A community-based cross-sectional study conducted in Biratnagar Metropolitan City, Nepal, measured the practice of exclusive breastfeeding (EBF) among mothers of children aged 6–23 months. Among 202 participating mothers (mean age 25.65 ± 4.15 years), the reported prevalence of EBF since birth was 37.6%, and the median duration of exclusive breastfeeding was four months. Only 21.8% of mothers had what the investigators classified as adequate knowledge about EBF. In early infancy many infants received non-breastmilk liquids or substitutes: 53.5% were given plain water with milk and 35.6% received infant formula. The principal reasons given for introducing mixed feeding were perceived insufficient milk supply and the mother’s return to work. Multivariable analysis identified residence in joint/extended families, maternal illiteracy, and absence of breastfeeding problems as independent correlates of greater likelihood to practice EBF.
The investigators contextualized the research within global and national breastfeeding goals and programs. Exclusive breastfeeding for the first six months is highlighted as a key, evidence-based intervention to reduce child morbidity and mortality and to confer maternal health benefits. The authors noted declining EBF rates reported in Nepal between recent Demographic and Health Surveys and emphasized urban challenges—such as media exposure, rapid urbanization, marketing of breast-milk substitutes, and availability of artificial milk—that may act as barriers to sustained EBF. Given limited data from eastern Nepal urban areas, the study aimed to document EBF practice and determinants in Biratnagar to inform targeted interventions.
A community-based cross-sectional design was used. The study took place in Biratnagar Metropolitan City, an urban administrative area composed of 19 wards and representing around 19.7% of the Morang District population. The sampling frame included mothers who had resided in the city for at least one year and who had children aged between 6 months and under 2 years at the time of data collection. Mothers unavailable after two household visits and those with hearing or speech impairments that prevented effective interview were excluded.
The initial sample size was derived using Cochran’s formula with an estimated EBF proportion from prior studies; a finite population correction was applied given the local eligible population (N = 5,310). The final analytic sample reported in the manuscript included 202 mothers. Participants were selected using a Population Proportionate to Size (PPS) approach. Data were collected via face-to-face interviews using a structured questionnaire after obtaining written informed consent.
The primary outcome was reported practice of exclusive breastfeeding since birth, defined in the introduction as feeding only breast milk for the first six months of life. Knowledge about EBF was assessed and categorized by the study team; the manuscript reports the proportion assessed as having adequate knowledge. Early feeding practices and reasons for mixed feeding were recorded as self-reported by mothers during the interview.
The average maternal age was 25.65 years (SD 4.15). Approximately one-fourth of participants reported practicing early breastfeeding. For early infant feeding (prelacteal or early complementary feeds), the most frequently reported items were plain water with milk (53.5%) and infant formula (35.6%). These practices indicate substantial early introduction of non-breastmilk fluids and substitutes in this urban population.
Only 21.8% of mothers were categorized as having adequate knowledge regarding EBF. The study highlights this gap between knowledge and recommended practice and suggests that low knowledge likely contributes to suboptimal EBF prevalence in the urban setting studied.
The reported prevalence of exclusive breastfeeding since birth among study participants was 37.6%. The median reported duration of exclusive breastfeeding was four months, shorter than the WHO-recommended six months. These findings indicate lower-than-target EBF coverage in Biratnagar despite national initiatives and programs aimed at improving infant feeding.
Mothers most commonly cited perceived insufficient breast milk as the major reason for introducing mixed feeding. Maternal work responsibilities were the next most frequent reason. The manuscript emphasizes that perceived low milk supply and occupational demands are important barriers to sustained EBF in this urban population.
In multivariable logistic regression, three factors were significantly associated with higher odds of practicing EBF: living in a joint or extended family (adjusted odds ratio [AOR] = 1.95, 95% CI: 1.23–4.09), maternal illiteracy (AOR = 2.90, 95% CI: 1.14–7.41), and reporting no breastfeeding problems (AOR = 8.23, 95% CI: 2.97–22.74). The manuscript reports these associations as adjusted for other covariates included in the model; precise covariates adjusted for are reported in the source tables within the article.
The study authors conclude that the prevalence of exclusive breastfeeding in this urban Nepalese setting is low and that maternal knowledge about EBF is limited. Given that perceived insufficiency of milk and breastfeeding problems were important barriers, the authors recommend strengthening counselling on breastfeeding during antenatal care (ANC) and postnatal care (PNC) visits and providing targeted support to manage breastfeeding problems. The findings are presented as relevant for urban program planning and policy to improve EBF rates in Koshi Province and similar settings.
Note: All reported prevalence estimates, measures of association, and participant characteristics are taken directly from the source article. The manuscript includes supporting tables and figures cited in the original publication for further detail.