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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
Which one of the following do you think is/ are
important for the new born
Breast milk only
202
Breast milk with plain water
12
Breast milk with Butter
6
For how long should infant EBF only
< 4 months
2
4
-
6 months
200
> 6 months
18
Do you think
breast feeding harms the child
No
220
100
Do you think bottle feeding dangerous for the baby
Yes
136
No
84
Did you start complementary feeding before 4
months of age
Yes
28
No
192
If yes what is your possible reason
My breast
milk is not sufficient.
10
I don’t think as breast milk alone is sufficient for baby
12
Others
6
If the infant is less than 6 months how
frequent he/she gets breast feeding
<4 times
10
4
-
5 times
44
6
-
8 times
100
>8
times
66
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
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
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
>
4 times a day
214
Do you breast feed your baby
exclusively?
Yes
160
No
60
27.
3
If yes how long EBF?
2 months
8
3
months
8
4 months
48
>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
First milk is dirty like pus
40
18.
2
Everybody say it is shouldn’t be given
8
What was the first nutrient given for
the infant?
Plain water
8
Breast milk
208
Butter
4
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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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11/17/2014
... This result was comparable to the 5.5-8.5% role of the media as also observed in other studies in Nigeria [15,19]. However, in Kano State, [14] Bayelsa State, [20] Nigeria, and Mbedelle in South Western Ethiopia, [21] the contribution of the media in the dissemination of the information in EBF were much higher at 17.2%, 10.4% and 29.1% respectively. It is important for the media to be involved in the dissemination of information on EBF as they tend to have a wider reach and besides, it has the capacity to reach women that fail to register for antenatal care with the right information on EBF. ...
... This result is however lower than the 53%-64.6% reported in other studies conducted in Nigeria [3,11] and Ethiopia [21]. It was however higher than the 31% reported by Al Banali in Saudi Arabia [23]. ...
... The prevalence rate of exclusive breastfeeding for 6 months observed in this study compares to the observed 43.6% reported by Wolde et al. [21] in a study carried out in Ethiopia. There is a better EBF practice in this study compared to the earlier studies in Port Harcourt carried out about 3-4years before this study, that reported EBF prevalence of 11.7% [11] and 22.5% [12]. ...
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Background: Exclusive breastfeeding (EBF) provides all an infant requires for optimal growth and development in the first six months of life. Although most babies are breastfed in Nigeria, only 23% are exclusively breastfed. This study was carried out to ascertain the knowledge, practice and problems associated with EBF amongst mothers attending the Rivers State University Teaching Hospital (RSUTH). Methods: A 5-month cross sectional study was carried out in the Paediatric outpatient clinic (POPC) of RSUTH. A total of 343 mothers were randomly recruited and a pre-tested structured questionnaire administered after obtaining informed consent. Original Research Article Okari et al.; EJNFS, 12(9): 103-115, 2020; Article no.EJNFS.60903 104 Results: Ninety eight percent of the mothers had heard of EBF, 88% knew of its content and 80.2% knew that the duration of EBF was for 6 months. Only 46.4% exclusively breastfed their babies for 6 months and about 66% of participants knew of its benefits to both mother and child. Breastfeeding was commenced within 1 hour of delivery by 40.8% of mothers and pre-lacteal feeds given by 34.1% of mothers. Tertiary education, attending antenatal clinic and hospital delivery were significantly associated with good knowledge of EBF, while hospital delivery and multiparous women with at least 4 pregnancies were significantly associated with good EBF practice. Common challenges to EBF were perception that breast milk was insufficient for the babies (17.5%) and the need for mothers to return to work (9.3%). Conclusion: Knowledge of EBF was high among mothers attending the POPC in RSUTH but the EBF rate was suboptimal. Increased health education on the importance of EBF, the provision of creches at work places and the extension of maternity leave is advocated.
... The following assumptions have been made: a 95% confidence level, a 5% margin of error, and the prevalence of EBF practice (P = 43.6%) at Bedele [17], a finite population correction factor formula since the total number of under 6 month lactating mothers in the district (N) was 1332 according to the data from the district health office, a 10% non-response rate, and a design effect of 2 for the multi-stage sampling. The final sample size was 649 mothers. ...
