Exclusive breastfeeding and its determinants among infants attending a tertiary care hospital serving an underprivileged population in Rawalpindi, Pakistan: a cross-sectional study.

Abstract

To determine the pattern and determinants of exclusive breastfeeding (EBF) among infants visiting a tertiary care hospital of underprivileged population. Cross-sectional study. The Department of Pediatrics, Pakistan Railway Hospital, Rawalpindi, Pakistan. A total of 385 infants, born with gestational age between 34-42 weeks, were analysed. Data collection was performed through a structured questionnaire designed to capture relevant demographic and clinical details. The pattern of breastfeeding (BF), including EBF, formula milk, animal milk (cow/buffalo/goat milk) or mixed methods was determined. The collected data were entered and analysed using IBM-SPSS V.26. In a total of 385 infants, EBF was reported in 206 (53.5%) infants, while 36 (9.4%) were exclusively formula-fed (FF), 122 (31.7%) received a combination of BF and formula feeding (mixed FF and BF), 14 (3.6%) were given a mix of BF and animal milk, and 7 (1.8%) received BF along with water. Age (p=0.033), birth weight (p=0.050), mode of delivery, neonatal intensive care unit (NICU) admission (p=0.028), BF initiation timing (p<0.001), pre-lacteal feeding (p=0.021) and immunisation status (p=0.002) influenced EBF patterns. Maternal education (p=0.001) and antenatal counselling (p<0.001) had significant associations with BF patterns. Significant differences were observed in awareness of the appropriate duration of EBF (p=0.022). Despite the well-established benefits of EBF, only around half of the infants were exclusively breastfed, highlighting the need for targeted interventions. Cesarean delivery, NICU admission and pre-lacteal feeding practices were significant barriers to EBF, while early BF initiation, antenatal counselling and maternal education played pivotal roles in promoting EBF.