Skip to main content
NCBI home page
PLOS One logoLink to PLOS One
. 2024 Mar 28;19(3):e0299843. doi: 10.1371/journal.pone.0299843

Attitude and predictors of exclusive breastfeeding practice among mothers attending under-five welfare clinics in a rural community in Southwestern Nigeria

Tope Michael Ipinnimo 1,*, Olanrewaju Kassim Olasehinde 1, Taofeek Adedayo Sanni 1,2, Ayodeji Andrew Omotoso 1, Rita Omobosola Alabi 1, Paul Oladapo Ajayi 3, Kayode Rasaq Adewoye 1,2, John Olujide Ojo 1,2, Olayinka Oloruntoba 4, Ademuyiwa Adetona 2, Mojoyinola Oyindamola Adeosun 3, Temitope Moronkeji Olanrewaju 5, Oluseyi Adedeji Aderinwale 6, Blessing Omobolanle Osho 7, Adewumi Rufus Fajugbagbe 7, Precious Aderinsola Adeyeye 7, Ayotomiwa Fiyinfoluwa Ajayi 7
Editor: Kahsu Gebrekidan8
PMCID: PMC10977687  PMID: 38547170

Abstract

Background

Much previous research on exclusive breastfeeding has focused on urban and semi-urban communities, while there is still a paucity of data from rural areas. We assessed the attitude and practice of exclusive breastfeeding and its predictors among mothers attending the under-five welfare clinics in a rural community.

Methods

A cross-sectional study was conducted among consecutively recruited 217 mothers attending the three health facilities under-five welfare clinics in Ido-Ekiti, Southwest, Nigeria. Information was collected with a semi-structured interviewer-administered questionnaire adapted from previously published research works. Descriptive and inferential statistics were carried out using IBM SPSS Statistics for Windows, Version 26.0.

Results

More than half of the mothers, 117(53.9%) were ≥30 years old, and 191(88.0%) were married. Almost all, 216 (99.5%) attended an ante-natal clinic; however, 174(80.2%) delivered in the health facility. The respondent’s mean ± SD exclusive breastfeeding attitudinal score was 29.94 ± 2.14 (maximum obtainable score was 36), and the proportion of mothers that practiced exclusive breastfeeding was 40.6%. Married mothers were more likely to practice exclusive breastfeeding than their unmarried counterparts (AOR:6.324, 95%CI:1.809–22.114). The common reasons for not practicing exclusive breastfeeding were work schedule 57(26.3%), cultural beliefs and the need to introduce herbal medicine 32(14.7%), and insufficient breast milk 30(13.8%).

Conclusion

This study revealed a good disposition with a suboptimal practice towards exclusive breastfeeding. Also, being married was a positive predictor of exclusive breastfeeding. Therefore, we recommend policies that will improve exclusive breastfeeding among mothers in rural areas, especially those targeting the unmarried, to achieve the World Health Organization’s target.

Introduction

Breastmilk is described as the primary source of nutrition for newborns and provides all the nutritional needs for the first few months of life [1]. It is safe, clean and essentially contains water, nutrients, and antibodies in adequate proportions to promote child growth and development [2]. Exclusive breastfeeding (EBF) involves feeding only breastmilk to a child for the first six months of life, except for medically prescribed drugs or supplements [3]. The World Health Organisation (WHO) recommends EBF because it is cost-effective, and significantly lower the risk of diarrhoea, malnutrition as well as morbidity and mortality among the under-five age group [2]. Breastfeeding not only proves beneficial to child health but also contributes to maternal health as well as providing social and economic benefits [4].

Globally, the average EBF practice between 2015–2021 was 48% [5] and in Italy, only 33.3% practiced EBF. More than half of the Italian women had heard about EBF, with the majority of them believing that EBF is important to both mother and child [6]. However, a study in Bangladesh, which focused on mothers in rural areas, showed poor knowledge (34.5%) and practice (27.9%) of EBF [7]. In East Africa, a systematic review revealed that 42% of mothers preferred to feed their infants with breastmilk alone for the first six months of life, while 55.9% of them had practiced EBF for at least six months [8]. The West Africa region had a prevalence of 35.0% for EBF between 2015–2021, one of the lowest in the world for the same period [5].

In Nigeria, only 28.7% of babies were exclusively breastfed in 2018 [9]. This was even lower in the rural population, with a report of 24.3% [9]. A study in a semi-urban area of Sokoto state, Northwest Nigeria, indicated that only 31.0% of women practiced EBF [10]. Another study conducted in one of the urban centers in Abuja, the Federal Capital Territory of Nigeria showed that 54.4% had practiced EBF despite a significant positive attitude determined by the study (70% agreed that EBF was adequate for their children) [11]. A similar study in another urban center in Benin, Edo state, South-south Nigeria, showed an “ever-breastfed rate” of 100.0%, but only 40.7% practiced EBF [12]. A survey carried out in two tertiary hospitals in Ogun state, Southwest Nigeria, revealed that more than half (58.8%) of the women practiced EBF [13].

Optimal breastfeeding practices are important in preventing and managing malnutrition in children [2]. Stunting, which is a form of malnutrition and an indication of poor nutrition beginning in utero into early childhood, affecting an estimated 144 million (21.3%) under-five children globally in 2019 with the highest burdens in Africa and Asia continents [14]. Over one-third (37.0%) of Nigerian children aged 6–59 months are stunted, and the prevalence of stunting is almost twice as high among children in rural areas (45.0%) as among those in urban areas (27.0%) [9].

Many previous studies on EBF have centered on urban and semi-urban communities, while there is still a paucity of data from rural areas [10–13]. To the best of the authors’ knowledge, there has not been a study of this nature assessing the attitude and practice of mothers on EBF in our environment. This research was designed to identify the gap in the attitude and practice of mothers living in this area toward EBF as it may aid strategy development in improving the nutritional status of infants and children living in the communities.

