "compatible for use" and generally safe. Caution is warranted when prescribing antibiotics (ciprofloxacin, cotrimoxazole, metronidazole, levofloxacin) and antihypertensive medications (atenolol, losartan) to breastfeeding women, as these drug classes may pose potential risks to the breastfed infant, including gastrointestinal disturbances, alterations in gut microbiota, and possible cardiovascular or renal effects. Although metronidazole has been associated with potential risks to breastfed infants, including gastrointestinal disturbances and possible mutagenic effects in high doses, it remains an essential component of treatment for postpartum infections. Given its critical role in managing maternal health conditions, and the limited availability of safer equally effective alternatives, its use during breastfeeding is often necessary, with careful consideration of dosing and timing to minimize infant exposure. The limited availability of controlled studies conducted in this population underscores the need for careful consideration. These medications should only be administered if the potential benefits to the mother outweigh the potential risks to the infant. Some anti-fungal drugs such as griseofulvin were flagged as "probably Compatible," with limited safety data. Likewise, Yevgenia et al evaluated the strength of the data for the most commonly administered medications in lactating women and found that 51% of medicines had no associated data, 664 (47%) had minimal-moderate data, and 30 (2%) had strong data using the LactMed database and WHO classification ( 30 ). For medicines that are flagged for cautious use, it is generally recommended to adjust or avoid breastfeeding for 2–4 hours following administration. For medications flagged for cautious use, it is generally recommended to adjust or avoid breastfeeding for 2–4 hours after administration. However, for certain medications such as cotrimoxazole, it is advised to avoid breastfeeding in infants with G6PD deficiency, regardless of the standard recommendations. However, routine screening for G6PD deficiency remains uncommon in many low- and middle-income countries (LMICs), making it challenging to implement such targeted precautions in clinical practice. Nevertheless, women reported a lack of guidance from healthcare providers regarding breastfeeding adjustments while on certain medications. Furthermore, some women did not disclose their breastfeeding status to healthcare providers, highlighting a mutual gap in communication. Healthcare providers have a responsibility to inquire about breastfeeding and provide appropriate guidance before prescribing medications. Women reported receiving information mainly on dosing and timing of the drug. Despite these guidelines, breastfeeding women may be unaware of such precautions, and they may not always receive adequate information from their healthcare providers regarding the safe use of medications during lactation. Strengths and limitations This is the first study in Uganda to explore medication use among breastfeeding women. It provides essential data on medication use behaviors specific to breastfeeding women in a low-resource setting. As the first study on this topic in this country, this research establishes baseline data that can support national health policies and targeted interventions to promote safe medication use during breastfeeding. It also highlights the need for accessible information on medication safety. The study captures a significant proportion of breastfeeding women, offering a robust sample size that enhances the reliability and generalizability of the findings. Limitation Lactation risk categories used have several limitations, including reliance on limited or low-quality evidence, subjectivity in risk assignment, and failure to account for individual variations such as infant age, feeding patterns, and maternal health. The factors often oversimplify complex risks, focus predominantly on infant safety without balancing maternal treatment needs, and may not be updated frequently to reflect new evidence. The study was conducted in aa healthcare setting unlike in unregistered drug shops where most of the illegal medicines could be sold. Additionally, the lack of global consensus among classification systems leads to inconsistent recommendations, and over-reliance on these simplified categorizations can hinder case-specific clinical decision-making. The reliance on self-reported data may have introduced recall bias, particularly regarding past medication use, as well as social desirability bias, where participants may underreport self-medication behaviors. Moreover, the study was conducted at healthcare facilities, which might limit generalizability to all breastfeeding women in Uganda, especially those in rural or remote areas who may have different healthcare access and practices. Conclusion Breastfeeding women frequently acquired medicines without prescriptions, with high usage of compatible analgesics, like paracetamol, and antibiotics, such as amoxicillin. However, medications with higher Relative Infant Doses (RIDs), like caffeine-containing paracetamol and metronidazole, may pose risks, indicating a need for cautious administration. The findings underscore the necessity of safe medicine use guidelines and access to healthcare guidance to prevent potential infant exposure to unsafe medicines through breastfeeding. The study insights pave the way for improved healthcare interventions to support the safe and informed use of medications during breastfeeding in Uganda and similar settings. The identification of high-use medicines and their safety profiles allows healthcare providers and policymakers to develop targeted guidelines, prioritize education on safe medicine use, and support safer breastfeeding practices across similar populations. Future research should address safety data gaps, particularly for some antifungals, antihypertensives, metronidazole, and antimalarial drugs. Declarations Ethics approval The study obtained expedited ethical clearance for this study from the institutional review board (IRB) of the Infectious Diseases Institute (SPH-2023-448), Uganda National Council of Science and Technology (HS3166ES). Consent to participate Approval was sought from all study participants. Written informed consent was sought, and only those who consented participated in the study. The research team ensured the utmost confidentiality during the entire process of the study. Consent for Publications Not applicable. Authors Contributors RN, RK, LA, CW, RM, and CN contributed to the conceptualization design of the study, RN, and LN were involved in data collection, and RN, FD, and JM conducted the data analysis and interpretation. RN drafted the manuscript. FD, JM, RN, LA, and CW edited the draft manuscript. All authors reviewed and approved the manuscript before submission for publication. Acknowledgments We acknowledge the MILK Study team members, the study team that collected data, and the participants as well as the peer mothers and healthcare providers at the participating facilities. Funding The study was funded by Wellcome Clinical Research Career Development Fellowship 222075/Z/20/Z, awarded to CW. RK is funded by the UK Medical Research Council (MR/V03510X/1, MR/V030434/1). Competing Interests. The authors have no competing interests to declare. Availability of data and materials https://doi.org/10.5281/zenodo.15284583 References Organization WH. Indicators for assessing infant and young child feeding practices part 3: country profiles. World Health Organization; 2010. Arts M, Taqi I, Bégin FJBM. Improving the early initiation of breastfeeding: the WHO-UNICEF breastfeeding advocacy initiative. 2017;12(6):326-7. Nabunya P, Mubeezi R, Awor PJPO. Prevalence of exclusive breastfeeding among mothers in the informal sector, Kampala, Uganda. 2020;15(9):e0239062. 