... This finding was similar to reports from studies conducted at Goba (71.3%), and Enderta, Ethiopia (70.02%) [25,27]. The findings of this study were greater than the EDHS 2016 report (58%) and Bedele town (43.6%) [14,17], and other countries' findings such as Nairobi (45.5%), Abu Dhabi (44.3%), ...
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Background: Breastfeeding is the process of feeding a newborn with the mother's milk, and it is very important for enhancing child and maternal health. The proportion and duration of breastfeeding may vary by location, and is poorly practiced for cultural, economic, and societal reasons. Thus, this study was conducted to determine breastfeeding practices and determinants of exclusive breastfeeding among mothers of six month aged infants in the Horro district, Ethiopia. Methods: We used a community-based cross-sectional study among 649 mothers of index infants. A multi-stage sampling procedure was used to select the women. Data were collected from March 15 to April 5, 2020. Face-to-face interviews were used to collect data using a semi-structured questionnaire. Bivariable and multivariable logistic regression were performed to examine the factors associated with exclusive breastfeeding. Results: All women who participated in the study have ever breastfed their children at some point. Exclusive breastfeeding and breastfeeding initiation were found to be good (70.4% and 61.8%, respectively) within 24 hours prior to the survey time. Having had information about breastfeeding during antenatal care (AOR = 4.15, 95% CI = 2.36, 7.30), postnatal care follow-up (AOR = 4.74, 95% CI = 2.92, 7.70), having infant aged 0-1month (AOR = 12.14, 95% CI = 3.83, 38.46) and 2-3 month (AOR = 8.62, 95% CI = 5.00, 14.85), being a single birth (AOR = 12.91, 95% CI = 3.86, 43.21), having monthly income of ≤ 100 Ethiopian Birrs (AOR = 1.96, 95% CI = 1.16, 3.32), and breastfeeding initiation within one hour of birth (AOR = 1.94, 95% CI = 1.13, 3.35) were found to be a significantly associated factors of exclusive breastfeeding. Conclusion: Despite meeting the global nutrition target of 2025, the practice of exclusive breastfeeding was lower than the WHO recommendations. Providing education about breastfeeding during antenatal care follow-up and increasing access to postnatal care follow-up is recommended to enhance exclusive breastfeeding practices in the study area.
... Summary of the studies included in this review of East Africa countries published between 2001 and 2018 were shown in Table 1. Of the studies conducted; seven were from Ethiopia [26,30,33,[36][37][38][39], three from Kenya [28,29,35], two from Uganda [31,32], one from Rwanda [27], two from Tanzania [34,41], and one from South Sudan [40]. The sample sizes ranged from 90 to 640 participants. ...
... The sample sizes ranged from 90 to 640 participants. Seven studies reported knowledge, attitude, and practice [26,27,29,33,[37][38][39], seven studies reported knowledge and practice [31, 32, 34-36, 40, 41], and two studies reported knowledge and attitude [28,30]. However, there were no studies reported from the other east Africa countries due to lack of data. ...
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Background: Exclusive breastfeeding (EBF) is recommended for the first six months of age by the World Health Organization. Mothers' good knowledge and positive attitude play key roles in the process of exclusive breastfeeding practices. In this study, we report on a systematic review of the literature that aimed to examine the status of mothers' knowledge, attitude, and practices related to exclusive breastfeeding in East Africa, so as to provide clues on what can be done to improve exclusive breastfeeding. Methods: A systematic review of peer-reviewed literature was performed. The search for literature was conducted utilizing six electronic databases, Pub med, Web of Science, Google Scholar, Embase, Science Direct, and Cochrane library, for studies published in English from January 2000 to June 2019 and conducted in East Africa. Studies focused on mothers' knowledge, attitudes, or practices related to exclusive breastfeeding. All papers were reviewed using a predesigned data extraction form. Results: Sixteen studies were included in the review. This review indicates that almost 96.2% of mothers had ever heard about EBF, 84.4% were aware of EBF, and 49.2% knew that the duration of EBF was the first six months only. In addition, 42.1% of mothers disagreed and 24.0% strongly disagreed that giving breast milk for a newborn immediately and within an hour is important, and 47.9% disagreed that discarding the colostrum is important. However, 42.0% of mothers preferred to feed their babies for the first six months breast milk alone. In contrast, 55.9% of them had practiced exclusive breastfeeding for at least six months. Conclusions: Exclusively breastfeeding among our sample is suboptimal, compared to the current WHO recommendations. Thus, it is important to provide antenatal and early postpartum education and periodical breastfeeding counseling, to improve maternal attitudes and knowledge toward breastfeeding practices.