This study aims to determine the attitude, and practice as well as identify the predictors of practice of EBF among mothers attending the under-five welfare clinics in a rural community in Southwest Nigeria. The findings of this work would contribute to the literature and can help facilitate further research on the subject. Also, it would aid in defining the gaps in women’s attitude to EBF and its practice, especially in the rural areas. This could then serve as a basis for health planning, policy formulation and implementation to improve EBF practice in rural Nigeria in order to meet the World Health Organization (WHO) recommended target of at least 50.0% EBF rate in all communities by 2025 [15].

Methods

Study area and design

This was a cross-sectional study carried out between 1st and 30th November 2021 in all the under-five welfare clinics in Ido-Ekiti, Southwest, Nigeria. Ido-Ekiti is a town with an estimated population of 37,000 [16]. There are three health facilities with under-five welfare clinic in the community which included the Basic Health Centre (BHC), Comprehensive Health Centre (CHC) and the Federal Teaching Hospital (FTH), Ido-Ekiti. The BHC and CHC are primary health facilities, each with a staff strength of less than thirty healthcare workers mainly registered nurses/midwives and community health extension workers. The BHC and CHC under-five welfare clinics provides services such as immunization and growth monitoring on clinic days which is just once in a week and each of them sees an average of 10 to 20 children per clinic day. The FTH is a tertiary health facility that serves as a referral centre for other health facilities within the environs. The under-five welfare clinic in FTH is located at the Department of Community Medicine of the hospital and it offers services every day with the exception of weekends (Saturday to Sunday) to an average of 20 children per day. The staff in the clinic consists of community/public health physicians, public health nurses and community health extension workers.

Participants, sample size determination and sampling technique

The study population consisted of mothers attending the under-five welfare clinics in the community. The study included all healthy mothers with healthy baby(ies) attending the clinics. Mothers with adopted or fostered babies were excluded from the study. The minimum sample size for the study was determined using Leslie Fisher’s formula [17]. A 95% confidence interval, and 5% degree of accuracy was assumed. A sample size of 217 was obtained after using the prevalence of EBF from a previous study [18]. All the three health facilities were used for the study. The number of mothers selected from the health facilities was determined using proportionate allocation based on the under-five welfare clinic attendance. Eligible mothers attending the clinic were recruited consecutively into the study until the sample size was achieved.

Data collection methods

Researchers administered the questionnaire in a scheduled area of the health facilities through face-to-face interviews with the mothers immediately after their clinics.

Data collection tools

The study instrument used to collect information from the women is a 26-item semi-structured interviewer-administered questionnaire adapted from previously published research works [19, 20]. The questionnaire obtained data on socio-demographic and other (such as antenatal clinic attendance, place of delivery) variables, attitude towards EBF, practice of EBF and reasons for not breastfeeding exclusively. The questionnaire was pre-tested on a sample (twenty) of mothers in a CHC in another community which were neither analyzed nor included in the study. Necessary adjustments and corrections were made to the questionnaire after the pre-test. The items in the study instrument were tested for internal consistency using the Cronbach coefficient alpha test and a score of 0.9 was obtained. Twelve questions assessed the attitude of mothers on EBF. Mothers were asked to rate their responses on a 3-point Likert scale (1 to 3) measuring the intensity of mother’s attitudes [19]. A positive response was rated 3, a neutral was rated 2, and a negative was rated 1. The attitudinal score of each respondent was estimated by summing their rating with a maximum obtainable score of 36. Exclusive breastfeeding practice was assessed with a question inquiring if mothers have given only breast milk to the baby for the first 6 months without infant formula or any other product unless it was prescribed by a physician.

Variables

The independent variables in this study were sociodemographic variables, maternal characteristics such as antenatal clinic attendance, place of delivery and mode of delivery, while the dependent variable included the attitude and practice of EBF among the mothers.

Data management and statistical analysis

The data collected were entered, cleaned and analysed using computer software IBM SPSS (IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp). Data were summarized in tables using frequencies and percentages. The attitudinal scores of the participants were calculated and presented using mean and standard deviation. The mean attitudinal scores across each socio-demographic and maternal variables category was compared using the independent Student-T-test. The association between the mother’s characteristics and the practice of EBF was assessed using the Chi-square test. Binary logistic regression analysis was used to determine the predictors of EBF. The logistic regression model was built with variables with p ≤ 0.2 at the bivariate (Chi-square test) level of analysis. P-values <0.05 were considered significant for the inferential statistics.

Ethical considerations

Ethical approval (ERC/2021/10/18/937A) for this study was obtained from the Human Research and Ethics Review Committee of the Federal Teaching Hospital, Ido-Ekiti, Nigeria. Permission was obtained from the officer-in-charge of the BHC and CHC as well as the consultant-in-charge of the FTH clinics. Additionally, written informed consent to participate was obtained from the mothers before the interviews. Confidentiality and anonymity were maintained by not collecting personal data such as names and phone numbers from the respondents.

Results

Table 1 shows that the mean age (±standard deviation) of the mothers was 30.5 (±6.4) years. More than half of the mothers, 117 (53.9%) were ≥ 30 years and more than two-thirds, 148 (68.2%), held a post-secondary school degree. More than three-quarters, 191 (88.0%) and 179 (82.5%) were married and of Yoruba ethnicity respectively. Ninety-four (43.3%) of them were civil servants. The majority 216 (99.5%) of mothers attended the ante-natal clinic, out of which 214 (99.1%) were informed on EBF. Most, 174 (80.2%) delivered within a health facility and 182 (83.9%) deliveries were via vaginal delivery. Ninety-one (41.9%) mothers are currently nursing their first child.

