Knowledge, Attitude, Practice, self-efficacy, and Barriers to Exclusive Breastfeeding Practices among Women in a Middle Eastern Country

Knowledge, Attitude, Practice, self-efficacy, and Barriers to Exclusive Breastfeeding Practices among Women in a Middle Eastern Country | 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 Knowledge, Attitude, Practice, self-efficacy, and Barriers to Exclusive Breastfeeding Practices among Women in a Middle Eastern Country Girija Kalayil Madhavanprabhakaran, Judie Arulappan, Frincy Francis, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6187622/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 Objective The study identified the knowledge, attitude, practice, self- efficacy and barriers to exclusive breastfeeding practices among Omani women. Methods Quantitative longitudinal survey was conducted among 505 Omani breastfeeding women. An online questionnaire was used to collect data regarding the knowledge, attitude, practice, self-efficacy, and barriers to exclusive breastfeeding practices from 2020-2022. Results Majority of women belonged to 30- 34 years. Most of them were unemployed and majority of them had higher education and above. A large portion of women reported having good knowledge and very good attitude towards breastfeeding; however, 33.5 % reported less self-efficacy. While 77.3% practiced combination of both breast-feeding and formula feeding, only 22.7% reported exclusive breastfeeding practices. In addition, 81% of the women reported high level of barriers to exclusive breast-feeding. Most of the women believed that formula feeding is equivalent to breast-feeding. Further, embarrassment about feeding in public and lactation problems were reported as barriers to exclusive breast-feeding. Additionally, policies and practices by some health services and health care providers, lack of knowledge regarding essential diet for breast-feeding and lack of support from employer for allowing special time/facilities for breast-feeding were the predictors related to the barriers to exclusive breastfeeding Practices. The other predictors includes younger women, particularly <20yrs; less educated women; unsure if the baby is getting enough milk and a belief that formula is easy to use and more available soon after birth. Conclusion Exclusive breastfeeding is associated with innumerable benefits to both the mother and the child. The policy makers and healthcare providers must emphasize on the exclusive breastfeeding practices and create stringent policies allowing special time/facilities for breast-feeding. Strategies must be created to combat the barriers to exclusive breast feeding practices. Breastfeeding exclusive breastfeeding Knowledge Attitude Evidence-Based Practice Postnatal care Mothers Figures Figure 1 Introduction Breastfeeding improves the survival rates of newborns, infants, and children. Breastfeeding outcomes across the environmental, economic, and most importantly on the health of both the mother and the baby are proven facts. 1 Decrease in the breastfeeding practices including the exclusive breastfeeding and the early switching to a formula feed has been linked with significant increase in mortality and morbidity rates in children due to infectious diseases like respiratory conditions, otitis media, dental diseases, obesity in childhood and juvenile diabetes. 2 Infants who are exclusively breastfed in their first six months of life count for only 41% globally and the studies also reported that the proportion of children who receive breast milk until the age of 12 months are very less. 3 Infant formula industries are often violating the International Code of Marketing of Breastmilk substitutes, which is a failure to protect, support and promote breastfeeding. 4 Though widespread information in the form of reported research findings and awareness programs are being disseminated, only a slow increase in the percentage of breastfeeding is observed. 5 Around 45% of the global population of children succumb to death due to undernutrition. 6 Breastfeeding contributes to the overall development of the child, improvement of maternal and public health. 7 Initiating the first breastfeeding as early as within the first half an hour of birth is ideal and exclusive breastfeeding for the first six months is extremely important. Breastfeeding is being encouraged to be continued along with other foods until two years of age. 5 , 8 World Health Organization (WHO, 2018) is actively involved in the positive promotion of breastfeeding as the best source of nutrition for the infants and the young children. 5 The organization aims to increase the rates of exclusive breastfeeding practices up to 50 percent by 2025 though the current reports states that only 2 out of 3 babies are denied exclusive breastfeeding due to various reasons which means only 41 percent of babies within 6 months get breastfed exclusively. 9 Attributing factors to the declining rate of exclusive breastfeeding practice includes concerns about the breast health, maternal health, breast shape changes, tiring job, breastmilk insufficiency, lack of knowledge, caesarean section, short birth spacing, breastmilk aversion by babies, birth order where first child was exclusively breastfed than other children, inadequate health education from healthcare staff, negative societal influences, resuming job, poor familial support, lack of privacy to feed in public spaces, and economic status. 10 – 11 Additionally, a systematic review and meta-analysis conducted in Middle Eastern Countries like Egypt, Iran, Lebanon, Syria, Qatar, Kuwait, Turkey and Saudi Arabia reported that only 34.3% of neonates received breastmilk within the first hour of birth while only 20.5% were breastfed for the first six months of their life. The review among Middle Eastern mothers highlighted that exclusive breastfeeding practices were linked to the mother’s age, education and employment status of the. 12 Further, the Middle Eastern women rated maternal employment and lack of milk supply as the first and second main barriers to breastfeeding. In addition, the other barriers reported includes, cesarean section, and short maternity leave for the working women. 13 , 14 In Oman, Baby Friendly Hospital Initiative was implemented since 1990. Ministry of Health in Oman reported 93.4% early initiation of breastfeeding in 2015 and 90.8% in 2018 but. However, only 11.8% and 8.7% continued to exclusively breastfeed for a period of six months. 15 , 16 The other predictive factors for breastfeeding practices among Omani mothers includes the mother’s intention to breastfeed, knowledge about breastfeeding and its benefits, lactation support during hospitalization, previous experience of breastfeeding, resuming of work and length of maternity leave and perceived insufficiency in milk production and being employed. 17 , 18 Besides, breastfeeding support specifically in workplace is a concern in Oman. Moreover, a clear legislation or policy regarding breastfeeding in workplaces have not been implemented yet; moreover, no dedicated breastfeeding or breastmilk pumping and storage facilities are available in office spaces. Additionally, time allotment for breastfeeding poor organizational support are the barriers to breastfeeding in Oman. 19 Since the evidences are limited related to exclusive breastfeeding practices in Oman, this study has extensively surveyed the knowledge, attitude, self- efficacy, and barriers to exclusive breastfeeding practices among Omani women. Methods Research design A quantitative longitudinal survey was conducted. Research setting Omani postnatal women who fulfilled the inclusion criteria were chosen from all the 11 Governorates of Oman. Representative samples were selected from each Governorate. Governorate of Muscat (six) Wilayats; Dhofar (ten) Wilayats; Musandam (four) Wilayats; Buraymi (three) Wilayats; Dakhiliyah (eight) Wilayats; North Batinah (six) Wilayats; South Batinah (six) Wilayats; South Sharqiyah (five) Wilayats; North Sharqiyah (six) Wilayats; Dhahirah (three) Wilayats and the Wusta Governorate comprises of (four) Wilayats. Population, sample, Sample sixe and sampling technique Omani women who delivered and discharged from health care facilities of Oman covering all 11 Governorates during the period of study were considered the population for the study. The sample size N and margin of error E are given by x = Z(c/100)2r(100-r) n = N x/((N-1)E2 + x) E = Sqrt[(N - n)x/n(N-1)]. N is the population size, r is the fraction of responses interested in, and Z(c/100) is the critical value for the confidence level c. 505 samples participated in the study. Convenient sampling technique was adopted in the selection of samples. Inclusion criteria Postnatal women between the age of 18–35 years; both primi and multiparous postnatal women; the women who were able to read and write Arabic and postnatal women voluntarily willing to participate in the study were recruited as study samples. Exclusion criteria The study excluded women with HIV infection; women with postpartum blue and depression; women who are on oncology drugs; women who delivered before 37 weeks; high-risk pregnant women; women who developed complications of delivery; women having new born with cleft palate; women having sick new-born admitted to in NICU; women having new-born less than 2 kgs and women with contraindication to breastfeeding. Data collection instruments Part 1 Demographic profile Demographic profile included details such as age, education, occupation, type of Family, economic status, type of support, number of parity, history of abortion, any previous problems with breastfeeding, previous and current delivery, gender of the Baby, previous breast-feeding, type of infant feeding, previous breast-feeding duration and initiation of breast-feeding. Part 2 Infant Breastfeeding Knowledge Questionnaire (BFK) Mothers’ knowledge of breastfeeding was assessed using the Infant Breastfeeding Knowledge Questionnaire (BFK). BFK is a 20 items tool with total score of 20. Maternal breastfeeding knowledge was rated as very good, good, fair and poor based on total scores. This tool originally from World Health Organization and is being utilized in previous Omani studies. 5 , 8 , 15 , 19 which reported Cronbach's alpha reliability score of 0. 