... Although the 2016 survey report showed a slightly increment in the proportion of EBF, the practice declined with age from 74% in 0-1 months to 36% in 4-5 months with some regional variations. A more recent pocket study in rural Ethiopia reported EBF practice of 43.6% which is even lower than the 2016 national fidings [14]. It is important to note that the observed gap in EBF practice is not only due to lack of awarenesses-it is compounded by low physical access to health care facilities, economic, societal and cultural settings [15][16][17][18] are among other barriers. ...
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Background Despite the enormous benefit of exclusive breastfeeding (EBF) to mothers and infants, the practice of exclusive breastfeeding is globally low. In sub-Saharan Africa and Ethiopia, the prevalence of EBF stands at 35% and 59%, respectively. The low EBF practice in Ethiopia as well as in the studied region calls for further study and thus we studied the EBF practice in the study area since little is known about its current magnitude and factors influencing its practice for some programmatic improvements. Methods A facility based cross-sectional study linked to a community was conducted from June-July 2019 among 412 mothers who had antenatal follow-up and delivered in health facilities of Asosa town over a period of one year prior to the study. Data on socio demographic characteristics and other important variables were collected through face to face interview while gestational age in weeks was recorded from their medical chart by trained health extension workers in accordance with relevant ethical guidelines and regulations. The collected data were then cleaned and entered into Epi-data software version 3.02. Analysis was done by SPSS version 20. Binary and multivariate logistic regression were performed to identify the contributing factors. P-value of less than 0.05 and 95% confidence interval was considered to determine statistical significance. Results Of the 412 respondents, the majority (88.1%) were multi-gravida and above. Slightly higher than a quarter (26.0%) and over half (55.4%) had neither received antenatal nor postnatal care. The proportion of mothers who exclusively breastfed their children was 76.0% and the overall aggregated good practice of EBF score was 64.1%. Mothers who completed primary school [AOR = 4.5; 95% CI = 1.1,18.2], had four or more ANC [AOR = 1.8;95CI = 0.79–0.98], and postnatal follow-up [AOR = 0.21;95% CI = 0.07–0.67], and had male infants [AOR = 2.3; 95% CI = 1.0–4.95] were among the factors influencing the exclusive breastfeeding practice score. Conclusion While three in four mothers exclusively breastfed their newborns and about two-thirds had good EBF score, the observed women’s retention on the continuum of the maternal care pathway is low with one in four had no antenatal and over half had no postnatal care which are important derivers for EBF practice. To improve the EBF score and narrow the observed maternal and child health disparities, it is essential to promote maternal education and increase the recomended coverage of antenatal and postnatal care for mothers.
... A more recent pocket study in rural Ethiopia reported EBF practice of 43.6% which is even lower than the 2016 national dings (14). It is important to note that the observed gap in EBF practice is not only due to lack of awarenesses-it is compounded by low physical access to health care facilities, economic, societal and cultural settings (15)(16)(17)(18) are among other barriers to EBF practice. ...