Table 1. Socio-demographic and other characteristics of the respondents (N = 217).

Variable Frequency Percent
(N = 217) (%)
Age
< 30 years 100 46.1
≥ 30 years 117 53.9
Mean age (±Standard deviation) 30.5 (±6.4)
Level of education
Secondary 69 31.8
Post-secondary 148 68.2
Marital status
Unmarried 26 12.0
Married 191 88.0
Religion
Christianity 174 80.2
Islam 43 19.8
Tribe
Yoruba 179 82.5
Hausa 16 7.4
Igbo 22 10.1
Occupation
Farmer/trader/artisan 76 35.0
Civil servant 94 43.3
Professional 20 9.2
Student 27 12.5
ANC attendance during the pregnancy of this baby
Yes 216 99.5
No 1 0.5
If yes, were you informed on exclusive breastfeeding (n = 216)
Yes 214 99.1
No 2 0.9
Place of delivery of this baby
Outside health facility 43 19.8
Within health facility 174 80.2
Mode of delivery of this baby
Vaginal delivery 182 83.9
Caesarean section 35 16.1
Birth order of the baby
First 91 41.9
Second 75 34.6
3 and above 51 23.5
Open in a new tab

Table 2 shows that the mean (standard deviation) EBF attitudinal score for all respondents was 29.94 (2.14) out of 36 maximum possible scores. EBF attitudinal scores significantly differed across age (T = -2.844, p = 0.005), level of education (T = -2.273, p = 0.025), ante-natal clinic attendance during the pregnancy of the baby (T = 4.895, p < 0.001), been informed on EBF during ante-natal clinic (T = 14.378, p < 0.001), mode of delivery (T = -2.773, p = 0.008) and the birth order of the child (F = 9.533, p = 0.001). The attitudinal score was better among mothers aged ≥ 30 years, those with post-secondary education, mothers with antenatal clinic attendance, those informed on EBF, mothers who had caesarian section delivery, and those with higher birth orders. The attitudinal score did not significantly differ across other variables.

Table 2. Exclusive breastfeeding attitudinal score associated with respondents’ characteristics (N = 217).

Variable Attitudinal score
Mean ± SD Test p-value
All respondents 29.94 ± 2.14 - -
Age (in years) -2.844T 0.005
< 30 years 29.50 ± 1.956
≥ 30 years 30.30 ± 2.226
Level of education -2.273T 0.025
Secondary 29.43 ± 2.29
Post-secondary 30.16 ±2.02
Marital status -0.480T 0.634
Unmarried 29.76 ± 1.839
Married 29.95 ± 2.180
Religion 1.974T 0.053
Christianity 30.09 ± 2.007
Islam 29.27 ± 2.529
Tribe 0.317F 0.729
Yoruba 29.97 ± 2.075
Hausa 30.00 ± 1.591
Igbo 29.59 ± 2.938
Occupation 0.427F 0.734
Farmer/trader/artisan 29.72 ± 2.194
C/S 30.09 ± 2.374
Professional 30.00 ± 2.000
Student 29.92 ± 0.196
ANC attendance during the pregnancy of this baby 4.895T <0.001
Yes 29.98 ± 2.034
No 20.00 ± 0.000
If yes, were you informed on exclusive breastfeeding 14.378T <0.001
Yes 30.00 ± 2.034
No 28.00 ± 0.000
Place of delivery 0.571T 0.570
Outside health facility 30.11 ± 2.372
Within health facility 29.98 ± 2.083
Mode of delivery -2.773T 0.008
Vaginal delivery 29.78 ± 2.166
Caesarean section 30.74 ± 1.820
Birth order 9.533F 0.001
First 29.45 ± 2.088
Second 30.77 ± 1.713
Third and above 29.56 ± 2.443
Open in a new tab

SD: Standard deviation

T: Student T test

F: Analysis of variance

Eighty-eight (40.6%) mothers practiced EBF (Table 3). According to Fig 1, the reasons for the mothers not practicing EBF were work schedule 57 (26.3%), cultural beliefs and the need to introduce herbal medicine 32 (14.7%), insufficient breast milk 30 (13.8%), baby getting hungry and thirsty 28 (12.9%), HIV and unplanned pregnancy 19 (8.8%), early and single motherhood 14 (6.5%) and other reasons 4 (1.8%) [Fig 1]. Table 3 shows that there was a statistically significant association between marital status and the practice of EBF (X = 8.993, p = 0.003). A higher proportion of married mothers practiced EBF than unmarried mothers (married: 44.5%; unmarried: 11.5%). There was no statistically significant association between other respondents’ variables and the practice of EBF. Binary logistic regression in Table 4 revealed that married mothers were about 6 times more likely to practice EBF than those who were unmarried (AOR:6.324, 95%CI: 1.809–22.114).

Table 3. Association between respondents’ characteristics and practice of exclusive breastfeeding (N = 217).

