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Background Optimal infant and young child feeding (IYCF) practices, particularly exclusive breastfeeding (EBF) for the first 6 months, are critical for child survival and development. In low- and middle-income countries, EBF prevalence is commonly estimated using maternal 24-h recall, which may overestimate true practices. This study quantified discrepancies between self-reported and directly observed feeding behaviors and explored socio-cultural determinants of IYCF in rural eastern Ethiopia. Methods A sequential explanatory mixed-methods study was conducted among 106 mother-infant dyads with monthly maternal-recall surveys and two in-home observation sessions in a 79-infant subsample. Discrepancies were examined using chi-square or Fisher’s exact tests. To contextualize findings, 26 semi-structured interviews and five focus group discussions with caregivers and community influencers were conducted and thematically analyzed. Results Cumulative 24 h recall across the first 6 months classified 70% of infants 6 months as EBF. Stricter WHO criteria reduced prevalence (18%; p = 0.002). Direct observation confirmed early supplementation: 77% of infants 6 months received non-breastmilk substances, 5% met WHO criteria under survey and observation. Surveys indicated timely complementary feeding (6–8 months) in 55% of infants, 30% introduced early, 15% late. Key EBF barriers included prelacteal feeding, perceptions of milk insufficiency, seasonal food insecurity, and elder influence. Traditional postpartum rest ( ulma ) facilitated early breastfeeding, but its protective role diminished as mothers resumed livelihoods. Conclusion True EBF is markedly lower than 24 h recall estimates, highlighting the need for improved approaches and culturally tailored interventions that address feeding rituals, food insecurity, and elder’s social influence, while leveraging protective traditions like ulma .
Ahmed et al. (Tue,) studied this question.