752. Part 3 Breastfeeding Self Efficacy Scale – Shot Form (BSES-SF) Participants perceived self-efficacy in breastfeeding was assessed by using the Breastfeeding Self Efficacy Scale – Shot Form (BSES-SF) 5 which is a 14 item positively worded 5 – point self-report Likert scale ranging from 1(not at all confident) to 5 (always confident). Higher scores indicate higher levels of breastfeeding self-efficacy. Part 4 Iowa Infant Feeding Attitude Scale (IIFAS). We assessed the breastfeeding attitude of women through Iowa Infant Feeding Attitude Scale (IIFAS). IIFAS, a 5-point Likert-type scale composed of 17 items with scores ranging from 17 to 85 with higher scores reflecting more positive attitudes toward breastfeeding. Part 5 Breastfeeding practices Self-rating scale Breastfeeding practices were measured through a 14 item self-rating scale, which evaluated five characteristics of breastfeeding and how well each mother breast feed her baby according to the recommendation by WHO/UNICEF. 5 , 8 , 20 Part 5 Questionnaire to assess the barriers to exclusive breast-feeding Questionnaire to assess the barriers to exclusive breast feeding was developed and validated by the researchers with existing tools of World Breastfeeding Trend initiative (WBTi) Assessment tool, 2014 21 , WHO 8 , 15 and the literature review. Ethical considerations The study was ethically approved by the research and ethics committee and was funded by the Deanship of research fund (IG/CON/MCHH/20/02). The purpose of the study was explained and implied consent was obtained from the study participants. None of the participants were forced to participate in the study. The investigators assured that none of their personal identifying information would be collected during the data collection. The collected data were stored in a password protected file and was kept under the custody of the principal investigator of the study. Data collection procedure The data were collected between 2020–2022 to explore the knowledge, attitude, practice, self- efficacy, and barriers to exclusive breastfeeding practices among Omani women. An online self -rating questionnaire on breastfeeding knowledge, attitude, practice, self-efficacy and barriers to exclusive breast feeding practices were distributed to the eligible participants. Their breastfeeding practices were further explored at one, three and at six months after delivery in addition to the initial response within one week of delivery. Multiple reminders through WhatsApp message and calls ensured that sixth month response was received. Data analysis Data was analyzed with SPSS version 23 using both descriptive and inferential statistics. Results Table 1 (Demographic data of the study participants) shows the demographic details of the samples. Among the participants, 33.6% were in the age between 30- 34 years. Majority of the mothers (68.6%) were unemployed and (58.1%) of them were educated with higher education. Of the samples, 90.5% of them live in extended family. Most (86.8%) of them belonged to moderate economic status. Majority of the women (44.6%) received support from their husbands. Considering the number of parity, similar proportion of women (27.2 and 27.1) had the parity of one and two. A large number of women (68.8%) did not have the history of abortion. 66.2% of women experienced previous problems with breastfeeding. Majority (85.8% and 84.0%) of the women had previous and current normal delivery. More than half (53%) of women delivered males. 53.6% had previous breastfeeding experience. Of the samples, 71.8% of them practiced partial breast-feeding. Most (72.6%) of the women breast fed their children for more than 12 months. Women’s knowledge, attitude, self-efficacy and level of barriers are presented in Table 2. It shows that the women exhibited good knowledge and very good attitude, whereas 33.5 % of breastfeeding women reported less confidence in their breastfeeding self- efficacy. In addition, a major portion (81.0%) of women expressed high levels of barriers towards exclusive breast feeding practices. Lastly, 53.2% of women initiated breast-feeding within one hour after delivery. However, only 22.7 % continued with exclusive breastfeeding pattern while 77.3% reported partial breastfeeding with combination of both breastfeeding and formula milk (Figure 1 Distribution of Mothers with Exclusive Breastfeeding Practices). Women varied in their practices of introducing artificial formula. Of the study participants, 5.3% started artificial formula at the first week of the baby’s life and 32% of the women initiated other feeds at one month of age, and the remaining 40 % women opted for other forms of feed from three months onwards. Most (75%) of the mothers reported that they were practicing demand feeding. However, 25% mothers practiced scheduled breastfeeding for every 3-4 hours. In most of the cases (70.2%), breast-feeding was extended for more than one year even though the women experienced challenges with exclusive breastfeeding practices. Many of the participants (81%) reported barriers as a major challenge to exclusive breast-feeding practices. The major barriers reported were misconception that formula feeding is equivalent to breastfeeding (87.9%); not sure if the baby is getting enough or too much milk (79.6%); lack of knowledge regarding essential diet for breast feeding (79.2%); lack of support from the employer for allowing special time/facilities for breast feeding (86.7%); embarrassment about feeding in public (85.5%); lactation problems (85%); formula is easy to use and available soon after birth (75.9%); returning to work and accessing supportive childcare (70.4); policies and practices by some health services and health care providers (53.3), and promotion and marketing of infant formula (62.1%). The possible predicators of breastfeeding barriers was analyzed using liner regression analysis using enter method. The results showed that the overall breastfeeding barriers were statistically significant (OR=0.688; F=44.287; p<0.001) with R 2 of 0.621 (adjusted R 2 = 0.0.607). Table.3 shows statistically significant predictors of barriers to exclusive breastfeeding. The identified barriers includes misconception that formula feeding is equivalent to breast-feeding; embarrassment about feeding in public; lactation problems; policies and practices by some health services and health care providers; younger women, particularly <20yrs; less educated women; not sure if my baby is getting enough milk; lack of knowledge regarding essential diet for breast feeding; lack of support from employer for allowing special time/facilities for breast feeding and a belief that formula is easy to use and more available soon after birth. Discussion This study reported that the Omani women exhibited good knowledge and very good attitude towards breastfeeding. However, most women reported less confidence in their breastfeeding self- efficacy. In consistent to this finding, a systematic review of sixteen studies reported that most of the women knew exclusive breastfeeding but only few practiced until first six months. 23 Designing policies for educating women about EBF routinely in both the hospital and community would be the fundamental step. 22 , 23 All participating women in the present study initiated breastfeeding; however, very less proportion of women continued exclusive breastfeeding and majority of them ended up giving both breastfeeding and formula milk. A similar finding was noted from other Omani studies. 15 , 18 , 22 In addition, in Saudi Arabia, breastfeeding initiation within the first hour after childbirth was only 13.9% and the prevalence of exclusive breastfeeding was 16.3%. In the United Arab Emirates, exclusive breastfeeding prevalence was 24.4%. 24,25 Ethiopian study also found the prevalence of exclusive breastfeeding only in 46.2% of mothers. 23 These findings mandate to promote breastfeeding education during prenatal period and implement policies to initiate breastfeeding within the first hour alongside the skin-to-skin contact. Previous authors also recommended similar suggestions. 15 , 18 , 22 , 25 With numerous benefits of breastfeeding, yet exclusive breastfeeding rates are declined globally causing concern. 26 Sub optimal breastfeeding practices are reported across the world due to various barriers to breastfeeding practices. 13 , 14 , 24 , 27 Current study also demonstrated that initiation of EBF was achievable while the women faced many challenges. Similar finding was reported by Al Ghannami et al. 18 Further, the present study revealed various barriers to exclusive breastfeeding practices. The Omani women felt that formula feeding is equivalent to breastfeeding. In addition, the women were not sure if the baby is getting enough or too much milk and the women did not have sufficient knowledge regarding essential diet for breast-feeding. Likewise, the women had lack of support from the employer for allowing special time/facilities for breast-feeding and experienced embarrassment about feeding in public. Moreover, the women had problems with lactation and felt that formula is easy to use and available soon after birth. The women also faced challenges returning to work and accessing supportive childcare. These findings are in par with previous study of findings. 18 , 19 , 22 As shown in the current study, Saudi mothers also expressed work related barriers such as busy working hours, absence of privacy at workplace, and work regulations not allowing attending to the children. Further, the breastfeeding women from other middle east countries also mentioned insufficient breastmilk and maternal employment with short leave as a barrier for breastfeeding. 24 , 25 , 27 Additionally, Sri Lankan mothers reported poor breast latch, suboptimal maternity ward environment, lack of support for breastfeeding, cesarean section pain, heavy workload and maternal exhaustion as barriers for exclusive breastfeeding. 28 Therefore, improving the support services and strengthening the policies to foster the exclusive breastfeeding practices will enhance the breastfeeding practices. In the present study, most of the participants-initiated breastfeeding within an hour and within the first 24 hours. Most of mothers reported that they were practicing demand feeding though few mothers followed scheduled breastfeeding of every 3–4 hours. Similar to the present study, most of the mothers of United Arab Emirates, Saudi Arabia and Bangladesh initiated breastfeeding within the first hour of delivery, while some of them initiated breastfeeding during their stay in the hospital. However, some of the mothers did not initiate the breastfeeding in the first hour. 24 , 29 In order to enhance the optimal breastfeeding practices, initiatives should be taken to increase the breastfeeding practices during the first hour after birth. 