Research ArticleExclusive Breastfeeding Practice and Its Associated Factorsamong Mothers of Infants Less Than Six Months of Age inDebre Tabor Town Northwest Ethiopia A Cross-Sectional Study
Getachew Arage and Haileyesus Gedamu
Department of Nursing College of Health Sciences Debre Tabor University PO Box 272 Debre Tabor Ethiopia
Correspondence should be addressed to Getachew Arage getachewarage2004gmailcom
Received 2 February 2016 Revised 9 May 2016 Accepted 25 May 2016
Academic Editor Ronald J Prineas
Copyright copy 2016 G Arage and H Gedamu This is an open access article distributed under the Creative Commons AttributionLicense which permits unrestricted use distribution and reproduction in any medium provided the original work is properlycited
Background Exclusive breastfeeding for the first six months of life is recommended by the World Health Organization and UnitedNations Childrenrsquos Fund However the prevalence of exclusive breastfeeding is very low in many developing countries includingEthiopia Objectives The study was aimed at assessing the prevalence of exclusive breastfeeding practice and its associated factorsamong infants aged six months in Debre Tabor town Methods Community based cross-sectional study was conducted Simplerandom sampling technique was employed in the selection of participants Data were collected using pretested and structuredquestionnaire through face-to-face interview Odds ratios with their 95 CI were computed and variables having 119901 value less than005 in the multivariable logistic regression were considered as significantly associated with the dependent variable Result Of 470mother-infant pairrsquos samples 453 were included in the final analysis The overall age appropriate rate of EBF practice was foundto be 708 Having an infant aged 2-3 months [AOR = 23 (95 CI 112 642)] giving birth in the health facility [AOR = 38(95 CI 218 732)] being a house wife in occupation [AOR = 24 (95 CI (122 692)] receiving counselingadvice on infantfeeding [AOR = 21 (95 CI 161 541)] and colostrums feeding [AOR = 15 (95 CI 128 798)] were found to be significantlyassociated with EBF practice Conclusion and Recommendations A small proportion of infants are exclusively breastfed during thefirst 6months Promoting institutional delivery revising the leave after birth advice and counseling pregnant mothers about EBFand enabling every mother to encourage colostrum feeding were recommended in order to increase the proportion of womenpracticing exclusive breastfeeding
1 Back Ground
Exclusive breastfeeding (EBF) is the optimal feeding practiceto achieve infantsrsquo growth and development It is one ofthe strategies to improve nutritional status and growth inchildren EBF can avert the major causes of neonatal deathsuch as sepsis acute respiratory tract infections meningitisand diarrhoea [1] Moreover breastfeeding delays the returnof a womanrsquos fertility and reduces the risks of postpartumhemorrhage premenopausal breast cancer and ovarian can-cer [2]
In view of the above suboptimum breastfeeding partic-ularly nonexclusive breastfeeding results in 14 million childdeaths and 10 of disease burden in children under fiveyears [3] Global risk assessment of suboptimal breastfeeding
indicates that 96 of all infant deaths in developing countriesare attributable to inappropriate feeding occurring during thefirst six months of life [4] The 2011 Ethiopian Demographicand Health Survey (EDHS) showed 52 of children less than6 months of age are exclusively breastfed In Amhara regionwith high prevalence rates of stunting which is above thenational average (52) is mainly caused by inappropriateneonatal feeding [5]
The immediate consequence of poor nutrition during 0ndash6 months of age leads to morbidity mortality and delayedmental and motor development Gradually early nutritionaldeficits are linked to impairments in intellectual perfor-mance work capacity reproductive outcomes and overallhealth during adolescence and adulthood [6]
Hindawi Publishing CorporationAdvances in Public HealthVolume 2016 Article ID 3426249 7 pageshttpdxdoiorg10115520163426249
2 Advances in Public Health
Sociocultural factors food insecurity poor professionalcounseling on breastfeeding place of delivery mode ofdelivery obstetrics and medical factors are considered asfactors influencing feeding practice by different studies [7ndash9]
Despite many studies conducted on exclusive breastfeed-ing and well-recognized importance of exclusive breastfeed-ing the practice is not widespread in the developing worldand increase on the global level is still verymodest withmuchroom for improvement Moreover the associated factors aredifferent from country to country and even within the samecountry [1 2]
Breastfeeding is nearly universal in Ethiopia but EBFduring the first six months after birth is not widely practicedAmong subgroups the percentage of young children who areexclusively breastfed decreases sharply from 70 percent ofinfants aged 0-1month to 55 percent of those aged 2-3monthsand further to 32 percent among infants 4-5 months old Inaddition to breastmilk 19 percent of infants under sixmonthsof age are given plain water only while 14 percent receivemilkin addition to breast milk and 4 percent are given nonmilkliquids and juice Sixteen percent of infants under six monthsof age are fed using a bottle with a nipple [5]
To strengthen the effort in reducing child mortalitythe Ethiopian Ministry of Health (MOH) had targeted anincrease in the proportion of exclusively breastfed infantsunder the age of 6 months to 70 percent by 2015 asone strategy to improve child health [1 10] In line withthis the Ethiopian government has increased its efforts toenhance good nutritional practices through health educationand developed the infant and young child feeding (IYCF)guideline in 2004 [11] and the Health Extension Program( HEP) has included exclusive breastfeeding as one part ofthe health care package [12] Identifying factors associatedwith breastfeeding practices in different contexts is assumedto facilitate better advocacy and wider coverage in thecountry Therefore the current study will reveal the practiceof exclusive breastfeeding and associated factors which arecrucial for decision-makers at different levels for designingempirical and evidence based intervention in Debre Tabortown
2 Methods
21 Study Design and Study Period Institution based cross-sectional study was conducted in April 2014 at Debre Tabortown of the Amhara Region of Ethiopia about 130 kilometerssoutheast of Gondar town 50 kilometers east of Lake Tanaand 666 kilometers from Addis Ababa It has an area of 1562hectares that extends from 11∘511015840N to 38∘11015840E with an elevationof 2706 meters above sea level It has a total population of46397 and 10790 households The town is divided into fourkebeles There are 3682 3594 1284 and 2230 households inkebele 1 kebele 2 kebele 3 and kebele 4 respectively Thereare three health centers and one hospitalThere are two healthextensionworkers in each kebele who provided basic primaryhealth care services [13]
The sample size was calculated by considering theassumptions for single population proportion formula theproportion (119875) = 503 exclusive breastfeeding rate [10] 119885
the standard normal distribution value at 95 confidencelevel of Za2 = 196 5 of absolute precision and 10nonresponse rate Hence the total sample size was 426However therewere 470mother-infant pairs during the studyperiod and therefore all were included
Simple random sampling technique using computer gen-erated random number was employed in the selection ofparticipants The registration of mothers who have a childaged less than 6 months by the local health extensionworkers (HEW) were used as a sampling frame In the studyarea Debre Tabor town there are 4 kebeles Proportionalallocation was used to select the participants Based on this139 148 59 and 124 mother-infant pairs were selected fromkebeles 1 2 3 and 4 respectively
Pretested and structured questionnaires using face-to-face interviewing with caregivers were used for data collec-tion The questionnaire was partly adapted from EDHS andWHO which is designed to assess infant and young childfeeding practices in developing countries including Ethiopia[5 7 8]
Theprevalence of EBFwas calculated based on the respec-tive age of the infants Whenever study participants were notable to be interviewed for some reason (eg absence refusal)attempts were made three times to interview the respondentrather than simply considering them as nonresponse
Data were collected by four diploma nurses (supervisedby two BSc nurses) A two-day comprehensive trainingwas given to data collectors and supervisors The question-naire was first prepared in English and then translated intoAmharic (the local language) and back into English to ensureconsistency Pretesting of the questionnaire was undertakenon 5 (24 mothers) of the sample size in Debre Tabor townat Gasay town before the actual data collection
The questionnaires were coded and entered into EPI Infoversion 353 statistical software and then exported to SPSSwindows version 16 for further analysis Data were summa-rized and presented using descriptive statistics Bivariate andmultiple logistic regressions were computed to identify thepresence and strength of associations Odds ratios with 95CIwere computed and variables having119901 values less than 005in the multiple logistic regression models were consideredsignificantly associated with the dependent variable
22 Operational Definition
221 Prevalence of Exclusive Breastfeeding Prevalence ofexclusive breastfeeding was calculated as newbornsinfantsbelow 6months who were fed only on breast milk in the 24hours preceding the survey to the total number of children inthe same age group (lt6months of age) andmultiplied by 100
3 Ethical Considerations
Ethical clearance was obtained from the Ethical ReviewCommittee of the Debre Tabor University An official letterof cooperation was gained from South Gondar Zone HealthDepartment and Debre Tabor town administrative healthoffices Verbal consent was obtained from each participantbefore the start of interview Confidentiality was kept by
Advances in Public Health 3
justifying that no information was disclosed individually andusing anonymous data The respondents were having theright not to participate in or withdraw from the study at anystage
4 Results
41 Sociodemographic Characteristics of the Participants Atotal of 453 mothers of children were included in the studywith a response rate of 964 The mean age of the motherswas 284 years (SD plusmn 53 years) whereas the median age ofthe infants was 3 months (IQR = 2 months) A majority412 (909) of the mothers were married 448 (988) wereAmhara by ethnicity and 231 (509) were housewives byoccupation Three hundred eighty (838) of mothers hadprimary education Regarding infants 294 (649) werefemale and 180 (398) were between 2 and 3 months of age(Table 1)
42 Obstetric Characteristics of the Participants Most ofthe respondents 446 (985) had ANC follow-up with amean number of ANC visits of 31 (SD plusmn 104) however47 were not counseled on exclusive breastfeeding for sixmonths during their ANC follow-up Concerning the placeof delivery 370 (816) delivered their youngest child athealth institutions Four hundred and fifty-one (996) ofthe mothers delivered vaginally and 324 (875) of themothers who delivered at health institutions were counseledon breastfeeding (Table 2)
