Maternal factors associated with exclusive breastfeeding failure: A community-based cross-sectional study in the north of Iran

Maternal factors associated with exclusive breastfeeding failure: A community-based cross-sectional study in the north of Iran | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Maternal factors associated with exclusive breastfeeding failure: A community-based cross-sectional study in the north of Iran Zahra Akbarian-rad, Hossein-Ali Nikbakht, Maryam Nikpour, Jamileh Aqatabar Roudbari, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4641710/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background To improve exclusive breastfeeding, we have to resolve challenges for mothers and babies. This study aims to determine the maternal factors causing to failure in exclusive breastfeeding. Methods This cross-sectional study was conducted on all infants who had attended the healthcare centers for their first 6-month vaccinations, from 2019 to 2021 in xxx, xxx. Maternal factors including demographic, social, and midwifery information were collected using a checklist. Failure of exclusive breastfeeding was defined as using anything other than breast milk, such as pacifiers, bottles, sugar water, or complementary feeding for infants during the first 6 months of age. Binary Logistic analysis examined the influence of predictor variables on exclusive breastfeeding. The significance level was considered at P < 0.05. Result Out of the 1,400 infants at the end of the study, 413 29.5% were exclusively breastfed. Multivariate regression showed education level OR: 1.42, P = 0.003 and urban residence OR: 1.89, P < 0.001 were associated with increased discontinuation, while term pregnancy OR: 0.47, P = 0.008 served as a preventive factor. Breastfeeding education OR: 6.7, P = 0.067 and breast problems OR: 6.4, P = 0.082 had a 6-fold effect on the decrease and increase of discontinuation of exclusive breastfeeding, respectively, although this relationship was not statistically significant. Conclusion This study showed preterm delivery, higher education and living in urban area can increase the probability of failure of exclusive breastfeeding. These findings provide valuable insights for healthcare professionals and policymakers working to promote and support exclusive breastfeeding. Maternal factors exclusive breastfeeding failure exclusive breastfeeding infants. Figures Figure 1 Figure 2 Key messages Mother's higher education and urban residence are associated with increased discontinuation of exclusive breastfeeding. Breast problems had a 6-fold effect on the increase of discontinuation of exclusive breastfeeding, The mothers with preterm infant, mothers with higher education and living in the city have challenges in breastfeeding.need more training, attention and support in exclusive breastfeeding. Introduction Mother's milk is the gold standard of nutrition for the growth and development of infants [ 1 ] and has a unique biological and emotional impact on the health of both mother and baby [ 2 ]. Mother's milk is highly effective in promoting health and preventing numerous disorders and diseases in children[ 3 ]. Furthermore, breastfeeding offers significant economic and social benefits for both families and a nation's healthcare system[ 1 ]. According to WHO guidelines, exclusive breastfeeding entails the first hour of birth and continuing it for the first 6 months without introducing complementary foods such as formula, bottles, pacifiers, or even water, except for necessary vitamin supplements. Breastfeeding should ideally continue up to the age of 2 years [ 4 – 6 ] . WHO estimates that approximately one-third of breastfeeding mothers exclusively breastfeed during the first 6 months[ 7 ]. In a global survey of 194 countries conducted in 2018, the rate of exclusive breastfeeding was around 40%. Only 23 countries reported rates exceeding 60% [ 5 , 8 ]. Research from countries such as the United States, Tanzania, Brazil, Turkey, Australia, and Thailand suggests that exclusive breastfeeding is approximately 21–68% for the first three months and 15–30% for six months[ 7 , 9 ]. The results of a systematic study and meta-analysis in Iran show that the rate of exclusive breastfeeding for 6 months ranges from 38–59%[ 10 ]. The significance of breastfeeding in low-income and middle-income countries surpasses that of high-income countries[ 11 ], even though the rate of exclusive breastfeeding in these countries is only 37%. However, the duration of breastfeeding in these countries tends to be longer compared to developed nations[ 11 ]. Studies indicate that, in many societies, although breastfeeding initiation rates are high, they sharply decline in the first weeks postpartum[ 7 , 12 ]. Researchers have identified various reasons for the reduction or cessation of exclusive breastfeeding. In a qualitative review of 40 studies, Sari Laanterä highlighted that the primary cause of exclusive breastfeeding failure is mothers' lack of knowledge Sari Laanterä. Another meta-analysis found that the rate of early breastfeeding after cesarean delivery was significantly lower than that after vaginal delivery, although no significant difference was observed during the first 6 months[ 13 ]. In Saudi Arabia, factors such as the mother's young age, sore nipples, insufficient breastfeeding skills, and the perception of insufficient milk supply have been cited as contributing to decreased exclusive breastfeeding[ 14 ]. In Ghana, in addition to the aforementioned factors, insufficient support from spouses has led to early discontinuation of breastfeeding. Concerns about HIV also play a role[ 15 ]. Other studies have indicated that lack of support from those around first-time mothers, return to the workplace, and education levels below a diploma are reasons for exclusive breastfeeding failure[ 16 ]. As part of the WHO and UNICEF's goals for 2025, exclusive breastfeeding for the first 6 months of life is recommended to reach at least 50% [ 7 , 8 , 10 ]. Among WHO's guidelines for supporting breastfeeding, 10 actions in child-friendly hospitals can enhance the practice of exclusive breastfeeding [ 17 ]. Studies have shown that in addition to child-friendly hospitals, home visits during the first month postpartum to provide guidance and support to mothers play a pivotal role [ 4 ]. Additionally, planning for community support and creating a child-friendly environment can improve the conditions for exclusive breastfeeding[ 18 ]. In light of the changing individual and societal conditions across time and regions, the causes for exclusive breastfeeding failure in each society require continuous evaluation. In recent years, no comprehensive study has been conducted to identify the maternal factors contributing to the failure of exclusive breastfeeding in Mazandaran State in Iran. By pinpointing the causes of both continued and exclusive breastfeeding failure, we can better plan to address this critical issue in infant health. Consequently, this study aims to determine the maternal factors contributing to exclusive breastfeeding failure in xxx at 2019. Method and Material Study Type and Samples This cross-sectional study was conducted on all infants who had attended the healthcare centers under the purview of xxx University of Medical Sciences for their 6-month vaccinations, spanning from October 1, 2019, to July 15, 2021. Sampling was carried out using a census approach, encompassing all infants who met the entry criteria, which included parental consent and the absence of congenital abnormalities in the infants. Data Collection xxx, located in northern xxx and home to a population of 550,000, comprises 16 urban health centers and 33 rural health centers. Initially, a healthcare clerk, who was a permanent staff member of each center, was selected. These healthcare clerks then received training from the project manager, who is also the responsible author, to ensure proper completion of the questionnaires. Trained health supervisors conducted interviews with nursing mothers to gather data. The approximate time required to complete each questionnaire was around 10 minutes. Assessment Variables In line with the objectives of this study, demographic, social, and midwifery information was collected, focusing on maternal factors influencing exclusive breastfeeding. Maternal demographic and social information included age, education level Secondary, Diploma, Bachelor’s, occupation, and place of residence. Obstetrical information comprised the type of delivery vaginal or cesarean section, the number of children, gestational age at the time of birth, receipt of breastfeeding education, and breast-related issues, such as abscess, fissure, and mastitis. A gestational age equal to or greater than 37 weeks was categorized as a term pregnancy. Regarding the assessment of exclusive breastfeeding failure, adhering to the World Health Organization's definition, all mothers were asked if they had provided their child with anything other than breast milk, such as pacifiers, bottles, sugar water, or complementary feeding for infants during the first 6 months. They were also queried