Exclusive Breastfeeding Practices Among Somali Children: A Scoping Review

Exclusive Breastfeeding Practices Among Somali Children: A Scoping Review | 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 Systematic Review Exclusive Breastfeeding Practices Among Somali Children: A Scoping Review Mohamed Said Hassan, Mohamoud Abdulahi, Abdirahman Ibrahim said, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5851813/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: Exclusive breastfeeding (EBF) is crucial for infant health, yet its practice remains suboptimal in many settings, including Somalia. This scoping review aimed to map the available literature on EBF practices among children in Somalia, identifying key factors and barriers. Methods: A comprehensive search was conducted using Google Scholar, PubMed, and Portal Garuda for studies on EBF in Somalia. A structured approach was used to screen, assess eligibility, and extract data from 10 relevant articles. The data was then synthesized using a narrative approach to identify key themes. Results: The reviewed studies, conducted across various regions of Somalia, revealed wide variations in EBF rates, ranging from 5.2% to 68%. The factors associated with higher EBF rates included maternal education, antenatal care attendance, and social support. Barriers to EBF included low socioeconomic status, cultural beliefs, and perceptions of insufficient milk. The lack of Scopus indexing in some of the included journals was noted, but the studies were retained to capture the diversity of data in this area. Conclusion: This scoping review highlights the complex interplay of factors affecting EBF in Somalia. The findings underscore the need for comprehensive and context-specific interventions that address maternal education, healthcare access, and social support networks to improve EBF rates in Somalia. Exclusive Breastfeeding Somalia Infant Feeding Maternal Health Scoping Review Child Health Breastfeeding Practices Socioeconomic Factors Figures Figure 1 Background Breastfeeding is globally recognized as the optimal feeding method for infants and young children, providing essential nutrients, antibodies, and promoting healthy growth and development (World Health Organization, 2022). The World Health Organization (WHO) and UNICEF recommend exclusive breastfeeding (EBF) for the first six months of life, followed by the introduction of complementary foods while continuing breastfeeding for up to two years or beyond (World Health Organization, 2022) (UNICEF, 2023a ). EBF, defined as giving an infant only breast milk without any other liquids or solids, not even water, has been linked to numerous benefits, including reduced risk of infections, improved cognitive development, and decreased maternal morbidity (Victora et al., 2016 ). Despite these well-established benefits, achieving and sustaining high rates of EBF remains a global challenge, particularly in low- and middle-income countries (LMICs). Somalia, a nation facing protracted humanitarian crises and instability, presents a particularly complex context for infant and young child feeding practices (OCHA, 2023 ). The country has endured decades of conflict, displacement, and climate-related shocks, which have severely impacted its health infrastructure and socio-economic conditions (UNICEF, 2023b ). These factors can profoundly affect families' access to healthcare, resources, and information necessary for optimal breastfeeding practices. Previous studies have indicated that EBF rates in Somalia are suboptimal, with variations across different regions and socioeconomic groups (UNICEF, 2020 ) ((SDHS), 2020). Cultural norms, misinformation, and lack of awareness among caregivers, alongside limited access to skilled breastfeeding counseling, often contribute to suboptimal feeding practices (Hassan & Hossain, 2023 ). Additionally, the challenging humanitarian context in Somalia often leads to reliance on other infant feeding alternatives due to food insecurity and perceptions of inadequate breastmilk supply, further impacting EBF rates (IFRC, 2022 ). Understanding the specific challenges and barriers to EBF in Somalia is crucial for designing effective interventions and policies to improve infant and child health outcomes in this vulnerable population. Therefore, this scoping review seeks to systematically map the existing literature on exclusive breastfeeding practices among children in Somalia. By examining the range of published studies, grey literature, and other available resources, this review aims to identify the factors that influence EBF rates in Somalia, highlight existing knowledge gaps, and inform future research and public health programming to promote optimal infant and young child feeding practices. Methods This scoping review aimed to map the available literature on exclusive breastfeeding (EBF) practices among children in Somalia. The review followed a structured approach to systematically identify, screen, and synthesize relevant studies. The methodological approach is described below: 1. Search Strategy: A comprehensive search was conducted across multiple electronic databases, including Google Scholar, PubMed, and Portal Garuda, to identify studies related to exclusive breastfeeding in Somalia. The search terms included variations and combinations of the following keywords: "exclusive breastfeeding," "breastfeeding," "infant feeding," "Somalia," "Somaliland," "child health," "maternal health," "infant nutrition," and "early childhood." The search strategy was intentionally broad to capture a wide range of studies on the topic. No date restrictions were applied to the search to ensure all relevant literature was captured. 2. Study Selection: The study selection process followed a staged approach, as summarized in the PRISMA flow. Initial Identification: The initial search across the three databases yielded a total of 28 records. After the removal of duplicates, 25 unique articles were identified. Screening: The titles and abstracts of the identified records were screened for relevance to the research question, which is an exploration of EBF practices in Somalia. Studies that did not directly address EBF practices in Somalia were excluded at this stage, resulting in the exclusion of 15 articles. The screening criteria included relevance to EBF, location within Somalia, and availability of an abstract. Eligibility: The full texts of the remaining 10 articles were assessed against the eligibility criteria. The primary criteria for inclusion were: Focus on EBF practices or factors associated with EBF Study population from Somalia. The study was peer-reviewed and available in English language. No studies were excluded at this stage due to inability to find the full text, resulting in 10 articles that met the final inclusion criteria. 4. Data Synthesis : The extracted data was synthesized and presented using a narrative approach. The focus of the synthesis was to identify and map key themes related to EBF practices in Somalia, including the prevalence of EBF, factors associated with or acting as barriers to EBF, and common recommendations. The analysis included both the quantitative findings (e.g. EBF rates) and qualitative findings. Attention was also paid to regional differences and trends in the data. 5. Quality Assessment: Due to the scoping nature of this review, a formal methodological quality assessment was not performed. However, the limitations of using non-Scopus indexed journals and studies with cross-sectional designs were considered during the interpretation and synthesis of the results. 