Exclusive breastfeeding for the first six months is identified as one of interventions to reduce infant morbidity and mortality. Exclusively breastfed children have a much lower risk of infectious diseases than infants who receive other foods [5].
In this study, the rate of exclusive breastfeeding appropriate to the infant’s age was found to be 50.3%. This finding was similar to the 2011 EDHS report (52%) [9], and a study conducted in Ghana (51.6%) [12], but less than the study done in the community assessment finding by Essential Service for Health in Ethiopia (ESHE) in Amhara (87%), Oromiya (79%) and Southern Nation, Nationalities and Peoples Region (66%) [13]. This might be due to the fact that the city of Bahir Dar is not an area of focus for ESHE -the nongovernmental organization that works with local health offices on EBF employed as one strategy to reduce child mortality. However, the findings of this study illustrated higher rates than that of a study conducted in five East and South East Asian Countries (pooled EBF proportion of 35.8%), Malaysia (43.1%) and Nigeria (16.4%) [14–16]. Cross-cultural differences in breastfeeding practices may be part of the explanation.
When asked retrospectively, women with infants aged six months or more reported that only 45.3% had received EBF for six months. This finding was lower than studies done in Cambodia (51.3%), India (61.5%), Iran (56.4%), and Tanzania (58%) [17–20] but higher than that of Canada (13.8%), Thailand (11%), Saudi Arabia (12.2%), Egypt (9.7%) and Kenya (2%) [21–25]. Again cross–cultural differences in breastfeeding practices are likely. The other possible explanation for the variation in EBF practice found in different studies may be the different methods used for computing EBF. In this study we have used since birth dietary recall method which is not standard methods of computing EBF. Many studies such as Ghanaian study [12] showed a significant difference in determining EBF by 24-hour recall methods (a method of computing EBF by asking the respondents to recall what was offered to infants within the last 24 hours preceding the interview) and since birth dietary recall methods (70.2% versus 51.6%).
In this study child age, maternal occupation, prenatal EBF plan, place of delivery, mode of delivery and receiving counseling/advice on infant feeding were significantly and independently associated with the EBF practice in multiple logistic regression analysis.
This study revealed that child age was significantly associated with EBF practice. Infants in age group of 0-1 month and 2-3 months had an odds ratio of 3.8 and 2.8 respectively to receive EBF than whose ages were six months and above. This finding was consistent with the analysis of demographic health survey of Nigeria and Ethiopia [16, 26]. The possible explanations for this might be due to the fact that during this period there is a traditional postpartum rest that restricts women from working outside their home, which facilitates and creates favorable conditions for breastfeeding. Another explanation may be due to the short maternity leave in Ethiopia for government employers. There might be also short birth intervals that force the mother to discontinue EBF early.
In this study, housewives were more likely to practice EBF than any other occupations. This finding was consistent with the study done in Saudi Arabia [23], and similar to Canadian [21] and Malaysian [15] studies which showed a positive association between non-working mothers and EBF practice. This might be due to the fact that housewife mothers get to stay longer with their newborn so they may also breastfeed their newborn.
Prenatal EBF plan was also found to be one of the predictors of EBF practice. Mothers who had planned to provide EBF for their last child during pregnancy had an odds ratio of 3.8 to practise EBF compared to those who had not. This finding was in agreement with a study from Cambodia [17]. This might be attributable to planning, increased preparedness, and commitment to achieve EBF.
Place of delivery was one of the predictors of EBF practice. Mothers who delivered their last child at health facility were more likely to practise EBF compared to those who delivered at home. This result was consistent with other studies from Ghana, India, and Tanzania [12, 18, 20]. This might be due to the postpartum breastfeeding counseling and support provided at the health facility as part of discharge practices. In addition, mothers who gave birth vaginally were more likely to practise EBF than those who gave birth by caesarean section. This finding was consistent with a study from Canada [21].This might be due to the fact that caesarean section related pain and discomfort may prevent mothers from practising EBF.
Receiving infant feeding counseling/advice was also associated with EBF practice. Those mothers who received EBF counseling/advice were more likely to practise EBF than those who did not. Similar results were found by the study conducted in India [18]. This suggests that counseling/advice is effective in improving maternal knowledge and facilitates breastfeeding.
Limitations
Since we have used the dietary recall since birth method, we might have introduced recall bias, as the mothers might not have recalled accurately when they introduced a food item.
This may under- or over-estimate the true prevalence of EBF. It is also difficult to establish a temporal relationship as the study design was cross-sectional. Despite these limitations, the findings from this study will contribute to the understanding of the factors associated with the EBF practice in the study area.