about when they initiated breastfeeding. Statistical Data Analysis Following data collection to ensure their accuracy, descriptive statistics were reported using measures such as the mean, standard deviation, numbers, and percentages. Independent Samples T Test and Chi-square tests were employed for analytical statistics and to explore relationships between qualitative variables. Binary Logistic Regression analysis was used to examine the individual raw effects and combined comparative effects influence of predictor variables on exclusive breastfeeding and to elucidate their interrelationships. Some factors that could impact this relationship were considered for adjustment in the final analysis. The backward method was employed in the multivariate analysis, and the variables retained in the final model at each stage were presented. Odds Ratios OR and 95% confidence intervals CI were used to indicate effect size in the model. Additionally, a supplementary analysis employing machine learning methods utilized the random Forest Model to identify the most significant variables. In these models, the Gini coefficient index played a crucial role in determining the importance of variables for predicting factors related to exclusive breastfeeding. All analyses were conducted using SPSS software version 22 and R version 4.1.3, with a significance level set at P < 0.05. Results Out of the 1,432 individuals initially included in the study, 32 participants were excluded due to non-cooperation and incomplete questionnaire responses. Statistical analysis was conducted on the data from the remaining 1,400 infants. The average age of the infants' mothers and fathers was 29.20 ± 5.22 and 33.76 ± 5.52, respectively. Approximately half of the parents resided in urban areas. Most nursing mothers held a diploma level of education 42% and were housewives 87.7%. A majority of nursing mothers 91% had experienced term deliveries, and 64% had undergone cesarean sections. Furthermore, 92% of nursing mothers received breastfeeding education from healthcare clerks, and 1.2% encountered breast problems Table 1 . Table 1 Demographic characteristics and maternal factors in the study according to exclusive breastfeeding. Characteristics Total (N = 1400) Mean (SD) Breastfeeding at 6 months Yes (n = 413) Mean (SD) No(n = 987) Mean (SD) Mother age (Years) 29.20 (5.22) 28.86(5.08) 29.34(5.28) Father age (Years) 33.766 (5.52) 33.48(5.09) 33.88(5.69) Characteristics N (%) N (%) N (%) Educational status (Mother) Secondary 233 (16.6) 79(33.9) 154(66.1) Diploma 588 (42.0) 205(34.9) 383(65.1) Bachelor’s 579 (41.4) 129(22.3) 450(77.7) Educational status (Father) Secondary 385 (27.5) 136(35.3) 249(64.7) Diploma 499 (35.6) 165(33.1) 334(66.9) Bachelor’s 516 (36.9) 112(21.7) 404(78.3) Place of residence Urban areas 768 (54.9) 169(22.0) 599(78.0) Rural areas 632 (45.1) 244(38.6) 388(61.4) Mother Job Worker 171 (12.2) 38(22.2) 133(77.8) Household 1229 (87.8) 375(30.5) 854(69.5) Route of delivery Normal vaginal 502 (35.9) 164(32.7) 338(67.3) Cesarean section 898 (64.1) 249(27.7) 649(72.3) Number of children 1 682 (48.7) 179(26.3) 503(73.8) ≥ 2 718 (51.3) 234(32.6) 484(67.4) Gestational Age ≥ 37 1276 (91.1) 392(30.7) 884(69.3) < 37 124 (8.9) 21(16.9) 103(83.1) Breast problem (Mother) Yes 17 (1.2) 1(5.09) 16(94.1) No 1383 (98.8) 412(29.8) 971(70.2) Breastfeeding training Yes 1282 (91.6) 391(30.5) 891(69.5) No 118 (8.4) 22(18.6) 96(81.4) The study results revealed that out of the 1,400 infants, 413 29.5% were exclusively breastfed. Univariate regression was employed to assess the relationship between maternal demographic factors age and education level, social factors occupation and place of residence, and midwifery factors type of delivery, gestational age, number of children, breastfeeding education, and breast problems with exclusive breastfeeding. The results showed that an increase in the mother's age was associated with a 2% increase in the likelihood of ceasing exclusive breastfeeding, albeit close to significance OR: 1.02. University education and maternal employment were risk factors for discontinuing exclusive breastfeeding. Mothers with university degrees and those who worked had an 84% and 53% increased likelihood of discontinuing exclusive breastfeeding, respectively, compared to mothers with diploma-level education and housewives OR: 1.84 and OR: 1.53. Place of residence also played a significant role, with urban residents being 2.22 times more likely to discontinue exclusive breastfeeding compared to rural residents OR: 2.22. Mothers with breast troubles had a sixfold increased chance of ceasing exclusive breastfeeding OR: 6.78. Cesarean delivery also increased the likelihood of discontinuing exclusive breastfeeding by 26% compared to natural delivery OR: 1.26. Additionally, receiving breastfeeding education, having a full-term pregnancy, and having two or more children had significant and inverse relationships with discontinuing exclusive breastfeeding, serving as preventive factors. Receiving breastfeeding education reduced the likelihood by 48% OR: 0.52, full-term pregnancy by 54% OR: 0.46, and having two or more children by 27% OR: 0.73 Table 2 . Table 2 Relationship between exclusive breastfeeding with mother's demographic,social and midwifery variables using univariate regression analysis (unadjusted effects). Characteristics Sub groups B(SE) OR %95CI P-value Mother age - 0.02(0.01) 1.02 0.99–1.04 0.114 Educational status (Mother) Diploma\Secondary R 0.61(0.12) 1.84 1.44–2.35 < 0.001 Bachelor’s Mother job House hold R 0.43(0.19) 1.53 1.05–2.24 0.027 Worker Place of residence Rural areas R 0.80(0.11) 2.22 1.76–2.81 < 0.001 Urban areas Breastfeeding training No R -0.65(0.24) 0.52 0.32–0.84 0.008 Yes Route of delivery Normal vaginal R 0.23(0.12) 1.26 0.99–1.60 0.052 Cesarean section Number of children 1 R -0.30(0.11) 0.73 0.58–0.92 0.009 ≥ 2 Breast problem No R 1.91(1.03) 6.78 0.89–51.36 0.064 Yes Gestational Age < 37 R -0.77(0.24) 0.46 0.28–0.74 0.002 ≥ 37 Hierarchical analysis was employed for multivariate regression, incorporating demographic, social, and midwifery variables. In the final model, which included all study variables, education level, place of residence, term pregnancy, and breast problems were significant factors affecting the cessation of exclusive breastfeeding. Mother’s education level OR: 1.42, P = 0.003 and urban residence OR: 1.89, P < 0.001 were associated with increased discontinuation, while term pregnancy OR: 0.47, P = 0.008 served as a preventive factor. Breastfeeding education OR: 0.64 and breast problem also influenced discontinuation decrease and increase respectively and but were not statistically significant Table 3 and Fig. 1. Table 3 The relationship between exclusive breastfeeding with mother's demographic, social and midwifery variables using multivariate regression modeling (adjusted effects) Characteristics Sub groups B(SE) OR %95CI P-value Model 1 * Mother age - 0.007(0.01) 1.007 0.98–1.03 0.566 Educational status (Mother) Diploma\Secondary R 0.34(0.13) 1.41 1.07–1.85 0.013 Bachelor’s Mother Job House hold R 0.03(0.21) 1.03 0.68–1.55 0.895 Worker Place of residence Rural areas R 0.66(0.13) 1.94 1.51–2.50 < 0.001 Urban areas Model 2 ** Breastfeeding training No R -0.56(0.24) 0.56 0.35–0.92 0.022 Yes Method of delivery Normal vaginal R 0.23(0.12) 1.26 0.99–1.60 0.059 Cesarean section Number of children 1 R -0.29(0.11) 0.74 0.59–0.94 0.015 ≥ 2 Breast problem No R 1.82(1.03) 6.21 0.81–47.34 0.078 Yes Gestational Age < 37 R -0.74(024) 0.47 0.29–0.77 0.003 ≥ 37 Model 3 *** Educational status (Mother) Diploma\Secondary R 0.30(0.14) 1.42 1.09–1.86 0.008 Bachelor’s Place of residence Rural areas R 0.61(0.13) 1.89 1.47–2.44 < 0.001 Urban areas Gestational Age < 37 R -0.74 (0.25) 0.47 0.28–0.77 0.003 ≥ 37 Breastfeeding training No R -0.42 (0.25) 0.64 0.39–1.07 0.082 Yes Breast problem No R 1.88 (1.04) 6.71 0.87–51.58 0.067 Yes * Variables include: Mother’s age, Educational status, Mother’s Job, and Place of residence. **Variables include: Breastfeeding training, delivery method, Number of children, Breast problem, and Gestational Age. *** Variables include in the Backward model: all variables in models 1 and 2 The results from the random Forest Model, encompassing the nine variables in the study, indicated that all variables were important and none were excluded from the model. The Gini importance index Mean Decrease Gini revealed that the mother's age 53.52%, place of residence 17.67%, and mother's education 11.08% were the most influential variables for predicting and identifying factors related to exclusive breastfeeding Fig. 2. Discussion This study was conducted to investigate the maternal factors affecting exclusive breastfeeding in north of xxx. The findings of the study revealed that nearly one-third of the mothers 29.5% achieved exclusive breastfeeding at the end of 6 months. The results indicated that high levels of maternal education, breast troubles, and urban residence significantly increased the likelihood of discontinuing exclusive breastfeeding. In contrast, term pregnancies and receiving breastfeeding education were factors that reduced the