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Background

Breastfeeding is the practice of feeding a woman's breast / young child the milk produced by her breasts, usually directly from her nipples. Breast milk is better than anything given to a baby. It is a natural food that cannot be bought with money and is uniquely adapted to the needs of the child. It is immediately available, nutritionally balanced, fresh, the temperature is always correct and constant, economical and provides antibodies (increased immunity to infection). The benefits of breastfeeding for newborns and infants are well documented. Breastfeeding provides infants with high-quality nutrients, which can improve infants’ immunity and may reduce future medical care [1]. In 1990, WHO/UNICEF called for policies to foster a culture of breastfeeding and encourage women to exclusively breastfeed for the first 6 months children are 2 years and older. However, a recent estimate by the World Health Organization indicates that only 35% of infants worldwide are completely breastfed from birth to the fifth month. In 2003, 22.3% of children were breastfed only under 6 months, based on WHO Global Data on Infant Breastfeeding in Nigeria. According to the Nigerian Demographics and Health Survey (NDHS), in 2008 17% of children were breastfed for less than 4 months, while 13% were breastfed for less than 6 months. The monthly media-exclusive breastfeeding period in southwestern Nigeria in 2003 was seven months. In 2008, it was six months, but at the same time, the early start of breastfeeding for women in the region increased from 12.7% in 2003 to 35.5% in 2008. All these figures are below the 90% level recommended by the World Health Organization [2]. As described by the World Health Organization, breastfeeding is an unparalleled way to provide ideal food for the survival, healthy growth, and development of infants and young children. Child mortality is still a major public health problem in the world. Since the practice of breastfeeding in Ethiopia, poverty has been caused by various factors. Among them, lack of knowledge and lack of knowledge about breastfeeding are the main reasons for the high child mortality rate. Therefore, this study mainly aims to evaluate the knowledge and practice of breastfeeding mothers of children under two years old in Dilla Township, southern Ethiopia.

Statement of the Problem

The feeding methods of infants and young children all over the world are not optimal. It only accounts for 39% of all exclusively breastfed babies worldwide. In most developing countries, the prevalence of exclusive breastfeeding rarely exceeds 30%. Globally, more than 10 million children under the age of five die every year. In Africa, 41% of deaths occurred in sub-Saharan Africa, and the other 34% occurred in South Asia. A major cause of death is insufficient breastfeeding practices and high disease incidence. In Ethiopia, as in other developing countries, diarrhea is the main cause of morbidity and mortality in young children due to improper breastfeeding practices, especially in urban areas. Approximately 58.0% of child deaths are attributed to malnutrition, which makes malnutrition the single largest cause of child death. Around 70.0% of infants are sub-optimally breastfed, which is another major provider of infant mortality rate. At this time, 24.0% of infant death is due to poor breastfeeding practices [3,4].

Factors Affecting Breastfeeding Practice

Worldwide, only 37% of these infants under the age of 6 months are breastfed alone, with only 37% of these infants consuming other foods and fluids early on. Although the initiation of breastfeeding is universal in most developing countries discontinuation and early introduction of complementary foods for breastfeeding have been observed in a significant proportion of cases [5]. The types of complementary foods used and the changes in breastfeeding duration are similar to the changes in industrialized countries observed since the mid-19th century. Many of the related factors are similar (urbanization, female participation in the workforce, increased availability of processed milk, and their promotion by businesses). Factors affecting the onset and duration of breastfeeding include socio-demographics, biological support, and psychosocial issues. The literature shows that increasing the rate of onset and duration of breastfeeding not only provides advantages for mothers and babies, but also has environmental and economic benefits for the healthcare system and individual families. A review of studies in developing countries shows that babies who are not breastfed are 6 to 10 times more likely to die in the first month of life than breastfed babies. Diarrhea and pneumonia are more common and more severe in artificially fed children and are responsible for many of these deaths. It is estimated that suboptimal breastfeeding, especially nonexclusive breastfeeding during the first 6 months of life, will cause 1.4 million deaths and the burden of disease for children less than 5 years old accounts for 10% [6]. Overall, breastfeeding interventions can prevent 13% of deaths under the age of 5 in developing regions of the world and are the most important preventive approach to saving the lives of millions of children. It is ranked. Of these, 23% of deaths are preventable as a result of continued breastfeeding in the age group of 6 to 24 months and older. On the other hand, proper complementary eating habits will reduce the mortality rate of children under the age of 5 by an additional 6%. Breastfeeding babies are a widely accepted and admired behavior in Ethiopian culture, but it does not necessarily follow the recommendations of the National Strategy for Infant Breastfeeding, a guideline established and adopted by the World Health Organization.

