Background: Over two-thirds of deaths occurring worldwide during the first year of life children are often associated with inappropriate feeding practice, especially due to poor exclusive breastfeeding practice. However, efforts to identify predictors of exclusive breastfeeding in the study area are limited.

Methods: A retrospective follow-up study was employed from February to March 2019 in Dessie city, Northeast Ethiopia. About 346 mothers who had infants below the age of 6 months were selected by simple random sampling technique. A structured and pre-tested questionnaire was used to obtain information from respondents. The data were entered using Epi Data version 3.0.2 and analyzed using SPSS version 25.0. Frequency tables, charts, and measures of central tendency were used to describe the data. Cox multivariable regression model was used to identify the predictors of exclusive breastfeeding duration. Adjusted Hazard Ratio with 95% confidence interval and p≤0.05 was used to identify predictors of exclusive breastfeeding duration.

Results: The median duration of exclusive breastfeeding was 3.93 months. Mothers who were unemployed (AHR = 3.48; 95% CI: 1.74-6.96), mothers employed in a private institution (AHR = 4.00; 95% CI: 1.68-9.53), mothers counseled on exclusive breastfeeding during antenatal care follow up (AHR = 1.92; 95% CI: 1.15-3.22), and vaginal delivery (AHR = 4.87; 95% CI: 1.47-16.11) were found to be predictors of exclusive breastfeeding.

Conclusions: The median duration of exclusive breastfeeding was lower compared to the country’s recommended level. Mothers who were unemployed and employed in a private institution, mothers counseled on exclusive breastfeeding during antenatal care follow up, and vaginal delivery was found to be predictors of exclusive breastfeeding. Therefore, revision of the legislation of the four-months postpartum maternity leaves and launch of on-site or near-site childcare centers and strengthening counseling to pregnant women attending antenatal care follow up with emphasis on exclusive breastfeeding are exceedingly needed.

Key Words: Predictors; Exclusive breastfeeding; Infants; Ethiopia