30 The findings of the study will further assist in strengthening the implementation of the breastfeeding policies, help the healthcare personnel to plan wide range of effective awareness and promotional activities to facilitate and promote breastfeeding practices among the Omani population. Conclusion Barriers in breastfeeding affect women in Oman in a similar way as the women worldwide. Reinforcing and modifying the breastfeeding policies and programs build up maternal confidences in their ability to have sufficient breast milk and enhances exclusive breastfeeding practices. Achieving the target of EBF to a 50% by 2025 is a myriad task requiring public health action focusing on ensuring the sustenance of EBF practices. Visible efforts to increase the knowledge, skills and attitude of health care workers at all levels is essential followed by appropriate monitoring of implementation of breastfeeding policies. Paid maternity leave and supportive workplace environment are viable solutions too. Declarations Conflict of Interest: The authors declare that they do not have any conflict of interest in publishing this manuscript. Funding Sultan Qaboos University’s Internal Grant Fund funded this project. Acknowledgement The authors acknowledge all the study participants. Data availability statement The data will be made available upon request. Human Ethics and Consent to Participate The ethical and fund approval was obtained. Implied consent was obtained from the study participants. The study was conducted in accordance with the Declaration of Helsinki. Permission to reproduce material from other sources. NA Clinical trial registration NA References Byrom A, Thomson G, Dooris M, Dykes F. UNICEF UK Baby Friendly Initiative: Providing, receiving and leading infant feeding care in a hospital maternity setting-A critical ethnography. Matern Child Nutr. 2021 Apr;17(2):e13114. doi: 10.1111/mcn.13114. Epub 2021 Jan 20. Sankar MJ, Sinha B, Chowdhury R, Bhandari N, Taneja S, Martines J, Bahl R. Optimal breastfeeding practices and infant and child mortality: a systematic review and meta-analysis. Acta Paediatr. 2015 Dec;104(467):3-13. doi: 10.1111/apa.13147. Sarki M, Parlesak A, Robertson A. Comparison of national cross-sectional breast-feeding surveys by maternal education in Europe (2006-2016). Public Health Nutr. 2019 Apr;22(5):848-861. doi: 10.1017/S1368980018002999. Bagci Bosi AT, Eriksen KG, Sobko T, Wijnhoven TM, Breda J. Breastfeeding practices and policies in WHO European Region Member States. Public Health Nutr. 2016 Mar;19(4):753-64. doi: 10.1017/S1368980015001767. Organization WH. Implementation guidance: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services: the revised baby-friendly hospital initiative. 2018. Koletzko B, Hirsch NL, Jewell JM, Dos Santos Q, Breda J, Fewtrell M, Weber MW. National Recommendations for Infant and Young Child Feeding in the World Health Organization European Region. J Pediatr Gastroenterol Nutr. 2020 Nov;71(5):672-678. doi: 10.1097/MPG.0000000000002912. Couto G, Dias V, Oliveira I. Benefits of exclusive breastfeeding: An integrative review. NPT. 2020;7(4):245-254 https://doi.org/10.18502/npt.v7i4.4034 Guideline: Counselling of Women to Improve Breastfeeding Practices. Geneva: World Health Organization; 2018. Agusningtyas NH, Dewi YLR, Murti B. Effect of Antenatal Care and Postnatal Care on Exclusive Breastfeeding Practice: Meta Analysis. Journal of Maternal and Child Health. 2023;8(6):672-81. DOI: https://doi.org/10.26911/thejmch.2023.08.06.01 Jama NA, Wilford A, Masango Z, Haskins L, Coutsoudis A, Spies L, Horwood C. Enablers and barriers to success among mothers planning to exclusively breastfeed for six months: a qualitative prospective cohort study in KwaZulu-Natal, South Africa. Int Breastfeed J. 2017 Oct 3;12:43. doi: 10.1186/s13006-017-0135-8. Patil DS, Pundir P, Dhyani VS, Krishnan JB, Parsekar SS, D'Souza SM, Ravishankar N, Renjith V. A mixed-methods systematic review on barriers to exclusive breastfeeding. Nutr Health. 2020 Dec;26(4):323-346. doi: 10.1177/0260106020942967. Alzaheb RA. A Review of the Factors Associated With the Timely Initiation of Breastfeeding and Exclusive Breastfeeding in the Middle East. Clin Med Insights Pediatr. 2017 Dec 17;11:1179556517748912. doi: 10.1177/1179556517748912. Sodeno M, Tappis H, Burnham G, Ververs M. Associations between caesarean births and breastfeeding in the Middle East: a scoping review. East Mediterr Health J. 2021 Sep 21;27(9):931-940. doi: 10.26719/emhj.21.027. Nguyen NT, Do HT, Pham NTV. Barriers to exclusive breastfeeding: A cross-sectional study among mothers in Ho Chi Minh City, Vietnam. Belitung Nurs J. 2021 Jun 28;7(3):171-178. doi: 10.33546/bnj.1382. Al-Nuaimi N, Katende G, Arulappan J. Breastfeeding Trends and Determinants: Implications and recommendations for Gulf Cooperation Council countries. Sultan Qaboos Univ Med J. 2017 May;17(2):e155-e161. doi: 10.18295/squmj.2016.17.02.004. Annual health report. Muscat: Ministry of Health, Department of Health Information & Statistics; 2018. Al Barwani S, Hodges E, Crandell J, Thoyre S, Knafl K, Sullivan C. Predicting infant feeding intention and intensity in Oman using a path analysis approach. East Mediterr Health J. 2023 May 31;29(5):324-334. doi: 10.26719/emhj.23.057. Al-Ghannami S, Al-Mamari S, Chekaraou D, Abla C, Al-Ghmmari I, Al-Ajmi A, Al-Shammkhi S, Al-Balushi RM, Al-Mamari F, Mabry RM. Exclusive Breastfeeding: Barrier analysis amongst Omani mothers. Sultan Qaboos Univ Med J. 2023 May;23(2):158-167. doi: 10.18295/squmj.5.2022.038. Al-Marzouq ZK. Investigating the Support of Exclusive Breastfeeding among Working Mothers in Oman. Middle East Journal of Scientific Publishing Vol. (6) Issue (3) Edition 20th 2023 (1 - 15) UNICEF (2019). Infant and young child feeding. Available at: https://data.unicef.org/topic/nutrition/infant-and-young-child-feeding/ (accessed 18 February 2020) World Breastfeeding Trends initiative tools accessed from (WBT i ) https://www.worldbreastfeedingtrends.org/resources/wbti-tool (accessed 18 February 2022). Al Maamari S, Al Shammakhi S, Alghamari I, Jabbour J, Al-Jawaldeh A. Young Children Feeding Practices: An Update from the Sultanate of Oman. Children (Basel). 2021 Sep 17;8(9):818. doi: 10.3390/children8090818. Yimer DS, Adem OS, Arefayene M, Chanie T, Endalifer ML. Exclusive breastfeeding practice and its associated factors among children aged 6-23 months in Woldia Town, Northwest Ethiopia. Afr Health Sci. 2021 Dec;21(4):1877-1886. doi: 10.4314/ahs.v21i4.46. Alshammari MB, Haridi HK. Prevalence and Determinants of Exclusive Breastfeeding Practice among Mothers of Children Aged 6-24 Months in Hail, Saudi Arabia. Scientifica (Cairo). 2021 Mar 27;2021:2761213. doi: 10.1155/2021/2761213. Al Sabbah H, Assaf EA, Taha Z, Qasrawi R, Radwan H. Determinants of Exclusive Breastfeeding and Mixed Feeding Among Mothers of Infants in Dubai and Sharjah, United Arab Emirates. Front Nutr. 2022 May 10;9:872217. doi: 10.3389/fnut.2022.872217 Kavle JA, LaCroix E, Dau H, Engmann C. Addressing barriers to exclusive breast-feeding in low- and middle-income countries: a systematic review and programmatic implications. Public Health Nutr. 2017 Dec;20(17):3120-3134. doi: 10.1017/S1368980017002531. Kimuli D, Nakaggwa F, Namuwenge N, Nsubuga RN, Isabirye P, Kasule K, Katwesige JF, Nyakwezi S, Sevume S, Mubiru N, Amuron B, Bukenya D. Sociodemographic and health-related factors associated with exclusive breastfeeding in 77 districts of Uganda. Int Breastfeed J. 2023 Dec 5;18(1):66. doi: 10.1186/s13006-023-00604-x. Agampodi TC, Dharmasoma NK, Koralagedara IS, Dissanayaka T, Warnasekara J, Agampodi SB, Perez-Escamilla R. Barriers for early initiation and exclusive breastfeeding up to six months in predominantly rural Sri Lanka: a need to strengthen policy implementation. Int Breastfeed J. 2021 Apr 8;16(1):32. doi: 10.1186/s13006-021-00378-0. Radwan H, Fakhry R, Metheny N, Baniissa W, Faris MAIE, Obaid RS, Al Marzooqi S, Al Ghazal H, ElHalik M, Dennis CL. Prevalence and multivariable predictors of breastfeeding outcomes in the United Arab Emirates: a prospective cohort study. Int Breastfeed J. 2021 Oct 12;16(1):79. doi: 10.1186/s13006-021-00428-7. Dudukcu FT, Aygor H, Karakoc H. Factors Affecting Breastfeeding within the First Hour After Birth. Niger J Clin Pract. 2022 Jan;25(1):62-68. doi: 10.4103/njcp.njcp_703_20. Tables Table-1: Demographic data of the study participants (N 505) Variables Frequency % Age _40 49 9.7 Education Primary school 11 2.2 Graduate 173 34.2 Higher Education 294 58.1 Advanced 27 5.3 Occupation Employed 176 34.8 Non employed 329 68.6 Type of Family Extend 455 90.5 Single 50 9.5 Economic status Low 34 6.5 Moderate 439 86.8 High 32 6.3 Type of support Mother 150 29.7 Sisters 30 5.9 Husband 225 44.6 Friends 23 4.6 Relatives 24 4.8 Breastfeeding support group 53 10.5 No of Parity 1 138 27.2 2 137 27.1 3 104 20.6 >3 1261 25.1 History of abortion None 348 68.8 Yes 157 31.2 Any previous problems with breastfeeding No 171 33.8 Yes 335 66.2 Previous delivery Normal 434 85.8 Cesarean 62 12.5 Vacuum 9 1.8 Current delivery Normal 425 84.0 Cesarean 72 14.2 Vacuum 6 1.2 Gender of the Baby Male 236 46.6 Female 268 53.0 Previous Breast feeding (BF) No 229 45.3 Yes 271 53.6 Type of infant feeding Breastfeeding 114 22.7 Partial breastfeeding 356 71.8 Artificial feeding 30 6 Previous Breast-feeding duration (BF) 1month 18 3.6 3 months 30 10 6 months 27 5.3 less 12 months 39 7.7 >12- months 192 72.6 Initiation of BF 1 hour 269 53.2 2-4 hours 129 25.5 Within 24 hrs 60 11.9 After 24hrs 46 9.1 Table 2: Distribution of level of Knowledge, Attitude, Efficacy and Barriers to exclusive Breastfeeding practices Variables Category Frequency Percentage Level of Knowledge Poor 10 2.0 Good 288 57.0 Very Good 207 41.0 Level of Attitude Poor 2 .4 Good 173 34.2 Very good 330 65.2 Level of Efficacy Less Confident 169 33.5 Confident 336 66.5 Barriers Moderate 96 19.0 High 409 81.0 Table 3: Predictors related to the barriers to Exclusive breastfeeding Practices Predictors related to the barriers of exclusive breast feeding Unstandardized Coefficient Standardized Coefficients Significance B Std. Error Beta t-Value (Constant) 1.012 .133 7.594 .000 Lack of knowledge about breast feeding .016 .026 .020 .615 .539 Misconception that formula feeding is equivalent to breast feeding .118 .028 .151 4.232 .000 Breastfeeding is not the social norm in many