Exclusive Breastfeeding Practice and Associated Factors among Mothers Having Infants (Aged 0-6 Months) in the Pastoral Community of Sawena District, Bale Zone Oromia, Ethiopia, 2023

Exclusive Breastfeeding Practice and Associated Factors among Mothers Having Infants (Aged 0-6 Months) in the Pastoral Community of Sawena District, Bale Zone Oromia, Ethiopia, 2023 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exclusive Breastfeeding Practice and Associated Factors among Mothers Having Infants (Aged 0-6 Months) in the Pastoral Community of Sawena District, Bale Zone Oromia, Ethiopia, 2023 Dursa Hussein, Derara Girma, Befekadu Tesfaye Oyato, Belete Birhanu, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4076682/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Breastfeeding is the easiest, healthiest, and most cost-effective feeding method forinfants. Despite the promotion of exclusive breastfeeding, its importance is poorly understood in pastoral communities. Little information is available on the practices and factors underlyingexclusive breastfeeding, especially in pastoral communities in the Sawena district, Bale zone, Oromia region, and Ethiopia. Objective: This study aimed to assess the prevalence of and factors associated with exclusive breastfeeding among mothers with infant (aged 0-6 months) in pastoral communities in the Sawena district, Bale Zone, Oromia Region, SoutheastEthiopia, 2023. Method: A community-based cross-sectional study design was employed from March 01 to April 2023. A total of 631 women were selected using simple random sampling. The data were collected through face-to-face interviews. The collected data were entered into Epi Data software version 4.6 and subsequently exported into SPSS version 26 for analysis. Variables with a P value < 0.25 in the bivariate analysis were included in the multivariable logistic regression model. The degree of association was expressed using adjusted odds ratios (AOR) with a 95% confidence interval (CI) of < 0.05. Results: Out of 631 eligible mothers, 625 participated in this study, for a response rate of 99.0%. The prevalence of exclusive breastfeeding (EBF) practices among mothers in the study area was 53.8% (95% CI; 49.8%–57.4%). Household food security status [AOR=1.6, 95% CI (1.1-2.2)], ANC follow-up during pregnancy, [AOR = 5.3, 95% CI (2.4-11.9)], counselling about EBF during ANC visits[AOR=5; 95% CI (2.1-11.7)], number of children [AOR =1.6, 95% CI (1.1-2.3)] and attitudes toward EBF [AOR= 1.8; 95% CI (1.4-2.6)] were significantly associated with EBF. The majority of interviewees explained that there were various reasons why exclusive breastfeeding was not practiced, including beliefs that breast milk was insufficient, giving babies water would reduce colic, and fears of food refusal. Conclusion: The prevalence of exclusive breastfeeding practices in the study area was lower than the country-recommended level. Household food security status, ANC follow-up during pregnancy, counselling about breastfeeding during ANC, number of children and attitude toward EBF practice were significantly associated with EBF. BF counselling during ANC services can be provided to mothers to improve their BF knowledge and subsequently improve their EBF practices. Exclusive breastfeeding practice infants aged 0-6 months associated factors Sawena district. Figures Figure 1 INTRODUCTION Exclusive breastfeeding (EBF) is defined as giving a baby just breast milk for the first six months of its life, without any additional food, drink, or water—aside from prescription drugs or vitamin and mineral supplements [ 1 ]. The World Health Organization (WHO) and the United Nation Children’s Fund (UNICEF) recommend initiation of breastfeeding within the first hour after birth; EBF should be done from the first six months of age and breastfeeding should continue until two years old or beyond, with adequate complementary foods [ 1 ]. EBF is an important public health strategy for improving children’s and mother’s health by reducing child morbidity and mortality and helping to control healthcare costs in society [ 2 ]. Moreover, one of the main tactics supporting the most well-known and successful intervention for preventing early childhood deaths is EBF [ 3 ]. In addition to its positive impact on the mother-child bond, breastfeeding reduces the risk of a number of childhood diseases, including pneumonia, ear infections, diabetes mellitus, diarrhea, and sudden infant