Rate of Exclusive Breastfeeding Among Postpartum Mothers at Hoima Regional Referral Hospital’s Postnatal Clinic

Nagudi Flavia Kiwuso

Faculty of Clinical Medicine and Dentistry Kampala International University Western Campus Uganda.


Despite active promotion, Uganda reports that 36% of children under 6 months are not exclusively breastfed, impacting infant health. This study focuses on 428 interviews within the Kampala district’s informal sector, aiming to understand exclusive breastfeeding practices among mothers with infants aged 0–5 months. Results indicated a 41.1% prevalence of exclusive breastfeeding. Factors linked to this practice included attending antenatal care at least four times, intending to breastfeed exclusively for six months or more, adopting proper breastfeeding techniques, and the age of the infant. Notably, working in lower positions was associated with a lower likelihood of exclusive breastfeeding. Recommendations emphasize the importance of antenatal care in educating mothers about exclusive breastfeeding’s advantages, enabling informed decisions. Additionally, enforcing maternity leave benefits outlined in Uganda’s Employment Act within the informal sector can support women in practicing exclusive breastfeeding.

Keywords: Exclusive breastfeeding, Children below 6 months, Antenatal care, Maternity leave.


Exclusive breastfeeding (EBF) is defined as giving breast milk to the infant, without any additional food or drink, not even water in the first 6 months of life, except vitamins, mineral supplements or medicines [1]. Breastfeeding is one of the oldest practices recommended by all religions and it is the universally endorsed solution in the prevention of early malnutrition. Breastfeeding is a natural process of infant feeding involving two main methods; exclusive and partial with the latter being the trendiest [2, 3]. Full breastfeeding is breastfeeding either exclusive or predominant. Partial breastfeeding includes other feeding methods in addition to breastfeeding regardless of content. [4, 5]. The United Nations developed the Millennium Development Goals with goal 4 (MDG-4) aimed to reduce the under-5 mortality rates by two-thirds between 1990 and 2015 and when the MDGs were recently evaluated exclusive breastfeeding for six months was considered one of the most effective interventions to achieve MDG-4 [6]. To achieve the above goal WHO developed a Global Strategy for Infant and Young Child Feeding recommends planning and monitoring of the Baby-Friendly Hospital Initiative and expanded it beyond the maternity care setting. Step number five of the “Ten steps to successful breastfeeding” is “Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants” [7]. Breastfeeding is important for the growth and development of newborn babies by providing vital nutrients. World Health Organization (WHO) recommends that breastfeeding should be initiated within the first hours of life and exclusive breastfeeding is enough, without any additional foods or drinks up to six months [8]. The WHO guidelines assert that breast milk is the natural first food for babies; it provides all the energy and nutrients that the infant needs for the first six months of life and it continues to provide up to half or more of a child’s nutritional needs during the second half of the first year and up to one-third during the second year of life. WHO recommends colostrum, the yellowish sticky breast milk produced at the end of pregnancy as the perfect food for the newborn; this can be tapped through early initiation of breastfeeding [9]. In view of the benefits of breastfeeding, starting breastfeeding in the first hour of delivery, exclusive breastfeeding (EBF) for the first 6 months of life, and continued breastfeeding together with suitable complementary foods for up to 2 years or beyond is recommended as the best infant feeding plan for optimal growth, development, and health [10]. Exclusive breastfeeding offers short-term and long-term health benefits both to the mother and the infant. It also provides economic benefits by reducing both the direct and indirect costs related to healthcare and infant feeding [11]. Breast milk is the best food for the infant for the first 6 months of life and it should be initiated within 1 hour of birth, even before the expulsion of the placenta [12]. Optimal breastfeeding practices play a key role in improving the health and development of children under 5 years [13]. Human breast milk is the ideal food for human infants. It offers nutrients that are essential for normal growth and proper development and is central to establishing the foundation for a long healthy life [14]. The antibodies contained in breast milk, which mothers transfer to their infants, act as the first line of defense against some childhood killer diseases. This mother-to-child transfer of antibodies is considered passive immunization. Breastfeeding is also of immense benefit to the mother. When exclusively done, it could be a natural method of delaying pregnancy. This is called the lactational amenorrhea method (LAM); a form of contraception that has wide cultural acceptability [15]. As well, breast cancer and ovarian cancer risk prospects are reduced among mothers who give exclusive breast milk [5, 16, 17]. Furthermore, breast milk contains essential fatty acids needed for the infant’s growing brain, eyes, and blood vessels and these are not available in other types of milk [18]. Although studies show that EBF has the potential to reduce under-five mortalities by 11.6%, the prevalence of EBF is still below the WHO recommendation of 90% worldwide [9]. Globally, only 38% of infants are exclusively breastfed. The prevalence varied from country to country. In Canada,10.4% of mothers exclusively breastfed while in the Republic of Congo, 2.8% did so. The prevalence of EBF was generally higher in developing countries than in developed ones, 49% in Timor, Asia, and 35.4% in Korea [19]. The overall prevalence in sub-Saharan countries was 36.0% with the highest being in Rwanda, Malawi, Burundi, Ghana, and Zambia and the lowest in Guinea, Nigeria, Cote d Ivoire, Sierra Leone, and Gabon [13]. In East Africa, the EBF rates are quite impressive with Rwanda (84.9%), Burundi (69.3%), Kenya (61.4%), and Tanzania (50%) all having more than half of the infants 0–5 months old exclusively breastfed [20]. Only six in 10 Ugandan children below the age of six months are exclusively breastfed. It is no wonder then that the under-five and infant mortality rates stand at 128 and 79 per 1,000 live births respectively, which is very high by developing world standards [9]. This rate is associated with a number of factors such as educational level, occupation, cesarean delivery higher educational level, and many others [21]. Although information about EBF is scanty in Uganda the few reports postulate that the situation is not that good. The objective of this study was to establish the prevalence, patterns, and factors affecting exclusive breastfeeding among mothers attending the postnatal clinic at Hoima Regional Referral Hospital.