communities. .053 .027 .067 1.926 .055 Poor family and social support. .064 .026 .077 2.463 .014 Embarrassment about feeding in public. .176 .035 .157 4.963 .000 Lactation problems. .252 .032 .284 7.868 .000 Returning to work and accessing supportive childcare. -.038 .030 -.044 -1.262 .207 Policies and practices by some health services and health care providers. .130 .024 .168 5.341 .000 Promotion and marketing of infant formula. .034 .029 .042 1.178 .239 Younger women, particularly <20yrs .061 .028 .077 2.158 .031 Less educated women .108 .025 .136 4.273 .000 Women with low-income and socioeconomic status .055 .032 .060 1.721 .086 Women from a culturally and linguistically diverse background .025 .028 .032 .888 .375 Not sure if my baby is getting enough milk .214 .030 .219 7.091 .000 Lack of knowledge regarding essential diet for breast feeding .307 .031 .317 10.056 .000 Lack of support from employer for allowing special time/facilities for breast feeding .133 .032 .154 5.231 .000 The concept that the infant did not tolerate breast milk -.015 .027 -.018 -.539 .590 Formula is easy to use and more available soon after birth .146 .034 .159 4.364 .000 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-6187622","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":435047963,"identity":"b02c7a7d-9e6e-4df1-8b61-3c60510cb669","order_by":0,"name":"Girija Kalayil Madhavanprabhakaran","email":"","orcid":"","institution":"Sultan Qaboos University College of Nursing","correspondingAuthor":false,"prefix":"","firstName":"Girija","middleName":"Kalayil","lastName":"Madhavanprabhakaran","suffix":""},{"id":435047965,"identity":"4aac4d46-afe2-4657-9797-cc5a05cb9d09","order_by":1,"name":"Judie Arulappan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtklEQVRIiWNgGAWjYBACxgYGgwMMFRCOBAlazpCiBQgMGBjbSNHCPCN544GP8+pkNxxgPnibh8EmmrDDZqQVHJy57bDxhgNsydY8DGm5DYS15Bgc5t12IHHDAR4zaR6Gw0Rq+TunDqiF/xsJWhgbmEG2sBGppedZwcGeY4eNZx5mM7acY0CEXwzbkzd/+FFTJ9t3vPnhjTcVNkRogaoAug1EGRBSDwTyMAcSNHwUjIJRMApGLgAAxkhBeU8+qvYAAAAASUVORK5CYII=","orcid":"","institution":"Sultan Qaboos University College of Nursing","correspondingAuthor":true,"prefix":"","firstName":"Judie","middleName":"","lastName":"Arulappan","suffix":""},{"id":435047966,"identity":"23c5ae5b-fe69-4388-a21f-5c9ae55d83f5","order_by":2,"name":"Frincy Francis","email":"","orcid":"","institution":"Sultan Qaboos University College of Nursing","correspondingAuthor":false,"prefix":"","firstName":"Frincy","middleName":"","lastName":"Francis","suffix":""},{"id":435047967,"identity":"1f503c72-83e7-4272-9f21-24ec63570340","order_by":3,"name":"Basma Al Yazeedi","email":"","orcid":"","institution":"Sultan Qaboos University College of Nursing","correspondingAuthor":false,"prefix":"","firstName":"Basma","middleName":"Al","lastName":"Yazeedi","suffix":""},{"id":435047968,"identity":"8fc1b150-04b3-440a-a415-4930586ca264","order_by":4,"name":"Tamima Al-Dughaishi","email":"","orcid":"","institution":"Sultan Qaboos University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tamima","middleName":"","lastName":"Al-Dughaishi","suffix":""},{"id":435047970,"identity":"131bd548-f8b8-4928-a416-57573087d054","order_by":5,"name":"Suwaina Khalfan Al Mandhari","email":"","orcid":"","institution":"Sultan Qaboos University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Suwaina","middleName":"Khalfan Al","lastName":"Mandhari","suffix":""},{"id":435047972,"identity":"1011ad63-077c-44f6-8107-2991e9d6af18","order_by":6,"name":"Siham Saif Saleh Al Jabri","email":"","orcid":"","institution":"Sultan Qaboos University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Siham","middleName":"Saif Saleh Al","lastName":"Jabri","suffix":""},{"id":435047973,"identity":"121a3002-aceb-4b1c-9d04-2fc0ce2a598d","order_by":7,"name":"Hanan Soud Al Mawali","email":"","orcid":"","institution":"Sultan Qaboos University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hanan","middleName":"Soud Al","lastName":"Mawali","suffix":""}],"badges":[],"createdAt":"2025-03-09 08:38:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6187622/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6187622/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":79664201,"identity":"c2e38c84-9634-4f72-80f9-a343c436cba0","added_by":"auto","created_at":"2025-04-01 10:00:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":21354,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of Mothers with Exclusive Breastfeeding Practices\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6187622/v1/4c1cd00314693a0eea3a47a0.png"},{"id":81336105,"identity":"60ef57e2-e156-4df4-9551-fec5efaa4bf5","added_by":"auto","created_at":"2025-04-25 01:46:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1378838,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6187622/v1/36823ab9-1d84-486a-8131-73502e7a856f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Knowledge, Attitude, Practice, self-efficacy, and Barriers to Exclusive Breastfeeding Practices among Women in a Middle Eastern Country","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBreastfeeding improves the survival rates of newborns, infants, and children. Breastfeeding outcomes across the environmental, economic, and most importantly on the health of both the mother and the baby are proven facts.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Decrease in the breastfeeding practices including the exclusive breastfeeding and the early switching to a formula feed has been linked with significant increase in mortality and morbidity rates in children due to infectious diseases like respiratory conditions, otitis media, dental diseases, obesity in childhood and juvenile diabetes.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Infants who are exclusively breastfed in their first six months of life count for only 41% globally and the studies also reported that the proportion of children who receive breast milk until the age of 12 months are very less.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Infant formula industries are often violating the International Code of Marketing of Breastmilk substitutes, which is a failure to protect, support and promote breastfeeding.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Though widespread information in the form of reported research findings and awareness programs are being disseminated, only a slow increase in the percentage of breastfeeding is observed.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAround 45% of the global population of children succumb to death due to undernutrition.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Breastfeeding contributes to the overall development of the child, improvement of maternal and public health.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Initiating the first breastfeeding as early as within the first half an hour of birth is ideal and exclusive breastfeeding for the first six months is extremely important. Breastfeeding is being encouraged to be continued along with other foods until two years of age.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e World Health Organization (WHO, 2018) is actively involved in the positive promotion of breastfeeding as the best source of nutrition for the infants and the young children.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e The organization aims to increase the rates of exclusive breastfeeding practices up to 50 percent by 2025 though the current reports states that only 2 out of 3 babies are denied exclusive breastfeeding due to various reasons which means only 41 percent of babies within 6 months get breastfed exclusively.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAttributing factors to the declining rate of exclusive breastfeeding practice includes concerns about the breast health, maternal health, breast shape changes, tiring job, breastmilk insufficiency, lack of knowledge, caesarean section, short birth spacing, breastmilk aversion by babies, birth order where first child was exclusively breastfed than other children, inadequate health education from healthcare staff, negative societal influences, resuming job, poor familial support, lack of privacy to feed in public spaces, and economic status.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Additionally, a systematic review and meta-analysis conducted in Middle Eastern Countries like Egypt, Iran, Lebanon, Syria, Qatar, Kuwait, Turkey and Saudi Arabia reported that only 34.3% of neonates received breastmilk within the first hour of birth while only 20.5% were breastfed for the first six months of their life. The review among Middle Eastern mothers highlighted that exclusive breastfeeding practices were linked to the mother\u0026rsquo;s age, education and employment status of the.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eFurther, the Middle Eastern women rated maternal employment and lack of milk supply as the first and second main barriers to breastfeeding. In addition, the other barriers reported includes, cesarean section, and short maternity leave for the working women.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e In Oman, Baby Friendly Hospital Initiative was implemented since 1990. Ministry of Health in Oman reported 93.4% early initiation of breastfeeding in 2015 and 90.8% in 2018 but. However, only 11.8% and 8.7% continued to exclusively breastfeed for a period of six months.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e The other predictive factors for breastfeeding practices among Omani mothers includes the mother\u0026rsquo;s intention to breastfeed, knowledge about breastfeeding and its benefits, lactation support during hospitalization, previous experience of breastfeeding, resuming of work and length of maternity leave and perceived insufficiency in milk production and being employed. \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eBesides, breastfeeding support specifically in workplace is a concern in Oman. Moreover, a clear legislation or policy regarding breastfeeding in workplaces have not been implemented yet; moreover, no dedicated breastfeeding or breastmilk pumping and storage facilities are available in office spaces. Additionally, time allotment for breastfeeding poor organizational support are the barriers to breastfeeding in Oman.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e Since the evidences are limited related to exclusive breastfeeding practices in Oman, this study has extensively surveyed the knowledge, attitude, self- efficacy, and barriers to exclusive breastfeeding practices among Omani women.