Background Breastfeeding is the process of feeding a newborn with the mother’s milk, and it is very important for enhancing child and maternal health. The proportion and duration of breastfeeding may vary by location, and is poorly practiced for cultural, economic, and societal reasons. Thus, this study was conducted to determine breastfeeding practices and determinants of exclusive breastfeeding among mothers of six month aged infants in the Horro district, Ethiopia. Methods We used a community-based cross-sectional study among 649 mothers of index infants. A multi-stage sampling procedure was used to select the women. Data were collected from March 15 to April 5, 2020. Face-to-face interviews were used to collect data using a semi-structured questionnaire. Bivariable and multivariable logistic regression were performed to examine the factors associated with exclusive breastfeeding. Results All women who participated in the study have ever breastfed their children at some point. Exclusive breastfeeding and breastfeeding initiation were found to be good (70.4% and 61.8%, respectively) within 24 hours prior to the survey time. Having had information about breastfeeding during antenatal care (AOR = 4.15, 95% CI = 2.36, 7.30), postnatal care follow-up (AOR = 4.74, 95% CI = 2.92, 7.70), having infant aged 0-1month (AOR = 12.14, 95% CI = 3.83, 38.46) and 2–3 month (AOR = 8.62, 95% CI = 5.00, 14.85), being a single birth (AOR = 12.91, 95% CI = 3.86, 43.21), having monthly income of ≤ 100 Ethiopian Birrs (AOR = 1.96, 95% CI = 1.16, 3.32), and breastfeeding initiation within one hour of birth (AOR = 1.94, 95% CI = 1.13, 3.35) were found to be a significantly associated factors of exclusive breastfeeding. Conclusion Despite meeting the global nutrition target of 2025, the practice of exclusive breastfeeding was lower than the WHO recommendations. Providing education about breastfeeding during antenatal care follow-up and increasing access to postnatal care follow-up is recommended to enhance exclusive breastfeeding practices in the study area.
This cross-sectional survey was carried out in Horro district, which is located in Horro Guduru Wollega Zone, Oromia Regional State, Ethiopia, around 315 kilometers west of the country’s capital, Addis Ababa. This district has an elevation of 2503 meter above sea level and located at 9° 34′ 0″ North, 37° 6′ 0″ East. The district consists of both rural and urban residents. A majority of the people are engaged in agricultural activities as a major livelihood means. The district has one hospital, seven health centers and 23 health posts owned by the government and five privately owned clinics. The study was conducted from March 15 to April 5, 2020. The sample size was calculated using a single population proportion formula. The following assumptions have been made: a 95% confidence level, a 5% margin of error, and the prevalence of EBF practice (P = 43.6%) at Bedele [17], a finite population correction factor formula since the total number of under 6 month lactating mothers in the district (N) was 1332 according to the data from the district health office, a 10% non-response rate, and a design effect of 2 for the multi-stage sampling. The final sample size was 649 mothers. There were 23 Kebeles (i.e., the smallest unit of administration) in the Horro district, two of which were urban and twenty-one of which were rural. Thirteen kebeles (1 urban and 12 rural) were selected using simple random sampling, a lottery method. The number of study participants was proportionally distributed to each Kebele depending on the number of mother-infant pairs in each kebele. As a sampling frame, the local health extension worker’s registration form for women with infants under the age of six months was used. In order to obtain the required sample size as per the proportional allocation, mothers who had an infant aged less than 6 months were selected by employing simple random sampling techniques. Only mothers who are permanent residents of the selected kebeles were included. Semi-structured questionnaire was prepared by adopting from the EDHS (2016) and other related studies which were designed to assess infant and young child feeding practices in developing countries [14, 18–20]. The questionnaire considered the study objectives and the local situation of the study area. It was initially prepared in English and then translated into Afaan Oromo, the local language, and translated back to English by language experts to ensure consistency. The questionnaire was pre-tested on 5% of the sample size prior to the real data collection process at non-sampled Kebeles, and modifications were made as needed. Face-to-face interviews were conducted to collect data on socio-demographic variables, obstetric characteristics, and EBF practices of mothers by using a pre-tested questionnaire. Eight local health extension workers (i.e., at out of their kebele to prevent bias) collected the data, and two nurses, including the principal investigators, served as supervisors. Both the interviewers and supervisors were trained for one day on the objective of the research, data collection procedures, and interviewing approach. The WHO definition of EBF was adopted, which stated that nothing other than breast milk had been administered in the previous 24 hours prior to the interview. EBF was calculated by asking mothers of infants aged 0 to 6 months to provide information about their infant’s feeding history for the previous 24 hours. The dependent variable was exclusive breastfeeding practice. The independent variables were: The following operational definitions were applied, consistent with WHO definitions: The data were coded and entered into the statistical software EPI Info version 3.5.4, then exported to SPSS version 20 for analysis. To describe respondents using various characteristics of interest and establish the prevalence of exclusive breastfeeding, descriptive statistics were utilized. The prevalence of EBF was determined as the ratio of infants under the age of 6 months who only fed breast milk in the 24 hours leading up to the survey to the total number of children in the same age group. Bivariable and multivariable logistic regressions were performed to examine the association between independent variables and EBF. In the multiple logistic regression models, odds ratios with 95% confidence intervals were calculated, and variables with p-values less than 0.05 were considered significantly associated with the dependent variable. The study was first approved by Bahir Dar Institute of Technology, faculty of Chemical and Food Engineering. Officials at various levels in the study area were notified via letters from Bahir Dar Institute of Technology, and an official letter of cooperation was obtained from the Horro district Health bureau. Before the interview, each respondent gave their informed verbal consent after explaining the study objectives for the participants. Participation was voluntary and mothers/caregivers signed (or provided a thumbprint if illiterate) a statement of an informed consent, after which they were interviewed. Respondents were given the option of not responding to any questions they didn’t want to answer, as well as assurances concerning the confidentiality of the data. Following the interview, the importance of EBF was discussed with those who had not done so previously, and they were encouraged to do so.
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