43 Breastfeeding Practices Almost all 452 (998) childrenhad ever breastfed at some point in the past Of those whohad ever breastfed 356 (786) of the mothers initiatedbreastfeeding within one hour of birth 441 (973) had fedcolostrum and 116 (256) of mothers gave one or moreprelacteal feeds
The majority 280 (618) of mothers give breast milkfor their infant eight times and above per 24 hrs Despite thefact that on-demand breastfeeding is recommended 443of mothers breastfed their infants only when the infant criesand 428 of mothers apply the on-demand feeding Theprevalence of EBF computed using 24-hour dietary recallmethod showed 321 (708) of the participants practiced EBFappropriate to their age (Table 3)
For mothers who have not ever breastfeed the perceivedreasons were as follows child refused to take BM (289) andbreast problems (245) (Figure 1)
Based on the 24-dietary recall period about 482 ofmothers gave breast milk with someaddition of foods likecowrsquosmilk (170) cereal based fluids (132) tea (29) andformula milk (18) (Figure 2)
44 Factors Associated with Exclusive Breastfeeding PracticeBinary logistic regression analysis showed that infant ageoccupation and educational status of the mother monthlyincome ANC visit during last pregnancy place of deliverymode of delivery colostrums feeding sex of infant and
Table 1 Sociodemographic characteristics of themothers with theirinfants (119899 = 453) amongmotherswho gave birth in the last 6monthsin Debre Tabor town Northwest Ethiopia 2014
Variables Frequency Percentage ()Age of mother (in years)lt20 21 4620ndash29 279 616ge30 153 338
Infants age (in months)le1 105 2322-3 180 3984ndash6 168 370119874119905ℎ119890119903
lowast students farmers and daily laborers
receiving counselingadvice on infant feedingwere associatedwith adherence
In multiple logistic regression age of the infant [AOR =23 (95 CI 112 6)] giving birth in the health facility [AOR= 38 (95 CI 218 732)] being a housewife in occupa-tion [AOR = 24 (95 CI (122 692)] receiving counsel-ingadvice on infant feeding [AOR = 21 (95 CI 161 541)]and colostrums feeding [AOR = 15 (95 CI 128 798)]
4 Advances in Public Health
0302890
5384
101225
245
OthersRefusal to take BM
Maternal illnessChild illness
Breast milk insufficiencyMothers returning to work
Breast problems
Figure 1 Reasons for not to breastfeed infants among mothers in Debre Tabor town Northwest Ethiopia in Debre Tabor town NorthwestEthiopia
130
22
70
18290
132170
Others
Water with sugar
Water
Formula feed
Tea
Cereal fluid
Cowrsquos milk
Figure 2 Mixing of breast milk with some foods among mothers in Debre Tabor town
were found to be significantly associated with EBF practice(Table 4)
5 Discussion
This study assessed the prevalence of exclusive feeding prac-tice and its associated factors among mother-infant pairs atDebre Tabor town Northwest Ethiopia The prevalence ofexclusive breastfeeding was found to be 696 in the 24 hourspreceding the survey
This finding is comparable to similar studies conductedin Goba district (713) [14] Jimma town (672) [15] Mada-gascar (68) [16] and Brazil (725) [17] It was lower thanstudies conducted in Ghana (79) [16] and Iran (82) [18]This might be because of the small sample size in Ghana andIran which increases estimation of exclusive breastfeedingrate Nevertheless it higher than studies conducted in BahirDar City Administration (5036) [4] EDHS (52) [7]Bolivia (65) [16] Turk Islands (506) [19] UK (35)[20] and Canada (138) [21] This might be due to theaccessibility of information in the recent times It might bealso because a higher number of participants are housewivesthus increasing the mother-infant bond which in turn boostsbreastfeeding
In the present study breast related problem was reportedas the major reason (245) for not breastfeeding infants Astudy conducted in GobaWoreda [14] supported this findingThis could be because the mothers may fear child illnesssecondary to breast problems
Similar to other studies [4 14] child refusal to take breastmilk (289) and mothers returning to work (225) leadthem to not giving breast milk
A number of factors were reported as predictors ofexclusive breastfeeding among infants In the present studyif the age of the infant is 4ndash6 months then the child was lesslikely to be exclusively breastfed Studies conducted in BaleGoba [14] Jimma town [15] and Brazil [17] showed similarfindings This is due to the fact that when the age of the babyincreases the mothers may return to work
The findings also showed that those infants who are bornin health institutions were about four times more likely tobe exclusively breastfed than those who are born at homeThis finding is supported by a study conducted at Bahir Dar[10] This may be because mothers get counseling and advicewhen they give birth at the health facility and understand therationale behind exclusive breastfeeding
This study also showed that mothersrsquo occupation orbeing a housewife was associatedwith exclusive breastfeedingwhich is in line with findings from Bahir Dar [10]This could
Advances in Public Health 5
Table 2 Obstetric characteristics of participants (119899 = 453) in DebreTabor town Northwest Ethiopia 2014
Variables Frequency PercentageFollow-up of ANC
Yes 446 985
No 7 15
Frequency of ANC visitsle2 39 86
3-4 366 808
4 and above 48 106
Counsel on EBF during ANC visitYes 240 528
No 213 472
Place of deliveryHealth facility 370 816
Home 83 184BF counseling at health facility duringdelivery
Yes 324 715
No 129 285
Mode of deliveryVaginal 451 996
CS 2 04
happen because the mothers can have frequent contact withtheir babies and give breast milk On the other hand motherswere more likely employed and thus spend less time with thechild to give the breast milk consistently
In the present study those mothers who received infantfeeding counselingadvice practiced exclusive breastfeedingabout two times more than those who did not get counselingabout exclusive breastfeeding This finding is consistent withthat of a study conducted in Bale Goba and Bahir Dar [10 14]
If mothers do not understand benefits of exclusive breast-feeding to infants they might be poorly motivated to giveexclusive breastfeeding
In this study giving the first milkcolostrums was pos-itively associated with exclusive breastfeeding This couldbe explained by the idea that the baby will be healthy andsecretion of breast milk increases
However the present study does have some inherentlimitations Using a 24-hour recall period measures currentstatus and may cause the proportion of exclusively breastfedinfants to be slightly overestimated since some infants whowere given other liquids regularly may not have receivedthem in the 24 hours before the survey Despite the effortsmade during data collection to minimize the recall biasesthis may not be eliminated The cross-sectional nature ofthe study which used a snapshot of prevalence of exclusivebreastfeeding practice at one point in time may hinder thecause and effect relationship [22]
Table 3 Breastfeeding practices of the respondents (119899 = 453) inDebre Tabor town Northwest Ethiopia 2014
Variables Frequency PercentageEver breastfedYes 452 998
No 1 02
Initiation timeWithin 1 hour 356 786
After 1 hour 43 94
Do not remember 54 119
Colostrum discardedYes 12 27
No 441 973
Prelacteal feedingYes 116 256
No 337 744
Exclusive breastfeeding practiceYes 321 708
No 132 292
Breastfeeding frequency per 24 hrsge8 hrs 280 618
lt8 173 382
Time to give BFlowast
On demand 194 428
When the baby cry 201 443
On schedule 41 90
Otherslowastlowast 17 37lowast
119861119865 breastfeeding 119900119905ℎ119890119903119904lowastlowast on convince breast full
6 Conclusion
A small proportion of infants are exclusively breastfed duringthe first 6months despite what is recommended in thenational and global infant and young child feeding guidelinesStrengthening infant feeding advicecounseling during ANCfollow-up and birth promoting institutional delivery andenabling every mother to encourage colostrums feeding wererecommended in order to increase the proportion of womenpracticing EBF
Disclosure
Getachew Arage BSc is MSc lecturer in Debre Tabor Uni-versity College of Health Sciences Department of NursingHaileyesusGedamu BSc isMSc lecturer inDebre TaborUni-versity College of Health Sciences Department of Nursing
Competing Interests
The authors declare that they have no competing interests
6 Advances in Public Health
Table 4 Bivariate and multivariate analysis of factors associated with exclusive breastfeeding practices among mothers who gave birth in thelast 6 months (119899 = 453) in Debre Tabor town 2014 lowast119875 gt 005 lowastlowast119875 ge 005
Variables EBF practice OR (95 CI)Yes No COR (95 CI) AOR (95 CI)
Sex of the infantMale 119 40 1Female 227 67 14 (088 225)lowast
Age of the motherslt30 13 8 120ndash29 233 46 121 (067 216)ge30 123 30 081 (047 163)lowast
Educational status of the mothersCannot read and write 16 27 1Elementary school 299 81 14 (077 252)Secondary education and higher 19 11 0752 (043 129)lowast
GetachewArage andHaileyesus Gedamuwrote the proposalparticipated in data collection analyzed the data and draftedthe paper All authors read and approved the final paperGetachewArage andHaileyesusGedamu contributed equallyto this work
Acknowledgments
The authors are very grateful to the Debre Tabor Universityfor the approval of the ethical clearance and financial supportof this study Then the authors would like to thank allstudy participants who participated in this study for theircommitment in responding to their interviews
Advances in Public Health 7
References
[1] UNICEFWHO ldquoIndicators for assessing infant and youngchild feeding practices part 3 Country profilesrdquo 2010 httpwwwuniceforgnutritionfilesIYCF Indicators part III cou-ntry profilespdf
[2] UNICEF ldquoA conceptual framework and research approachfor identifying analyzing and prioritizing barriers to effectivematernal newborn and child health interventions 2011rdquo httpinnovationsformnchorguploadspublications2011-01 Innov-ations-Conceptual-Framework low respdf
[3] R E Black L H Allen Z A Bhutta et al ldquoMaternal and childundernutrition global and regional exposures and health con-sequencesrdquoThe Lancet vol 371 no 9608 pp 243ndash260 2008
[4] A Sefene D BirihanuWAwoke andT Taye ldquoDeterminants ofexclusive breastfeeding practice amongmothers of children ageless than 6 month in Bahir Dar city administration NorthwestEthiopia a community based cross-sectional surveyrdquo ScienceJournal of Clinical Medicine vol 2 no 6 pp 153ndash159 2013
[5] J-QMa L-L Zhou Y-QHu et al ldquoA summary index of infantand child feeding practices is associated with child growth inurban Shanghairdquo BMC Public Health vol 12 no 1 article 5682012
[6] Infant and Young Child Feeding Practices Collecting and UsingData A Step-by-Step Guide Cooperative for Assistance andRelief Everywhere Inc (CARE) 2010
[7] WHO Infant and Young Child Feeding 2009 httpwhqlibdocwhointpublications20099789241597494 engpdf
[8] UNICEF Programming Guide Infant and Young Child Feed-ing 2011 httpwwwuniceforgnutritionfilesFinal IYCFprogramming guide 2011pdf
[9] WHOUNICEF ldquoAcceptable medical reasons for use of breast-milk substitutesrdquo 2009 httpwhqlibdocwhointhq2009WHO FCH CAH 0901 engpdf
