Knowledge, Attitude and Practice of Exclusive Breast Feeding Among Lactating Mothers in Bedelle Town, Southwestern Ethiopia: Descriptive Cross Sectional Study

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Knowledge, Attitude and Practice of Exclusive Breast Feeding Among Lactating Mothers in Bedelle Town,
Southwestern Ethiopia: Descriptive Cross Sectional Study
Tsedeke Wolde1*, Gadisa Diriba2, Ababa Wakjira2, Genet Misganu2, Girma Negesse2
,
Habtamu Debela2, Tadesse
Birhanu3 and Eyasu Ejeta4
1Department of Public Health, College of Medical and Health Sciences, Wollega University, P.O. Box 395,
Nekemte, Ethiopia
2Department of Nursing, College of Medical and Health Sciences, Wollega University, P.O. Box 395, Nekemte,
Ethiopia
3School of Veterinary Medicine, Collage of Medical and Health Science, Wollega University, P.O. Box 395,
Nekemte, Ethiopia
4Medical Laboratory Sciences, College of Medical and Health Sciences, Wollega University, P.O. Box 395,
Nekemte, Ethiopia
*Corresponding author: tsedekewolde@yahoo.com
Abstract: Breast feeding contributes to reduced infant morbidity and mortality due to diarrhea, respiratory or ear
infections and other infectious diseases even though it remains a challenging due to lack of knowledge mothers.
There is only limited information on exclusive breastfeeding practices in urban settings of Ethiopia especially in
Bedelle town, Illubabor Zone, Southwestern Ethiopia. Thus, this study was aimed to assess knowledge, attitude and
practice related with exclusive breastfeeding among lactating mothers in study area. A community based descriptive
cross-sectional study was conducted among 220 lactating mothers who had a child aged less than 24 months from
April to May, 2013 using a structured interviewer questionnaire. Systematic random sampling was used selected the
study participants and descriptive statistics was carried out using SPSS for windows version 20.0. The majority of
mothers, 91.8% knew the importance of exclusive breastfeeding and 87.3% mothers were had good attitude and
strongly agree that the exclusive breastfeeding is advantageous for infants aged less than six months. Only 43.6% of
mothers practiced exclusive breastfeeding for the first six months after delivery. This study indicated better
understanding and perception of the importance of exclusive breastfeeding and poor practice to exclusive
breastfeeding for the first six months postpartum among urban mothers. Thus, health care providers and decision
makers should be comprehensively addressed on adverse work related issues to improve exclusively breast feeding
practices in the study community.
[Tsedeke Wolde, Gadisa Diriba, Ababa Wakjira, Genet Misganu, Girma Negesse, Habtamu Debela, Tadesse
Birhanu and Eyasu Ejeta. Knowledge, Attitude and Practice of Exclusive Breast Feeding Among Lactating
Mothers in Bedelle Town, Southwestern Ethiopia: Descriptive Cross Sectional Study. Researcher
2014;6(11):91-97]. (ISSN: 1553-9865). http://www.sciencepub.net/researcher. 14
Keywords: Attitude, Exclusive Breast Feeding, Lactating Mother, Knowledge, Practice
1. Introduction
Over the last decade, over whelming scientific
evidence supporting the integral role of breast feeding
in the survival, growth and development of a child, as
well as in the health and wellbeing of mothers, has
come to light. According to world health organization
(WHO), breast milk has the complete nutritional
requirements that a baby needs for health
development. Furthermore, it is safe and contains anti
bodies that help protect infants and boost immunity.
Consequently, breast feeding contributes to reduced
infant morbidity and mortality due to diarrhea,
respiratory or ear infections and other infectious
diseases. For the mother, breast feeding is economical;
breast milk is always available, clean and at the right
temperature. Breast feeding also delays the return of
fertility and reduces the risk of developing breast and
ovarian cancers [1].
The WHO recommends that for the first six
months of life, infants should be exclusively breast
feed to achieve optimal growth, development and
health. Thereafter, infants should receive nutritionally
adequate and safe complementary foods, while
continuing to breast for up to two years or more [2].
