Factors associated with exclusive breastfeeding practices in Debre Berhan District, Central Ethiopia: A cross sectional community based study

International Breastfeeding Journal, Volume 10, No. 1, Year 2015

Interpretation

Background: Globally, an estimated 6.3 million children under-five years of age died in the year 2013. To reduce the burden of morbidity and mortality of infants, Ethiopia adopted the World Health Organization (WHO) recommendation of exclusive breastfeeding (EBF) for the first six months of life. The objective of this study was to assess factors associated with EBF practices among mothers who have an infant aged below 12 months in Debre Berhan District, Ethiopia. Methods: In this study we employed a cross sectional community based quantitative survey method, and data were collected from January through April 2014. Univariate statistical analysis was used to describe variables using frequencies and percentages. Multivariable logistic regression model was developed; the factors associated with EBF practice were identified. Result: We enrolled 634 mothers with their index infant aged under 12 months. Four hundred thirty five (68.6 %; 95 % CI: 64.9 %, 72.2 %) mothers practiced EBF to six months. In this study 83.4 % of mothers were knowledgeable with the recommended duration of EBF. About 97.5 % of mothers had a positive attitude towards EBF practice. Mothers from rural places were 4.54 times likely to EBF than mothers residing in urban areas Adjusted Odds Ratio (AOR 4.54; 95 % CI: 2.64, 7.81, p = 0.001). The odds of mothers aged 25 to 35 years to practice EBF was up to 8.9 times more than mothers aged less than 25 years (AOR 8.99; 95 % CI: 4.56, 17.73, p = 0.001). The odds of mothers who didn’t receive infant feeding counselling was 0.42 times less likely to practice EBF than those who received Counselling services (AOR 0.42; 95 % CI: 0.24, 0.73, p = 0.002). Employed mothers were found to be 0.36 times less likely to practice EBF than housewives (AOR 0.36; 95 % CI: 0.18, 0.73, p = 0.005). Household income did not show a statistically significant association with EBF. Conclusions: The knowledge and attitude of mothers towards EBF was found to be very high. In this study, two thirds of mothers practiced exclusive breastfeeding. Improving access to information on recommended infant feeding during routine maternal and child health services is recommended. It is important to encourage EBF among the young, employed and urban mothers through proper counselling and mother friendly work environment. The study was conducted in Debre Berhan District, one of the 177 districts of Amhara Region of Ethiopia. The district is located 125 km to the North of Addis Ababa, the capital city of Ethiopia. Debre Berhan district has nine kebeles, of which five kebeles are categorized as urban and the remaining four are rural. Based on the projection of the 2007 population census in the year 2014, the district has an estimated 84,920 (41,187 males and 43,733 females) inhabitants, of which 2,649 are infants. There are ten health extension posts and five health centres with at potential health service coverage of 100 % [24]. A cross sectional community based survey was conducted among mothers with their index infant age less than 12 months from January through April 2014, in Debre Berhan District, of North Shoa Administrative Zone, in Amhara Region. The sample size was determined using Cochran’s formula [25]: Where, ni is the sample size, Z is standard normal variable at 95 % Confidence Interval (1.96), P is (0.52) the proportion of mothers who practiced exclusively breastfeeding for their infants in Ethiopia [8], d is the marginal error (0.05), design effect (1.5) and contingency for non-response (0.10). First we selected four (2 urban and 2 rural) out of nine kebeles, the smallest administrative units, using lottery methods. Then, we conducted population census in these kebeles and identified 1177 mother with index infant aged less than 12 months. Sampling frame was developed and study subjects were selected every other household with systematic random sampling techniques. During data collection 53 mothers and their index infants were replaced by the next study subject due to incomplete responses and missing basic information. Data were collected from 634 mothers with their index infant aged less than 12 months. At the end of the data collection the recommended infant feeding practices were delivered to all mothers as key health messages. In this study we included mothers who lived in the study area for more than six months, with one infant at the time of the survey and who have no restrictions to breastfeed their index infant due to serious