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Background: Despite the enormous benefit of exclusive breastfeeding (EBF) to mothers and infants, the practice of exclusive breastfeeding is globally low. In sub-Saharan Africa and Ethiopia, the prevalence of EBF stands at 35% and 58%, respectively. The low EBF practice in Ethiopia calls for further study and thus we studied the EBF practice in the study area since little is known about its current magnitude and factors influencing its practice for some programmatic improvements. Methods: A cross-sectional study was conducted from June-July 2019 among 412 mothers who delivered in health facilities of Asosa town. Data on socio demographic characteristics and other important variables were collected through face to face interview by trained health extension workers in accordance with relevant ethical guidelines and regulations. The collected data were then cleaned and entered into Epi-data software version 3.02. Analysis was done by SPSS version 20. Binary and multivariate logistic regression were performed to identify the contributing factors. P-value of less than 0.05 and 95% confidence interval was considered to determine statistical significance. Results: Of the 412 respondents, the majority (88.1%) were multi-gravida and above. Less than a quarter (26.0%) and over half (55.4%) had neither received antenatal nor postnatal care. The proportion of mothers who exclusively breastfed their children was 76.0% and the overall aggregated good practice of EBF score was 64.1%. mothers who completed primary school [AOR=4.5; 95%CI=1.1,18.2], had three or more ANC [AOR=0.018;95CI=0.003-0.12], and postnatal follow-up [AOR=0.218;95%CI=0.07-0.67], and had male infants [AOR= 2.3; 95%CI=1.0-4.95] were among the enabling factors influencing the exclusive breastfeeding practice score. Conclusion: Women’s retention on the continuum of the maternal care pathway is low with about a quarter of mothers were not practicing EBFand one in two had no postnatal care. To narrow the observed maternal and child health disparities, it is essential to intervene through focused actions that address the above enabling factors.
... Structured and semi-structured questionnaires were used for the data collection in the form of a closedended (multiple choice) question style. The items included in the questionnaire were chosen based on previously published investigations of a validated standardized questionnaire, the questionnaire used in the present [17,[19][20][21][22], or because they were considered interesting, or modi ed to meet our objectives of the study by the research team. The questionnaire will include a set of questions organized under ve main sections was aimed at gathering information from mothers about exclusive breastfeeding. ...
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Background: Exclusive breastfeeding (EBF) for 6 months is considered a major public health intervention to reduce the escalating child mortality of neonates and infants in low and middle-income countries. In most East Africa countries, exclusive breastfeeding did not meet the recommendation of WHO/UNICEF that a baby should be fed only breast milk for the first 6 months. This study is aimed to provide knowledge, attitudes, and practice (KAP) towards EBF and identify factors associated with the practice of exclusive breastfeeding. Methods: A cross-sectional study was conducted from January to April 2020. A total of 364 mothers were interviewed using a questionnaire. Univariate statistical analysis was used to define variables using frequencies and percentages. Multiple logistic regression was also applied to identify the factors associated with EBF practice. Results: In the current study, the majority of mothers, 84%, presented good knowledge, 87.0% also showed a good attitude toward EBF. Nearly 95.9% of the respondents understood the benefits of EBF practice for at least six months, 86.0% also responded that breast milk should be started immediately after birth within an hour. Besides, 87.6% knew the importance of the first breast milk or colostrum. 92.3% of mothers understand that breastfeeding increases mother-infant bonding, 92.3% of mothers understand that breastfed babies are healthier than formula-fed babies, and 94.8% believed that breast milk is the ideal food for babies. Furthermore, 76.4% of the surveyed mothers exclusively breastfed their infants for the first 6 months after delivery A married women (OR=.270; 95%CI=.160-.457, p<.001), had a high school degree(OR= .150; 95CI=.073-.307; p<.001), mothers whose had babies more than three (OR=.090; 95%CI=.035-.233, p<.001), good knowledge score(OR=2.535; 95%CI=1.399-4.594, P=0.002) and positive attitude score OR=2.051; 95%CI=1.149-3.662, P=0.015) were statistically significant association with EBF. Conclusion: In the studied area; knowledge and attitude of mothers towards EBF are relatively high. However, the level of EBF is still below the WHO recommendation. The findings of this study highly inform policymakers and healthcare providers to direct their efforts to provide evidence-based information and recommendations on the benefits of breastfeeding to promote the practice of exclusive breastfeeding.
... Guba Lafto Woreda Ethiopia (65.1%), Calabar Nigeria (80%) and Bedele Town Ethiopia (87.3%) [56][57][58][59][60]. The lower percentage of mothers' knowledge might be due to the limited distribution or access to information about exclusive breastfeeding. ...
