{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T08:41:27Z","timestamp":1786264887908,"version":"build-2736575974"},"reference-count":54,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100022150","name":"Debre Tabor University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100022150","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Hum Lact"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Ineffective breastfeeding techniques are associated with nipple trauma and the early discontinuation of exclusive breastfeeding. Despite frequent contact with healthcare services, many mothers do not acquire the practical skills needed for effective breastfeeding techniques. This study assessed the prevalence of ineffective breastfeeding techniques, identified associated factors, and evaluated maternal knowledge among lactating mothers attending public hospitals in northwest Ethiopia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      A facility-based cross-sectional study was conducted among 420 systematically selected lactating mothers attending public hospitals . Data were collected using interviewer-administered questionnaires to assess sociodemographic characteristics, obstetric history, prior breastfeeding counseling, and maternal knowledge of breastfeeding practices. Breastfeeding techniques were evaluated through direct observation using the World Health Organization (WHO) B-R-E-A-S-T Feed tool, assessing positioning, attachment, and effective suckling. Ineffective breastfeeding technique was defined as failure to meet criteria in any of these domains. Bivariate and multivariate logistic regression analyses were performed to identify factors associated with ineffective breastfeeding, and statistical significance was set at\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The prevalence of ineffective breastfeeding techniques was 54.3% (95% CI [49.9%, 59.8%]), while 56% (95% CI [51.3%, 60.7%]) of the mothers demonstrated poor knowledge of optimal breastfeeding practice. Although 85% of mothers attended antenatal care (ANC), only 19% received counseling on breastfeeding techniques. Lack of ANC follow-up (AOR = 3.09), absence of prior breastfeeding information (AOR = 1.94), being primiparous woman (AOR = 2.16), and having no formal education (AOR = 1.74) were significantly associated with ineffective breastfeeding techniques. In contrast, mothers aged 21\u201330 years were more likely to demonstrate effective breastfeeding techniques compared with those aged \u2264 20 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Ineffective breastfeeding techniques and poor maternal knowledge remained common despite high antenatal care (ANC) attendance. Several sociodemographic and obstetric factors were associated with ineffective breastfeeding techniques. Strengthening practical, skill-based breastfeeding support during ANC and the early postnatal period is essential, particularly for first-time and less-educated mothers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08903344261451968","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T06:30:52Z","timestamp":1786084252000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Determinants of Suboptimal Breastfeeding Techniques and Maternal Knowledge in Northwest Ethiopia: A Cross-Sectional Observational Study"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9140-4400","authenticated-orcid":false,"given":"Habtam Desse","family":"Alemayehu","sequence":"first","affiliation":[{"name":"Department of Midwifery, School of Nursing and Midwifery, College of Health Sciences, Debre Tabor University, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3858-190X","authenticated-orcid":false,"given":"Sagni","family":"Girma","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Leiden University Medical Centre, The Netherlands"},{"name":"College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Getahun","family":"Tiruye","sequence":"additional","affiliation":[{"name":"College of Health Sciences, Arsi University, Asella, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tesfaye Assebe","family":"Yadeta","sequence":"additional","affiliation":[{"name":"Department of Public Health and Maternal and Child Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"crossref","unstructured":"Alebel A. Tesma C. Temesgen B. Ferede A. Kibret G. D. (2018). Exclusive breastfeeding practice in Ethiopia and its association with antenatal care and institutional delivery: A systematic review and meta-analysis. International Breastfeeding Journal 13 Article 31. https:\/\/doi.org\/10.1186\/s13006-018-0173-x","DOI":"10.1186\/s13006-018-0173-x"},{"key":"e_1_3_3_3_1","doi-asserted-by":"crossref","unstructured":"Alemie K. Eshete T. Ashebir W. Gedif G. Desta M. Ayenew T. Alamneh A. A. Ketema D. B. Tsega T. D. Telayneh A. T. (2023). Ineffective breastfeeding techniques and associated factors among breastfeeding mothers who gave birth in the last 6 months in Sinan Woreda Northwest Ethiopia. Journal of Public Health Research 12(2) 22799036231181184. https:\/\/doi.org\/10.1177\/22799036231181184","DOI":"10.1177\/22799036231181184"},{"key":"e_1_3_3_4_1","doi-asserted-by":"crossref","unstructured":"Allen E. Rumbold A. R. Keir A. Collins C. T. Gillis J. Suganuma H. (2021). Avoidance of bottles during the establishment of breastfeeds in preterm infants. Cochrane Database of Systematic Reviews. https:\/\/doi.org\/10.1002\/14651858.CD005252.pub5","DOI":"10.1002\/14651858.CD005252.pub5"},{"key":"e_1_3_3_5_1","doi-asserted-by":"crossref","unstructured":"Arefaynie M. Mohammed A. Tareke A. A. Keleb A. Kebede N. Tsega Y. Endawkie A. Kebede S. D. Abera K. M. Abeje E. T. Enyew E. B. Daba C. Asmare L. Bayou F. D. (2024). Educational inequalities and decomposition of the urban-rural disparities in maternal health care utilization in Ethiopia: Further analysis of 2019 intermediate Ethiopian demography and health survey. BMC Public Health 24(1) Article 3415. https:\/\/doi.org\/10.1186\/s12889-024-20689-1","DOI":"10.1186\/s12889-024-20689-1"},{"key":"e_1_3_3_6_1","doi-asserted-by":"crossref","unstructured":"Ashique S. S. Afroze A. Rana R. A. Jesmin H. Sharmin S. Sharmin S. (2022). Position and attachment of the babies during breastfeeding: A comparison of before and after counselling the mothers. Community Based Medical Journal 11(2) 102\u2013107. https:\/\/doi.org\/10.3329\/cbmj.v11i2.61226","DOI":"10.3329\/cbmj.v11i2.61226"},{"key":"e_1_3_3_7_1","doi-asserted-by":"crossref","unstructured":"Asmamaw D. B. Habitu Y. A. Negash W. D. Desta D. Z. Mekonnen E. G. (2022). Effective breastfeeding technique and associated factors among lactating mothers in Gidan District North-East Ethiopia: A community-based cross-sectional study. BMJ Open 12(7) Article e059518. https:\/\/doi.org\/10.1136\/bmjopen-2021-059518","DOI":"10.1136\/bmjopen-2021-059518"},{"key":"e_1_3_3_8_1","doi-asserted-by":"crossref","unstructured":"Aswathaman N. Sajjid M. Kamalarathnam C. Seeralar A. (2018). Assessment of Breastfeeding Position and Attachment (ABPA) in a tertiary care centre in Chennai India: An observational descriptive cross-sectional study. International Journal of Contemporary Pediatrics 5 