the actual exclusive breastfeeding rate in a population study and the one- day assessment overestimated exclusive breastfeeding rates among infants younger than 4 months. Similar findings were obtained in an analysis of the Ethiopia Demo- graphic and Health Surveys 2000, where even larger discrepancies were found among children 4–6 months old between the 24-hour recall and the 7-day recall method [34]. Several authors have questioned the validity of the 24-hour recall method [35,36]. The major criticism of the 24-hour recall method is that it misclassified too many mothers as exclusively breastfeeding [37,38]; a pro- portion of mothers may be providing substances other than breast milk on an irregular, not daily, basis. Many studies have shown that a large proportion of infants who were exclusively breastfed in the previous 24 hours were either not exclusively breastfed during the previous seven days, and/or, not exclusively breastfed since birth [26,38,39]. Median duration can also be affected by maternal recall, which might be prone to recall and social desirability bias. Therefore, readers are recommended to take this into account during interpretation of these findings. There are also unusually large odds ratios and a wide confidence interval observed in this study. In addition, there are also some variables that were not significantly associated (however known in several studies) with the outcome of interest which might affect the precision. This might be due to the sample size, which might not be adequate to justify the relationships between the explanatory variables and outcome of interest, and the observed counts are also so small in some of the cells making the odds ratios so large and so wide. Therefore, any interpretation of this finding should take into account the degree of precision. In addition, this study used a cross-sectional study design, making it is difficult to establish causal associations. The fact that this study did not assess individual factors, including knowledge and attitude of mothers, as well as variables related to family and peers, are the limitations of our study.
Conclusions
The study revealed that the prevalence of exclusive breastfeeding using 24-hour recall method was suboptimal. In this study, the duration and frequency of exclusive breastfeeding were below the World Health Organization and national infant and young child feeding recommendations. Working mothers were more likely not to exclusively breastfeed their babies. Promotion of exclusive breastfeeding through creating an enabling, breastfeeding-friendly working environment for working mothers is recommended. In addition, advocacy efforts targeting the extension of maternity leave up to the first six months after delivery should be exerted to prevent sub-optimal exclusive breastfeeding and associated health problems among children.