[10] AM SeidM E Yesuf andDNKoye ldquoPrevalence of ExclusiveBreastfeeding Practices and associated factors among mothersin Bahir Dar city Northwest Ethiopia a community basedcross-sectional studyrdquo International Breastfeeding Journal vol8 article 14 2013
[11] Federal Ministry of Health ldquoNational strategy for infant andyoung child feeding-Extranet Systemsrdquo 2004 httpsextranetwhointnutritionginasitesdefaultfilesETH20200420N-ational20Strategy20for20Infant20and20Young20C-hild20Feedingpdf
[12] Health Extension Education Center Health Extension Programin Ethiopia Health Education and Extension Center AddisAbaba Ethiopia 2007
[13] South Gondar Zone Statistics Department Population andHousing Census Preliminary Report Gambia Bureau of Statis-tics 2013
[14] T Setegn T Belachew M Gerbaba K Deribe A Deribew andS Biadgilign ldquoFactors associated with exclusive breastfeedingpractices among mothers in Goba district south east Ethiopiaa cross-sectional studyrdquo International Breastfeeding Journal vol7 article 17 pp 1ndash8 2012
[15] W Seifu G Assefa andG Egata ldquoPrevalence of exclusive breastfeeding and its predictors among infants aged six months inJimma Town Southwest Ethiopia 2013rdquo Journal of Pediatrics ampNeonatal Care vol 1 no 3 pp 4ndash6 2014
[16] J Victoria B Agnes W Joan et al ldquoImproving breastfeedingpractices on a broad scale at the community level success stories
from Africa and Latin Americardquo Journal of Human Lactationvol 21 no 3 pp 345ndash354 2005
[17] M B R do Nascimento M A M Reis S C Franco H IsslerA A Ferraro and S J F E Grisi ldquoExclusive breastfeeding insouthern Brazil prevalence and associated factorsrdquo Breastfeed-ing Medicine vol 5 no 2 pp 79ndash85 2010
[18] A Koosha R Hashemifesharaki and N MousavinasabldquoBreast-feeding patterns and factors determining exclusivebreast-feedingrdquo Singapore Medical Journal vol 49 no 12 pp1002ndash1006 2008
[19] Z Karacam ldquoFactors affecting exclusive breastfeeding ofhealthy babies aged zero to four months a community-basedstudy of Turkish womenrdquo Journal of Clinical Nursing vol 17 no3 pp 341ndash349 2008
[21] B Al-Sahab A Lanes M Feldman andH Tamim ldquoPrevalenceand predictors of 6-month exclusive Breastfeeding amongCanadian women a national surveyrdquo BMC Pediatrics vol 10article 20 2010
[22] G Arage G A Tessema andH Kassa ldquoAdherence to antiretro-viral therapy and its associated factors among children at SouthWollo Zone Hospitals Northeast Ethiopia a cross-sectionalstudyrdquo BMC Public Health vol 14 article 365 2014
Sociocultural factors food insecurity poor professionalcounseling on breastfeeding place of delivery mode ofdelivery obstetrics and medical factors are considered asfactors influencing feeding practice by different studies [7ndash9]
Despite many studies conducted on exclusive breastfeed-ing and well-recognized importance of exclusive breastfeed-ing the practice is not widespread in the developing worldand increase on the global level is still verymodest withmuchroom for improvement Moreover the associated factors aredifferent from country to country and even within the samecountry [1 2]
Breastfeeding is nearly universal in Ethiopia but EBFduring the first six months after birth is not widely practicedAmong subgroups the percentage of young children who areexclusively breastfed decreases sharply from 70 percent ofinfants aged 0-1month to 55 percent of those aged 2-3monthsand further to 32 percent among infants 4-5 months old Inaddition to breastmilk 19 percent of infants under sixmonthsof age are given plain water only while 14 percent receivemilkin addition to breast milk and 4 percent are given nonmilkliquids and juice Sixteen percent of infants under six monthsof age are fed using a bottle with a nipple [5]
To strengthen the effort in reducing child mortalitythe Ethiopian Ministry of Health (MOH) had targeted anincrease in the proportion of exclusively breastfed infantsunder the age of 6 months to 70 percent by 2015 asone strategy to improve child health [1 10] In line withthis the Ethiopian government has increased its efforts toenhance good nutritional practices through health educationand developed the infant and young child feeding (IYCF)guideline in 2004 [11] and the Health Extension Program( HEP) has included exclusive breastfeeding as one part ofthe health care package [12] Identifying factors associatedwith breastfeeding practices in different contexts is assumedto facilitate better advocacy and wider coverage in thecountry Therefore the current study will reveal the practiceof exclusive breastfeeding and associated factors which arecrucial for decision-makers at different levels for designingempirical and evidence based intervention in Debre Tabortown
2 Methods
21 Study Design and Study Period Institution based cross-sectional study was conducted in April 2014 at Debre Tabortown of the Amhara Region of Ethiopia about 130 kilometerssoutheast of Gondar town 50 kilometers east of Lake Tanaand 666 kilometers from Addis Ababa It has an area of 1562hectares that extends from 11∘511015840N to 38∘11015840E with an elevationof 2706 meters above sea level It has a total population of46397 and 10790 households The town is divided into fourkebeles There are 3682 3594 1284 and 2230 households inkebele 1 kebele 2 kebele 3 and kebele 4 respectively Thereare three health centers and one hospitalThere are two healthextensionworkers in each kebele who provided basic primaryhealth care services [13]
The sample size was calculated by considering theassumptions for single population proportion formula theproportion (119875) = 503 exclusive breastfeeding rate [10] 119885
the standard normal distribution value at 95 confidencelevel of Za2 = 196 5 of absolute precision and 10nonresponse rate Hence the total sample size was 426However therewere 470mother-infant pairs during the studyperiod and therefore all were included
Simple random sampling technique using computer gen-erated random number was employed in the selection ofparticipants The registration of mothers who have a childaged less than 6 months by the local health extensionworkers (HEW) were used as a sampling frame In the studyarea Debre Tabor town there are 4 kebeles Proportionalallocation was used to select the participants Based on this139 148 59 and 124 mother-infant pairs were selected fromkebeles 1 2 3 and 4 respectively
Pretested and structured questionnaires using face-to-face interviewing with caregivers were used for data collec-tion The questionnaire was partly adapted from EDHS andWHO which is designed to assess infant and young childfeeding practices in developing countries including Ethiopia[5 7 8]
Theprevalence of EBFwas calculated based on the respec-tive age of the infants Whenever study participants were notable to be interviewed for some reason (eg absence refusal)attempts were made three times to interview the respondentrather than simply considering them as nonresponse
Data were collected by four diploma nurses (supervisedby two BSc nurses) A two-day comprehensive trainingwas given to data collectors and supervisors The question-naire was first prepared in English and then translated intoAmharic (the local language) and back into English to ensureconsistency Pretesting of the questionnaire was undertakenon 5 (24 mothers) of the sample size in Debre Tabor townat Gasay town before the actual data collection
The questionnaires were coded and entered into EPI Infoversion 353 statistical software and then exported to SPSSwindows version 16 for further analysis Data were summa-rized and presented using descriptive statistics Bivariate andmultiple logistic regressions were computed to identify thepresence and strength of associations Odds ratios with 95CIwere computed and variables having119901 values less than 005in the multiple logistic regression models were consideredsignificantly associated with the dependent variable
22 Operational Definition
221 Prevalence of Exclusive Breastfeeding Prevalence ofexclusive breastfeeding was calculated as newbornsinfantsbelow 6months who were fed only on breast milk in the 24hours preceding the survey to the total number of children inthe same age group (lt6months of age) andmultiplied by 100
3 Ethical Considerations
Ethical clearance was obtained from the Ethical ReviewCommittee of the Debre Tabor University An official letterof cooperation was gained from South Gondar Zone HealthDepartment and Debre Tabor town administrative healthoffices Verbal consent was obtained from each participantbefore the start of interview Confidentiality was kept by
Advances in Public Health 3
justifying that no information was disclosed individually andusing anonymous data The respondents were having theright not to participate in or withdraw from the study at anystage
4 Results
41 Sociodemographic Characteristics of the Participants Atotal of 453 mothers of children were included in the studywith a response rate of 964 The mean age of the motherswas 284 years (SD plusmn 53 years) whereas the median age ofthe infants was 3 months (IQR = 2 months) A majority412 (909) of the mothers were married 448 (988) wereAmhara by ethnicity and 231 (509) were housewives byoccupation Three hundred eighty (838) of mothers hadprimary education Regarding infants 294 (649) werefemale and 180 (398) were between 2 and 3 months of age(Table 1)
42 Obstetric Characteristics of the Participants Most ofthe respondents 446 (985) had ANC follow-up with amean number of ANC visits of 31 (SD plusmn 104) however47 were not counseled on exclusive breastfeeding for sixmonths during their ANC follow-up Concerning the placeof delivery 370 (816) delivered their youngest child athealth institutions Four hundred and fifty-one (996) ofthe mothers delivered vaginally and 324 (875) of themothers who delivered at health institutions were counseledon breastfeeding (Table 2)
43 Breastfeeding Practices Almost all 452 (998) childrenhad ever breastfed at some point in the past Of those whohad ever breastfed 356 (786) of the mothers initiatedbreastfeeding within one hour of birth 441 (973) had fedcolostrum and 116 (256) of mothers gave one or moreprelacteal feeds
The majority 280 (618) of mothers give breast milkfor their infant eight times and above per 24 hrs Despite thefact that on-demand breastfeeding is recommended 443of mothers breastfed their infants only when the infant criesand 428 of mothers apply the on-demand feeding Theprevalence of EBF computed using 24-hour dietary recallmethod showed 321 (708) of the participants practiced EBFappropriate to their age (Table 3)
For mothers who have not ever breastfeed the perceivedreasons were as follows child refused to take BM (289) andbreast problems (245) (Figure 1)
Based on the 24-dietary recall period about 482 ofmothers gave breast milk with someaddition of foods likecowrsquosmilk (170) cereal based fluids (132) tea (29) andformula milk (18) (Figure 2)
44 Factors Associated with Exclusive Breastfeeding PracticeBinary logistic regression analysis showed that infant ageoccupation and educational status of the mother monthlyincome ANC visit during last pregnancy place of deliverymode of delivery colostrums feeding sex of infant and
Table 1 Sociodemographic characteristics of themothers with theirinfants (119899 = 453) amongmotherswho gave birth in the last 6monthsin Debre Tabor town Northwest Ethiopia 2014
Variables Frequency Percentage ()Age of mother (in years)lt20 21 4620ndash29 279 616ge30 153 338
Infants age (in months)le1 105 2322-3 180 3984ndash6 168 370119874119905ℎ119890119903