risk of discontinuing exclusive breastfeeding. The exclusive breastfeeding rate of 29.5% observed among the study mothers was lower compared to countries with similar cultural and religious backgrounds, such as Saudi Arabia and Turkey [ 19 ]. Saudi Arabia reported a rate of 60% and Turkey 38.9%. However, the rate in the current study was higher compared to Canada and the United States and was closer to the European exclusive breastfeeding rate[ 20 ]. It's noteworthy that a meta-analysis conducted in Iran in 2019 reported an exclusive breastfeeding rate of 52% [ 21 ], which was higher than the current study. This variation may be attributed to changes in social and cultural conditions influenced by technological progress, economic factors, and political conditions. The study results suggested that higher maternal education levels, urban residence, and term pregnancies were associated with an increased likelihood of discontinuing exclusive breastfeeding. This contradicts findings from some previous studies while aligning with others [ 7 , 22 ]. For instance, a study in China by Tang et al found that mothers with higher education were less likely to practice exclusive breastfeeding [ 23 ]. The discrepancy may be due to highly educated mothers being less inclined to attend prenatal training classes and not fully comprehending the importance of exclusive breastfeeding. On the other hand, breastfeeding education was an effective factor in reducing the risk of discontinuing exclusive breastfeeding in the current study. Mothers with higher education might also be more likely to work or continue studying, which can contribute to early discontinuation. Working mothers have been identified as a risk factor for exclusive breastfeeding failure in various studies [ 4 , 7 ]. Urban living emerged as a significant factor influencing the likelihood of exclusive breastfeeding discontinuation in this study, which is in line with research conducted by Wallenborn JT and colleagues [ 24 ]. This finding may be attributed to rural women receiving more family support compared to their urban counterparts. However, studies in urban areas in Zimbabwe [ 25 ] showed an increase in exclusive breastfeeding, while research on rural women in Zimbabwe indicated that false beliefs and severe poverty in rural regions contributed to exclusive breastfeeding failure [ 15 ]. Gestational age was another factor associated with exclusive breastfeeding failure. Term deliveries were found to have a 54% lower risk of exclusive breastfeeding discontinuation compared to preterm deliveries. This result aligns with previous studies[ 12 ] and is largely due to the hospitalization of preterm infants, which often leads to temporary separation between mother and baby, making breastfeeding challenging. Therefore, greater attention and support should be provided to mothers with preterm births, and improved breastfeeding practices in neonatal care units should be a priority. A significant finding in this study was that the presence of breast troubles such as nipple sores, cracks, painful breasts, or sunken nipples was associated with a higher likelihood of exclusive breastfeeding discontinuation, although it did not reach statistical significance. This may be due to the relatively small number of cases with breast troubles 17 out of 1400 infants. This observation aligns with the findings of other studies that consider breast troubles as risk factors for exclusive breastfeeding failure. First-time breastfeeding experience was found to increase the risk of exclusive breastfeeding discontinuation in this study. Primiparous mothers had a significantly higher likelihood of exclusive breastfeeding failure compared to mothers with two or more children. This indicates that maternal experience and self-confidence in breastfeeding increase the chances of successful exclusive breastfeeding. These findings correspond with research by Seval Keloglan and colleagues [ 26 ]. The impact of delivery method on exclusive breastfeeding has been a concern for healthcare clerks. Some studies suggest that Cesarean Delivery CD without labor hurts early exclusive breastfeeding, but if breastfeeding is initiated, it does not affect the overall type of delivery at 6 months. In the present study, no significant difference was observed between CD and Vaginal Delivery VD in terms of exclusive breastfeeding, although other reports indicated a higher risk of failure in CD cases. This underscores the need for further investigation into the relationship between delivery method and exclusive breastfeeding. Conclusion This study shows that mothers with preterm infant mothers with higher education and living in the city have challenges in exclusive breastfeeding. These mothers need more training, attention and support in breastfeeding. It is better for these mothers to receive special training. The findings provide valuable insights for healthcare professionals and policymakers working to promote and support exclusive breastfeeding in northern xxx. Declarations Ethics approval and consent to participate The study received approval from the ethics committee of Babol University of Medical Sciences and was assigned a specific code for reference ID: IR.MUBABOL.REC. 1399.200. Informed consent was obtained from all mother included in the study. Consent for publication All mother have consented to the inclusion of their data in this study Competing interests The authors have no conflict of interest to declare that are relevant to the content of this article. Funding This study was supported from the Non-Communicable Pediatric Diseases Research Center of Babol University of Medical Sciences. Author contribution The authors confirm contribution to the paper as follows: Study conception and design: M. ED; and Z.A ;Data collection: F. Z; J. AR; Analysis and interpretation of results: H-A. N; M. N ;Draft manuscript preparation: M. N ; J.A.; All authors reviewed the results and approved the final version of the manuscript. Acknowledgment The authors would like to thank the Clinical Research Development Department of Amirkola Children's Hospital for their necessary collaboration. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. References Motee A, Jeewon R. Importance of exclusive breastfeeding and complementary feeding among infants. Curr Res Nutr Food Sci J. 2014;2(2):56–72. Olang B, et al. Reasons given by mothers for discontinuing breastfeeding in Iran. Int Breastfeed J. 2012;7(1):1–7. Islami Z, et al. Relationship between delivery type and successful breastfeeding. Iran J Pediatr. 2008;18(s1):47–52. Zhang Y, et al. Breastfeeding experience, challenges and service demands among Chinese mothers: A qualitative study in two cities. Appetite. 2018;128:263–70. Charantimath U, et al. Facilitators and challenges to exclusive breastfeeding in Belagavi District, Karnataka, India. PLoS ONE. 2020;15(5):e0231755. Dun-Dery EJ, Laar AK. Exclusive breastfeeding among city-dwelling professional working mothers in Ghana. Int Breastfeed J. 2016;11(1):23. Chang P-C, et al. Factors associated with cessation of exclusive breastfeeding at 1 and 2 months postpartum in Taiwan. Int Breastfeed J. 2019;14(1):1–7. Organization WH. Global breastfeeding scorecard, 2019: increasing commitment to breastfeeding through funding and improved policies and programmes. World Health Organization; 2019. Yang Z, et al. Breastfeeding rates in China: a cross-sectional survey and estimate of benefits of improvement. Lancet. 2016;388:S47. Baba Ahmadi A, Pajouhideh ZS, Mohammadi S. Prevalence of exclusive breastfeeding and its related factors in Iran: A systematic review and meta-analysis. Iran J Obstet Gynecol Infertility. 2021;24(5):103–15. Victora CG, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. lancet. 2016;387(10017):475–90. Zimmerman DR, et al. Breastfeeding challenges and support in a high initiation population. Isr J Health Policy Res. 2022;11(1):31. Prior E, et al. Breastfeeding after cesarean delivery: a systematic review and meta-analysis of world literature. Am J Clin Nutr. 2012;95(5):1113–35. Aldalili AYA, El AA. Mahalli, Research title: Factors associated with cessation of exclusive breastfeeding. J Multidisciplinary Healthc, 2021: p. 239–46. Nduna T, Marais D, van Wyk B. An explorative qualitative study of experiences and challenges to exclusive breastfeeding among mothers in rural Zimbabwe. ICAN: Infant, Child, & Adolescent Nutrition, 2015. 7(2): pp. 69–76. McAllister H, Bradshaw S, Ross-Adjie G. A study of in-hospital midwifery practices that affect breastfeeding outcomes. Breastfeed Rev. 2009;17(3):11–5. Kellams A, et al. ABM clinical protocol# 3: supplementary feedings in the healthy term breastfed neonate, revised 2017. Breastfeed Med. 2017;12(4):188–98. Lee CC, et al. Breastfeeding-Friendly Environmental Factors and Continuing Breastfeeding Until 6 Months Postpartum: 2008–2011 National Surveys in Taiwan. Birth. 2015;42(3):242–8. Salcan S, Topal I, Ates I. The frequency and effective factors of exclusive breastfeeding for the first six months in babies born in Erzincan Province in 2016. Eurasian J Med. 2019;51(2):145. Jones JR, et al. Factors associated with exclusive breastfeeding in the United States. Pediatrics. 