death syndrome [ 4 ]. The World Health Assembly (WHA) has set a global target in order to increase the rate of EBF for infants aged 0–6 months up to at least 50% in 2012–2025 [ 5 ]. Adherence to these guidelines varies globally, only 38% of infants are exclusively breastfed for the first six months of life [ 6 ]. High-income countries such as the United States (19%), United Kingdom (1%), and Australia (15%) [ 7 ]. have a shorter breastfeeding duration than nations with middle-class and lower-class incomes. Only 37% of newborns under six months old are exclusively breastfed, even in low- and middle-income nations [ 8 ]. According to recent papers in the sub-Saharan Africa region, only 53.5% of infants in east African countries were EBF for six months which is way below the WHO target of 90% [ 3 ]. In Ethiopia approximately half (52%) of children less than six months old are exclusively breastfed. The practice of EBF at age 0–1 month is 70%, 55% at 2–3 months and 32% among 4–5-month-old infants [ 9 ]. Despite all the recognized benefits and efforts to promote EBF, practice is still far from recommended levels. In Ethiopia out of 97% of breastfeeding, only 58% of mothers exclusively breastfeed. This number drops to 36% in infants aged 4–5 months [ 10 ]. Several associated factors have been identified with exclusive breastfeeding practices. Sociodemographic, environmental, and health facility-related factors are among the frequently cited factors[ 11 ]. The Ethiopian government has taken several steps to improve exclusive breastfeeding practices. The National Strategy on Infant and Young Child Nutrition, National Nutrition Program I and II, has been developed by the Government of Ethiopia to promote and improve the practice of exclusive breastfeeding during the first six months of life in collaboration with various stakeholders [ 12 ]. In addition, non-governmental organizations are also addressing the issue of optimal breastfeeding in different parts of the country through advocacy, community mobilization and the press [ 13 ]. Pastoralists comprise a significant part of Ethiopia’s population, but the promotion of exclusive breastfeeding less than 6 months of age and its importance is poorly understood in pastoral communities [ 14 ]. Moreover, there is little information on the practice and factors associated with EBF less than 6 months of age in pastoral communities. In addition, information on the implementation and determinants of EBF in pastoral communities, especially pastoral areas are lacking and needs to be planned and intervened accordingly. To promote the benefits of EBF to the community, as well as to apply EBF properly to reduce the health impact, morbidity of infants and influence on economic grows due to not use of EBF properly. Therefore, the aim of this study was to assess the prevalence of EBF and associated factors among women who have a child aged < 6 months in the study area. METHODS Study design, period, and setting A community-based cross-sectional study design was employed from March 01 to April 2023. In pastoral communities in the Sawena district, Bale Zone, Oromia Region, Southeast Ethiopia, among mothers of infants aged 0–6 months were included. The Sawena district is approximately 675 KMs Southeast east of Addis Ababa, with a latitude and longitude of 7° 23 ’ N 41° 16’ E and an elevation of 1161 meters. The estimated population size is 98751, 46,518 (47%) of which are males and 52,233 (53%) of which are females. Approximately 4% (2089) of the total female women had babies less than 6 months old, and approximately 37% (17211) had babies. This district has 30 kebeles, 5 health centers, 32 health posts, 4 primary clinics, and 2 private drug stores. Different obstetric services, such as FP, ANC, delivery services, PNC, and counselling services, were provided at those health facilities. The majority of the climate conditions are dry (kola), 1/3 of the area is temperate (woynadaga), and Khat, peppers, fruits, Teff, and wheat are important cash crops for this woreda. Regarding occupation, the majority of the people in rural areas are pastoralists, and farmers dominate in rural areas. Population All mothers who had infants (aged 0–6 months) in the Sawena district pastoral community were the source of the population. The study population consisted of randomly selected mothers who fulfilled the inclusion criteria. For the qualitative part, health care professionals from maternal and child