lowast students farmers and daily laborers
receiving counselingadvice on infant feedingwere associatedwith adherence
In multiple logistic regression age of the infant [AOR =23 (95 CI 112 6)] giving birth in the health facility [AOR= 38 (95 CI 218 732)] being a housewife in occupa-tion [AOR = 24 (95 CI (122 692)] receiving counsel-ingadvice on infant feeding [AOR = 21 (95 CI 161 541)]and colostrums feeding [AOR = 15 (95 CI 128 798)]
4 Advances in Public Health
0302890
5384
101225
245
OthersRefusal to take BM
Maternal illnessChild illness
Breast milk insufficiencyMothers returning to work
Breast problems
Figure 1 Reasons for not to breastfeed infants among mothers in Debre Tabor town Northwest Ethiopia in Debre Tabor town NorthwestEthiopia
130
22
70
18290
132170
Others
Water with sugar
Water
Formula feed
Tea
Cereal fluid
Cowrsquos milk
Figure 2 Mixing of breast milk with some foods among mothers in Debre Tabor town
were found to be significantly associated with EBF practice(Table 4)
5 Discussion
This study assessed the prevalence of exclusive feeding prac-tice and its associated factors among mother-infant pairs atDebre Tabor town Northwest Ethiopia The prevalence ofexclusive breastfeeding was found to be 696 in the 24 hourspreceding the survey
This finding is comparable to similar studies conductedin Goba district (713) [14] Jimma town (672) [15] Mada-gascar (68) [16] and Brazil (725) [17] It was lower thanstudies conducted in Ghana (79) [16] and Iran (82) [18]This might be because of the small sample size in Ghana andIran which increases estimation of exclusive breastfeedingrate Nevertheless it higher than studies conducted in BahirDar City Administration (5036) [4] EDHS (52) [7]Bolivia (65) [16] Turk Islands (506) [19] UK (35)[20] and Canada (138) [21] This might be due to theaccessibility of information in the recent times It might bealso because a higher number of participants are housewivesthus increasing the mother-infant bond which in turn boostsbreastfeeding
In the present study breast related problem was reportedas the major reason (245) for not breastfeeding infants Astudy conducted in GobaWoreda [14] supported this findingThis could be because the mothers may fear child illnesssecondary to breast problems
Similar to other studies [4 14] child refusal to take breastmilk (289) and mothers returning to work (225) leadthem to not giving breast milk
A number of factors were reported as predictors ofexclusive breastfeeding among infants In the present studyif the age of the infant is 4ndash6 months then the child was lesslikely to be exclusively breastfed Studies conducted in BaleGoba [14] Jimma town [15] and Brazil [17] showed similarfindings This is due to the fact that when the age of the babyincreases the mothers may return to work
The findings also showed that those infants who are bornin health institutions were about four times more likely tobe exclusively breastfed than those who are born at homeThis finding is supported by a study conducted at Bahir Dar[10] This may be because mothers get counseling and advicewhen they give birth at the health facility and understand therationale behind exclusive breastfeeding
This study also showed that mothersrsquo occupation orbeing a housewife was associatedwith exclusive breastfeedingwhich is in line with findings from Bahir Dar [10]This could
Advances in Public Health 5
Table 2 Obstetric characteristics of participants (119899 = 453) in DebreTabor town Northwest Ethiopia 2014
Variables Frequency PercentageFollow-up of ANC
Yes 446 985
No 7 15
Frequency of ANC visitsle2 39 86
3-4 366 808
4 and above 48 106
Counsel on EBF during ANC visitYes 240 528
No 213 472
Place of deliveryHealth facility 370 816
Home 83 184BF counseling at health facility duringdelivery
Yes 324 715
No 129 285
Mode of deliveryVaginal 451 996
CS 2 04
happen because the mothers can have frequent contact withtheir babies and give breast milk On the other hand motherswere more likely employed and thus spend less time with thechild to give the breast milk consistently
In the present study those mothers who received infantfeeding counselingadvice practiced exclusive breastfeedingabout two times more than those who did not get counselingabout exclusive breastfeeding This finding is consistent withthat of a study conducted in Bale Goba and Bahir Dar [10 14]
If mothers do not understand benefits of exclusive breast-feeding to infants they might be poorly motivated to giveexclusive breastfeeding
In this study giving the first milkcolostrums was pos-itively associated with exclusive breastfeeding This couldbe explained by the idea that the baby will be healthy andsecretion of breast milk increases
However the present study does have some inherentlimitations Using a 24-hour recall period measures currentstatus and may cause the proportion of exclusively breastfedinfants to be slightly overestimated since some infants whowere given other liquids regularly may not have receivedthem in the 24 hours before the survey Despite the effortsmade during data collection to minimize the recall biasesthis may not be eliminated The cross-sectional nature ofthe study which used a snapshot of prevalence of exclusivebreastfeeding practice at one point in time may hinder thecause and effect relationship [22]
Table 3 Breastfeeding practices of the respondents (119899 = 453) inDebre Tabor town Northwest Ethiopia 2014
Variables Frequency PercentageEver breastfedYes 452 998
No 1 02
Initiation timeWithin 1 hour 356 786
After 1 hour 43 94
Do not remember 54 119
Colostrum discardedYes 12 27
No 441 973
Prelacteal feedingYes 116 256
No 337 744
Exclusive breastfeeding practiceYes 321 708
No 132 292
Breastfeeding frequency per 24 hrsge8 hrs 280 618
lt8 173 382
Time to give BFlowast
On demand 194 428
When the baby cry 201 443
On schedule 41 90
Otherslowastlowast 17 37lowast
119861119865 breastfeeding 119900119905ℎ119890119903119904lowastlowast on convince breast full
6 Conclusion
A small proportion of infants are exclusively breastfed duringthe first 6months despite what is recommended in thenational and global infant and young child feeding guidelinesStrengthening infant feeding advicecounseling during ANCfollow-up and birth promoting institutional delivery andenabling every mother to encourage colostrums feeding wererecommended in order to increase the proportion of womenpracticing EBF
Disclosure
Getachew Arage BSc is MSc lecturer in Debre Tabor Uni-versity College of Health Sciences Department of NursingHaileyesusGedamu BSc isMSc lecturer inDebre TaborUni-versity College of Health Sciences Department of Nursing
Competing Interests
The authors declare that they have no competing interests
6 Advances in Public Health
Table 4 Bivariate and multivariate analysis of factors associated with exclusive breastfeeding practices among mothers who gave birth in thelast 6 months (119899 = 453) in Debre Tabor town 2014 lowast119875 gt 005 lowastlowast119875 ge 005
Variables EBF practice OR (95 CI)Yes No COR (95 CI) AOR (95 CI)
Sex of the infantMale 119 40 1Female 227 67 14 (088 225)lowast
Age of the motherslt30 13 8 120ndash29 233 46 121 (067 216)ge30 123 30 081 (047 163)lowast
Educational status of the mothersCannot read and write 16 27 1Elementary school 299 81 14 (077 252)Secondary education and higher 19 11 0752 (043 129)lowast
GetachewArage andHaileyesus Gedamuwrote the proposalparticipated in data collection analyzed the data and draftedthe paper All authors read and approved the final paperGetachewArage andHaileyesusGedamu contributed equallyto this work
Acknowledgments
The authors are very grateful to the Debre Tabor Universityfor the approval of the ethical clearance and financial supportof this study Then the authors would like to thank allstudy participants who participated in this study for theircommitment in responding to their interviews
Advances in Public Health 7
References
[1] UNICEFWHO ldquoIndicators for assessing infant and youngchild feeding practices part 3 Country profilesrdquo 2010 httpwwwuniceforgnutritionfilesIYCF Indicators part III cou-ntry profilespdf
[2] UNICEF ldquoA conceptual framework and research approachfor identifying analyzing and prioritizing barriers to effectivematernal newborn and child health interventions 2011rdquo httpinnovationsformnchorguploadspublications2011-01 Innov-ations-Conceptual-Framework low respdf
[3] R E Black L H Allen Z A Bhutta et al ldquoMaternal and childundernutrition global and regional exposures and health con-sequencesrdquoThe Lancet vol 371 no 9608 pp 243ndash260 2008
[4] A Sefene D BirihanuWAwoke andT Taye ldquoDeterminants ofexclusive breastfeeding practice amongmothers of children ageless than 6 month in Bahir Dar city administration NorthwestEthiopia a community based cross-sectional surveyrdquo ScienceJournal of Clinical Medicine vol 2 no 6 pp 153ndash159 2013
[5] J-QMa L-L Zhou Y-QHu et al ldquoA summary index of infantand child feeding practices is associated with child growth inurban Shanghairdquo BMC Public Health vol 12 no 1 article 5682012
[6] Infant and Young Child Feeding Practices Collecting and UsingData A Step-by-Step Guide Cooperative for Assistance andRelief Everywhere Inc (CARE) 2010
[7] WHO Infant and Young Child Feeding 2009 httpwhqlibdocwhointpublications20099789241597494 engpdf
[8] UNICEF Programming Guide Infant and Young Child Feed-ing 2011 httpwwwuniceforgnutritionfilesFinal IYCFprogramming guide 2011pdf
[9] WHOUNICEF ldquoAcceptable medical reasons for use of breast-milk substitutesrdquo 2009 httpwhqlibdocwhointhq2009WHO FCH CAH 0901 engpdf
[10] AM SeidM E Yesuf andDNKoye ldquoPrevalence of ExclusiveBreastfeeding Practices and associated factors among mothersin Bahir Dar city Northwest Ethiopia a community basedcross-sectional studyrdquo International Breastfeeding Journal vol8 article 14 2013
[11] Federal Ministry of Health ldquoNational strategy for infant andyoung child feeding-Extranet Systemsrdquo 2004 httpsextranetwhointnutritionginasitesdefaultfilesETH20200420N-ational20Strategy20for20Infant20and20Young20C-hild20Feedingpdf
[12] Health Extension Education Center Health Extension Programin Ethiopia Health Education and Extension Center AddisAbaba Ethiopia 2007
[13] South Gondar Zone Statistics Department Population andHousing Census Preliminary Report Gambia Bureau of Statis-tics 2013
[14] T Setegn T Belachew M Gerbaba K Deribe A Deribew andS Biadgilign ldquoFactors associated with exclusive breastfeedingpractices among mothers in Goba district south east Ethiopiaa cross-sectional studyrdquo International Breastfeeding Journal vol7 article 17 pp 1ndash8 2012
[15] W Seifu G Assefa andG Egata ldquoPrevalence of exclusive breastfeeding and its predictors among infants aged six months inJimma Town Southwest Ethiopia 2013rdquo Journal of Pediatrics ampNeonatal Care vol 1 no 3 pp 4ndash6 2014
[16] J Victoria B Agnes W Joan et al ldquoImproving breastfeedingpractices on a broad scale at the community level success stories
from Africa and Latin Americardquo Journal of Human Lactationvol 21 no 3 pp 345ndash354 2005
[17] M B R do Nascimento M A M Reis S C Franco H IsslerA A Ferraro and S J F E Grisi ldquoExclusive breastfeeding insouthern Brazil prevalence and associated factorsrdquo Breastfeed-ing Medicine vol 5 no 2 pp 79ndash85 2010
[18] A Koosha R Hashemifesharaki and N MousavinasabldquoBreast-feeding patterns and factors determining exclusivebreast-feedingrdquo Singapore Medical Journal vol 49 no 12 pp1002ndash1006 2008
