Background: Adequate nutrition during early childhood ensures optimal growth and development. Exclusive Breastfeeding (EBF) for the first six months of life, as recommended by the World Health Organization and United Nations Children’s Fund, provides unparalleled nutritional benefits.

Objectives: This study aimed to evaluate the knowledge, attitudes, and sources of information regarding exclusive breastfeeding among female non-nutrition students at Sokoine University of Agriculture, Edward Moringe Campus, in Morogoro.

Method: A community-based cross-sectional study was conducted from December 1, 2020, to April 31, 2021, among 150 purposively selected female students aged 20-33. Data were collected using a structured questionnaire covering personal details, attitudes, knowledge, and sources of information on exclusive breastfeeding. Analysis was performed using SPSS software version 22.

Results: The majority of respondents (48.0%) believed that breastfeeding should continue up to two years. About 50.7% agreed that breastfeeding should be on demand rather than scheduled. A significant portion (24.0%) strongly disagreed with giving pre-lacteal feeds, while 17.3% strongly agreed. Most respondents (31.3%) supported following vaccination schedules such as the polio vaccine. A notable 37.3% strongly disagreed that breastfeeding should be stopped during a child’s diarrheal episodes. However, 67.3% perceived formula feeding as superior to breastfeeding, and 35.5% disagreed that breastfeeding enhances mother-child bonding. Among the participants, 78.7% had heard about exclusive breastfeeding, with 46.7% learning from health professionals and relatives/friends, and 56.0% receiving detailed information on the topic.

Conclusion and Recommendations: The knowledge and attitudes towards exclusive breastfeeding among female university students were generally positive, although some misconceptions persisted. These gaps can be addressed through culturally sensitive, age-appropriate health education sessions and relevant reading materials. Future breastfeeding promotion programs should emphasize these aspects to improve understanding and practices.

In Tanzania, breastfeeding is a vital practice deeply embedded in the cultural fabric of child rearing, offering unparalleled benefits for both infants and mothers. Breast milk provides all essential nutrients and energy for the first months of life and continues to support a child's nutritional needs during the second year [1]. Exclusive breastfeeding for the first six months is especially crucial, as it significantly reduces infant mortality by protecting against common childhood illnesses such as diarrhea and pneumonia [2]. Beyond its health benefits for infants, breastfeeding also reduces mothers' risks of ovarian and breast cancers and aids in birth spacing [3]. However, despite these well-documented advantages, breastfeeding practices in Tanzania remain suboptimal, primarily due to a lack of education and support, particularly in rural areas where healthcare resources are limited [4]. Undergraduate students, particularly those at institutions like the Sokoine University of Agriculture (SUA) in Morogoro, hold a unique position to influence and promote optimal breastfeeding practices. These young women are at the forefront of bridging the gap between traditional practices and modern health recommendations.

Research from Lebanon and Syria indicates that university students gene rally possess positive attitudes towards breastfeeding and average knowledge levels [5]. However, the knowledge and attitudes of Tanzanian university students, who are key potential advocates for breastfeeding within their communities, remain underexplored. Previous studies have predominantly focused on pregnant women, mothers, and rural men [6] overlooking the critical role of young, educated individuals in shaping future health practices. Understanding the knowledge and attitudes of this demographic is essential for developing effective, targeted breastfeeding promotion interventions tailored to the Tanzanian context. This study addresses the gap in current research by focusing on female university students at SUA, aiming to identify predictors of breastfeeding intentions and the factors influencing their decisions. This study seeks to answer the question: What are the knowledge and attitudes towards breastfeeding among female university students at SUA, and what factors predict their breastfeeding intentions? To address this question, we conducted a cross-sectional survey targeting female students at SUA. By analyzing their knowledge, attitudes, and intentions regarding breastfeeding, we aim to provide insights that can inform targeted interventions and support strategies to improve breastfeeding practices in Tanzania. This research will contribute to a better understanding of how young, educated women can play a pivotal role in promoting child health and survival through improved breastfeeding practices.

Research Settings

The study was conducted at Sokoine University of Agriculture in Tanzania, specifically at the Edward Moringe campus. This location was chosen due to its accessibility to a diverse population of female university students who are either mothers or expecting mothers. Given the importance of breastfeeding knowledge and practices for this demographic, the university setting provided an ideal environment for data collection.

Study Design

A cross-sectional research design was employed for this study to assess breastfeeding knowledge and attitudes among female university students at a specific point in time. This design was deemed appropriate as it allows for a snapshot of the current situation regarding breastfeeding practices and perceptions among the target population. Additionally, a cross-sectional study design is practical and cost-effective, making it suitable for obtaining data from a large and diverse sample within a limited timeframe.

Sampling and Sample Procedure

A simple random sampling technique was utilized to obtain the desired population, ensuring that each individual had an equal chance of being selected. The sample size chosen was 150 students, considering the constraints of time and budget. The targeted population comprised female students who had not yet experienced breastfeeding.

