Prevalence of Ineffective Breastfeeding Techniques and Associated Factors Among Breastfeeding Mothers in South Gondar Hospitals, Ethiopia: A Cross- Sectional Study

Prevalence of Ineffective Breastfeeding Techniques and Associated Factors Among Breastfeeding Mothers in South Gondar Hospitals, Ethiopia: A Cross- Sectional Study | 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 Prevalence of Ineffective Breastfeeding Techniques and Associated Factors Among Breastfeeding Mothers in South Gondar Hospitals, Ethiopia: A Cross- Sectional Study Habtam Desse Alemayehu, Tesfaye Assebe Yadeta, Sagni Girma Fage, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8481912/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Ineffective breastfeeding techniques contribute substantially to early discontinuation of exclusive breastfeeding and to maternal breast complications. Despite their public health importance, evidence on the magnitude and determinants of ineffective breastfeeding practices in Ethiopia—particularly in the South Gondar Zone—remains limited. This study aimed to determine the prevalence of ineffective breastfeeding techniques and to identify associated factors among lactating mothers attending public hospitals in the South Gondar Zone, Ethiopia. Method An institution-based cross-sectional study was conducted among lactating mothers. A total of 423 participants were selected using systematic random sampling. Data were collected through direct observation using a structured checklist and via interviewer-administered questionnaires. Ineffective breastfeeding technique was defined and assessed based on the standard components of positioning, attachment, and suckling. Data were entered into EpiData and analyzed using SPSS. Bivariable and multivariable logistic regression analyses were performed to identify independent predictors of ineffective breastfeeding techniques. Result The prevalence of ineffective breastfeeding techniques was 54.3% (95% CI: 49.9%–59.8%). Ineffective breastfeeding was significantly associated with having poor knowledge of breastfeeding practices(AOR = 1.8; 95% CI; 1.52–4.6), no formal education (AOR = 1.74; 95% CI: 1.15–3.00), primiparity (AOR = 2.16; 95% CI: 1.15–3.73), bottle-feeding practice (AOR = 1.95; 95% CI: 1.14–3.33), lack of antenatal care follow-up (AOR = 3.09; 95% CI: 1.56–6.09), absence of prior information on breastfeeding techniques (AOR = 1.94; 95% CI: 1.20–3.14), and a history of breast-related problems (AOR = 2.22; 95% CI: 1.15–4.65). Conclusion Ineffective breastfeeding technique was found to be highly prevalent, and more than half of the mothers demonstrated inadequate knowledge of proper breastfeeding practices. Interventions aimed at reducing this burden should prioritize enhancing women’s education, promote antenatal care attendance, and provide mothers with comprehensive information, counselling, and education to improve both technique and knowledge. Positioning Attachment Suckling Breastfeeding technique Maternal knowledge Figures Figure 1 Figure 2 Figure 3 Introduction Breastfeeding is a cornerstone of infant nutrition and survival. The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of life to optimize infant growth, immunity, and survival( 1 ). However, effective breastfeeding depends not only on early initiation and duration but also on the correct application of essential technical skills. Successful breastfeeding requires the integration of appropriate positioning, proper attachment, and effective suckling, which are critical for adequate milk transfer and favorable maternal and neonatal outcomes ( 2 ). Ineffective breastfeeding techniques, characterized by poor positioning, inadequate attachment, and ineffective suckling, impair milk transfer and result in insufficient breast milk intake. Infants exposed to these practices are at increased risk of poor weight gain, stunting, weakened immunity, and infectious diseases. For mothers, ineffective techniques place excessive stress on the nipple and breast tissue, increasing the risk of nipple trauma, engorgement, mastitis, and persistent pain, which can compromise breastfeeding confidence and continuation. Globally, the prevalence of ineffective breastfeeding techniques varies widely, ranging from 30% to 70% in countries including Denmark, Brazil, Nepal, and India( 3 – 5 ). In Sub-Saharan Africa, the burden remains substantial; a study from southeast Nigeria reported that 51% of lactating mothers practiced ineffective breastfeeding techniques( 6 ). These findings highlight ineffective breastfeeding as a widespread public health concern, particularly in low- and middle-income settings. In Ethiopia, the magnitude of ineffective breastfeeding techniques is notably high. A national systematic review and meta-analysis involving 4,470 lactating mothers reported a pooled prevalence of 53.13%( 7 ). Individual studies have documented even higher proportions, including 66.8% in Sinan Woreda of Northwest Ethiopia and 63.5% in South Ari District of Southern Ethiopia ( 8 ). Such persistently high levels underscore ineffective breastfeeding technique as a significant contributor to infant malnutrition and maternal morbidity. The determinants of ineffective breastfeeding techniques are multifactorial. Evidence consistently identifies sociodemographic factors, particularly low maternal educational status and younger maternal age, as key predictors. Other associated factors include primiparity, home delivery, absence of postnatal care follow-up, preterm birth, low birth weight, and lack of counselling on breastfeeding techniques during antenatal and postnatal care ( 9 ). These determinants reflect gaps in maternal health services and limited access to skilled breastfeeding support. To address this challenge, global initiatives such as the WHO–UNICEF Baby-Friendly Hospital Initiative (BFHI) have been implemented to strengthen breastfeeding support within healthcare facilities ( 9 – 11 ). The BFHI emphasizes skilled counselling and practical demonstrations to enhance mothers’ technical competence and confidence in breastfeeding ( 8 , 10 ). In Ethiopia, the Ministry of Health has introduced policies including the National Nutrition Program II and the National Guidelines on Maternal, Infant and Young Child Nutrition. Notably, ineffective breastfeeding technique has been incorporated as a diagnostic criterion for acute malnutrition among infants under six months, reflecting its recognized clinical importance( 11 ). Despite these efforts, ineffective breastfeeding techniques remain highly prevalent in Ethiopia, with rates consistently exceeding 50%. Moreover, many studies have assessed breastfeeding technique during the immediate postpartum period, when maternal discomfort and psychological adjustment may affect accurate assessment. To reduce this potential bias, the present study was conducted during Expanded Programme on Immunization (EPI) visits, a period when mothers are presumed to be more physiologically and psychologically stable( 12 , 13 ) Furthermore, evidence on the magnitude and determinants of ineffective breastfeeding techniques in the South Gondar Zone is limited. Therefore, this study aimed to assess the prevalence of ineffective breastfeeding techniques and identify associated factors among breastfeeding mothers attending public hospitals in South Gondar, Northwest Ethiopia. Materials and Methods Study design and setting An institution-based cross-sectional study was conducted in public hospitals of the South Gondar Zone, Amhara Regional State, Ethiopia, from 24 May to 21 June 2022 . The administrative center of the zone is Debre Tabor town , which is located approximately 103 km from Bahir Dar , the regional capital, and 668 km from Addis Ababa , the national capital. During the study period, public healthcare services in the zone were provided through one general hospital (Debre Tabor General Hospital) and seven primary hospitals , all of which were included as study sites. Source and study population The source population comprised all breastfeeding mothers with their youngest infants who attended public hospitals in the South Gondar Zone for the Expanded Programme on Immunization (EPI) visit. The study population consisted of all eligible mother–infant dyads who presented to the EPI units of the selected public hospitals during the data collection period. Inclusion and exclusion criteria Inclusion criteria: All candidate breastfeeding mothers with infants aged 42 days and above who came for their Expanded Programme on Immunization (EPI) visit, were eligible for inclusion in the study. Exclusion criteria: Mother–infant dyads were excluded if the infant had a severe illness, cleft lip or palate, or any other condition that substantially interfered with breastfeeding, or if the mother was critically ill and physically unable to breastfeed. Sample Size Determination The minimum required sample size was calculated using the single population proportion formula. The calculation was based on the following assumptions: a prevalence ( ) of ineffective breastfeeding techniques of 52%, obtained from a previous study conducted in Gondar, Northwest Ethiopia (14); a 95% confidence level ( ); and a margin of error ( ) of 5%. The initial sample size was calculated as: To account for potential non-response, 10% was added to the calculated sample size, resulting in a final minimum sample size of 423 breastfeeding mothers. Sampling Technique and Procedure Six public hospitals were selected from the eight hospitals in the South Gondar Zone using a simple random (lottery) method. The selected hospitals were Debre Tabor, Mekane-Eyesus, Andabet, Nefas Mewucha, Addis Zemen, and Wogeda. The total sample size of 423 breastfeeding mothers was proportionally allocated to each hospital based on the average monthly client load of their Expanded Programme on Immunization (EPI) units, obtained from the last quarter of 2021. The monthly average attendance figures were Addis Zemen (388), Mekane-Eyesus (598), Debre Tabor (333), Andabet (100), Nefas Mewucha (100), and Wogeda (200), giving a total population (N) of 1,719 mothers. Within each hospital’s EPI unit, participants were selected using a systematic random sampling technique. The sampling interval ( ) for each facility was calculated by dividing its average monthly client load by the allocated sample size. Overall, the approximate sampling interval was . The first participant was selected randomly within the first interval, and every 4th mother–infant dyad was invited to participate until the hospital’s allocated sample size was reached. A schematic representation of the sampling procedure is shown in Figure 1. Data collection tool and procedure Data were collected by a team of six female clinicians and three senior midwives, all holding master’s degrees, recruited from external health facilities. Both data collectors and supervisors received comprehensive three-day training covering study protocols, standardized observation of maternal positioning, infant attachment, and suckling effectiveness, as well as the use of video recordings, still images, and live demonstrations for assessment. Breastfeeding technique was evaluated using the validated WHO B-R-E-A-S-T Feed observation form. Each mother–infant dyad was observed for a five-minute period. To ensure valid assessment, mothers were asked to initiate feeding if the infant had not been fed within the previous hour; if the infant had been fed, observation was scheduled for the next anticipated feeding time. The principal investigator and supervisors provided continuous oversight throughout data collection. Completed questionnaires were checked daily for completeness and accuracy, with immediate corrective measures implemented as necessary. Operational definition Breastfeeding Technique: A composite measure of positioning, attachment, and suckling during breastfeeding, as defined by the World Health Organization(14). Positioning : Physical alignment or the way a mother holds her baby Good positioning: when at least three out of four criteria for infant positioning was fulfilled; average positioning: when any two of the four criteria were correct and poor positioning when only one or none criterion has been fulfilled (15). Attachment : The manner in which the infant takes the breast into its mouth, including the amount of areola and breast tissue grasped. Good attachment: when at least three out of four criterions have been fulfilled. Average attachment: when any two of the four criterions have been fulfilled. Poor attachment: when only one or none out of four criterions have been fulfilled (15). Suckling: The action by which a baby removes milk from the breast. Effective suckling: at least two out of three criterions have been fulfilled. Ineffective suckling: only one or none from three criterions has been fulfilled (15). Ineffective breastfeeding technique: ineffective breast feeding techniques was a composite variable of the three constructs (positioning, attachment, and suckling) such that breastfeeding women with at least one of the constructs categorized as “poor” were regarded as having IBT(16, 17). knowledge of breastfeeding practices : Knowledge was assessed using twelve relevant questions. A correct answer was scored '1' and an incorrect answer '0'. A composite knowledge score was calculated for each participant. Respondents scoring at or above the mean score were categorized as having good knowledge, while those scoring below the mean were categorized as having poor knowledge (18). Data processing and analysis Collected data were carefully processed in multiple steps. All questionnaires were visually inspected and coded. Double data entry was performed independently by two data clerks using EpiData version 4.6. The two datasets