Article
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Introduction: World Health Organization (WHO) recommends exclusive breastfeeding for new-borns until 6 months of age. However, exclusive breastfeeding in Indonesia only reached 52.3% in 2014 and 65.16% in 2018. It is known that administration of infant formula and non-formula supplements to infants aged less than 6 months increases the risk of Acute Respiratory Infections (ARIs). In addition, the high prevalence of ARIs in infants in Sleman Regency, Indonesia indicates the need of optimal early prevention. Therefore, we conducted this study to confirm that mothers' knowledge of breastfeeding and infant feeding types affect the prevalence of Acute Respiratory Infections (ARIs). Methods: Data were collected through questionnaires from 50 mothers with infants aged 7-12 months who had experienced ARIs in the last 3 months (case group) and 50 mothers with healthy infants (control group). Collected data were then analysed using Chi-Square, Logistic Regression, Lambda, and Somers' D tests. Results: The results showed that types of infant feeding are associated with the prevalence of ARIs. Non-breastfed infants were 14 times riskier to contract ARIs. Mothers' knowledge of exclusive breastfeeding influenced their preferences of feeding practice. However, their attitude towards breastfeeding did not appear to significantly affect their choices of feeding practice. Conclusions: Exclusive breastfeeding during the first 6 months of an infant's life can lower the prevalence of ARIs for when they are older. Mothers' good knowledge of breastfeeding is associated with its practice.
... An Ethiopian study at Raya Kobo district also showed that the main reason to give prelacteal feeds for sick neonates were to treat neonatal illness believing that their illness is attributable to 'evil eye' [18]. Furthermore, different studies in different Ethiopian towns namely at Ambo [26], Dabat [27], Mizan Aman [28] and Bedelle [29] revealed the presence of maternal knowledge and practice gap about WHO recommendations of exclusive breast feeding. ...
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Background: Prelacteal feeding compromises the benefits of exclusive breastfeeding, thereby increasing neonatal malnutrition, infection and mortality. About 26% of the Ethiopian neonates are given prelacteal feeds and nearly 48% of whom are attributed to Amhara region. Besides, prior Ethiopian studies have shown significance of the problem at different community settings in the country. However, the prevalence and associated factors of prelacteal feeding among neonatal admissions has been overlooked in the country in general and in the study area in particular. Therefore, this study was aimed to assess the prevalence and associated factors of prelacteal feeding among neonatal admissions in the study setting. Methods: A cross-sectional study was conducted among 321 mother-neonate pairs admitted to Neonatal Intensive Care Unit (NICU) of Debre Tabor General Hospital between September 2018 and February 2019. Every fourth mother neonate pair was included to the study. Multivariable logistic regressions were fitted to find out adjusted odds ratios (AORs) of factors associated with pre-lacteal feeding. Results: The prevalence of prelacteal feeding was 20.2% [95% CI: 15.31–26.75%]. Plain water was the most common prelacteal food (32.3%). Factors associated with prelacteal feeding include rural residence (AOR = 4.07, 95% CI: 1.30, 12.81), primiparity (AOR = 4.50, 95% CI: 1.30–12.81), less than four ANC visits (AOR = 4.71, 95% CI: 1.23–17.84), spousal accompany to ANC (AOR = 0.20, 95% CI: 0.05–0.75), home delivery (AOR = 5.94, 95% CI: 1.80–19.67), having twin newborns (AOR = 6.69, 95% CI: 1.25, 35.91) and maternal belief on the purported advantages of prelacteal feeding (AOR = 2.74, 95% CI: 2.09–25.39). Conclusion and recommendation: One out of five sick neonates was given prelacteal feeds. Twin neonates, home delivered neonates, rural neonates, neonates born to primiparous mothers, neonates delivered from mothers who had less than four ANC visits, neonates born to mothers who weren’t accompanied by their spouse during ANC and those born to mothers who believe on the purported advantages of prelacteal feeding had higher odds of receiving prelacteal feeds. Therefore, mothers of these vulnerable neonates should be provided with more emphasis about counseling of infant and young child feeding practice during their stay at NICU. Keywords: Prevalence, Factors, Prelacteal, Neonates, Ethiopia
... An Ethiopian study at Raya Kobo district also showed that the main reason to give prelacteal feeds for sick neonates were to treat neonatal illness believing that their illness is attributable to 'evil eye' [18]. Furthermore, different studies in different Ethiopian towns namely at Ambo [26], Dabat [27], Mizan Aman [28] and Bedelle [29] revealed the presence of maternal knowledge and practice gap about WHO recommendations of exclusive breast feeding. ...
