Methods: A community-based cross sectional study was conducted in Feb 19/ 2016- march 20/2016. A total of 421 mothers were randomly selected. Semi-structured and pretested questionnaires were administered to collect data. One day training was given for data collectors and supervisors. The collected data was entered in to Epi info version7, cleaned and transported to SPSS windows version 20 then analyzed. The crude and adjusted odds ratio (AOR) together with their corresponding 95% confidence intervals was computed. Bivariate and multivariate logistic regression analysis was computed to identify factors associated EBF. A P-value < 0.05 were considered to declare a result as statistically significant in this study.
Results: In this study, prevalence of exclusive breast feeding in the study area was 64.8 % [95% CI: 2.3 (61, 69.5)]. The independent predictors of Exclusive breast feeding practice on the multivariate analysis include age of mother, who have age between 26- 37 year’s [AOR: 0.592, 95% CI: (0.373, 0.938)] and age between 38-49 year [AOR: 0.557, 95% CI: (0.255, 0.989)], Availability information of exclusive breast feeding [AOR: 0.432, 95% CI: (0.271,0.687)] and had adequate knowledge of mother [AOR: 2.508, 95% CI: (1.475,4.265)] were significantly associated with Exclusive breast feeding practice.
Conclusion: In this study, the prevalence of exclusive breast feeding practice was lower than that of the previous Ethiopian health sector development plan fourth achievement of, 70%, next five years health sector transformation plan two targeted for, 72% by the end of 2020 and WHO recommendation, 90% [10]. But, higher than that of national prevalence of, 52%, reported in the EDHS. Interventions to promote age of mothers’, Availability information during ANC and adequate knowledge about exclusive breast feeding. Recommendations should be include encourage ANC and PNC service utilization, strengthening nutrition counseling during antenatal and postnatal sessions.
Keywords: Exclusive breast feeding; SNNPRS; Ethiopia.
Globally, nearly to, 40%, of infants less than six months of age are exclusively breast feed [8]. Only, 38%, of infants are exclusively breast feeding in the developing countries [9]. EBF Practice is the most effective intervention to save the lives of infants and children. Nearly, 13% -15%, of deaths of children aged less than five years could be prevented if universal coverage of EBF were increased to 90% among infants aged less than six months [10]. A child who is exclusively breastfeed is 14 times less likely to die in the first six months compared to its counterpart while exclusive Breastfeeding highly reduces deaths from the child killer diseases; respiratory infections and diarrhea [11].
In developing countries breastfeeding is a very common practice; however there exist serious obstacles to practicing it until six months from the infant’s birth [12,13]. Study showed that the prevalence of EBF in Brazil 4% , Bangladesh 16%, Rwanda 38%, Saudi Arabia 8.3 %, Congo 2.8 %, of infants were exclusively breastfed [14-17]. In Ethiopia the range of prevalence of EBF less than six months were 24.4 % - 81.1% [19–29]. Currently, the Health Sector Transformation Plan Two (HSPII) has set a target to increase exclusive breastfeeding from 52% to 72% in Ethiopia by the end of 2020 [30]. Exclusive breast milk feeding for the first six months of an infant’s life is associated with mother knowledge and attitude, age of mother, occupation, family member, Counseling during antenatal and postnatal care, prelacteal feeding, early initiation of breastfeeding, and age of infants, Mothers’ income, mode of delivery, place of delivery [20- 27]. Therefore, this study will review exclusive breast feeding practice and associated factors among under 6-month-old children in selected Woreda South Nation Nationality of People Regional State in Ethiopia.
The sample size was determined by using Epi-info version 7 depending on single population proportion formula by the following assumptions. Z α/2 (95% confidence interval), prevalence of exclusive breast feeding was 52% National prevalence of Ethiopia, α, 0.05, design effect,1.0, and nonresponse rate, 10% respectively [32]. Therefore, sample size becomes 383, having 10% non-response rate 38 the total sample size become 421 mothers of under six-month-old children.
On site supervision was carried out during the whole period of data collection on daily basis. At the end of each day questionnaires were reviewed and cross checked for completeness, accuracy and consistency by the principal investigator and corrective measures were under taken. The data was entered, coded, and analyzed using SPSS for windows version 20.0. Descriptive statistics such as mean was computed. The findings were presented with tables. Bivariate analysis was performed to identify the association of dependent and independent variables. Odds ratio was computed to see the strength of association between independent and dependent variables. To identify independent predictors, first a bivariate logistic regression was performed at p< 0.25 for each independents and outcome of interest. Finally a multivariate logistic regression analysis was made to identify the predictors of exclusive breast feeding practices. Variables which were significant on p-values of less than 0.05 were reported as predictors of exclusive breast feeding.