2209\u20132216. https:\/\/doi.org\/10.18203\/2349-3291.ijcp20184282","DOI":"10.18203\/2349-3291.ijcp20184282"},{"key":"e_1_3_3_9_1","doi-asserted-by":"crossref","unstructured":"Ayele S. Zegeye E. A. Nisbett N. (2020). Multi-sectoral nutrition policy and programme design coordination and implementation in Ethiopia. Institute of DevelopmentStudies. https:\/\/doi.org\/10.19088\/IDS.2020.004","DOI":"10.19088\/IDS.2020.004"},{"key":"e_1_3_3_10_1","doi-asserted-by":"crossref","unstructured":"Batista C. L. C. Ribeiro V. S. Nascimento M. Rodrigues V. P. (2018). Association between pacifier use and bottle-feeding and unfavorable behaviors during breastfeeding. The Journal of Pediatrics 94(6) 596\u2013601. https:\/\/doi.org\/10.1016\/j.jped.2017.10.005","DOI":"10.1016\/j.jped.2017.10.005"},{"key":"e_1_3_3_11_1","doi-asserted-by":"crossref","unstructured":"Brito J. D. S. Singh K. Falcon L. Elkhaligy S. Alshdafat T. Alrawaili S. Alansari L. (2025). Healthcare providers insights on the Baby-Friendly Hospital Initiative: A cross-sectional study in Qatar. European Journal of Midwifery 9 1\u20139. https:\/\/doi.org\/10.18332\/ejm\/203687","DOI":"10.18332\/ejm\/203687"},{"key":"e_1_3_3_12_1","doi-asserted-by":"crossref","unstructured":"Camacho-Morales A. Caba M. Garc\u00eda-Ju\u00e1rez M. Caba-Flores M. D. Viveros-Contreras R. Mart\u00ednez-Valenzuela C. (2021). Breastfeeding contributes to physiological immune programming in the newborn. Frontiers in Pediatrics 9 Article 744104. https:\/\/doi.org\/10.3389\/fped.2021.744104","DOI":"10.3389\/fped.2021.744104"},{"key":"e_1_3_3_13_1","doi-asserted-by":"crossref","unstructured":"\u00c7etindemir E. O. Cang\u00f6l E. (2024). The effect of breastfeeding education given through the teach-back method on mothers\u2019 breastfeeding self-efficacy and breastfeeding success: A randomized controlled study. BMC Pregnancy Childbirth 24(1) Article 453. https:\/\/doi.org\/10.1186\/s12884-024-06601-0","DOI":"10.1186\/s12884-024-06601-0"},{"key":"e_1_3_3_14_1","unstructured":"Chandwani H. (2018). A community based assessment study of positioning attachment and suckling during breastfeeding among 0-6 months aged infants in rural area of Hapur district Uttar Pradesh India. International Journal of Community Medicine and Public Health 3(7) 1921\u20131926. https:\/\/doi.org\/10.18203\/2394-6040.ijcmph20182947"},{"key":"e_1_3_3_15_1","doi-asserted-by":"crossref","unstructured":"Chethana K. Maria N. Manjula A. Jayaram S. (2020). Role of mother\u2019s education and antenatal counselling on breast feeding practices among women in coastal Karnataka: A community based cross sectional study. International Journal of Community Medicine and Public Health 7(1) 122\u2013127. https:\/\/doi.org\/10.18203\/2394-6040.ijcmph20195840","DOI":"10.18203\/2394-6040.ijcmph20195840"},{"key":"e_1_3_3_16_1","doi-asserted-by":"crossref","unstructured":"Degefa N. Tariku B. Bancha T. Amana G. Hajo A. Kusse Y. Zerihun E. Aschalew Z. (2019). Breast feeding practice: Positioning and attachment during breast feeding among lactating mothers visiting health facility in Areka Town Southern Ethiopia. International Journal of Pediatrics 2019 Article 8969432. https:\/\/doi.org\/10.1155\/2019\/8969432","DOI":"10.1155\/2019\/8969432"},{"key":"e_1_3_3_17_1","doi-asserted-by":"crossref","unstructured":"Dewidar O. John J. Baqar A. Madani M. T. Saad A. Riddle A. Ota E. Kung\u2019u J. K. Arabi M. Raut M. K. Klobodu S. S. Rowe S. Hatchard J. Busch-Hallen J. Jalal C. Wuehler S. Welch V. (2023). Effectiveness of nutrition counseling for pregnant women in low- and middle-income countries to improve maternal and infant behavioral nutritional and