6. Ethical Considerations As this is a scoping review of already published research, no additional ethical approvals were sought. 7. PRISMA Flow: A PRISMA-like flow was used to visually present the study selection process. The PRISMA flow follows these phases: Identification, Screening, Eligibility, and Inclusion. It clearly outlines the number of records identified from the various databases, excluded, and ultimately included for analysis. Table 1 For the 10 studies that met the inclusion criteria, the following information was extracted into a structured table: Author Title Aim Study Design Results Journal Abdiasis Jama et al. ( 2020 ) Exclusive breastfeeding for the first six months of life and its associated factors among children in Burao Assess exclusive breastfeeding for 6 months and associated factors in Burao, Somaliland Community-based cross-sectional study Prevalence of EBF was 20.47%. Key factors: mother's education, income, husband's support, and antenatal care counseling. Recommendations: improved education, engagement of husbands, and counseling. International Breastfeeding Journal Mohamed Said Hassan et al. (2023) Challenges for influencing exclusive breastfeeding among mothers in Borama Examine barriers to EBF among lactating mothers with infants aged < 6 months in Borama Descriptive cross-sectional study EBF prevalence was low due to lack of education, marital status, employment, and perceptions of insufficient milk. Recommendations: targeted counseling and community-based interventions. Health Science Reports Ahmed Ismail Mohamed et al. ( 2020 ) Prevalence of Exclusive Breastfeeding Practice and Its Associated Factors in Hargeisa Assess EBF prevalence and its factors among mothers in Hargeisa Community-based cross-sectional study EBF prevalence was 68%. Influencing factors: antenatal care attendance, awareness about EBF benefits, and feeding colostrum. EBF was significantly associated with receiving information and attending ANC. Science Journal of Public Health Abdiwali M. Mohamud et al. ( 2021 ) Prevalence of Optimal Breastfeeding and Maternal and Child Health Care Service-Related Factors in Dollow Establish prevalence of optimal breastfeeding and its associated factors in Dollow District, Somalia Descriptive cross-sectional study EBF prevalence was 27.6%. Key factors: skilled birth attendance, child growth monitoring, and postpartum care. Recommendations: interventions to promote income-generating activities and nutrition education. African Journal of Health Sciences Adan Yusuf Mahdi et al. ( 2020 ) Prevalence, Level of Awareness and Socio-Demographic Predictors of Exclusive Breastfeeding in Waberi District Determine prevalence, awareness, and socio-demographic predictors of EBF in Waberi District, Mogadishu Descriptive cross-sectional survey EBF prevalence was low. Predictors: education, ANC attendance, and socio-economic factors. Recommendations: education campaigns and improved ANC services. African Journal of Health Sciences Adam A. Mohamed et al. ( 2018 ) Prevalence and Associated Factors of Exclusive Breastfeeding in Galkayo Assess EBF prevalence and its associated factors among mothers in Galkayo, Somalia Community-based cross-sectional study EBF prevalence was only 5.2%. Predictors: education, health facility delivery, and counseling. Recommendations: enhance education, facility-based delivery, and awareness campaigns. Science Journal of Public Health Deka A. Gaal ( 2022 ) Maternal factors associated with exclusive breastfeeding in post-conflict Mogadishu Identify maternal factors influencing EBF among mothers in Mogadishu Cross-sectional study EBF prevalence was 30%. Key factors: education, marital status, ANC visits, and delivery at health facilities. Recommendations: improved maternal education and support during ANC and delivery. International Journal of Health Sciences Abdirahman M.A. et al. (2024) Assessment of Prevalence and Determinants of Exclusive Breastfeeding among Mothers with Infants Aged under Six Months in Wadajir District, Somalia Assess EBF prevalence and determinants among mothers with infants under six months in Wadajir District Descriptive cross-sectional study EBF prevalence was 65%. Determinants included maternal education, cultural barriers, and ANC visits. Recommendations: localized EBF campaigns and better maternal support services. International Journal of Tropical Disease and Health Amal Hussein Abdulle et al. ( 2023 ) Determinants of Exclusive Breastfeeding Practice amongst Mothers with Children below Six Months of Age in Dayah IDP Camp, Mogadishu Investigate determinants of EBF among mothers with children under six months in Dayah IDP Camp Descriptive cross-sectional study EBF prevalence was 20.1%. Key determinants included knowledge level, socio-cultural practices, and access to healthcare. Recommendations: Improve EBF awareness and encourage deliveries in healthcare facilities. Asian Journal of Medical Principles and Clinical Practice Khadija Mohamed Adam et al. ( 2022 ) Incomplete Exclusive Breastfeeding among Women: A Case Study of Darussalam MCH Center in Baidoa Explore the prevalence of incomplete exclusive breastfeeding and its contributing factors Cross-sectional study High prevalence of incomplete exclusive breastfeeding due to factors like illness, economic issues, and early pregnancy. Recommendations include improving awareness about the benefits of EBF and addressing socio-economic barriers. European Journal of Medical and Health Sciences Discussion This scoping review provides a comprehensive analysis of exclusive breastfeeding (EBF) practices in Somalia, drawing on ten studies conducted across diverse regions, including Burao (Jama et al., 2020 ), Borama (Hassan & Hossain, 2023 ), Hargeisa (A. I. Mohamed, Tegene, & Jonah, 2020 ), Dollow (Mohamud, Nzioki, & Muhamud, 2021 ), Mogadishu (Gaal, 2022 ) (Mahdi, Nzioki, & Kubende, 2020 ), Galkayo (A. A. Mohamed et al., 2018 ), Wadajir District (Abdirahman, Mogere, Musotsi, & Omoto, 2024 ), Dayah IDP camp (Abdulle, Suleiman, & Kariuki, 2023 ) and Baidoba (Adam et al., 2022 ). These studies consistently underscore the multi-faceted nature of EBF, influenced by a complex interplay of maternal, socio-economic, cultural, and healthcare-related factors. The prevalence of EBF varied widely across the studies, ranging from 5.2% in Galkayo (A. A. Mohamed et al., 2018 ), to 68% in Hargeisa (A. I. Mohamed et al., 2020 ). Other notable rates include 20.47% in Burao (Jama et al., 2020 ), 27.6% in Dollow (Mohamud et al., 2021 ), 65% in Wadajir District (Abdirahman et al., 2024 ) and 20.1% in Dayah IDP camp (Abdulle et al., 2023 ). This substantial variation highlights the importance of considering localized contexts and the potential influence of region-specific factors in shaping breastfeeding practices. Maternal education consistently emerged as a key determinant of EBF. Numerous studies, such as those conducted in Burao (Jama et al., 2020 ), Borama (Hassan & Hossain, 2023 ), Wadajir District (Abdirahman et al., 2024 ), and Mogadishu (Gaal, 2022 ), found that mothers with higher levels of education were more likely to practice EBF. This underscores the significance of female education as a tool for promoting informed infant feeding practices. Antenatal care (ANC) attendance also consistently emerged as a positive predictor of EBF (Mahdi et al., 2020 ). Regular ANC visits offer critical opportunities for mothers to receive