TITLE:
Factors Associated with Maternal-Reported Adherence to the Recommended Six-Month Duration of Exclusive Breastfeeding in the Lwani Health Area, Bandundu Urban-Rural Zone (DRC)
AUTHORS:
Merry Basema, Zébédée Biba, José Ezonga, Eric Bokabo, Tonton Paul Vita, Serge Mazamay
KEYWORDS:
Exclusive Breastfeeding, Breastfeeding Adherence, Maternal Knowledge, Occupational Constraints, Firth Logistic Regression, Democratic Republic of Congo, Cross-Sectional Study
JOURNAL NAME:
Health,
Vol.18 No.11,
November
10,
2026
ABSTRACT: Background: Exclusive breastfeeding (EBF) for the first six months of life is recommended to promote optimal infant health and development. However, adherence remains suboptimal in many low- and middle-income settings, including the Democratic Republic of the Congo (DRC). Objective: To assess maternal-reported adherence to the recommended six-month duration of EBF and examine sociodemographic, knowledge-related, and contextual factors associated with reported adherence among mothers in the Lwani Health Area, DRC. Methods: A facility-based cross-sectional study was conducted among 394 mothers aged 18 - 45 years attending preschool consultations with infants aged 0 - 12 months. Data were collected using a structured, pretested interview questionnaire. Descriptive statistics and bivariate analyses were followed by Firth penalized logistic regression because of sparse covariate patterns and potential instability of conventional maximum-likelihood estimates. The primary multivariable model included education, occupation, number of living children, and knowledge of the recommended EBF duration. Model diagnostics and sensitivity analyses assessed covariate overlap and estimate stability. Results: Of 394 mothers, 92 (23.4%) reported adherence to the recommended six-month duration of EBF and 302 (76.6%) reported non-adherence. Among non-adherent mothers, 45.4% reported introducing other foods or liquids at 3 - 5 months and 38.7% before three months. Work or daily occupational commitments were the most frequently reported reason for non-adherence (68.9%). Only 27.2% correctly identified six months as the recommended EBF duration. No sociodemographic or knowledge-related variable was significantly associated with adherence in bivariate analysis. In the primary multivariable Firth model, mothers with 2 - 3 living children (aOR = 0.08; 95% CI: 0.02 - 0.23; p Conclusion: Maternal-reported adherence to the recommended six-month duration of EBF was low in this facility-based sample. Work and daily occupational commitments were frequently reported barriers, although occupational category was not independently associated with adherence. Number of living children was the only factor associated with adherence in the primary adjusted model, but the ≥4 child estimate was sensitive to model specification. Because exact infant age at interview was not recorded, six-month completion could not be independently verified; findings should therefore be interpreted as maternal-reported adherence rather than objectively verified completed six-month EBF.