were cross-checked for consistency to produce a clean and accurate master file, which was then exported to SPSS version 26 for statistical analysis. The primary outcome variable, ineffective breastfeeding technique, was derived from three components: maternal positioning, infant attachment, and suckling. Each component was first assessed and categorized (e.g., attachment: good, average, poor). For the binary composite outcome, the ‘good’ and ‘average’ categories for positioning and attachment were merged and coded as ‘1’ (effective), while ‘poor’ was coded as ‘0’ (ineffective). Suckling was directly classified as effective or ineffective. A participant was considered to have ineffective breastfeeding technique (‘1’) if any one of the three components was poor/ineffective. Descriptive statistics (frequencies, percentages, means, and standard deviations) were used to summarize participant characteristics. Binary logistic regression was employed to identify factors associated with ineffective breastfeeding techniques. Variables with a p-value < 0.25 in bivariable analysis were included in the multivariable logistic regression to adjust for potential confounders. Multicollinearity was assessed using the Variance Inflation Factor (VIF) and standard errors. Model fit was evaluated using the Hosmer-Lemeshow goodness-of-fit test and the Omnibus test. Associations are reported as Adjusted Odds Ratios (AOR) with 95% Confidence Intervals (CI). A two-sided p-value < 0.05 was considered statistically significant. Results are presented using frequency tables and graphical illustrations, including pie charts and bar graphs. Results Sociodemographic Characteristics A total of 420 lactating mother–infant dyads participated in the study, resulting in a response rate of 99.3%. The median age of the mothers was 28 years (interquartile range [IQR]: 22–33 years), with more than one-third (149; 35.5%) aged above 31 years. The majority of participants (225; 53.6%) had attained secondary education or higher. A detailed summary of the sociodemographic characteristics is presented in Table 1 . Table 1 Sociodemographic characteristics of lactating mothers attending public hospitals in South Gondar Zone, Northwest Ethiopia, 2022 (n = 420). Variables Category Frequency Percent (%) Age (years) ≤ 20 70 16.6 21–25 92 21.9 26–30 109 26.0 ≥ 31 149 35.5 Place of residences Urban 235 56.0 Rural 185 44.0 Ethnicity Amhara 409 97.4 Others 11 2.6 Religion Orthodox 277 66.0 Muslim 116 27.6 Protestant 27 6.4 Marital Status Currently married 415 98.8 Non-married 5 1.2 Mother’s Occupation Housewife 183 43.6 Governmental employee 112 26.7 Self-employee 65 15.4 Farmer 28 6.7 Daily laborer 16 3.8 Others 16 3.8 Mother’s educational status No Formal Education 128 30.4 Primary School 67 16.0 Secondary and above 225 53.6 Husband Educational status (n = 415) No formal education 75 18.1 Primary school 83 20.0 Secondary and above 257 61.9 NB: Others (marital status) -Single, divorced, and widowed, Others (Occupation) -Student, and N.G.O employee. Health-Related Characteristics of the younger Infants Among the younger infants, 228 (54.3%) were male. The majority (343; 81.7%) were under 42 days of age. Regarding perinatal characteristics, 360 (85.7%) were born with a normal birth weight, and 379 (90.2%) were delivered at term. A detailed summary of infant characteristics is presented in Table 2 . Table 2 Characteristics of younger infants of lactating mothers attending public hospitals in the South Gondar Zone, Northwest Ethiopia, 2022 (n = 420) Variable Category Frequency Percent (%) younger infant age in (days) < 42 days 343 81.7 ≥ 42 days 77 18.3 Gestational age at birth Preterm 33 7.8 Term 379 90.2 Unknown 8 2.0 Birth weight NBW 360 85.7 LBW 19 4.6 Macrosomia 18 4.3 Unknown 23 5.4 Infant’s sex Male 228 54.3 Female 192 45.7 Pacifier used No 360 85.7 Yes 60 14.3 Bottle feeding No 318 75.7 Yes 102 24.3 Complementary started Yes 169 40.2 No 251 59.8 Time of initiation (n = 169) < 6 months 90 53.3 ≥ 6 months 79 46.7 Maternal and Infant Health Service Utilization Characteristics The study revealed high utilization of maternal health services, with 85% of mothers attending antenatal care (ANC) and 96.4% receiving postnatal care (PNC). However, among those who attended ANC, only 19% received counseling on breastfeeding techniques (BFT). Knowledge of breastfeeding practices was classified as poor in 56% of participants. The maternal cohort was nearly evenly distributed between primiparous (50.2%) and multiparous (49.8%) women. Most deliveries occurred in a health facility (94%), with hospitals accounting for the majority (65.4%) and spontaneous vaginal delivery being the predominant mode of birth (84.1%) (Fig. 2 ). Breastfeeding Technique practices and Associated factors The prevalence of ineffective breastfeeding technique among the study participants was 54.3% (95% CI: 49.8–59.8). Suboptimal practices were observed across key components of breastfeeding: 17.6% of mothers demonstrated poor positioning, 32.9% exhibited poor attachment, and 24.3% showed ineffective suckling. Analysis of supportive practices further indicated that only 29.8% of mothers provided full body support to their infant, 29.9% ensured that the infant’s chin was in contact with the breast, and 36.7% maintained proper alignment of the infant’s head and body (Fig. 3 ). Factors associated with ineffective breast feeding Multivariable logistic regression analysis identified several factors significantly associated with ineffective breastfeeding technique (IBT) among lactating mothers. Maternal age was protective: mothers aged 21–25 and 26–30 years had 77% (AOR = 0.23; 95% CI: 0.11–0.48) and 52% (AOR = 0.48; 95% CI: 0.27–0.84) lower odds of IBT, respectively, compared with mothers aged ≥ 31 years. Mothers with no formal education had 1.74-fold higher odds of IBT (AOR = 1.74; 95% CI: 1.15–3.00) than those with secondary education or higher. Primiparous mothers were 2.16 times more likely to demonstrate IBT compared with multiparous mothers (AOR = 2.16; 95% CI: 1.25–3.73). The absence of antenatal care (ANC) follow-up increased the likelihood of IBT threefold (AOR = 3.09; 95% CI: 1.56–6.09). Mothers experiencing breast problems had 2.22-fold higher odds of IBT (AOR = 2.22; 95% CI: 1.15–4.65), and those who practiced bottle feeding in combination with breastfeeding had 1.95-fold higher odds (AOR = 1.95; 95% CI: 1.14–3.33). Mothers with no prior information on breastfeeding techniques were 1.94 times more likely to exhibit IBT (AOR = 1.94; 95% CI: 1.20–3.14). Additionally, breastfeeding mothers with poor knowledge of breastfeeding practices had 1.8 times greater odds of demonstrating ineffective breastfeeding (AOR = 1.80; 95% CI: 1.52–4.6) compared with those with good knowledge. (Table 3 ). Table 3 Factors associated with ineffective breast-feeding technique among lactating mothers visiting public hospitals in south Gondar zone, northwest Ethiopia,2022 (n = 420) Variable Ineffective BFT COR 95%CI AOR 95%CI P-value Yes (%) No (%) Age category ≤ 20 years 49(70.0) 21(30.0) 1.61(0.88,2.96)) 0.55 (0.25,1.18)) 0.126 21–25 47 (51.1) 45(48.9) 0.72(0.41,1.22) 0.23(0.11 ,0.48)) *** 0.000 26–30 44(40.3) 65(59.7) 0.46(0.28 0.77) *** 0.48(0.27 ,0.84) ** 0.011 ≥ 31 88(59.1) 61(40.9) 1.0 1.0 Education status of mothers No formal education 85(66.4) 43(33.6) 2.10(1.34,3.30) *** 1.74(1.15, 3.00) * * 0.029 Primary school 34(50.7) 33(49.2) 1.09(0.65,1.89) 1.01(0.55 ,2.01) 0.762 2 ry school &above 109(48.4) 116(51.6) 1.0 1.0 Parity Primipara 132(62.6 79(37.4) 1.96(1.33,2.90) * * 2.16(1.25,3.73) * * * 0.005 Multipara 96(46.0) 113(54.0) 1.0 1.0 ANC No 49(77.7) 14(22.2) 3.48 (1.86, 6.52) * * * 3.09(1.56 ,6.09) ** * 0.001 Yes 179(50.1) 178(49.9) 1.0 1.0 Previous information about BFT No 145(63.8) 82(36.2) 2.34(1.58 ,3.47) * * * 1.94(1.20 ,3.14 ) *** 0.006 Yes 83(43.0) 110(57.0) 1.0 1.0 Knowledge of breastfeeding practices Poor 139((59.1) 96(40.9) 1.56(1.10,2.30) 1.8(1.52 ,4.6) 0.003 Good 89(48.1 96(51.9) 1.0 1.0 Breas problem Yes 30(69.7) 13(30.2) 2.08(1.15,4.124) * 2.22(1.15, 4.65) ** 0.035 No 198(52.5) 179(47.5) 1.0 1.0 1.0 Residence Rural 111(60) 74( 40 ) 1.51(1.12,2.23) 0.91(0.56,1.48) 0.708 Urban 117(49.8) 118(50.2) 1.0 1.0 Combine use of bottle feeding with breastfeeding Yes 70(68.6 32(31.4) 2.21(1.38,3.55)) *** 1.95(1.14,3.33) ** 0.014 No 158(49.6 160(50.4) 1.0 1.0 Pacifier use Yes 40((66.6) 20(33.4) 1.83(1,12,3.25) 1.27(0.65,2.47) 0.479 No 188(52.2) 172(47.8) 1.0 1.0 Complementary feeding Yes 108(63.9) 61(36.1) 1.93(1.29,2.88) 1.36(0.86,2.85) 0.185 No 120(47.8 131(52.2) 1.0 1.0 Significant at *, * * and ***: P value; ≤ 0.05, ≤ 0.01 and ≤ 0.001 both in the COR and AOR respectively CI, Confidence interval; COR, Crude Odds Ratio; AOR, Adjusted Odds Ratio; ANC, antenatal care Discussion Breastfeeding is a cornerstone of infant nutrition, essential for optimal growth, immune protection, and survival, particularly during the first six months of life. Effective breastfeeding relies on correct maternal positioning, infant attachment, and suckling technique. Ineffective breastfeeding can result in inadequate milk intake, poor weight gain, and increased susceptibility to infections, contributing to adverse infant health outcomes( 9 ). This study aimed to determine the prevalence of ineffective breastfeeding technique (IBT) and its associated factors among breastfeeding mothers attending public hospitals in the South Gondar Zone, Northwest Ethiopia. The findings revealed that a substantial proportion of mothers exhibited IBT, underscoring a significant public health concern. Several maternal, infant, and health service-related factors were identified as determinants of ineffective breastfeeding, highlighting the multifactorial nature of breastfeeding practices. By situating these results within the broader literature on breastfeeding in low-resource settings, this study provides valuable insight into the behavioural, educational, and healthcare factors influencing breastfeeding outcomes, which can inform strategies to improve maternal and infant health in the region. The prevalence of IBT in this study was 54.3%. This finding is consistent with studies conducted in Gondar, Ethiopia (52%)( 19 ), south Nigeria (51%) ( 6 ), and Harar (56.6%) ( 20 ). This consistency suggests that IBT remains a common challenge in low-resource settings. However, the proportion was higher than that reported in a study from Denmark (48%) ( 21 ). This discrepancy may be explained by differences in maternal education, healthcare quality, and breastfeeding support. Mothers in Denmark generally have higher education levels and greater access to structured lactation counselling, trained healthcare providers, and postnatal follow-up, which promote effective breastfeeding practices. In contrast, in South Gondar, limited access to breastfeeding information, lower rates of antenatal counselling, and fewer supportive services likely contribute to the higher prevalence. Cultural practices, socioeconomic factors, and maternal or infant health challenges, such as primiparity or breast problems, may also increase the risk of ineffective breastfeeding in this setting (( 22 , 23 )). Conversely, the current finding is lower than rates reported from India (69.7%) ( 24 ) and the Ari District, Ethiopia (63.5%) ( 17 ). This difference may be explained by the lower proportion of mothers with no formal education (30.4% vs. 60.5%) and fewer mothers experiencing breast problems (10.2% vs. 14.3%) in the current study. Additionally, higher utilization of antenatal and postnatal care, greater exposure to breastfeeding information, and regional differences in cultural practices and maternal support may have contributed to the lower prevalence of IBT in this setting ( 17 ). Multivariable analysis showed that maternal age was a significant protective factor, with mothers aged 21–25 and 26–30 years having 77% and 52% lower odds of ineffective breastfeeding technique, respectively, compared to mothers aged 31 years and above. This may be explained by better physical comfort and fewer age-related breast or musculoskeletal issues, greater exposure to breastfeeding information through antenatal and postnatal care, and higher motivation to adopt recommended practices. Additionally, younger mothers may receive more guidance and support from healthcare providers and family members, which can enhance correct positioning, attachment, and suckling.