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Tables Table 1 :Demographic characteristics of participants Characteristic Frequency N(Col%) Characteristic Frequency N(Col%) Overall 294 Demographics Obstetric history Maternal Age Contraceptive Use = 25yrs 186 (63.3) Yes 105 (35.7) Age of Infant Contraceptive (N=105) 6months 92 (31.3) Implant (Jadelle) 38 (36.2) Education level of women Pills (Microgynon) 8 (7.6) Post-primary 194 (66.0) IUD 5 (4.8) Primary and below 100 (34.0) Tubal ligation 3 (2.9) Marital status (N=293) Condoms 3 (2.9) Married 213 (72.7) Mode of delivery last baby Not Married 80 (27.3) Spontaneous vaginal delivery 243 (82.7) Employment Category (N=289) C-section 51 (17.3) Employed 169 (58.5) Medical history Unemployed 120 (41.5) Current chronic comorbid conditions Social History HIV/AIDS 116 (39.5) Alcohol intake Hypertension 9 (3.1) No 252 (85.7) TB 8 (2.7) Yes 42 (14.3) Depression 1 (0.3) Smoking Other (Asthma (3), Diabetes (1), Chronic mastitis (1) 5 (1.7) No 286 (97.3) Yes 8 (2.7) Table 2; Modified Poisson Regression model examining participants' characteristics associated with taking medicine while breastfeeding Characteristics Prevalence of taking medicine while breastfeeding n/N (%), Un-adjusted PR (95% CI) P-value Adjusted PR (95% CI) P-value Maternal Age = 25yrs 147/181 (81.2) Reference N/A N/A Age of Infant <= 6months 171/198(86.4) 1.3(1.2-1.7) 6months 56/90(62.2) Reference Reference Education level Primary and below 67/98(68.4) Reference Reference Post-primary 160/190(84.2) 1.2(1.1-1.4) 0.006 1.3(1.1-1.4) 0.001 Employment Category Employed 133/168(79.2) 1.0(0.9-1.1) 0.865 N/A N/A Unemployed 94/120(78.3) Reference N/A N/A Marital status (N=293) Married 176/211(83.4) 1.3(1.1-1.5) 0.008 1.2(1.0-1.5) 0.051 Not Married 51/77(66.2) Reference Reference Alcohol intake No 199/248(80.2) Reference N/A N/A Yes 28/40(70.0) 0.9(0.7-1.1) 0.207 N/A N/A Smoking No 223/280(79.6) Reference Reference Yes 4/8(50.0) 0.6(0.3-1.3) 0.190 0.6(0.3-1.1) 0.073 Mode of delivery last baby C-section 37/51(72.5) 0.9(0.8-1.1) 0.278 1.1(1.0-1.3) 0.136 Spontaneous vaginal delivery 190/237(80.2) Reference Reference Current Acute Medical condition No 175/228(76.8) Reference Reference Yes 52/60(86.7) 1.1(1.0-1.3) 0.052 1.1(1.1-1.3) 0.013 Current chronic condition (non-HIV) No 205/261(78.5) Reference N/A N/A Yes 22/27(81.5) 1.0(0.9-1.3) 0.706 N/A N/A HIV Status Positive 84/113(74.3) 0.9(0.8-1.0) 0.151 1.1(0.9-1.2) 0.448 Negative 143/175(81.7) Reference Reference Participants who were currently on medication while breastfeeding, and those who had “Ever taken medication while breastfeeding,” were assigned “Yes,” and those who had “Not taken any medication while breastfeeding,” as well as those who “stopped breastfeeding while on medication,” were assigned “No”. PR denotes Prevalence Ratios, and 95% CI is obtained by fitting a modified Poisson regression model on complete cases (N=288). Factors were selected into the adjusted model if p-value<0.2 at un-adjusted as well as clinical significance. The mode of delivery had a p-value greater than 0.2 at unadjusted, but was considered in the adjusted model because of its clinical justification. Additional Declarations No competing interests reported. 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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-6546740","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":458934633,"identity":"f0312aa1-5006-49e0-bec5-dcbb6fac1ed2","order_by":0,"name":"Ritah Nakijoba","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYHACZoYEHoYEBvbGBokE0rTwHCRFCxAkMADVSxCl3nx282ODBzI2efwzHzfeeMBgJ8cgkX4BrxaZO8eMExJ40oolbic2WyQwJBszSOQU4NUiIZFgfCCB53Biw+3ENqDbDiQ2SOQkENCS/hmsZf7Ng0RryQE57HDihhuMMC3pBwhpKTYA+cXwDMgvBsnGbDxv8OoAOWyz5M8emzy548cf3vxRYSfHz57+AL8eEGDsgbEMGBjYGHgMCGth+IHCYyfCllEwCkbBKBhJAABfjkSxAM8kjwAAAABJRU5ErkJggg==","orcid":"","institution":"1.\tInfectious Diseases Institute, Makerere University College of Health Sciences, Kampala","correspondingAuthor":true,"prefix":"","firstName":"Ritah","middleName":"","lastName":"Nakijoba","suffix":""},{"id":458934634,"identity":"8b164e01-a58e-4aa2-87f3-1b3b017fd1ea","order_by":1,"name":"Ronald Kiguba","email":"","orcid":"","institution":"3.\tDepartment of Pharmacology, Makerere University College of Health Sciences, Kampala","correspondingAuthor":false,"prefix":"","firstName":"Ronald","middleName":"","lastName":"Kiguba","suffix":""},{"id":458934635,"identity":"29f82107-e854-41ce-b8c6-13b3ff1243b6","order_by":2,"name":"Flavia Dhikusooka","email":"","orcid":"","institution":"1.\tInfectious Diseases Institute, Makerere University College of Health Sciences, Kampala","correspondingAuthor":false,"prefix":"","firstName":"Flavia","middleName":"","lastName":"Dhikusooka","suffix":""},{"id":458934636,"identity":"68a87d77-2298-47bb-811c-8d00d6f86b3f","order_by":3,"name":"Lilliane Namyenya","email":"","orcid":"","institution":"1.\tInfectious Diseases Institute, Makerere University College of Health Sciences, Kampala","correspondingAuthor":false,"prefix":"","firstName":"Lilliane","middleName":"","lastName":"Namyenya","suffix":""},{"id":458934637,"identity":"edf0e256-dd59-4fb9-b4be-91a20344772b","order_by":4,"name":"Joseph Musaazi","email":"","orcid":"","institution":"1.\tInfectious Diseases Institute, Makerere University College of Health Sciences, Kampala","correspondingAuthor":false,"prefix":"","firstName":"Joseph","middleName":"","lastName":"Musaazi","suffix":""},{"id":458934638,"identity":"0273786b-a010-41b1-a37b-078d14fae1b4","order_by":5,"name":"Lynn M. Atuyambe","email":"","orcid":"","institution":"2.\tDepartment of Community Health and Behavior Sciences, Makerere University School of Public Health, College of Health Sciences, Kampala","correspondingAuthor":false,"prefix":"","firstName":"Lynn","middleName":"M.","lastName":"Atuyambe","suffix":""},{"id":458934639,"identity":"98f48aaa-3a35-4db1-b263-5d3f01836ab8","order_by":6,"name":"Catriona Waitt","email":"","orcid":"","institution":"4.\tDepartment of Women’s and Children’s Health, University of Liverpool","correspondingAuthor":false,"prefix":"","firstName":"Catriona","middleName":"","lastName":"Waitt","suffix":""}],"badges":[],"createdAt":"2025-04-28 10:23:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6546740/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6546740/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12905-025-03939-1","type":"published","date":"2025-08-11T15:57:02+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":83292964,"identity":"9f67542f-ceea-40b8-9cb4-d367744c4f26","added_by":"auto","created_at":"2025-05-22 13:22:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":36872,"visible":true,"origin":"","legend":"\u003cp\u003eA graph showing medicine use while breastfeeding among the participants\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6546740/v1/a3f027e20acc9ef54d89226f.png"},{"id":83292965,"identity":"a4426d0c-ba05-4b59-b31c-74a5d87ea29d","added_by":"auto","created_at":"2025-05-22 13:22:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":29773,"visible":true,"origin":"","legend":"\u003cp\u003eDrug classes taken by risk category\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6546740/v1/d1e26a0a753915ee405d24c7.png"},{"id":83292970,"identity":"5f77214c-b6fc-4ce3-a998-2df1d2692549","added_by":"auto","created_at":"2025-05-22 13:22:08","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":708639,"visible":true,"origin":"","legend":"\u003cp\u003eFrequencies of drugs co-administered during breastfeeding\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6546740/v1/e7c5b7c67c0093b8157351fd.png"},{"id":89310517,"identity":"4eb4f46e-6be2-42cc-a778-e262f3b27907","added_by":"auto","created_at":"2025-08-18 16:05:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2219778,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6546740/v1/b0d67c34-5f67-4d3e-be89-43b978773cfd.pdf"},{"id":83292968,"identity":"3f7b47e5-a7d7-4e41-b10b-1e1444390945","added_by":"auto","created_at":"2025-05-22 13:22:08","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":301953,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTablesandFigures.docx","url":"https://assets-eu.researchsquare.com/files/rs-6546740/v1/5183f0ca5528b6fa2a9a234b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence, Safety Evidence, and Determinants of Medicine Use during Breastfeeding among Women in Kampala, Uganda","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBreastfeeding is one of the most effective practices for promoting child health and survival. The World Health Organization (WHO) and United Nations Children's Fund (UNICEF) guidelines advise initiating breastfeeding within the first hour after birth, followed by exclusive breastfeeding for the