Characteristics |
variable |
Frequency |
Percent |
Age of mother |
15-25 |
170 |
40.4 |
26-37 |
213 |
50.6 |
|
38-49 |
38 |
9 |
|
Education level of mothers |
no formal education |
176 |
41.8 |
primary |
147 |
34.9 |
|
seconder and above |
99 |
23.3 |
|
Religion status of respondent |
Christian |
292 |
69.4 |
Muslim |
103 |
24.4 |
|
others |
26 |
6.2 |
|
Occupation status of mother |
Farmer |
66 |
15.7 |
House Wife |
320 |
76 |
|
other |
35 |
8.3 |
|
Monthly income |
less than 700 birr |
280 |
66.5 |
greater or equal 700 birr |
141 |
33.5 |
|
family members |
Less or equal to 3 |
84 |
20 |
Between 4-6 |
201 |
47.7 |
|
More or equal 7 |
136 |
32.3 |
|
Marital status |
Married |
417 |
99 |
single |
4 |
1 |
|
Educational status of husband |
no formal education |
98 |
23.3 |
Primary school |
135 |
32.1 |
|
Secondary school |
83 |
19.7 |
|
Tertiary and above |
105 |
24.9 |
|
Occupation status of husband |
Farmer |
333 |
78.9 |
Governmental |
26 |
6.2 |
|
Merchants |
26 |
6.2 |
|
others |
37 |
8.8 |
|
Other wife of husband |
yes |
48 |
11.4 |
no |
373 |
88.6 |
|
Substances use of husband |
yes |
116 |
27.6 |
no |
307 |
72.4 |
Characteristics |
variable |
Frequency |
Percent |
Child Sex |
male |
213 |
50.6 |
female |
208 |
49.4 |
|
Child age |
less than three month |
144 |
34 |
three -four month |
151 |
36 |
|
five –six month |
126 |
30 |
|
Birth interval |
less than two month |
38 |
9 |
greater than two month |
287 |
68. 2 |
|
First son |
96 |
22.8 |
|
Order of child birth |
first birth |
97 |
23 |
Two- four |
194 |
46.1 |
|
Fifth and above |
130 |
30.9 |
|
GMP |
yes |
66 |
15.7 |
no |
355 |
84.3 |
|
Child sick past 2weeks |
yes |
159 |
37.8 |
no |
262 |
62.2 |
|
Reason of Child sick past 2 weeks (160) |
diarrhea |
51 |
32 |
vomiting |
12 |
7.5 |
|
malaria |
38 |
23.75 |
|
Skin infection |
18 |
11 |
|
eye infection |
9 |
5.75 |
|
other |
32 |
20% |
Characteristics |
variable |
Frequency |
Percent |
ANC visit |
yes |
350 |
83.1 |
No |
71 |
16.9 |
|
Frequent visit ANC(353) |
at least one |
24 |
6.7 |
two -three time |
257 |
61 |
|
four or more visit |
136 |
32.3 |
|
Please of delivery |
home |
216 |
51.3 |
hospital |
25 |
5.9 |
|
health institute |
180 |
42.8 |
|
Mode of delivery |
caesarean section |
3 |
0.7 |
vaginally |
418 |
99.3 |
|
PNC visit |
yes |
108 |
25.7 |
No |
313 |
74.3 |
|
PNC visit frequency (108) |
At least one |
67 |
15.9 |
two- three |
39 |
9.3 |
|
four or more visit |
2 |
0.5 |
|
Available Information on ANC EBF |
yes |
294 |
69.8 |
no |
127 |
30.2 |
|
Available Information on PNC EBF |
yes |
250 |
59.4 |
no |
171 |
40.6 |
|
Have sufficient knowledge |
Have knowledge |
306 |
72.7 |
Have no sufficient knowledge |
115 |
27.3 |
|
Attitude |
Positive attitude |
343 |
81.5 |
Negative attitude |
78 |
18.5 |
Characteristics |
variable |
Frequency |
Percent |
Ever Breast feed child |
yes |
410 |
97.4 |
no |
11 |
2.6 |
|
Time interval of breast feeding after birth |
Within one hours |
93 |
22 |
After one hours |
328 |
78 |
|
First three day colostrum’s given |
yes |
353 |
84 |
no |
68 |
16 |
|
After birth three day given liquid |
yes |
20 |
4.8 |
no |
401 |
95.2 |
|
Breasted feed within 24h |
yes |
402 |
94.5 |
no |
19 |
4.5 |
|
Frequents of Bf with 24h |
less than 8 times |
158 |
37.5 |
More than 8 times |
263 |
62.5 |
|
Exclusive breast feeding |
no |
148 |
35.2 |
yes |
273 |
64.8 |
|
Bottle feeding |
yes |
42 |
10 |
no |
379 |
90 |
|
Yesterday other than breast milk at food |
yes |
366 |
87 |
no |
55 |
13 |
|
Special type of feeding during child illness |
yes |
36 |
8.5 |
no |
385 |
91.5 |
|
Satisfied with infant feeding practice |
completely satisfied |
306 |
72.7 |
partially satisfied |
94 |
22.3 |
|
initially satisfied but now |
9 |
2.1 |
|
now am satisfied but not previously |
6 |
1.4 |
|
not satisfied |
6 |
1.4 |
|
Early imitation |
no |
114 |
27 |
yes |
307 |
73 |
In this study, the independent predictors of Exclusive breast feeding practice on the multivariate analysis include age of mother, who have age between 26- 37 year’s [AOR: 0.592, 95% CI: (0.373,0.938)] and age between 38-49 year [AOR: 0.557, 95%CI: (0.255,0.989)], Availability information of exclusive breast feeding during ANC [AOR: 0.432, 95% CI: (0.271,0.687)] and adequate knowledge of mother [AOR: 2.508, 95% CI: (1.475,4.265)] Table 5.