[19] Z Karacam ldquoFactors affecting exclusive breastfeeding ofhealthy babies aged zero to four months a community-basedstudy of Turkish womenrdquo Journal of Clinical Nursing vol 17 no3 pp 341ndash349 2008
[21] B Al-Sahab A Lanes M Feldman andH Tamim ldquoPrevalenceand predictors of 6-month exclusive Breastfeeding amongCanadian women a national surveyrdquo BMC Pediatrics vol 10article 20 2010
[22] G Arage G A Tessema andH Kassa ldquoAdherence to antiretro-viral therapy and its associated factors among children at SouthWollo Zone Hospitals Northeast Ethiopia a cross-sectionalstudyrdquo BMC Public Health vol 14 article 365 2014
justifying that no information was disclosed individually andusing anonymous data The respondents were having theright not to participate in or withdraw from the study at anystage
4 Results
41 Sociodemographic Characteristics of the Participants Atotal of 453 mothers of children were included in the studywith a response rate of 964 The mean age of the motherswas 284 years (SD plusmn 53 years) whereas the median age ofthe infants was 3 months (IQR = 2 months) A majority412 (909) of the mothers were married 448 (988) wereAmhara by ethnicity and 231 (509) were housewives byoccupation Three hundred eighty (838) of mothers hadprimary education Regarding infants 294 (649) werefemale and 180 (398) were between 2 and 3 months of age(Table 1)
42 Obstetric Characteristics of the Participants Most ofthe respondents 446 (985) had ANC follow-up with amean number of ANC visits of 31 (SD plusmn 104) however47 were not counseled on exclusive breastfeeding for sixmonths during their ANC follow-up Concerning the placeof delivery 370 (816) delivered their youngest child athealth institutions Four hundred and fifty-one (996) ofthe mothers delivered vaginally and 324 (875) of themothers who delivered at health institutions were counseledon breastfeeding (Table 2)
43 Breastfeeding Practices Almost all 452 (998) childrenhad ever breastfed at some point in the past Of those whohad ever breastfed 356 (786) of the mothers initiatedbreastfeeding within one hour of birth 441 (973) had fedcolostrum and 116 (256) of mothers gave one or moreprelacteal feeds
The majority 280 (618) of mothers give breast milkfor their infant eight times and above per 24 hrs Despite thefact that on-demand breastfeeding is recommended 443of mothers breastfed their infants only when the infant criesand 428 of mothers apply the on-demand feeding Theprevalence of EBF computed using 24-hour dietary recallmethod showed 321 (708) of the participants practiced EBFappropriate to their age (Table 3)
For mothers who have not ever breastfeed the perceivedreasons were as follows child refused to take BM (289) andbreast problems (245) (Figure 1)
Based on the 24-dietary recall period about 482 ofmothers gave breast milk with someaddition of foods likecowrsquosmilk (170) cereal based fluids (132) tea (29) andformula milk (18) (Figure 2)
44 Factors Associated with Exclusive Breastfeeding PracticeBinary logistic regression analysis showed that infant ageoccupation and educational status of the mother monthlyincome ANC visit during last pregnancy place of deliverymode of delivery colostrums feeding sex of infant and
Table 1 Sociodemographic characteristics of themothers with theirinfants (119899 = 453) amongmotherswho gave birth in the last 6monthsin Debre Tabor town Northwest Ethiopia 2014
Variables Frequency Percentage ()Age of mother (in years)lt20 21 4620ndash29 279 616ge30 153 338
Infants age (in months)le1 105 2322-3 180 3984ndash6 168 370119874119905ℎ119890119903
lowast students farmers and daily laborers
receiving counselingadvice on infant feedingwere associatedwith adherence
In multiple logistic regression age of the infant [AOR =23 (95 CI 112 6)] giving birth in the health facility [AOR= 38 (95 CI 218 732)] being a housewife in occupa-tion [AOR = 24 (95 CI (122 692)] receiving counsel-ingadvice on infant feeding [AOR = 21 (95 CI 161 541)]and colostrums feeding [AOR = 15 (95 CI 128 798)]
4 Advances in Public Health
0302890
5384
101225
245
OthersRefusal to take BM
Maternal illnessChild illness
Breast milk insufficiencyMothers returning to work
Breast problems
Figure 1 Reasons for not to breastfeed infants among mothers in Debre Tabor town Northwest Ethiopia in Debre Tabor town NorthwestEthiopia
130
22
70
18290
132170
Others
Water with sugar
Water
Formula feed
Tea
Cereal fluid
Cowrsquos milk
Figure 2 Mixing of breast milk with some foods among mothers in Debre Tabor town
were found to be significantly associated with EBF practice(Table 4)
5 Discussion
This study assessed the prevalence of exclusive feeding prac-tice and its associated factors among mother-infant pairs atDebre Tabor town Northwest Ethiopia The prevalence ofexclusive breastfeeding was found to be 696 in the 24 hourspreceding the survey
This finding is comparable to similar studies conductedin Goba district (713) [14] Jimma town (672) [15] Mada-gascar (68) [16] and Brazil (725) [17] It was lower thanstudies conducted in Ghana (79) [16] and Iran (82) [18]This might be because of the small sample size in Ghana andIran which increases estimation of exclusive breastfeedingrate Nevertheless it higher than studies conducted in BahirDar City Administration (5036) [4] EDHS (52) [7]Bolivia (65) [16] Turk Islands (506) [19] UK (35)[20] and Canada (138) [21] This might be due to theaccessibility of information in the recent times It might bealso because a higher number of participants are housewivesthus increasing the mother-infant bond which in turn boostsbreastfeeding
In the present study breast related problem was reportedas the major reason (245) for not breastfeeding infants Astudy conducted in GobaWoreda [14] supported this findingThis could be because the mothers may fear child illnesssecondary to breast problems
Similar to other studies [4 14] child refusal to take breastmilk (289) and mothers returning to work (225) leadthem to not giving breast milk
A number of factors were reported as predictors ofexclusive breastfeeding among infants In the present studyif the age of the infant is 4ndash6 months then the child was lesslikely to be exclusively breastfed Studies conducted in BaleGoba [14] Jimma town [15] and Brazil [17] showed similarfindings This is due to the fact that when the age of the babyincreases the mothers may return to work
The findings also showed that those infants who are bornin health institutions were about four times more likely tobe exclusively breastfed than those who are born at homeThis finding is supported by a study conducted at Bahir Dar[10] This may be because mothers get counseling and advicewhen they give birth at the health facility and understand therationale behind exclusive breastfeeding
This study also showed that mothersrsquo occupation orbeing a housewife was associatedwith exclusive breastfeedingwhich is in line with findings from Bahir Dar [10]This could
Advances in Public Health 5
Table 2 Obstetric characteristics of participants (119899 = 453) in DebreTabor town Northwest Ethiopia 2014
Variables Frequency PercentageFollow-up of ANC
Yes 446 985
No 7 15
Frequency of ANC visitsle2 39 86
3-4 366 808
4 and above 48 106
Counsel on EBF during ANC visitYes 240 528
No 213 472
Place of deliveryHealth facility 370 816
Home 83 184BF counseling at health facility duringdelivery
Yes 324 715
No 129 285
Mode of deliveryVaginal 451 996
CS 2 04
happen because the mothers can have frequent contact withtheir babies and give breast milk On the other hand motherswere more likely employed and thus spend less time with thechild to give the breast milk consistently
In the present study those mothers who received infantfeeding counselingadvice practiced exclusive breastfeedingabout two times more than those who did not get counselingabout exclusive breastfeeding This finding is consistent withthat of a study conducted in Bale Goba and Bahir Dar [10 14]
If mothers do not understand benefits of exclusive breast-feeding to infants they might be poorly motivated to giveexclusive breastfeeding
In this study giving the first milkcolostrums was pos-itively associated with exclusive breastfeeding This couldbe explained by the idea that the baby will be healthy andsecretion of breast milk increases
However the present study does have some inherentlimitations Using a 24-hour recall period measures currentstatus and may cause the proportion of exclusively breastfedinfants to be slightly overestimated since some infants whowere given other liquids regularly may not have receivedthem in the 24 hours before the survey Despite the effortsmade during data collection to minimize the recall biasesthis may not be eliminated The cross-sectional nature ofthe study which used a snapshot of prevalence of exclusivebreastfeeding practice at one point in time may hinder thecause and effect relationship [22]
Table 3 Breastfeeding practices of the respondents (119899 = 453) inDebre Tabor town Northwest Ethiopia 2014
Variables Frequency PercentageEver breastfedYes 452 998
No 1 02
Initiation timeWithin 1 hour 356 786
After 1 hour 43 94
Do not remember 54 119
Colostrum discardedYes 12 27
No 441 973
Prelacteal feedingYes 116 256
No 337 744
Exclusive breastfeeding practiceYes 321 708
No 132 292
Breastfeeding frequency per 24 hrsge8 hrs 280 618
lt8 173 382
Time to give BFlowast
On demand 194 428
When the baby cry 201 443
On schedule 41 90
Otherslowastlowast 17 37lowast
119861119865 breastfeeding 119900119905ℎ119890119903119904lowastlowast on convince breast full
6 Conclusion
A small proportion of infants are exclusively breastfed duringthe first 6months despite what is recommended in thenational and global infant and young child feeding guidelinesStrengthening infant feeding advicecounseling during ANCfollow-up and birth promoting institutional delivery andenabling every mother to encourage colostrums feeding wererecommended in order to increase the proportion of womenpracticing EBF
Disclosure
Getachew Arage BSc is MSc lecturer in Debre Tabor Uni-versity College of Health Sciences Department of NursingHaileyesusGedamu BSc isMSc lecturer inDebre TaborUni-versity College of Health Sciences Department of Nursing
Competing Interests
The authors declare that they have no competing interests
6 Advances in Public Health
Table 4 Bivariate and multivariate analysis of factors associated with exclusive breastfeeding practices among mothers who gave birth in thelast 6 months (119899 = 453) in Debre Tabor town 2014 lowast119875 gt 005 lowastlowast119875 ge 005
Variables EBF practice OR (95 CI)Yes No COR (95 CI) AOR (95 CI)
Sex of the infantMale 119 40 1Female 227 67 14 (088 225)lowast
Age of the motherslt30 13 8 120ndash29 233 46 121 (067 216)ge30 123 30 081 (047 163)lowast
Educational status of the mothersCannot read and write 16 27 1Elementary school 299 81 14 (077 252)Secondary education and higher 19 11 0752 (043 129)lowast
GetachewArage andHaileyesus Gedamuwrote the proposalparticipated in data collection analyzed the data and draftedthe paper All authors read and approved the final paperGetachewArage andHaileyesusGedamu contributed equallyto this work
Acknowledgments
The authors are very grateful to the Debre Tabor Universityfor the approval of the ethical clearance and financial supportof this study Then the authors would like to thank allstudy participants who participated in this study for theircommitment in responding to their interviews