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eResearch design\u003c/h2\u003e \u003cp\u003eA quantitative longitudinal survey was conducted.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eResearch setting\u003c/h3\u003e\n\u003cp\u003eOmani postnatal women who fulfilled the inclusion criteria were chosen from all the 11 Governorates of Oman. Representative samples were selected from each Governorate. Governorate of Muscat (six) Wilayats; Dhofar (ten) Wilayats; Musandam (four) Wilayats; Buraymi (three) Wilayats; Dakhiliyah (eight) Wilayats; North Batinah (six) Wilayats; South Batinah (six) Wilayats; South Sharqiyah (five) Wilayats; North Sharqiyah (six) Wilayats; Dhahirah (three) Wilayats and the Wusta Governorate comprises of (four) Wilayats.\u003c/p\u003e\n\u003ch3\u003ePopulation, sample, Sample sixe and sampling technique\u003c/h3\u003e\n\u003cp\u003eOmani women who delivered and discharged from health care facilities of Oman covering all 11 Governorates during the period of study were considered the population for the study. The sample size N and margin of error E are given by x\u0026thinsp;=\u0026thinsp;Z(c/100)2r(100-r) n\u0026thinsp;=\u0026thinsp;N x/((N-1)E2\u0026thinsp;+\u0026thinsp;x) E\u0026thinsp;=\u0026thinsp;Sqrt[(N - n)x/n(N-1)]. N is the population size, r is the fraction of responses interested in, and Z(c/100) is the critical value for the confidence level c. 505 samples participated in the study. Convenient sampling technique was adopted in the selection of samples.\u003c/p\u003e\n\u003ch3\u003eInclusion criteria\u003c/h3\u003e\n\u003cp\u003ePostnatal women between the age of 18\u0026ndash;35 years; both primi and multiparous postnatal women; the women who were able to read and write Arabic and postnatal women voluntarily willing to participate in the study were recruited as study samples.\u003c/p\u003e\n\u003ch3\u003eExclusion criteria\u003c/h3\u003e\n\u003cp\u003eThe study excluded women with HIV infection; women with postpartum blue and depression; women who are on oncology drugs; women who delivered before 37 weeks; high-risk pregnant women; women who developed complications of delivery; women having new born with cleft palate; women having sick new-born admitted to in NICU; women having new-born less than 2 kgs and women with contraindication to breastfeeding.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData collection instruments\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e\u003cem\u003ePart 1 Demographic profile\u003c/em\u003e\u003c/h2\u003e \u003cp\u003eDemographic profile included details such as age, education, occupation, type of Family, economic status, type of support, number of parity, history of abortion, any previous problems with breastfeeding, previous and current delivery, gender of the Baby, previous breast-feeding, type of infant feeding, previous breast-feeding duration and initiation of breast-feeding.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003ePart 2 Infant Breastfeeding Knowledge Questionnaire (BFK)\u003c/h3\u003e\n\u003cp\u003eMothers\u0026rsquo; knowledge of breastfeeding was assessed using the Infant Breastfeeding Knowledge Questionnaire (BFK). BFK is a 20 items tool with total score of 20. Maternal breastfeeding knowledge was rated as very good, good, fair and poor based on total scores. This tool originally from World Health Organization and is being utilized in previous Omani studies.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e which reported Cronbach's alpha reliability score of 0. 752.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e\u003cem\u003ePart 3 Breastfeeding Self Efficacy Scale \u0026ndash; Shot Form (BSES-SF)\u003c/em\u003e\u003c/h2\u003e \u003cp\u003eParticipants perceived self-efficacy in breastfeeding was assessed by using the Breastfeeding Self Efficacy Scale \u0026ndash; Shot Form (BSES-SF)\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e which is a 14 item positively worded 5 \u0026ndash; point self-report Likert scale ranging from 1(not at all confident) to 5 (always confident). Higher scores indicate higher levels of breastfeeding self-efficacy.\u003c/p\u003e \u003cp\u003e \u003cem\u003ePart 4 Iowa Infant Feeding Attitude Scale (IIFAS).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eWe assessed the breastfeeding attitude of women through Iowa Infant Feeding Attitude Scale (IIFAS). IIFAS, a 5-point Likert-type scale composed of 17 items with scores ranging from 17 to 85 with higher scores reflecting more positive attitudes toward breastfeeding.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePart 5 Breastfeeding practices Self-rating scale\u003c/h2\u003e \u003cp\u003eBreastfeeding practices were measured through a 14 item self-rating scale, which evaluated five characteristics of breastfeeding and how well each mother breast feed her baby according to the recommendation by WHO/UNICEF. \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePart 5 Questionnaire to assess the barriers to exclusive breast-feeding\u003c/h2\u003e \u003cp\u003eQuestionnaire to assess the barriers to exclusive breast feeding was developed and validated by the researchers with existing tools of World Breastfeeding Trend initiative (WBTi) Assessment tool, 2014\u003csup\u003e21\u003c/sup\u003e, WHO \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e and the literature review.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003e The study was ethically approved by the research and ethics committee and was funded by the Deanship of research fund (IG/CON/MCHH/20/02). The purpose of the study was explained and implied consent was obtained from the study participants. None of the participants were forced to participate in the study. The investigators assured that none of their personal identifying information would be collected during the data collection. The collected data were stored in a password protected file and was kept under the custody of the principal investigator of the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eData collection procedure\u003c/h2\u003e \u003cp\u003eThe data were collected between 2020\u0026ndash;2022 to explore the knowledge, attitude, practice, self- efficacy, and barriers to exclusive breastfeeding practices among Omani women. An online self -rating questionnaire on breastfeeding knowledge, attitude, practice, self-efficacy and barriers to exclusive breast feeding practices were distributed to the eligible participants. Their breastfeeding practices were further explored at one, three and at six months after delivery in addition to the initial response within one week of delivery. Multiple reminders through WhatsApp message and calls ensured that sixth month response was received.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData was analyzed with SPSS version 23 using both descriptive and inferential statistics.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eTable 1 (Demographic data of the study participants) shows the demographic details of the samples. Among the participants, 33.6% were in the age between 30- 34 years. Majority of the mothers (68.6%) were unemployed and (58.1%) of them were educated with higher education. \u0026nbsp;Of the samples, 90.5% of them live in extended family. Most (86.8%) of them belonged to moderate economic status. Majority of the women (44.6%) received support from their husbands. Considering the number of parity, similar proportion of women (27.2 and 27.1) had the parity of one and two. A large number of women (68.8%) did not have the history of abortion. 66.2% of women experienced previous problems with breastfeeding. Majority (85.8% and 84.0%) of the women had previous and current normal delivery. More than half (53%) of women delivered males. 53.6% had previous breastfeeding experience. Of the samples, 71.8% of them practiced partial breast-feeding. Most (72.6%) of the women breast fed their children for more than 12 months.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWomen’s knowledge, attitude, self-efficacy and level of barriers are presented in Table 2. It shows that the women exhibited good knowledge and very good attitude, whereas 33.5 % of breastfeeding women reported less confidence in their breastfeeding self- efficacy. In addition, a major portion (81.0%) of women expressed high levels of barriers towards exclusive breast feeding practices. Lastly, 53.2% of women initiated breast-feeding within one hour after delivery. However, only\u0026nbsp;22.7\u0026nbsp;% continued with exclusive breastfeeding pattern while 77.3% reported partial breastfeeding with combination of both breastfeeding and formula milk\u0026nbsp;(Figure 1 Distribution of Mothers with Exclusive Breastfeeding Practices). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWomen varied in their practices of introducing artificial formula. Of the study participants, 5.3% started artificial formula at the first week of the baby’s life and 32% of the women initiated other feeds at one month of age, and the remaining 40 % women opted for other forms of feed from three months onwards.\u0026nbsp;Most (75%) of the mothers reported that they were practicing demand feeding. However, 25% mothers practiced scheduled breastfeeding for every 3-4 hours. In most of the cases (70.2%), breast-feeding was extended for more than one year even though the women experienced challenges with exclusive breastfeeding practices.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMany of the participants (81%) reported barriers as a major challenge to exclusive breast-feeding practices. The major barriers reported were misconception that formula feeding is equivalent to breastfeeding (87.9%); not sure if the baby is getting enough or too much milk (79.6%); lack of knowledge regarding essential diet for breast feeding (79.2%); lack of support from the employer for allowing special time/facilities for breast feeding (86.7%); embarrassment about feeding in public (85.5%); lactation problems (85%); formula is easy to use and \u0026nbsp;available soon after birth (75.9%); returning to work and accessing supportive childcare (70.4); policies and practices by some health services and health care providers (53.3), and promotion and marketing of infant formula (62.1%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe possible predicators of breastfeeding barriers was analyzed using liner regression analysis using enter method. The results showed that the overall breastfeeding barriers were statistically significant (OR=0.688; F=44.287; p\u0026lt;0.001) with R\u003csup\u003e2\u003c/sup\u003e of 0.621 (adjusted R\u003csup\u003e2\u003c/sup\u003e = 0.0.607). Table.3 shows statistically significant predictors of barriers to exclusive breastfeeding. The identified barriers includes misconception that formula feeding is equivalent to breast-feeding; embarrassment about feeding in public; lactation problems; policies and practices by some health services and health care providers; younger women, particularly \u0026lt;20yrs; less educated women; not sure if my baby is getting enough milk; lack of knowledge regarding essential diet for breast feeding; lack of support from employer for allowing special time/facilities for breast feeding and a belief that formula is easy to use and more available soon after birth.