( 20 , 25 ) .This finding contrasts with a previous study in Gondar( 26 ), The discrepancy may be due to differences in study population characteristics, including variations in maternal education, parity, exposure to antenatal and postnatal counselling, and access to updated breastfeeding information. Additionally, methodological differences in the assessment of breastfeeding techniques and sample size could have contributed to the observed variation ( 9 , 17 ). Maternal educational attainment was significantly associated with IBT. Mothers without formal education had 1.74-fold higher odds of IBT compared to those with secondary education or higher. This result aligns with studies from Delhi, Nepal, and Harari, Ethiopia ( 20 , 24 , 27 ). The association may be attributed to the challenges illiterate mothers face in comprehending nursing instructions, lower motivation to seek professional support, and reduced health-seeking behaviors, potentially limiting their access to antenatal and postnatal counselling on breastfeeding( 28 ). To address this, promoting home visits by health extension workers and implementing targeted educational interventions for illiterate mothers are recommended. Breastfeeding mothers with poor knowledge of breastfeeding practices had 1.8 times higher odds of demonstrating ineffective compared with those with good knowledge. This underscores the crucial role of maternal knowledge in ensuring proper positioning, attachment, and suckling. Mothers lacking adequate knowledge may be unaware of correct techniques and the importance of frequent feeding, leading to suboptimal practices and adverse infant outcomes. These findings align with studies from Ethiopia and India, highlighting that targeted educational interventions through antenatal counselling, postnatal support, and community health programs are essential to improve breastfeeding practices and optimize infant health. The use of bottle feeding in combination with breastfeeding was associated with a 1.95-fold increase in the odds of ineffective breastfeeding technique. Our finding was supported by studies from Brazil and Gondar ( 19 , 29 ). The association between bottle feeding and ineffective breastfeeding may be explained by nipple confusion, where infants struggle to coordinate sucking at the breast, resulting in poor attachment and ineffective suckling. Bottle-fed infants may also feed less frequently at the breast, limiting maternal practice and mastery of correct positioning and attachment. Additionally, bottle feeding can contribute to breast refusal and reduced milk supply, shortening feeding duration and further compromising breastfeeding technique. These observations are consistent with previous studies( 30 , 31 ). and reinforce WHO recommendations for exclusive breastfeeding during the first six months to promote effective breastfeeding practices. Parity emerged as a significant determinant of ineffective breastfeeding technique (IBT), with primiparous mothers having twice the odds of IBT compared to multiparous mothers. This association may be explained by the limited prior breastfeeding experience among first-time mothers, which can negatively affect their ability to correctly position the infant, achieve proper attachment, and ensure effective suckling. Additionally, primiparous mothers may experience lower confidence, heightened anxiety, and reduced problem-solving skills during breastfeeding, which further impairs their technique. In contrast, multiparous mothers often benefit from previous breastfeeding experiences, allowing them to refine their skills, anticipate common challenges, and implement effective corrective measures during feeds. These observations are supported by evidence from studies conducted in India and Ethiopia, which similarly reported higher odds of IBT among primiparous mothers due to inexperience and lower practical competence in breastfeeding( 17 , 19 , 32 ). This finding highlights the importance of targeted counselling and hands-on support for first-time mothers during antenatal and postnatal care to improve breastfeeding practices and optimize infant nutrition outcomes. The absence of antenatal care (ANC) follow-up was a significant predictor of ineffective breastfeeding technique (IBT), with mothers who did not attend ANC exhibiting three times higher odds of IBT (AOR = 3.09) compared to those who attended. This may be attributed to missed opportunities for structured breastfeeding education and guidance, including proper positioning, attachment, and suckling techniques, as well as counselling on exclusive breastfeeding and early problem-solving. ANC serves as a critical platform for delivering maternal health and nutritional interventions( 33 ), and missing these sessions deprives mothers—particularly first-time mothers—of opportunities to build the self-confidence, skills, and knowledge essential for proper breastfeeding practices in the postnatal period ( 34 ).Consequently, mothers without ANC follow-up are more likely to experience ineffective breastfeeding. This finding aligns with studies from Nigeria, India, and Wollo, Ethiopia( 35 – 37 ), highlighting the crucial role of antenatal care in promoting effective breastfeeding practices. The experience of breast problems was associated with a 2.2-fold increase in the odds of ineffective breastfeeding technique (IBT). This finding is consistent with studies conducted in Ethiopia, India, and Indonesia( 3 , 17 , 38 ). Breast conditions such as mastitis, engorgement, and cracked nipples often cause pain and discomfort, which can interfere with proper infant positioning, attachment, and effective suckling. In an attempt to minimize pain, mothers may adopt suboptimal breastfeeding techniques, thereby increasing the likelihood of IBT ( 39 ). These problems may also reduce feeding frequency and duration, limiting opportunities to practise and maintain correct techniques. Early identification and management of breast problems during antenatal care and the early postpartum period, together with appropriate counselling on prevention and treatment, are therefore critical to improving breastfeeding technique and outcomes.( 40 , 41 ). Finally, mothers who had no prior information on breastfeeding techniques had nearly twofold higher odds of ineffective breastfeeding technique (AOR = 1.94), a finding consistent with studies from India and Harar, Ethiopia( 20 , 38 ). This association may be explained by the lack of essential knowledge and practical guidance on correct positioning, attachment, and effective suckling among uninformed mothers. In the absence of prior information, mothers may also have limited confidence in their breastfeeding abilities and reduced awareness of the benefits of proper technique, increasing reliance on inappropriate practices and hindering early correction of breastfeeding problems, thereby predisposing them to ineffective breastfeeding. This study demonstrates that ineffective breastfeeding technique is highly prevalent among breastfeeding mothers in South Gondar hospitals, indicating a substantial public health concern. The practice was influenced by a combination of maternal, behavioural, and health service–related factors, including maternal age, education, parity, antenatal care attendance, bottle feeding, breast problems, and lack of prior breastfeeding information. Younger maternal age was protective, whereas primiparity, absence of ANC follow-up, limited breastfeeding counselling, and breast-related complications increased the likelihood of ineffective technique. These findings underscore the critical role of quality antenatal and postnatal care, early breastfeeding education, and targeted support for first-time mothers in improving breastfeeding practices and optimising infant health outcomes. Limitation This study has several limitations that should be considered when interpreting the findings. First, information on some maternal practices and prior experiences was collected through self-report, which may be subject to recall bias. Second, because breastfeeding techniques were assessed through direct observation, the possibility of a Hawthorne effect cannot be excluded, whereby mothers may have modified their breastfeeding behavior due to awareness of being observed, despite attempts to minimize this effect through unobtrusive assessment procedures. Conclusion and Recommendations Ineffective breastfeeding technique is highly prevalent among breastfeeding mothers attending public hospitals in the South Gondar Zone, with over half of the participants demonstrating suboptimal practices. The study identified several factors associated with ineffective breastfeeding, including maternal age, educational level, parity, antenatal care attendance, prior breastfeeding information, breast problems, and the use of bottle feeding. Younger maternal age and prior exposure to breastfeeding guidance were protective, whereas primiparity, lack of ANC follow-up, limited breastfeeding counselling, breast-related complications, and bottle feeding significantly increased the risk of ineffective technique. To address these challenges, targeted interventions are essential. Health facilities should strengthen antenatal and postnatal breastfeeding education, incorporating practical demonstrations of proper positioning, attachment, and suckling techniques. Primiparous mothers require focused guidance and support to build confidence and competence in breastfeeding. Educational strategies should be tailored for mothers with limited formal education, including home visits and practical teaching methods. Early identification and management of breast complications, along with counselling on exclusive breastfeeding and the risks of bottle feeding, are critical to improving technique and infant nutrition. Integrating these strategies into maternal and child health programs can enhance breastfeeding practices, promote infant health, and reduce the burden of ineffective breastfeeding in the region. Abbreviations AAP-America Academy of Pediatrics; ANC Antenatal Care; BFIH Baby-Friendly Hospital Initiative; FT- Breastfeeding Techniques; EBF Exclusive Breastfeeding; EBT Effective Breastfeeding Techniques ; EDHS -Ethiopian Demographic Health Survey; EPI Expanded Program of Immunization; FMOH-Federal Ministry of Health; IMNCI Integrated Management of Neonatal and Childhood Illness; IYCF - Infant Young Child Feeding; PNC Postnatal Care; SIDS Sudden Infant Death Syndrome; SPSS- Statistical Package for Social Science; SSA Sub-Saharan Africa; TBA Traditional Birth Attendant ;WHO World Health Organization. Declarations Ethical Approval and Consent to Participate: Ethical approval was obtained from the Institutional Health Research Ethics Review Committee (IHRERC) of Haramaya University, College of Health and Medical Sciences ( Ref: IHRERC/077/2022) , and permission was secured from the heads of participating health facilities. The study was conducted in accordance with the Declaration of Helsinki, ensuring respect for participants’ rights, safety, and well-being. Written informed consent was obtained from all mothers after explaining the study objectives, potential risks, and benefits, ensuring voluntary participation and full understanding of their rights. Consent for publication: Not applicable Conflicts of interest; The author(s) declared no potential conflicts of interest for the research, authorship, and/or publication of this article. Availability of data and materials The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request. Clinical trial number : not applicable. Funding: The funding was obtained from Debre Tabor University College of Health and Medical Sciences. There was no code for the budget and it was released by simple signature of the correspondent author. Author's Contributions: All authors contributed to the study conception and design. TE and HD drafted the original manuscript, performed data analysis, and revised the manuscript. HD managed data curation. TA participated in data analysis. SG handled data entry and cleaning. GT AND HD supervised data collection and provided critical revisions. All authors reviewed, validated, and approved the final manuscript. Acknowledgement Above all, we would like to thank Debre Tabor University, and HU-CHMS. Secondly, we would like to give our thanks to south Gonder zonal hospitals administers Thirdly, we would like to thank respected advisors, data collectors, supervisors, and study participants . Authors’ information HD (MSc. in maternity and Neonatal care in Nursing) - Lecturer at Debre Tabor university, College of Health and Medical Sciences, School of Nursing TA (PhD. in public health) - Lecturer at Haramaya University, College of Health and Medical Sciences, School of Nursing and Midwifery. SG (PhD fellow, LUMC, The Netherlands; Assistant Professor, Haramaya University,) - Lecturer at Haramaya University, College of Health and Medical Science, School of Nursing and Midwifery.GT (Assistant Professor of Maternal and child health at Haramaya University-- Lecturer at Haramaya University, College of Health and Medical Science, School of Nursing and Midwifery. References UNICEF. Infant and young child feeding. 2018. Dostupno na: https://data unicef org/topic/nutrition/infant-and-young-child-feeding/(0909 2018). 2017. Boquien C-Y. Human Milk: An Ideal Food for Nutrition of Preterm Newborn. Frontiers in Pediatrics. 2018;6. Rinata E, Sari PA. BREASTFEEDING PRACTICES [POSITIONING, ATTACHMENT/LATCH-ON AND EFFECTIVE SUCKLING. SEAJOM: The Southeast Asia Journal of Midwifery. 2017;3(2):1-6. Khanal V. Breastfeeding practices and lactation mastitis in Western Nepal: A prospective cohort study: Curtin University; 2016. Goyal RC, Banginwar AS, Ziyo F, Toweir AA. Breastfeeding practices: positioning, attachment (latch-on) and effective suckling–a hospital-based study in Libya. Journal of Family and Community Medicine. 2011;18(2):74. Nduagubam OC, Ndu IK, Bisi-Onyemaechi A, Onukwuli VO, Amadi OF, Okeke IB, et al. Assessment of breastfeeding techniques in Enugu, South-East Nigeria. Ann Afr Med. 2021;20(2):98-104. Bellù R, Condò M. Breastfeeding promotion: evidence and problems. La Pediatria Medica e Chirurgica. 2017;39(2). Kent JC, Ashton E, Hardwick CM, Rowan MK, Chia ES, Fairclough KA, et al. Nipple Pain in Breastfeeding Mothers: Incidence, Causes and Treatments. Int J Environ Res Public Health. 2015;12(10):12247-63. Yilak G, Tilahun BD, Abate BB, Zemariam AB, Lake ES, Ayele M, et al. Prevalence of ineffective breastfeeding techniques and its associated factors among breastfeeding mothers in Ethiopia: A systematic review and meta-analysis. PLoS One. 2024;19(6):e0303749. ACOG. . 2021. Tonguet-Papucci A, Houngbe F, Huybregts L, Ait-Aissa M, Altare C, Kolsteren P, et al. Unconditional seasonal cash transfer increases intake of high-nutritional-value foods in young Burkinabe children: results of 24-hour dietary recall surveys within the Moderate Acute Malnutrition Out (MAM'Out) randomized controlled trial. The Journal of Nutrition. 