Facility based cross-sectional study with internal comparison was performed in all public health centers in Addis Ababa, capital city of Ethiopia, in February 2011. The source population is all mothers with children eligible for vaccination in Addis Ababa. The study population included all mothers who attended a public health center for their children’s measles vaccination at nine months of age and the inclusion criteria were mothers who attended a public health center for their children’s measles vaccination during the data collection period.
The sample size was calculated by using a single population proportion formula considering the following assumptions: based on Ethiopian DHS 2011 prevalence of 52 % EBF, with 95 % confidence level and 4 % marginal error. Allowing for a 10 % non-response rate the total planned sample size was 660.
Data were collected using interviewer administered structured questionnaire. The questionnaire was adapted from the child health module of the Ethiopian DHS 2005 and other large-scale National Community Based Nutrition surveys. It assessed the study participants socio-demographic, reproductive and health service characteristics. The questionnaire was prepared in English and translated to Amharic by a panel of public health experts to check its consistency and conceptual equivalence.
Ten nurses were recruited as data collectors and they were trained for three days by the principal investigator on the objective of the study tool and data collection procedures. The interviews were conducted in the compound of a health facility after the mother received the service from immunization room. Each interview took about 15 min on average.
In the Addis Ababa health bureau there are ten sub cities and under these 27 public health centers available. All health centers except one were included in this study and the excluded health center was used for pretesting. The sample was proportionally allocated for each health center based on the number of children came for vaccination previous year.
All mothers who came to each facility for their children’s measles vaccination were invited and included until the required number obtained. The routine delivery of the health service was not disrupted during data collection period.
The principal investigator supervised the data collection regularly. Data were edited and coded manually before entering in to computer software. Double entry was done to reduce error during data entry.
The investigator used “since birth” method to calculate the prevalence of exclusive breastfeeding. The analysis was performed with the SPSS version 15 software package. The prevalence of EBF was calculated by taking mothers whose children were fed only breast milk until six months of age as numerator and all children nine months old whose mothers were interviewed as denominator. Sociodemographic and health service factor were presented with numbers and percentages. Bivariate and multivariate analysis was done to see association between EBF and factors to control for confounders respectively. All variables with p-value < 0.2 were entered in the multiple logistic model. The association was presented using crude and adjusted odds ratio with 95 % confidence interval. A p-value of < 0.05 was taken to be statistically significant.
Ethical approval was obtained from the University of Gondar. The necessary permission and letter of support to all the study health centers were obtained from Addis Ababa Region Health Bureau. Informed consent was obtained from each study participant after explaining the purpose of the study and assuring confidentiality of their responses. Participating in this research was on a voluntary basis and the risks were minimal.
Definition of terms
Exclusive breastfeeding since birth
An infant fed only breast milk from the mother or expressed breast milk, and not fed on any other liquids or solids with the exception of drops or syrups consisting of vitamins, mineral supplements, or medicines till six months.
Predominant breastfeeding
The infant’s predominant source of nourishment has been breast milk. However, the infant may also have received water and water-based drinks (sweetened and flavored water, teas, infusions, etc.), fruit juice, oral rehydration salts solution (ORS), drop and syrup forms of vitamins, minerals and medicines, and ritual foods (in limited quantities). With the exception of fruit and sugar water, no food-based fluid is allowed under this definition.
Partial breastfeeding
Giving a baby some breastfeeds, and some artificial feeds, either milk or cereal, or other food.
No breast milk
The infant receives no breast milk.