Among mothers attending the postnatal clinic at Hoima Regional Referral Hospital, the factors associated with exclusive breastfeeding are number of antenatal care attendance, intention to exclusively breastfeed, proper breastfeeding practices, infant’s age and position at work. 


  1. Alebel, A., Tesma, C., Temesgen, B., Ferede, A., & Kibret, G. D. (2018). Exclusive breastfeeding practice in Ethiopia and its association with antenatal care and institutional delivery: a systematic review and meta-analysis. International Breastfeeding Journal, 13(1), 31. doi: 10.1186/s13006-018-0173-x.
  2. Mbina, S. A., Magaji, G., Fanuel, A., Pius, T., Gorret, A., Mavine, A. N., & Stellamaris, K. (2021). Breastfeeding Practices Among Infants and Young Children in Bushenyi, Uganda: Influence of Maternal Knowledge and Occupation. Journal of Family Medicine and Health Care7(4), 90-97.
  3. Ogomaka, I. A., & Obeagu, E. I. (2019). Methods of Breast Feeding as Determinants of Malaria Infections among Babies in IMO State, Nigeria. breast2(01), 17-24.
  4. Misrach Z. L., Vempati P., Vulli V. R., & Suberu S. A. (2018). The Effect of Fenugreek Seed powder in Augmenting Expressed Breast Milk Volume from Mothers of Preterm Infants at Tikur Anbessa Neonatal Intensive Care Unit. Global Journal for Research Analysis 7 (3)
  5. El-Houfey, A., Saad, K., Abbas, A., Rashad, S., & Wadani, M. (2017). Factors That Influence Exclusive Breastfeeding: A literature Review. International Journal of Nursing Didactics, 7. doi: 10.15520/ijnd.2017.vol7.iss11.264.24-31.
  6. Engebretsen, I. M. S., Wamani, H., Karamagi, C., Semiyaga, N., Tumwine, J., & Tylleskär, T. (2007). Low adherence to exclusive breastfeeding in Eastern Uganda: A community-based cross-sectional study comparing dietary recall since birth with 24-hour recall. BMC Pediatrics, 7(1), 10. doi: 10.1186/1471-2431-7-10.
  7. Talbert, A. W., Tsofa, B., Mumbo, E., Berkley, J. A., & Mwangome, M. (2018). Knowledge of, and attitudes to giving expressed breastmilk to infants in rural coastal Kenya; focus group discussions of first-time mothers and their advisers. International Breastfeeding Journal, 13(1), 16. doi: 10.1186/s13006-018-0158-9.
  8. Belachew, A. (2019). Timely initiation of breastfeeding and associated factors among mothers of infants age 0–6 months old in Bahir Dar City, Northwest, Ethiopia, 2017: a community based cross-sectional study. International Breastfeeding Journal, 14(1), 5. doi: 10.1186/s13006-018-0196-3.
  9. Bbaale, E. (2014). Determinants of early initiation, exclusiveness, and duration of breastfeeding in Uganda. Journal of health, population, and nutrition, 32(2), 249-260.
  10. Asare, B. Y.-A., Preko, J. V., Baafi, D., & Dwumfour-Asare, B. (2018). Breastfeeding practices and determinants of exclusive breastfeeding in a cross-sectional study at a child welfare clinic in Tema Manhean, Ghana. International Breastfeeding Journal, 13(1), 12. doi: 10.1186/s13006-018-0156-y.
  11. Adugna, B., Tadele, H., Reta, F., & Berhan, Y. (2017). Determinants of exclusive breastfeeding in infants less than six months of age in Hawassa, an urban setting, Ethiopia. International Breastfeeding Journal, 12(1), 45. doi: 10.1186/s13006-017-0137-6.
  12. Alebel, A., Dejenu, G., Mullu, G., Abebe, N., Gualu, T., & Eshetie, S. (2017). Timely initiation of breastfeeding and its association with birth place in Ethiopia: a systematic review and meta-analysis. International Breastfeeding Journal, 12(1), 44. doi: 10.1186/s13006-017-0133-x.
