Achieving optimal exclusive breastfeeding (EBF) remains a challenge. Because intention is a precursor of practice, we examined factors associated with EBF intention during pregnancy in two rural sub-districts of Kishoreganj district, Bangladesh. We studied 2,400 pregnant women in their third trimester (26-32 weeks gestation). We assessed knowledge (6 items, scale range 0-6), attitudes (15 items, scale range 15-75) and self-efficacy (6 items, scale range 6-30) by interview using a standardized questionnaire. 83.9 % of pregnant women reported EBF intention. Mean breastfeeding knowledge was 3.5 (SD 1.3), mean attitude was 55.8 (SD 8.1) and mean self-efficacy was 25.6 (SD 3.4). Knowledge was associated with EBF intention (OR 2.47, 95 % CI 1.74, 3.51), attitudes toward EBF (OR 1.68, 95 % CI 1.31, 2.16) and self-efficacy (OR 1.72, 95 % CI 1.23, 2.40) were independently associated with EBF intention in the model in which all three constructs were entered simultaneously. Receipt of breastfeeding counseling during pregnancy and being literate were each associated with EBF knowledge and EBF intention (all p < 0.05). Increasing maternal knowledge, positive attitudes, and self-efficacy regarding EBF were associated with prenatal EBF intention. These results reinforce the importance of appropriate counseling to increase EBF prevalence .

Objective: To assess the relationships between maternal breast-feeding intention, attitudes, self-efficacy and knowledge at 7 months' gestation with exclusive or full breast-feeding at 3 months postpartum. Design: Prospective cohort study with structured home interviews during pregnancy and 3 months after delivery. Setting: Two rural sub-districts of Kishoreganj district, Bangladesh. Subjects: Mother-infant dyads. Results: Over 80 % of 2178 pregnant women intended to exclusively breast-feed (EBF). Maternal positive attitudes, self-efficacy and knowledge about breastfeeding were positively associated with EBF intention (all P < 0·05). All mothers except one reported initiating breast-feeding and 99·6 % of children were still breast-fed at 3 months. According to 24 h dietary recalls, we categorized 985 (45·2 %) infants as EBF at 3 months (47·8 % among mothers with EBF intention; 31·7 % among mothers with no EBF intention; P < 0·05) and 551 (25·3 %) infants as predominantly breast-fed at 3 months (24·2 % among mothers with EBF intention; 30·8 % among mothers with no EBF intention; P < 0·05). Prenatal EBF intention was associated with EBF (OR = 1·48, 95 % CI 1·14, 1·91) and with full breastfeeding (OR = 1·34, 95 % CI 1·04, 1·72) at age 3 months. EBF at age 3 months was not associated with maternal breast-feeding knowledge, attitudes or self-efficacy. Conclusions: Despite widespread expressed maternal EBF intention and universal breast-feeding initiation, prevalence of both exclusive and full breast-feeding at 3 months remains lower than WHO recommendations. EBF intention predicts breast-feeding behaviours, suggesting the importance of prenatal counselling to improve infant feeding behaviours.Keywords Breast-feeding Attitude Self-efficacy KnowledgeGlobally, over 55 % of infant deaths from diarrhoeal disease and acute respiratory infections are preventable by appropriate breast-feeding and complementary feeding (1) . Suboptimal infant feeding and endemic malnutrition contribute to mortality and morbidity, as well as to detrimental long-term developmental consequences, poorer educational performance and decreased productivity (2)(3)(4)(5)(6)(7) . Although the potential benefits of exclusive breastfeeding (EBF) through to infant age 6 months are widely recognized, EBF remains low in both developed and developing countries.Maternal psychosocial factors and intentions to breastfeed have been associated, to varying extents, with infant feeding behaviours in previous literature. A nationally representative US study among 2372 women found that intention to partially or fully breast-feed predicted breastfeeding duration (>6 months) (8) . Similarly, in a cohort of 566 Australian women, intention to breast-feed was also positively associated with breast-feeding duration (9) . In separate study among 733 women, attitudes about benefits and barriers to breast-feeding, health-care systems, as well as social support were associated with breast-feeding initiation (10) .Over the past two decades, many studies have incorporate...

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