title: Predictors of knowledge and practice of exclusive breastfeeding among health workers in Mwanza city, northwest Tanzania.
abstract: BACKGROUND
  Universal exclusive breastfeeding (EBF) for the first 6 months is estimated to reduce infant mortality by 13-15% (9 million) in resource poor countries. Although 97% of women initiate breastfeeding in Tanzania, exclusive breastfeeding for 6 months remains below 50%. Accurate knowledge and practical skills pertaining to exclusive breastfeeding among health workers is likely to improve breastfeeding rates. Our study reports the health workers' knowledge and practice on EBF in Mwanza City, northwest of Tanzania.
  
  
  METHODS
  One principal researcher and two research assistants conducted data collection from 11 June-6 July 2012. In total, 220 health care workers including: 64 clinicians (medical specialists, residents, registrars, assistant medical officers and clinical officers) and 156 nurses were interviewed using a structured knowledge questionnaire. Amongst 220 health workers, 106 were observed supporting Breastfeeding using a checklist. Logistic regression was used to determine factors associated with exclusive breastfeeding knowledge and desirable skills.
  
  
  RESULTS
  Almost half of the 220 health workers interviewed correctly described EBF as defined by the World Health Organization. Only 52 of 220 respondents had good knowledge. In the adjusted analysis, working at hospital facility level compared to dispensary (OR 2.1; 95% CI 1.1-4.0,p-value = 0.032) and attending on job training (OR 2.7; 95% CI 1.2-6.1,p-value = 0.015) were associated with better knowledge. In total, 38% of respondents had a desirable level of practical skills. Clinicians were more likely to have good practice (OR 3.6; 95% CI 1.2-10.8;p-value = 0.020) than nurses. Most of the health workers had no training on EBF, and were not familiar with breastfeeding policy.
  
  
  CONCLUSIONS
  Less than 25% of healthcare workers surveyed had good knowledge of EBF. These findings identify the need for comprehensive training and mentoring of health workers on exclusive breastfeeding, making breastfeeding policies available and understood, along with supportive supervision and monitoring.
authors.affiliation: Bugando Medical Centre, Department of community health services, Faculty of Nursing, Catholic University of Health and allied sciences (CUHAS), Mwanza, Northwest Tanzania.
authors.forename: Lucy E
authors.initials: LE
authors.lastname: Chale
authors.affiliation: Nutrition Services, Alberta Health Services, Department of Community Health Sciences, Alberta Children's Hospital Research Institute, O'Brien Institute for Public Health, Faculty of Medicine, University of Calgary, Calgary, AB Canada.
authors.forename: Tanis R
authors.initials: TR
authors.lastname: Fenton
authors.affiliation: Bugando Medical Centre, Department of community health services, Faculty of Nursing, Catholic University of Health and allied sciences (CUHAS), Mwanza, Northwest Tanzania ; Bugando Medical centre, Department of Paediatrics, Faculty of Medicine, Catholic University of Health and Allied Sciences (CUHAS), Mwanza, Northwest Tanzania.
authors.forename: Neema
authors.initials: N
authors.lastname: Kayange
keywords: Exclusive breastfeeding; Health workers; Knowledge; Practices