  13. Ogbo, F. A., Agho, K. E., & Page, A. (2015). Determinants of suboptimal breastfeeding practices in Nigeria: evidence from the 2008 demographic and health survey. BMC public health, 15, 259-259. doi: 10.1186/s12889-015-1595-7.
  14. Obeagu, E. I., Bot, Y. S., Obeagu, G. U., Alum, E. U., & Ugwu, O. P. C. (2023). Anaemia and risk factors in lactating mothers: a concern in Africa. International Journal of Innovative and Applied Research, 11(2): 15-17. Article DOI: 10.58538/IJIAR/2012 DOI URL:
  15. Umeobieri, A.-K., Mbachu, C., Uzochukwu, B. S. C., Elias, A., Omotowo, B., Agunwa, C., & Obi, I. (2018). Perception and practice of breastfeeding among HIV positive mothers receiving care for prevention of mother to child transmission in South-East, Nigeria. International Breastfeeding Journal, 13(1), 50. doi: 10.1186/s13006-018-0191-8.
  16. Ginsburg, O., Rositch, A. F., Conteh, L., Mutebi, M., Paskett, E. D., & Subramanian, S. (2018). Breast cancer disparities among women in low-and middle-income countries. Current Breast Cancer Reports10, 179-186.
  17. Obeagu, E. I., Ahmed, Y. A., Obeagu, G. U., Bunu, U. O., Ugwu, O. P. C., & Alum, E. U. Biomarkers of breast cancer: Overview. J. Curr. Res. Biol. Med., 2023; (1): 8-16. DOI:10.22192/ijcrbm.2023.08.01.002.
  18. Elyas, L., Mekasha, A., Admasie, A., & Assefa, E. (2017). Exclusive Breastfeeding Practice and Associated Factors among Mothers Attending Private Pediatric and Child Clinics, Addis Ababa, Ethiopia: A Cross-Sectional Study. International journal of pediatrics, 2017, 8546192-8546192. doi: 10.1155/2017/8546192.
  19. Ayalew, D. D., Kassie, B. A., Hunegnaw, M. T., Gelaye, K. A., & Belew, A. K. (2022). Determinants of Early Initiation of Breastfeeding in West Belessa District, Northwest Ethiopia. Nutr Metab Insight, 8;15:11786388211065221. doi: 10.1177/11786388211065221. PMID: 35023927; PMCID: PMC8744188.
  20. Mohamed, M. J., Ochola, S., & Owino, V. O. (2018). Comparison of knowledge, attitudes and practices on exclusive breastfeeding between primiparous and multiparous mothers attending Wajir District hospital, Wajir County, Kenya: a cross-sectional analytical study. International Breastfeeding Journal, 13(1), 11. doi: 10.1186/s13006-018-0151-3.
  21. Jirakittidul, P., Panichyawat, N., Chotrungrote, B., & Mala, A. (2019). Prevalence and associated factors of breastfeeding in women with gestational diabetes in a University Hospital in Thailand. International Breastfeeding Journal, 14(1), 34. doi: 10.1186/s13006-019-0227-8.
  22. Uganda MOH. Annual Health Sector Performance Report,
  23. Wiegand, H., & Kish, L., (1968). Survey Sampling. John Wiley & Sons, Inc., New York, London 1965, IX + 643 S., 31 Abb., 56 Tab., Preis 83 s. Biometrische Zeitschrift. 10, 88–89.
  24. Sankar, M. J., Sinha, B., Chowdhury, R., Bhandari, N., Taneja, S., Martines, J., & Bahl, R. (2015). Optimal breastfeeding practices and infant and child mortality: a systematic review and meta-analysis. Acta Paediatrica, 104: 3–13.
  25. Oyang, W. (2017). Prevalence and factors affecting exclusive breastfeeding among mother-infant pairs in Kawempe Division, Kampala District. School of Medicine (Sch. of Med.) Collections, Makarere University.
  26. Mogre, V., Dery, M. & Gaa, P. K. (2016). Knowledge, attitudes and determinants of exclusive breastfeeding practice among Ghanaian rural lactating mothers. Int Breastfeed J11, 12.
  27. Melina Mgongo, Tamara H. Hussein, Babill Stray-Pedersen, Siri Vangen, Sia E. Msuya, Margareta Wandel, (2019). “Facilitators and Barriers to Breastfeeding and Exclusive Breastfeeding in Kilimanjaro Region, Tanzania: A Qualitative Study”, International Journal of Pediatrics, Article ID 8651010, 7.