health care delivery, health extension workers, traditional birth attendants (TBAs), and developmental health armies were purposively selected. Inclusion and Exclusion Criteria Inclusion criteria : All mothers who had infant (aged 0–6 months) and had been residents of the study areas for more than six months during the data collection period. Exclusion criteria Children with evidence of chronic health problems and mothers who were unable to communicate or were seriously ill and unable to provide information were excluded from the study. Sample size determination The sample size was determined using the single population proportion formula for the Epi Info STAT CALC cohort. version 7.2.4 Based on the assumptions of a 95% confidence level (CL), a 52% proportion of EBF practices[ 15 ], and 5% marginal error from the study conducted among mothers who had infant (aged 0–6 months) in the Somalia Region, Ethiopia, a 10% nonresponse and a 1.5 design effect, the final sample size was 631 mother–infant pairs. Sampling procedure A multistage, simple random sampling technique was used to select the study participants. In the first stage, nine kebeles were selected randomly from 30 kebeles in the districts. In the second stage, from the selected kebeles, a list of all eligible mothers with their households (HHs) in each selected kebele was obtained from the kebele health post by using family folders collaborating with health extension workers (HEWs). The sample size for each selected kebele was determined proportionally to the number of eligible HHs within each selected kebele. Finally, a simple random sampling technique was used to select the required number of eligible mothers from each kebele by using the HH listed as a sampling frame, which was obtained from family folders. If eligible mothers were not present at the time of data collection, a return visit was arranged a minimum of three times during the time of the HH survey. Data collection procedures (tools, techniques and personnel) A structured, closed-ended questionnaire developed from different kinds of literature [ 4 , 9 , 15 ] was used. The questionnaires consisted of six parts: sociodemographic factors, household food security status, infant and maternal health service utilization, knowledge about breastfeeding, attitudes towards EBE, and EBF practices. The data were collected through face-to-face interviews. Seven data collectors and one supervisor participated in the data collection process. Study variables Dependent variable Exclusive breastfeeding practice Independent variable Sociodemographic factors (maternal age, marital status, maternal education level, Mom’s occupation, and maternal knowledge of breastfeeding). Factors related to obstetrics and health services (parity, prenatal care, breastfeeding advice during pregnancy, place of birth, and how to give birth). Infant-related factors (infant age, infant sex, birth spacing) Economic factor wealth index. Household Food Security Status Attitudes toward EBF Operational definition Exclusive breastfeeding means feeding your baby only breast milk, not any other foods or liquids (including infant formula or water), except for medications or vitamin and mineral supplements [ 11 ] Wealth Index : The wealth index was computed for owner ships of different assets, house characteristics and types of animals. The resulting wealth indices were categorized into three categories: lowest, middle, and highest [ 4 ]. Practice of EBF - If a mother gives her only breast milk for her infant for the full 6 months, no other liquids or solids except vitamins, mineral supplements, or medicines until she is born for 6 months [ 9 ] Data quality assurance The questionnaire was pretested on 5% of the sample at Micha Kebele. The questionnaire was modified to enhance the consistency of understanding by the respondents as well as by the data collector. The data collectors were trained by the principal investigator about the general purpose of the study and the data collection procedures. The structured questionnaire was prepared first in English and then translated to the local language (Afan Oromo) by language experts. Finally, the data were checked for completeness before being entered into computer software for analysis. For the qualitative part, in-depth interviews and key informant interviews were facilitated by the moderator, and adequate field notes were taken by experienced note-takers. The interviews were tape-recorded and