education, counseling, and support related to breastfeeding. The findings also show that access to health services (Abdirahman et al., 2024 ), (Abdulle et al., 2023 ) is important. Socioeconomic factors were also found to play a significant role, with lower household income often associated with decreased rates of EBF. The study from the Dayah IDP camp (Abdulle et al., 2023 )highlights the vulnerabilities of displaced populations and their EBF practices. In addition, cultural beliefs, lack of support networks, and perceptions of insufficient milk were also identified as significant barriers (Hassan & Hossain, 2023 ) ;(Abdirahman et al., 2024 ). Social support, particularly from husbands, was identified as a positive influence on EBF (Jama et al., 2020 ), (Abdirahman et al., 2024 ) demonstrating that a holistic approach, including families and communities, is needed to promote EBF. Several studies show that knowledge, while important, does not always translate to better EBF practice (Mohamud et al., 2021 ), (Abdulle et al., 2023 )), and highlights the need for consistent support and counseling for mothers. Scopus Indexing and Rationale for Inclusion of All Studies It is important to note that not all of the ten studies included in this scoping review were published in journals indexed in Scopus. While Scopus indexing is often considered an indicator of a journal’s quality and impact, we have chosen to include studies from non-Scopus-indexed journals to capture all available research from Somalia on exclusive breastfeeding. The limited research drives this decision, which specifically focuses on EBF within Somalia. Limitations and Future Research This scoping review provides a valuable synthesis of the available evidence on exclusive breastfeeding practices in Somalia. However, several limitations must be acknowledged. Most included studies utilized cross-sectional designs, limiting our ability to make causal inferences. Moreover, the scarcity of qualitative research restricts our understanding of the complex social and cultural factors influencing EBF practices. Given the limited body of research on EBF in Somalia, this review includes studies from journals not indexed in major databases like Scopus. While these journals provide crucial regional insights, the absence of Scopus indexing—with only 4 of the 10 studies being indexed—might indicate that some included studies have not undergone the same rigorous peer review as those in major databases. This limitation underscores the need for caution when interpreting the generalizability of our findings. The reliance on self-reported data is also susceptible to recall and social desirability bias, which may affect the accuracy of reported EBF practices. Future research should address these issues by employing more robust study designs, incorporating qualitative research, and minimizing bias. This review may have also missed relevant grey literature or non-English publications that could have further contributed to the findings." Future research should prioritize: Qualitative Studies: To deeply explore cultural and social factors influencing EBF behaviors. Intervention Studies: To evaluate the effectiveness of specific interventions to enhance EBF rates in different contexts. Longitudinal Studies: To examine the temporal relationship between factors and EBF practices, and assess long-term impacts of interventions. Community-Based Participatory Research: To engage local communities and stakeholders in identifying barriers and designing context-specific interventions. Exploration of Regional Disparities: A further in-depth study is needed to address the differences in EBF practices across different regions of Somalia. Conclusion This scoping review provides a detailed understanding of EBF practices in Somalia, highlighting the critical importance of maternal education, access to ANC services, social support (especially husbands), and the complex socioeconomic and cultural factors that influence breastfeeding behaviors. There is a critical need for implementing comprehensive, context-specific, and community-based interventions to enhance exclusive breastfeeding rates. Addressing existing research limitations through further studies incorporating qualitative methods and evaluating intervention effectiveness is essential for developing evidence-based policies and programs promoting EBF and improving child health outcomes across Somalia. Declarations Data Availability All data analyzed in this scoping review are derived from publicly available sources. The references section details specific sources. Ethics Declaration Ethics declaration: not applicable. This scoping review analyzes data from published literature and does not involve human subjects or interventions. Therefore, ethics approval was not required. Consent to Publish Declaration Consent to Publish declaration: not applicable. This scoping review does not contain any person’s data and does not require separate consent to publish. Consent to Participate Declaration Consent to Participate declaration: not applicable. This scoping review does not involve the direct participation of any human subjects. Author Contributions: MSH: Conceptualization, methodology, data analysis, writing - original draft, writing - review & editing, corresponding author. MA: Literature search, data analysis, writing - review & editing. AIS: Literature search, table creation, writing - review & editing. MB: Data analysis, writing - review & editing. Explanation of the Contributions: Mohamed Said Hassan (MSH): As the corresponding author, he led the project, designed the methodology, performed the data analysis, wrote the initial draft, and oversaw the revisions. This indicates a significant leadership role. Mohamoud Abdulahi (MA): Contributed to the literature search, performed data analysis, and assisted with the writing and editing of the manuscript. Abdirahman Ibrahim Said (AIS): Participated in the literature search, constructed the tables, and contributed to the writing and editing of the manuscript. Muna Boqore (MB): Participated in the data analysis and contributed to the writing and editing of the manuscript. Competing Interests The authors declare that they have no competing interests. References (SDHS). S. D. a. H. S. (2020). SHDS-Report-2020. Abdirahman MA, Mogere D, Musotsi AA, Omoto AL. Assessment of Prevelance and Determinants of Exclusive Breastfeeding among Mothers with Infants Aged under Six Months in Wadajir District, Banadir Region, Somalia. Int J Trop DISEASE Health. 2024;45(5):12–28. Abdulle AH, Suleiman MA, Kariuki JG. Determinants of Exclusive Breastfeeding Practice amongst Mothers with Children below Six Months of Age in Dayah IDP Camp Mogadishu, Somalia. Asian J Med Principles Clin Pract. 