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study reported that the Omani women exhibited good knowledge and very good attitude towards breastfeeding. However, most women reported less confidence in their breastfeeding self- efficacy. In consistent to this finding, a systematic review of sixteen studies reported that most of the women knew exclusive breastfeeding but only few practiced until first six months.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e Designing policies for educating women about EBF routinely in both the hospital and community would be the fundamental step.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAll participating women in the present study initiated breastfeeding; however, very less proportion of women continued exclusive breastfeeding and majority of them ended up giving both breastfeeding and formula milk. A similar finding was noted from other Omani studies.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e In addition, in Saudi Arabia, breastfeeding initiation within the first hour after childbirth was only 13.9% and the prevalence of exclusive breastfeeding was 16.3%. In the United Arab Emirates, exclusive breastfeeding prevalence was 24.4%.\u003csup\u003e24,25\u003c/sup\u003e Ethiopian study also found the prevalence of exclusive breastfeeding only in 46.2% of mothers.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e These findings mandate to promote breastfeeding education during prenatal period and implement policies to initiate breastfeeding within the first hour alongside the skin-to-skin contact. Previous authors also recommended similar suggestions. \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWith numerous benefits of breastfeeding, yet exclusive breastfeeding rates are declined globally causing concern.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Sub optimal breastfeeding practices are reported across the world due to various barriers to breastfeeding practices.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e Current study also demonstrated that initiation of EBF was achievable while the women faced many challenges. Similar finding was reported by Al Ghannami et al.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Further, the present study revealed various barriers to exclusive breastfeeding practices. The Omani women felt that formula feeding is equivalent to breastfeeding. In addition, the women were not sure if the baby is getting enough or too much milk and the women did not have sufficient knowledge regarding essential diet for breast-feeding. Likewise, the women had lack of support from the employer for allowing special time/facilities for breast-feeding and experienced embarrassment about feeding in public. Moreover, the women had problems with lactation and felt that formula is easy to use and available soon after birth. The women also faced challenges returning to work and accessing supportive childcare. These findings are in par with previous study of findings. \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e ,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAs shown in the current study, Saudi mothers also expressed work related barriers such as busy working hours, absence of privacy at workplace, and work regulations not allowing attending to the children. Further, the breastfeeding women from other middle east countries also mentioned insufficient breastmilk and maternal employment with short leave as a barrier for breastfeeding.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e Additionally, Sri Lankan mothers reported poor breast latch, suboptimal maternity ward environment, lack of support for breastfeeding, cesarean section pain, heavy workload and maternal exhaustion as barriers for exclusive breastfeeding.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e Therefore, improving the support services and strengthening the policies to foster the exclusive breastfeeding practices will enhance the breastfeeding practices.\u003c/p\u003e \u003cp\u003eIn the present study, most of the participants-initiated breastfeeding within an hour and within the first 24 hours. Most of mothers reported that they were practicing demand feeding though few mothers followed scheduled breastfeeding of every 3\u0026ndash;4 hours. Similar to the present study, most of the mothers of United Arab Emirates, Saudi Arabia and Bangladesh initiated breastfeeding within the first hour of delivery, while some of them initiated breastfeeding during their stay in the hospital. However, some of the mothers did not initiate the breastfeeding in the first hour.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e In order to enhance the optimal breastfeeding practices, initiatives should be taken to increase the breastfeeding practices during the first hour after birth.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e The findings of the study will further assist in strengthening the implementation of the breastfeeding policies, help the healthcare personnel to plan wide range of effective awareness and promotional activities to facilitate and promote breastfeeding practices among the Omani population.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBarriers in breastfeeding affect women in Oman in a similar way as the women worldwide. Reinforcing and modifying the breastfeeding policies and programs build up maternal confidences in their ability to have sufficient breast milk and enhances exclusive breastfeeding practices. Achieving the target of EBF to a 50% by 2025 is a myriad task requiring public health action focusing on ensuring the sustenance of EBF practices. Visible efforts to increase the knowledge, skills and attitude of health care workers at all levels is essential followed by appropriate monitoring of implementation of breastfeeding policies. Paid maternity leave and supportive workplace environment are viable solutions too.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e The authors declare that they do not have any conflict of interest in publishing this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSultan Qaboos University’s Internal Grant Fund funded this project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge all the study participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data will be made available upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ethical and fund approval was obtained. Implied consent was obtained from the study participants. The study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePermission to reproduce material from other sources.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNA\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eByrom A, Thomson G, Dooris M, Dykes F. UNICEF UK Baby Friendly Initiative: Providing, receiving and leading infant feeding care in a hospital maternity setting-A critical ethnography. Matern Child Nutr. 2021 Apr;17(2):e13114. doi: 10.1111/mcn.13114. Epub 2021 Jan 20.\u003c/li\u003e\n\u003cli\u003eSankar MJ, Sinha B, Chowdhury R, Bhandari N, Taneja S, Martines J, Bahl R. Optimal breastfeeding practices and infant and child mortality: a systematic review and meta-analysis. Acta Paediatr. 2015 Dec;104(467):3-13. doi: 10.1111/apa.13147.\u003c/li\u003e\n\u003cli\u003eSarki M, Parlesak A, Robertson A. Comparison of national cross-sectional breast-feeding surveys by maternal education in Europe (2006-2016). Public Health Nutr. 2019 Apr;22(5):848-861. doi: 10.1017/S1368980018002999. \u003c/li\u003e\n\u003cli\u003eBagci Bosi AT, Eriksen KG, Sobko T, Wijnhoven TM, Breda J. Breastfeeding practices and policies in WHO European Region Member States. Public Health Nutr. 2016 Mar;19(4):753-64. doi: 10.1017/S1368980015001767.\u003c/li\u003e\n\u003cli\u003eOrganization WH. Implementation guidance: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services: the revised baby-friendly hospital initiative. 2018.\u003c/li\u003e\n\u003cli\u003eKoletzko B, Hirsch NL, Jewell JM, Dos Santos Q, Breda J, Fewtrell M, Weber MW. National Recommendations for Infant and Young Child Feeding in the World Health Organization European Region. J Pediatr Gastroenterol Nutr. 2020 Nov;71(5):672-678. doi: 10.1097/MPG.0000000000002912.\u003c/li\u003e\n\u003cli\u003eCouto G, Dias V, Oliveira I. Benefits of exclusive breastfeeding: An integrative review. NPT. 2020;7(4):245-254 https://doi.org/10.18502/npt.v7i4.4034 \u003c/li\u003e\n\u003cli\u003eGuideline: Counselling of Women to Improve Breastfeeding Practices. Geneva: World Health Organization; 2018.\u003c/li\u003e\n\u003cli\u003eAgusningtyas NH, Dewi YLR, Murti B. Effect of Antenatal Care and Postnatal Care on Exclusive Breastfeeding Practice: Meta Analysis. Journal of Maternal and Child Health. 2023;8(6):672-81. DOI: https://doi.org/10.26911/thejmch.2023.08.06.01 \u003c/li\u003e\n\u003cli\u003eJama NA, Wilford A, Masango Z, Haskins L, Coutsoudis A, Spies L, Horwood C. Enablers and barriers to success among mothers planning to exclusively breastfeed for six months: a qualitative prospective cohort study in KwaZulu-Natal, South Africa. Int Breastfeed J. 2017 Oct 3;12:43. doi: 10.1186/s13006-017-0135-8.\u003c/li\u003e\n\u003cli\u003ePatil DS, Pundir P, Dhyani VS, Krishnan JB, Parsekar SS, D\u0026apos;Souza SM, Ravishankar N, Renjith V. A mixed-methods systematic review on barriers to exclusive breastfeeding. Nutr Health. 2020 Dec;26(4):323-346. doi: 10.1177/0260106020942967.\u003c/li\u003e\n\u003cli\u003eAlzaheb RA. A Review of the Factors Associated With the Timely Initiation of Breastfeeding and Exclusive Breastfeeding in the Middle East. Clin Med Insights Pediatr. 2017 Dec 17;11:1179556517748912. doi: 10.1177/1179556517748912.