2011;128(6):1117–25. Behzadifar M, et al. Prevalence of exclusive breastfeeding practice in the first six months of life and its determinants in Iran: a systematic review and meta-analysis. BMC Pediatr. 2019;19(1):1–10. Laksono AD, et al. The effects of mother’s education on achieving exclusive breastfeeding in Indonesia. BMC Public Health. 2021;21(1):1–6. Tang X, et al. Workplace programmes for supporting breast-feeding: a systematic review and meta-analysis. Public Health Nutr. 2021;24(6):1501–13. Wallenborn JT, et al. Urban-rural gaps in breastfeeding practices: evidence from lao people’s democratic republic. Int J public health. 2021;66:1604062. Lubala TK, et al. Infant feeding practices in urban and rural southern Katanga communities in Democratic Republic of Congo. J Med Res. 2016;2(3):65–70. Keloglan S, Yilmaz A, Gumus K. Factors Affecting Mothers' Breastfeeding. Int J Caring Sci January-April. 2018;11(1):225. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4641710","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":330866153,"identity":"902884f2-0bea-46ff-97b8-5f401bf0efa2","order_by":0,"name":"Zahra Akbarian-rad","email":"","orcid":"","institution":"Babol University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Zahra","middleName":"","lastName":"Akbarian-rad","suffix":""},{"id":330866154,"identity":"c073b67c-b01e-42da-97a6-a85e80906141","order_by":1,"name":"Hossein-Ali Nikbakht","email":"","orcid":"","institution":"Babol University of Medical 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09:44:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4641710/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4641710/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":61181982,"identity":"0625390d-d1b0-4ad8-aabf-3cd8c824456f","added_by":"auto","created_at":"2024-07-26 16:53:07","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":409011,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4641710/v1/8f1a667cb3119e66d5fe98d5.jpg"},{"id":61180929,"identity":"55c53d02-e30c-4c4a-952c-76aade4300cb","added_by":"auto","created_at":"2024-07-26 16:45:07","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":427591,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4641710/v1/d2187aa899312394da1b98ba.jpg"},{"id":73041996,"identity":"c5a20bcb-0f05-4559-855d-3415400a3839","added_by":"auto","created_at":"2025-01-06 08:02:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1427879,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4641710/v1/c32e6d64-b7c9-4b0d-92c8-b01b647e4be9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Maternal factors associated with exclusive breastfeeding failure: A community-based cross-sectional study in the north of Iran","fulltext":[{"header":"Key messages","content":"\u003cp\u003eMother's higher education and urban residence are associated with increased discontinuation of exclusive breastfeeding.\u003c/p\u003e \u003cp\u003eBreast problems had a 6-fold effect on the increase of discontinuation of exclusive breastfeeding,\u003c/p\u003e \u003cp\u003eThe mothers with preterm infant, mothers with higher education and living in the city have challenges in breastfeeding.need more training, attention and support in exclusive breastfeeding.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eMother's milk is the gold standard of nutrition for the growth and development of infants [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] and has a unique biological and emotional impact on the health of both mother and baby [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Mother's milk is highly effective in promoting health and preventing numerous disorders and diseases in children[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Furthermore, breastfeeding offers significant economic and social benefits for both families and a nation's healthcare system[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e According to WHO guidelines, exclusive breastfeeding entails the first hour of birth and continuing it for the first 6 months without introducing complementary foods such as formula, bottles, pacifiers, or even water, except for necessary vitamin supplements. Breastfeeding should ideally continue up to the age of 2 years [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] .\u003c/p\u003e \u003cp\u003eWHO estimates that approximately one-third of breastfeeding mothers exclusively breastfeed during the first 6 months[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In a global survey of 194 countries conducted in 2018, the rate of exclusive breastfeeding was around 40%. Only 23 countries reported rates exceeding 60% [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Research from countries such as the United States, Tanzania, Brazil, Turkey, Australia, and Thailand suggests that exclusive breastfeeding is approximately 21\u0026ndash;68% for the first three months and 15\u0026ndash;30% for six months[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The results of a systematic study and meta-analysis in Iran show that the rate of exclusive breastfeeding for 6 months ranges from 38\u0026ndash;59%[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe significance of breastfeeding in low-income and middle-income countries surpasses that of high-income countries[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], even though the rate of exclusive breastfeeding in these countries is only 37%. However, the duration of breastfeeding in these countries tends to be longer compared to developed nations[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Studies indicate that, in many societies, although breastfeeding initiation rates are high, they sharply decline in the first weeks postpartum[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eResearchers have identified various reasons for the reduction or cessation of exclusive breastfeeding. In a qualitative review of 40 studies, Sari Laanter\u0026auml; highlighted that the primary cause of exclusive breastfeeding failure is mothers' lack of knowledge Sari Laanter\u0026auml;. Another meta-analysis found that the rate of early breastfeeding after cesarean delivery was significantly lower than that after vaginal delivery, although no significant difference was observed during the first 6 months[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In Saudi Arabia, factors such as the mother's young age, sore nipples, insufficient breastfeeding skills, and the perception of insufficient milk supply have been cited as contributing to decreased exclusive breastfeeding[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In Ghana, in addition to the aforementioned factors, insufficient support from spouses has led to early discontinuation of breastfeeding. Concerns about HIV also play a role[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Other studies have indicated that lack of support from those around first-time mothers, return to the workplace, and education levels below a diploma are reasons for exclusive breastfeeding failure[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs part of the WHO and UNICEF's goals for 2025, exclusive breastfeeding for the first 6 months of life is recommended to reach at least 50% [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Among WHO's guidelines for supporting breastfeeding, 10 actions in child-friendly hospitals can enhance the practice of exclusive breastfeeding [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Studies have shown that in addition to child-friendly hospitals, home visits during the first month postpartum to provide guidance and support to mothers play a pivotal role [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Additionally, planning for community support and creating a child-friendly environment can improve the conditions for exclusive breastfeeding[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn light of the changing individual and societal conditions across time and regions, the causes for exclusive breastfeeding failure in each society require continuous evaluation. In recent years, no comprehensive study has been conducted to identify the maternal factors contributing to the failure of exclusive breastfeeding in Mazandaran State in Iran. By pinpointing the causes of both continued and exclusive breastfeeding failure, we can better plan to address this critical issue in infant health. Consequently, this study aims to determine the maternal factors contributing to exclusive breastfeeding failure in xxx at 2019.