Advances in Public Health 7
References
[1] UNICEFWHO ldquoIndicators for assessing infant and youngchild feeding practices part 3 Country profilesrdquo 2010 httpwwwuniceforgnutritionfilesIYCF Indicators part III cou-ntry profilespdf
[2] UNICEF ldquoA conceptual framework and research approachfor identifying analyzing and prioritizing barriers to effectivematernal newborn and child health interventions 2011rdquo httpinnovationsformnchorguploadspublications2011-01 Innov-ations-Conceptual-Framework low respdf
[3] R E Black L H Allen Z A Bhutta et al ldquoMaternal and childundernutrition global and regional exposures and health con-sequencesrdquoThe Lancet vol 371 no 9608 pp 243ndash260 2008
[4] A Sefene D BirihanuWAwoke andT Taye ldquoDeterminants ofexclusive breastfeeding practice amongmothers of children ageless than 6 month in Bahir Dar city administration NorthwestEthiopia a community based cross-sectional surveyrdquo ScienceJournal of Clinical Medicine vol 2 no 6 pp 153ndash159 2013
[5] J-QMa L-L Zhou Y-QHu et al ldquoA summary index of infantand child feeding practices is associated with child growth inurban Shanghairdquo BMC Public Health vol 12 no 1 article 5682012
[6] Infant and Young Child Feeding Practices Collecting and UsingData A Step-by-Step Guide Cooperative for Assistance andRelief Everywhere Inc (CARE) 2010
[7] WHO Infant and Young Child Feeding 2009 httpwhqlibdocwhointpublications20099789241597494 engpdf
[8] UNICEF Programming Guide Infant and Young Child Feed-ing 2011 httpwwwuniceforgnutritionfilesFinal IYCFprogramming guide 2011pdf
[9] WHOUNICEF ldquoAcceptable medical reasons for use of breast-milk substitutesrdquo 2009 httpwhqlibdocwhointhq2009WHO FCH CAH 0901 engpdf
[10] AM SeidM E Yesuf andDNKoye ldquoPrevalence of ExclusiveBreastfeeding Practices and associated factors among mothersin Bahir Dar city Northwest Ethiopia a community basedcross-sectional studyrdquo International Breastfeeding Journal vol8 article 14 2013
[11] Federal Ministry of Health ldquoNational strategy for infant andyoung child feeding-Extranet Systemsrdquo 2004 httpsextranetwhointnutritionginasitesdefaultfilesETH20200420N-ational20Strategy20for20Infant20and20Young20C-hild20Feedingpdf
[12] Health Extension Education Center Health Extension Programin Ethiopia Health Education and Extension Center AddisAbaba Ethiopia 2007
[13] South Gondar Zone Statistics Department Population andHousing Census Preliminary Report Gambia Bureau of Statis-tics 2013
[14] T Setegn T Belachew M Gerbaba K Deribe A Deribew andS Biadgilign ldquoFactors associated with exclusive breastfeedingpractices among mothers in Goba district south east Ethiopiaa cross-sectional studyrdquo International Breastfeeding Journal vol7 article 17 pp 1ndash8 2012
[15] W Seifu G Assefa andG Egata ldquoPrevalence of exclusive breastfeeding and its predictors among infants aged six months inJimma Town Southwest Ethiopia 2013rdquo Journal of Pediatrics ampNeonatal Care vol 1 no 3 pp 4ndash6 2014
[16] J Victoria B Agnes W Joan et al ldquoImproving breastfeedingpractices on a broad scale at the community level success stories
from Africa and Latin Americardquo Journal of Human Lactationvol 21 no 3 pp 345ndash354 2005
[17] M B R do Nascimento M A M Reis S C Franco H IsslerA A Ferraro and S J F E Grisi ldquoExclusive breastfeeding insouthern Brazil prevalence and associated factorsrdquo Breastfeed-ing Medicine vol 5 no 2 pp 79ndash85 2010
[18] A Koosha R Hashemifesharaki and N MousavinasabldquoBreast-feeding patterns and factors determining exclusivebreast-feedingrdquo Singapore Medical Journal vol 49 no 12 pp1002ndash1006 2008
[19] Z Karacam ldquoFactors affecting exclusive breastfeeding ofhealthy babies aged zero to four months a community-basedstudy of Turkish womenrdquo Journal of Clinical Nursing vol 17 no3 pp 341ndash349 2008
[21] B Al-Sahab A Lanes M Feldman andH Tamim ldquoPrevalenceand predictors of 6-month exclusive Breastfeeding amongCanadian women a national surveyrdquo BMC Pediatrics vol 10article 20 2010
[22] G Arage G A Tessema andH Kassa ldquoAdherence to antiretro-viral therapy and its associated factors among children at SouthWollo Zone Hospitals Northeast Ethiopia a cross-sectionalstudyrdquo BMC Public Health vol 14 article 365 2014
Breast milk insufficiencyMothers returning to work
Breast problems
Figure 1 Reasons for not to breastfeed infants among mothers in Debre Tabor town Northwest Ethiopia in Debre Tabor town NorthwestEthiopia
130
22
70
18290
132170
Others
Water with sugar
Water
Formula feed
Tea
Cereal fluid
Cowrsquos milk
Figure 2 Mixing of breast milk with some foods among mothers in Debre Tabor town
were found to be significantly associated with EBF practice(Table 4)
5 Discussion
This study assessed the prevalence of exclusive feeding prac-tice and its associated factors among mother-infant pairs atDebre Tabor town Northwest Ethiopia The prevalence ofexclusive breastfeeding was found to be 696 in the 24 hourspreceding the survey
This finding is comparable to similar studies conductedin Goba district (713) [14] Jimma town (672) [15] Mada-gascar (68) [16] and Brazil (725) [17] It was lower thanstudies conducted in Ghana (79) [16] and Iran (82) [18]This might be because of the small sample size in Ghana andIran which increases estimation of exclusive breastfeedingrate Nevertheless it higher than studies conducted in BahirDar City Administration (5036) [4] EDHS (52) [7]Bolivia (65) [16] Turk Islands (506) [19] UK (35)[20] and Canada (138) [21] This might be due to theaccessibility of information in the recent times It might bealso because a higher number of participants are housewivesthus increasing the mother-infant bond which in turn boostsbreastfeeding
In the present study breast related problem was reportedas the major reason (245) for not breastfeeding infants Astudy conducted in GobaWoreda [14] supported this findingThis could be because the mothers may fear child illnesssecondary to breast problems
Similar to other studies [4 14] child refusal to take breastmilk (289) and mothers returning to work (225) leadthem to not giving breast milk
A number of factors were reported as predictors ofexclusive breastfeeding among infants In the present studyif the age of the infant is 4ndash6 months then the child was lesslikely to be exclusively breastfed Studies conducted in BaleGoba [14] Jimma town [15] and Brazil [17] showed similarfindings This is due to the fact that when the age of the babyincreases the mothers may return to work
The findings also showed that those infants who are bornin health institutions were about four times more likely tobe exclusively breastfed than those who are born at homeThis finding is supported by a study conducted at Bahir Dar[10] This may be because mothers get counseling and advicewhen they give birth at the health facility and understand therationale behind exclusive breastfeeding
This study also showed that mothersrsquo occupation orbeing a housewife was associatedwith exclusive breastfeedingwhich is in line with findings from Bahir Dar [10]This could
Advances in Public Health 5
Table 2 Obstetric characteristics of participants (119899 = 453) in DebreTabor town Northwest Ethiopia 2014
Variables Frequency PercentageFollow-up of ANC
Yes 446 985
No 7 15
Frequency of ANC visitsle2 39 86
3-4 366 808
4 and above 48 106
Counsel on EBF during ANC visitYes 240 528
No 213 472
Place of deliveryHealth facility 370 816
Home 83 184BF counseling at health facility duringdelivery
Yes 324 715
No 129 285
Mode of deliveryVaginal 451 996
CS 2 04
happen because the mothers can have frequent contact withtheir babies and give breast milk On the other hand motherswere more likely employed and thus spend less time with thechild to give the breast milk consistently
In the present study those mothers who received infantfeeding counselingadvice practiced exclusive breastfeedingabout two times more than those who did not get counselingabout exclusive breastfeeding This finding is consistent withthat of a study conducted in Bale Goba and Bahir Dar [10 14]
If mothers do not understand benefits of exclusive breast-feeding to infants they might be poorly motivated to giveexclusive breastfeeding
In this study giving the first milkcolostrums was pos-itively associated with exclusive breastfeeding This couldbe explained by the idea that the baby will be healthy andsecretion of breast milk increases
However the present study does have some inherentlimitations Using a 24-hour recall period measures currentstatus and may cause the proportion of exclusively breastfedinfants to be slightly overestimated since some infants whowere given other liquids regularly may not have receivedthem in the 24 hours before the survey Despite the effortsmade during data collection to minimize the recall biasesthis may not be eliminated The cross-sectional nature ofthe study which used a snapshot of prevalence of exclusivebreastfeeding practice at one point in time may hinder thecause and effect relationship [22]
Table 3 Breastfeeding practices of the respondents (119899 = 453) inDebre Tabor town Northwest Ethiopia 2014
Variables Frequency PercentageEver breastfedYes 452 998
No 1 02
Initiation timeWithin 1 hour 356 786
After 1 hour 43 94
Do not remember 54 119
Colostrum discardedYes 12 27
No 441 973
Prelacteal feedingYes 116 256
No 337 744
Exclusive breastfeeding practiceYes 321 708
No 132 292
Breastfeeding frequency per 24 hrsge8 hrs 280 618
lt8 173 382
Time to give BFlowast
On demand 194 428
When the baby cry 201 443
On schedule 41 90
Otherslowastlowast 17 37lowast
119861119865 breastfeeding 119900119905ℎ119890119903119904lowastlowast on convince breast full
6 Conclusion
A small proportion of infants are exclusively breastfed duringthe first 6months despite what is recommended in thenational and global infant and young child feeding guidelinesStrengthening infant feeding advicecounseling during ANCfollow-up and birth promoting institutional delivery andenabling every mother to encourage colostrums feeding wererecommended in order to increase the proportion of womenpracticing EBF
Disclosure
Getachew Arage BSc is MSc lecturer in Debre Tabor Uni-versity College of Health Sciences Department of NursingHaileyesusGedamu BSc isMSc lecturer inDebre TaborUni-versity College of Health Sciences Department of Nursing
Competing Interests
The authors declare that they have no competing interests
6 Advances in Public Health
Table 4 Bivariate and multivariate analysis of factors associated with exclusive breastfeeding practices among mothers who gave birth in thelast 6 months (119899 = 453) in Debre Tabor town 2014 lowast119875 gt 005 lowastlowast119875 ge 005
Variables EBF practice OR (95 CI)Yes No COR (95 CI) AOR (95 CI)
Sex of the infantMale 119 40 1Female 227 67 14 (088 225)lowast
Age of the motherslt30 13 8 120ndash29 233 46 121 (067 216)ge30 123 30 081 (047 163)lowast
Educational status of the mothersCannot read and write 16 27 1Elementary school 299 81 14 (077 252)Secondary education and higher 19 11 0752 (043 129)lowast
GetachewArage andHaileyesus Gedamuwrote the proposalparticipated in data collection analyzed the data and draftedthe paper All authors read and approved the final paperGetachewArage andHaileyesusGedamu contributed equallyto this work
Acknowledgments
