This study aimed to determine the prevalence of exclusive breastfeeding, including associated factors. Ninety-eight percent of mothers had ever practiced breastfeeding which is almost similar to the national and Oromia regional ever breastfeeding rate (96%) (94%) respectively [11, 17]. This study revealed that the prevalence of exclusive breastfeeding practice for infants less than six months old was 71.3%. This finding is similar to other countries such as Jordan (77%), Madagascar, (70%), Zambia, (74%), Ghana, (79%) and Bolivia (65%). This is also similar with findings in Amhara Region, (81%), Oromia Region, (62%) and South Nations and Nationalities Peoples Region (64%). But this finding is higher than the findings in Lebanon (10%), Bangladesh (36%) and the national exclusive breastfeeding prevalence in Ethiopia (49%) [7, 11, 17, 21, 22]. The median duration of exclusive breastfeeding for infants less than six months was three months. The median duration of exclusive breastfeeding in Ethiopia was documented with a wide range of variety from lowest (0.4 month for Afar Region) through the highest (4.3 months for Amhara region). Month-specific lifetime exclusive breastfeeding was assessed for those mothers with infants above six months who are currently breastfeeding and fed their infant nothing other than breast milk til six months of age. The majority (89%) of infants less than 2 months were breastfed exclusively, dropping to 17% when infants were 4–5 months of age. This finding is higher than the Ethiopian national month-specific exclusive breastfeeding rate of 67% for infants < 2 months and 32% for infants aged 4–5 months . Maternal educational status and exclusive breastfeeding did not show any significant association. This is contrary to the result obtained from the Ethiopian demographic health survey, which indicated a declining trend of exclusive breastfeeding practice with the higher maternal education status [6, 17].
The multivariable logistic regression analysis showed that age of infant was a predictor of exclusive breastfeeding practice. Infants in the age group < 2 months were about 6 times more likely to be exclusively breastfed when compared to infants in the age group 4–5 months. Infants in the age group 2–3 months were 2 times more likely to breastfeed exclusively when compared to those infants in the age group 4–5 months. As the age of the children approached 6 months, the rate of exclusive breastfeeding decreased significantly, which is similar to studies conducted in Iran, Uganda, Sudan, and Ethiopia [17, 23–25]. This might be due to the fact that post-partum care is traditionally given in the first few months after birth where mothers remain at home, creating a chance to exclusively breastfeed their infant. The other possible reason might be that mothers might have introduced complementary feeding for their infants due to the assumption that breast milk alone would not satisfy their needs as the infant gets older. As the age of the child increased, the rate of EBF decreased significantly, which is again in conformity with reports of studies done in Uganda, Pakistan and India [26–28]. This could probably be explained by the short birth interval/spacing and other economic factors. It can also be attributed to the fact that post partum care traditionally is given in the first few months when mothers are confined at home, creating an opportunity to exclusively breastfeed their child.
This study has indicated a significant difference among employed and unemployed mothers with regard to exclusive breastfeeding (33% vs 73%) and also revealed that unemployment of the mothers is a predictor of exclusive breastfeeding, which is consistent with the findings of several studies [29–32]. This might be explained by the fact of less maternity leave (two months after delivery in our context), which makes employed mothers have less opportunity to stay at home, compromising exclusive breastfeeding. Mothers also may have to leave their babies to search for a job. These findings call for policy arguments to initiate breastfeeding-friendly work environments, as well as the extension of maternity leave to encourage mothers to exclusively breastfeed their babies to improve child health outcomes .
This study can be interpreted in light of its strengths and limitations. The use of validated questionnaires, both quantitative and qualitative methods of data collection and data triangulation were the strengths of this study. However, the 24-hour recall to determine exclusive breastfeeding practice means some infants who were given other liquids regularly may not have received them in the last 24 hours before the survey, which may cause overestimation of the proportion exclusively breastfed. Similar findings were also observed in several studies, showing that the 24-hour recall method can overestimate the actual EBF rate in a population study and the one-day assessment overestimated exclusive breastfeeding rates among infants younger than 4 months. Similar findings were obtained in an analysis of the Ethiopia Demographic and Health Surveys 2000, where even larger discrepancies were found among children 4–6 months old between the 24-hour recall and the 7-day recall method . Several authors have questioned the validity of the 24-hour recall method [35, 36]. The major criticism of the 24-hour recall method is that it misclassifies too many mothers as exclusively breastfeeding [37, 38]; a proportion of mothers may be providing substances other than breast milk on an irregular, not daily, basis. Many studies have shown that a large proportion of infants who were exclusively breastfed in the previous 24 hours were either not exclusively breastfed during the previous seven days, and/or, not exclusively breastfed since birth [26, 38, 39]. Median duration can also be affected by maternal recall, which might be prone to recall and social desirability bias. Therefore, readers are recommended to take this into account during interpretation of these findings. There are also unusually large odds ratios and a wide confidence interval observed in this study. In addition, there are also some variables that were not significantly associated (however known in several studies) with the outcome of interest which might affect the precision. This might be due to the sample size, which might not be adequate to justify the relationships between the explanatory variables and outcome of interest, and the observed counts are also so small in some of the cells making the odds ratios so large and so wide. Therefore, any interpretation of this finding should take into account the degree of precision. In addition, this study used a cross-sectional study design, making it is difficult to establish causal associations. The fact that this study did not assess individual factors, including knowledge and attitude of mothers, as well as variables related to family and peers, are the limitations of our study.