transcribed daily word by word. Furthermore, before deployment in the field, the completeness, accuracy, and clarity of the collected data were checked carefully. Any ambiguity or incompleteness encountered was addressed on the following day before starting the next day activities. Data processing and analysis The data were entered, cleaned and edited using EPI-data 4.6 and subsequently transferred to SPSS version 26 for further analysis. Descriptive statistics such as frequency, percentage, mean and standard deviation were calculated. Binary logistic regression was performed to assess the crude relationship between the independent variables and the dependent variable. All variables with a P value < 0.25 were candidates for multivariate logistic regression to control for possible confounding effects. The multicollinearity was checked with variance inflation factors (VIFs) and tolerance tests, which had VIFs less than 5 and tolerance tests less than 1; these values were used as cut-off points for diagnosing multicollinearity. Model fitness was checked using the Hosmer and Lemeshow goodness-of-fit model, and the results were fitted (p value = 0.5). The final results of the associations are presented as AORs with 95% CIs, and a p value < 0.05 was considered to indicate statistical significance. Qualitative field notes were taken during the data collection session in addition to the tape recorder, after which the notes from all in-depth interviews were compiled and labelled according to participant type. The qualitative data were analysed using thematic analysis. The analysis started by transcribing into Afan Oromo from records and then translating the results to the English language. The transcribed data were read carefully, categorized, and summarized manually. Ethical considerations The study protocol was approved, and an ethical approval was provided by the Ethical Review Board of the Oromia Regional State Health Bureau (reference number IRB/688/15). The study was performed in accordance with the World Medical Association Declaration of Helsinki on medical research. Written informed consent was obtained from every study subject before the data collection. All the information collected from the study participants was handled confidentially by omitting their identification. RESULTS Sociodemographic Characteristics of Hypertensive Patients Out of the 631 eligible mothers, 625 participated in this study, for a response rate of 99.0%. The age of the mothers included in this study ranged between 17 and 40 years, with a mean age of 26.7 (SD = ± 4.2) years. Concerning ethnicity, 542 (86.7%) study participants were Oromo, while the majority (576; 92.2%) were religious Muslims. Regarding the educational status of mothers, the majority (64.2%) of them could not read or write. Almost all of the mothers, 615 (98.4%), were legally married. The majority of the respondents (225; 36.0%) were in the second wealth quintile group (Table 1 ). Table 1 Sociodemographic characteristics of mothers with infants (aged 0–6 months) in the pastoral community of the Sawena district east bale zone Oromia southeastern Ethiopia, 2023. Variables Categories Frequency(n) Percent (%) Age of mother (years) 15–19 20–24 25–29 30–34 ≥ 35 26 172 275 132 20 4.2 27.5 44.0 21.1 3.2 Marital status Married Separated 615 10 98.4 1.6 Ethnicity of mother Oromo Somali Amara 542 80 3 86.7 12.8 0.5 Religion of mother Muslim Orthodox Protestant 476 38 11 92.2 6.1 1.8 Educational status mother Unable to read and write Primary education Secondary education College and above 401 161 31 32 64.2 25.8 5.0 5.1 Education of husband (n = 615) Unable to read and write Primary education Secondary education College and above 221 270 59 65 35.9 4.9 9.6 10.6 Wealth Index Highest Middle Lowest 212 225 188 33.9 36.0 30.1 Household Food Security Status Based on the calculated household food security, a total of 341 (54.6%) of the sample households were food secure, and a total of 284 (45.4%) of the sample households were food insecure in the study area (Table 2 ). Table 2 Household food security status in the pastoral community of the Sawena district East Bale Zone Oromia, southeastern Ethiopia, 2023. Variables Categories Frequency(n) Percent (%) Worried about household would not have enough food (the past month) No Often Rarely Sometime 84 5 376 160 13.4 0.8 60.2 25.6 Household member not able to eat the kinds of foods you preferred (the past month) No Rarely Sometime 89 376 