Beyond knowledge: Psychosocial, traditional, and structural determinants of exclusive breastfeeding among young mothers aged 15-29 years in Peri-urban Lusaka, Zambia. A Facility-based cross-sectional study

Exclusive breastfeeding (EBF) for the first six months is a critical protective practice, yet determinants beyond knowledge among young mothers in peri-urban sub-Saharan Africa remain insufficiently understood. This facility-based cross-sectional study assessed factors associated with EBF among 413 mothers aged 15-29 attending postnatal services at two public facilities in Lusaka, Zambia (Aug-Oct, 2025). Data from structured interviewer-administered questionnaires covered demographic, socioeconomic, cultural, mental health, peer support, and neonatal care knowledge factors. Logistic regression produced adjusted odds ratios (AOR) with 95% confidence intervals (CI). Although 99.5% reported receiving neonatal care education, 71.6% practiced EBF. Mothers aged 25-29 had lower odds of EBF than those aged 15-19 (AOR = 0.17, 95% CI: 0.03-0.99). Married mothers were more likely to exclusively breastfeed (AOR = 4.83, 95% CI: 1.59-14.65). Separated mothers also showed higher odds (AOR = 13.66, 95% CI: 1.89-98.71), although the wide confidence interval indicates substantial uncertainty and its based on a small subgroup (n=13). Formal employment was positively associated with EBF (AOR = 3.94, 95% CI: 1.12-13.85). Avoidance of specific traditional neonatal practices (AOR = 0.14, 95% CI: 0.04-0.53) and not consulting traditional healers (AOR = 0.06, 95% CI: 0.02-0.18) were also independently associated with EBF. Postnatal anxiety showed a strong inverse association (AOR = 0.14, 95% CI: 0.03-0.76). Parity, income, education, neonatal care awareness, and receipt of health education were not independently associated. These findings suggest that EBF in peri-urban Lusaka is shaped more by social, cultural, and psychological influences than knowledge alone, underscoring the need to integrate mental health screening, culturally sensitive counselling, and family-centred support within postnatal services to improve EBF uptake among young mothers in similar settings.