The findings of the study indicated that a significant proportion (55.9%) of the mothers interviewed fell within the age range of 20-30 years. Additionally, 34.5% of the respondents were older than 30 years, while 9.6% were below 20 years of age.

In terms of marital status, the study revealed that a substantial majority (84.3%) of the interviewed women were currently in a marriage contract, demonstrating a strong presence of married participants. Conversely, 15.7% of the women were either divorced or widowed.

In regard to education, a considerable percentage of both the interviewed women and their husbands lacked formal education, with approximately 56% of the women and 39% of the husbands falling into this category.

Furthermore, the study highlighted that a majority (73%) of the respondents were housewives, suggesting a high level of unemployment among the participants. Moreover, the majority (70.7%) of the respondents reported a monthly family income of less than 300 USD, indicating a prevalence of relatively low-income households within the studied population (Table 1).

Of the 345 mothers who participated in the study, 181 (52.5%) of the mothers had more than three living children at the time of the study. The majority (62.3%) of the mothers at least attended ante natal care service once of whom 31% were given health education during the ANC visits.

However, 345 of the participants who took part in the study, 189 (54.8%) delivered in health facility while the remaining 45.2% delivered at homes. Similarly, 87.2% delivered through spontaneous vaginal delivery.

Regarding the child’s demographic characteristics, majority (81.4%) of the infants were born term, 55.9% females, 55.1% aged between 3-6 months and majority (66.1%) of them with preceding birth interval of <24 months. With respect to post-natal care, the majority (65.5%) of the respondents weren’t given post-natal counselling (Table 2).

The study findings indicated that a majority (50%) of the interviewed mothers followed a mixed feeding practice, where their babies were fed with both breast milk and other types of milk. On the other hand, 44% of the mothers practiced exclusive breastfeeding, providing only breast milk to their infants. A smaller proportion (6%) of the mothers used cow's milk and infant formulas as feeding options for their babies (Figure 1). The study findings indicate that a mere 19% of mothers reported engaging in early breastfeeding initiation. This means that a relatively small proportion of the surveyed or studied mothers began breastfeeding their infants shortly after giving birth.

Inquiring about the factors contributing to the non-practice of exclusive breastfeeding, the primary reason cited by the majority of mothers was insufficient breast milk. Various factors such as perceived low milk supply and breastfeeding difficulties were attributed to this issue. The second most common reason mentioned was employment commitments, as mothers faced challenges in finding sufficient time for exclusive breastfeeding due to work obligations. Maternal and infant health issues also played a significant role, including medical conditions affecting breastfeeding or difficulties with infant latch and feeding. Pregnancy, particularly when occurring while breastfeeding, was another hindrance. Some mothers reported infant refusal of breastfeeding due to nipple confusion, discomfort, or alternative feeding preferences. Travel commitments were mentioned as well. It is noteworthy that some mothers chose not to disclose specific reasons, which could be personal or influenced by undisclosed factors. (Figure 2).

The study investigated the reported frequency of infant illness among mothers adopting different feeding practices, including exclusive breastfeeding, mixed feeding, and formula feeding. The findings revealed that among the interviewed mothers, only 3% of those practicing exclusive breastfeeding reported frequent infant sickness. In contrast, 25% of mothers using mixed feeding and a substantial 55% of those practicing formula feeding exclusively reported frequent illness in their infants. These results indicate a lower likelihood of infant sickness among breastfed infants, as reported by the participating mothers (Figure 3).

The study utilized binary logistic regression to investigate the relationship between exclusive breastfeeding and demographic, obstetric, and health service utilization factors. By employing this statistical analysis method, the researchers aimed to identify the specific factors that influence exclusive breastfeeding practices.

The results indicated that marital status, education level, and maternal working status were statistically significant factors in relation to exclusive breastfeeding. The findings revealed that mothers who were married had more than three times higher odds of practicing exclusive breastfeeding compared to those who were not married (adjusted odds ratio (AOR)=3.44, 95% confidence interval (CI): 1.559-7.598). Interestingly, the study found that education level had a somewhat unexpected impact on exclusive breastfeeding. Mothers with no formal education and those with primary education had approximately nine- and five-times higher odds, respectively, of practicing exclusive breastfeeding compared to those with post-secondary education. However, when it came to paternal education, the results differed. Babies whose fathers had secondary education were almost six times more likely to be breastfed compared to those whose fathers had no formal education (AOR=5.83, 95% CI: 2.555-13.312). Regarding maternal working status, the study revealed that housewives were about seven times more likely to practice exclusive breastfeeding compared to mothers who worked during the data collection period (AOR=6.77, 95% CI: 3.321-13.814).