2017;147(7):1418-25. Bizuneh FK, Tolossa T, Bekonjo NE, Wakuma B. Time to recovery from severe acute malnutrition and its predictors among children aged 6–59 months at Asosa general hospital, Northwest Ethiopia. A retrospective follow up study. PloS one. 2022;17(8):e0272930. Ababa A. Essential Health Services Package of Ethiopia. 2019. WHO. Infant and young child feeding: model chapter for textbooks for medical students and allied health professionals: World Health Organization; 2009. Degefa N, Tariku B, Bancha T, Amana G, Hajo A, Kusse Y, et al. Breast Feeding Practice: Positioning and Attachment during Breast Feeding among Lactating Mothers Visiting Health Facility in Areka Town, Southern Ethiopia. International journal of pediatrics. 2019;2019:8969432. WHO. Breastfeeding counselling a training course. 2014. Yilak G, Gebretsadik W, Tadesse H, Debalkie M, Bante A. Prevalence of ineffective breastfeeding technique and associated factors among lactating mothers attending public health facilities of South Ari district, Southern Ethiopia. PloS one. 2020;15(2):e0228863. Thakre SB, Thakre SS, Ughade SM, Golawar S, Thakre AD, Kale P. The Breastfeeding Practices: The Positioning and Attachment Initiative Among the Mothers of Rural Nagpur. Journal of Clinical & Diagnostic Research. 2012;6(7). Safayi BL, Assimamaw NT, Kassie DG. Breastfeeding technique and associated factors among lactating mothers visiting Gondar town health facilities, Northwest Ethiopia: observational method. Italian Journal of Pediatrics. 2021;47(1):1-10. Tiruye G, Mesfin F, Geda B, Shiferaw K. Breastfeeding technique and associated factors among breastfeeding mothers in Harar city, Eastern Ethiopia. International breastfeeding journal. 2018;13(1):1-9. Lording R. How are effective breastfeeding technique and pacifier use related to breastfeeding problems and breastfeeding duration? Breastfeeding Review. 2010;18(1):34-5. Kitil GW, Butta FW, Tadesse S, Degefa BD, Feyisa GT, Demsash AW, et al. Effective breastfeeding techniques and associated factors among lactating women in Ethiopia: A systematic review and meta-analysis. PLoS One. 2024;19(6):e0306167. Zegeye AF, Gebrehana DA, Bezabih SA, Mengistu SA, Adane KC, Lakew AM. Poor access to breastfeeding counseling services and associated factors among lactating mothers who had optimal antenatal care follow-up in Sub-saharan Africa: a multilevel analysis of the recent Demographic and Health Survey. BMC health services research. 2024;24(1):1577. Dasgupta U, Mallik S, Bhattacharyya K, Sarkar J, Bhattacharya S, Halder A. Breastfeeding practices: positioning, attachment and effective suckling—a hospital based study in West Bengal/Kolkata. Indian J Mater Child Health. 2013;15:1-11. Can V, Bulduk M, Can EK, Ayşin N. Impact of social support and breastfeeding success on the self-efficacy levels of adolescent mothers during the postpartum period. Reproductive health. 2025;22(1):19. Safayi BL, Assimamaw NT, Kassie DG. Breastfeeding technique and associated factors among lactating mothers visiting Gondar town health facilities, Northwest Ethiopia: observational method. Italian Journal of Pediatrics. 2021;47(1):206. Paudel DP, Giri S. Breast feeding practices and associated factors in Bhaktapur District of Nepal: A community based cross-sectional study among lactating mothers. Journal of the Scientific Society. 2014;41(2):108-13. Toe SY, Higuchi M, Hamajima N. Health care seeking behaviors regarding maternal care and the associated factors among married women in Naung Cho Township, Myanmar. Nagoya Journal of Medical Science. 2021;83(4):727. Batista CL, Ribeiro VS, Nascimento MdDS, Rodrigues VP. Association between pacifier use and bottle-feeding and unfavorable behaviors during breastfeeding. Jornal de Pediatria. 2018;94:596-601. Eidelman AI. Routine pacifier use in infants: pros and cons. SciELO Brasil; 2019. p. 121-3. Zimmerman E, Thompson K. Clarifying nipple confusion. Journal of Perinatology. 2015;35(11):895-9. Joshi H, Magon P, Raina S. Effect of mother-infant pair's latch-on position on child's health: A lesson for nursing care. J Family Med Prim Care. 2016;5(2):309-13. Biks GA, Tariku A, Tessema GA. Effects of antenatal care and institutional delivery on exclusive breastfeeding practice in northwest Ethiopia: a nested case–control study. International Breastfeeding Journal. 2015;10(1):30. Piro SS, Ahmed HM. Impacts of antenatal nursing interventions on mothers’ breastfeeding self-efficacy: an experimental study. BMC Pregnancy and Childbirth. 2020;20(1):19. Nduagubam OC, Ndu IK, Bisi-Onyemaechi A, Onukwuli VO, Amadi OF, Okeke IB, et al. Assessment of breastfeeding techniques in enugu, south-east Nigeria. Annals of African Medicine. 2021;20(2):98. Chethana K, Maria N, Manjula A, Jayaram S. Role of mother’s education and antenatal counselling on breast feeding practices among women in coastal Karnataka: A community based cross sectional study. 2020. Asmamaw DB, Habitu YA, Negash WD, Desta DZ, Mekonnen EG. Effective breastfeeding technique and associated factors among lactating mothers in Gidan District, North-East, Ethiopia: a community-based cross-sectional study. BMJ open. 2022;12(7):e059518. Aswathaman N, Sajjid M, Kamalarathnam C, Seeralar A. Assessment of Breastfeeding Position and Attachment (ABPA) in a tertiary care centre in Chennai, India: An observational descriptive cross-sectional study. Int J Contemp Pediatr. 2018;5:2209-16. Boskabadi H, Ramazanzadeh M, Zakerihamidi M, Omran FR. Risk factors of breast problems in mothers and its effects on newborns. Iranian Red Crescent Medical Journal. 2014;16(6). Kent JC, Ashton E, Hardwick CM, Rowan MK, Chia ES, Fairclough KA, et al. Nipple Pain in Breastfeeding Mothers: Incidence, Causes and Treatments. Int J Environ Res Public Health. 2015;12(10):12247-63. Shitie A, Adimasu A, Tsegaye D, Belete D, Mislu E, Assfaw M, et al. Breast problems and associated factors among lactating women in Northeast Ethiopia, 2022. Scientific reports. 2024;14(1):9202. 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. 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1","display":"","copyAsset":false,"role":"figure","size":113343,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic representation of the sampling procedure for assessing ineffective breastfeeding techniques and associated factors among lactating mothers attending public hospitals in South Gondar Zone, Ethiopia.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8481912/v1/be9bd5136b5fec663e734924.png"},{"id":100013866,"identity":"aba3ca5e-08e8-4f29-a5e7-a87f92bcc1ff","added_by":"auto","created_at":"2026-01-12 06:22:46","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":127435,"visible":true,"origin":"","legend":"\u003cp\u003eObstetric-related characteristics of lactating mothers visiting public hospitals in south Gondar zone, northwest, Ethiopia, 2022\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8481912/v1/1baf0ff486927239290d18fc.png"},{"id":100362276,"identity":"122c18f0-4990-48a3-b5e9-b31d4b505cee","added_by":"auto","created_at":"2026-01-16 07:46:28","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":285244,"visible":true,"origin":"","legend":"\u003cp\u003eEffective breastfeeding practice for each item among lactating mothers visiting public hospitals in south Gondar zone, northwest, Ethiopia, 2022 (n=420).\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8481912/v1/2ba4931af2a7415bf2381189.png"},{"id":101848929,"identity":"43a5476e-5211-469d-9679-263436b9dbb3","added_by":"auto","created_at":"2026-02-04 09:43:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1672277,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8481912/v1/03419584-69f3-4f25-8c60-c45ffff557de.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence of Ineffective Breastfeeding Techniques and Associated Factors Among Breastfeeding Mothers in South Gondar Hospitals, Ethiopia: A Cross- Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBreastfeeding is a cornerstone of infant nutrition and survival. The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of life to optimize infant growth, immunity, and survival(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). However, effective breastfeeding depends not only on early initiation and duration but also on the correct application of essential technical skills. Successful breastfeeding requires the integration of appropriate positioning, proper attachment, and effective suckling, which are critical for adequate milk transfer and favorable maternal and neonatal outcomes (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIneffective breastfeeding techniques, characterized by poor positioning, inadequate attachment, and ineffective suckling, impair milk transfer and result in insufficient breast milk intake. Infants exposed to these practices are at increased risk of poor weight gain, stunting, weakened immunity, and infectious diseases. For mothers, ineffective techniques place excessive stress on the nipple and breast tissue, increasing the risk of nipple trauma, engorgement, mastitis, and persistent pain, which can compromise breastfeeding confidence and continuation.\u003c/p\u003e \u003cp\u003eGlobally, the prevalence of ineffective breastfeeding techniques varies widely, ranging from 30% to 70% in countries including Denmark, Brazil, Nepal, and India(\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In Sub-Saharan Africa, the burden remains substantial; a study from southeast Nigeria reported that 51% of lactating mothers practiced ineffective breastfeeding techniques(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). These findings highlight ineffective breastfeeding as a widespread public health concern, particularly in low- and middle-income settings.\u003c/p\u003e \u003cp\u003eIn Ethiopia, the magnitude of ineffective breastfeeding techniques is notably high. A national systematic review and meta-analysis involving 4,470 lactating mothers reported a pooled prevalence of 53.13%(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Individual studies have documented even higher proportions, including 66.8% in Sinan Woreda of Northwest Ethiopia and 63.5% in South Ari District of Southern Ethiopia (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Such persistently high levels underscore ineffective breastfeeding technique as a significant contributor to infant malnutrition and maternal morbidity.\u003c/p\u003e \u003cp\u003eThe determinants of ineffective breastfeeding techniques are multifactorial. Evidence consistently identifies sociodemographic factors, particularly low maternal educational status and younger maternal age, as key predictors. Other associated factors include primiparity, home delivery, absence of postnatal care follow-up, preterm birth, low birth weight, and lack of counselling on breastfeeding techniques during antenatal and postnatal care (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). These determinants reflect gaps in maternal health services and limited access to skilled breastfeeding support.\u003c/p\u003e \u003cp\u003eTo address this challenge, global initiatives such as the WHO\u0026ndash;UNICEF Baby-Friendly Hospital Initiative (BFHI) have been implemented to strengthen breastfeeding support within healthcare facilities (\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The BFHI emphasizes skilled counselling and practical demonstrations to enhance mothers\u0026rsquo; technical competence and confidence in breastfeeding (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In Ethiopia, the Ministry of Health has introduced policies including the National Nutrition Program II and the National Guidelines on Maternal, Infant and Young Child Nutrition. Notably, ineffective breastfeeding technique has been incorporated as a diagnostic criterion for acute malnutrition among infants under six months, reflecting its recognized clinical importance(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite these efforts, ineffective breastfeeding techniques remain highly prevalent in Ethiopia, with rates consistently exceeding 50%. Moreover, many studies have assessed breastfeeding technique during the immediate postpartum period, when maternal discomfort and psychological adjustment may affect accurate assessment. To reduce this potential bias, the present study was conducted during Expanded Programme on Immunization (EPI) visits, a period when mothers are presumed to be more physiologically and psychologically stable(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eFurthermore, evidence on the magnitude and determinants of ineffective breastfeeding techniques in the South Gondar Zone is limited. Therefore, this study aimed to assess the prevalence of ineffective breastfeeding techniques and identify associated factors among breastfeeding mothers attending public hospitals in South Gondar, Northwest Ethiopia.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn institution-based cross-sectional study was conducted in public hospitals of the South Gondar Zone, Amhara Regional State, Ethiopia, from \u003cstrong\u003e24 May to 21 June 2022\u003c/strong\u003e. The administrative center of the zone is \u003cstrong\u003eDebre Tabor town\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e which is located approximately \u003cstrong\u003e103 km from Bahir Dar\u003c/strong\u003e, the regional capital, and \u003cstrong\u003e668 km from Addis Ababa\u003c/strong\u003e, the national capital. During the study period, public healthcare services in the zone were provided through \u003cstrong\u003eone general hospital (Debre Tabor General Hospital)\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eand \u003cstrong\u003eseven primary hospitals\u003c/strong\u003e, all of which were included as study sites.