first six months (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) while continued breastfeeding with complementary foods is recommended for up to two years and beyond (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In Uganda, exclusive breastfeeding rates for the first 6 months range from 40\u0026ndash;67%, although they vary by region (\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). However, as breastfeeding mothers frequently encounter health problems that may necessitate medication, such as postpartum pain, infections, and chronic conditions, they must make informed decisions about safe medication use to avoid potential adverse effects on their infants. Various factors, including healthcare access, education, cultural beliefs, and individual health status, can affect mothers' medication choices. Medicine use can substantially influence breastfeeding patterns and duration (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), as certain drugs may interfere with milk production, composition, or flow. Specifically, drugs such as diphenhydramine, pseudoephedrine, haloperidol, and furosemide have been shown to impact milk synthesis and secretion, potentially leading to reduced breastfeeding efficacy or, in some cases, cessation of breastfeeding (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Moreover, there exists a substantial gap in the literature concerning the safety of drugs used during lactation (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). While some medications are considered compatible with breastfeeding, limited evidence is available to assess the risks associated with many commonly used drugs.\u003c/p\u003e \u003cp\u003eIt is important to note that in Uganda, medications that typically require a prescription in many parts of the world, such as antibiotics, diazepam, amitriptyline, and codeine, can be purchased over the counter. This practice may pose potential risks, including improper use, lack of professional guidance, and increased likelihood of adverse effects or antimicrobial resistance (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Similarly, breastfeeding women may resort to self-medication practices, obtaining medications without prescriptions or professional guidance, despite the increasing awareness of the benefits of breastfeeding. The topic of safe medication use among breastfeeding women remains under-researched, particularly in low- and middle-income countries (LMIC) like Uganda. Studies in other populations have shown that commonly used medications among breastfeeding women include analgesics, antibiotics, and antipyretics, regarded as generally safe due to their low levels of transfer to breast milk and low percentage of the dose prescribed to the mother that is received by the infant known as the Relative Infant Doses (RIDs) (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Studies have highlighted that self-medication practices are prevalent among breastfeeding mothers, especially in settings with limited access to healthcare, where women may obtain medications informally without prescriptions. In these settings, many medications requiring a prescription in other countries are available over the counter (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The lack of context-specific research on medication use among breastfeeding women in Uganda presents a significant gap in developing targeted interventions and educational resources that can support safe medication practices among breastfeeding women. Given these considerations, this study aims to investigate the influences of medication use among breastfeeding mothers, as well as evaluate the safety of medicines commonly used during breastfeeding.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting\u003c/h2\u003e \u003cp\u003eIn this cross-sectional study, we investigated the prevalence of medicines use, safety evidence, and factors associated with medication use in breastfeeding women. The study was conducted in six Urban healthcare clinics in Kampala Uganda; which included the Infectious Diseases Institute (IDI) and Kampala City Council Authority (KCCA) IDI-affiliated clinics that provide free maternal child health services, immunization, treatment for persons with HIV, and outpatient and in-patient services. The IDI is a research institution affiliated with the College of Health Sciences, Makerere University that supports over 200,000 People Living with HIV through the Health Systems Strengthening Programme. The KCCA healthcare facilities serve a population of over half a million people.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePatient and Public Involvement\u003c/h3\u003e\n\u003cp\u003eEach questionnaire was subjected to user testing by peer mothers affiliated with sexual and reproductive health clinics to assess its content, length, and usability, specifically among breastfeeding women. Peer mothers played a vital role in providing emotional support, educating breastfeeding women about medication safety, facilitating study participation, promoting adherence to study protocols, and fostering community engagement to ensure the success of the study. Throughout the study, ongoing engagement was maintained through regular meetings with Community Advisory Board (CAB) members and peer mothers to monitor the study's progress. The roles of community members, peer mothers, and the CAB have previously been shown to bridge the gap between researchers and the community, offering valuable advice from a community perspective (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).These sessions provided a platform for feedback on study implementation. The questionnaires were also reviewed by the authors (LA, CW, RK) and multiple revisions were made to integrate user feedback.\u003c/p\u003e\n\u003ch3\u003eEligibility and recruitment\u003c/h3\u003e\n\u003cp\u003eWe included breastfeeding women aged 18 years and older who had finished breastfeeding in the past three months, and whose infants were twelve months or younger. The age group for infants was chosen because they rely heavily on breast milk for nutrition, and medication taken by the mother can be transferred to the infant through breast milk. Women with children more than twelve months of age were excluded from the study. We used systematic random sampling to recruit participants from September to January 2024. The sampling interval of approaching every fifth potential eligible woman was used based on the average attendance at the maternal and child health (MCH) clinic. To ensure fairness and minimize selection bias, the first potential woman was randomly chosen through a lottery drawing method. Subsequently, every 5th woman was selected in accordance with the predetermined interval. A sample size of 294 participants was required for enrollment based on the assumption that 80% of women use medicines while breastfeeding. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eData collection procedures\u003c/h3\u003e\n\u003cp\u003eThe survey questionnaire was developed based on insights from a comprehensive literature review and previously published surveys (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). It was administered face-to-face to potential participants, and a series of structured questions were designed to be completed within 40 minutes. The research assistants translated the survey questions into the participants' preferred language, which was mainly Luganda due to the study setting in central Uganda. The questionnaire gathered information on demographic characteristics (e.g., maternal age, education level, and parity and child\u0026rsquo;s age), types of medicines used, and breastfeeding practices. Breastfeeding was defined broadly to include all practices incorporating breast milk, such as exclusive breastfeeding (EBF), complementary breastfeeding (CBF), and expressed breast milk feeding. Medicines were defined as all prescribed and non-prescribed medicines, including oral contraceptives and herbs. Participants were categorized into four groups: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) currently using medication while breastfeeding, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) previously used medication while breastfeeding, (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) not