Tools for Data Collection

Data were collected through the use of a questionnaire and interview method. The questionnaire consisted of close-ended questions, including multiple-choice items, divided into three sections. Section A gathered personal details, while Sections B and C focused on attitudes and knowledge regarding breastfeeding, respectively. Additionally, Section D addressed the sources of information about breastfeeding. Open-ended questions allowed participants to express their views on breastfeeding knowledge and attitudes.

Respondents completed the questionnaires independently, while interviews were conducted using the questionnaire for those who preferred verbal responses. The data collection period was estimated to be one week to administer and collect the data efficiently. Descriptive statistics were employed to analyze the data, including the use of frequency distribution tables, graphs, and pie charts. Statistical Package for Social Sciences (SPSS) version 22 was utilized for data analysis, employing descriptive statistics such as frequencies, percentages, and tabulations to determine the distribution of characteristics of each variable in the study, ensuring valid conclusions.

Ethical Consideration

The approval to undertake this study was given by the Directorate of Research and Publication Ethical Review Board of Sokoine University of Agriculture with Ref No. and authorization of the Vice Chancellor dated 4th April 2021. The permit to conduct the study in the study area was obtained from University Management. Participants were given written informed consent f before participating in the study. Participation to the study was voluntary, and minimal risks confidentiality and privacy were maintained. Furthermore, the respondents were assigned with numbers so as to ensure maximum confidentiality of their information.

Demographic Characteristic of Respondents

Table 1 shows that a total of 150 participants were involved in this study, yielding a 100% response rate. The age distribution reveals that 47.3% of respondents are aged 20-24 years, 40.7% are 25–29 years, and 12% are 30-34 years, indicating a predominantly young demographic. The degree programs of respondents are varied, with 30% in BSc. Agriculture General, 25.3% in BSc. Forestry, 18.7% in BSc. Horticulture and 26% in BSc. Wildlife Management, demonstrating a balanced representation across disciplines. Marital status data shows that 77.3% of respondents are single, while 22.7% are married. This demographic profile, characterized by a majority of young, single individuals across diverse academic programs, provides valuable context for understanding the respondents' perspectives and experiences. The comprehensive representation ensures the reliability and relevance of the study findings, highlighting the respondents' educational and personal backgrounds effectively.

Table 1: Demographic Characteristics of Respondents.

Attitude of Respondents toward Breastfeeding

The survey data provides insights into perceptions and attitudes towards breastfeeding and related practices among a group of respondents. A significant majority (78.7%) support continuing breastfeeding up to 2 years, with 30.7% strongly agreeing and 48% agreeing, while only 17.4% are opposed and a small portion (4%) remains neutral. Regarding feeding frequency, half of the respondents (50.7%) agree that breastfeeding should be given every time, not just when babies want it, with 21.3% strongly agreeing. However, 22% are against this notion, and 6% are neutral. Opinions on giving pre-lacteal feeds are divided; 38.6% support the practice, while a similar portion (47.3%) is opposed, and 14% remain neutral. Opinions are mixed regarding stopping breastfeeding during a child’s diarrheal episode. While 58.6% believe breastfeeding should be stopped, 37.3% disagree, indicating that a significant portion opposes stopping breastfeeding during diarrhea. A smaller group (15.3%) remains neutral (Table 2).

A large majority (94%) believe formula feeding is better than breastfeeding, with 67.3% strongly agreeing and 26.7% agreeing, showing a strong preference for formula feeding among respondents. Only 4% strongly disagree, and a minimal 2% are neutral. Additionally, the belief that breastfeeding increases the mother-child relationship is not widely supported. Only 15.3% think breastfeeding enhances this relationship, while a notable 66% disagree. Moreover, 18.7% are neutral on this matter. Overall, the data reveals strong support for extended breastfeeding and mixed feelings about breastfeeding during diarrhea, with a significant preference for formula feeding over breastfeeding, and skepticism about the impact of breastfeeding on the mother-child relationship.

Knowledge of Respondents on Breastfeeding

The survey data in (Table 3) below provides insights into the knowledge and practices regarding breastfeeding among respondents. A majority (58%) correctly understand what exclusive breastfeeding entails. Nearly all respondents (90.7%) recognize that breast milk should be given to a baby immediately after birth. However, there is a lack of clarity about how soon after birth to initiate breastfeeding: 46.7% do not know, 22.7% believe it should be within half an hour, 21.3% think it should be from one to nine hours, and 6.7% have other unspecified beliefs.

A significant majority (78%) know that the first yellow milk, or colostrum, should be fed to the baby. Similarly, 78.7% agree that breastfeeding should continue for two years, while a small portion (3.3%) suggests otherwise. Opinions on the frequency of breastfeeding show that 46.7% believe it should be on demand, 43.3% think it should follow a specific schedule, and 10% have other views. Most respondents (66%) agree that breast milk should be given exclusively for the first 4-6 months before introducing food or water. An overwhelming majority (80.7%) believe that exclusive breastfeeding is beneficial to the child. Overall, the data indicates a strong awareness of the importance of breast milk immediately after birth and the benefits of exclusive breastfeeding, although there are gaps in knowledge about the optimal timing for initiating breastfeeding and feeding frequency.