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource and study population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe source population comprised all breastfeeding mothers with their youngest infants who attended public hospitals in the South Gondar Zone for the Expanded Programme on Immunization (EPI) visit. The study population consisted of all eligible mother\u0026ndash;infant dyads who presented to the EPI units of the selected public hospitals during the data collection period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion and exclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria:\u0026nbsp;\u003c/strong\u003eAll candidate breastfeeding mothers with infants aged 42 days and above who came for their Expanded Programme on Immunization (EPI) visit, were eligible for inclusion in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria:\u0026nbsp;\u003c/strong\u003eMother\u0026ndash;infant dyads were excluded if the infant had a severe illness, cleft lip or palate, or any other condition that substantially interfered with breastfeeding, or if the mother was critically ill and physically unable to breastfeed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size Determination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe minimum required sample size was calculated using the single population proportion formula. The calculation was based on the following assumptions: a prevalence (\u0026nbsp;) of ineffective breastfeeding techniques of 52%, obtained from a previous study conducted in Gondar, Northwest Ethiopia (14); a 95% confidence level (\u0026nbsp;); and a margin of error (\u0026nbsp;) of 5%.\u003c/p\u003e\n\u003cp\u003eThe initial sample size was calculated as:\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\" style=\"width: 497px; height: 65.6572px;\" width=\"497\" height=\"65.6572\"\u003e\u003c/p\u003e\n\u003cp\u003eTo account for potential non-response, 10% was added to the calculated sample size, resulting in a final minimum sample size of 423 breastfeeding mothers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling Technique and Procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSix public hospitals were selected from the eight hospitals in the South Gondar Zone using a simple random (lottery) method. The selected hospitals were Debre Tabor, Mekane-Eyesus, Andabet, Nefas Mewucha, Addis Zemen, and Wogeda.\u003c/p\u003e\n\u003cp\u003eThe total sample size of 423 breastfeeding mothers was proportionally allocated to each hospital based on the average monthly client load of their Expanded Programme on Immunization (EPI) units, obtained from the last quarter of 2021. The monthly average attendance figures were Addis Zemen (388), Mekane-Eyesus (598), Debre Tabor (333), Andabet (100), Nefas Mewucha (100), and Wogeda (200), giving a total population (N) of 1,719 mothers. \u0026nbsp;Within each hospital\u0026rsquo;s EPI unit, participants were selected using a systematic random sampling technique. The sampling interval ( ) for each facility was calculated by dividing its average monthly client load by the allocated sample size. Overall, the approximate sampling interval was \u0026nbsp;. The first participant was selected randomly within the first interval, and every 4th mother\u0026ndash;infant dyad was invited to participate until the hospital\u0026rsquo;s allocated sample size was reached. A schematic representation of the sampling procedure is shown in Figure 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection tool and procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected by a team of six female clinicians and three senior midwives, all holding master\u0026rsquo;s degrees, recruited from external health facilities. Both data collectors and supervisors received comprehensive three-day training covering study protocols, standardized observation of maternal positioning, infant attachment, and suckling effectiveness, as well as the use of video recordings, still images, and live demonstrations for assessment.\u003c/p\u003e\n\u003cp\u003eBreastfeeding technique was evaluated using the validated WHO B-R-E-A-S-T Feed observation form. Each mother\u0026ndash;infant dyad was observed for a five-minute period. To ensure valid assessment, mothers were asked to initiate feeding if the infant had not been fed within the previous hour; if the infant had been fed, observation was scheduled for the next anticipated feeding time. The principal investigator and supervisors provided continuous oversight throughout data collection. Completed questionnaires were checked daily for completeness and accuracy, with immediate corrective measures implemented as necessary.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOperational definition\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBreastfeeding Technique:\u0026nbsp;\u003c/strong\u003eA composite measure of positioning, attachment, and suckling during breastfeeding, as defined by the World Health Organization(14).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePositioning\u003c/strong\u003e: Physical alignment or the way a mother holds her baby\u003c/p\u003e\n\u003cp\u003eGood positioning: when at least three out of four criteria for infant positioning was fulfilled; average positioning: when any two of the four criteria were correct and poor positioning when only one or none criterion has been fulfilled (15).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAttachment\u003c/strong\u003e: The manner in which the infant takes the breast into its mouth, including the amount of areola and breast tissue grasped.\u003c/p\u003e\n\u003cp\u003eGood attachment: when at least three out of four criterions have been fulfilled. Average attachment: when any two of the four criterions have been fulfilled. Poor attachment: when only one or none out of four criterions have been fulfilled (15).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSuckling:\u003c/strong\u003e The action by which a baby removes milk from the breast.\u003c/p\u003e\n\u003cp\u003eEffective suckling: at least two out of three criterions have been fulfilled. Ineffective suckling: only one or none from three criterions has been fulfilled (15).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIneffective breastfeeding technique:\u003c/strong\u003e ineffective breast feeding techniques was a composite variable of the three constructs (positioning, attachment, and suckling) such that breastfeeding women with at least one of the constructs categorized as \u0026ldquo;poor\u0026rdquo; were regarded as having IBT(16, 17).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eknowledge of breastfeeding practices\u003c/strong\u003e: Knowledge was assessed using twelve relevant questions. A correct answer was scored \u0026apos;1\u0026apos; and an incorrect answer \u0026apos;0\u0026apos;. A composite knowledge score was calculated for each participant. Respondents scoring at or above the mean score were categorized as having good knowledge, while those scoring below the mean were categorized as having poor knowledge (18).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData processing and analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCollected data were carefully processed in multiple steps. All questionnaires were visually inspected and coded. Double data entry was performed independently by two data clerks using EpiData version 4.6. The two datasets were cross-checked for consistency to produce a clean and accurate master file, which was then exported to SPSS version 26 for statistical analysis. The primary outcome variable, ineffective breastfeeding technique, was derived from three components: maternal positioning, infant attachment, and suckling. Each component was first assessed and categorized (e.g., attachment: good, average, poor). For the binary composite outcome, the \u0026lsquo;good\u0026rsquo; and \u0026lsquo;average\u0026rsquo; categories for positioning and attachment were merged and coded as \u0026lsquo;1\u0026rsquo; (effective), while \u0026lsquo;poor\u0026rsquo; was coded as \u0026lsquo;0\u0026rsquo; (ineffective). Suckling was directly classified as effective or ineffective. A participant was considered to have ineffective breastfeeding technique (\u0026lsquo;1\u0026rsquo;) if any one of the three components was poor/ineffective.\u003c/p\u003e\n\u003cp\u003eDescriptive statistics (frequencies, percentages, means, and standard deviations) were used to summarize participant characteristics. Binary logistic regression was employed to identify factors associated with ineffective breastfeeding techniques. Variables with a p-value \u0026lt; 0.25 in bivariable analysis were included in the multivariable logistic regression to adjust for potential confounders. Multicollinearity was assessed using the Variance Inflation Factor (VIF) and standard errors. Model fit was evaluated using the Hosmer-Lemeshow goodness-of-fit test and the Omnibus test. \u0026nbsp; \u0026nbsp;Associations are reported as Adjusted Odds Ratios (AOR) with 95% Confidence Intervals (CI). A two-sided p-value \u0026lt; 0.05 was considered statistically significant. Results are presented using frequency tables and graphical illustrations, including pie charts and bar graphs.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic Characteristics\u003c/h2\u003e \u003cp\u003eA total of 420 lactating mother\u0026ndash;infant dyads participated in the study, resulting in a response rate of 99.3%. The median age of the mothers was 28 years (interquartile range [IQR]: 22\u0026ndash;33 years), with more than one-third (149; 35.5%) aged above 31 years. The majority of participants (225; 53.6%) had attained secondary education or higher. A detailed summary of the sociodemographic characteristics is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of lactating mothers attending public hospitals in South Gondar Zone, Northwest Ethiopia, 2022 (n\u0026thinsp;=\u0026thinsp;420).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePlace of residences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e56.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmhara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e409\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e97.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOrthodox\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProtestant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCurrently married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e415\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e98.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eMother\u0026rsquo;s Occupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovernmental employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDaily laborer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMother\u0026rsquo;s educational status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo Formal Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eHusband Educational status (n\u0026thinsp;=\u0026thinsp;415)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e61.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNB: Others (marital status) -Single, divorced, and widowed, Others (Occupation) -Student, and N.G.O employee.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eHealth-Related Characteristics of the younger Infants\u003c/h2\u003e \u003cp\u003eAmong the younger infants, 228 (54.3%) were male. The majority (343; 81.7%) were under 42 days of age. Regarding perinatal characteristics, 360 (85.7%) were born with a normal birth weight, and 379 (90.2%) were delivered at term. A detailed summary of infant characteristics is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of younger infants of lactating mothers attending public hospitals in the South Gondar Zone, Northwest Ethiopia, 2022 (n\u0026thinsp;=\u0026thinsp;420)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eyounger infant age in (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;42 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e81.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026nbsp;42 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eGestational age at birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreterm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTerm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e379\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eBirth weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNBW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e360\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e85.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLBW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMacrosomia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInfant\u0026rsquo;s sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePacifier used\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e360\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e85.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBottle feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e318\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e75.