using any medication while breastfeeding, and (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) discontinued breastfeeding while on medication. The availability of safety information for medicines and the Relative Infant Dose (RID) was evaluated according to the LactMed database, Hales Lactation Risk Category, and the World Health Organization (WHO) Anatomic Therapeutic Chemical (ATC) classification system (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were used to summarize participants\u0026rsquo; characteristics with frequencies and percentages. The prevalence of medication use during breastfeeding was defined as the proportion of participants who were actively using medicines at the time of recruitment into the study. A modified Poisson Regression model was fitted to identify factors associated with the prevalence of medicine use among breastfeeding women. Factors were selected for the adjusted model if p\u0026thinsp;\u0026lt;\u0026thinsp;0.2 at the univariate level, as well as based on clinical significance. In the regression model, the association of medication use with the following factors was examined: maternal age, infant age, education level, employment status, marital status, alcohol intake, smoking, mode of delivery for the last baby, presence of a current non-chronic medical condition, chronic condition (non-HIV), and HIV status.\u003c/p\u003e \u003cp\u003eDescriptive statistics were used to summarize medication categories, lactation risk, relative infant dose (RID), and breastfeeding recommendations for participants taking medication while breastfeeding. Percentages of medication use were calculated by dividing the number of participants who reported using each specific medication by the total sample size (N\u0026thinsp;=\u0026thinsp;294) and multiplying the result by 100. The lactation risk assessments and drug categories were based on the Lactmed database and the WHO Anatomic Therapeutic Chemical (ATC) classification system. RID was used to assess potential exposure risks to infants, with values\u0026thinsp;\u0026gt;\u0026thinsp;10% marked as higher exposure and flagged for additional precautionary recommendations. RID is calculated by dividing the infant\u0026rsquo;s dose via milk (in mg/kg/day) by the mother\u0026rsquo;s dose (in mg/kg/day) *100. A RID of 10% is a pragmatic cut-off that is less likely to be of concern to an infant\u0026rsquo;s well-being. Medications were classified as \"L1-compatible (safest),\" \"L2-probably compatible,\" \"L3-presumed compatible, L4-Possibly hazardous, and L5-Hazardous (contraindicated) according to the LactMed database and Hale medication and mothers milk (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Recommendations provided reflect guidelines from published pharmacological safety databases and lactation risk assessments. We used a heat map to present the co-administration of medication medicines taken while breastfeeding visually. In contrast, a stacked bar graph was used to present risk categories for these medicines by drug classification.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 294 participants were enrolled in the study. The majority of women, 63.3% (186/294), were 25 years or older, 68.7% (202/294) had infants 6 months or younger, 66.0% (194/294) of participants had post-primary education, and 72.7% (194/294) were married. Two-thirds (65.0%, 191/294) did not use any form of contraception, while 35.0% (103/294) reported contraceptive use. The most frequently used method was Depo-Provera (injectable), 45.7% (48/105). 82.7% had spontaneous vaginal deliveries. HIV/AIDS was the most common chronic condition, 39.5% (116/294), as shown in Table 1 of the demographic characteristics.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePrevalence of medicine use while breastfeeding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of medication use was 78.9%, while 8.2% had not taken any medicines while breastfeeding, and 12.9% of women stopped breastfeeding while on medications on clinical recommendation due to high HIV viral load (\u003cstrong\u003eFigure 1).\u0026nbsp;\u003c/strong\u003eAdditionally, a total of 168 (57.1%) of women exclusively breastfed, while none of the women pumped or expressed breastmilk. The majority, 198 (67.3%) of women acquired medicines without a prescription, and 63 (21.4%) consumed herbal remedies, including bitter leaf, African basil, and desmodium, while breastfeeding,as detailed in \u003cstrong\u003eTable 4 of the Supplementary material\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u0026apos; characteristics associated with taking medicine while breastfeeding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWomen with infants aged six months or younger were significantly more likely to use medicines while breastfeeding compared to those with infants older than six months (adjusted prevalence ratio [aPR] = 1.4; 95% CI: 1.1\u0026ndash;1.6). Additionally, women who attained education beyond the primary level were more likely to report medicine use during breastfeeding compared to those whose education ended at the primary level (aPR = 1.3; 95% CI: 1.1\u0026ndash;1.4). Women with current acute medical conditions were 1.2 times more likely to take medications than those mothers without current acute medical conditions \u003cstrong\u003e(aPR=1.1, 95%CI\u003c/strong\u003e \u003cstrong\u003e\u003cem\u003e1.1-1.3\u003c/em\u003e\u003c/strong\u003e) as shown in \u003cstrong\u003eTable 2\u003c/strong\u003e.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eMedicines consumed while breastfeeding\u0026nbsp;\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eAnalgesics/antipyretics were highly used, representing 219(74.5%) of total medications. Antibiotics were widely used by 112 (38.1%), mostly amoxicillin and ampicillin/cloxacillin. Notably, metronidazole was consumed by 137 (46.6%) of women. A comprehensive heat map of all reported medicines used by participants is provided in Supplementary material, Figure 3, and Table 3. The map highlights significant variability in drug usage among breastfeeding mothers, with paracetamol, amoxicillin, and ibuprofen being the most frequently used medications. These medicines were co-administered, with paracetamol commonly paired with amoxicillin and ibuprofen to manage pain, fever, or inflammation during infections. In contrast, most other medicines showed minimal usage, suggesting limited prescription or accessibility.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEvidence of the safety of medicines consumed while breastfeeding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe majority of medications (61.04%) were classified as Level 1 (L1) - Compatible, indicating they are safe for breastfeeding, including commonly used medicines like antibiotics and analgesics. A smaller proportion were Level 3 (L3) - presumed compatible (Moderately safe) (20.78%), and Level 2 (L2) - probably compatible (safer) (15.58%). A few drugs (2.60%) were Level 4 (L4)-Possibly Hazardous, posing potential risks to infants. Reported adverse effects associated with these medications include dry mouth, constipation, urinary retention, and central nervous system depressant effects.\u003c/p\u003e\n\u003cp\u003eParacetamol was highly compatible with a low RID (0.1\u0026ndash;0.2%), while acetaminophen/caffeine and metronidazole required cautious use or breastfeeding discontinuation due to higher RIDs. Most drug categories, such as antiretrovirals and antihistamines, were compatible, though anti-tuberculosis and anti-malaria drugs lacked sufficient data. Cyproheptadine and phenylpropanolamine were possibly hazardous due to their effects on lactation, while prednisolone and chlorpheniramine required timing adjustments to reduce infant exposure. Griseofulvin lacked adequate safety data., \u003cstrong\u003eTable 3, S3\u003c/strong\u003e. The drug classes versus risk categories consumed by women are illustrated in Figure 2.