health outcomes: A systematic review. Campbell Systematic Reviews 19(4) Article e1361. https:\/\/doi.org\/10.1002\/cl2.1361","DOI":"10.1002\/cl2.1361"},{"key":"e_1_3_3_18_1","doi-asserted-by":"crossref","unstructured":"Emagneneh T. Mulugeta C. Alamrew A. Ejigu B. Abebe W. (2025). Early cessation of exclusive breastfeeding and associated factors in Ethiopia: A systematic review and meta-analysis. Frontiers in Nutrition 12 Article 1500077. https:\/\/doi.org\/10.3389\/fnut.2025.1500077","DOI":"10.3389\/fnut.2025.1500077"},{"key":"e_1_3_3_19_1","doi-asserted-by":"crossref","unstructured":"Engti R. Mane S. S. Goswami N. (2025). Breastfeeding and latching practices among postnatal mothers: A mixed methods study conducted in a tertiary care hospital in northeastern India. Indian Journal of Community and Family Medicine 11(2) 91\u201395. https:\/\/doi.org\/10.4103\/ijcfm.ijcfm_91_24","DOI":"10.4103\/ijcfm.ijcfm_91_24"},{"key":"e_1_3_3_20_1","unstructured":"Federal Democratic Republic of Ethiopia Ministry of Health. (2025). National guidelines for integrated management of acute malnutrition (IMAM). Ministry of Health. https:\/\/www.moh.gov.et"},{"key":"e_1_3_3_21_1","unstructured":"George A. Bonne S. Ekpenyong E. N. Edem E. N. Ajayi S. (2024). Breastfeeding and acute respiratory infection (ARI) in infants: A systematic review in Nigeria. Annals of Ibadan Postgraduate Medicine 22(3) 39\u201347. https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC12082678\/"},{"key":"e_1_3_3_22_1","doi-asserted-by":"crossref","unstructured":"Gurung A. Paudel B. (2025). Breastfeeding technique among postnatal mothers at the teaching hospital Bharatpur Nepal. International Journal of Medical and Health Research 3(2) 1\u201316. https:\/\/doi.org\/10.61424\/ijmhr.v3i2.205","DOI":"10.61424\/ijmhr.v3i2.205"},{"key":"e_1_3_3_23_1","doi-asserted-by":"crossref","unstructured":"Guzm\u00e1n S\u00e1nchez P. A. Arciniegas Morera M. M. C\u00e1rdenas Jaramillo L. Larrahondo G\u00f3mez M. Lambis Cano C. P. Meneses-Urrea L. A. (2025). Oral suction capacity in breastfeeding vs. bottle feeding. A systematic review. Frontiers in Pediatrics 13 Article 1646225. https:\/\/doi.org\/10.3389\/fped.2025.1646225","DOI":"10.3389\/fped.2025.1646225"},{"key":"e_1_3_3_24_1","doi-asserted-by":"crossref","unstructured":"Hailu W. S. Bayih M. T. Babble N. F. (2020). Four in every ten infants in Northwest Ethiopia exposed to sub-optimal breastfeeding practice. PLoS One 15(11) Articlee0238576. https:\/\/doi.org\/10.1371\/journal.pone.0238576","DOI":"10.1371\/journal.pone.0238576"},{"key":"e_1_3_3_25_1","doi-asserted-by":"crossref","unstructured":"Handebo S. Demie T. G. Gessese G. T. Woldeamanuel B. T. Biratu T. D. (2023). Effect of women\u2019s literacy status on maternal healthcare services utilisation in Ethiopia: A stratified analysis of the 2019 mini Ethiopian Demographic and Health Survey. BMJ Open 13(11) Article e076869. https:\/\/doi.org\/10.1136\/bmjopen-2023-076869","DOI":"10.1136\/bmjopen-2023-076869"},{"key":"e_1_3_3_26_1","doi-asserted-by":"crossref","unstructured":"Jia X. Dong Y. Shen C. Cai Y. Xu Y. Yang L. Jiang J. Sun T. Lu W. Huang R. (2025). Interventions for breastfeeding-related nipple pain or injury: a meta-analysis. Frontiers in Global Women\u2019s Health 6 Article 1507723. https:\/\/doi.org\/10.3389\/fgwh.2025.1507723","DOI":"10.3389\/fgwh.2025.1507723"},{"key":"e_1_3_3_27_1","doi-asserted-by":"crossref","unstructured":"Khanal A. (2019). Knowledge and practice of positioning technique and attachment of breastfeeding among postnatal mothers. Journal of Patan Academy of Health Sciences 6(1) 