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eComplementary started\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTime of initiation (n\u0026thinsp;=\u0026thinsp;169)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eMaternal and Infant Health Service Utilization Characteristics\u003c/h2\u003e \u003cp\u003eThe study revealed high utilization of maternal health services, with 85% of mothers attending antenatal care (ANC) and 96.4% receiving postnatal care (PNC). However, among those who attended ANC, only 19% received counseling on breastfeeding techniques (BFT). Knowledge of breastfeeding practices was classified as poor in 56% of participants. The maternal cohort was nearly evenly distributed between primiparous (50.2%) and multiparous (49.8%) women. Most deliveries occurred in a health facility (94%), with hospitals accounting for the majority (65.4%) and spontaneous vaginal delivery being the predominant mode of birth (84.1%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eBreastfeeding Technique practices and Associated factors\u003c/h2\u003e \u003cp\u003eThe prevalence of ineffective breastfeeding technique among the study participants was 54.3% (95% CI: 49.8\u0026ndash;59.8). Suboptimal practices were observed across key components of breastfeeding: 17.6% of mothers demonstrated poor positioning, 32.9% exhibited poor attachment, and 24.3% showed ineffective suckling. Analysis of supportive practices further indicated that only 29.8% of mothers provided full body support to their infant, 29.9% ensured that the infant\u0026rsquo;s chin was in contact with the breast, and 36.7% maintained proper alignment of the infant\u0026rsquo;s head and body (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with ineffective breast feeding\u003c/h2\u003e \u003cp\u003eMultivariable logistic regression analysis identified several factors significantly associated with ineffective breastfeeding technique (IBT) among lactating mothers. Maternal age was protective: mothers aged 21\u0026ndash;25 and 26\u0026ndash;30 years had 77% (AOR\u0026thinsp;=\u0026thinsp;0.23; 95% CI: 0.11\u0026ndash;0.48) and 52% (AOR\u0026thinsp;=\u0026thinsp;0.48; 95% CI: 0.27\u0026ndash;0.84) lower odds of IBT, respectively, compared with mothers aged\u0026thinsp;\u0026ge;\u0026thinsp;31 years. Mothers with no formal education had 1.74-fold higher odds of IBT (AOR\u0026thinsp;=\u0026thinsp;1.74; 95% CI: 1.15\u0026ndash;3.00) than those with secondary education or higher. Primiparous mothers were 2.16 times more likely to demonstrate IBT compared with multiparous mothers (AOR\u0026thinsp;=\u0026thinsp;2.16; 95% CI: 1.25\u0026ndash;3.73).\u003c/p\u003e \u003cp\u003eThe absence of antenatal care (ANC) follow-up increased the likelihood of IBT threefold (AOR\u0026thinsp;=\u0026thinsp;3.09; 95% CI: 1.56\u0026ndash;6.09). Mothers experiencing breast problems had 2.22-fold higher odds of IBT (AOR\u0026thinsp;=\u0026thinsp;2.22; 95% CI: 1.15\u0026ndash;4.65), and those who practiced bottle feeding in combination with breastfeeding had 1.95-fold higher odds (AOR\u0026thinsp;=\u0026thinsp;1.95; 95% CI: 1.14\u0026ndash;3.33). Mothers with no prior information on breastfeeding techniques were 1.94 times more likely to exhibit IBT (AOR\u0026thinsp;=\u0026thinsp;1.94; 95% CI: 1.20\u0026ndash;3.14). Additionally, breastfeeding mothers with poor knowledge of breastfeeding practices had 1.8 times greater odds of demonstrating ineffective breastfeeding (AOR\u0026thinsp;=\u0026thinsp;1.80; 95% CI: 1.52\u0026ndash;4.6) compared with those with good knowledge. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors associated with ineffective breast-feeding technique among lactating mothers visiting public hospitals in south Gondar zone, northwest Ethiopia,2022 (n\u0026thinsp;=\u0026thinsp;420)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eIneffective BFT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e \u003cp\u003eCOR 95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c8\" namest=\"c7\" rowspan=\"2\"\u003e \u003cp\u003eAOR 95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNo (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eAge category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e49(70.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21(30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.61(0.88,2.96))\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.55 (0.25,1.18))\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e47 (51.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45(48.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.72(0.41,1.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.23(0.11 ,0.48)) \u003cb\u003e***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e44(40.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65(59.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.46(0.28 0.77) \u003cb\u003e***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.48(0.27 ,0.84) \u003cb\u003e**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e88(59.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61(40.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eEducation status of mothers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85(66.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e43(33.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.10(1.34,3.30) \u003cb\u003e***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.74(1.15, 3.00) * *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34(50.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e33(49.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.09(0.65,1.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.01(0.55 ,2.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.762\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003csup\u003ery\u003c/sup\u003e school \u0026amp;above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109(48.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e116(51.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimipara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e132(62.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e79(37.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.96(1.33,2.90) \u003cb\u003e* *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e2.16(1.25,3.73) * * *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultipara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96(46.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e113(54.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eANC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49(77.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e14(22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3.48 (1.86, 6.52) \u003cb\u003e* * *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e3.09(1.56 ,6.09) **\u003cb\u003e*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e179(50.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e178(49.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003ePrevious information about BFT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e145(63.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e82(36.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.34(1.58 ,3.47) \u003cb\u003e* * *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.94(1.20 ,3.14 )\u003cb\u003e***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83(43.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e110(57.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eKnowledge of breastfeeding practices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e139((59.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e96(40.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.56(1.10,2.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.8(1.52 ,4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89(48.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e96(51.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eBreas problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30(69.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e13(30.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.08(1.15,4.124) \u003cb\u003e*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e2.22(1.15, 4.65) \u003cb\u003e**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e198(52.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e179(47.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e111(60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e74(\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.51(1.12,2.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.91(0.56,1.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.708\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e117(49.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e118(50.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eCombine use of bottle feeding with breastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70(68.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e32(31.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.21(1.38,3.55)) \u003cb\u003e***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.95(1.14,3.33) \u003cb\u003e**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e158(49.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e160(50.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePacifier use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40((66.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e20(33.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.83(1,12,3.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.27(0.65,2.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.479\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e188(52.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e172(47.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003eComplementary feeding\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108(63.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e61(36.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.93(1.29,2.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.36(0.86,2.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.185\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e120(47.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e131(52.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eSignificant at *, * * and ***: P value; \u0026le; 0.05, \u0026le; 0.01 and \u0026le;\u0026thinsp;0.001 both in the COR and AOR respectively CI, Confidence interval; COR, Crude Odds Ratio; AOR, Adjusted Odds Ratio; ANC, antenatal care\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eBreastfeeding is a cornerstone of infant nutrition, essential for optimal growth, immune protection, and survival, particularly during the first six months of life. Effective breastfeeding relies on correct maternal positioning, infant attachment, and suckling technique. Ineffective breastfeeding can result in inadequate milk intake, poor weight gain, and increased susceptibility to infections, contributing to adverse infant health outcomes(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study aimed to determine the prevalence of ineffective breastfeeding technique (IBT) and its associated factors among breastfeeding mothers attending public hospitals in the South Gondar Zone, Northwest Ethiopia. The findings revealed that a substantial proportion of mothers exhibited IBT, underscoring a significant public health concern. Several maternal, infant, and health service-related factors were identified as determinants of ineffective breastfeeding, highlighting the multifactorial nature of breastfeeding practices. By situating these results within the broader literature on breastfeeding in low-resource settings, this study provides valuable insight into the behavioural, educational, and healthcare factors influencing breastfeeding outcomes, which can inform strategies to improve maternal and infant health in the region.\u003c/p\u003e \u003cp\u003eThe prevalence of IBT in this study was 54.3%. This finding is consistent with studies conducted in Gondar, Ethiopia (52%)(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), south Nigeria (51%) (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), and Harar (56.6%) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). This consistency suggests that IBT remains a common challenge in low-resource settings. However, the proportion was higher than that reported in a study from Denmark (48%) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). This discrepancy may be explained by differences in maternal education, healthcare quality, and breastfeeding support. Mothers in Denmark generally have higher education levels and greater access to structured lactation counselling, trained healthcare providers, and postnatal follow-up, which promote effective breastfeeding practices. In contrast, in South Gondar, limited access to breastfeeding information, lower rates of antenatal counselling, and fewer supportive services likely contribute to the higher prevalence. Cultural practices, socioeconomic factors, and maternal or infant health challenges, such as primiparity or breast problems, may also increase the risk of ineffective breastfeeding in this setting ((\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)). Conversely, the current finding is lower than rates reported from India (69.7%) (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) and the Ari District, Ethiopia (63.5%) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). This difference may be explained by the lower proportion of mothers with no formal education (30.4% vs. 60.5%) and fewer mothers experiencing breast problems (10.2% vs. 14.3%) in the current study. Additionally, higher utilization of antenatal and postnatal care, greater exposure to breastfeeding information, and regional differences in cultural practices and maternal support may have contributed to the lower prevalence of IBT in this setting (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMultivariable analysis showed that maternal age was a significant protective factor, with mothers aged 21–25 and 26–30 years having 77% and 52% lower odds of ineffective breastfeeding technique, respectively, compared to mothers aged 31 years and above. This may be explained by better physical comfort and fewer age-related breast or musculoskeletal issues, greater exposure to breastfeeding information through antenatal and postnatal care, and higher motivation to adopt recommended practices. Additionally, younger mothers may receive more guidance and support from healthcare providers and family members, which can enhance correct positioning, attachment, and suckling.