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study revealed that more than 70% of the breastfeeding mothers attending six facilities in Kampala consumed medications, and more than 50% obtained drugs without prescriptions. Women with younger infants, higher education, or current acute conditions were more likely to use medications. Analgesics, particularly paracetamol, were the most commonly used medications among breastfeeding women, with high compatibility and low exposure to infants, although acetaminophen/caffeine required caution due to a higher exposure. Antibiotics, including amoxicillin and ampicillin/cloxacillin, were also widely used (38.1%) and showed low exposure to the infant through breastmilk, indicating safe compatibility.\u003c/p\u003e \u003cp\u003eIt is plausible that women with younger infants may exhibit higher medication use, potentially driven by increased exposure to infections during the postpartum period and the heightened vulnerability associated with factors that elevate the risk of infections during this time. Thus, mothers of younger infants may prioritize their health to maintain optimal care for their infants, leading to increased medication use. Similarly, higher education levels could have been linked to better access to healthcare information, which could raise awareness and acceptance of medication use when necessary. Also, the increasing health disparities based on education level are a significant social concern that may warrant targeted interventions, as noted by Goldman et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur study revealed that more than half of the women (57.1%) exclusively breastfed without pumping or expressing milk. This rate of exclusive breastfeeding suggests moderate adherence to breastfeeding practices, which is essential for optimal infant nutrition and immune support. The results show decreasing rates of exclusive breastfeeding as mothers seek paid work, reducing the time available for exclusive breastfeeding. Similarly, Nabunya\u0026rsquo;s study revealed a prevalence of exclusive breastfeeding of 42.8% among mothers in the informal sector (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). However, the absence of milk expression could indicate limited awareness or access to pumping methods, which can help manage breastfeeding challenges, such as maintaining milk supply or balancing work demands. Encouraging safe and accessible milk expression options could enhance breastfeeding continuity for those who may face time constraints or work obligations.\u003c/p\u003e \u003cp\u003eAdditionally, 67.3% of participants obtained medications without prescriptions, raising concerns about self-medication practices and the potential risks of using non-prescribed medicines while breastfeeding. This behavior suggests a gap in access to healthcare or a reliance on informal health advice. Unregulated medication use may increase the risk of exposure to medicines that could transfer into breast milk at potentially harmful levels, and incorrect dosing, which can increase the risk of adverse effects and drug interactions (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Furthermore, a notable portion of women (78.9%) reported recent medication use within the past six months, as observed in Nigeria, where over 95% of women consumed medicines while breastfeeding (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). In this study. 8.2% had never used medications while breastfeeding; however, while some breastfeeding women were comfortable using medicines when needed, a subset of 10% stopped breastfeeding while on antiretroviral therapy because of high viral load, which would increase the chances of HIV exposure to the infant, as recommended by the healthcare providers. Our findings indicate that analgesics, particularly paracetamol, are the most frequently used medications among breastfeeding women (74.5%). Paracetamol, with its high compatibility for breastfeeding, is commonly prescribed for pain and fever relief due to its well-documented safety profile and low relative infant dose, which minimizes risk to infants through breast milk exposure. This is consistent with other studies showing that analgesics and antipyretics are the most commonly used medications among breastfeeding women (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), making it one of the safest analgesics for breastfeeding mothers. However, formulations containing caffeine require cautious use due to their higher exposure to breastfed infants (7\u0026ndash;18%), which could increase infant exposure to caffeine, potentially leading to irritability or sleep disturbances in infants (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). The extensive use of antibiotics, including amoxicillin and ampicillin/cloxacillin, also reflects a pattern of safe medication practices among breastfeeding women. These antibiotics are generally regarded as compatible with breastfeeding, and their low exposure to infants (0.5-1%) supports their safety profile, posing minimal risk of adverse effects to the infant. This is in line with studies from similar populations that show amoxicillin and cloxacillin were the most used antibiotics due to their safety profiles and effectiveness in treating maternal infections while minimizing infant exposure risks (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). This study reveals varying safety levels across drug categories for breastfeeding women. While most categories, such as antiretrovirals, antihistamines, corticosteroids, and supplements, are deemed \"compatible for use\" and generally safe. Caution is warranted when prescribing antibiotics (ciprofloxacin, cotrimoxazole, metronidazole, levofloxacin) and antihypertensive medications (atenolol, losartan) to breastfeeding women, as these drug classes may pose potential risks to the breastfed infant, including gastrointestinal disturbances, alterations in gut microbiota, and possible cardiovascular or renal effects. Although metronidazole has been associated with potential risks to breastfed infants, including gastrointestinal disturbances and possible mutagenic effects in high doses, it remains an essential component of treatment for postpartum infections. Given its critical role in managing maternal health conditions, and the limited availability of safer equally effective alternatives, its use during breastfeeding is often necessary, with careful consideration of dosing and timing to minimize infant exposure. The limited availability of controlled studies conducted in this population underscores the need for careful consideration. These medications should only be administered if the potential benefits to the mother outweigh the potential risks to the infant.\u003c/p\u003e \u003cp\u003eSome anti-fungal drugs such as griseofulvin were flagged as \"probably Compatible,\" with limited safety data. Likewise, Yevgenia et al evaluated the strength of the data for the most commonly administered medications in lactating women and found that 51% of medicines had no associated data, 664 (47%) had minimal-moderate data, and 30 (2%) had strong data using the LactMed database and WHO classification (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). For medicines that are flagged for cautious use, it is generally recommended to adjust or avoid breastfeeding for 2\u0026ndash;4 hours following administration. For medications flagged for cautious use, it is generally recommended to adjust or avoid breastfeeding for 2\u0026ndash;4 hours after administration. However, for certain medications such as cotrimoxazole, it is advised to avoid breastfeeding in infants with G6PD deficiency, regardless of the standard recommendations. However, routine screening for G6PD deficiency remains uncommon in many low- and middle-income countries (LMICs), making it challenging to implement such targeted precautions in clinical practice. Nevertheless, women reported a lack of guidance from healthcare providers regarding breastfeeding adjustments while on certain medications. Furthermore, some women did not disclose their breastfeeding status to healthcare providers, highlighting a mutual gap in communication. Healthcare providers have a responsibility to inquire about breastfeeding and provide appropriate guidance before prescribing medications. Women reported receiving information mainly on dosing and timing of the drug. Despite these guidelines, breastfeeding women may be unaware of such precautions, and they may not always receive adequate information from their healthcare providers regarding the safe use of medications during lactation.