The authors are very grateful to the Debre Tabor Universityfor the approval of the ethical clearance and financial supportof this study Then the authors would like to thank allstudy participants who participated in this study for theircommitment in responding to their interviews
Advances in Public Health 7
References
[1] UNICEFWHO ldquoIndicators for assessing infant and youngchild feeding practices part 3 Country profilesrdquo 2010 httpwwwuniceforgnutritionfilesIYCF Indicators part III cou-ntry profilespdf
[2] UNICEF ldquoA conceptual framework and research approachfor identifying analyzing and prioritizing barriers to effectivematernal newborn and child health interventions 2011rdquo httpinnovationsformnchorguploadspublications2011-01 Innov-ations-Conceptual-Framework low respdf
[3] R E Black L H Allen Z A Bhutta et al ldquoMaternal and childundernutrition global and regional exposures and health con-sequencesrdquoThe Lancet vol 371 no 9608 pp 243ndash260 2008
[4] A Sefene D BirihanuWAwoke andT Taye ldquoDeterminants ofexclusive breastfeeding practice amongmothers of children ageless than 6 month in Bahir Dar city administration NorthwestEthiopia a community based cross-sectional surveyrdquo ScienceJournal of Clinical Medicine vol 2 no 6 pp 153ndash159 2013
[5] J-QMa L-L Zhou Y-QHu et al ldquoA summary index of infantand child feeding practices is associated with child growth inurban Shanghairdquo BMC Public Health vol 12 no 1 article 5682012
[6] Infant and Young Child Feeding Practices Collecting and UsingData A Step-by-Step Guide Cooperative for Assistance andRelief Everywhere Inc (CARE) 2010
[7] WHO Infant and Young Child Feeding 2009 httpwhqlibdocwhointpublications20099789241597494 engpdf
[8] UNICEF Programming Guide Infant and Young Child Feed-ing 2011 httpwwwuniceforgnutritionfilesFinal IYCFprogramming guide 2011pdf
[9] WHOUNICEF ldquoAcceptable medical reasons for use of breast-milk substitutesrdquo 2009 httpwhqlibdocwhointhq2009WHO FCH CAH 0901 engpdf
[10] AM SeidM E Yesuf andDNKoye ldquoPrevalence of ExclusiveBreastfeeding Practices and associated factors among mothersin Bahir Dar city Northwest Ethiopia a community basedcross-sectional studyrdquo International Breastfeeding Journal vol8 article 14 2013
[11] Federal Ministry of Health ldquoNational strategy for infant andyoung child feeding-Extranet Systemsrdquo 2004 httpsextranetwhointnutritionginasitesdefaultfilesETH20200420N-ational20Strategy20for20Infant20and20Young20C-hild20Feedingpdf
[12] Health Extension Education Center Health Extension Programin Ethiopia Health Education and Extension Center AddisAbaba Ethiopia 2007
[13] South Gondar Zone Statistics Department Population andHousing Census Preliminary Report Gambia Bureau of Statis-tics 2013
[14] T Setegn T Belachew M Gerbaba K Deribe A Deribew andS Biadgilign ldquoFactors associated with exclusive breastfeedingpractices among mothers in Goba district south east Ethiopiaa cross-sectional studyrdquo International Breastfeeding Journal vol7 article 17 pp 1ndash8 2012
[15] W Seifu G Assefa andG Egata ldquoPrevalence of exclusive breastfeeding and its predictors among infants aged six months inJimma Town Southwest Ethiopia 2013rdquo Journal of Pediatrics ampNeonatal Care vol 1 no 3 pp 4ndash6 2014
[16] J Victoria B Agnes W Joan et al ldquoImproving breastfeedingpractices on a broad scale at the community level success stories
from Africa and Latin Americardquo Journal of Human Lactationvol 21 no 3 pp 345ndash354 2005
[17] M B R do Nascimento M A M Reis S C Franco H IsslerA A Ferraro and S J F E Grisi ldquoExclusive breastfeeding insouthern Brazil prevalence and associated factorsrdquo Breastfeed-ing Medicine vol 5 no 2 pp 79ndash85 2010
[18] A Koosha R Hashemifesharaki and N MousavinasabldquoBreast-feeding patterns and factors determining exclusivebreast-feedingrdquo Singapore Medical Journal vol 49 no 12 pp1002ndash1006 2008
[19] Z Karacam ldquoFactors affecting exclusive breastfeeding ofhealthy babies aged zero to four months a community-basedstudy of Turkish womenrdquo Journal of Clinical Nursing vol 17 no3 pp 341ndash349 2008
[21] B Al-Sahab A Lanes M Feldman andH Tamim ldquoPrevalenceand predictors of 6-month exclusive Breastfeeding amongCanadian women a national surveyrdquo BMC Pediatrics vol 10article 20 2010
[22] G Arage G A Tessema andH Kassa ldquoAdherence to antiretro-viral therapy and its associated factors among children at SouthWollo Zone Hospitals Northeast Ethiopia a cross-sectionalstudyrdquo BMC Public Health vol 14 article 365 2014
Table 2 Obstetric characteristics of participants (119899 = 453) in DebreTabor town Northwest Ethiopia 2014
Variables Frequency PercentageFollow-up of ANC
Yes 446 985
No 7 15
Frequency of ANC visitsle2 39 86
3-4 366 808
4 and above 48 106
Counsel on EBF during ANC visitYes 240 528
No 213 472
Place of deliveryHealth facility 370 816
Home 83 184BF counseling at health facility duringdelivery
Yes 324 715
No 129 285
Mode of deliveryVaginal 451 996
CS 2 04
happen because the mothers can have frequent contact withtheir babies and give breast milk On the other hand motherswere more likely employed and thus spend less time with thechild to give the breast milk consistently
In the present study those mothers who received infantfeeding counselingadvice practiced exclusive breastfeedingabout two times more than those who did not get counselingabout exclusive breastfeeding This finding is consistent withthat of a study conducted in Bale Goba and Bahir Dar [10 14]
If mothers do not understand benefits of exclusive breast-feeding to infants they might be poorly motivated to giveexclusive breastfeeding
In this study giving the first milkcolostrums was pos-itively associated with exclusive breastfeeding This couldbe explained by the idea that the baby will be healthy andsecretion of breast milk increases
However the present study does have some inherentlimitations Using a 24-hour recall period measures currentstatus and may cause the proportion of exclusively breastfedinfants to be slightly overestimated since some infants whowere given other liquids regularly may not have receivedthem in the 24 hours before the survey Despite the effortsmade during data collection to minimize the recall biasesthis may not be eliminated The cross-sectional nature ofthe study which used a snapshot of prevalence of exclusivebreastfeeding practice at one point in time may hinder thecause and effect relationship [22]
Table 3 Breastfeeding practices of the respondents (119899 = 453) inDebre Tabor town Northwest Ethiopia 2014
Variables Frequency PercentageEver breastfedYes 452 998
No 1 02
Initiation timeWithin 1 hour 356 786
After 1 hour 43 94
Do not remember 54 119
Colostrum discardedYes 12 27
No 441 973
Prelacteal feedingYes 116 256
No 337 744
Exclusive breastfeeding practiceYes 321 708
No 132 292
Breastfeeding frequency per 24 hrsge8 hrs 280 618
lt8 173 382
Time to give BFlowast
On demand 194 428
When the baby cry 201 443
On schedule 41 90
Otherslowastlowast 17 37lowast
119861119865 breastfeeding 119900119905ℎ119890119903119904lowastlowast on convince breast full
6 Conclusion
A small proportion of infants are exclusively breastfed duringthe first 6months despite what is recommended in thenational and global infant and young child feeding guidelinesStrengthening infant feeding advicecounseling during ANCfollow-up and birth promoting institutional delivery andenabling every mother to encourage colostrums feeding wererecommended in order to increase the proportion of womenpracticing EBF
Disclosure
Getachew Arage BSc is MSc lecturer in Debre Tabor Uni-versity College of Health Sciences Department of NursingHaileyesusGedamu BSc isMSc lecturer inDebre TaborUni-versity College of Health Sciences Department of Nursing
Competing Interests
The authors declare that they have no competing interests
6 Advances in Public Health
Table 4 Bivariate and multivariate analysis of factors associated with exclusive breastfeeding practices among mothers who gave birth in thelast 6 months (119899 = 453) in Debre Tabor town 2014 lowast119875 gt 005 lowastlowast119875 ge 005
Variables EBF practice OR (95 CI)Yes No COR (95 CI) AOR (95 CI)
Sex of the infantMale 119 40 1Female 227 67 14 (088 225)lowast
Age of the motherslt30 13 8 120ndash29 233 46 121 (067 216)ge30 123 30 081 (047 163)lowast
Educational status of the mothersCannot read and write 16 27 1Elementary school 299 81 14 (077 252)Secondary education and higher 19 11 0752 (043 129)lowast
GetachewArage andHaileyesus Gedamuwrote the proposalparticipated in data collection analyzed the data and draftedthe paper All authors read and approved the final paperGetachewArage andHaileyesusGedamu contributed equallyto this work
Acknowledgments
The authors are very grateful to the Debre Tabor Universityfor the approval of the ethical clearance and financial supportof this study Then the authors would like to thank allstudy participants who participated in this study for theircommitment in responding to their interviews
Advances in Public Health 7
References
[1] UNICEFWHO ldquoIndicators for assessing infant and youngchild feeding practices part 3 Country profilesrdquo 2010 httpwwwuniceforgnutritionfilesIYCF Indicators part III cou-ntry profilespdf
[2] UNICEF ldquoA conceptual framework and research approachfor identifying analyzing and prioritizing barriers to effectivematernal newborn and child health interventions 2011rdquo httpinnovationsformnchorguploadspublications2011-01 Innov-ations-Conceptual-Framework low respdf
[3] R E Black L H Allen Z A Bhutta et al ldquoMaternal and childundernutrition global and regional exposures and health con-sequencesrdquoThe Lancet vol 371 no 9608 pp 243ndash260 2008
[4] A Sefene D BirihanuWAwoke andT Taye ldquoDeterminants ofexclusive breastfeeding practice amongmothers of children ageless than 6 month in Bahir Dar city administration NorthwestEthiopia a community based cross-sectional surveyrdquo ScienceJournal of Clinical Medicine vol 2 no 6 pp 153ndash159 2013
[5] J-QMa L-L Zhou Y-QHu et al ldquoA summary index of infantand child feeding practices is associated with child growth inurban Shanghairdquo BMC Public Health vol 12 no 1 article 5682012
[6] Infant and Young Child Feeding Practices Collecting and UsingData A Step-by-Step Guide Cooperative for Assistance andRelief Everywhere Inc (CARE) 2010
[7] WHO Infant and Young Child Feeding 2009 httpwhqlibdocwhointpublications20099789241597494 engpdf
[8] UNICEF Programming Guide Infant and Young Child Feed-ing 2011 httpwwwuniceforgnutritionfilesFinal IYCFprogramming guide 2011pdf
[9] WHOUNICEF ldquoAcceptable medical reasons for use of breast-milk substitutesrdquo 2009 httpwhqlibdocwhointhq2009WHO FCH CAH 0901 engpdf
[10] AM SeidM E Yesuf andDNKoye ldquoPrevalence of ExclusiveBreastfeeding Practices and associated factors among mothersin Bahir Dar city Northwest Ethiopia a community basedcross-sectional studyrdquo International Breastfeeding Journal vol8 article 14 2013
[11] Federal Ministry of Health ldquoNational strategy for infant andyoung child feeding-Extranet Systemsrdquo 2004 httpsextranetwhointnutritionginasitesdefaultfilesETH20200420N-ational20Strategy20for20Infant20and20Young20C-hild20Feedingpdf
[12] Health Extension Education Center Health Extension Programin Ethiopia Health Education and Extension Center AddisAbaba Ethiopia 2007
[13] South Gondar Zone Statistics Department Population andHousing Census Preliminary Report Gambia Bureau of Statis-tics 2013