(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) .This finding contrasts with a previous study in Gondar(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), The discrepancy may be due to differences in study population characteristics, including variations in maternal education, parity, exposure to antenatal and postnatal counselling, and access to updated breastfeeding information. Additionally, methodological differences in the assessment of breastfeeding techniques and sample size could have contributed to the observed variation (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMaternal educational attainment was significantly associated with IBT. Mothers without formal education had 1.74-fold higher odds of IBT compared to those with secondary education or higher. This result aligns with studies from Delhi, Nepal, and Harari, Ethiopia (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). The association may be attributed to the challenges illiterate mothers face in comprehending nursing instructions, lower motivation to seek professional support, and reduced health-seeking behaviors, potentially limiting their access to antenatal and postnatal counselling on breastfeeding(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). To address this, promoting home visits by health extension workers and implementing targeted educational interventions for illiterate mothers are recommended.\u003c/p\u003e \u003cp\u003eBreastfeeding mothers with poor knowledge of breastfeeding practices had 1.8 times higher odds of demonstrating ineffective compared with those with good knowledge. This underscores the crucial role of maternal knowledge in ensuring proper positioning, attachment, and suckling. Mothers lacking adequate knowledge may be unaware of correct techniques and the importance of frequent feeding, leading to suboptimal practices and adverse infant outcomes. These findings align with studies from Ethiopia and India, highlighting that targeted educational interventions through antenatal counselling, postnatal support, and community health programs are essential to improve breastfeeding practices and optimize infant health.\u003c/p\u003e \u003cp\u003eThe use of bottle feeding in combination with breastfeeding was associated with a 1.95-fold increase in the odds of ineffective breastfeeding technique. Our finding was supported by studies from Brazil and Gondar (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). The association between bottle feeding and ineffective breastfeeding may be explained by nipple confusion, where infants struggle to coordinate sucking at the breast, resulting in poor attachment and ineffective suckling. Bottle-fed infants may also feed less frequently at the breast, limiting maternal practice and mastery of correct positioning and attachment. Additionally, bottle feeding can contribute to breast refusal and reduced milk supply, shortening feeding duration and further compromising breastfeeding technique. These observations are consistent with previous studies(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). and reinforce WHO recommendations for exclusive breastfeeding during the first six months to promote effective breastfeeding practices.\u003c/p\u003e \u003cp\u003eParity emerged as a significant determinant of ineffective breastfeeding technique (IBT), with primiparous mothers having twice the odds of IBT compared to multiparous mothers. This association may be explained by the limited prior breastfeeding experience among first-time mothers, which can negatively affect their ability to correctly position the infant, achieve proper attachment, and ensure effective suckling. Additionally, primiparous mothers may experience lower confidence, heightened anxiety, and reduced problem-solving skills during breastfeeding, which further impairs their technique. In contrast, multiparous mothers often benefit from previous breastfeeding experiences, allowing them to refine their skills, anticipate common challenges, and implement effective corrective measures during feeds. These observations are supported by evidence from studies conducted in India and Ethiopia, which similarly reported higher odds of IBT among primiparous mothers due to inexperience and lower practical competence in breastfeeding(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). This finding highlights the importance of targeted counselling and hands-on support for first-time mothers during antenatal and postnatal care to improve breastfeeding practices and optimize infant nutrition outcomes.\u003c/p\u003e \u003cp\u003eThe absence of antenatal care (ANC) follow-up was a significant predictor of ineffective breastfeeding technique (IBT), with mothers who did not attend ANC exhibiting three times higher odds of IBT (AOR = 3.09) compared to those who attended. This may be attributed to missed opportunities for structured breastfeeding education and guidance, including proper positioning, attachment, and suckling techniques, as well as counselling on exclusive breastfeeding and early problem-solving. ANC serves as a critical platform for delivering maternal health and nutritional interventions(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), and missing these sessions deprives mothers—particularly first-time mothers—of opportunities to build the self-confidence, skills, and knowledge essential for proper breastfeeding practices in the postnatal period (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).Consequently, mothers without ANC follow-up are more likely to experience ineffective breastfeeding. This finding aligns with studies from Nigeria, India, and Wollo, Ethiopia(\u003cspan additionalcitationids=\"CR36\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e–\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), highlighting the crucial role of antenatal care in promoting effective breastfeeding practices.\u003c/p\u003e \u003cp\u003eThe experience of breast problems was associated with a 2.2-fold increase in the odds of ineffective breastfeeding technique (IBT). This finding is consistent with studies conducted in Ethiopia, India, and Indonesia(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Breast conditions such as mastitis, engorgement, and cracked nipples often cause pain and discomfort, which can interfere with proper infant positioning, attachment, and effective suckling. In an attempt to minimize pain, mothers may adopt suboptimal breastfeeding techniques, thereby increasing the likelihood of IBT (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). These problems may also reduce feeding frequency and duration, limiting opportunities to practise and maintain correct techniques. Early identification and management of breast problems during antenatal care and the early postpartum period, together with appropriate counselling on prevention and treatment, are therefore critical to improving breastfeeding technique and outcomes.(\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFinally, mothers who had no prior information on breastfeeding techniques had nearly twofold higher odds of ineffective breastfeeding technique (AOR = 1.94), a finding consistent with studies from India and Harar, Ethiopia(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). This association may be explained by the lack of essential knowledge and practical guidance on correct positioning, attachment, and effective suckling among uninformed mothers. In the absence of prior information, mothers may also have limited confidence in their breastfeeding abilities and reduced awareness of the benefits of proper technique, increasing reliance on inappropriate practices and hindering early correction of breastfeeding problems, thereby predisposing them to ineffective breastfeeding.\u003c/p\u003e \u003cp\u003eThis study demonstrates that ineffective breastfeeding technique is highly prevalent among breastfeeding mothers in South Gondar hospitals, indicating a substantial public health concern. The practice was influenced by a combination of maternal, behavioural, and health service–related factors, including maternal age, education, parity, antenatal care attendance, bottle feeding, breast problems, and lack of prior breastfeeding information. Younger maternal age was protective, whereas primiparity, absence of ANC follow-up, limited breastfeeding counselling, and breast-related complications increased the likelihood of ineffective technique. These findings underscore the critical role of quality antenatal and postnatal care, early breastfeeding education, and targeted support for first-time mothers in improving breastfeeding practices and optimising infant health outcomes.\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLimitation\u003c/h2\u003e \u003cp\u003eThis study has several limitations that should be considered when interpreting the findings. First, information on some maternal practices and prior experiences was collected through self-report, which may be subject to recall bias. Second, because breastfeeding techniques were assessed through direct observation, the possibility of a Hawthorne effect cannot be excluded, whereby mothers may have modified their breastfeeding behavior due to awareness of being observed, despite attempts to minimize this effect through unobtrusive assessment procedures.\u003c/p\u003e \u003c/div\u003e "},{"header":"Conclusion and Recommendations","content":"\u003cp\u003eIneffective breastfeeding technique is highly prevalent among breastfeeding mothers attending public hospitals in the South Gondar Zone, with over half of the participants demonstrating suboptimal practices. The study identified several factors associated with ineffective breastfeeding, including maternal age, educational level, parity, antenatal care attendance, prior breastfeeding information, breast problems, and the use of bottle feeding. Younger maternal age and prior exposure to breastfeeding guidance were protective, whereas primiparity, lack of ANC follow-up, limited breastfeeding counselling, breast-related complications, and bottle feeding significantly increased the risk of ineffective technique.\u003c/p\u003e\u003cp\u003eTo address these challenges, targeted interventions are essential. Health facilities should strengthen antenatal and postnatal breastfeeding education, incorporating practical demonstrations of proper positioning, attachment, and suckling techniques. Primiparous mothers require focused guidance and support to build confidence and competence in breastfeeding. Educational strategies should be tailored for mothers with limited formal education, including home visits and practical teaching methods. Early identification and management of breast complications, along with counselling on exclusive breastfeeding and the risks of bottle feeding, are critical to improving technique and infant nutrition. Integrating these strategies into maternal and child health programs can enhance breastfeeding practices, promote infant health, and reduce the burden of ineffective breastfeeding in the region.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAAP-America Academy of Pediatrics; ANC Antenatal Care; BFIH Baby-Friendly Hospital Initiative; FT- Breastfeeding Techniques; EBF Exclusive Breastfeeding; \u0026nbsp;EBT Effective Breastfeeding Techniques ; EDHS -Ethiopian Demographic Health Survey; \u0026nbsp; EPI Expanded Program of Immunization; FMOH-Federal Ministry of Health; IMNCI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Integrated Management of Neonatal and Childhood Illness; IYCF - Infant Young Child Feeding; PNC Postnatal Care; \u0026nbsp;SIDS Sudden Infant Death Syndrome; SPSS- Statistical Package for Social Science; SSA \u0026nbsp;Sub-Saharan Africa; TBA \u0026nbsp;Traditional Birth Attendant ;WHO World Health Organization.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent to Participate:\u003c/strong\u003e Ethical approval was obtained from the Institutional Health Research Ethics Review Committee (IHRERC) of Haramaya University, College of Health and Medical Sciences (\u003cstrong\u003eRef: IHRERC/077/2022)\u003c/strong\u003e, and permission was secured from the heads of participating health facilities. The study was conducted in accordance with the Declaration of Helsinki, ensuring respect for participants’ rights, safety, and well-being. Written informed consent was obtained from all mothers after explaining the study objectives, potential risks, and benefits, ensuring voluntary participation and full understanding of their rights.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest;\u0026nbsp;\u003c/strong\u003eThe author(s) declared no potential conflicts of interest for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The funding was obtained from Debre Tabor University College of Health and Medical Sciences. There was no code for the budget and it was released by simple signature of the correspondent author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor's Contributions:\u0026nbsp;\u003c/strong\u003eAll authors contributed to the study conception and design. TE and HD drafted the original manuscript, performed data analysis, and revised the manuscript. HD managed data curation. TA participated in data analysis. SG handled data entry and cleaning. GT AND HD supervised data collection and provided critical revisions. All authors reviewed, validated, and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Above all, we would like to thank Debre Tabor University, and HU-CHMS. Secondly, we would like to give our thanks to south Gonder zonal hospitals administers Thirdly, we would like to thank respected advisors, data collectors, supervisors, and study participants\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHD (MSc. in maternity and Neonatal care in Nursing) - Lecturer at Debre Tabor\u0026nbsp;\u003c/p\u003e\n\u003cp\u003euniversity, College of Health and Medical Sciences, School of Nursing\u003c/p\u003e\n\u003cp\u003eTA \u0026nbsp;(PhD. in public health) - Lecturer at Haramaya University, College of\u003c/p\u003e\n\u003cp\u003eHealth and Medical Sciences, School of Nursing and Midwifery. SG (PhD fellow, LUMC, The Netherlands; Assistant Professor, Haramaya University,) - Lecturer at Haramaya University, College of Health and Medical Science, School of Nursing and Midwifery.GT (Assistant Professor of Maternal and child health at Haramaya University-- Lecturer at Haramaya University, College of Health and Medical Science, School of Nursing and Midwifery.