\u003c/p\u003e"},{"header":"Method and Material","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy Type and Samples\u003c/h2\u003e \u003cp\u003eThis cross-sectional study was conducted on all infants who had attended the healthcare centers under the purview of xxx University of Medical Sciences for their 6-month vaccinations, spanning from October 1, 2019, to July 15, 2021. Sampling was carried out using a census approach, encompassing all infants who met the entry criteria, which included parental consent and the absence of congenital abnormalities in the infants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003exxx, located in northern xxx and home to a population of 550,000, comprises 16 urban health centers and 33 rural health centers. Initially, a healthcare clerk, who was a permanent staff member of each center, was selected. These healthcare clerks then received training from the project manager, who is also the responsible author, to ensure proper completion of the questionnaires. Trained health supervisors conducted interviews with nursing mothers to gather data. The approximate time required to complete each questionnaire was around 10 minutes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eAssessment Variables\u003c/h2\u003e \u003cp\u003eIn line with the objectives of this study, demographic, social, and midwifery information was collected, focusing on maternal factors influencing exclusive breastfeeding. Maternal demographic and social information included age, education level Secondary, Diploma, Bachelor\u0026rsquo;s, occupation, and place of residence. Obstetrical information comprised the type of delivery vaginal or cesarean section, the number of children, gestational age at the time of birth, receipt of breastfeeding education, and breast-related issues, such as abscess, fissure, and mastitis. A gestational age equal to or greater than 37 weeks was categorized as a term pregnancy.\u003c/p\u003e \u003cp\u003eRegarding the assessment of exclusive breastfeeding failure, adhering to the World Health Organization's definition, all mothers were asked if they had provided their child with anything other than breast milk, such as pacifiers, bottles, sugar water, or complementary feeding for infants during the first 6 months. They were also queried about when they initiated breastfeeding.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Data Analysis\u003c/h2\u003e \u003cp\u003eFollowing data collection to ensure their accuracy, descriptive statistics were reported using measures such as the mean, standard deviation, numbers, and percentages. Independent Samples T Test and Chi-square tests were employed for analytical statistics and to explore relationships between qualitative variables. Binary Logistic Regression analysis was used to examine the individual raw effects and combined comparative effects influence of predictor variables on exclusive breastfeeding and to elucidate their interrelationships. Some factors that could impact this relationship were considered for adjustment in the final analysis. The backward method was employed in the multivariate analysis, and the variables retained in the final model at each stage were presented. Odds Ratios OR and 95% confidence intervals CI were used to indicate effect size in the model. Additionally, a supplementary analysis employing machine learning methods utilized the random Forest Model to identify the most significant variables. In these models, the Gini coefficient index played a crucial role in determining the importance of variables for predicting factors related to exclusive breastfeeding. All analyses were conducted using SPSS software version 22 and R version 4.1.3, with a significance level set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOut of the 1,432 individuals initially included in the study, 32 participants were excluded due to non-cooperation and incomplete questionnaire responses. Statistical analysis was conducted on the data from the remaining 1,400 infants.\u003c/p\u003e \u003cp\u003eThe average age of the infants' mothers and fathers was 29.20\u0026thinsp;\u0026plusmn;\u0026thinsp;5.22 and 33.76\u0026thinsp;\u0026plusmn;\u0026thinsp;5.52, respectively. Approximately half of the parents resided in urban areas. Most nursing mothers held a diploma level of education 42% and were housewives 87.7%. A majority of nursing mothers 91% had experienced term deliveries, and 64% had undergone cesarean sections. Furthermore, 92% of nursing mothers received breastfeeding education from healthcare clerks, and 1.2% encountered breast problems Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics and maternal factors in the study according to exclusive breastfeeding.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal (N\u0026thinsp;=\u0026thinsp;1400)\u003c/p\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eBreastfeeding at 6 months\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;413)\u003c/p\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo(n\u0026thinsp;=\u0026thinsp;987)\u003c/p\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMother age (Years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.20 (5.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.86(5.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29.34(5.28)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFather age (Years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.766 (5.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.48(5.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.88(5.69)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEducational status (Mother)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e233 (16.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79(33.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e154(66.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e588 (42.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e205(34.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e383(65.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor\u0026rsquo;s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e579 (41.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e129(22.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e450(77.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEducational status (Father)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e385 (27.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e136(35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e249(64.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e499 (35.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e165(33.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e334(66.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor\u0026rsquo;s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e516 (36.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e112(21.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e404(78.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePlace of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban areas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e768 (54.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e169(22.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e599(78.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural areas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e632 (45.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e244(38.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e388(61.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMother Job\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWorker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e171 (12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38(22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e133(77.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHousehold\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1229 (87.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e375(30.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e854(69.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRoute of delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal vaginal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e502 (35.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e164(32.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e338(67.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e898 (64.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e249(27.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e649(72.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNumber of children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e682 (48.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e179(26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e503(73.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e718 (51.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e234(32.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e484(67.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGestational Age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1276 (91.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e392(30.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e884(69.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e124 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21(16.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e103(83.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBreast problem (Mother)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(5.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16(94.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1383 (98.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e412(29.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e971(70.