Background: Exclusive breastfeeding (EBF) is the best nutrition for the children during the first 6 months of life, yet despite knowing the clear benefits, the practice of EBF is low. The aim of the study is to determine prevalence of exclusive breastfeeding practice and associated factors in Addis Ababa. Methods: A facility based cross-sectional study with internal comparison was conducted among 648 mothers attending immunization sessions in all public health centers in Addis Ababa, Ethiopia, in February 2011. Prevalence of EBF was determined using 'recall since birth' method. Multiple logistic regression was used to adjust for confounding effects while determining the association between exclusive breastfeeding practice and selected factors. Results: The prevalence of EBF under six months was 29.3 % (95 % CI 25.9, 32.9). Mothers whose monthly income 500 - 1000birr (US$56 - 113) were more likely to exclusively breastfeed than those who earn more than 1000birr (US$113) (Adjusted Odds Ratio [AOR] = 2.49; 95 % Confidence Interval [CI] 1.06, 5.88). Mothers who reported having antenatal counseling (AOR = 1.99; 95 % CI 1.16, 3.43) and postnatal counseling were more likely to exclusively breastfeed than those who did not have counseling (AOR = 2.12; 95 % CI 1.28, 3.54). Mothers who gave birth vaginally were more likely to exclusively breastfeed than those who had a Caesarean section (AOR = 2.40; 95 % CI 1.25, 4.61). Conclusions: The prevalence of exclusive breastfeeding was low in Addis Ababa. Mothers' income, antenatal and postnatal counseling and mode of delivery were found to be associated with EBF practices. Recommendations include strengthening nutrition counseling during antenatal and postnatal sessions, further exploring the barriers to EBF for higher income mothers and offering continuous assistance and safe pain relief medication for mothers who gave birth by caesarean section.
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