It does not mean. According to the Federal Ministry of Health of Ethiopia for optimal breastfeeding, many newborns are neither breastfed with colostrum in the first few hours of life, nor are they breastfed exclusively for the first six months. Instead, they were given liquids and complementary foods at a very young age [7]. There are many reasons for improper breastfeeding in Ethiopia, including traditional and cultural beliefs, low level of education, mothers’ heavy work, poor sanitation, type of midwifery, time spent at home, ethnicity, mother’s poor knowledge, age, parity, prenatal health service utilization and delivery location. Therefore, this study is expected to address these factors by evaluating mothers’ knowledge of their children’s breastfeeding practices. Therefore, this study mainly focuses on assessing the knowledge and practice of breastfeeding mothers of children less than two years of age in Dilla Township, Gedeo Region, southern Ethiopia, which will have important input in the development of appropriate strategies to improve mothers’ breastfeeding in Dilla Township and the entire region. Awareness to promote breastfeeding practices [8].

Study Design, Area and Period

From February 9, 2020 to March 2020, a community-based descriptive cross-sectional study was conducted in the town of Dilla in the Gedeo district of SNNPRE. Dilla is a cash crop area in southern Ethiopia. Gedeo Zone is the administrative center of the Southern Countries, Nationalities, and Ethnic Regions (SNNPR). It is located on the main road from Addis Ababa to Nairobi. The latitude and longitude of the town is 6°24′30″N 38° 18′30″E coordinates: 6°24′30″N 38°18′30″E, 1570 meters above sea level. According to SNNPR's Bureau of Finance and Economic Development, as of 2003, Dilla's public facilities include digital telephone access, postal service, 24-hour electricity service, numerous banks, and referral hospitals. According to data from the Central Bureau of Statistics in 2005, the total population of Dilla is estimated to be 61,114, including 31,329 males and 29,785 females [9].

Sampling Techniques and Procedures

The study subjects were selected using the multistage sampling technique; the town has three sub cities with three kebeles each. Among these three sub cities, one sub city (Hara Wolabo) was selected randomly. Then one kebele (Buno) was selected from the selected sub-city randomly. 362 households were selected from kebele using systematic random sampling technique by dividing the total number of houses (H) = 2886 by the required number of houses (h=362). The number "k" is obtained by dividing H/h = k =2886/362=8th. The samples were selected in every 8th interval of the households. The starting household was selected by using a simple random sampling method. Finally, from each housing unit, one mother was selected for the interview. In the absence of an eligible respondent in the given household, no substitution was made. Three repeated attempts were made before the labeling individuals were unavailable for the study. Structured questionnaire was used to collect the data. The questionnaire is adapted from a study done in Addis Ababa [10]. It is prepared originally in English and then will be translated to Amharic language. And it will be administered and supervised by the principal investigator. Finally, eligible target groups were selected from each selected house unit. From each household one eligible child aged less than 2 years and who have a biological mother at the time of the survey was selected. The youngest child was selected from mothers who have two children less than two years. If an eligible child is not found, the consecutive households were selected until an eligible child was found.

Data Quality Assurance

Well-designed data acquisition tools are available to ensure the quality of your data. Training was conducted for data collectors, and on each data collection day, a few percent of the collected data was investigated by the principal investigator and the transferred issues were resolved immediately. Prior to actual data collection, to confirm the validity and reliability of the data, at 5% of the total sample size (362) of 18 mothers with children less than 2 years of age in Kebere outside the selected area. I tested the questionnaire. The questionnaire will be pretested and then modified and modified as needed [11].

Operational definition

Exclusive breastfeeding: it is defined by the World Health Organization (WHO): as the infant only receives breast milk without any additional food or drink, not even water, is breastfeeding on demand – that is as often as the child wants, day and night, with no use of bottles.

Optimal breast feeding: relates to adherence to standard recommendations such as initiation of breastfeeding within one hour, exclusive breastfeeding for 6 months, and introduction of safe , nutritious, age-appropriate complementary food around 6 months, on-demand breast feeding and giving colostrum.

Good optimal breastfeeding practice: When the study subjects have practiced exclusive breastfeeding, they started complementary food at six months post-delivery and currently breastfeeding their children for greater than six months.

Bottle feeding: Liquid or semisolid infant/child food given on feeding bottle teat.

Data Analysis Method

The data was checked for completeness, inconsistency, and then it was analyzed manually. Table’s charts, frequency distribution, mean, median and percentage were used to show the results of the study.

Socio demographic characteristics

A total of 362 women were included in the study with a response rate of 98%. The mean age of the respondents was +27 years and the majority of them 328 (90.60%) were married. Concerning of educational status, about 102 (28.17%) of the total study participants have a primary level of education below grade 6. This number also represents the largest proportion compared to other levels of education. About 136 (37.56%) of the respondents were protestant in religion followed by orthodox 133 (36.74%). ethically, gedeo ethnic group 137 (37.8%) is the leading number of population followed by Oromo which accounts 56 (15.4%) of the total study participants. Concerning the average monthly income of women attending epic services, around 167 (46.13%) of them have got more than 500 birr per month [12]. This is the highest proportion. Majority of the study subjects 153 (42.3%) were house wives in occupation followed by merchant women (14.9%) who were getting their income from trade and other activities. Women were also asked about the educational status of their husbands, the majority of those women were answered that their husbands were in secondary level 130 (35.9%).