44\u201348. https:\/\/doi.org\/10.3126\/jpahs.v6i1.27079","DOI":"10.3126\/jpahs.v6i1.27079"},{"key":"e_1_3_3_28_1","doi-asserted-by":"crossref","unstructured":"Kitil G. W. Butta F. W. Tadesse S. Degefa B. D. Feyisa G. T. Demsash A. W. Shibabaw A. A. Marami S. N. Walle A. D. Dube G. N. Wedajo L. F. Dirirsa D. E. Jifar W. W. Dube G. N. (2024). Effective breastfeeding techniques and associated factors among lactating women in Ethiopia: A systematic review and meta-analysis. PLoS One 19(6) Article e0306167.https:\/\/doi.org\/10.1371\/journal.pone.0306167","DOI":"10.1371\/journal.pone.0306167"},{"key":"e_1_3_3_29_1","unstructured":"Lawrence R. A. Lawrence R. M. (2021). Breastfeeding: A guide for the medical professional (9th ed.). Elsevier Health Sciences. https:\/\/doi.org\/10.1016\/C2019-0-02452-3"},{"key":"e_1_3_3_30_1","doi-asserted-by":"crossref","unstructured":"Mislu E. Kumsa H. Arage M. W. Shitie A. Adimasu A. (2024). Effective breastfeeding techniques and associated factors among lactating women: A community-based study north east Ethiopia. Frontiers in Public Health 12 Article 1337822. https:\/\/doi.org\/10.3389\/fpubh.2024.1337822","DOI":"10.3389\/fpubh.2024.1337822"},{"key":"e_1_3_3_31_1","doi-asserted-by":"crossref","unstructured":"Nagendra K. Shetty P. N. Rudrappa S. Jaganath S. Nair R. (2017). Evaluation of breast feeding techniques among postnatal mothers and effectiveness of intervention: Experience in a tertiary care centre. Sri Lanka Journal of Child Health 46(1) 39\u201343. https:\/\/doi.org\/10.4038\/sljch.v46i1.8237.","DOI":"10.4038\/sljch.v46i1.8237"},{"key":"e_1_3_3_32_1","doi-asserted-by":"crossref","unstructured":"Nancy S. Sindhuri R. Arunagirinathan A. Dongre A. R. (2022). Breastfeeding positioning and attachment among postnatal mothers: A mixed methods study in a tertiary care hospital in Puducherry South India. Indian Journal of Community Medicine 47(1) 120\u2013124. https:\/\/doi.org\/10.4103\/ijcm.ijcm_859_21","DOI":"10.4103\/ijcm.ijcm_859_21"},{"key":"e_1_3_3_33_1","doi-asserted-by":"crossref","unstructured":"Nduagubam O. C. Ndu I. K. Bisi-Onyemaechi A. Onukwuli V. O. Amadi O. F. Okeke I. B. Ogbuka F. N. Ezenwosu O. U. Iheji C. C. (2021). Assessment of breastfeeding techniques in Enugu South-East Nigeria. Annals of African Medicine 20(2) 98\u2013104. https:\/\/doi.org\/10.4103\/aam.aam_22_20","DOI":"10.4103\/aam.aam_22_20"},{"key":"e_1_3_3_34_1","doi-asserted-by":"crossref","unstructured":"Necipoglu D. Bebis H. (2025). The effect of antenatal interventions on breastfeeding self-efficacy of first-time mothers: A systematic review. International Breastfeeding Journal 21(1) Article 6. https:\/\/doi.org\/10.1186\/s13006-025-00795-5","DOI":"10.1186\/s13006-025-00795-5"},{"key":"e_1_3_3_35_1","doi-asserted-by":"crossref","unstructured":"Nist M. D. (2025). Progress and challenges in global breastfeeding rates. MCN: The American Journal of Maternal\/Child Nursing 50(1) Article 55. https:\/\/doi.org\/10.1097\/NMC.0000000000001064","DOI":"10.1097\/NMC.0000000000001064"},{"key":"e_1_3_3_36_1","doi-asserted-by":"crossref","unstructured":"Oyato B. Gutema B. Feyisa M. (2024). Effective breast feeding techniques and associated factors among lactating mothers: A community-based cross-sectional study in Dugda district central Ethiopia. Journal of Pediatrics & Neonatal Care 14(1) 33\u201339. https:\/\/doi.org\/10.15406\/jpnc.2024.14.00538","DOI":"10.15406\/jpnc.2024.14.00538"},{"key":"e_1_3_3_37_1","doi-asserted-by":"crossref","unstructured":"Piro S. S. Ahmed H. M. (2020). Impacts of antenatal nursing interventions on mothers\u2019 breastfeeding self-efficacy: An experimental