Variable Exclusive breastfeeding
Yes No
(n = 88) (%) (n = 129) (%) Test p-value
All respondents 88 (40.6) 129 (59.4) - -
Age group (years) 0.015X 1.000
<30 years 41 (41.0) 59 (59.0)
>30 years 47 (40.2) 70 (59.8)
Level of education 0.091X 0.769
Secondary 29 (42.0) 40 (58.0)
Post-secondary 59 (39.9) 89 (60.1)
Marital status 8.993Y 0.003
Unmarried 3 (11.5) 23 (88.5)
Married 85 (44.5) 106 (55.5)
Religion 0.249X 0.729
Christianity 72 (41.4) 102 (58.6)
Islam 16 (37.2) 27 (52.8)
Tribe 3.506F 0.173
Yoruba 75 (49.1) 104 (58.9)
Hausa 3 (18.8) 13 (81.3)
Igbo 10 (45.5) 12 (54.5)
Occupation 2.257X 0.529
Farmer/trader/artisan 32 (42.9) 44 (57.1)
C/S 34 (36.2) 60 (63.8)
Professional 8 (40.0) 12 (60.0)
Student 14 (51.9) 13 (48.1)
ANC attendance during the pregnancy of this baby <0.001Y 1.000
Yes 88 (40.7) 128 (59.3)
No 0 (0.0) 1 (100.0)
If yes to question 7, were you informed on exclusive breastfeeding 0.207Y 0.649
Yes 88 (41.1) 126 (58.9)
No 0 (0.0) 2 (100.0)
Place of delivery of this baby 0.715X 0.488
Outside HF 15 (34.9) 28 (65.1)
Within HF 73 (42.0) 101 (58.0)
Mode of delivery 0.005X 1.000
Vaginal delivery 74 (40.7) 108 (59.3)
Caesarean section 14 (40.0) 21 (60.0)
Birth order 2.859X 0.245
First 32 (35.2) 59 (54.8)
Second 36 (48.0) 39 (52.0)
Third and above 20 (39.2) 31 (60.8)
Mean attitudinal score 30.09 ± 1.891 29.82 ± 2.295 0.883T 0.378
Open in a new tab

X: Pearson Chi-Square

Y: Continuity correction

F: Fisher’s Exact Test

Fig 1. Reasons for not practicing exclusive breastfeeding (N = 217).

Fig 1

Open in a new tab

*Multiple response.

Table 4. Predictors of practice of excusive breastfeeding.

Predictors B P-value AOR 95% CI for AOR
Lower Upper
Marital Status (Unmarried)Ref 1.000
Marital Status (Married) 1.844 0.004 6.324 1.809 22.114
Tribe (Yoruba)Ref 1.000
Tribe (Hausa) 0.357 0.459 1.429 0.556 3.674
Tribe (Igbo) 1.429 0.072 4.173 0.879 19.803
Open in a new tab

B: Intercept, AOR: Adjusted odd ratio, CI: Confidence interval

Discussion

This study assessed the attitude towards EBF, its practice, and predictors among mothers attending under-five welfare clinics in a rural community. The mean attitude score towards EBF for all mothers in this study was 29.9 out of 36 maximum possible scores. This is 83.2% of the maximum obtainable score which depicts a good disposition towards EBF among the mothers. This finding is higher than what was obtained in rural communities of Lagos, Nigeria [20]. However, it is similar to what was found in studies done among lactating mothers in a rural Ghana community and Ethiopia [19, 21]. This level of attitude is good for the mothers, although there is room for improvement.

This study revealed that EBF attitude was positively associated with age, as mothers who were 30 years and over had a better attitude than those aged less than 30 years. This finding is consistent with findings from studies in Ondo state, Southwest, Nigeria [22] and in the Island of Abu Dhabi, United Arab Emirates [23]. Also, mothers who had attended the antenatal clinic during the pregnancy of the baby had a better attitude than mothers who did not attend the clinic. The antenatal clinic provides nutritional counseling and education including the health benefits of EBF and other infant feeding practices as part of the health promotion measures during visits. Unsurprisingly, this exposure not only improves maternal attitude but subsequently brings about the likelihood of better practice as reported in a study done in Rawalpindi [24].

This study found that mothers with a higher level of education had better attitude toward EBF. Maternal level of education is a significant determinant of infant feeding practices, and this is supported by a study done in Ondo state, Southwest, Nigeria which found that attitude towards EBF is higher among lactating mothers with higher levels of education [22]. Mothers with higher levels of education can understand and quickly realize the benefits of EBF to their infants and are more motivated to practice it. Programs promoting EBF should be adapted to appeal to mothers who have lower levels of education. The maternal attitude of EBF was better among mothers with 2nd birth than those with their first birth. This is similar to the findings in a study done in Ibadan, Southwest, Nigeria [25]. This finding is not surprising as multiparous mothers have previously developed a prior experience and skillset allowing for better EBF attitude in subsequent deliveries.

Less than half (40.6%) of mothers in this study practiced EBF. This is similar to a study done in Edo state, South-south, Nigeria with a prevalence of 40.7% [12]. However, it is higher than the findings in previous studies done in Italy (33.3%), Bangladesh (34.5%), Southern Ethiopia (14.9%), Jigawa (26.8%) and Sokoto (31.0%) states, Northern, Nigeria (31.0%) [6, 7, 10, 26, 27] and lower than the prevalence recorded from studies conducted in Debre Berhan District, Ethiopia (68.6%), urban centers of Abuja (54.4%), Ikorodu, Lagos (69.4%) and in Ogun State, Southwest, Nigeria (58.8%) [11, 13, 20, 28]. Interestingly, the prevalence of practice of EBF in this study aligns with the WHO targets of at least 50.0% rate in all communities whether rural or urban by 2025 [15]. Though, close to the WHO target, several barriers still hinder the practice of EBF. Work schedule, cultural beliefs and the need to introduce herbal medicine, insufficient breast milk, baby gets hungry and thirsty, HIV and unplanned pregnancy, early and single motherhood were mentioned by the mothers as barriers to EBF. Some of these barriers have equally been reported in previous studies [29, 30].

It was observed from this study that mothers who are married were about 6 times more likely to practice EBF than those who are unmarried. Expectedly, this result is substantiated by another study in Ethiopia [31]. This may be due to the responsibility-sharing and support provided by the husband that could aid the practice of EBF. However, this finding contrast that found in a study done among first-time mothers in Ethiopia which revealed that participants who were not married were almost 3-fold more likely to practice EBF compared with married counterpart [32]. This difference could be due to birth-related traditional practices of some Ethiopian where first-time mothers at 8 months gestational age visit their parent’s home in preparation for births, and afterward, stay for 40 days after birth with their infant and never left alone. Against these background, one can deduce that a good support system from husbands of married women or from parents of unmarried women post-delivery makes the practice of EBF more feasible.