160 14.2 60.2 25.6 Household members have to eat a limited variety of foods due to a lack of resources (the past) No Often Rarely Sometime 121 6 313 185 19.4 1.0 50.1 29.6 Household members have to eat some foods that they did not want to eat (the past month) No Rarely Sometime 131 314 180 21.0 50.2 28.8 Household members have to eat a smaller meal than they felt you needed (the past month) No Often Rarely Sometime 124 3 346 152 19.8 0.5 55.4 24.3 Household members have to eat fewer meals in a day (the past month) No Often Rarely Sometime 196 11 285 133 31.4 1.8 45.6 21.3 No food to eat of any kind in your household (the past month) No Often Rarely Sometime 526 9 5 85 84.2 1.4 0.8 13.6 Household members go to sleep at night hungry (the past month) No Often Rarely Sometime 554 7 6 58 88.6 1.1 1.0 9.3 Household members go a whole day and night without eating anything (the past month) No Rarely Sometime 550 3 72 88.0 0.5 11.5 Overall household food security status Food secure Food in secured 317 308 50.7 49.3 Infant and Maternal Health Service Utilization Characteristics The majority (579; 92.6%) of the mothers had ANC visits during their recent pregnancy and were counselled about breastfeeding. The majority (524, 83.8%) of the mothers gave birth to their last child in health facilities (Table 3 ). The qualitative findings proved that the majority of the interviewees mentioned the ideal desire for exclusive breastfeeding, and most of the women interviewers mentioned, “Breastfeeding is our culture”. However, they perceived mixed feeding rather than exclusive breastfeeding. A 34-year-old breastfeeding mother said, “We have been informed by health professionals that giving cow’s milk and other foods, even water, to infants less than six months old is unnecessary” . "Even though most mothers receive breastfeeding counselling and antenatal care, they did not apply exclusive breastfeeding practices properly," the women interviewees confirmed. The MCH focal person described exclusively breastfed babies as having higher intelligence, being physically stronger, and being protected from illness. Babies who were exclusively breastfed were said to be much healthier than those who began consuming extra meals or liquids before the age of six months. Table 3 Infant and maternal health service utilization characteristics of study participants in the pastoral community of the Sawena district in the eastern Bale zone in southeastern Ethiopia, Oromia, 2023. Variables Categories Frequency(n) Percent (%) Any breastfeeding problems Yes No 265 360 42.4 57.6 What was the problem (n = 265) Abscess. Mastitis Sore/cracked nipples 60 116 89 22.6 43.8 33.6 Number of children 1–2 3–5 6–8 227 360 38 36.3 57.6 6.1 Birth order of infant First Second Third Fourth and above 52 167 178 228 8.3 26.7 28.5 36.5 Birth interval (years) (n = 573) 1–2 3–4 549 24 95.8 4.2 ANC services Yes No 579 46 92.6 7.4 Counselled about breastfeeding during ANC Yes No 579 46 92.6 7.4 Place of birth Health facility Home 524 101 83.8 16.2 Mode of delivery C/S Vaginal 17 608 2.7 97.3 Postnatal care Yes No 364 261 58.2 41.8 Age of infant (months) 1–2 3–4 5–6 259 288 78 41.4 46.1 12.5 Sex of infant Males Females 402 223 64.3 35.7 Attitudes toward exclusive breastfeeding practice Of the 625 respondents, 609 (97.4%) agreed that EBF is necessary for their baby. In addition, 20 (3.2%) of the respondents considered breastfeeding to have cosmetically affected mothers’ shape. The majority of them (22) (35.8%) considered household economic capacity to determine mothers’ breastfeeding practices. The overall attitudes of the study participants showed that 319 (51.0%) of the respondents had positive attitudes toward EBF practices (Table 4 ). Table 4 Attitudes toward exclusive breastfeeding among mothers with infants aged less than six months in the pastoral community of the Sawena district in the eastern Bale zone in southeastern Ethiopia, Oromia, 2023. Variables Categories Frequency(n) Percent (%) Breastfeeding is good for my baby Disagree Neutral Agree 11 5 609 1.8 0.8 97.4 Breastfeeding is not good because cosmetically affects the mother’s shape. Disagree Neutral Agree 551 54 20 88.2 8.6 3.2 Maternity leave of three months is enough to successful breastfeeding. Disagree Neutral Agree 520 65 40 83.2 10.4 6.4 The household economic capacity determines the mother Breastfeeding practice. Disagree Neutral Agree 214 187 224 34.2 29.9 35.8 Breast-feeding has an advantage to the mother