medical or surgical health conditions. Furthermore, mothers who were pregnant at the time of the survey, were excluded. In the case of having two or more mothers with infants in the household we selected the one with younger age infant. The data were collected using interview method by pretested questionnaires. The questionnaire was prepared first in English and then translated into Amharic. To maintain the consistency of the tool it was back translated to English by two different public health professionals. The data collectors and their supervisors attended the necessary training on the objective of the study, data collection techniques, procedures and instruction to complete the questionnaires. The tool was pretested with 70 mothers who had infants under one year old in Basona Worana District of North Shoa Administrative Zone, which was not the part of our study area. Then the data collection tools were amended and rearranged to accommodate the desired data for the study. The data were collected using a tool designed and piloted by the researchers [8]. The data were collected by volunteers who have completed 10th grade education. The supervisors were two health professionals with a Masters degree in Public Health. The data collection team were trained and the data collection process was supervised by the researchers. The questionnaires have socio-demographic information of mothers and infants, knowledge, attitude and practice of mothers on exclusive breastfeeding. In this study the dependent variable was EBF Practice [6] for the first six month of the index infant by mothers. In the regression analysis EBF practice was coded as ‘1’ while ‘0’ was coded for non-EBF practices. The independent variable were age, educational status, residence, marital status of mother, household income, occupation, family size, birth order, sex of infant, place of delivery, antenatal and postnatal service uptake. To estimate the knowledge of mothers on EBF, we asked mothers about ideal duration of EBF and the time to wean off infants. In this study, those mothers who correctly identified the duration of EBF as six months were considered as knowledgeable. Five questions were presented to mothers to identify their attitudes towards EBF practice. Mothers who want to EBF their next baby or those who encourage their peers to do so were considered to have a favourable attitude towards EBF. The practice of mothers were measured based on their report on initiation time of breastfeeding, provision of colostrum, and the duration of EBF for the index infant. Mothers who fed their infant only breast milk for the first six months of life were considered as having an ideal practice. The age of mothers were categorized into three groups i.e. < 25, 25–35 and > 35 years. The younger age group was taken as a reference population in the regression analysis. Religion of mothers was coded as ‘0’ for Christian and ‘1’ for Muslim. Urban and rural residences of mothers were coded as ‘0’ and ‘1’ respectively. With regard to educational status of parents those who could not read and write were coded ‘0’ while the rest were coded as ‘1’. Mothers who were reported as housewife were coded ‘0’ while farmers and employed mothers were coded ‘1’. The lowest household income was coded ‘0’ while the other two levels were coded ‘1’. Mothers who received infant feeding counselling and delivered in health institution were coded as ‘0’, their counter parts coded as ‘1’. The data were checked for completeness, consistency and cleaned manually. It was entered into EPI Info version 3.5.3.(CDC, Atlanta, Georgia) statistical software and exported to Statistical Package for Social Science (SPSS) research IBM version 20.0 for Window, (IBM SPSS Version 20.0. Armonk, NY: IBM Corp). The descriptive finding was presented with tables and graphs. Univariable statistical tests were computed to identify all possible predictor variables. Then the multi-variable logistic regression model was developed considering EBF practice as dependent and those nominee variables selected based on the result of the uni-variable test statistics which had a Wald Statistics with p-value < 0.20. This decision was made based on suggestion to capture all important variables made by Bendel and Afiff [26]. Results are reported as Crude Odds Ratio (COR) or Adjusted Odds Ratio (AOR) with 95 % Confidence Intervals (CIs). The statistical significance tests was accepted at p < 0.05. Ethical clearance was obtained from Institute Review Board (IRB) of Debre Berhan University. Permission was granted from Debre Berhan District Health Office and Kebele Administrations. Verbal consent was taken from all mothers who participating in the study.