Globally, less than 40% of infants under six
months of age are exclusively breast feed, despite the
documented benefits of breast feeding [3]. In addition,
only 38% of infants aged less than six months in the
developing world, Africa included, are exclusively
breast fed [4]. Breast feeding is known to promote
optimal nutrition for infants during early post natal
life. Although the promotion of breast feeding is
integral part of the special supplemental nutrition
program for women, infants and children (WIC).
According to WIC participant’s study of five agencies

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in San Diego country, California, were recruited to
complete on attitudinal survey on breast feeding [5].
Poor practices and attitudes toward exclusive
breastfeeding have been reported to be among the
major reasons for poor health outcomes among
children, particularly in developing countries. The six
causes of 90% of under-five child mortality
worldwide - acute respiratory infections, diarrhea,
measles, malaria, HIV and AIDS and neonatal
conditions - are easily preventable [6]. The highest
levels of under-five mortality continue to be found in
Sub-Saharan Africa, where one in eight children die
before the age of five (129 deaths per 1,000 live
births) - nearly twice the average in developing
regions overall and around 18 times the average in
developed regions [7]. Diarrhea, malaria and
pneumonia are responsible for more than half the
deaths of children under five in Sub-Saharan Africa
[8]. Breastfeeding strengthens children’s immunity,
ensures child health and survival, and reduces their
vulnerability to these diseases. Scientific evidence has
shown that breastfeeding could lead to a 13%
reduction in deaths of children under five, if infants
were exclusively breastfed for six months and
continued to be breastfed for up to one year [8].
The 2011 Ethiopian DHS shows, 52 percent of
children under six months (aged 0-5 months) are
exclusively breastfed. In addition to breast milk, 19
percent of infants under six months are given plain
water only, while 14 percent are given milk other than
breast milk and 4 percent are given non-milk liquids
and juice. Furthermore, 10 percent of infants under six
months are given complementary foods. By age 6-9
months, 51 percent of infants are given
complementary foods. Sixteen percent of infants
under six months are fed using a bottle with a nipple, a
practice that is discouraged because of the risk of
illness to the child [9].
This may be due to the barriers of translating the
message of exclusive breast feeding into practice.
Therefore, this study was designed to investigate the
different aspect of lactating mothers of Bedelle town
to assess their knowledge, attitude and practice (KAP)
on exclusive breast feeding. In addition to the above
stated aims, this study also used to collect base line
information about current knowledge, attitude and
practice related to feeding of infants with special focus
on exclusive breast feeding. The information
generated from this study will be provided to the
concerned bodies and can be useful for designing
appropriate strategies for exclusive breast feeding.
2. Methods and Materials
2.1 Study area
The study was conducted in Oromia regional
state, Illu-Abba-Bora zone at Bedele City which is
found south west of Addis Ababa about 480 km, the
capital city of Ethiopia. The City is located between
latitude 826’60.0000’’N, longitude of 3621’0.0000”E
and altitude of 253m. According to the 2007
population census, the population of the town was
estimated to be 19,904. Of these 9,824 are males and
9,680 are females [14].
2.2 Study population
The study population was lactating mothers who
had infant less than 24 months were participated in
Bedelle town, Illu-Abba-Bora zone. A community
based descriptive cross-sectional study was employed
to assess mother’s KAP towards exclusive breast
feeding among lactating mothers of Bedelle town
from April to May, 2013.
2.3 Sampling and Size Determination
The sample size was calculated using a sample
size determination formula for a single population
proportion (n= [(Z (1-α/2)) 2. p. (1-p)]/d2) with the
following assumptions: 52% prevalence of exclusive
breast feeding at national level (9), 95% confidence
level, 5% degree of desired precision, finite
population correction factor formula (n=no/1+no/N)
since the total number of lactating mothers in the city
(N) is 460 and 5% for non-response rate. A total of
220 mothers were selected by systematic random
sampling from households who had a child of less
than two years old. Mothers with infants presenting
specific feeding problems (cleft palate or lip, severely
ill) were excluded.
2.4 Study Methodology
A structured interviewer administered
questionnaire was used to collect data related to the
objectives of the study. The questionnaires on KAP
levels were adopted from the Ethiopian DHS and
different literatures. The questionnaire covered a
range of topics including socio-economic and
demographic factors, knowledge, attitude and
practices of exclusive breastfeeding. 5% pre-test of
questionnaires was done in a similar area, which was
not included in the study area and some modifications
were made on the basis of the findings. Three days
intensive training was given for five diploma nurses as
enumerators. The data collection was supervised by
the principal investigator. The principal investigator
supervised and reviewed every questionnaire for
completeness and logical consistency and made
corrections on the spot.