Article
Full-text available
Background: Prelacteal feeding compromises the benefits of exclusive breastfeeding, thereby increasing neonatal malnutrition, infection and mortality. About 26% of the Ethiopian neonates are given prelacteal feeds and nearly 48% of whom are attributed to Amhara region. Besides, prior Ethiopian studies have shown significance of the problem at different community settings in the country. However, the prevalence and associated factors of prelacteal feeding among neonatal admissions has been overlooked in the country in general and in the study area in particular. Therefore, this study was aimed to assess the prevalence and associated factors of prelacteal feeding among neonatal admissions in the study setting. Methods: A cross-sectional study was conducted among 321 mother-neonate pairs admitted to Neonatal Intensive Care Unit (NICU) of Debre Tabor General Hospital between September 2018 and February 2019. Every fourth mother neonate pair was included to the study. Multivariable logistic regressions were fitted to find out adjusted odds ratios (AORs) of factors associated with pre-lacteal feeding. Results: The prevalence of prelacteal feeding was 20.2% [95% CI: 15.31-26.75%]. Plain water was the most common prelacteal food (32.3%). Factors associated with prelacteal feeding include rural residence (AOR = 4.07, 95% CI: 1.30, 12.81), primiparity (AOR = 4.50, 95% CI: 1.30-12.81), less than four ANC visits (AOR = 4.71, 95% CI: 1.23-17.84), spousal accompany to ANC (AOR = 0.20, 95% CI: 0.05-0.75), home delivery (AOR = 5.94, 95% CI: 1.80-19.67), having twin newborns (AOR = 6.69, 95% CI: 1.25, 35.91) and maternal belief on the purported advantages of prelacteal feeding (AOR = 2.74, 95% CI: 2.09-25.39). Conclusion and recommendation: One out of five sick neonates was given prelacteal feeds. Twin neonates, home delivered neonates, rural neonates, neonates born to primiparous mothers, neonates delivered from mothers who had less than four ANC visits, neonates born to mothers who weren't accompanied by their spouse during ANC and those born to mothers who believe on the purported advantages of prelacteal feeding had higher odds of receiving prelacteal feeds. Therefore, mothers of these vulnerable neonates should be provided with more emphasis about counseling of infant and young child feeding practice during their stay at NICU.
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Background: Globally, less than 40% of infants under six months of age are exclusively breastfed. Researchers have established the prevalence, nature, and the degree of this problem; however, less is known about the knowledge, attitudes, and practices (KAP) of exclusive breastfeeding (EBF) among mothers of children aged 0-6 months in Ethiopia. This research addresses this knowledge gap by examining (a) the maternal KAP of breastfeeding and (b) the association between sociodemographic variables and KAP. Methods: This research draws on a sample of women (n = 415) from Finote-Selam town, derived using simple, systematic, and multistage sampling techniques. Data were analyzed using univariate analysis and binary logistic regression. Results: Results show that the vulnerable groups, such as mothers being illiterate, low-income group, and lived in rural areas have encountered a double burden of death during delivery and having no knowledge of, positive attitudes, and practices of breastfeeding compared with other mothers of children aged 0-6 months because the respondents have differences in socio-economic characteristics and how they are under cultural influence. Furthermore, the results also affirmed that the age limit could also determine approaches and perceptions of mothers for the exclusive breastfeeding of mothers: mothers aged 25-34 and above 35 years old had good knowledge of and attitude towards breastfeeding, respectively. Furthermore, the poor practice of breastfeeding did not save any baseline variable, such as educational level, level of employment, and level of income. Conclusion: This study would allow policymakers, medical sociologists, and health extension practitioners to develop more effective all-rounded interventions to minimize the poor practice of EBF.