In contrast to the other factors examined, the study did not find any significant association between exclusive breastfeeding and maternal age or income (Table 3).

The study focused on examining obstetric and health service utilization factors associated with exclusive breastfeeding. The results indicated significant associations between exclusive breastfeeding and three key factors: antenatal care (ANC) attendance, ANC health education, and postnatal care (PNC) counseling.

The study demonstrated that attending ANC sessions had a positive impact on exclusive breastfeeding. Mothers who attended at least one ANC appointment were nearly three times more likely to engage in exclusive breastfeeding compared to those who did not attend any ANC appointments (adjusted odds ratio (AOR)=2.89, 95% confidence interval (CI): 1.556-5.382). Regarding ANC health education, the findings revealed that mothers who received health education during ANC sessions had over 10 times higher odds of practicing exclusive breastfeeding compared to those who did not receive such education (AOR=10.42, 95% CI: 5.915-18.369).

Furthermore, the study found that postnatal counseling had a significant association with exclusive breastfeeding. Mothers who received counseling during the postnatal period were three times more likely to practice exclusive breastfeeding compared to those who did not receive any counseling (AOR=3.12, 95% CI: 1.64-5.928).

On the other hand, the study did not find any significant associations between exclusive breastfeeding and variables such as parity (number of previous births), place of birth, and mode of delivery (Table 4).

With respect to the baby-related factors, the study revealed that child sex and child age. Male babies had almost three times odd for exclusive breastfeeding compared to female babies (AOR=2.74, 95%CI:1.736-4.314). Similarly, children whose age is below 3 months of age had 1.6 odds for exclusive breastfeeding compared to those older than 3 months of age (AOR=1.62, 95%CI:1.023-2.547) (Table 5).

Breastfeeding goes beyond being a mere choice of lifestyle; it is a valuable investment in the realm of health. It offers unparalleled advantages for both infants and mothers. Babies who receive breast milk experience decreased chances of developing asthma, obesity, Type 1 diabetes, severe lower respiratory disease, acute otitis media, sudden infant death syndrome, gastrointestinal infections, and necrotizing enterocolitis in the case of preterm infants1314. The WHO and the United Nations Children's Fund (UNICEF) recommend that children be exclusively breastfed for the first 6 months of life—meaning no other foods or liquids are provided, including water13.

In this study, the prevalence of exclusive breastfeeding was found to be 44%. Although this rate is slightly higher than the general prevalence of exclusive breastfeeding in the country15, it is still lower than the rates reported in neighboring countries1617. Among the remaining 56% of mothers, 50% engage in mixed feeding practices, which involve the combination of breastmilk and animal milks. On the other hand, approximately 6% of the mothers exclusively rely on cow's milk and infant formulas as feeding options for their babies.

The study has uncovered several factors linked to the practice of exclusive breastfeeding. In terms of demographic characteristics, the findings of the study demonstrated that marital status, educational attainment, and maternal employment were statistically significant factors associated with exclusive breastfeeding.

The results indicated that married mothers had over three times greater likelihood of engaging in exclusive breastfeeding in comparison to unmarried mothers. Similarly, a study conducted in Ethiopia yielded comparable results. Just like our findings, the study in Ethiopia also revealed a higher prevalence of exclusive breastfeeding among married mothers. This consistent pattern suggests that marital status may be an influential factor in promoting exclusive breastfeeding practices18.

Surprisingly, the study discovered an intriguing relationship between education level and exclusive breastfeeding. Contrary to various studies conducted in Africa and Asia 19202122, our findings revealed that mothers with no formal education had around nine times higher odds of practicing exclusive breastfeeding, while those with primary education had approximately five times higher odds in comparison with university graduates. Almost similar result was reported by Hossain et al23. This deviation from previous research highlights a unique perspective on the impact of education on exclusive breastfeeding practices. This disparity could potentially be attributed to multiple factors. One possible explanation is that mothers with university education often have demanding jobs that require regular attendance, making it challenging to exclusively breastfeed their infants.