because it prevents pregnancy Disagree Neutral Agree 88 69 468 14.1 11.0 74.9 Breast-feeding the baby helps the child to grow well. Disagree Neutral Agree 88 23 514 14.1 3.7 82.2 Your husband support is needed for you to breastfeed your child Disagree Neutral Agree 319 25 281 51.0 4.0 45.0 Your family members support is needed for you to breastfeed your child? Disagree Neutral Agree 315 151 159 50.4 24.2 25.4 Overall attitudes score Positive attitude Negative attitude 319 306 51.0 49.0 Exclusive breastfeeding practice The prevalence of exclusive breastfeeding practice was 53.8%, within the 95% CI (49.8–57.4%). Among mothers who did not exclusively breastfeed their infant, the main reasons mentioned were that the perception of breast milk alone was not sufficient for 323 infants (51.2%) (Fig. 1 , Table 5 ). Table 5 Breastfeeding practices of mothers with infants aged less than six months in the pastoral community of the Sawena district in the eastern Bale zone in southeastern Ethiopia, Oromia, 2023. Variables Categories Frequency(n) Percent (%) Infant feeding practice one day before the survey Exclusively breastfeeding Mixed breastfeeding 336 289 53.8 46.2 Extra liquid/solid food given for their child in the previous 24 hours Yes No 32 599 5.1 94.9 Mentioned what they gave (n = 32) Butter Sugar with water 26 6 81.3 18.7 The reason of giving additional food to infant Breast milk only not sufficient Breast produce less milk 26 6 81.3 18.7 The qualitative findings proved that the majority of the interviewees mentioned that breastfeeding is important for the infant, but breastfeeding alone may not be sufficient for the infant until 6 months. Therefore, the mother should give additional food to her baby; otherwise, the baby should be starved, and the baby may refuse to consume food if he/she does not start early. An old woman from the health developmental army states that “mothers must care for their children by giving breast milk and other additional food after 4 months unless the baby may refuse food after 6 months if she/he didn’t start food early for her baby”. A 28-year-old from the health developmental army said that “only breast milk may not be sufficient for the baby until 6 months, so giving additional food and water after 4 months is important for the baby”. Some of the interviewees mentioned that early initiation and exclusive breast feeding are important for the baby and the mother, so the baby must consume only breast milk until 6 months, but after 6 months, the baby should consume additional food because after 6 months, only breast milk may not be sufficient”. An old TBA said that “As soon as the child is delivered, breast milk giving is necessary. The infant should only consume breast milk from birth to six months of age” . A 28-year-old multiparous woman interviewer states that “I had never practised EBF in two of my babies because I believe the breast milk is not sufficient but for the third baby, I gave only breast milk for 6 months because the doctor told me to give only breast milk for 6 months”. Another 34-year-old interviewer said, “I understand that the child should be breastfed for 6 months without mixing, but the problem is that he may refuse to take other food after 6 months”. Factors associated with exclusive breast feeding Variables associated with a significance level of p < 0.25 in the bivariate analysis were considered candidates for the final multivariate analysis to determine their significant association with the practice of EBF. The independent predictors of EBF status included maternal educational status, household food security status, knowledge about EBF, number of children, birth order, birth interval, ANC follow-up, counselling about EBF during ANC service, place of birth, counselling about EBF during PNC service, attitudes toward EBF, and wealth index status. The final predictors of EBF practices were household food security status, ANC follow-up during pregnancy, counselling about EBF during ANC services, number of children, and attitudes toward EBF. Mothers with a household food security status were 1.6 times more likely to practice good EBF than were those who were food insecure [AOR = 1.6, 95% CI (1.1–2.2)]. Mothers who had ANC follow-up data were 5.3 times more likely to practice EBF than women who had no ANC follow-up data [AOR = 5.3, 95% CI (2.4–11.9)]. Additionally, mothers who received counselling about EBF during ANC follow-up were 5 times more likely to practice