\u003c/li\u003e\n\u003cli\u003eSodeno M, Tappis H, Burnham G, Ververs M. Associations between caesarean births and breastfeeding in the Middle East: a scoping review. East Mediterr Health J. 2021 Sep 21;27(9):931-940. doi: 10.26719/emhj.21.027. \u003c/li\u003e\n\u003cli\u003eNguyen NT, Do HT, Pham NTV. Barriers to exclusive breastfeeding: A cross-sectional study among mothers in Ho Chi Minh City, Vietnam. Belitung Nurs J. 2021 Jun 28;7(3):171-178. doi: 10.33546/bnj.1382.\u003c/li\u003e\n\u003cli\u003eAl-Nuaimi N, Katende G, Arulappan J. Breastfeeding Trends and Determinants: Implications and recommendations for Gulf Cooperation Council countries. Sultan Qaboos Univ Med J. 2017 May;17(2):e155-e161. doi: 10.18295/squmj.2016.17.02.004.\u003c/li\u003e\n\u003cli\u003eAnnual health report. Muscat: Ministry of Health, Department of Health Information \u0026amp; Statistics; 2018.\u003c/li\u003e\n\u003cli\u003eAl Barwani S, Hodges E, Crandell J, Thoyre S, Knafl K, Sullivan C. Predicting infant feeding intention and intensity in Oman using a path analysis approach. East Mediterr Health J. 2023 May 31;29(5):324-334. doi: 10.26719/emhj.23.057.\u003c/li\u003e\n\u003cli\u003eAl-Ghannami S, Al-Mamari S, Chekaraou D, Abla C, Al-Ghmmari I, Al-Ajmi A, Al-Shammkhi S, Al-Balushi RM, Al-Mamari F, Mabry RM. Exclusive Breastfeeding: Barrier analysis amongst Omani mothers. Sultan Qaboos Univ Med J. 2023 May;23(2):158-167. doi: 10.18295/squmj.5.2022.038.\u003c/li\u003e\n\u003cli\u003eAl-Marzouq ZK. Investigating the Support of Exclusive Breastfeeding among Working Mothers in Oman. Middle East Journal of Scientific Publishing Vol. (6) Issue (3) Edition 20th 2023 (1 - 15)\u003c/li\u003e\n\u003cli\u003eUNICEF (2019). Infant and young child feeding. Available at: https://data.unicef.org/topic/nutrition/infant-and-young-child-feeding/ (accessed 18 February 2020)\u003c/li\u003e\n\u003cli\u003eWorld Breastfeeding Trends initiative tools accessed from (WBT\u003cem\u003ei\u003c/em\u003e) https://www.worldbreastfeedingtrends.org/resources/wbti-tool (accessed 18 February 2022).\u003c/li\u003e\n\u003cli\u003eAl Maamari S, Al Shammakhi S, Alghamari I, Jabbour J, Al-Jawaldeh A. Young Children Feeding Practices: An Update from the Sultanate of Oman. Children (Basel). 2021 Sep 17;8(9):818. doi: 10.3390/children8090818.\u003c/li\u003e\n\u003cli\u003eYimer DS, Adem OS, Arefayene M, Chanie T, Endalifer ML. Exclusive breastfeeding practice and its associated factors among children aged 6-23 months in Woldia Town, Northwest Ethiopia. Afr Health Sci. 2021 Dec;21(4):1877-1886. doi: 10.4314/ahs.v21i4.46.\u003c/li\u003e\n\u003cli\u003eAlshammari MB, Haridi HK. Prevalence and Determinants of Exclusive Breastfeeding Practice among Mothers of Children Aged 6-24 Months in Hail, Saudi Arabia. Scientifica (Cairo). 2021 Mar 27;2021:2761213. doi: 10.1155/2021/2761213.\u003c/li\u003e\n\u003cli\u003eAl Sabbah H, Assaf EA, Taha Z, Qasrawi R, Radwan H. Determinants of Exclusive Breastfeeding and Mixed Feeding Among Mothers of Infants in Dubai and Sharjah, United Arab Emirates. Front Nutr. 2022 May 10;9:872217. doi: 10.3389/fnut.2022.872217\u003c/li\u003e\n\u003cli\u003eKavle JA, LaCroix E, Dau H, Engmann C. Addressing barriers to exclusive breast-feeding in low- and middle-income countries: a systematic review and programmatic implications. Public Health Nutr. 2017 Dec;20(17):3120-3134. doi: 10.1017/S1368980017002531. \u003c/li\u003e\n\u003cli\u003eKimuli D, Nakaggwa F, Namuwenge N, Nsubuga RN, Isabirye P, Kasule K, Katwesige JF, Nyakwezi S, Sevume S, Mubiru N, Amuron B, Bukenya D. Sociodemographic and health-related factors associated with exclusive breastfeeding in 77 districts of Uganda. Int Breastfeed J. 2023 Dec 5;18(1):66. doi: 10.1186/s13006-023-00604-x.\u003c/li\u003e\n\u003cli\u003eAgampodi TC, Dharmasoma NK, Koralagedara IS, Dissanayaka T, Warnasekara J, Agampodi SB, Perez-Escamilla R. Barriers for early initiation and exclusive breastfeeding up to six months in predominantly rural Sri Lanka: a need to strengthen policy implementation. Int Breastfeed J. 2021 Apr 8;16(1):32. doi: 10.1186/s13006-021-00378-0.\u003c/li\u003e\n\u003cli\u003eRadwan H, Fakhry R, Metheny N, Baniissa W, Faris MAIE, Obaid RS, Al Marzooqi S, Al Ghazal H, ElHalik M, Dennis CL. Prevalence and multivariable predictors of breastfeeding outcomes in the United Arab Emirates: a prospective cohort study. Int Breastfeed J. 2021 Oct 12;16(1):79. doi: 10.1186/s13006-021-00428-7.\u003c/li\u003e\n\u003cli\u003eDudukcu FT, Aygor H, Karakoc H. Factors Affecting Breastfeeding within the First Hour After Birth. Niger J Clin Pract. 2022 Jan;25(1):62-68. doi: 10.4103/njcp.njcp_703_20. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable-1:\u0026nbsp;\u003c/strong\u003eDemographic data of the study participants \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cstrong\u003e(N 505)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"600\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 354px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026lt;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e21-25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e20.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e26-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e22.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e30-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e33.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e35-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026gt;_40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e9.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eGraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e34.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eHigher Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e58.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eAdvanced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e34.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eNon employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e68.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eType of Family\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eExtend\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e455\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e90.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eEconomic status\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e439\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e86.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eType of support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eMother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e29.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eSisters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eHusband\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e44.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eFriends\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eRelatives\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eBreastfeeding support group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eNo of Parity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e27.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e27.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e20.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026gt;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e1261\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e25.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eHistory of abortion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eNone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e348\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e68.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e31.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eAny previous problems with breastfeeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e33.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e335\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e66.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003ePrevious delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e434\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e85.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eCesarean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eVacuum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eCurrent delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e425\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e84.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eCesarean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e14.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eVacuum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eGender of the Baby\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e46.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e53.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003ePrevious Breast feeding (BF)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e45.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e53.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eType of infant feeding\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eBreastfeeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e22.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003ePartial breastfeeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e356\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e71.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eArtificial feeding\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003ePrevious Breast-feeding duration (BF)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e1month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eless 12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026gt;12- months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e72.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eInitiation of BF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e1 hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e269\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e53.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e2-4 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e25.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eWithin 24 hrs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eAfter 24hrs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u0026nbsp;\u003c/strong\u003eDistribution of level of Knowledge, Attitude, Efficacy and Barriers to exclusive Breastfeeding practices\u0026nbsp;\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of Knowledge\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e57.