2023;6(2):145–52. Adam KM, Ahmed IA, Abdulle IH, Abdulbari KA, Aden AO, Jawaani2,., Eno MA. (2022). Incomplete Exclusive Breastfeeding among Women: A Case Study of Darussalam MCH Center in Baidoa, Southwest State of Somalia. European Journal of Medical and Health Sciences, 4 (5), 163–172. Gaal DA. (2022). The maternal factors associated with exclusive breastfeeding among postnatal mothers at A private hospital in post-Conflict mogadishu. Int J health Sci, 2578–86. Hassan MS, Hossain MM. (2023). Challenges for influencing exclusive breastfeeding practice among lactating mothers with infants aged 0–6 months in Borama District, Somaliland: A cross-sectional study. Health Sci Rep, 6(11), e1693. IFRC. Somalia: Humanitarian Crisis. International Federation of Red Cross and Red Crescent Societies.; 2022. Jama A, Gebreyesus H, Wubayehu T, Gebregyorgis T, Teweldemedhin M, Berhe T, Berhe N. Exclusive breastfeeding for the first six months of life and its associated factors among children age 6–24 months in Burao district, Somaliland. Int Breastfeed J. 2020;15:1–8. Mahdi AY, Nzioki JM, Kubende P. Prevalence, Level of Awareness and Socio-Demographic Predictors of Exclusive Breastfeeding among Women of Reproductive Age in Waberi District, Mogadishu, Somalia. Afr J Health Sci. 2020;33(5):110–7. Mohamed AA, Mohamud SA, Mohamud FY, Ali KA, Abdulle FA, Hussein AA. Prevalence and Associated Factors of Exclusive Breastfeeding Practices Among Mothers of Infants Less Than Six Months in Galkayo, Somalia: A Community Based Cross-Sectional Study. Sci J Public Health. 2018;6(5):133–9. Mohamed AI, Tegene Y, Jonah K. Prevalence of Exclusive Breastfeeding Practice and Its Associated Factors Among Mothers with Children Aged 6–12 Months in Hargeisa City, Somaliland. Somaliland SJPH. 2020;8(2):43–9. Mohamud AM, Nzioki JM, Muhamud C. Prevalence of Optimal Breastfeeding and Maternal and Child Health Care Service-Related Factors Associated with Optimal Breastfeeding in Dollow District, Somalia. Afr J Health Sci. 2021;34(2):230–9. OCHA. (2023). Somalia Humanitarian Response Plan. UNICEF. (2020). RB_Situation_Somalia_20230430. UNICEF. (2023a). Infant and young child feeding. from https://data.unicef.org/topic/nutrition/infant-and-young-child-feeding/ UNICEF. (2023b). RB_Situation_Somalia_20230430. Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, Rollins NC. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475–90. World Health Organization, W. (2022). Infant and young child feeding. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5851813","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":403963440,"identity":"e1c654de-8b4b-415c-9d24-58d4c36eee56","order_by":0,"name":"Mohamed Said Hassan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIiWNgGAWjYBACAziLvQFEMgNxArFaeA6QrEUigUgt5uzHH3/4uYMhWn7m46cbPrZZM/Cz5xgw/qjArcWyJ8dMsvcMQ+6G22lmN2e2pTNI9rwxYOY5g8dhB3LYGHjbgFqkE8xu87YdZjC4kWPAzNiGR8v5548//gVqmT/z+DewFnugFsaf+LTcSDCQBtnScIMHaotEjgHIXjxa3phJy7ZJ5G44k1N2c8a5dB6JM88KDuP1y/n0xx/fttnkzm8/vu3GhzJrOf725I0P8YUYFEjAWTwg4gBBDaNgFIyCUTAK8AIAA9FTsc+r7D8AAAAASUVORK5CYII=","orcid":"","institution":"Amoud University","correspondingAuthor":true,"prefix":"","firstName":"Mohamed","middleName":"Said","lastName":"Hassan","suffix":""},{"id":403963441,"identity":"b54bddda-dbf6-480c-b6d2-655a3c81c781","order_by":1,"name":"Mohamoud Abdulahi","email":"","orcid":"","institution":"Amoud University","correspondingAuthor":false,"prefix":"","firstName":"Mohamoud","middleName":"","lastName":"Abdulahi","suffix":""},{"id":403963442,"identity":"6c952191-f00d-4333-a034-5220ba202f84","order_by":2,"name":"Abdirahman Ibrahim said","email":"","orcid":"","institution":"Amoud University","correspondingAuthor":false,"prefix":"","firstName":"Abdirahman","middleName":"Ibrahim","lastName":"said","suffix":""},{"id":403963443,"identity":"cfa4472a-d73c-4dd0-a65d-07cc108a5e05","order_by":3,"name":"Muna Boqore","email":"","orcid":"","institution":"Amoud University","correspondingAuthor":false,"prefix":"","firstName":"Muna","middleName":"","lastName":"Boqore","suffix":""}],"badges":[],"createdAt":"2025-01-17 21:38:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5851813/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5851813/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":74246749,"identity":"2357c50f-263c-4df6-9716-5b61f54c828d","added_by":"auto","created_at":"2025-01-20 09:55:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":59954,"visible":true,"origin":"","legend":"\u003cp\u003eStudy Selection with Prisma ScR diagram\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5851813/v1/f8cf18f12ed87626529b54f7.png"},{"id":74303167,"identity":"b5341894-7ebc-40b6-af2d-4694a216a8c2","added_by":"auto","created_at":"2025-01-20 22:01:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":670099,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5851813/v1/22a80dce-2fac-4bf8-bea2-52d145e47dd5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exclusive Breastfeeding Practices Among Somali Children: A Scoping Review","fulltext":[{"header":"Background","content":"\u003cp\u003eBreastfeeding is globally recognized as the optimal feeding method for infants and young children, providing essential nutrients, antibodies, and promoting healthy growth and development (World Health Organization, 2022). The World Health Organization (WHO) and UNICEF recommend exclusive breastfeeding (EBF) for the first six months of life, followed by the introduction of complementary foods while continuing breastfeeding for up to two years or beyond (World Health Organization, 2022) (UNICEF, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023a\u003c/span\u003e). EBF, defined as giving an infant only breast milk without any other liquids or solids, not even water, has been linked to numerous benefits, including reduced risk of infections, improved cognitive development, and decreased maternal morbidity (Victora et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite these well-established benefits, achieving and sustaining high rates of EBF remains a global challenge, particularly in low- and middle-income countries (LMICs). Somalia, a nation facing protracted humanitarian crises and instability, presents a particularly complex context for infant and young child feeding practices (OCHA, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The country has endured decades of conflict, displacement, and climate-related shocks, which have severely impacted its health infrastructure and socio-economic conditions (UNICEF, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023b\u003c/span\u003e). These factors can profoundly affect families' access to healthcare, resources, and information necessary for optimal breastfeeding practices.\u003c/p\u003e \u003cp\u003ePrevious studies have indicated that EBF rates in Somalia are suboptimal, with variations across different regions and socioeconomic groups (UNICEF, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) ((SDHS), 2020). Cultural norms, misinformation, and lack of awareness among caregivers, alongside limited access to skilled breastfeeding counseling, often contribute to suboptimal feeding practices (Hassan \u0026amp; Hossain, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Additionally, the challenging humanitarian context in Somalia often leads to reliance on other infant feeding alternatives due to food insecurity and perceptions of inadequate breastmilk supply, further impacting EBF rates (IFRC, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Understanding the specific challenges and barriers to EBF in Somalia is crucial for designing effective interventions and policies to improve infant and child health outcomes in this vulnerable population.\u003c/p\u003e \u003cp\u003eTherefore, this scoping review seeks to systematically map the existing literature on exclusive breastfeeding practices among children in Somalia. By examining the range of published studies, grey literature, and other available resources, this review aims to identify the factors that influence EBF rates in Somalia, highlight existing knowledge gaps, and inform future research and public health programming to promote optimal infant and young child feeding practices.