The collected data were checked for
completeness, coded and entered in to a computer.
Statistical analysis was carried out using SPSS for
windows version 20.0. The quantitative data were
summarized by descriptive statistics using the
frequency, percentage and tables for categorical
variables.
Ethical clearance was obtained from Wollega
University, College of Medical and Health Sciences

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and the research was done in conformity with the
ethical guidelines approved by the Institutional
Review Board (IRB) of Wollega University.
Supporting letter was written by Wollega University
to concerned institutions to get institutional consent
and official permission.
3. Results
3.1 Demographic characteristics
In total 220 mothers who had children less than
24 months were successfully interviewed and
participated in the study, yielding a response rate of
100%. The majority 194(88.18%) mothers were in the
age group of ≤ 30 years (Table 1).
Table 1: Socio-demographic characteristics of study participants in study area
Variables Frequency Percent (%)
Age of mothers in year ≤ 30 194 88.2
> 30 26 11.8
Age of child in months 0-6 74 33.6
7-12 74 33.6
13-24 72 32.7
Sex of child Male 108 49.1
Female 112 50.9
Religion of mothers Orthodox 78 35.46
Muslim 58 26.36
Protestant 74 33.64
Others 10 4.54
Ethnicity of mothers Oromo 178 80.90
Amhara 32 14.55
Others 10 4.55
Maternal Education level Illiterate 38 17.27
≤ Grade 4 30 13.63
Grade 5–8 50 22.73
> Grade 8 102 46.36
Maternal employment Employed 92 41.82
Unemployed* 128 58.18
*Mothers have no formal job; they are mostly self-employed subsistence farmers.
3.2 Factors influencing breast feeding
All mothers in the study 216 (98.2%) were ever practiced breast feeding and were got health information about
breast feeding. Their main source of information was health institutions 146(66.36%), health institutions and mass
media 64 (29.1%), books 08 (3.64%) and others 02(0.90%). From the total 220 mothers who were participated in the
study, 104 (47.3%) mothers had good health status with fertility determinants showed that 54 (24.5%) long birth
interval greater than 04 years (Table 2).
Table 2: Influencing factors of breast feeding of respondents in study area
Variables Frequency Percent (%)
Have you ever practiced breast
feeding
Yes 216 98.2
No 4 1.82
Have you ever get any health
information BF
Yes 216 98.2
No 4 1.82
If yes can you mention the source of
information
Health institution 146 66.4
Books 08 3.64
Health institutions and mass media 64 29.1
Others 02 0.90
How you evaluate your general health
status
Very good 94 42.7
Good 104 47.3
Bad 20 9.10
Very bad 02 0.90
What is the interval between this
child and one just before
1-2 years 24 10.9
3 years 34 15.5
>4 years 86 39.1
Not applicable 76 34.6

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3.3 Knowledge of respondents about exclusive breast feeding
Regarding women’s knowledge, all mothers 220 (100%) knew the importance of breast feeding/EBF and 202
(91.8%) were reported breast milk alone is important for new born infant. 200 (90.9%) mothers reported frequent
breast feeding needed for less than 6 months of infant and 100 (45.5%) mothers were reported between 6-8 times
breast fed per day. From study participants, 192 (87.3%) had knowledge about EBF and 28 (12.7%) mothers hadn’t
the knowledge about EBF and were started complementary feeding before 4 months of age due to the reason they
didn’t think breast milk alone is sufficient for the baby 12 (5.45%), their breast milk is not sufficient 10 (4.55%), 6
(2.73%) were due to work related problems. Of study subjects, only 136 (61.8%) mothers had knowledge about the
danger of bottle feeding and said that it is not safe for the child, it can cause child hood infections like diarrhea,
vomiting, respiratory infections and other infectious diseases (Table 3).
