Background: Exclusive breastfeeding (EBF) is recommended the first six months after birth as one of cost effective interventions in saving children's lives.

Objective: To determine the prevalence of exclusive breastfeeding and describe the common foods introduced to infants before 6months.

Design: A prospective cohort study.

Setting: Poor community of Moshi urban, Kilimanjaro region, Tanzania.

Subjects: Women in their third trimester and were followed to 18 months after delivery. A questionnaire was used to collect information on maternal socio-demographics, delivery status and infant feeding practices at each visit. Maternal HIV status was checked at enrolment.

Results: Out of 2231 women, with a live birth, 70% (1535) came back at least once after delivery and information on infant feeding were collected. 94% of the women were living below the poverty line. The prevalence of EBF at 1, 3 and up to 6 months was 48.8%, 22.0% and 0.2% respectively. Two percent of the infants were given semi-solids at 1 month, 35% at 3 months and 95% at 5 months. Water and cow’s milk were the most common liquids introduced to infants by one month, while porridge, cow’s milk and mtori were commonly introduced at 3 months.

Conclusions: EBF up to 6 month is very rare in Kilimanjaro. There is an urgent need to strengthen community and health facility based EBF interventions so as to reach the 90% recommended coverage by the WHO. This will help in improving child survival and in attaining the Millennium Development Goal 4.