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis scoping review aimed to map the available literature on exclusive breastfeeding (EBF) practices among children in Somalia. The review followed a structured approach to systematically identify, screen, and synthesize relevant studies. The methodological approach is described below:\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1. Search Strategy:\u003c/h2\u003e \u003cp\u003eA comprehensive search was conducted across multiple electronic databases, including Google Scholar, PubMed, and Portal Garuda, to identify studies related to exclusive breastfeeding in Somalia. The search terms included variations and combinations of the following keywords: \"exclusive breastfeeding,\" \"breastfeeding,\" \"infant feeding,\" \"Somalia,\" \"Somaliland,\" \"child health,\" \"maternal health,\" \"infant nutrition,\" and \"early childhood.\" The search strategy was intentionally broad to capture a wide range of studies on the topic. No date restrictions were applied to the search to ensure all relevant literature was captured.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e2. Study Selection:\u003c/h3\u003e\n\u003cp\u003eThe study selection process followed a staged approach, as summarized in the PRISMA flow.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eInitial Identification: The initial search across the three databases yielded a total of 28 records. After the removal of duplicates, 25 unique articles were identified.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eScreening: The titles and abstracts of the identified records were screened for relevance to the research question, which is an exploration of EBF practices in Somalia. Studies that did not directly address EBF practices in Somalia were excluded at this stage, resulting in the exclusion of 15 articles. The screening criteria included relevance to EBF, location within Somalia, and availability of an abstract.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEligibility: The full texts of the remaining 10 articles were assessed against the eligibility criteria. The primary criteria for inclusion were:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eFocus on EBF practices or factors associated with EBF\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStudy population from Somalia.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe study was peer-reviewed and available in English language.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eNo studies were excluded at this stage due to inability to find the full text, resulting in 10 articles that met the final inclusion criteria.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e4. \u003cb\u003eData Synthesis\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eThe extracted data was synthesized and presented using a narrative approach. The focus of the synthesis was to identify and map key themes related to EBF practices in Somalia, including the prevalence of EBF, factors associated with or acting as barriers to EBF, and common recommendations. The analysis included both the quantitative findings (e.g. EBF rates) and qualitative findings. Attention was also paid to regional differences and trends in the data.\u003c/p\u003e \u003cp\u003e5. Quality Assessment:\u003c/p\u003e \u003cp\u003eDue to the scoping nature of this review, a formal methodological quality assessment was not performed. However, the limitations of using non-Scopus indexed journals and studies with cross-sectional designs were considered during the interpretation and synthesis of the results.\u003c/p\u003e \u003cp\u003e6. Ethical Considerations\u003c/p\u003e \u003cp\u003eAs this is a scoping review of already published research, no additional ethical approvals were sought.\u003c/p\u003e \u003cp\u003e7. PRISMA Flow:\u003c/p\u003e \u003cp\u003eA PRISMA-like flow was used to visually present the study selection process. The PRISMA flow follows these phases: Identification, Screening, Eligibility, and Inclusion. It clearly outlines the number of records identified from the various databases, excluded, and ultimately included for analysis.\u003c/p\u003e \u003cp\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\u003eFor the 10 studies that met the inclusion criteria, the following information was extracted into a structured table:\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTitle\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAim\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStudy Design\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eResults\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eJournal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdiasis Jama et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExclusive breastfeeding for the first six months of life and its associated factors among children in Burao\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssess exclusive breastfeeding for 6 months and associated factors in Burao, Somaliland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCommunity-based cross-sectional study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePrevalence of EBF was 20.47%. Key factors: mother's education, income, husband's support, and antenatal care counseling. Recommendations: improved education, engagement of husbands, and counseling.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eInternational Breastfeeding Journal\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMohamed Said Hassan et al. (2023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChallenges for influencing exclusive breastfeeding among mothers in Borama\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExamine barriers to EBF among lactating mothers with infants aged\u0026thinsp;\u0026lt;\u0026thinsp;6 months in Borama\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDescriptive cross-sectional study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEBF prevalence was low due to lack of education, marital status, employment, and perceptions of insufficient milk. Recommendations: targeted counseling and community-based interventions.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eHealth Science Reports\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAhmed Ismail Mohamed et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrevalence of Exclusive Breastfeeding Practice and Its Associated Factors in Hargeisa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssess EBF prevalence and its factors among mothers in Hargeisa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCommunity-based cross-sectional study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEBF prevalence was 68%. Influencing factors: antenatal care attendance, awareness about EBF benefits, and feeding colostrum. EBF was significantly associated with receiving information and attending ANC.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eScience Journal of Public Health\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdiwali M. Mohamud et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrevalence of Optimal Breastfeeding and Maternal and Child Health Care Service-Related Factors in Dollow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEstablish prevalence of optimal breastfeeding and its associated factors in Dollow District, Somalia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDescriptive cross-sectional study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEBF prevalence was 27.6%. Key factors: skilled birth attendance, child growth monitoring, and postpartum care. Recommendations: interventions to promote income-generating activities and nutrition education.