Strengths and limitations

To the best of our knowledge, this is the first study in Ekiti state that assessed the attitude and practice of exclusive breastfeeding among rural mothers. We also identified predictors of exclusive breastfeeding among this population.

However, the study shares the limitations of the cross-sectional study design. In addition, the research is prone to social desirability and recall bias since questions were asked about the past experiences of the mothers on breastfeeding. Lastly, this health facility-based study that was carried out in the under-five welfare clinic and might have left out mothers who do not seek healthcare in health facilities or patronize other institutions such as patent medicine stores, drug hawkers and herbalists for their healthcare.

Conclusion and recommendation

The study revealed a good disposition towards EBF among mothers with less than half (40.6%) breastfeeding their babies exclusively. Married mothers were more likely to practice EBF than unmarried mothers. We, therefore, recommend policies that will improve the EBF of mothers in rural areas toward achieving the WHO target. It is also important to carry out further quantitative and qualitative studies to identify factors associated with low uptake of EBF among unmarried women and develop interventions to improve their practice.

Supporting information

S1 File. Minimal data set.

(XLSX)

pone.0299843.s001.xlsx (35.8KB, xlsx)

Acknowledgments

We express gratitude to all the participants of this study.

Data Availability

All relevant data are within the manuscript and its Supporting Information files.

Funding Statement

The author(s) received no specific funding for this work.