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBreastfeeding training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1282 (91.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e391(30.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e891(69.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e118 (8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22(18.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e96(81.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe study results revealed that out of the 1,400 infants, 413 29.5% were exclusively breastfed. Univariate regression was employed to assess the relationship between maternal demographic factors age and education level, social factors occupation and place of residence, and midwifery factors type of delivery, gestational age, number of children, breastfeeding education, and breast problems with exclusive breastfeeding. The results showed that an increase in the mother's age was associated with a 2% increase in the likelihood of ceasing exclusive breastfeeding, albeit close to significance OR: 1.02. University education and maternal employment were risk factors for discontinuing exclusive breastfeeding. Mothers with university degrees and those who worked had an 84% and 53% increased likelihood of discontinuing exclusive breastfeeding, respectively, compared to mothers with diploma-level education and housewives OR: 1.84 and OR: 1.53. Place of residence also played a significant role, with urban residents being 2.22 times more likely to discontinue exclusive breastfeeding compared to rural residents OR: 2.22. Mothers with breast troubles had a sixfold increased chance of ceasing exclusive breastfeeding OR: 6.78. Cesarean delivery also increased the likelihood of discontinuing exclusive breastfeeding by 26% compared to natural delivery OR: 1.26. Additionally, receiving breastfeeding education, having a full-term pregnancy, and having two or more children had significant and inverse relationships with discontinuing exclusive breastfeeding, serving as preventive factors. Receiving breastfeeding education reduced the likelihood by 48% OR: 0.52, full-term pregnancy by 54% OR: 0.46, and having two or more children by 27% OR: 0.73 Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRelationship between exclusive breastfeeding with mother's demographic,social and midwifery variables using univariate regression analysis (unadjusted effects).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub groups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eB(SE)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%95CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.02(0.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.99\u0026ndash;1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.114\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEducational status (Mother)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma\\Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eR\u003c/p\u003e \u003cp\u003e0.61(0.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.44\u0026ndash;2.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor\u0026rsquo;s\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMother job\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHouse hold\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eR\u003c/p\u003e \u003cp\u003e0.43(0.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.05\u0026ndash;2.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWorker\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePlace of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural areas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eR\u003c/p\u003e \u003cp\u003e0.80(0.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.76\u0026ndash;2.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban areas\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBreastfeeding training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eR\u003c/p\u003e \u003cp\u003e-0.65(0.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.32\u0026ndash;0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRoute of delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal vaginal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eR\u003c/p\u003e \u003cp\u003e0.23(0.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.99\u0026ndash;1.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCesarean section\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNumber of children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eR\u003c/p\u003e \u003cp\u003e-0.30(0.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.58\u0026ndash;0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBreast problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eR\u003c/p\u003e \u003cp\u003e1.91(1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e6.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.89\u0026ndash;51.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.064\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGestational Age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eR\u003c/p\u003e \u003cp\u003e-0.77(0.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.28\u0026ndash;0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eHierarchical analysis was employed for multivariate regression, incorporating demographic, social, and midwifery variables. In the final model, which included all study variables, education level, place of residence, term pregnancy, and breast problems were significant factors affecting the cessation of exclusive breastfeeding. Mother\u0026rsquo;s education level OR: 1.42, P\u0026thinsp;=\u0026thinsp;0.003 and urban residence OR: 1.89, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001 were associated with increased discontinuation, while term pregnancy OR: 0.47, P\u0026thinsp;=\u0026thinsp;0.008 served as a preventive factor. Breastfeeding education OR: 0.64 and breast problem also influenced discontinuation decrease and increase respectively and but were not statistically significant Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Fig.\u0026nbsp;1.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe relationship between exclusive breastfeeding with mother's demographic, social and midwifery variables using multivariate regression modeling (adjusted effects)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSub groups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eB(SE)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e%95CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eModel 1\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMother age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.007(0.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.98\u0026ndash;1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.566\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEducational status (Mother)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDiploma\\Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eR\u003c/p\u003e \u003cp\u003e0.34(0.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.07\u0026ndash;1.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBachelor\u0026rsquo;s\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMother Job\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHouse hold\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eR\u003c/p\u003e \u003cp\u003e0.03(0.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.68\u0026ndash;1.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.895\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWorker\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePlace of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRural areas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eR\u003c/p\u003e \u003cp\u003e0.66(0.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.51\u0026ndash;2.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUrban areas\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003eModel 2\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBreastfeeding training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eR\u003c/p\u003e \u003cp\u003e-0.56(0.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.35\u0026ndash;0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMethod of delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNormal vaginal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eR\u003c/p\u003e \u003cp\u003e0.23(0.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.99\u0026ndash;1.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCesarean section\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNumber of children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eR\u003c/p\u003e \u003cp\u003e-0.29(0.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.59\u0026ndash;0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBreast problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eR\u003c/p\u003e \u003cp\u003e1.82(1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e6.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.81\u0026ndash;47.