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eAfrican Journal of Health Sciences\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdan Yusuf Mahdi et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrevalence, Level of Awareness and Socio-Demographic Predictors of Exclusive Breastfeeding in Waberi District\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDetermine prevalence, awareness, and socio-demographic predictors of EBF in Waberi District, Mogadishu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDescriptive cross-sectional survey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEBF prevalence was low. Predictors: education, ANC attendance, and socio-economic factors. Recommendations: education campaigns and improved ANC services.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eAfrican Journal of Health Sciences\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdam A. Mohamed et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrevalence and Associated Factors of Exclusive Breastfeeding in Galkayo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssess EBF prevalence and its associated factors among mothers in Galkayo, Somalia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCommunity-based cross-sectional study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEBF prevalence was only 5.2%. Predictors: education, health facility delivery, and counseling. Recommendations: enhance education, facility-based delivery, and awareness campaigns.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eScience Journal of Public Health\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeka A. Gaal (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaternal factors associated with exclusive breastfeeding in post-conflict Mogadishu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIdentify maternal factors influencing EBF among mothers in Mogadishu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCross-sectional study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEBF prevalence was 30%. Key factors: education, marital status, ANC visits, and delivery at health facilities. Recommendations: improved maternal education and support during ANC and delivery.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eInternational Journal of Health Sciences\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdirahman M.A. et al. (2024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssessment of Prevalence and Determinants of Exclusive Breastfeeding among Mothers with Infants Aged under Six Months in Wadajir District, Somalia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssess EBF prevalence and determinants among mothers with infants under six months in Wadajir District\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDescriptive cross-sectional study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEBF prevalence was 65%. Determinants included maternal education, cultural barriers, and ANC visits. Recommendations: localized EBF campaigns and better maternal support services.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eInternational Journal of Tropical Disease and Health\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmal Hussein Abdulle et al. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDeterminants of Exclusive Breastfeeding Practice amongst Mothers with Children below Six Months of Age in Dayah IDP Camp, Mogadishu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInvestigate determinants of EBF among mothers with children under six months in Dayah IDP Camp\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDescriptive cross-sectional study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEBF prevalence was 20.1%. Key determinants included knowledge level, socio-cultural practices, and access to healthcare. Recommendations: Improve EBF awareness and encourage deliveries in healthcare facilities.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eAsian Journal of Medical Principles and Clinical Practice\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKhadija Mohamed Adam et al. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncomplete Exclusive Breastfeeding among Women: A Case Study of Darussalam MCH Center in Baidoa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExplore the prevalence of incomplete exclusive breastfeeding and its contributing factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCross-sectional study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHigh prevalence of incomplete exclusive breastfeeding due to factors like illness, economic issues, and early pregnancy. Recommendations include improving awareness about the benefits of EBF and addressing socio-economic barriers.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eEuropean Journal of Medical and Health Sciences\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis scoping review provides a comprehensive analysis of exclusive breastfeeding (EBF) practices in Somalia, drawing on ten studies conducted across diverse regions, including Burao (Jama et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), Borama (Hassan \u0026amp; Hossain, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), Hargeisa (A. I. Mohamed, Tegene, \u0026amp; Jonah, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), Dollow (Mohamud, Nzioki, \u0026amp; Muhamud, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), Mogadishu (Gaal, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) (Mahdi, Nzioki, \u0026amp; Kubende, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), Galkayo (A. A. Mohamed et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), Wadajir District (Abdirahman, Mogere, Musotsi, \u0026amp; Omoto, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), Dayah IDP camp (Abdulle, Suleiman, \u0026amp; Kariuki, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) and Baidoba (Adam et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). These studies consistently underscore the multi-faceted nature of EBF, influenced by a complex interplay of maternal, socio-economic, cultural, and healthcare-related factors.\u003c/p\u003e \u003cp\u003eThe prevalence of EBF varied widely across the studies, ranging from 5.2% in Galkayo (A. A. Mohamed et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), to 68% in Hargeisa (A. I. Mohamed et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Other notable rates include 20.47% in Burao (Jama et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), 27.6% in Dollow (Mohamud et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), 65% in Wadajir District (Abdirahman et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) and 20.1% in Dayah IDP camp (Abdulle et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). This substantial variation highlights the importance of considering localized contexts and the potential influence of region-specific factors in shaping breastfeeding practices.\u003c/p\u003e \u003cp\u003eMaternal education consistently emerged as a key determinant of EBF. Numerous studies, such as those conducted in Burao (Jama et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), Borama (Hassan \u0026amp; Hossain, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), Wadajir District (Abdirahman et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), and Mogadishu (Gaal, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), found that mothers with higher levels of education were more likely to practice EBF. This underscores the significance of female education as a tool for promoting informed infant feeding practices.