Assessment of Knowledge, Attitude, and Practice Regarding Exclusive Breastfeeding Among Lactating Mothers in Tertiary Hospital Rawalpindi, Punjab (A Cross-Sectional Study)

Abstract

Background: Exclusive breastfeeding (EBF) for the first six months is a core child-survival intervention, yet gaps persist between maternal awareness and guideline-concordant practice in many low- and middle-income settings. Objective: To assess knowledge, attitudes, and practices regarding EBF among lactating mothers attending a tertiary care hospital in Rawalpindi, Punjab, and to examine factors associated with EBF practice. Methods: A hospital-based cross-sectional study was conducted at Holy Family Hospital, Rawalpindi, from 25 August 2025 to 16 January 2026 among 384 lactating mothers selected via convenience sampling. Data were collected using a structured interviewer-administered questionnaire assessing socio-demographics and KAP domains. Good knowledge was defined as achieving ≥70% on a composite knowledge score; attitude was assessed using a composite Likert-based score. EBF practice was operationalized using the WHO 24-hour recall definition. Associations were evaluated using chi-square tests and multivariable logistic regression in SPSS v20 with p<0.05. Results: Good knowledge was observed in 65.1% (95% CI: 60.2–69.7) and positive attitude in 74.2% (95% CI: 69.6–78.4). EBF practice prevalence was 50.3% (95% CI: 45.3–55.2). Independent predictors of EBF included good knowledge (AOR 2.01; 95% CI: 1.32–3.06; p=0.001), positive attitude (AOR 1.68; 95% CI: 1.05–2.68; p=0.029), and secondary or higher education (AOR 1.74; 95% CI: 1.13–2.69; p=0.012). Conclusion: Despite favorable knowledge and attitudes, only half of mothers practiced EBF per WHO criteria; strengthening targeted antenatal and postpartum counseling and addressing cultural supplementation practices are essential to improve adherence.