study. BMC Pregnancy and Childbirth 20(1) Article 19. https:\/\/doi.org\/10.1186\/s12884-019-2701-0","DOI":"10.1186\/s12884-019-2701-0"},{"key":"e_1_3_3_38_1","doi-asserted-by":"crossref","unstructured":"Rajak P. Jana J. K. Gayen S. Mandal A. K. (2023). Knowledge of breastfeeding practices among mothers attending a tertiary care setting in East India. Cureus 15(4) Article e37146. https:\/\/doi.org\/10.7759\/cureus.37146","DOI":"10.7759\/cureus.37146"},{"key":"e_1_3_3_39_1","doi-asserted-by":"crossref","unstructured":"Rinata E. Sari P. A. (2017). Breastfeeding practices [Positioning attachment\/latch-on and effective suckling]. SEAJOM: The Southeast Asia Journal of Midwifery 3(2) 1\u20136.https:\/\/doi.org\/10.36749\/seajom.v3i2.48","DOI":"10.36749\/seajom.v3i2.6"},{"key":"e_1_3_3_40_1","doi-asserted-by":"crossref","unstructured":"Roth M. C. Humphreys K. L. King L. S. Gotlib I. H. Robakis T. K. (2021). Breastfeeding difficulties predict mothers\u2019 bonding with their infants from birth to age six months. Maternal and Child Health Journal 25(5) 777\u2013785. https:\/\/doi.org\/10.1007\/s10995-020-03084-4","DOI":"10.1007\/s10995-020-03036-9"},{"key":"e_1_3_3_41_1","doi-asserted-by":"crossref","unstructured":"Safayi B. L. Assimamaw N. T. Kassie D. G. (2021). Breastfeeding technique and associated factors among lactating mothers visiting Gondar town health facilities Northwest Ethiopia: Observational method. Italian Journal of Pediatrics 47(1) Article 206. https:\/\/doi.org\/10.1186\/s13052-021-01158-6","DOI":"10.1186\/s13052-021-01158-6"},{"key":"e_1_3_3_42_1","doi-asserted-by":"crossref","unstructured":"Safitriana S. Budiati T. Rachmawati I. (2024). Management of breast and nipple problems in breastfeeding mothers: Systematic review. Disease Prevention and Public Health Journal 18(1) 47\u201361. https:\/\/doi.org\/10.12928\/dpphj.v18i1.10274","DOI":"10.12928\/dpphj.v18i1.10274"},{"key":"e_1_3_3_43_1","doi-asserted-by":"crossref","unstructured":"Shitie A. Adimasu A. Tsegaye D. Belete D. Mislu E. Assfaw M. Kettema W. G. (2024). Breast problems and associated factors among lactating women in Northeast Ethiopia 2022. Scientific Reports 14(1) Article 9202. https:\/\/doi.org\/10.1038\/s41598-024-58957-0","DOI":"10.1038\/s41598-024-58957-0"},{"key":"e_1_3_3_44_1","doi-asserted-by":"crossref","unstructured":"S\u00f6nmez T. S\u00fcr\u00fcc\u00fc \u015e. G. Vurge\u00e7 B. A. (2025). Effects of hybrid breastfeeding counseling on women\u2019s breastfeeding behaviors: A randomized controlled longitudinal study. BMC Pregnancy Childbirth 25(1) Article 663. https:\/\/doi.org\/10.1186\/s12884-025-06663-7","DOI":"10.1186\/s12884-025-07781-z"},{"key":"e_1_3_3_45_1","doi-asserted-by":"crossref","unstructured":"Sultania P. Agrawal N. R. Rani A. Dharel D. Charles R. Dudani R. (2019). Breastfeeding knowledge and behavior among women visiting a tertiary care center in India: A cross-sectional survey. Annals of Global Health 85(1) Article 64. https:\/\/doi.org\/10.5334\/aogh.2436","DOI":"10.5334\/aogh.2093"},{"key":"e_1_3_3_46_1","doi-asserted-by":"crossref","unstructured":"Tamiru D. Jisha H. (2017). Breastfeeding skills in Arba Minch Zuria: The positioning and attachment initiatives. International Journal of Nursing and Midwifery 9(4) 46\u201352. https:\/\/doi.org\/10.5897\/IJNM2016.0237","DOI":"10.5897\/IJNM2016.0237"},{"key":"e_1_3_3_47_1","doi-asserted-by":"crossref","unstructured":"Tesfau Y. B. Kahsay A. B. Gebrehiwot T. G. Medhanyie A. A. Godefay H. (2020). Postnatal home visits by health extension workers in rural areas of Ethiopia: A cross-sectional study design. BMC Pregnancy