# Longitudinal survey of knowledge, attitude, and practice of breastfeeding during the COVID-19 pandemic

## TL;DR

This study tracked how Thai mothers' knowledge, attitudes, and practices around breastfeeding changed during the pandemic, finding improvements over time linked to sustained breastfeeding.

## Contribution

A longitudinal survey revealing how maternal KAP related to breastfeeding and COVID-19 evolved over 24 weeks, with associations to breastfeeding outcomes.

## Key findings

- One-third of mothers had good KAP, with increasing trends over 24 weeks.
- Knowledge and practice scores improved among mothers without recent COVID-19 illness by 24 weeks.
- Early knowledge and attitudes were linked to sustained predominant breastfeeding.

## Abstract

Concerns about viral transmission through breast milk may impact breastfeeding recommendations and success. This study examined the changes in maternal knowledge, attitudes, and practices (KAP) related to breastfeeding and COVID-19 transmission during the pandemic.

A longitudinal survey of Thai mothers was conducted when infants were 2, 12, and aged 24 weeks (March 2022–April 2023). The questionnaire, assessing knowledge of SARS-CoV-2 transmission, attitudes toward breastfeeding, and hygiene practices, was validated using the Item-Objective Congruence index. Good KAP was defined as scoring >60% in each section. Associated factors, including maternal age, education level, occupation, breastfeeding experience, and history of recent COVID-19 illness, were analyzed using multivariable linear regression.

A total of 195 mothers (mean age: 30.6 ± 6 years) completed the survey. One-third had good KAP, with an increasing trend over 24 weeks. Knowledge and practice scores among mothers without a recent history of COVID-19 illness demonstrated a positive change at an infant age of 24 weeks (95% CI: 0.08–0.96 and 0.02–0.76, respectively), while attitude scores remained unchanged. Maternal age at delivery was positively associated with the attitude changes (β=0.19; 95% CI: 0.02–0.20), whereas maternal education level and monthly family income were negatively associated. Better knowledge and attitudes about COVID-19 transmission during breastfeeding at 2 and 12 weeks were linked to a higher likelihood of predominant breastfeeding at 24 weeks postpartum.

Maternal knowledge, attitudes, and practices (KAP) improved over 24 weeks, with significant gains in knowledge and practice among mothers who had not recently contracted COVID-19. Early knowledge and attitude were linked to sustained predominant breastfeeding, highlighting the importance of targeted education.

The study was part of the study entitled ‘Infant feeding survey during COVID-19 pandemic’ registered on the official website of Thaiclinicaltrials.org

ID TCTR20220215012