EBF than mothers who did not receive such counselling (AOR = 5; 95% CI (2.1–11.7)) (Table 6 ). Table 6 Bivariate and multivariate logistic regression analyses showing factors associated with EBF practices among mothers of infants aged (0–6 months) in the pastoral community of the Sawena district in the eastern Bale zone in southeastern Ethiopia, Oromia, 2023. Variables EBF Practice COR (95% CI) AOR (95% CI) P Value Yes (%) No (%) Mother’s Educational level Unable to read and write Primary Secondary College and above 138(41.1) 154(45.8) 19(5.7) 25(7.4) 263(91.0) 8(2.8) 11(3.8) 7(2.4) 1 37.0[0.01–0.06] 3.3[0.1–0.6] 6.9[0.1–0.3] 1 0.02[0.01–1.5] 0.2[0.07–1.4] 1.1[0.06–2.3] 1 0.1 0.11 0.21 household food security status Food secured Food in secured 184(54.8) 152(45.2) 133(46.0) 156(19.4) 1.4[1.1–1.9] 🞹 1 1.6[1.1–2.2] 1 0.008 🞹🞹 1 Knowledge Knowledgeable Not knowledgeable 99(29.5) 237(70.5) 99(34.3) 190(65.7) 0.8[0.6–1.1] 1 1.2[0.8–1.7] 1 0.3 1 Number of children 1 2–4 ≥ 5 133(39.6) 181(53.9) 22(6.5) 94(32.5) 179(69.9) 16(5.5) 1.03[1.0-1.9] 🞹 0.73[0.5–2.1] 1 1.6[1.1–2.3] 1.1[0.5–2.4] 1 0.006 🞹🞹 0.637 1 Birth order of infant First Second Third Fourth and above 22(6.5) 102(30.5) 104(30.9) 108(32.1) 30(10.4) 120(41.5) 65(22.5) 74(25.6) 0.5[0.4–1.5] 0.6[0.3–0.9] 1.1[0.3-1.0] 1 1.3[0.6–2.6] 1.2[0.8–2.1] 0.7[0.4–1.2] 1 0.54 0.37 0.16 1 Birth interval 1–2 3–4 305(97.1) 9(2.9) 244(94.2) 15(5.8) 2.1[1.1–4.9] 1 1.7[0.1–12.8] 1 0.42 1 ANC service Yes No 321(95.5) 15(4.5) 258(89.3) 31(10.7) 2.6[1.4–4.9] 🞹 1 5.3[2.4–11.9] 1 0.001 🞹🞹 1 Counselled about breastfeeding during ANC No Yes 33(9.8) 303(90.2) 13(4.5) 276(95.5) 1 2.3[1.2–4.9] 🞹 1 5.0[2.1–11.7] 0.001 🞹🞹 Place of birth Health facility Home 286(85.1) 50(14.9) 238(82.4) 51(17.6) 1.2[0.8–1.9] 1 1.1[0.5–2.4] 1 0.29 1 Attitudes towards EBF Positive attitude Negative attitude 186(55.4) 150(44.6) 120(41.5) 169(58.5) 1.8[1.3–2.4] 🞹 1 1.8[1.4–2.6] 1 0.001 🞹🞹 1 Wealth index Quintile 1 Quintile 2 Quintile 3 119(35.4) 123(36.6) 94(28.0) 93(32.2) 102(35.3) 94(32.5) 1.3[0.7–1.5] 1.2[0.9–1.9] 1 1.9[1.1–3.2] 0.9[0.5–1.6] 1 0.9 0.87 1 Discussion The purpose of this study was to assess EBF practices and associated factors among exclusive breastfeeding mothers during the first six months of life. This study revealed that the prevalence of EBF in the pastoral community of Sawena District was 53.8%, within a 95% CI (49.8–57.4%). These findings are similar to those of studies conducted in North West Ethiopia Mecha district (47.1%); Somalia region (52.0%); and other countries, such as Tanzania which had a prevalence of 55.0%, and Indonesia (51.2%) [ 7 , 16 – 18 ] respectively. This percentage was lower than that reported in Debrebirhan (68.8%), Ambo (82.2%), Halaba (70.5%), Hawassa (60.9%) and Dubti afar (81.1%) respectively [ 14 , 19 – 22 ]. It was also lower than that reported in the 2019 mini-EDHS results, which was 59%, [ 23 ] and that reported in other countries, such as West Mamprusi District in Northern Ghana (84.3%) [ 4 ]. Conversely, this number was greater than that reported in studies performed in Addis Ababa (29.3%).[ 24 ] Bangladesh (35.9%) [ 25 ] and Saudi Arabia (31.1%) [ 26 ]. Variations in healthcare coverage and health service accessibility may be the cause of this disparity. Another explanation can be the differences in the researchers' study time and design. Disparities in health care service utilization, sociocultural backgrounds, and economic status may have contributed to these variations both nationally and internationally. Among the variables identified in the multivariate analysis, household food security status, ANC follow-up during pregnancy, counselling about EBF during ANC, number of children and attitudes towards EBF were significantly associated with EBF. The present study revealed that mothers with a household food security status were 1.6 times more likely to practice good EBF than mothers who were food insecure. This study is supported by other studies conducted in Ethiopia [ 3 ] and Bangladesh [ 27 ]. A possible explanation may be that when a household is food secure, meaning that it has consistent access to an adequate quantity and quality of food, it can positively impact a mother's ability to exclusively breastfeed her child. Food security ensures that the mother has the necessary nutrition to sustain her own health and produce breast milk of sufficient quality and quantity to meet her infant's needs. In contrast, households experiencing food insecurity