\u003c/p\u003e \u003cp\u003eAntenatal care (ANC) attendance also consistently emerged as a positive predictor of EBF (Mahdi et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Regular ANC visits offer critical opportunities for mothers to receive education, counseling, and support related to breastfeeding. The findings also show that access to health services (Abdirahman et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), (Abdulle et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) is important.\u003c/p\u003e \u003cp\u003eSocioeconomic factors were also found to play a significant role, with lower household income often associated with decreased rates of EBF. The study from the Dayah IDP camp (Abdulle et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)highlights the vulnerabilities of displaced populations and their EBF practices. In addition, cultural beliefs, lack of support networks, and perceptions of insufficient milk were also identified as significant barriers (Hassan \u0026amp; Hossain, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) ;(Abdirahman et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Social support, particularly from husbands, was identified as a positive influence on EBF (Jama et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), (Abdirahman et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) demonstrating that a holistic approach, including families and communities, is needed to promote EBF.\u003c/p\u003e \u003cp\u003eSeveral studies show that knowledge, while important, does not always translate to better EBF practice (Mohamud et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), (Abdulle et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)), and highlights the need for consistent support and counseling for mothers.\u003c/p\u003e\n\u003ch3\u003eScopus Indexing and Rationale for Inclusion of All Studies\u003c/h3\u003e\n\u003cp\u003eIt is important to note that not all of the ten studies included in this scoping review were published in journals indexed in Scopus. While Scopus indexing is often considered an indicator of a journal\u0026rsquo;s quality and impact, we have chosen to include studies from non-Scopus-indexed journals to capture all available research from Somalia on exclusive breastfeeding. The limited research drives this decision, which specifically focuses on EBF within Somalia.\u003c/p\u003e\n\u003ch3\u003eLimitations and Future Research\u003c/h3\u003e\n\u003cp\u003eThis scoping review provides a valuable synthesis of the available evidence on exclusive breastfeeding practices in Somalia. However, several limitations must be acknowledged. Most included studies utilized cross-sectional designs, limiting our ability to make causal inferences. Moreover, the scarcity of qualitative research restricts our understanding of the complex social and cultural factors influencing EBF practices.\u003c/p\u003e \u003cp\u003eGiven the limited body of research on EBF in Somalia, this review includes studies from journals not indexed in major databases like Scopus. While these journals provide crucial regional insights, the absence of Scopus indexing\u0026mdash;with only 4 of the 10 studies being indexed\u0026mdash;might indicate that some included studies have not undergone the same rigorous peer review as those in major databases. This limitation underscores the need for caution when interpreting the generalizability of our findings. The reliance on self-reported data is also susceptible to recall and social desirability bias, which may affect the accuracy of reported EBF practices. Future research should address these issues by employing more robust study designs, incorporating qualitative research, and minimizing bias. This review may have also missed relevant grey literature or non-English publications that could have further contributed to the findings.\"\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eFuture research should prioritize:\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eQualitative Studies: To deeply explore cultural and social factors influencing EBF behaviors.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eIntervention Studies: To evaluate the effectiveness of specific interventions to enhance EBF rates in different contexts.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eLongitudinal Studies: To examine the temporal relationship between factors and EBF practices, and assess long-term impacts of interventions.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCommunity-Based Participatory Research: To engage local communities and stakeholders in identifying barriers and designing context-specific interventions.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eExploration of Regional Disparities: A further in-depth study is needed to address the differences in EBF practices across different regions of Somalia.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis scoping review provides a detailed understanding of EBF practices in Somalia, highlighting the critical importance of maternal education, access to ANC services, social support (especially husbands), and the complex socioeconomic and cultural factors that influence breastfeeding behaviors. There is a critical need for implementing comprehensive, context-specific, and community-based interventions to enhance exclusive breastfeeding rates. Addressing existing research limitations through further studies incorporating qualitative methods and evaluating intervention effectiveness is essential for developing evidence-based policies and programs promoting EBF and improving child health outcomes across Somalia.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data analyzed in this scoping review are derived from publicly available sources. The references section details specific sources.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics declaration: not applicable. This scoping review analyzes data from published literature and does not involve human subjects or interventions. Therefore, ethics approval was not required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent to Publish declaration: not applicable. This scoping review does not contain any person\u0026rsquo;s data and does not require separate consent to publish.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent to Participate declaration: not applicable. This scoping review does not involve the direct participation of any human subjects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eMSH:\u003c/strong\u003e Conceptualization, methodology, data analysis, writing - original draft, writing - review \u0026amp; editing, corresponding author.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMA:\u003c/strong\u003e Literature search, data analysis, writing - review \u0026amp; editing.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAIS:\u003c/strong\u003e Literature search, table creation, writing - review \u0026amp; editing.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMB:\u003c/strong\u003e Data analysis, writing - review \u0026amp; editing.