Article
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Promotion of proper breastfeeding practices for the first six months of life is the most cost-effective intervention for reducing childhood morbidity and mortality. However, the adherence to breastfeeding recommendations in many developing countries is not satisfactory. The aims of the study were to determine breastfeeding and infant feeding patterns at nine months of age and to assess factors influencing exclusive breastfeeding practices. In Bhaktapur, Nepal, we carried out a cross-sectional survey of 325 infants who came for measles vaccination at the age of nine months. Mothers were interviewed on details regarding feeding of their child and health since birth. Three quarters of all mothers reported that they did not receive any information on breastfeeding during the antenatal visit. Two hundred and ninety five (91%) mothers gave colostrum and 185 (57%) initiated breastfeeding within one hour of delivery. The prevalence of exclusively breastfeeding at 1, 3 and 6 months were 240 (74%), 78 (24%) and 29 (9%), and partial feeding was initiated in 49 (15%), 124 (38%) and 257 (79%) babies, respectively. The main reason, according to the mother, for introducing other foods before six months of age was insufficient breast milk. In logistic regression analyses, mother's knowledge on how long child should be given only breast milk and not living in joint families were associated positively with exclusive or predominant breastfeeding for four months or beyond. Despite the high proportion of mothers who initiated breastfeeding immediately after birth, continuation of exclusive breastfeeding for up to six months was not common. Very few mothers received any information on breastfeeding during the antenatal visit, indicating a need for counseling on exclusive breastfeeding. Possible options for this counseling could be during antenatal visits and at regular clinic visits for vaccination.
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Suboptimal breastfeeding is associated with higher mortality among infants and young children in the developing world. We describe patterns in 'exclusive breastfeeding' and 'any breastfeeding' rates and quantify exposure to suboptimal breastfeeding among children aged two years or younger in developing countries. We reviewed nationally representative surveys that collected data on breastfeeding rates in 94 developing countries. Surveys were categorized by completeness and comprehensiveness of data. Complete and comprehensive data were analysed with minimum chi-square regression. With a fitting procedure, estimated parameters were used to impute missing observations for incomplete or non-comprehensive surveys. Breastfeeding indicators were calculated and are reported for 135 developing countries by UN region. Amongst infants aged six months or younger in the developing world, the prevalence of exclusive breastfeeding is 39% and the prevalence of no breastfeeding is 5.6%. The prevalence of continued breastfeeding is 86% and 68% for infants and children aged 6-11 and 12-23 months, respectively, in the developing world. Imputation expands population coverage of indicators, especially for infants. Breastfeeding trends are highly linear and estimated parameters defining the age-specific attrition hazard are robust. Survey-reported rates, particularly for exclusive breastfeeding, appear to have systematic upward bias, and exposure estimates must be considered conservative. Compliance with breastfeeding recommendations in developing countries is low, and more attention should be given to increasing breastfeeding - especially exclusive breastfeeding - and to monitoring trends. Although the introduction of more standardized and better validated survey instruments is desirable, since data coverage, completeness and comprehensiveness are extensive, global exposure assessment is relatively robust. Moreover, the regularity of breastfeeding patterns show existing survey data capture real biological and social phenomena. Our method for the analysis of breastfeeding rates provides a potent tool for summarizing trends, validating observations, translating and extrapolating indicators (as well as projecting and imputing estimates when necessary) and should support more effective child health monitoring.
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From 2009 (English) and 2008 (French and Spanish): Online document
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This is the second of five papers in the child survival series. The first focused on continuing high rates of child mortality (over 10 million each year) from preventable causes: diarrhoea, pneumonia, measles, malaria, HIV/AIDS, the underlying cause of undernutrition, and a small group of causes leading to neonatal deaths. We review child survival interventions feasible for delivery at high coverage in low-income settings, and classify these as level 1 (sufficient evidence of effect), level 2 (limited evidence), or level 3 (inadequate evidence). Our results show that at least one level-1 intervention is available for preventing or treating each main cause of death among children younger than 5 years, apart from birth asphyxia, for which a level-2 intervention is available. There is also limited evidence for several other interventions. However, global coverage for most interventions is below 50%. If level 1 or 2 interventions were universally available, 63% of child deaths could be prevented. These findings show that the interventions needed to achieve the millennium development goal of reducing child mortality by two-thirds by 2015 are available, but that they are not being delivered to the mothers and children who need them.
Assessment of Attitudes towards breast feeding among WIC participants
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