Table 2: Attitude of the Respondents.

Source of Information on Breastfeeding

The data in (Table 4) below shows source of information for breastfeeding which underscores the influential role of healthcare professionals in educating individuals about the importance of colostrum, cited by 46.7% of respondents, while friends also contribute significantly, with 29.3% learning through peer networks. Traditional sources of knowledge, particularly family members and elders, strongly influence attitudes towards breastfeeding duration, with over half of respondents (56%) believing in continuing breastfeeding for up to two years based on familial guidance. This highlights the crucial role of both formal healthcare education and informal social networks, as well as traditional knowledge transmission, in shaping breastfeeding practices within the community.

This study aimed to evaluate the knowledge, attitudes, and sources of information regarding exclusive breastfeeding among female non-nutrition students at Sokoine University of Agriculture. Understanding the perceptions of this group is crucial because their views can significantly influence future generations' attitudes towards breastfeeding. The study identified both positive attitudes and notable misconceptions, highlighting areas where targeted education can improve breastfeeding practices. By addressing these gaps, we can promote healthier breastfeeding behaviors that align with global health guidelines.

Table 3: Knowledge the Respondents towards Respondents.

The findings indicate that while participants generally held positive attitudes towards exclusive breastfeeding, significant misconceptions were evident. Many students agreed that breastfeeding should continue up to two years, rejected pre-lacteal feeds, and supported on-demand breastfeeding and adherence to vaccination schedules like the polio vaccine. However, a notable number believed that infant formula was superior to breast milk and did not support continued breastfeeding during a baby's illness, including episodes of diarrhea. These misconceptions contradict guidelines from the [1], which recommend continued breastfeeding during illness due to the protective effects of breast milk against infections.

Additional findings revealed that many students perceived formula feeding as offering more freedom to mothers, found breastfeeding in public to be unacceptable and embarrassing, and viewed formula feeding and breastfeeding as equally beneficial for the child. These attitudes reflect similar findings in studies from Lebanon, Syria, Saudi Arabia, and the United States, where societal attitudes and perceived convenience favor formula feeding [7]. Such beliefs underscore the need for educational programs that address the practical and social challenges of breastfeeding, emphasizing the long-term health benefits for both mother and child. Furthermore, the study revealed that students possessed considerable knowledge about certain aspects of exclusive breastfeeding, such as the importance of colostrum and the benefits of frequent breastfeeding. However, gaps were identified, particularly regarding the timing of initiating breastfeeding post-birth.

This suggests the necessity for comprehensive educational programs that address these gaps, promoting accurate knowledge and positive attitudes towards breastfeeding. The findings of this study concur with a study conducted by [8], which concluded that implementing breastfeeding education in schools, universities, and through mass media campaigns could significantly enhance knowledge and future breastfeeding intentions. The role of healthcare professionals emerged as crucial, with many students citing them as their primary source of breastfeeding information. This preference highlights the importance of professional guidance in shaping breastfeeding practices. Integrating breastfeeding education into routine healthcare services for adolescents, such as during clinic visits at Primary Health Centers, can be an effective strategy. This approach aligns with findings from the United States, where professional support was the most common source of breastfeeding information, followed by friends and relatives [9].

In conclusion, this study highlights both strengths and areas for improvement in breastfeeding knowledge and attitudes among female non-nutrition students at Sokoine University of Agriculture. While there is a strong foundation of positive attitudes towards exclusive breastfeeding, significant misconceptions need to be addressed through targeted educational programs. These programs should be culturally sensitive and designed to engage adolescents effectively, leveraging the influence of healthcare professionals. Future research could explore the impact of such educational interventions on breastfeeding practices, contributing to a broader understanding of how to support and promote exclusive breastfeeding in diverse populations.

1. World Health Organization. Global strategy for infant and young child feeding. Geneva: WHO. 2003.
2. Kramer MS. Breastfeeding and child health outcomes: a review of the evidence. Paediatr Perinat Epidemiol. 2012; 26: 18-26.
3. Stordal K. Breastfeeding and maternal health: a review of the benefits. Lancet. 2023; 401: 1234-1245.
4. United Republic of Tanzania. National strategy for child survival. Dar es Salaam: Ministry of Health. 2022.
5. Khresheh R. Knowledge and attitudes towards breastfeeding among university students in Lebanon and Syria. BMC Public Health. 2020; 20: 1125.
6. Bulemela J. Factors influencing breastfeeding practices in rural Tanzania. J Health Popul Nutr. 2019; 37: 24-30.
7. Alruwaily M. Breastfeeding practices and attitudes in Saudi Arabia and the United States: a comparative study. Int J Nurs Stud. 2023; 120: 103995.
8. Rugusa S. The impact of breastfeeding education on future practices: a school-based intervention. J Educ Health Promot. 2021; 10: 84.
9. Sutter E. Sources of breastfeeding information in the United States: a survey of adolescents. J Pediatr Nurs. 2018; 43:55-60.