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eVery Good\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e41.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of Attitude\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e34.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eVery good\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e330\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e65.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of Efficacy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eLess Confident\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e33.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eConfident\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e336\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e66.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBarriers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e19.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e409\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e81.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u0026nbsp;\u003c/strong\u003ePredictors related to the barriers to Exclusive breastfeeding Practices\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePredictors related to the barriers of exclusive breast feeding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnstandardized\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCoefficient\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandardized Coefficients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSignificance\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003eStd. Error\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003eBeta\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp; t-Value\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e(Constant)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e1.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e.133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e7.594\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eLack of knowledge about breast feeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e.615\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e.539\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMisconception that formula feeding is equivalent to breast feeding\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.118\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.028\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.151\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.232\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eBreastfeeding is not the social norm in many communities.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1.926\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e.055\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003ePoor family and social support.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e2.463\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e.014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmbarrassment about feeding in public.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.176\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.035\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.157\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.963\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLactation problems.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.252\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.032\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.284\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.868\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eReturning to work and accessing supportive childcare.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e-1.262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e.207\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePolicies and practices by some health services and health care providers.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.130\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.024\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.168\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.341\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003ePromotion and marketing of infant formula.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1.178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e.239\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYounger women, particularly \u0026lt;20yrs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.061\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.028\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.077\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.158\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.031\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLess educated women\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.108\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.025\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.136\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.273\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eWomen with low-income and socioeconomic status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1.721\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e.086\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eWomen from a culturally and linguistically diverse background\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e.888\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e.375\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot sure if my baby is getting enough milk\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.214\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.030\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.219\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.091\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLack of knowledge regarding essential diet for breast feeding\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.307\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.031\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.317\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10.056\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLack of support from employer for allowing special time/facilities for breast feeding\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.133\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.032\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.154\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.231\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eThe concept that the infant did not tolerate breast milk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e-.539\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e.590\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFormula is easy to use and more available soon after birth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.146\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.034\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.159\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.364\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\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":"Breastfeeding, exclusive breastfeeding, Knowledge, Attitude, Evidence-Based Practice, Postnatal care, Mothers ","lastPublishedDoi":"10.21203/rs.3.rs-6187622/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6187622/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study\u003cstrong\u003e \u003c/strong\u003eidentified the\u003cstrong\u003e \u003c/strong\u003eknowledge, attitude, practice, self- efficacy and barriers to exclusive breastfeeding practices among Omani women.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuantitative longitudinal survey was conducted among 505 Omani breastfeeding women. An online questionnaire was used to collect data regarding the knowledge, attitude, practice, self-efficacy, and barriers to exclusive breastfeeding practices from 2020-2022.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMajority of women belonged to 30- 34 years. Most of them were unemployed and majority of them had higher education and above. A large portion of women reported having good knowledge and very good attitude towards breastfeeding; however, 33.5 % reported less self-efficacy. While 77.3% practiced combination of both breast-feeding and formula feeding, only 22.7% reported exclusive breastfeeding practices. In addition, 81% of the women reported high level of barriers to exclusive breast-feeding. Most of the women believed that formula feeding is equivalent to breast-feeding. Further, embarrassment about feeding in public and lactation problems were reported as barriers to exclusive breast-feeding. Additionally, policies and practices by some health services and health care providers, lack of knowledge regarding essential diet for breast-feeding and lack of support from employer for allowing special time/facilities for breast-feeding were the predictors related to the barriers to exclusive breastfeeding Practices. The other predictors includes younger women, particularly \u0026lt;20yrs; less educated women; unsure if the baby is getting enough milk and a belief that formula is easy to use and more available soon after birth.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExclusive breastfeeding is associated with innumerable benefits to both the mother and the child. The policy makers and healthcare providers must emphasize on the exclusive breastfeeding practices and create stringent policies allowing special time/facilities for breast-feeding. Strategies must be created to combat the barriers to exclusive breast feeding practices.\u003c/p\u003e","manuscriptTitle":"Knowledge, Attitude, Practice, self-efficacy, and Barriers to Exclusive Breastfeeding Practices among Women in a Middle Eastern Country","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-01 10:00:26","doi":"10.21203/rs.3.rs-6187622/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":"ec9646fe-bd11-4c60-89e1-abb18c743363","owner":[],"postedDate":"April 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-25T01:38:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-01 10:00:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6187622","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6187622","identity":"rs-6187622","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}