Contrastingly, the results showed a divergence in the influence of paternal education. Infants whose fathers had received formal education exhibited nearly six times higher odds of being breastfed in comparison to those whose fathers had no formal education. This finding aligns with the results of a controlled randomized trial conducted in Iran. The study conducted in Iran reported similar outcomes, reinforcing the notion that paternal education plays a significant role in promoting breastfeeding practices24. This can be attributed to the influential role that fathers play in decision-making regarding the mode of feeding for their child.

In terms of maternal employment status, the study findings indicated that housewives had approximately seven times higher odds of practicing exclusive breastfeeding compared to mothers who were employed. Consistent findings have been reported by several studies conducted in various countries and settings. These studies have also reported similar trends and associations, further strengthening the evidence regarding the impact of maternal employment on exclusive breastfeeding practices252627.

In addition to demographic characteristics, the study revealed that obstetric and health service utilization factors were also associated with exclusive breastfeeding. Specifically, significant associations were found between exclusive breastfeeding and three key factors: attendance of antenatal care (ANC), receipt of ANC health education, and postnatal care (PNC) counseling.

Mothers who attended at least one ANC appointment were nearly three times more likely to engage in exclusive breastfeeding compared to those who did not attend any ANC appointments. This finding is consistent with the results of another study conducted in India, which also demonstrated similar outcomes28. This can be attributed to the fact that during antenatal care (ANC) visits, mothers receive education and information regarding the significance of exclusive breastfeeding. The counseling and educational sessions provided during ANC visits likely contribute to the increased awareness and understanding among mothers about the benefits and importance of exclusive breastfeeding.

The study revealed an important finding regarding the impact of health education during ANC visits on exclusive breastfeeding practices. It was observed that ANC visits with health education sessions had over 10 times higher odds of practicing exclusive breastfeeding compared to visits without such sessions. The observed association can be attributed to the positive impact of health education talks provided during ANC visits. These informative sessions contribute to raising awareness and promoting the practice of exclusive breastfeeding among mothers. Similar studies have consistently reported comparable findings, further corroborating the obtained results293031.

Postnatal counseling emerged as another significant factor influencing exclusive breastfeeding practices. The study revealed that mothers who received counseling during the postnatal period were three times more likely to engage in exclusive breastfeeding compared to those who did not receive any postnatal care (PNC) counseling. A comparable study yielded comparable results, further strengthening the findings of the current study32.

The study uncovered noteworthy findings related to baby-related factors and their association with exclusive breastfeeding. Specifically, child sex and age were identified as statistically significant factors. Male babies were found to have nearly three times higher odds of exclusive breastfeeding compared to female babies. This observation may be attributed to cultural preferences among Somali families, where there is a tendency to prioritize male babies over female babies.

Likewise, the study revealed a similar pattern with regards to the age of the children. Infants below the age of 3 months were found to have 1.6 times higher odds of practicing exclusive breastfeeding compared to those who were older than 3 months. This finding underscores the importance of early initiation of exclusive breastfeeding and the potential decline in exclusive breastfeeding rates as infants grow older. This finding is in line with the results of a separate study conducted in neighboring Ethiopia, which also indicated a decrease in exclusive breastfeeding with increasing age of the child33. This can be attributed to several factors. As the child's age increases, some mothers may perceive breast milk as insufficient to meet the growing nutritional needs of their child, leading them to introduce supplementary feeds.

In relation to infants' health status and exclusive breastfeeding, the study revealed that mothers who exclusively breastfed their infants reported a significantly lower frequency of infant sickness (3%) compared to mothers who practiced mixed feeding (25%) or formula feeding (55%). Similar findings have been reported by other studies conducted in different settings, further supporting the association between exclusive breastfeeding and a lower frequency of infant sickness. These studies have consistently shown that infants who are exclusively breastfed have a reduced risk of various infections, respiratory illnesses, gastrointestinal disorders, and other health-related issues3435. The lower frequency of infant sickness reported among mothers practicing exclusive breastfeeding can be attributed to the unique composition of breast milk, which provides optimal nutrition and essential antibodies that help boost the infant's immune system.