The 2011 Ethiopian Demographic and Health Survey (EDHS) was conducted in the nine regional states of Ethiopia; namely Tigray, Afar, Amhara, Oromia, Somali, Benishangul-Gumuz, Southern Nations Nationalities and Peoples (SNNP), Gambella and Harari and two city Administrations named Addis Ababa and Dire Dawa. Ethiopia is one of the sub-Saharan countries found in the Horn of Africa with a population of 73.5 million according to the 2007 national housing and population census .
Data type and study design
This study is based on cross-sectional secondary data from the 2011 EDHS. The 2011 EDHS samples were selected using a stratified, two-stage cluster sampling design. In the first stage, the enumeration areas called clusters were selected with probability proportional to the enumeration area size with independent selection in each sampling stratum. In the second stage, a fixed number of 30 households were selected for each enumeration area. All women age 15–49 who were usual residents or who slept in the selected households the night before the survey were eligible. The survey data included a women’s questionnaire to measure socio-demographic characteristics of the mothers, information on reproductive health and service use behaviours. The tool was pretested and translated into three local languages - Amharic, Oromefa and Tigregna. The EDHS was designed to provide population and health indicators at national and regional levels. The survey is conducted every five years. The detailed methodology is found elsewhere .
The 2011 EDHS data were downloaded with permission from the Measure DHS website in SPSS format. After reviewing the detailed data coding, further data recoding was performed. A total of 11,654 live births in five years preceding the survey were included in the analysis. Based on the published literature, we extracted a wide-range of socio-demographic and economic variables, health service related factors and breastfeeding initiation. The chosen variables were residence, region, wealth index, education, husband education, occupation, age, birth order, parity, Provide antenatal care (ANC) attendance, place of delivery, type of delivery, birth interval, sex of child , awareness of community conversation (CC) program, family size and exposure to mass media (indexed from television (TV), newspaper and radio).
Measurement of variables
Timely initiation of breastfeeding was measured by asking mothers to provide information regarding the time at which their index infant was put to the breast after delivery. For this analysis, occupational status was defined as non-working and working. Any professional/technical/managerial, clerical, sales and services, skilled manual, unskilled manual and agriculture classifications were classified as working. Parity defined as the number of children ever born, was categorized as 1–4, 5–9 and 10+. Wealth index was constructed using household asset data via a principal components analysis to categorize individuals into wealth quintiles (poorest, poorer, middle, rich and richest). However, wealth index was re-categorized into three groups (poor, middle and rich) to give more meaningful and practical sub-population categories for designing program interventions in the general community. The Community Conversation (CC) program is a social mobilization method implemented in Ethiopia with an objective “to generate a response to HIV/AIDS and other health issues that integrates individual and community concerns, values, and beliefs and addresses attitudes and behaviours embedded in social systems and structures”. Trained facilitators lead community meetings over a ten month period to determine a plan of action for the community . Awareness of the CC program was measured by asking women whether or not they had heard of the CC program.
For all analysis, sample weights were applied in order to compensate for the unequal probability of selection between the strata defined by geographic location as well as for non-responses. A detailed explanation of the weighting procedure can be found in the EDHS methodology report . We used “svy” in STATA version 11 to weight the survey data and do the analyses.
Descriptive statistics were used to show the prevalence of timely breastfeeding initiation with background characteristics. Bivariate and multivariable logistic regression statistical analysis was carried out to determine the factors associated with timely breastfeeding initiation. Variables found statistically significant at p-value < 0.25 during bivariate analysis were then included in the multivariable logistic regression model . This p-value cutoff point prevented removing variables that would potentially have an effect during multivariable analysis. Both crude and adjusted odds ratios (COR and AOR) were reported with a 95 % confidence intervals (CI). Variables at p-value < 0.05 were considered statistically significant in the multivariable logistic regression model.
The data were downloaded and used after the purpose of the analysis was communicated and approved by Measure DHS. The original DHS data were collected in confirmation with international and national ethical guidelines. Ethical clearance for the original survey was provided by Ethiopian Public Health Institute (EPHI) Review Board, the National Research Ethics Review Committee (NRERC) at the Ministry of Science and Technology, the Institutional Review Board of ICF International, and the Center for Disease Prevention and Control (CDC).