AI Digest

Study Justification:

– The study aimed to assess factors associated with exclusive breastfeeding (EBF) practices among mothers in Debre Berhan District, Ethiopia.
– This is important because globally, millions of children under-five years of age die each year, and EBF can help reduce the burden of morbidity and mortality in infants.
– Ethiopia has adopted the World Health Organization (WHO) recommendation of EBF for the first six months of life, and understanding the factors influencing EBF practices can help improve infant health outcomes.

Study Highlights:

– The study enrolled 634 mothers with infants aged under 12 months.
– 68.6% of mothers practiced EBF to six months.
– 83.4% of mothers were knowledgeable about the recommended duration of EBF.
– 97.5% of mothers had a positive attitude towards EBF practice.
– Mothers from rural areas were 4.54 times more likely to practice EBF than mothers from urban areas.
– Mothers aged 25 to 35 years were up to 8.9 times more likely to practice EBF than younger mothers.
– Mothers who didn’t receive infant feeding counseling were 0.42 times less likely to practice EBF than those who did receive counseling.
– Employed mothers were 0.36 times less likely to practice EBF than housewives.
– Household income did not show a statistically significant association with EBF.

Recommendations for Lay Reader and Policy Maker:

– Improve access to information on recommended infant feeding during routine maternal and child health services.
– Encourage exclusive breastfeeding among young, employed, and urban mothers through proper counseling and mother-friendly work environments.

Key Role Players:

– Maternal and child health service providers
– Health extension workers
– Community health workers
– Non-governmental organizations (NGOs) working in maternal and child health
– Policy makers and government officials responsible for health programs

Cost Items for Planning Recommendations:

– Training and capacity building for health service providers
– Development and dissemination of educational materials on recommended infant feeding
– Counseling services for mothers
– Support for creating mother-friendly work environments
– Monitoring and evaluation of the implementation of recommendations

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is relatively strong, but there are some areas for improvement. The study employed a cross-sectional community-based survey method, which is a suitable design for assessing factors associated with exclusive breastfeeding practices. The sample size was determined using Cochran’s formula, which helps ensure adequate representation. The study collected data from 634 mothers, providing a substantial amount of information. The statistical analysis included univariate analysis and multivariable logistic regression, which allows for the identification of factors associated with exclusive breastfeeding. The study found that 68.6% of mothers practiced exclusive breastfeeding to six months, and identified factors such as rural residence, age, counseling services, and employment status that were associated with exclusive breastfeeding. The study also highlighted the importance of improving access to information and counseling services to promote exclusive breastfeeding. However, the abstract could be improved by providing more details on the methodology, such as the specific survey questions used and the training provided to data collectors. Additionally, the abstract could include information on the limitations of the study, such as potential biases or confounding factors. Overall, the evidence in the abstract is strong, but providing more details and addressing potential limitations would further strengthen the study.