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eThis is the first study in Uganda to explore medication use among breastfeeding women. It provides essential data on medication use behaviors specific to breastfeeding women in a low-resource setting. As the first study on this topic in this country, this research establishes baseline data that can support national health policies and targeted interventions to promote safe medication use during breastfeeding. It also highlights the need for accessible information on medication safety. The study captures a significant proportion of breastfeeding women, offering a robust sample size that enhances the reliability and generalizability of the findings.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLimitation\u003c/strong\u003e \u003cp\u003eLactation risk categories used have several limitations, including reliance on limited or low-quality evidence, subjectivity in risk assignment, and failure to account for individual variations such as infant age, feeding patterns, and maternal health. The factors often oversimplify complex risks, focus predominantly on infant safety without balancing maternal treatment needs, and may not be updated frequently to reflect new evidence. The study was conducted in aa healthcare setting unlike in unregistered drug shops where most of the illegal medicines could be sold.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eAdditionally, the lack of global consensus among classification systems leads to inconsistent recommendations, and over-reliance on these simplified categorizations can hinder case-specific clinical decision-making. The reliance on self-reported data may have introduced recall bias, particularly regarding past medication use, as well as social desirability bias, where participants may underreport self-medication behaviors. Moreover, the study was conducted at healthcare facilities, which might limit generalizability to all breastfeeding women in Uganda, especially those in rural or remote areas who may have different healthcare access and practices.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBreastfeeding women frequently acquired medicines without prescriptions, with high usage of compatible analgesics, like paracetamol, and antibiotics, such as amoxicillin. However, medications with higher Relative Infant Doses (RIDs), like caffeine-containing paracetamol and metronidazole, may pose risks, indicating a need for cautious administration. The findings underscore the necessity of safe medicine use guidelines and access to healthcare guidance to prevent potential infant exposure to unsafe medicines through breastfeeding. The study insights pave the way for improved healthcare interventions to support the safe and informed use of medications during breastfeeding in Uganda and similar settings. The identification of high-use medicines and their safety profiles allows healthcare providers and policymakers to develop targeted guidelines, prioritize education on safe medicine use, and support safer breastfeeding practices across similar populations. Future research should address safety data gaps, particularly for some antifungals, antihypertensives, metronidazole, and antimalarial drugs.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study obtained expedited ethical clearance for this study from the institutional review board (IRB) of the Infectious Diseases Institute (SPH-2023-448), Uganda National Council of Science and Technology (HS3166ES).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproval was sought from all study participants. Written informed consent was sought, and only those who consented participated in the study. The research team ensured the utmost confidentiality during the entire process of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contributors\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRN, RK, LA, CW, RM, and CN contributed to the conceptualization design of the study, RN, and LN were involved in data collection, and RN, FD, and JM conducted the data analysis and interpretation. RN drafted the manuscript. FD, JM, RN, LA, and CW edited the draft manuscript. All authors reviewed and approved the manuscript before submission for publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge the MILK Study team members, the study team that collected data, and\u0026nbsp;the participants as well as the peer mothers and healthcare providers at the participating facilities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was funded by Wellcome Clinical Research Career Development Fellowship 222075/Z/20/Z, awarded to CW. RK is funded by the UK Medical Research Council (MR/V03510X/1, MR/V030434/1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ehttps://doi.org/10.5281/zenodo.15284583\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eOrganization WH. Indicators for assessing infant and young child feeding practices part 3: country profiles. World Health Organization; 2010.\u003c/li\u003e\n \u003cli\u003eArts M, Taqi I, B\u0026eacute;gin FJBM. Improving the early initiation of breastfeeding: the WHO-UNICEF breastfeeding advocacy initiative. 2017;12(6):326-7.\u003c/li\u003e\n \u003cli\u003eNabunya P, Mubeezi R, Awor PJPO. Prevalence of exclusive breastfeeding among mothers in the informal sector, Kampala, Uganda. 2020;15(9):e0239062.\u003c/li\u003e\n \u003cli\u003eKimuli D, Nakaggwa F, Namuwenge N, Nsubuga RN, Isabirye P, Kasule K, et al. Sociodemographic and health-related factors associated with exclusive breastfeeding in 77 districts of Uganda. 2023;18(1):66.\u003c/li\u003e\n \u003cli\u003eMawa R, Nabasirye CK, Mulira J, Nakidde C, Kalyango F, Wakida DMAA, et al. Socio-economic status and exclusive breastfeeding among infants in a Ugandan cross-sectional study. 2019;7(1):16.\u003c/li\u003e\n \u003cli\u003eScime NV, Metcalfe A, Nettel‐Aguirre A, Tough SC, Chaput KHJAoegS. Association of postpartum medication practices with early breastfeeding cessation among mothers with chronic conditions: A prospective cohort study. 2023;102(4):420-9.\u003c/li\u003e\n \u003cli\u003eVerstegen RH, Anderson PO, Ito SJBJoCP. 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Prevalence and determinants of self-medication practice among selected households in Addis Ababa community. 2018;13(3):e0194122.\u003c/li\u003e\n \u003cli\u003eMohamed El Sheshtawy O, Mohamed Arafa N, Deyab A-hJEJoHC. Self-Medication practices among mothers having children under five-years. 2019;10(2):430-40.\u003c/li\u003e\n \u003cli\u003eWaitt C, Asiimwe SP, Ojara FW, Nakijoba R, Kawuma AN, Castelnuovo B. Attaining equity of access to research: perspective on research in pregnancy and breastfeeding following Dolores Shockley lecture at ASCPT2024. Clinical Pharmacology \u0026amp; Therapeutics. 2024;116(6):1506-12.\u003c/li\u003e\n \u003cli\u003eNakijoba R, Kawuma AN, Asiimwe SP, Turyahabwe C, Tabwenda JC, Kyeyune J, et al. Recruitment of pregnant and breastfeeding women in pharmacokinetic studies: strategies, opportunities, barriers, and recommendations. BMC Research Notes. 2024;17(1):312.\u003c/li\u003e\n \u003cli\u003eSchirm E, Schwagermann M, Tobi H, de Jong-van den Berg LJEjocn. 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Drugs and breastfeeding. 1999;26(2):447-78.\u003c/li\u003e\n \u003cli\u003eDavanzo R, Bua J, Paloni G, Facchina GJEjocp. Breastfeeding and migraine drugs. 2014;70:1313-24.\u003c/li\u003e\n \u003cli\u003eAbdulraheem I, Adegboye A, Fatiregun AJBJoPR. Self-medication with antibiotics: empirical evidence from a Nigerian rural population. 2016;11(5):1-13.\u003c/li\u003e\n \u003cli\u003evan Wattum JJ, Leferink TM, Wilffert B, Ter Horst PGJB, pharmacology c, toxicology. Antibiotics and lactation: An overview of relative infant doses and a systematic assessment of clinical studies. 2019;124(1):5-17.\u003c/li\u003e\n \u003cli\u003eFomina YY, Byrne JJ, Spong CYJTJoM-F, Medicine N. Evaluating strength of recommendations for commonly administered medications in lactating women. 2023;36(1):2163626.