Abstract
INTRODUCTION: Exclusive breastfeeding (EBF) is vital for optimal infant health, reducing the risk of infections and enhancing cognitive development. Despite WHO's recommendation of EBF for the first six months of life, global adherence remains suboptimal, particularly in low-resource settings. This study evaluates the impact of mobile health (mHealth) interventions on exclusive breastfeeding (EBF) among mothers in South Ethiopia. METHODS: A cluster randomized controlled trial was conducted in the Gamo Gofa zones, South Ethiopia, involving 20 health facilities (10 intervention and 10 control). The study included 680 pregnant mothers recruited using simple random sampling from antenatal care (ANC) registers and family folders. Mothers in the intervention group received mHealth support, including breastfeeding information and reminders, while the control group received standard care. Participants were followed from the second trimester to six months postpartum. Multilevel survival analysis was applied to assess EBF duration, and multilevel logistic regression was used to evaluate complementary feeding within the first month. RESULTS: The intervention group had a significantly higher probability of maintaining EBF at six months than the control group (AHR = 0.40, 95% CI: 0.26-0.62, p < 0.001). The secondary outcome also shows higher odds of early breastfeeding initiation in the intervention group (AOR = 4.71, 95% CI: 3.10-7.16, p < 0.001). ANC frequency was associated with a lower hazard of stopping EBF (AHR = 0.87, 95% CI: 0.79-0.97, p <0.05). The presence of diarrhea was associated with a high hazard of EBF (AHR = 1.47, 95% CI: 1.07-2.02, p < 0.05). College and above partner education was associated with high hazards of EBF (AHR = 2.41, 95% CI: 1.01-5.78, p < 0.05). The random effects variance (Var = 0.10, 95% CI: 0.01-0.07) indicated significantly lowered cluster-level variability. CONCLUSION AND RECOMMENDATIONS: The mHealth intervention significantly improved EBF adherence and early breastfeeding initiation among mothers in South Ethiopia. Early breastfeeding, ANC frequency, and family size were protective factors, while high partner education and diarrhea disease increased the risk of early cessation of EBF. These findings highlight the potential of mHealth in addressing key barriers to EBF. Scaling up similar interventions, focusing on high-risk groups, could enhance adherence to WHO's breastfeeding recommendations and improve maternal and child health outcomes in resource-limited settings.