Childbirth 20(1) Article 305. https:\/\/doi.org\/10.1186\/s12884-020-03003-w","DOI":"10.1186\/s12884-020-03003-w"},{"key":"e_1_3_3_48_1","doi-asserted-by":"crossref","unstructured":"Tiruye G. Mesfin F. Geda B. Shiferaw K. (2018). Breastfeeding technique and associated factors among breastfeeding mothers in Harar city Eastern Ethiopia. International Breastfeeding Journal 13(1) Article 5. https:\/\/doi.org\/10.1186\/s13006-018-0147-z","DOI":"10.1186\/s13006-018-0147-z"},{"key":"e_1_3_3_49_1","unstructured":"World Health Organization. (2017). Guideline: Protecting promoting and supporting breastfeeding in facilities providing maternity and newborn services. https:\/\/www.who.int\/publications\/i\/item\/9789241550086"},{"key":"e_1_3_3_50_1","unstructured":"World Health Organization. (2021). Implementation guidance on counselling women to improve breastfeeding practices. https:\/\/www.who.int\/publications\/i\/item\/9789240025806"},{"key":"e_1_3_3_51_1","unstructured":"World Health Organization. (2025). Infant and young child feeding: Model chapter for textbooks for medical students and allied health professionals (2nd ed.). https:\/\/www.who.int\/publications\/i\/item\/9789240113732"},{"key":"e_1_3_3_52_1","unstructured":"World Health Organization & United Nations Children's Fund (UNICEF). (2020). Protecting promoting and supporting breastfeeding: The Baby-friendly Hospital Initiative for small sick and preterm newborns. https:\/\/www.who.int\/publications\/i\/item\/9789240005648"},{"key":"e_1_3_3_53_1","doi-asserted-by":"crossref","unstructured":"Yilak G. Gebretsadik W. Tadesse H. Debalkie M. Bante A. (2020). Prevalence of ineffective breastfeeding technique and associated factors among lactating mothers attending public health facilities of South Ari district Southern Ethiopia. PLoS One 15(2) Article e0228863. https:\/\/doi.org\/10.1371\/journal.pone.0228863.","DOI":"10.1371\/journal.pone.0228863"},{"key":"e_1_3_3_54_1","doi-asserted-by":"crossref","unstructured":"Yilak G. Tilahun B. D. Abate B. B. Zemariam A. B. Lake E. S. Ayele M. Belay A. S. (2024). Prevalence of ineffective breastfeeding techniques and its associated factors among breastfeeding mothers in Ethiopia: A systematic review and meta-analysis. PLoS One 19(6) Article e0303749. https:\/\/doi.org\/10.1371\/journal.pone.0303749","DOI":"10.1371\/journal.pone.0303749"},{"key":"e_1_3_3_55_1","doi-asserted-by":"crossref","unstructured":"Zakerihamidi M. Maamouri G. Boskabadi A. Rakhshanizadeh F. Parvini Z. Ramazani A. Bagheri F. Boskabadi H. (2025). Comparison of newborns\u2019 characteristics between neonates with proper and improper breastfeeding positions. Journal of Neonatal-Perinatal Medicine 18(3) 218\u2013225. https:\/\/doi.org\/10.1177\/19345798251327382","DOI":"10.1177\/19345798251327382"}],"container-title":["Journal of Human Lactation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08903344261451968","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/08903344261451968","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08903344261451968","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T07:46:26Z","timestamp":1786261586000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/08903344261451968"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,6]]},"references-count":54,"alternative-id":["10.1177\/08903344261451968"],"URL":"https:\/\/doi.org\/10.1177\/08903344261451968","relation":{},"ISSN":["0890-3344","1552-5732"],"issn-type":[{"value":"0890-3344","type":"print"},{"value":"1552-5732","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,6]]},"article-number":"08903344261451968"}}