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGestational Age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eR\u003c/p\u003e \u003cp\u003e-0.74(024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.29\u0026ndash;0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003eModel 3\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEducational status (Mother)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDiploma\\Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eR\u003c/p\u003e \u003cp\u003e0.30(0.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.09\u0026ndash;1.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBachelor\u0026rsquo;s\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePlace of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRural areas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eR\u003c/p\u003e \u003cp\u003e0.61(0.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.47\u0026ndash;2.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUrban areas\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGestational Age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eR\u003c/p\u003e \u003cp\u003e-0.74 (0.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.28\u0026ndash;0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBreastfeeding training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eR\u003c/p\u003e \u003cp\u003e-0.42 (0.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.39\u0026ndash;1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBreast problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eR\u003c/p\u003e \u003cp\u003e1.88 (1.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e6.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.87\u0026ndash;51.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e* Variables include: Mother\u0026rsquo;s age, Educational status, Mother\u0026rsquo;s Job, and Place of residence.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e**Variables include: Breastfeeding training, delivery method, Number of children, Breast problem, and Gestational Age.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e*** Variables include in the Backward model: all variables in models 1 and 2\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results from the random Forest Model, encompassing the nine variables in the study, indicated that all variables were important and none were excluded from the model. The Gini importance index Mean Decrease Gini revealed that the mother's age 53.52%, place of residence 17.67%, and mother's education 11.08% were the most influential variables for predicting and identifying factors related to exclusive breastfeeding Fig.\u0026nbsp;2.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study was conducted to investigate the maternal factors affecting exclusive breastfeeding in north of xxx. The findings of the study revealed that nearly one-third of the mothers 29.5% achieved exclusive breastfeeding at the end of 6 months. The results indicated that high levels of maternal education, breast troubles, and urban residence significantly increased the likelihood of discontinuing exclusive breastfeeding. In contrast, term pregnancies and receiving breastfeeding education were factors that reduced the risk of discontinuing exclusive breastfeeding.\u003c/p\u003e \u003cp\u003eThe exclusive breastfeeding rate of 29.5% observed among the study mothers was lower compared to countries with similar cultural and religious backgrounds, such as Saudi Arabia and Turkey [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Saudi Arabia reported a rate of 60% and Turkey 38.9%. However, the rate in the current study was higher compared to Canada and the United States and was closer to the European exclusive breastfeeding rate[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. It's noteworthy that a meta-analysis conducted in Iran in 2019 reported an exclusive breastfeeding rate of 52% [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], which was higher than the current study. This variation may be attributed to changes in social and cultural conditions influenced by technological progress, economic factors, and political conditions.\u003c/p\u003e \u003cp\u003eThe study results suggested that higher maternal education levels, urban residence, and term pregnancies were associated with an increased likelihood of discontinuing exclusive breastfeeding. This contradicts findings from some previous studies while aligning with others [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. For instance, a study in China by Tang et al found that mothers with higher education were less likely to practice exclusive breastfeeding [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The discrepancy may be due to highly educated mothers being less inclined to attend prenatal training classes and not fully comprehending the importance of exclusive breastfeeding. On the other hand, breastfeeding education was an effective factor in reducing the risk of discontinuing exclusive breastfeeding in the current study. Mothers with higher education might also be more likely to work or continue studying, which can contribute to early discontinuation. Working mothers have been identified as a risk factor for exclusive breastfeeding failure in various studies [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUrban living emerged as a significant factor influencing the likelihood of exclusive breastfeeding discontinuation in this study, which is in line with research conducted by Wallenborn JT and colleagues [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. This finding may be attributed to rural women receiving more family support compared to their urban counterparts. However, studies in urban areas in Zimbabwe [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] showed an increase in exclusive breastfeeding, while research on rural women in Zimbabwe indicated that false beliefs and severe poverty in rural regions contributed to exclusive breastfeeding failure [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGestational age was another factor associated with exclusive breastfeeding failure. Term deliveries were found to have a 54% lower risk of exclusive breastfeeding discontinuation compared to preterm deliveries. This result aligns with previous studies[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and is largely due to the hospitalization of preterm infants, which often leads to temporary separation between mother and baby, making breastfeeding challenging. Therefore, greater attention and support should be provided to mothers with preterm births, and improved breastfeeding practices in neonatal care units should be a priority.\u003c/p\u003e \u003cp\u003eA significant finding in this study was that the presence of breast troubles such as nipple sores, cracks, painful breasts, or sunken nipples was associated with a higher likelihood of exclusive breastfeeding discontinuation, although it did not reach statistical significance. This may be due to the relatively small number of cases with breast troubles 17 out of 1400 infants. This observation aligns with the findings of other studies that consider breast troubles as risk factors for exclusive breastfeeding failure.\u003c/p\u003e \u003cp\u003eFirst-time breastfeeding experience was found to increase the risk of exclusive breastfeeding discontinuation in this study. Primiparous mothers had a significantly higher likelihood of exclusive breastfeeding failure compared to mothers with two or more children. This indicates that maternal experience and self-confidence in breastfeeding increase the chances of successful exclusive breastfeeding. These findings correspond with research by Seval Keloglan and colleagues [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe impact of delivery method on exclusive breastfeeding has been a concern for healthcare clerks. Some studies suggest that Cesarean Delivery CD without labor hurts early exclusive breastfeeding, but if breastfeeding is initiated, it does not affect the overall type of delivery at 6 months. In the present study, no significant difference was observed between CD and Vaginal Delivery VD in terms of exclusive breastfeeding, although other reports indicated a higher risk of failure in CD cases. This underscores the need for further investigation into the relationship between delivery method and exclusive breastfeeding.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study shows that mothers with preterm infant mothers with higher education and living in the city have challenges in exclusive breastfeeding. These mothers need more training, attention and support in breastfeeding. It is better for these mothers to receive special training. The findings provide valuable insights for healthcare professionals and policymakers working to promote and support exclusive breastfeeding in northern xxx.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received approval from the ethics committee of Babol University of Medical Sciences and was assigned a specific code for reference ID: IR.MUBABOL.REC. 1399.200.