Abstract

The study was conducted in Debre Berhan District, one of the 177 districts of Amhara Region of Ethiopia. The district is located 125 km to the North of Addis Ababa, the capital city of Ethiopia. Debre Berhan district has nine kebeles, of which five kebeles are categorized as urban and the remaining four are rural. Based on the projection of the 2007 population census in the year 2014, the district has an estimated 84,920 (41,187 males and 43,733 females) inhabitants, of which 2,649 are infants. There are ten health extension posts and five health centres with at potential health service coverage of 100 % [24]. A cross sectional community based survey was conducted among mothers with their index infant age less than 12 months from January through April 2014, in Debre Berhan District, of North Shoa Administrative Zone, in Amhara Region. The sample size was determined using Cochran’s formula [25]: Where, ni is the sample size, Z is standard normal variable at 95 % Confidence Interval (1.96), P is (0.52) the proportion of mothers who practiced exclusively breastfeeding for their infants in Ethiopia [8], d is the marginal error (0.05), design effect (1.5) and contingency for non-response (0.10). First we selected four (2 urban and 2 rural) out of nine kebeles, the smallest administrative units, using lottery methods. Then, we conducted population census in these kebeles and identified 1177 mother with index infant aged less than 12 months. Sampling frame was developed and study subjects were selected every other household with systematic random sampling techniques. During data collection 53 mothers and their index infants were replaced by the next study subject due to incomplete responses and missing basic information. Data were collected from 634 mothers with their index infant aged less than 12 months. At the end of the data collection the recommended infant feeding practices were delivered to all mothers as key health messages. In this study we included mothers who lived in the study area for more than six months, with one infant at the time of the survey and who have no restrictions to breastfeed their index infant due to serious medical or surgical health conditions. Furthermore, mothers who were pregnant at the time of the survey, were excluded. In the case of having two or more mothers with infants in the household we selected the one with younger age infant. The data were collected using interview method by pretested questionnaires. The questionnaire was prepared first in English and then translated into Amharic. To maintain the consistency of the tool it was back translated to English by two different public health professionals. The data collectors and their supervisors attended the necessary training on the objective of the study, data collection techniques, procedures and instruction to complete the questionnaires. The tool was pretested with 70 mothers who had infants under one year old in Basona Worana District of North Shoa Administrative Zone, which was not the part of our study area. Then the data collection tools were amended and rearranged to accommodate the desired data for the study. The data were collected using a tool designed and piloted by the researchers [8]. The data were collected by volunteers who have completed 10th grade education. The supervisors were two health professionals with a Masters degree in Public Health. The data collection team were trained and the data collection process was supervised by the researchers. The questionnaires have socio-demographic information of mothers and infants, knowledge, attitude and practice of mothers on exclusive breastfeeding. In this study the dependent variable was EBF Practice [6] for the first six month of the index infant by mothers. In the regression analysis EBF practice was coded as ‘1’ while ‘0’ was coded for non-EBF practices. The independent variable were age, educational status, residence, marital status of mother, household income, occupation, family size, birth order, sex of infant, place of delivery, antenatal and postnatal service uptake. To estimate the knowledge of mothers on EBF, we asked mothers about ideal duration of EBF and the time to wean off infants. In this study, those mothers who correctly identified the duration of EBF as six months were considered as knowledgeable. Five questions were presented to mothers to identify their attitudes towards EBF practice. Mothers who want to EBF their next baby or those who encourage their peers to do so were considered to have a favourable attitude towards EBF. The practice of mothers were measured based on their report on initiation time of breastfeeding, provision of colostrum, and the duration of EBF for the index infant. Mothers who fed their infant only breast milk for the first six months of life were considered as having an ideal practice. The age of mothers were categorized into three groups i.e. 35 years. The younger age group was taken as a reference population in the regression analysis. Religion of mothers was coded as ‘0’ for Christian and ‘1’ for Muslim. Urban and rural residences of mothers were coded as ‘0’ and ‘1’ respectively. With regard to educational status of parents those who could not read and write were coded ‘0’ while the rest were coded as ‘1’. Mothers who were reported as housewife were coded ‘0’ while farmers and employed mothers were coded ‘1’. The lowest household income was coded ‘0’ while the other two levels were coded ‘1’. Mothers who received infant feeding counselling and delivered in health institution were coded as ‘0’, their counter parts coded as ‘1’. The data were checked for completeness, consistency and cleaned manually. It was entered into EPI Info version 3.5.3.(CDC, Atlanta, Georgia) statistical software and exported to Statistical Package for Social Science (SPSS) research IBM version 20.0 for Window, (IBM SPSS Version 20.0. Armonk, NY: IBM Corp). The descriptive finding was presented with tables and graphs. Univariable statistical tests were computed to identify all possible predictor variables. Then the multi-variable logistic regression model was developed considering EBF practice as dependent and those nominee variables selected based on the result of the uni-variable test statistics which had a Wald Statistics with p-value < 0.20. This decision was made based on suggestion to capture all important variables made by Bendel and Afiff [26]. Results are reported as Crude Odds Ratio (COR) or Adjusted Odds Ratio (AOR) with 95 % Confidence Intervals (CIs). The statistical significance tests was accepted at p < 0.05. Ethical clearance was obtained from Institute Review Board (IRB) of Debre Berhan University. Permission was granted from Debre Berhan District Health Office and Kebele Administrations. Verbal consent was taken from all mothers who participating in the study.

Materials

N/A

Innovations

Based on the information provided, here are some potential innovations that can be used to improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop and implement mobile applications that provide information and support to mothers regarding exclusive breastfeeding practices. These apps can provide educational resources, reminders for breastfeeding sessions, and connect mothers with healthcare professionals for counseling and support.

2. Telemedicine: Establish telemedicine services to provide remote consultations and counseling for mothers who may not have easy access to healthcare facilities. This can help address barriers such as distance and transportation, allowing mothers to receive guidance and support from healthcare professionals without having to travel long distances.

3. Community Health Workers: Train and deploy community health workers to provide education and support to mothers in rural areas. These workers can visit homes, conduct group sessions, and provide personalized guidance on exclusive breastfeeding practices. They can also serve as a bridge between the community and healthcare facilities, helping to improve access to maternal health services.

4. Workplace Support: Advocate for policies and programs that support breastfeeding in the workplace. This can include providing designated breastfeeding areas, flexible work schedules, and paid maternity leave to encourage and support working mothers to continue exclusive breastfeeding.

5. Integration of Services: Integrate maternal health services with other existing healthcare programs, such as immunization and family planning services. This can help ensure that mothers receive comprehensive care and support throughout the different stages of motherhood, improving access and continuity of care.

6. Health Education Campaigns: Conduct targeted health education campaigns to raise awareness about the benefits of exclusive breastfeeding and address common misconceptions and cultural beliefs. These campaigns can use various media channels, including radio, television, and community events, to reach a wide audience and promote behavior change.