  28. Kimani-Murage, E. W., Wekesah, F., Wanjohi, M., Kyobutungi, C., Ezeh, A. C., Musoke, R. N., Norris, S. A., Madise, N. J., & Griffiths, P. (2015). Factors affecting actualisation of the WHO breastfeeding recommendations in urban poor settings in Kenya. Matern Child Nutr., 11(3):314-32. doi: 10.1111/mcn.12161. Epub 2014 Dec 17. PMID: 25521041; PMCID: PMC6860346.
  29. Alum, E. U., Ugwu, O. P.C., Obeagu, E. I., & Okon, M. B. (2023). Curtailing HIV/AIDS Spread: Impact of Religious Leaders. Newport International Journal of Research in Medical Sciences (NIJRMS), 3(2): 28-31.
  30. Obeagu, E.I., Alum, E.U., & Obeagu, G.U. (2023). Factors Associated with Prevalence of HIV Among Youths: A Review of Africa Perspective. Madonna University Journal of Medicine and Health Sciences, 3(1): 13-18.
  31. Alum, E. U., Ugwu, O. P. C., Obeagu, E. I., Aja, P. M., Okon, M. B., & Uti, D. E.  (2023). Reducing HIV Infection Rate in Women: A Catalyst to reducing HIV Infection pervasiveness in Africa. International Journal of Innovative and Applied Research, 11(10):01-06. DOI: 58538/IJIAR/2048.
  32. Thomson, G., Crossland, N., & Dykes, F. (2012). Giving me hope: women’s reflections on a breastfeeding peer support service.  Child Nutr. 8, 340–353. doi: 10.1111/j.1740-8709.2011.00358.x
  33. Oddo, V. M., & Ickes, S. B. (2018). Maternal employment in low- and middle-income countries is associated with improved infant and young child feeding. Am J Clin Nutr., 107(3):335-344. doi: 10.1093/ajcn/nqy001.
  34. Agho, K.E., Dibley, M.J., Odiase, J.I. et al.(2011). Determinants of exclusive breastfeeding in Nigeria. BMC Pregnancy Childbirth 11, 2.
  35. Ssemukasa, E., Kearney, J., & Ssemukasa, E. (2014). Complementary feeding practices in Wakiso District of Uganda. African Journal of Food, Agriculture, Nutrition and Development.
  36. Besore, C. T. (2014). Barriers to breastfeeding for hispanic mothers. Breastfeeding Medicine, 9(7):352–4. 10.1089/bfm.2014.0090
  37. Abekah-Nkrumah, G., Antwi, M.Y., Nkrumah, J. et al.Examining working mothers’ experience of exclusive breastfeeding in Ghana. Int Breastfeed J 15, 56 (2020).
  38. Arthur Ganafa. (2023). Knowledge, Attitude and Practices regarding Exclusive Breastfeeding Among Mothers Attending Maternal Child Health Clinic at Kitagata Hospital, Sheema District, Uganda. IAA Journal of Applied Sciences. 9(1), 17-26.
  39. Emmanuel Ifeanyi Obeagu, Sunday Bot Yakubu, Getrude Uzoma Obeagu, Esther U. Alum, Okechukwu Paul-Chima Ugwu. (2023). ANAEMIA AND RISK FACTORS IN LACTATING MOTHERS: A CONCERN IN AFRICA. International Journal of Innovative and Applied Research. 11(2),15-17.
  40. Adaobi Maryan Ibekwe, Emmanuel Ifeanyi Obeagu, Chinonye Ibekwe, Chisom Evelyn, Onyekwuo, Chioma Vivian Ibekwe, Amarachukwu Doris Okoro, Chioma Blessing Ifezue. (2022), Challenges of Exclusive Breastfeeding among Working Class Women in a Teaching Hospital South East, Nigeria. Journal of Pharmaceutical Research International. 34(46A), 1-10.
  41. Angel Michelle Matsiko.(2023). First-Time Motherhood and Exclusive Breastfeeding Practice in some Health Facilities in the Bushenyi District. EURASIAN EXPERIMENT JOURNAL OF BIOLOGICAL SCIENCES (EEJBS).4(1), 22-35.

CITE AS: Nagudi Flavia Kiwuso (2023). Rate of Exclusive Breastfeeding Among Postpartum Mothers at Hoima Regional Referral Hospital’s Postnatal Clinic. INOSR APPLIED SCIENCES 11(1):37-49.