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e:Demographic characteristics of participants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"661\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency N(Col%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency N(Col%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e294\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eObstetric history\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal Age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eContraceptive Use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026lt;25yrs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e108 (36.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e189 (64.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026gt;= 25yrs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e186 (63.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e105 (35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 210px;\"\u003e\n \u003cp\u003eAge of Infant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 211px;\"\u003e\n \u003cp\u003eContraceptive (N=105)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026lt;= 6months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e202 (68.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Depo-Provera (Injectable)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e48 (45.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026gt;6months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e92 (31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Implant (Jadelle)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e38 (36.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation level of women\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Pills (Microgynon)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e8 (7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Post-primary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e194 (66.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; IUD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Primary and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e100 (34.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Tubal ligation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status (N=293)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Condoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e213 (72.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 343px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMode of delivery last baby\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Not Married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e80 (27.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Spontaneous vaginal delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e243 (82.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment Category (N=289)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; C-section\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e51 (17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e169 (58.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eMedical history\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Unemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e120 (41.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrent chronic comorbid conditions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 318px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eSocial History\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eHIV/AIDS\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e116 (39.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol intake\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 211px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e9 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e252 (85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 211px;\"\u003e\n \u003cp\u003eTB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e8 (2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e42 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 211px;\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 211px;\"\u003e\n \u003cp\u003eOther (Asthma (3),\u0026nbsp;Diabetes (1), Chronic mastitis (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e286 (97.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e8 (2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2; Modified Poisson Regression model examining participants\u0026apos; characteristics associated with taking medicine while breastfeeding\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"685\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevalence of taking medicine while breastfeeding\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en/N (%),\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUn-adjusted PR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted PR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal Age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026lt;25yrs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e80/107(74.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.9(0.8-1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.214\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026gt;= 25yrs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e147/181 (81.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge of Infant\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026lt;= 6months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e171/198(86.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1.3(1.2-1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e1.4(1.1-1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026gt;6months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e56/90(62.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Primary and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e67/98(68.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Post-primary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e160/190(84.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cem\u003e1.2(1.1-1.4)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.006\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cem\u003e1.3(1.1-1.4)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment Category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e133/168(79.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1.0(0.9-1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.865\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Unemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e94/120(78.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status (N=293)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e176/211(83.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1.3(1.1-1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.008\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e1.2(1.0-1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.051\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Not Married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e51/77(66.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol intake\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e199/248(80.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e28/40(70.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.9(0.7-1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.207\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e223/280(79.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e4/8(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.6(0.3-1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.190\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e0.6(0.3-1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.073\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMode of delivery last baby\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; C-section\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e37/51(72.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.9(0.8-1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.278\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e1.1(1.0-1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.136\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Spontaneous vaginal delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e190/237(80.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrent Acute Medical condition\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e175/228(76.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e52/60(86.