References

  • 1.World Health Organization. Breastfeeding. 2024. Available from: https://www.who.int/health-topics/breastfeeding#tab=tab_1 [Last accessed 12 January 2024].
  • 2.World Health Organization. Infant and young child feeding. 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding [Last accessed 8 February 2023].
  • 3.Centre for Disease Control and Prevention. Nutrition: Infant and Toddler nutrition. 2022. https://www.cdc.gov/nutrition/infantandtoddlernutrition/definitions.html [Last accessed 8 February 2023].
  • 4.The Innocenti declaration on the protection, promotion, and support of breastfeeding. 1990. Florence, Italy. World Health Organization/United Nation Children’s Fund. [Google Scholar]
  • 5.United Nation Children’s Fund. Global Database for Exclusive Breastfeeding. 2022. Available from: https://data.unicef.org/topic/nutrition/breastfeeding/ [Last accessed 8 February 2023].
  • 6.Cascone D, Tomassoni D, Napolitano F, Di Giuseppe G. Evaluation of Knowledge, Attitudes, and Practices about Exclusive Breastfeeding among Women in Italy. Int J Environ Res Public Health. 2019;16(12):2118. doi: 10.3390/ijerph16122118 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Rana MM, Islam MR, Karim MR, Islam AZ, Haque MA, Shahiduzzaman M, et al. Knowledge and practices of exclusive breastfeeding among mothers in rural areas of Rajshahi district in Bangladesh: A community clinic-based study. PLoS One. 2020;15(5):e0232027. doi: 10.1371/journal.pone.0232027 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Dukuzumuremyi JPC, Acheampong K, Abesig J, Luo J. Knowledge, attitude, and practice of exclusive breastfeeding among mothers in East Africa: a systematic review. Int Breastfeed J. 2020;15(1):70. doi: 10.1186/s13006-020-00313-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.National Demographic and Health Survey. 2018. National Population Commission. Federal Republic of Nigeria.
  • 10.Oche MO, Umar AS, Ahmed H. Knowledge and practice of exclusive breastfeeding in Kware, Nigeria. African Health Sciences 2011; 11(3): 518–523. [PMC free article] [PubMed] [Google Scholar]
  • 11.Okoroiwu GIA, Ubosi NI, Aliyu SM, Eya CP. Knowledge, Attitude and Practice of Exclusive Breastfeeding amongst Mothers of Infants in Gwagwalada Area Council, FCT, Abuja, Nigeria. J. Appl. Sci. Environ. Manage. 2021;25(1):127–132. doi: 10.4314/jasem.v25i1.18 [DOI] [Google Scholar]
  • 12.Akpan UJ, Ibadin MO, Abiodun PO. Breastfeeding practices in early infancy in Benin City, Nigeria. Niger J Paed. 2015;42(2): 126–131. doi: 10.4314/njp.v42i2.11 [DOI] [Google Scholar]
  • 13.Adebayo A, Oluwaseyi O. Breastfeeding Practices among Mothers in Southwest Nigeria. Ethiop J Health Sci. 2020;30(5):697. doi: 10.4314/ejhs.v30i5.8 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.United Nations Children’s Fund, World Health Organization & World Bank. ‎2020. ‎. Levels and trends in child malnutrition: UNICEF/WHO/The World Bank Group joint child malnutrition estimates: key findings of the 2020 edition. World Health Organization. Available from: https://apps.who.int/iris/handle/10665/331621 [Last accessed 4 March 2023]. [Google Scholar]
  • 15.World Health Organization. Global nutrition targets 2025: Policy brief series. 2014. Available from: https://www.who.int/publications/i/item/WHO-NMH-NHD-14.2 [Last accessed 4 March 2023]. [Google Scholar]
  • 16.City-facts. Ido-Ekiti. 2015. Available from: https://www.city-facts.com/ido-ekiti [Last accessed 4 March 2023].
  • 17.Ipinnimo TM, Abodunrin OL, Durowade KA. Relationship between Cost of Care and Medication Adherence among Hypertensive Patients attending a Tertiary Health Facility in Ekiti State, Nigeria. Journal of community medicine and primary health care. 2022; 34(1):38–57. 10.4314/jcmphc.v34i1.3. [DOI] [Google Scholar]
  • 18.Adewuyi EO, Adefemi K. Breastfeeding in Nigeria: a systematic review. Int J Community Med Public Health. 2016;3(2):385–396. 10.18203/2394-6040.ijcmph20160421. [DOI] [Google Scholar]
  • 19.Mogre V., Dery M., Gaa P.K. Knowledge, attitudes and determinants of exclusive breastfeeding practice among Ghanaian rural lactating mothers. Int Breastfeed J. 2016;11:12. doi: 10.1186/s13006-016-0071-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Balogun MR, Okpalugo OA, Ogunyemi AO, Sekoni AO. Knowledge, Attitude, and Practice of Breastfeeding: A Comparative Study of Mothers in Urban and Rural Communities of Lagos, Southwest Nigeria. Niger Med J. 2017;58(4):123–130. doi: 10.4103/nmj.NMJ_289_16 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Tadele N, Habta F, Akmel D, Deges E. Knowledge, attitude and practice towards exclusive breastfeeding among lactating mothers in Mizan Aman town, Southwestern Ethiopia: descriptive cross-sectional study. Int Breastfeed J. 2016;11:3. doi: 10.1186/s13006-016-0062-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Adegboro JS. Influence of demographic variables on attitude of nursing mothers towards exclusive breastfeeding in Akoko South West Local Government Area of Ondo State, Nigeria. International Journal of Life Science Research Archive. 2022;3(1):031–8. 10.53771/ijlsra.2022.3.1.0065. [DOI] [Google Scholar]
  • 23.Al Ketbi MI, Al Noman S, Al Ali A, Darwish E, Al Fahim M, Rajah J. Knowledge, attitudes, and practices of breastfeeding among women visiting primary healthcare clinics on the island of Abu Dhabi, United Arab Emirates. Int Breastfeed J. 2018;13:26. doi: 10.1186/s13006-018-0165-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Ahmad MO, Sughra U, Kalsoom U, Imran M, Hadi U. Effect of antenatal counseling on exclusive breastfeeding. J Ayub Med Coll Abbottabad. 2012;24(2):116–9. [PubMed] [Google Scholar]
  • 25.Ayinde AO, Adedokun B, Adeloye AI, Agbonjimi LA, Ayinde TO, Ogunode NJ. Birth order and exclusive breastfeeding practices among mothers with two or more children. Ijcsmr. 2021;1(1):1–10. https://journalofmedical.org/index.php/ijcsmr. [Google Scholar]
  • 26.Ermancho B., Lette A., Tamirat A., Ermeko T. Determinants of exclusive breastfeeding practice in Southern Ethiopia. J. Food Nutr. Popul. Health. 2021;5(4):50. [Google Scholar]
  • 27.Sabo A, Abba J, Sunusi Usman U, Musa Saulawa I, Alzoubi MM, Al-Mugheed K, et al. Knowledge, attitude, and practice of exclusive breastfeeding among mothers of childbearing age. Front Public Health. 2023;11:1277813. doi: 10.3389/fpubh.2023.1277813 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Asfaw MM, Argaw MD, Kefene ZK. Factors associated with exclusive breastfeeding practices in Debre Berhan District, Central Ethiopia: a cross sectional community based study. Int Breastfeed J. 2015. Aug 13;10:23. doi: 10.1186/s13006-015-0049-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Otoo GE, Lartey AA, Pérez-Escamilla R. Perceived incentives and barriers to exclusive breastfeeding among periurban Ghanaian women. Journal of Human Lactation. 2009;25(1):34–41. doi: 10.1177/0890334408325072 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Apanga PA. A review on facilitators and barriers to exclusive breastfeeding in West Africa. Journal of Biology, Agriculture and Healthcare. 2014;4:9–15. [Google Scholar]
  • 31.Mamo K, Dengia T, Abubeker A, Girmaye E. Assessment of Exclusive Breastfeeding Practice and Associated Factors among Mothers in West Shoa Zone, Oromia, Ethiopia. Obstet Gynecol Int. 2020;2020:3965873. doi: 10.1155/2020/3965873 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Ayalew T. Exclusive breastfeeding practice and associated factors among first-time mothers in Bahir Dar city, North West Ethiopia, removed: A community based cross sectional study. Heliyon. 2020;6(9):e04732. doi: 10.1016/j.heliyon.2020.e04732 [DOI] [PMC free article] [PubMed] [Google Scholar]

Decision Letter 0

Kahsu Gebrekidan

26 Dec 2023

PONE-D-23-40179Attitude and Predictors of Exclusive Breastfeeding Practice among Mothers Attending Under-Five Welfare Clinics in a Rural Community in Southwestern NigeriaPLOS ONE

Dear Dr. Ipinnimo,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Feb 09 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

  • A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

  • A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

  • An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Kahsu Gebrekidan

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at 

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and 

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. We suggest you thoroughly copyedit your manuscript for language usage, spelling, and grammar. If you do not know anyone who can help you do this, you may wish to consider employing a professional scientific editing service.  

Whilst you may use any professional scientific editing service of your choice, PLOS has partnered with both American Journal Experts (AJE) and Editage to provide discounted services to PLOS authors. Both organizations have experience helping authors meet PLOS guidelines and can provide language editing, translation, manuscript formatting, and figure formatting to ensure your manuscript meets our submission guidelines. To take advantage of our partnership with AJE, visit the AJE website (http://learn.aje.com/plos/) for a 15% discount off AJE services. To take advantage of our partnership with Editage, visit the Editage website (www.editage.com) and enter referral code PLOSEDIT for a 15% discount off Editage services.  If the PLOS editorial team finds any language issues in text that either AJE or Editage has edited, the service provider will re-edit the text for free.

