A mixed-methods investigation of infant and young child feeding practices in rural Ethiopia: integrating insights from surveys, direct observation, and qualitative research

Background: Optimal infant and young child feeding (IYCF) practices, particularly exclusive breastfeeding (EBF) for the first 6 months, are critical for child survival and development. In low- and middle-income countries, EBF prevalence is commonly estimated using maternal 24-h recall, which may overestimate true practices. This study quantified discrepancies between self-reported and directly observed feeding behaviors and explored socio-cultural determinants of IYCF in rural eastern Ethiopia. Methods: A sequential explanatory mixed-methods study was conducted among 106 mother-infant dyads with monthly maternal-recall surveys and two in-home observation sessions in a 79-infant subsample. Discrepancies were examined using chi-square or Fisher's exact tests. To contextualize findings, 26 semi-structured interviews and five focus group discussions with caregivers and community influencers were conducted and thematically analyzed. Results: ) facilitated early breastfeeding, but its protective role diminished as mothers resumed livelihoods. Conclusion: .