Table 3: Knowledge of lactating mothers towards exclusive breastfeeding in study area
Variables
Frequency
Percent (%)
Do you know the importance of breast feeding
Yes
220
100
No
0
0.00
Which one of the following do you think is/ are
important for the new born
Breast milk only
202
91.8
Breast milk with plain water
12
5.45
Breast milk with Butter
6
2.73
For how long should infant EBF only
< 4 months
2
0.90
4
-
6 months
200
90.9
> 6 months
18
8.18
Do you think
breast feeding harms the child
No
220
100
Do you think bottle feeding dangerous for the baby
Yes
136
61.8
No
84
38.2
Did you start complementary feeding before 4
months of age
Yes
28
12.7
No
192
87.3
If yes what is your possible reason
My breast
milk is not sufficient.
10
4.55
I don’t think as breast milk alone is sufficient for baby
12
5.45
Others
6
2.73
If the infant is less than 6 months how
frequent he/she gets breast feeding
<4 times
10
4.55
4
-
5 times
44
20.0
6
-
8 times
100
45.5
>8
times
66
30.0
3.4 Attitudes of respondents towards exclusive breast feeding
Regarding the community’s attitude towards breast feeding, majority of mothers 192 (87.3%) had good attitude
and strongly agree that the EBF is advantageous for infants aged less than 6 months. In contrary, 28 (12.7%) were
disagree and had negative attitude on EBF. Furthermore, 78 (35.5%) agree that colostrum should be discarded, 140
(63.6%) agree that colostrum should not be discarded and the rest 2(0.91%) were neutral.
A large majority of mothers, 192 (87.3%) were suggested that EBF is useful and sufficient for infants aged less
than 6 months and 28 (12.7%) were forwarded their opinion that EBF is useful but not sufficient for infants aged
less than 6 months. 202 (91.9%) mothers believed that the infant should be breast fed as frequently as he/she needs.
82 (37.3%) mothers were considered bottle feeding is dangerous and should not be used at all. Majority of mothers
in this study were familiar with concept of breast feeding, 214 (97.3%) had perception that breast feeding is natural
and appropriate today, 4 (1.82%) believed that it makes them old and 2 (0.91%) were suggested breast feeding is
outmoded (Table 4).

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Table 4: Attitudes of lactating mothers towards exclusive breastfeeding in study area
Variables
Frequency
Percent
(%)
What do you prefer to feed your baby for the first 6
months?
Breast milk alone
162
73.64
Breast milk with formula
5
2.2
7
Breast milk with cow milk
50
22.72
Others
3
1.37
Do you feel the EBF for 6 months infant has
advantageous?
Agree
192
87.27
Disagree
28
12.73
Do you believe that the first milk (colostrum) should
be discarded?
Agree
78
35.45
Neutral
2
0.91
Disagree
140
63.64
What is your opinion about EBF in the
first 6 months?
It is useful and
sufficient
192
87.27
3.5 Practice of study subjects towards exclusive breast feeding
142 (64.6%) mothers were started breast feeding immediately after delivery, but 78 (35.5%) were started breast
feeding after few hours of delivery. The study have shown that 160 (72.7%) practiced optimal breast feeding. Of this
only 96 (43.6%) mothers were exclusively breast fed their child. However, 60 (27.3%) were not practiced EBF.
They initiated pre lacteal feeding for their child such as 8 (3.64%) plain water and 4 (1.82%) butter in the first six
months.
Out of 60 (27.3%) mothers who were not practiced optimal BF/EBF, 4 (1.82%) were preferred to feed their
infant/young child by breast milk with formula, 50 (22.7%) breast milk with cow milk, 4 (1.82%) breast milk with
other semi solid food staffs because of work related issues. About 164 (74.6%) mothers did give colostrum for their
infants. But 56 (25.5%) did not gave colostrum to their infants. The major reasons cited for not giving colostrum are
believe that first milk is dirty like pus 40 (18.2%), everybody says it should not be given 8 (3.64%), and it had no
white milk 8 (3.64%) (Table 5).
Table 5: Practice of lactating mothers towards exclusive breastfeeding
Variables
Frequency
Percent
(%)
When did you start breast feeding
after delivery?
Immediately
142
64.55
After few hours
78
35.
5
Daily frequency of breast feeding
<4 times a day
6
2.73
>
4 times a day
214
97.3
Do you breast feed your baby
exclusively?
