Factors associated with successful exclusive breastfeeding among mothers in the formal sector: a mixed-method study in Kampala, Uganda.

BACKGROUND: Globally, evidence shows that exclusive breastfeeding (EBF) for the first six months of an infant's life has health benefits for families, communities, and the nation. However, many employed women discontinue EBF before six months, while others succeed. This study aims to identify and explain the factors that enable EBF success among employed mothers in the formal sector. METHODS: The study employed a sequential explanatory mixed-methods design. Quantitative phase used questionnaires administered to collect EBF data from 224 mothers with children 6-18 months. EBF was measured as self-reported by a mother who EBF her current infant/child for six months. Data was analyzed to guide the case study, where key-informant interviews were used to collect data from 10 mothers. Both phases lasted from November 2021 to February 2022. Multivariable logistic regression analysis of quantitative data established associated factors with EBF. Qualitative data was coded, grouped, and categorized to generate themes explaining EBF success. RESULTS: The majority (76.3%) of mothers were ≥ 25 years. Their mean age was 27.3 ± 3.65 years. Most (66%) were married. 87.4% had 3 ≥ months of maternity leave. Overall EBF prevalence at six months was 31.7%. Significant factors were: Bachelor's degree (AOR = 3.04; 95% CI. 1.04, 8.86), Financial support (AOR = 6.62; 95% CI. 2.27, 19.31), domestic support (AOR = 5.23; 95% CI. 1.88, 14.52), psychological support (AOR = 5.45; 95% CI. 1.47, 20.20), and workmate support (AOR = 2.95; 95% CI. 1.54, 5.67). Prelacteal feeding (AOR = 0.16; 95% CI, 0.06, 0.45). More than four ANCs (AOR = 0.18: 95% CI. 0.04, 0.82). The qualitative phase generated five themes, these were: context, social support system, breastfeeding-friendly hospitals and workplace, and maternal EBF mindset. These themes fit theory-relevant concepts: social cognition and institutional factors, individual cognition, and EBF behavior. These concepts align with Social Cognitive theory. CONCLUSION: A third of the mothers had EBF. Significant factors for EBF included, bachelor's degree, supportive environments at family, healthcare, and workplace, and a woman's mindset. This implies mothers, practitioners, managers, and policy-makers to optimize EBF rates among employed Ugandan working women, they need to integrate supportive environments at family, create breastfeeding-friendly environments, and empower women to a breastfeeding mindset.