It shows analysis of maternity experience of their children in Dilla University Referral Hospital, 2020.

About 240 (56.3%)women had at least two number of children and around 216 (59.6%) mothers had their last child of below 24 months old, which accounts the largest proportion with that of between 13-24 months old (146 (40.3%)). Among women having the last child, about 210 (58.01%) of them had a male infants among those respondents having the last child, about 130 (36.4%) were delivered their last 1-12 month child at Hospital assisted by 111 (30.6%) by a health professionals, 42 (11.6%) by TBA, 20 (5.5%) by non-trained traditional birth attendant [13].

Knowledge related analysis about breast feeding

Majority of the study subjects 228 (63.0%) have been ever advised or informed about breast feeding. The largest number of women attending EPI, which accounts 218 (60.22%), was heard t information from health workers.

Practice related analysis

Almost all studied women have ever breast fed their child. Among them around 320 (92.2%) had fed colostrum’s but 18 (4.97%) of them didn’t remember either they have fed or not. From those didn’t fed colostrum, majority (83.3%) have given plain water for their child? Concerning the current breast feeding status, about 233 (64.4%) of respondents have on breast feeding currently. Among respondents who are breast feeding now, near to 80.2% were fed not more than four times last night between sun set and sun rise. Starting from the date of birth up to the age of 6 months of the youngest child, 292 (80.66%) has fed nothing but 25 (6.9%) has fed cow’s milk. Other distributions of those mothers have fed their child listed in the following frequency distribution table. Considering exclusive breast feeding, about 329 (90.8%) of the respondents were fed their child up to 6 months or more but 33 (9.1%) of them were fed breast milk for at most 5 months. According to the mother’s opinion, the period of time that the child should breast fed is 6 months to 2 and half year which accounts 321 (88.6%) of the total respondents however, around 3.0% of them were not know how long the child should breastfed. About 296 (81.7%) of women included in the study were stopped breast feeding their last child between the age of 8 months to 2 years. When the mother were pregnant or after delivery the last child, about 228 (63%) of the respondents were informed about breast feeding but the rest were not informed or advised about it. From the total study subjects, around 218 (60.22%) were get help from health workers and they thought that BF helps for best growth of the child which accounts 262 (72.3%). In case of the advantage of BF for the mother most of the respondents were know that to prevent disease and pregnancy.

Breast milk is an ideal food for the healthy growth and development of infants and protects them from infections and their consequences. Promoting and supporting breastfeeding is a global priority. Extensive scientific literature shows the substantial health, social, and economic benefits associated with proper breastfeeding, including reduced morbidity and mortality in infants as a result of diarrhea and other infectious diseases. Breastfeeding practices are successful, starting within 1 hour of birth, 6 months of exclusive breastfeeding, timely and complementary breastfeeding with the right food, and continuous breastfeeding for more than 2 years or more. this study shows the largest proportion of study subjects had primary level of education (28.17%) and the knowledge of BF also depends on their level of education. The higher education becomes the higher knowledge about breast feeding. So, this study is consistence with the study conducted in developing countries.

Research in developing countries has shown that while most health care workers are generally good about breastfeeding, their knowledge of breastfeeding physiology and how to deal with breastfeeding is below standard. In addition, hospital practices of postpartum maternal separation, prelactal bottle feeding (“until breast milk arrives”), and lack of support for mothers with breastfeeding difficulties all play an important role in influencing the mother's attitude, when feeding babies. This study describes many factors associated with breastfeeding practices. These factors include maternal age, mother's education level, family household income, number of children, mother's knowledge about the benefits of breastfeeding, previous breastfeeding experience, attitude towards breastfeeding and the mother's social support network. Similarly, several studies were consistent with this study, which indicated that positive maternal breastfeeding attitudes are strongly correlated with maternal age, level of education, income, and marital status [14].

Based on the study findings, the following points are concluded,

Mothers who have a primary level of education have low breast feeding practice than that of those having a higher educational level. Women whose husband’s educational level also influences the breast feeding practice. The higher the educational level of the husband, the higher the practice of breast feeding.

Previous experience of breast feeding is good for the practice of breast feeding being facilitated.

Declarations section

Ethics approval and consent to participate.

Ethical clearance was obtained from Dilla Town Health office. The necessary explanation about the purpose of the study was given and informed consent was obtained from the recruited women’s a child less than two years. Confidentiality was maintained by omitting their name and personal identification.

Consent for publication

“Not applicable”

Availability of data and materials

“The data that support the findings of this study has a sort of identifier of individual participants and the researcher reserved to send it”

Competing of interest

All authors declare they have no conflict of interest.

Funding

“Not applicable”

Author contributions

YB has contributed in idea conception, topic selection, and writing of proposal for funding, contributed idea generation in title selection and AE contributed in organizing literatures important to the study, commented both proposal draft and results.

We are thankful for the data collectors, supervisor, study participants, Dilla Town, health biro office staffs.