Yes
160
72.7
No
60
27.
3
If yes how long EBF?
2 months
8
3.64
3
months
8
3.64
4 months
48
21.8
>4 months
96
43
.6
Did you give colostrum to your
baby?
Yes
164
74.
6
No
56
25.
5
If your answer is no what is your
reason not giving colostrum?
I
t
had no white milk
8
3.64
First milk is dirty like pus
40
18.
2
Everybody say it is shouldn’t be given
8
3.64
What was the first nutrient given for
the infant?
Plain water
8
3.64
Breast milk
208
94.5
Butter
4
1.82

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4. Discussion
A global evidence-based public health
resolution recommends exclusive breastfeeding for
the first six months of life and continued
breastfeeding up to two years of age and beyond [10].
In low-resource countries the prevalence of exclusive
breastfeeding at six months is generally low and
varies from 9-39% [11, 12]. Although this study
showed that almost all lactating mothers (98%) ever
breastfed their babies, exclusive breastfeeding up to
six months of baby’s life was not commonly
understood and was practiced by only 43.6% of
mothers. This is consistent with other low-resource
countries.
The breast feeding initiation rate defined as the
proportion of infants to receive any breast feeding
what so ever within the first 48 hours, was found to
be 100% and breast feeding was practiced by all
mothers who were participated in this study which is
higher than the reported evidence of Ethiopian DHS
which is 96% [13]. This might be due to the
expansion of health infrastructures, increasing
number of health personnel and widely dissemination
of IEC, community mobilization and health education
given at large.
The majority of respondents 202 (91.9%) had
good knowledge regarding the importance of EBF
and 192 (87.3%) had good attitude towards EBF. But
only 96 (43.6%) mothers were practiced exclusively
breast fed their infant/young child up to 6 months
without any supplementation which is lower than the
reported EBF by EDHS in 2011 which is 52% [9].
This is due to work related issues and the role of
extended family in decision making concerning
infant feeding.
The finding of this study indicates that there is a
positive attitude towards EBF evidenced by the fact
that 192 (87.3%) agree the advantage of EBF, 58
(26.4%) participants were reported that breast milk
alone is not enough for the baby, the baby needs
some other food staffs along with breast milk 50
(22.7%) were fed their baby breast milk with cow
milk, 5 (2.27%) breast milk with formula milk and
the rest 3 (1.37%) breast milk with water. The main
barriers to EBF here are work related issues, mothers
living in the extended family and the perception that
breast milk alone is not satisfying the infant/young
child. When the child is crying it is assumed that
he/she is not satisfied and is crying for more food.
This study has shown 56 (25.5%) participants
did not give colostrum to their infants. This finding is
inconsistent with the finding in (13), 44.0% didn’t
give colostrum to their infants. The improved
practice on giving colostrum for the newly born child
is more probably due to the improved awareness of
lactating mothers which is resulted from expansion of
health information on importance of EBF and giving
colostrum for the infant, by the health personnel at
any level of health institutions.
It is of outmost public health importance that
optimal breast feeding practices, particularly EBF,
are encouraged and practiced in order to promote the
growth, survival and health of children. It is evident
literature that countries in Sub-Saharan, including
Ethiopia, share similar attitudes and practices
regarding EBF. Major obstacles faced by mothers
that affect the successful implementation of EBF
include: the perception of insufficient milk
production, the perception of ‘bad milk’, the strong
role of the extended family in decision making
concerning infant feeding and work related issues.
5. Conclusions
In the present study, the majority of mothers has
known the importance of EBF and have good attitude
so that strongly agree that the EBF is advantageous
for infant aged less than six months. This study
concluded that most of mothers were had good
knowledge and attitude on the importance of EBF.
However, poor practice to exclusive breastfeeding for
the first six months postpartum among urban
mothers. Exclusive breastfeeding promotions
improve infant survival; more attention in health
planning should be given to its promotion. Thus,
health care providers and decision makers should be
comprehensively addressed on adverse work related
issues to improve exclusively breast feeding practices
in the study community.
Acknowledgements
The authors would like to thank Wollega
University, College of medical and Health Sciences
for technical and financial support to conduct the
research work. The study participants, data collectors
and all individuals who render help during the study
are also highly acknowledged.
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