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eUNICEF. Infant and young child feeding. 2018. Dostupno na: https://data unicef org/topic/nutrition/infant-and-young-child-feeding/(0909 2018). 2017.\u003c/li\u003e\n\u003cli\u003eBoquien C-Y. Human Milk: An Ideal Food for Nutrition of Preterm Newborn. Frontiers in Pediatrics. 2018;6.\u003c/li\u003e\n\u003cli\u003eRinata E, Sari PA. BREASTFEEDING PRACTICES [POSITIONING, ATTACHMENT/LATCH-ON AND EFFECTIVE SUCKLING. SEAJOM: The Southeast Asia Journal of Midwifery. 2017;3(2):1-6.\u003c/li\u003e\n\u003cli\u003eKhanal V. Breastfeeding practices and lactation mastitis in Western Nepal: A prospective cohort study: Curtin University; 2016.\u003c/li\u003e\n\u003cli\u003eGoyal RC, Banginwar AS, Ziyo F, Toweir AA. Breastfeeding practices: positioning, attachment (latch-on) and effective suckling\u0026ndash;a hospital-based study in Libya. Journal of Family and Community Medicine. 2011;18(2):74.\u003c/li\u003e\n\u003cli\u003eNduagubam OC, Ndu IK, Bisi-Onyemaechi A, Onukwuli VO, Amadi OF, Okeke IB, et al. Assessment of breastfeeding techniques in Enugu, South-East Nigeria. Ann Afr Med. 2021;20(2):98-104.\u003c/li\u003e\n\u003cli\u003eBell\u0026ugrave; R, Cond\u0026ograve; M. Breastfeeding promotion: evidence and problems. La Pediatria Medica e Chirurgica. 2017;39(2).\u003c/li\u003e\n\u003cli\u003eKent JC, Ashton E, Hardwick CM, Rowan MK, Chia ES, Fairclough KA, et al. Nipple Pain in Breastfeeding Mothers: Incidence, Causes and Treatments. Int J Environ Res Public Health. 2015;12(10):12247-63.\u003c/li\u003e\n\u003cli\u003eYilak G, Tilahun BD, Abate BB, Zemariam AB, Lake ES, Ayele M, et al. Prevalence of ineffective breastfeeding techniques and its associated factors among breastfeeding mothers in Ethiopia: A systematic review and meta-analysis. PLoS One. 2024;19(6):e0303749.\u003c/li\u003e\n\u003cli\u003eACOG. \u0026lt;Breastfeeding Challenges pdf\u0026gt;. 2021.\u003c/li\u003e\n\u003cli\u003eTonguet-Papucci A, Houngbe F, Huybregts L, Ait-Aissa M, Altare C, Kolsteren P, et al. Unconditional seasonal cash transfer increases intake of high-nutritional-value foods in young Burkinabe children: results of 24-hour dietary recall surveys within the Moderate Acute Malnutrition Out (MAM\u0026apos;Out) randomized controlled trial. The Journal of Nutrition. 2017;147(7):1418-25.\u003c/li\u003e\n\u003cli\u003eBizuneh FK, Tolossa T, Bekonjo NE, Wakuma B. Time to recovery from severe acute malnutrition and its predictors among children aged 6\u0026ndash;59 months at Asosa general hospital, Northwest Ethiopia. A retrospective follow up study. PloS one. 2022;17(8):e0272930.\u003c/li\u003e\n\u003cli\u003eAbaba A. Essential Health Services Package of Ethiopia. 2019.\u003c/li\u003e\n\u003cli\u003eWHO. Infant and young child feeding: model chapter for textbooks for medical students and allied health professionals: World Health Organization; 2009.\u003c/li\u003e\n\u003cli\u003eDegefa N, Tariku B, Bancha T, Amana G, Hajo A, Kusse Y, et al. Breast Feeding Practice: Positioning and Attachment during Breast Feeding among Lactating Mothers Visiting Health Facility in Areka Town, Southern Ethiopia. International journal of pediatrics. 2019;2019:8969432.\u003c/li\u003e\n\u003cli\u003eWHO. Breastfeeding counselling a training course. 2014.\u003c/li\u003e\n\u003cli\u003eYilak G, Gebretsadik W, Tadesse H, Debalkie M, Bante A. Prevalence of ineffective breastfeeding technique and associated factors among lactating mothers attending public health facilities of South Ari district, Southern Ethiopia. PloS one. 2020;15(2):e0228863.\u003c/li\u003e\n\u003cli\u003eThakre SB, Thakre SS, Ughade SM, Golawar S, Thakre AD, Kale P. The Breastfeeding Practices: The Positioning and Attachment Initiative Among the Mothers of Rural Nagpur. Journal of Clinical \u0026amp; Diagnostic Research. 2012;6(7).\u003c/li\u003e\n\u003cli\u003eSafayi BL, Assimamaw NT, Kassie DG. Breastfeeding technique and associated factors among lactating mothers visiting Gondar town health facilities, Northwest Ethiopia: observational method. Italian Journal of Pediatrics. 2021;47(1):1-10.\u003c/li\u003e\n\u003cli\u003eTiruye G, Mesfin F, Geda B, Shiferaw K. Breastfeeding technique and associated factors among breastfeeding mothers in Harar city, Eastern Ethiopia. International breastfeeding journal. 2018;13(1):1-9.\u003c/li\u003e\n\u003cli\u003eLording R. How are effective breastfeeding technique and pacifier use related to breastfeeding problems and breastfeeding duration? Breastfeeding Review. 2010;18(1):34-5.\u003c/li\u003e\n\u003cli\u003eKitil GW, Butta FW, Tadesse S, Degefa BD, Feyisa GT, Demsash AW, et al. Effective breastfeeding techniques and associated factors among lactating women in Ethiopia: A systematic review and meta-analysis. PLoS One. 2024;19(6):e0306167.\u003c/li\u003e\n\u003cli\u003eZegeye AF, Gebrehana DA, Bezabih SA, Mengistu SA, Adane KC, Lakew AM. Poor access to breastfeeding counseling services and associated factors among lactating mothers who had optimal antenatal care follow-up in Sub-saharan Africa: a multilevel analysis of the recent Demographic and Health Survey. BMC health services research. 2024;24(1):1577.\u003c/li\u003e\n\u003cli\u003eDasgupta U, Mallik S, Bhattacharyya K, Sarkar J, Bhattacharya S, Halder A. Breastfeeding practices: positioning, attachment and effective suckling\u0026mdash;a hospital based study in West Bengal/Kolkata. Indian J Mater Child Health. 2013;15:1-11.\u003c/li\u003e\n\u003cli\u003eCan V, Bulduk M, Can EK, Ayşin N. Impact of social support and breastfeeding success on the self-efficacy levels of adolescent mothers during the postpartum period. Reproductive health. 2025;22(1):19.\u003c/li\u003e\n\u003cli\u003eSafayi BL, Assimamaw NT, Kassie DG. Breastfeeding technique and associated factors among lactating mothers visiting Gondar town health facilities, Northwest Ethiopia: observational method. Italian Journal of Pediatrics. 2021;47(1):206.\u003c/li\u003e\n\u003cli\u003ePaudel DP, Giri S. Breast feeding practices and associated factors in Bhaktapur District of Nepal: A community based cross-sectional study among lactating mothers. Journal of the Scientific Society. 2014;41(2):108-13.\u003c/li\u003e\n\u003cli\u003eToe SY, Higuchi M, Hamajima N. Health care seeking behaviors regarding maternal care and the associated factors among married women in Naung Cho Township, Myanmar. Nagoya Journal of Medical Science. 2021;83(4):727.\u003c/li\u003e\n\u003cli\u003eBatista CL, Ribeiro VS, Nascimento MdDS, Rodrigues VP. Association between pacifier use and bottle-feeding and unfavorable behaviors during breastfeeding. Jornal de Pediatria. 2018;94:596-601.\u003c/li\u003e\n\u003cli\u003eEidelman AI. Routine pacifier use in infants: pros and cons. SciELO Brasil; 2019. p. 121-3.\u003c/li\u003e\n\u003cli\u003eZimmerman E, Thompson K. Clarifying nipple confusion. Journal of Perinatology. 2015;35(11):895-9.\u003c/li\u003e\n\u003cli\u003eJoshi H, Magon P, Raina S. Effect of mother-infant pair\u0026apos;s latch-on position on child\u0026apos;s health: A lesson for nursing care. J Family Med Prim Care. 2016;5(2):309-13.\u003c/li\u003e\n\u003cli\u003eBiks GA, Tariku A, Tessema GA. Effects of antenatal care and institutional delivery on exclusive breastfeeding practice in northwest Ethiopia: a nested case\u0026ndash;control study. International Breastfeeding Journal. 2015;10(1):30.\u003c/li\u003e\n\u003cli\u003ePiro SS, Ahmed HM. Impacts of antenatal nursing interventions on mothers\u0026rsquo; breastfeeding self-efficacy: an experimental study. BMC Pregnancy and Childbirth. 2020;20(1):19.\u003c/li\u003e\n\u003cli\u003eNduagubam OC, Ndu IK, Bisi-Onyemaechi A, Onukwuli VO, Amadi OF, Okeke IB, et al. Assessment of breastfeeding techniques in enugu, south-east Nigeria. Annals of African Medicine. 2021;20(2):98.\u003c/li\u003e\n\u003cli\u003eChethana K, Maria N, Manjula A, Jayaram S. Role of mother\u0026rsquo;s education and antenatal counselling on breast feeding practices among women in coastal Karnataka: A community based cross sectional study. 2020.\u003c/li\u003e\n\u003cli\u003eAsmamaw DB, Habitu YA, Negash WD, Desta DZ, Mekonnen EG. Effective breastfeeding technique and associated factors among lactating mothers in Gidan District, North-East, Ethiopia: a community-based cross-sectional study. BMJ open. 2022;12(7):e059518.\u003c/li\u003e\n\u003cli\u003eAswathaman N, Sajjid M, Kamalarathnam C, Seeralar A. Assessment of Breastfeeding Position and Attachment (ABPA) in a tertiary care centre in Chennai, India: An observational descriptive cross-sectional study. Int J Contemp Pediatr. 2018;5:2209-16.\u003c/li\u003e\n\u003cli\u003eBoskabadi H, Ramazanzadeh M, Zakerihamidi M, Omran FR. Risk factors of breast problems in mothers and its effects on newborns. Iranian Red Crescent Medical Journal. 2014;16(6).\u003c/li\u003e\n\u003cli\u003eKent JC, Ashton E, Hardwick CM, Rowan MK, Chia ES, Fairclough KA, et al. Nipple Pain in Breastfeeding Mothers: Incidence, Causes and Treatments. Int J Environ Res Public Health. 2015;12(10):12247-63.\u003c/li\u003e\n\u003cli\u003eShitie A, Adimasu A, Tsegaye D, Belete D, Mislu E, Assfaw M, et al. Breast problems and associated factors among lactating women in Northeast Ethiopia, 2022. Scientific reports. 2024;14(1):9202.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Positioning, Attachment, Suckling, Breastfeeding technique, Maternal knowledge","lastPublishedDoi":"10.21203/rs.3.rs-8481912/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8481912/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIneffective breastfeeding techniques contribute substantially to early discontinuation of exclusive breastfeeding and to maternal breast complications. Despite their public health importance, evidence on the magnitude and determinants of ineffective breastfeeding practices in Ethiopia\u0026mdash;particularly in the South Gondar Zone\u0026mdash;remains limited. This study aimed to determine the prevalence of ineffective breastfeeding techniques and to identify associated factors among lactating mothers attending public hospitals in the South Gondar Zone, Ethiopia.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eAn institution-based cross-sectional study was conducted among lactating mothers. A total of 423 participants were selected using systematic random sampling. Data were collected through direct observation using a structured checklist and via interviewer-administered questionnaires. Ineffective breastfeeding technique was defined and assessed based on the standard components of positioning, attachment, and suckling. Data were entered into EpiData and analyzed using SPSS. Bivariable and multivariable logistic regression analyses were performed to identify independent predictors of ineffective breastfeeding techniques.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eThe prevalence of ineffective breastfeeding techniques was 54.3% (95% CI: 49.9%\u0026ndash;59.8%). Ineffective breastfeeding was significantly associated with having poor knowledge of breastfeeding practices(AOR\u0026thinsp;=\u0026thinsp;1.8; 95% CI; 1.52\u0026ndash;4.6), no formal education (AOR\u0026thinsp;=\u0026thinsp;1.74; 95% CI: 1.15\u0026ndash;3.00), primiparity (AOR\u0026thinsp;=\u0026thinsp;2.16; 95% CI: 1.15\u0026ndash;3.73), bottle-feeding practice (AOR\u0026thinsp;=\u0026thinsp;1.95; 95% CI: 1.14\u0026ndash;3.33), lack of antenatal care follow-up (AOR\u0026thinsp;=\u0026thinsp;3.09; 95% CI: 1.56\u0026ndash;6.09), absence of prior information on breastfeeding techniques (AOR\u0026thinsp;=\u0026thinsp;1.94; 95% CI: 1.20\u0026ndash;3.14), and a history of breast-related problems (AOR\u0026thinsp;=\u0026thinsp;2.22; 95% CI: 1.15\u0026ndash;4.65).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIneffective breastfeeding technique was found to be highly prevalent, and more than half of the mothers demonstrated inadequate knowledge of proper breastfeeding practices. Interventions aimed at reducing this burden should prioritize enhancing women\u0026rsquo;s education, promote antenatal care attendance, and provide mothers with comprehensive information, counselling, and education to improve both technique and knowledge.\u003c/p\u003e","manuscriptTitle":"Prevalence of Ineffective Breastfeeding Techniques and Associated Factors Among Breastfeeding Mothers in South Gondar Hospitals, Ethiopia: A Cross- Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-12 06:22:42","doi":"10.21203/rs.3.rs-8481912/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":"89574300-0bcc-44d3-9542-dc790c0ddd7b","owner":[],"postedDate":"January 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-04T09:41:45+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-12 06:22:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8481912","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8481912","identity":"rs-8481912","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}