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eExplanation of the Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eMohamed Said Hassan (MSH):\u003c/strong\u003e As the corresponding author, he led the project, designed the methodology, performed the data analysis, wrote the initial draft, and oversaw the revisions. This indicates a significant leadership role.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMohamoud Abdulahi (MA):\u003c/strong\u003e Contributed to the literature search, performed data analysis, and assisted with the writing and editing of the manuscript.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAbdirahman Ibrahim Said (AIS):\u003c/strong\u003e Participated in the literature search, constructed the tables, and contributed to the writing and editing of the manuscript.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMuna Boqore (MB):\u003c/strong\u003e Participated in the data analysis and contributed to the writing and editing of the manuscript.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e(SDHS). S. D. a. H. S. (2020). SHDS-Report-2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbdirahman MA, Mogere D, Musotsi AA, Omoto AL. Assessment of Prevelance and Determinants of Exclusive Breastfeeding among Mothers with Infants Aged under Six Months in Wadajir District, Banadir Region, Somalia. Int J Trop DISEASE Health. 2024;45(5):12\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbdulle AH, Suleiman MA, Kariuki JG. Determinants of Exclusive Breastfeeding Practice amongst Mothers with Children below Six Months of Age in Dayah IDP Camp Mogadishu, Somalia. Asian J Med Principles Clin Pract. 2023;6(2):145\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdam KM, Ahmed IA, Abdulle IH, Abdulbari KA, Aden AO, Jawaani2,., Eno MA. (2022). Incomplete Exclusive Breastfeeding among Women: A Case Study of Darussalam MCH Center in Baidoa, Southwest State of Somalia. \u003cem\u003eEuropean Journal of Medical and Health Sciences, 4\u003c/em\u003e(5), 163\u0026ndash;172.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGaal DA. (2022). The maternal factors associated with exclusive breastfeeding among postnatal mothers at A private hospital in post-Conflict mogadishu. Int J health Sci, 2578\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHassan MS, Hossain MM. (2023). Challenges for influencing exclusive breastfeeding practice among lactating mothers with infants aged 0\u0026ndash;6 months in Borama District, Somaliland: A cross-sectional study. Health Sci Rep, 6(11), e1693.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIFRC. Somalia: Humanitarian Crisis. International Federation of Red Cross and Red Crescent Societies.; 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJama A, Gebreyesus H, Wubayehu T, Gebregyorgis T, Teweldemedhin M, Berhe T, Berhe N. Exclusive breastfeeding for the first six months of life and its associated factors among children age 6\u0026ndash;24 months in Burao district, Somaliland. Int Breastfeed J. 2020;15:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMahdi AY, Nzioki JM, Kubende P. Prevalence, Level of Awareness and Socio-Demographic Predictors of Exclusive Breastfeeding among Women of Reproductive Age in Waberi District, Mogadishu, Somalia. Afr J Health Sci. 2020;33(5):110\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMohamed AA, Mohamud SA, Mohamud FY, Ali KA, Abdulle FA, Hussein AA. Prevalence and Associated Factors of Exclusive Breastfeeding Practices Among Mothers of Infants Less Than Six Months in Galkayo, Somalia: A Community Based Cross-Sectional Study. Sci J Public Health. 2018;6(5):133\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMohamed AI, Tegene Y, Jonah K. Prevalence of Exclusive Breastfeeding Practice and Its Associated Factors Among Mothers with Children Aged 6\u0026ndash;12 Months in Hargeisa City, Somaliland. Somaliland SJPH. 2020;8(2):43\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMohamud AM, Nzioki JM, Muhamud C. Prevalence of Optimal Breastfeeding and Maternal and Child Health Care Service-Related Factors Associated with Optimal Breastfeeding in Dollow District, Somalia. Afr J Health Sci. 2021;34(2):230\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOCHA. (2023). Somalia Humanitarian Response Plan.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUNICEF. (2020). RB_Situation_Somalia_20230430.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUNICEF. (2023a). Infant and young child feeding. from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://data.unicef.org/topic/nutrition/infant-and-young-child-feeding/\u003c/span\u003e\u003cspan address=\"https://data.unicef.org/topic/nutrition/infant-and-young-child-feeding/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUNICEF. (2023b). RB_Situation_Somalia_20230430.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVictora CG, Bahl R, Barros AJ, Fran\u0026ccedil;a GV, Horton S, Krasevec J, Rollins NC. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization, W. (2022). Infant and young child feeding.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"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":"Exclusive Breastfeeding, Somalia, Infant Feeding, Maternal Health, Scoping Review, Child Health, Breastfeeding Practices, Socioeconomic Factors","lastPublishedDoi":"10.21203/rs.3.rs-5851813/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5851813/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Exclusive breastfeeding (EBF) is crucial for infant health, yet its practice remains suboptimal in many settings, including Somalia. This scoping review aimed to map the available literature on EBF practices among children in Somalia, identifying key factors and barriers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A comprehensive search was conducted using Google Scholar, PubMed, and Portal Garuda for studies on EBF in Somalia. A structured approach was used to screen, assess eligibility, and extract data from 10 relevant articles. The data was then synthesized using a narrative approach to identify key themes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The reviewed studies, conducted across various regions of Somalia, revealed wide variations in EBF rates, ranging from 5.2% to 68%. The factors associated with higher EBF rates included maternal education, antenatal care attendance, and social support. Barriers to EBF included low socioeconomic status, cultural beliefs, and perceptions of insufficient milk. The lack of Scopus indexing in some of the included journals was noted, but the studies were retained to capture the diversity of data in this area.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e This scoping review highlights the complex interplay of factors affecting EBF in Somalia. The findings underscore the need for comprehensive and context-specific interventions that address maternal education, healthcare access, and social support networks to improve EBF rates in Somalia.\u003c/p\u003e","manuscriptTitle":"Exclusive Breastfeeding Practices Among Somali Children: A Scoping Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-20 09:55:08","doi":"10.21203/rs.3.rs-5851813/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":"25d168ab-1df8-4dc3-bb95-1839424da512","owner":[],"postedDate":"January 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-20T21:53:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-20 09:55:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5851813","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5851813","identity":"rs-5851813","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}