7. Strengthening Health Systems: Invest in strengthening healthcare infrastructure, including training healthcare professionals, improving supply chains for essential maternal health commodities, and ensuring the availability of quality maternal health services in both urban and rural areas. This can help improve access to care and ensure that mothers receive the support they need to practice exclusive breastfeeding.

AI Innovations Description

Based on the study conducted in Debre Berhan District, Ethiopia, the following recommendations can be developed into an innovation to improve access to maternal health:

1. Improve access to information: The study found that the knowledge and attitude of mothers towards exclusive breastfeeding (EBF) was high. To further improve access to maternal health, it is recommended to provide information on recommended infant feeding practices during routine maternal and child health services. This can be done through educational campaigns, workshops, and counseling sessions for pregnant women and new mothers.

2. Increase availability of counseling services: The study found that mothers who received infant feeding counseling were more likely to practice EBF. To improve access to maternal health, it is important to ensure that counseling services are readily available to all mothers, especially those in rural areas. This can be achieved by training healthcare providers on infant feeding counseling and establishing counseling centers in health facilities.

3. Create mother-friendly work environments: The study found that employed mothers were less likely to practice EBF. To improve access to maternal health, it is recommended to create mother-friendly work environments that support breastfeeding. This can include providing breastfeeding breaks, establishing lactation rooms in workplaces, and implementing policies that protect the rights of working mothers to breastfeed.

4. Target young and urban mothers: The study found that younger and urban mothers were less likely to practice EBF. To improve access to maternal health, it is important to target these specific groups with tailored interventions. This can include educational campaigns specifically designed for young and urban mothers, as well as providing support and resources to help them overcome barriers to EBF.

Overall, the recommendations from this study highlight the importance of improving access to information, counseling services, and supportive environments to promote exclusive breastfeeding and improve maternal health outcomes.

AI Innovations Methodology

Based on the provided study, here are some potential recommendations to improve access to maternal health:

1. Increase access to infant feeding counseling: The study found that mothers who received infant feeding counseling were more likely to practice exclusive breastfeeding. Therefore, it is recommended to improve access to counseling services for mothers, especially in rural areas where access may be limited.

2. Improve knowledge and awareness: Although the study found that the knowledge and attitude of mothers towards exclusive breastfeeding was high, there is still room for improvement. It is important to continue educating mothers about the benefits and recommended duration of exclusive breastfeeding through routine maternal and child health services.

3. Create mother-friendly work environments: The study found that employed mothers were less likely to practice exclusive breastfeeding. To address this, it is recommended to create supportive work environments that enable mothers to continue breastfeeding, such as providing breastfeeding breaks and designated breastfeeding areas.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the target population: Identify the specific population that the recommendations aim to reach, such as mothers with infants aged below 12 months in a specific district or region.

2. Collect baseline data: Gather data on the current access to maternal health services, including the percentage of mothers practicing exclusive breastfeeding and the availability of counseling services.

3. Develop a simulation model: Create a model that simulates the impact of the recommendations on improving access to maternal health. This could involve using statistical techniques, such as logistic regression, to estimate the potential increase in exclusive breastfeeding rates based on factors such as increased access to counseling services and improved knowledge and awareness.

4. Input data and run simulations: Input the baseline data into the simulation model and run simulations to estimate the potential impact of the recommendations. This could involve adjusting the variables related to access to counseling services, knowledge and awareness, and work environments to reflect the proposed improvements.

5. Analyze results: Analyze the results of the simulations to determine the potential impact of the recommendations on improving access to maternal health. This could include estimating the percentage increase in exclusive breastfeeding rates and identifying any significant changes in access to counseling services.

6. Validate the model: Validate the simulation model by comparing the simulated results with real-world data, if available. This can help ensure the accuracy and reliability of the model.

7. Communicate findings: Present the findings of the simulation study to relevant stakeholders, such as policymakers and healthcare providers, to inform decision-making and potential implementation of the recommendations.

It is important to note that the methodology for simulating the impact of recommendations may vary depending on the specific context and available data.

Authors & Co-Authors

Statistics:

Citations: 54

Authors: 3

Identifiers:

DOI: 10.1186/s13006-015-0049-2

Research Areas:

Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants

Study Countries:

Ethiopia

Study Design:

Case-Control Study, Cross Sectional Study, Grounded Theory

Study Approach:

Quantitative

Participants Gender:

Female