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1.1(1.0-1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.052\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e1.1(1.1-1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.013\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrent chronic condition (non-HIV)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e205/261(78.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e22/27(81.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1.0(0.9-1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.706\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e84/113(74.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.9(0.8-1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.151\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e1.1(0.9-1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.448\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Negative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e143/175(81.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eParticipants who were currently on medication while breastfeeding, and those who had \u0026ldquo;Ever taken medication while breastfeeding,\u0026rdquo; were assigned \u0026ldquo;Yes,\u0026rdquo; and those who had \u0026ldquo;Not taken any medication while breastfeeding,\u0026rdquo; as well as those who \u0026ldquo;stopped breastfeeding while on medication,\u0026rdquo; were assigned \u0026ldquo;No\u0026rdquo;. \u0026nbsp; PR denotes Prevalence Ratios, and 95% CI is obtained by fitting a modified Poisson regression model on complete cases (N=288). Factors were selected into the adjusted model if p-value\u0026lt;0.2 at un-adjusted as well as clinical significance. The mode of delivery had a p-value greater than 0.2 at unadjusted, but was considered in the adjusted model because of its clinical justification.\u003c/em\u003e\u003c/strong\u003e\u003c/p\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-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Breastfeeding, lactation, medication, safety evidence, relative infant dose","lastPublishedDoi":"10.21203/rs.3.rs-6546740/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6546740/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eBreastfeeding is essential for child health and survival, yet breastfeeding mothers often require medications to manage postpartum and chronic conditions, raising concerns about potential infant safety. Limited research has been undertaken on medication practices during lactation, especially in low-resource settings like Uganda. The study aimed to investigate the prevalence of medicine use, evidence about safety, and factors that influence medicine use among breastfeeding women in Kampala, Uganda.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWe conducted a cross-sectional study using a structured questionnaire in six healthcare clinics in Kampala, Uganda, from September 2023 to January 2024 among breastfeeding women. We enrolled breastfeeding women aged 18 and older. We used modified Poisson regression to identify factors associated with medication use. We evaluated medication safety during breastfeeding and Relative Infant Dose (RID) using Hale\u0026rsquo;s Lactation Risk Category, the LactMed database, and the WHO Anatomic Therapeutic Chemical (ATC) classification system. Medicines with a RID\u0026thinsp;\u0026gt;\u0026thinsp;10% were flagged as potentially giving higher infant exposure.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eOf the 294 enrolled breastfeeding women, 168 (57.1%) practiced exclusive breastfeeding. A total of 232 women (78.9%) had used medicines in the preceding six months, and 98 (67.3%) of women reported obtaining medicines without prescriptions. Medicine use was significantly more common among women with younger infants (adjusted prevalence ratio [aPR]\u0026thinsp;=\u0026thinsp;1.4; 95% CI: 1.1\u0026ndash;1.6), higher educational attainment (aPR\u0026thinsp;=\u0026thinsp;1.3; 95% CI: 1.1\u0026ndash;1.4), and those without chronic health conditions (aPR\u0026thinsp;=\u0026thinsp;1.1; 95% CI: 1.1\u0026ndash;1.3). Antibiotics were the most frequently used class of medicines, with amoxicillin and ampicillin/cloxacillin reported by 112 women (38.1%). Metronidazole, an antimicrobial agent, was also commonly used, reported by 137 women (46.6%), raising concerns due to its potential for high infant exposure (estimated between 11\u0026ndash;24%). Analgesic use was also high, particularly paracetamol, used by 183 women (74.5%). Overall, 61.0% of medicines used were classified as compatible with breastfeeding, 35.4% as probably compatible, and 2.6% as possibly hazardous. Medicines requiring cautious use included frusemide, cyproheptadine, metronidazole, phenylpropanolamine, acetaminophen combined with caffeine, and griseofulvin owing to risks of significant infant exposure, potential interference with lactation, or limited safety data. In contrast, dihydroartemisinin/piperaquine phosphate, artemether/lumefantrine, cefixime, pyrazinamide, and ethambutol were frequently used and considered acceptable during lactation. However, it is important to note that controlled studies assessing their safety specifically in breastfeeding women are lacking.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eBreastfeeding women frequently used medicines, many of which were self-prescribed, including some that necessitate careful consideration due to safety concerns. Findings underscore the need for targeted education on safe medicines practices to support women's informed decision-making, conduct pharmacokinetics studies in breast milk, and impact on lactation.\u003c/p\u003e","manuscriptTitle":"Prevalence, Safety Evidence, and Determinants of Medicine Use during Breastfeeding among Women in Kampala, Uganda","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-22 13:22:04","doi":"10.21203/rs.3.rs-6546740/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-03T03:54:38+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-02T11:43:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-01T19:45:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-31T13:22:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-28T13:22:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-26T11:52:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"158377922663137835518564573700378321985","date":"2025-05-26T08:25:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-25T18:17:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"270185442720856605220336880624949005086","date":"2025-05-24T12:03:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"29263265684185677563352600640250290840","date":"2025-05-21T21:45:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-21T15:51:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"229353089567806138011107856212335707556","date":"2025-05-21T15:34:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"270008815030837749243994027337013166258","date":"2025-05-19T19:32:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"323974189172623931820700508508529822639","date":"2025-05-19T12:39:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"74917203964948433917211823090137278446","date":"2025-05-19T12:14:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-19T11:42:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-18T17:35:11+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-05T09:54:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-30T12:52:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2025-04-30T12:51:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0c3395e9-e06d-4fe4-afaf-8403c3ff3452","owner":[],"postedDate":"May 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-18T15:59:04+00:00","versionOfRecord":{"articleIdentity":"rs-6546740","link":"https://doi.org/10.1186/s12905-025-03939-1","journal":{"identity":"bmc-womens-health","isVorOnly":false,"title":"BMC Women's Health"},"publishedOn":"2025-08-11 15:57:02","publishedOnDateReadable":"August 11th, 2025"},"versionCreatedAt":"2025-05-22 13:22:04","video":"","vorDoi":"10.1186/s12905-025-03939-1","vorDoiUrl":"https://doi.org/10.1186/s12905-025-03939-1","workflowStages":[]},"version":"v1","identity":"rs-6546740","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6546740","identity":"rs-6546740","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}