\u0026nbsp;Informed consent was obtained from all mother included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll mother have consented to the inclusion of their data in this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The authors have no conflict of interest to declare that are relevant to the content of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported from the Non-Communicable Pediatric Diseases Research Center of Babol University of Medical Sciences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors confirm contribution to the paper as follows: \u0026nbsp;Study conception and design: M. ED; and Z.A ;Data collection: F. Z; J. AR; Analysis and interpretation of results: H-A. N; M. N ;Draft manuscript preparation: M. N ; J.A.; \u0026nbsp;All authors reviewed the results and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the Clinical Research Development Department of Amirkola Children\u0026apos;s Hospital for their necessary collaboration.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMotee A, Jeewon R. Importance of exclusive breastfeeding and complementary feeding among infants. Curr Res Nutr Food Sci J. 2014;2(2):56\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlang B, et al. Reasons given by mothers for discontinuing breastfeeding in Iran. Int Breastfeed J. 2012;7(1):1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIslami Z, et al. Relationship between delivery type and successful breastfeeding. Iran J Pediatr. 2008;18(s1):47\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Y, et al. Breastfeeding experience, challenges and service demands among Chinese mothers: A qualitative study in two cities. Appetite. 2018;128:263\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCharantimath U, et al. Facilitators and challenges to exclusive breastfeeding in Belagavi District, Karnataka, India. PLoS ONE. 2020;15(5):e0231755.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDun-Dery EJ, Laar AK. Exclusive breastfeeding among city-dwelling professional working mothers in Ghana. Int Breastfeed J. 2016;11(1):23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChang P-C, et al. Factors associated with cessation of exclusive breastfeeding at 1 and 2 months postpartum in Taiwan. Int Breastfeed J. 2019;14(1):1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrganization WH. Global breastfeeding scorecard, 2019: increasing commitment to breastfeeding through funding and improved policies and programmes. World Health Organization; 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang Z, et al. Breastfeeding rates in China: a cross-sectional survey and estimate of benefits of improvement. Lancet. 2016;388:S47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaba Ahmadi A, Pajouhideh ZS, Mohammadi S. Prevalence of exclusive breastfeeding and its related factors in Iran: A systematic review and meta-analysis. Iran J Obstet Gynecol Infertility. 2021;24(5):103\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVictora CG, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. lancet. 2016;387(10017):475\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZimmerman DR, et al. Breastfeeding challenges and support in a high initiation population. Isr J Health Policy Res. 2022;11(1):31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrior E, et al. Breastfeeding after cesarean delivery: a systematic review and meta-analysis of world literature. Am J Clin Nutr. 2012;95(5):1113\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAldalili AYA, El AA. Mahalli, Research title: Factors associated with cessation of exclusive breastfeeding. J Multidisciplinary Healthc, 2021: p. 239\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNduna T, Marais D, van Wyk B. An explorative qualitative study of experiences and challenges to exclusive breastfeeding among mothers in rural Zimbabwe. ICAN: Infant, Child, \u0026amp; Adolescent Nutrition, 2015. 7(2): pp. 69\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcAllister H, Bradshaw S, Ross-Adjie G. A study of in-hospital midwifery practices that affect breastfeeding outcomes. Breastfeed Rev. 2009;17(3):11\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKellams A, et al. ABM clinical protocol# 3: supplementary feedings in the healthy term breastfed neonate, revised 2017. Breastfeed Med. 2017;12(4):188\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee CC, et al. Breastfeeding-Friendly Environmental Factors and Continuing Breastfeeding Until 6 Months Postpartum: 2008\u0026ndash;2011 National Surveys in Taiwan. Birth. 2015;42(3):242\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalcan S, Topal I, Ates I. The frequency and effective factors of exclusive breastfeeding for the first six months in babies born in Erzincan Province in 2016. Eurasian J Med. 2019;51(2):145.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJones JR, et al. Factors associated with exclusive breastfeeding in the United States. Pediatrics. 2011;128(6):1117\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBehzadifar M, et al. Prevalence of exclusive breastfeeding practice in the first six months of life and its determinants in Iran: a systematic review and meta-analysis. BMC Pediatr. 2019;19(1):1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaksono AD, et al. The effects of mother\u0026rsquo;s education on achieving exclusive breastfeeding in Indonesia. BMC Public Health. 2021;21(1):1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTang X, et al. Workplace programmes for supporting breast-feeding: a systematic review and meta-analysis. Public Health Nutr. 2021;24(6):1501\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWallenborn JT, et al. Urban-rural gaps in breastfeeding practices: evidence from lao people\u0026rsquo;s democratic republic. Int J public health. 2021;66:1604062.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLubala TK, et al. Infant feeding practices in urban and rural southern Katanga communities in Democratic Republic of Congo. J Med Res. 2016;2(3):65\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKeloglan S, Yilmaz A, Gumus K. Factors Affecting Mothers' Breastfeeding. Int J Caring Sci January-April. 2018;11(1):225.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Maternal factors, exclusive breastfeeding failure, exclusive breastfeeding, infants.","lastPublishedDoi":"10.21203/rs.3.rs-4641710/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4641710/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTo improve exclusive breastfeeding, we have to resolve challenges for mothers and babies. This study aims to determine the maternal factors causing to failure in exclusive breastfeeding.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional study was conducted on all infants who had attended the healthcare centers for their first 6-month vaccinations, from 2019 to 2021 in xxx, xxx. Maternal factors including demographic, social, and midwifery information were collected using a checklist. Failure of exclusive breastfeeding was defined as using anything other than breast milk, such as pacifiers, bottles, sugar water, or complementary feeding for infants during the first 6 months of age. Binary Logistic analysis examined the influence of predictor variables on exclusive breastfeeding. The significance level was considered at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eOut of the 1,400 infants at the end of the study, 413 29.5% were exclusively breastfed. Multivariate regression showed education level OR: 1.42, P\u0026thinsp;=\u0026thinsp;0.003 and urban residence OR: 1.89, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001 were associated with increased discontinuation, while term pregnancy OR: 0.47, P\u0026thinsp;=\u0026thinsp;0.008 served as a preventive factor. Breastfeeding education OR: 6.7, P\u0026thinsp;=\u0026thinsp;0.067 and breast problems OR: 6.4, P\u0026thinsp;=\u0026thinsp;0.082 had a 6-fold effect on the decrease and increase of discontinuation of exclusive breastfeeding, respectively, although this relationship was not statistically significant.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study showed preterm delivery, higher education and living in urban area can increase the probability of failure of exclusive breastfeeding. These findings provide valuable insights for healthcare professionals and policymakers working to promote and support exclusive breastfeeding.\u003c/p\u003e","manuscriptTitle":"Maternal factors associated with exclusive breastfeeding failure: A community-based cross-sectional study in the north of Iran","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-26 16:45:02","doi":"10.21203/rs.3.rs-4641710/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7d04c2f9-cd6f-4f65-b4a2-b5ae85a54035","owner":[],"postedDate":"July 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-06T07:53:57+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-26 16:45:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4641710","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4641710","identity":"rs-4641710","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}