Upon resubmission, please provide the following: 

● The name of the colleague or the details of the professional service that edited your manuscript

● A copy of your manuscript showing your changes by either highlighting them or using track changes (uploaded as a *supporting information* file)

● A clean copy of the edited manuscript (uploaded as the new *manuscript* file)

3. We note that your Data Availability Statement is currently as follows: [All relevant data are within the manuscript and its Supporting Information files]

Please confirm at this time whether or not your submission contains all raw data required to replicate the results of your study. Authors must share the “minimal data set” for their submission. PLOS defines the minimal data set to consist of the data required to replicate all study findings reported in the article, as well as related metadata and methods (https://journals.plos.org/plosone/s/data-availability#loc-minimal-data-set-definition).

For example, authors should submit the following data:

- The values behind the means, standard deviations and other measures reported;

- The values used to build graphs;

- The points extracted from images for analysis.

Authors do not need to submit their entire data set if only a portion of the data was used in the reported study.

If your submission does not contain these data, please either upload them as Supporting Information files or deposit them to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. For a list of recommended repositories, please see https://journals.plos.org/plosone/s/recommended-repositories.

If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially sensitive information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. If data are owned by a third party, please indicate how others may request data access.

4. Please ensure that you include a title page within your main document. You should list all authors and all affiliations as per our author instructions and clearly indicate the corresponding author.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Partly

Reviewer #3: No

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: No

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Major comments

• You can include key messages in your final conclusion section

• The definition of breastmilk should be rewrite again.

• There is a reference repetition.

• This is more to the problem situation and it has to be coherent; revise the background section

• You didn't show the actual gap of the study area in this section

• The multivariate regression is don’t exist to the extent to identify the predictors

• The legend of the table description should clearly show the data

• It is good to display the multivariate data of what you have stated right here

• The discussion is not enough. You have to revise additional and similar topics in Ethiopia and other countries you have stated

In General, at this point I can give these comments.

Reviewer #2: The title has been over researched in Nigeria, so what did you add to the existing knowledge or what is your new finding? If you can justify this, what about the knowledge component? it should be included in the title or studied as a factor

The introduction section should clearly describe the public health importance of EBF and mother's attitude, it should be based on your objectives, and must show what interventions undertaken and the existing gaps

Regarding to sample size, your sample size is not adequate, and since the sampling technique is non random, it can not be used for generalization.

How do you measure attitude and practice? I think you used mean, what was your reason to use the mean? I haven't seen a clear operational definition. In addition to this using a five point Likert scale is better than 3 point Liker Scale.

It is better to show the dependent and independent variables clearly.

Regarding to ethical issue, how did you address the confidentiality issue?

Result: the statistical analysis is not performed appropriately and adequately, and lacks clarity. For example you said "The mean ± SD exclusive breastfeeding attitudinal score for the respondents was 29.94 ± 2.14 (maximum obtainable scores was 36) and the proportion of mothers that practiced exclusive breastfeeding was 40.6%." What are these numbers? showing the confidence interval is significant. The attitude score is not is not clear, you put only the mean score in table 2 there should be a table which shows the attitude components.

Marital status is the only variable associated with EBF practice, but what were the other variables in binary logistic regression which entered into multivariable logistic regression?

Discussion and conclusion should be objective based, and the recommendation should be based on your finding.

Additionally, I am not sure that the referencing style fulfils PLOS ONE's criteria.

Reviewer #3: GENERAL COMMENTS AND SUGGESTIONS

The study topic is scientifically sound and may contribute to body knowledge in maternal and child health. However, there are many gross editorial and methodological issues and problems. I have tracked and changed all the comments and suggestions with an attached document.

1. The study was written in standard academic English.

2. The methodology needs a massive correction. You could not provide a specific Analysis that fits the nature of your data.

a. You must have separate titles for data collection methods, tools, or study measurements. They are district features of the study methodology.

b. If you did a pre-test, what was the tool's reliability?

c. you need to state explicitly how you measured the exclusive breastfeeding outcome variable.

d. What is the need to use chi-square? Do you have a specific justification? You also used binary logistic regression, which measures the association between dependent and independent variables more accurately than chi-square. Table 2 also indicates you used Yate’s continuity correction and Fisher’s exact test.

e. Did you conclude the association between dependent and independent variables only based on the result of binary logic regression? This is not scientifically sound. Table 1 depicts. You used Analysis of variance and T-test. So, you did not select one appropriate analysis method for this study. If you have justification, why do you use a mix of different analyses to justify it?

3. You need to add the strengths and limitations of the study and the conclusion and recommendation sections.

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachment

Submitted filename: PONE-D-23-40179 (4).pdf_22_12.pdf

pone.0299843.s002.pdf (558.6KB, pdf)
Attachment

Submitted filename: PONE-D-23-40179_reviewer Commented.docx

pone.0299843.s003.docx (84.2KB, docx)
PLoS One. 2024 Mar 28;19(3):e0299843. doi: 10.1371/journal.pone.0299843.r002

Author response to Decision Letter 0

15 Jan 2024

Dear Academic Editor and Reviewers,

Thank you for taking the time to read and review this work, we are grateful for your insightful comments and contributions. Please find the response to each point raised within the uploaded rebuttal letter.

