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The compliance of mothers to the six items related to their practice of the 10 steps of successful breastfeeding (Immediate breastfeeding initiation, rooming in, breast-feeding on demand, avoiding prelacteal feeding, avoiding use of pacifier, and avoiding use of bottles) are of great importance to achieve better breastfeeding outcomes. The objectives of the study were to estimate the extent of compliance of mothers to these items and to identify some factors associated with this compliance. The study was fulfilled through a cross-sectional approach. It was conducted at the MCH and FH centers in Alexandria Governorate. The study included 390 mothers accompanying their breast-fed infants aged 0-12 months to well baby clinics at those health centers. A pre-designed structured interview questionnaire was constructed to collect the data required from mothers. Only 29.8% of mothers started breastfeeding within the 1st hour after labour, 57.2% of them practiced rooming in, and 78.7% of them regulated breastfeeding according to their infants needs. Prelacteal feeding was given to 58.2% of the infants. 22.8% of mothers used pacifiers and 41% used bottles for their infants. Scoring of the overall compliance of mothers to the 6 points related to their breastfeeding practice of the WHO/UNICEF joint statement showed that 24.1% of mothers scored satisfactory level, 41.3% average level while 34.6% scored as low level of compliance. The level of mothers compliance was positively affected by their level of knowledge about breastfeeding and the six items (χ=267.582, p<0.01) and by the increase in the child order (FET=15.618, p<0.01). It was adversely affected by their social level (χ=19.853, p<0.01), education (χ=28.289, p<0.01) and working status (χ=17.439, p<0.01). It was adversely associated with the history of neonatal asphyxia (FET=17.909, p<0.01), the delivery in health settings (FET=44.278, p<0.01), and the delivery by caesarian section (χ=40.193, p<0.01). INTRODUCTION Breastfeeding is the process of feeding an infant with milk produced in a woman’s mammary glands.(1) Breastfeeding has a major role to play in public health, promoting health in both short and long term for baby and mother.(2) Each year new evidence contributes to the knowledge of breastfeeding’s role in the survival, growth, and development of a child as well as the health and well-being of a mother.(3) UNICEF (2007) reported that the child who is breastfed is almost three times more 67 Bull High Inst Public Health Vol. 38 C.1 [2008] likely to survive infancy than a child who is not breastfed.(4) Increasing optimal breastfeeding practices could save as many as 1.5 million infant lives every year.(5) WHO and UNICEF (1989) had issued a joint statement on “Ten Steps to Successful Breastfeeding” to be implemented in every health facility providing maternity care and care for the newborn babies.(6) The compliance of mothers to the items related to their practice of this joint statement (immediate breastfeeding initiation, rooming-in, breastfeeding on demand, avoiding prelacteal feeding, avoiding use of pacifier, and avoiding use of bottles) is of great importance to achieve better breastfeeding outcomes.(7) In the year 1993, training on Baby Friendly Hospital Initiative (BFHI) had commenced in Egypt.(8) Also Ministry of Health and Population (MOHP) since 1997 is implementing a continuous program of inservice training for both physicians and nurses to support and promote good practice in breastfeeding.(9) Despite these mentioned efforts, only 42.9% of babies began breastfeeding within one hour of birth in the year 2005, a marked reduction from the figure of the year 2000 which was 57%. The rate of exclusive breastfeeding (EBF) in the year 2005 was 52.4 percent among infants zero to three months old, which dropped to 38.3 percent among infants zero to five months old. This leaves hundreds of thousands of children vulnerable to disease and death. Around 2.4 percent of all babies in Egypt die in the first month.(10) Low compliance of mothers with breastfeeding recommendations in developing countries was reported.(11) Also several studies in Egypt reported poor performance of both mothers and health care providers on the successful steps to breast feeding.(12-14) The aim of this study is to highlight the influence of breastfeeding promotion and support efforts on mother's compliance to the 6 items related to their

Compliance of Mothers to the Breastfeeding Guidelines in Alexandria