[14] T Setegn T Belachew M Gerbaba K Deribe A Deribew andS Biadgilign ldquoFactors associated with exclusive breastfeedingpractices among mothers in Goba district south east Ethiopiaa cross-sectional studyrdquo International Breastfeeding Journal vol7 article 17 pp 1ndash8 2012
[15] W Seifu G Assefa andG Egata ldquoPrevalence of exclusive breastfeeding and its predictors among infants aged six months inJimma Town Southwest Ethiopia 2013rdquo Journal of Pediatrics ampNeonatal Care vol 1 no 3 pp 4ndash6 2014
[16] J Victoria B Agnes W Joan et al ldquoImproving breastfeedingpractices on a broad scale at the community level success stories
from Africa and Latin Americardquo Journal of Human Lactationvol 21 no 3 pp 345ndash354 2005
[17] M B R do Nascimento M A M Reis S C Franco H IsslerA A Ferraro and S J F E Grisi ldquoExclusive breastfeeding insouthern Brazil prevalence and associated factorsrdquo Breastfeed-ing Medicine vol 5 no 2 pp 79ndash85 2010
[18] A Koosha R Hashemifesharaki and N MousavinasabldquoBreast-feeding patterns and factors determining exclusivebreast-feedingrdquo Singapore Medical Journal vol 49 no 12 pp1002ndash1006 2008
[19] Z Karacam ldquoFactors affecting exclusive breastfeeding ofhealthy babies aged zero to four months a community-basedstudy of Turkish womenrdquo Journal of Clinical Nursing vol 17 no3 pp 341ndash349 2008
[21] B Al-Sahab A Lanes M Feldman andH Tamim ldquoPrevalenceand predictors of 6-month exclusive Breastfeeding amongCanadian women a national surveyrdquo BMC Pediatrics vol 10article 20 2010
[22] G Arage G A Tessema andH Kassa ldquoAdherence to antiretro-viral therapy and its associated factors among children at SouthWollo Zone Hospitals Northeast Ethiopia a cross-sectionalstudyrdquo BMC Public Health vol 14 article 365 2014
Table 4 Bivariate and multivariate analysis of factors associated with exclusive breastfeeding practices among mothers who gave birth in thelast 6 months (119899 = 453) in Debre Tabor town 2014 lowast119875 gt 005 lowastlowast119875 ge 005
Variables EBF practice OR (95 CI)Yes No COR (95 CI) AOR (95 CI)
Sex of the infantMale 119 40 1Female 227 67 14 (088 225)lowast
Age of the motherslt30 13 8 120ndash29 233 46 121 (067 216)ge30 123 30 081 (047 163)lowast
Educational status of the mothersCannot read and write 16 27 1Elementary school 299 81 14 (077 252)Secondary education and higher 19 11 0752 (043 129)lowast
GetachewArage andHaileyesus Gedamuwrote the proposalparticipated in data collection analyzed the data and draftedthe paper All authors read and approved the final paperGetachewArage andHaileyesusGedamu contributed equallyto this work
Acknowledgments
The authors are very grateful to the Debre Tabor Universityfor the approval of the ethical clearance and financial supportof this study Then the authors would like to thank allstudy participants who participated in this study for theircommitment in responding to their interviews
Advances in Public Health 7
References
[1] UNICEFWHO ldquoIndicators for assessing infant and youngchild feeding practices part 3 Country profilesrdquo 2010 httpwwwuniceforgnutritionfilesIYCF Indicators part III cou-ntry profilespdf
[2] UNICEF ldquoA conceptual framework and research approachfor identifying analyzing and prioritizing barriers to effectivematernal newborn and child health interventions 2011rdquo httpinnovationsformnchorguploadspublications2011-01 Innov-ations-Conceptual-Framework low respdf
[3] R E Black L H Allen Z A Bhutta et al ldquoMaternal and childundernutrition global and regional exposures and health con-sequencesrdquoThe Lancet vol 371 no 9608 pp 243ndash260 2008
[4] A Sefene D BirihanuWAwoke andT Taye ldquoDeterminants ofexclusive breastfeeding practice amongmothers of children ageless than 6 month in Bahir Dar city administration NorthwestEthiopia a community based cross-sectional surveyrdquo ScienceJournal of Clinical Medicine vol 2 no 6 pp 153ndash159 2013
[5] J-QMa L-L Zhou Y-QHu et al ldquoA summary index of infantand child feeding practices is associated with child growth inurban Shanghairdquo BMC Public Health vol 12 no 1 article 5682012
[6] Infant and Young Child Feeding Practices Collecting and UsingData A Step-by-Step Guide Cooperative for Assistance andRelief Everywhere Inc (CARE) 2010
[7] WHO Infant and Young Child Feeding 2009 httpwhqlibdocwhointpublications20099789241597494 engpdf
[8] UNICEF Programming Guide Infant and Young Child Feed-ing 2011 httpwwwuniceforgnutritionfilesFinal IYCFprogramming guide 2011pdf
[9] WHOUNICEF ldquoAcceptable medical reasons for use of breast-milk substitutesrdquo 2009 httpwhqlibdocwhointhq2009WHO FCH CAH 0901 engpdf
[10] AM SeidM E Yesuf andDNKoye ldquoPrevalence of ExclusiveBreastfeeding Practices and associated factors among mothersin Bahir Dar city Northwest Ethiopia a community basedcross-sectional studyrdquo International Breastfeeding Journal vol8 article 14 2013
[11] Federal Ministry of Health ldquoNational strategy for infant andyoung child feeding-Extranet Systemsrdquo 2004 httpsextranetwhointnutritionginasitesdefaultfilesETH20200420N-ational20Strategy20for20Infant20and20Young20C-hild20Feedingpdf
[12] Health Extension Education Center Health Extension Programin Ethiopia Health Education and Extension Center AddisAbaba Ethiopia 2007
[13] South Gondar Zone Statistics Department Population andHousing Census Preliminary Report Gambia Bureau of Statis-tics 2013
[14] T Setegn T Belachew M Gerbaba K Deribe A Deribew andS Biadgilign ldquoFactors associated with exclusive breastfeedingpractices among mothers in Goba district south east Ethiopiaa cross-sectional studyrdquo International Breastfeeding Journal vol7 article 17 pp 1ndash8 2012
[15] W Seifu G Assefa andG Egata ldquoPrevalence of exclusive breastfeeding and its predictors among infants aged six months inJimma Town Southwest Ethiopia 2013rdquo Journal of Pediatrics ampNeonatal Care vol 1 no 3 pp 4ndash6 2014
[16] J Victoria B Agnes W Joan et al ldquoImproving breastfeedingpractices on a broad scale at the community level success stories
from Africa and Latin Americardquo Journal of Human Lactationvol 21 no 3 pp 345ndash354 2005
[17] M B R do Nascimento M A M Reis S C Franco H IsslerA A Ferraro and S J F E Grisi ldquoExclusive breastfeeding insouthern Brazil prevalence and associated factorsrdquo Breastfeed-ing Medicine vol 5 no 2 pp 79ndash85 2010
[18] A Koosha R Hashemifesharaki and N MousavinasabldquoBreast-feeding patterns and factors determining exclusivebreast-feedingrdquo Singapore Medical Journal vol 49 no 12 pp1002ndash1006 2008
[19] Z Karacam ldquoFactors affecting exclusive breastfeeding ofhealthy babies aged zero to four months a community-basedstudy of Turkish womenrdquo Journal of Clinical Nursing vol 17 no3 pp 341ndash349 2008
[21] B Al-Sahab A Lanes M Feldman andH Tamim ldquoPrevalenceand predictors of 6-month exclusive Breastfeeding amongCanadian women a national surveyrdquo BMC Pediatrics vol 10article 20 2010
[22] G Arage G A Tessema andH Kassa ldquoAdherence to antiretro-viral therapy and its associated factors among children at SouthWollo Zone Hospitals Northeast Ethiopia a cross-sectionalstudyrdquo BMC Public Health vol 14 article 365 2014
[1] UNICEFWHO ldquoIndicators for assessing infant and youngchild feeding practices part 3 Country profilesrdquo 2010 httpwwwuniceforgnutritionfilesIYCF Indicators part III cou-ntry profilespdf
[2] UNICEF ldquoA conceptual framework and research approachfor identifying analyzing and prioritizing barriers to effectivematernal newborn and child health interventions 2011rdquo httpinnovationsformnchorguploadspublications2011-01 Innov-ations-Conceptual-Framework low respdf
[3] R E Black L H Allen Z A Bhutta et al ldquoMaternal and childundernutrition global and regional exposures and health con-sequencesrdquoThe Lancet vol 371 no 9608 pp 243ndash260 2008
[4] A Sefene D BirihanuWAwoke andT Taye ldquoDeterminants ofexclusive breastfeeding practice amongmothers of children ageless than 6 month in Bahir Dar city administration NorthwestEthiopia a community based cross-sectional surveyrdquo ScienceJournal of Clinical Medicine vol 2 no 6 pp 153ndash159 2013
[5] J-QMa L-L Zhou Y-QHu et al ldquoA summary index of infantand child feeding practices is associated with child growth inurban Shanghairdquo BMC Public Health vol 12 no 1 article 5682012
[6] Infant and Young Child Feeding Practices Collecting and UsingData A Step-by-Step Guide Cooperative for Assistance andRelief Everywhere Inc (CARE) 2010
[7] WHO Infant and Young Child Feeding 2009 httpwhqlibdocwhointpublications20099789241597494 engpdf
[8] UNICEF Programming Guide Infant and Young Child Feed-ing 2011 httpwwwuniceforgnutritionfilesFinal IYCFprogramming guide 2011pdf
[9] WHOUNICEF ldquoAcceptable medical reasons for use of breast-milk substitutesrdquo 2009 httpwhqlibdocwhointhq2009WHO FCH CAH 0901 engpdf
[10] AM SeidM E Yesuf andDNKoye ldquoPrevalence of ExclusiveBreastfeeding Practices and associated factors among mothersin Bahir Dar city Northwest Ethiopia a community basedcross-sectional studyrdquo International Breastfeeding Journal vol8 article 14 2013
[11] Federal Ministry of Health ldquoNational strategy for infant andyoung child feeding-Extranet Systemsrdquo 2004 httpsextranetwhointnutritionginasitesdefaultfilesETH20200420N-ational20Strategy20for20Infant20and20Young20C-hild20Feedingpdf
[12] Health Extension Education Center Health Extension Programin Ethiopia Health Education and Extension Center AddisAbaba Ethiopia 2007
[13] South Gondar Zone Statistics Department Population andHousing Census Preliminary Report Gambia Bureau of Statis-tics 2013
[14] T Setegn T Belachew M Gerbaba K Deribe A Deribew andS Biadgilign ldquoFactors associated with exclusive breastfeedingpractices among mothers in Goba district south east Ethiopiaa cross-sectional studyrdquo International Breastfeeding Journal vol7 article 17 pp 1ndash8 2012
[15] W Seifu G Assefa andG Egata ldquoPrevalence of exclusive breastfeeding and its predictors among infants aged six months inJimma Town Southwest Ethiopia 2013rdquo Journal of Pediatrics ampNeonatal Care vol 1 no 3 pp 4ndash6 2014
[16] J Victoria B Agnes W Joan et al ldquoImproving breastfeedingpractices on a broad scale at the community level success stories
from Africa and Latin Americardquo Journal of Human Lactationvol 21 no 3 pp 345ndash354 2005
[17] M B R do Nascimento M A M Reis S C Franco H IsslerA A Ferraro and S J F E Grisi ldquoExclusive breastfeeding insouthern Brazil prevalence and associated factorsrdquo Breastfeed-ing Medicine vol 5 no 2 pp 79ndash85 2010
[18] A Koosha R Hashemifesharaki and N MousavinasabldquoBreast-feeding patterns and factors determining exclusivebreast-feedingrdquo Singapore Medical Journal vol 49 no 12 pp1002ndash1006 2008
[19] Z Karacam ldquoFactors affecting exclusive breastfeeding ofhealthy babies aged zero to four months a community-basedstudy of Turkish womenrdquo Journal of Clinical Nursing vol 17 no3 pp 341ndash349 2008
[21] B Al-Sahab A Lanes M Feldman andH Tamim ldquoPrevalenceand predictors of 6-month exclusive Breastfeeding amongCanadian women a national surveyrdquo BMC Pediatrics vol 10article 20 2010
[22] G Arage G A Tessema andH Kassa ldquoAdherence to antiretro-viral therapy and its associated factors among children at SouthWollo Zone Hospitals Northeast Ethiopia a cross-sectionalstudyrdquo BMC Public Health vol 14 article 365 2014
