Prevalence and factors associated with exclusive breast milk feeding among preterm infants at Kawempe Referral Hospital, Uganda

Abstract

Background: Exclusive breastfeeding is recommended for all infants, including preterm babies, during the first six months. However, at Kawempe National Referral Hospital, only about 60% of preterm infants are exclusively breastfed, below the global target of 70% by 2030. This gap increases the risk of adverse outcomes such as necrotizing enterocolitis and neonatal death. Identifying the factors associated with exclusive breastfeeding is essential for targeted interventions. Objective: To assess the prevalence and factors associated with exclusive breast milk feeding among preterm infants at Kawempe National Referral Hospital. Methods: A cross-sectional mixed-methods study was conducted among 352 mother and their infants, selected consecutively during routine visits. Quantitative data were collected using structured questionnaires, while qualitative data were collected through in-depth interviews with 10 purposively selected caregivers. Modified Poisson regression was used to determine associations, and thematic analysis was conducted for qualitative data. Results: The prevalence of exclusive breastfeeding among preterm infants was 59.4%. Positive predictors included maternal age 25–34 years (APR: 1.08; 95% CI: 1.00–1.16; P=0.048). healthcare worker support (APR: 1.11; 95% CI: 1.04–1.23; P=0.007), early initiation of breastfeeding (APR: 1.17; 95% CI: 1.06–1.30; P=0.002), emotional support (APR: 1.10; 95% CI: 1.02–1.19; P=0.010), belief in breast milk superiority (APR: 1.13; 95% CI: 1.03–1.24; P=0.010), being married (APR: 1.08; 95% CI: 1.00–1.16 ;P=0.043), and moderate to late gestational age (APR: 1.09; 95% CI: 1.00–1.21; P=0.047). Conversely, difficulty with breast milk expression (APR: 0.87; 95% CI: 0.80–0.94; P=0.000) and receiving breastfeeding counseling during antenatal visits (APR: 0.93; 95% CI: 0.87–0.99; P=0.024) were negatively associated. Qualitative themes emphasized the role of breastfeeding knowledge, prior experience of EBF, milk expression, family support, and health system assistance. Conclusion and recommendations: Exclusive breastfeeding among preterm infants remains below recommended levels. Strategies to strengthen family involvement, particularly father engagement, and enforce baby-friendly hospital policies are critical to improving breastfeeding outcomes. Keywords: Exclusive breast milk feeding, Preterm infant, Breast milk expression.