Attachment

Submitted filename: Response to Reviewers - Breastfeeding in Ido-Ekiti.doc

pone.0299843.s004.doc (50.5KB, doc)

Decision Letter 1

Kahsu Gebrekidan

8 Feb 2024

PONE-D-23-40179R1Attitude and Predictors of Exclusive Breastfeeding Practice among Mothers Attending Under-Five Welfare Clinics in a Rural Community in Southwestern NigeriaPLOS ONE

Dear Dr. Ipinnimo,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Mar 24 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

  • A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

  • A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

  • An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Kahsu Gebrekidan

Academic Editor

PLOS ONE

Additional Editor Comments:

The reviewer commented that the pevious comments are not fully addressed, you are expected to clearly address all comments.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #3: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #3: No

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #3: No

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #3: (No Response)

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #3: No

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: More or less, the authors addressed the comments, and the author amended them accordingly. There are some modifications that the author didn’t consider changing. The introductory sentence should be included in the background data.

There is still a gap in justifying the actual study area.

Results and discussion

It is better to report the mean age of mothers

One of the variables in the result section is work schedule, and the majority of the respondents are farmers. How do you justify this? Similar comments were made during the discussion as well.

Reviewer #3: General comments and suggestions.

The comments and suggestions are not adequately addressed. There are areas that have needed major revision. For instance, the Methodology, result, discussion, and recommendations sections. Additionally, there are editorial issues.

Methodology: Variable page 8. You treat Attitude as the dependent variable in the result section. See Table 2. It is so confusing.

Methodology: Data management and statistical analysis. Yes, you calculated the mean and standard deviation based on the attitudinal score for each independent variable. The question is: Is attitude toward breastfeeding not a dependent variable? The second question is, do you understand when we can use T-test and ANOVA? Because to use a T-test, you need to have at least two Mean scores. For Anova, it is supposed to be three means or more. You have a single population. You collected data at a single point. You did not have a standard attitudinal score to compare with. So, your statistical analysis selection reflects a poor understanding of this method. I Attached a document for your understanding.

Result Page 10. The logical order of the paragraphs is not correct. Some information is fabricated.

Discussion: page 10 paragraph 6. EBF attitude was not stated as the dependent variable in the methodology section. So, it is difficult to discuss here. Additionally, you used a T-test to identify associated factors to EBF attitude, which is an inappropriate and unacceptable choice of analysis. Review this thoroughly. (for reference table 2.)

Discussion: page 11 paragraph 2. Where did you find this finding? Education is not in the final model. Education is not significantly associated with the practice of exclusive breastfeeding in the Chi-square test (Reference Table 3)

Discussion: page 11 paragraph 3. First, discuss descriptive findings before analytic ones. Follow the logical order.

Discussion: page 11 paragraph . A logistic regression model with a single variable cannot predict the practice of exclusive breastfeeding. This is not utterly acceptable. (reference table 4)

Conclusion and recommendation: page 12 paragraph1. These are descriptive findings from this study. However, factors associated with exclusive breastfeeding are more reliable and credible for recommending solutions. It is not conclusive to recommend unless these factors are statistically significant with exclusive breastfeeding practice. (reference Figure 1) Hence, this study's analytical recommendation should come from analytical findings.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #3: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachment

Submitted filename: PONE-D-23-40179_R1_reviewer Commented second.docx

pone.0299843.s005.docx (381.4KB, docx)
PLoS One. 2024 Mar 28;19(3):e0299843. doi: 10.1371/journal.pone.0299843.r004

Author response to Decision Letter 1

12 Feb 2024

Dear Academic Editor and Reviewers,

Thank you once again for your comments and contributions. Explanations have been given and reference have been provided for the statistical method used in analysis. Please find the response to each point raised within the uploaded rebuttal letter.

Regards

Attachment

Submitted filename: R2.Response to Reviewers - Breastfeeding in Ido-Ekiti.doc

pone.0299843.s006.doc (51KB, doc)

Decision Letter 2

Kahsu Gebrekidan

19 Feb 2024

Attitude and Predictors of Exclusive Breastfeeding Practice among Mothers Attending Under-Five Welfare Clinics in a Rural Community in Southwestern Nigeria

PONE-D-23-40179R2

Dear Mr Tope MIchael,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Kahsu Gebrekidan

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #3: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #3: Authors addressed all comments and suggestion. This study will contribute a significant view toward maternal and child health body of knowledge specially in the area limited research has been conducted.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #3: No

**********

Acceptance letter

Kahsu Gebrekidan

19 Mar 2024

PONE-D-23-40179R2

PLOS ONE

Dear Dr. Ipinnimo,

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team.

At this stage, our production department will prepare your paper for publication. This includes ensuring the following:

* All references, tables, and figures are properly cited

* All relevant supporting information is included in the manuscript submission,

* There are no issues that prevent the paper from being properly typeset

If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps.

Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

If we can help with anything else, please email us at customercare@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Kahsu Gebrekidan

Academic Editor

PLOS ONE

Associated Data

    This section collects any data citations, data availability statements, or supplementary materials included in this article.

    Supplementary Materials

    S1 File. Minimal data set.

    (XLSX)

    pone.0299843.s001.xlsx (35.8KB, xlsx)
    Attachment

    Submitted filename: PONE-D-23-40179 (4).pdf_22_12.pdf

    pone.0299843.s002.pdf (558.6KB, pdf)
    Attachment

    Submitted filename: PONE-D-23-40179_reviewer Commented.docx

    pone.0299843.s003.docx (84.2KB, docx)
    Attachment

    Submitted filename: Response to Reviewers - Breastfeeding in Ido-Ekiti.doc

    pone.0299843.s004.doc (50.5KB, doc)
    Attachment

    Submitted filename: PONE-D-23-40179_R1_reviewer Commented second.docx

    pone.0299843.s005.docx (381.4KB, docx)
    Attachment

    Submitted filename: R2.Response to Reviewers - Breastfeeding in Ido-Ekiti.doc

    pone.0299843.s006.doc (51KB, doc)

    Data Availability Statement

    All relevant data are within the manuscript and its Supporting Information files.

    Articles from PLOS ONE are provided here courtesy of PLOS

    RESOURCES