variable |
Exclusive breast feeding |
Crude odds ratio (95% CI) |
Adjusted crude odds ratio (95% CI) |
||
Age of mother |
no |
Yes |
|||
15- 25 |
85 |
130 |
1.0 |
1.0 |
|
26- 37 |
15 |
23 |
0.597(0.388,0919) |
0.59(0.373,0.938) |
|
38-49 |
48 |
123 |
0.598(0.88,1.24) |
0.56(0.255,0.989) |
|
Counseling ANC on EBF |
yes |
65 |
62 |
1.0 |
1.0 |
no |
83 |
214 |
0.370(0.241,0.569) |
0.43(0.271,0.687) |
|
Place of delivery |
yes |
88 |
129 |
1.0 |
|
no |
60 |
147 |
1.671(1.115, 2.504) |
|
|
attitude |
Negative attitude |
41 |
38 |
1.0 |
|
Positive attitude |
107 |
238 |
2.400(1.460, 3.944) |
|
|
knowledge |
Have no sufficient knowledge |
64 |
52 |
1.0 |
1.0 |
Have knowledge |
84 |
224 |
3.282(2.106, 5.114) |
2.51(1.475,4.265) |
|
liquid given after birth |
yes |
12 |
8 |
1 |
|
no |
136 |
268 |
2.956(1.180, 7.403) |
|
•Counseling ANC about exclusive breast feeding: Mother who has visiting health institution or health post during antenatal care who has counseled about exclusive breast feeding.
•Place of delivery: Mothers delivered only in health institution or hospitals.
•Positive attitude about exclusive breast feeding: When the mothers agree and strongly agree to auspicious question to exclusive breast feeding.
•Negative attitude about exclusive breast feeding: When the mothers neutral, disagree and strongly disagree to auspicious question to exclusive breast feeding.
•Have no sufficient knowledge: When the mothers correctly answer blow 52 % of questions about exclusive breast feeding.
•Have sufficient knowledge: When the mothers correctly answer equal to 52 % or above 52% of questions about exclusive breast feeding.
•Liquid given after birth: Mother who gives any liquid (water, milk or milk products…etc.) after the birth.
•Exclusive breast feeding: Infants who have received only breast milk from his/her mother for six month without any other liquid or solids with exception of vitamins, minerals or medication.
One important finding of this study was the identification of independent predictors influencing Exclusive breast feeding. It was found that young mothers’ (15-25 years old) were 0.41times, 0.44 times more likely to practice exclusive breastfeed than age between 26-37 and 38-49 years old respectively. This is similar in Debre Markos town and Gozamen District [26]. The possible explanation could be due to health extension promotion availability on exclusive breast feeding practice, strong linkage health center with community health extension worker. Also, this study was inline agreement with studies in Gedeo [24]. That means it showed a more chance of exclusive breastfeeding in young mother age. A reason might be younger mothers makes them sensitive to exclusive breastfeeding.
Infant feeding counseling during ANC is one of child health service factor that has a significant association with EBF. Those mothers who received counseling concerning infant feeding during ANC were 0.57 times more likely to feed breast milk only for their infants than those not counseled. This is in line with a study from Addis Ababa and Debre Markos where the odds of EBF was higher among infants of mothers who received breastfeeding counseling during ANC follow up compared to those who doesn’t received breastfeeding counseling during ANC Follow up [20,25]. This finding was in line with those studies conducted Injibara and Arbaminch [34,35]. This confirmations is clarified that antenatal period is an exact time to provide breastfeeding counseling. The possible explanation may be expansion of antenatal care services, 1 to 5 mothers’ network awareness, and voluntary community health promotion and community health extension program may increase antenatal care service.
One of important independent outcome variable of factor that was shown to have a significant association with EBF is mothers’ breastfeeding knowledge. Mothers who had adequate knowledge about exclusively breastfeeding were 2.51 times more likely to exclusively breastfeed their infants than those who didn’t have adequate knowledge about breastfeeding. This has similarities with study findings from Debre Markos [25]. This effect could be partly explained by mother’s enhanced knowledge of the welfares of breastfeeding for themselves and their infants, improving the likelihood mothers will breastfeed their infants even if alternatives are available. Also, this outcome could be of community based and health promotion and level of mother education.
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