may face challenges in providing adequate nutrition for both the mother and the infant, which can potentially impact the practice of exclusive breastfeeding. Another factor that was shown to have a significant association with EBF is the number of children. Mothers who had only one child were 1.6 times more likely to EBF their infants than were those who had five or more children. This finding is similar to those of studies conducted in Debre Markos, Northwest Ethiopia [ 11 ], the Mecha district, Northwest Ethiopia [ 17 ] and other regions, such as Tanzania [ 5 ] and Nepal [ 28 ]. This may be due to time and attention, which means that mothers with only one child may have more time and attention available to focus on breastfeeding and caring for their infant. With fewer children to whom to attend, they may have fewer competing demands and more flexibility to dedicate themselves to EBF. This study also revealed that mothers who had ANC follow-up practices EBF better than mothers who did not. This finding is similar to those of studies performed in Northwest Ethiopia [ 9 ], Ambo [ 20 ] Halaba [ 21 ]and Dubti afar.[ 14 ] Moreover, in other countries, such as Tamandu, India [ 29 ], and Indonesia [ 18 ], this could be because mothers who attended ANC visits may receive different nutritional and other health-related education from health professionals during their follow-up appointments, which could have a significant impact on EBF. This effect might be attributed to the counselling provided to mothers regarding the importance of breastfeeding in health facilities during service delivery. Mothers who received counselling about breastfeeding during ANC were 5 times more likely to exclusively breastfeed their infants than were those who did not receive counselling. Similar findings were observed in Dubti town, afar regional state, northeast Ethiopia, Somali region of Ethiopia, Mecha District, North West Ethiopia [ 15 , 17 – 18 ] and in other counties, such as Tanzania, Bangladesh, Nigeria and India [ 5 , 25 , 29 – 30 ]. A possible explanation may be that since ANC follow-up is a continuing process, mothers could receive much information, and this information may increase the knowledge and attitudinal changes regarding neonatal feeding practices, as well as the nutritional benefits of breast milk for the health of mothers and newborns. Mothers who had positive attitudes toward EBF were more likely to practice EBF than were those who had negative attitudes. This study is supported by other studies conducted in Ghana, a systematic review conducted in East Africa and Nigeria [ 2 , 5 , 8 ]. Possible reasons for this association may be that beliefs and perceptions of EBF-related attitudes reflect beliefs about the benefits and importance of breastfeeding for the health and well-being of both mothers and infants. Mothers who hold positive attitudes may have stronger beliefs about the nutritional value, bonding benefits, and immune-boosting properties of breast milk. These beliefs can motivate them to prioritize and commit to practicing EBF. Strengths and limitations of the study Strength of the Study The data were collected through both quantitative and qualitative research approaches, which adds value to strengthen the study design. The study was conducted in a general population that may be representative of other rural communities or pastoral communities in Ethiopia. Limitations of the study As a cross-sectional study, a cause-and-effect relationship cannot be established to identify an actual predictor. Since the data were self-reported, there may be social desirability bias and recall bias. Conclusion The prevalence of EBF found in this study was lower than the WHO recommended level. This figure is also lower than the national figure reported by the 2019 mini-EDHS. Household food security status, ANC follow-up during pregnancy, counselling about breastfeeding during ANC, number of children and attitude toward EBF practice were significantly associated with EBF. Most of the interviewees believed that breastfeeding is important for the baby, but they thought it was not sufficient for the baby until 6 months. The most common reason for not practising EBF is due to differences in perception of the community; for example, if only the breast is not sufficient, babies might be thirsty unless they drink water, give water decreases or cause infantile colic, give only breastmilk to the baby to affect the mother, and waste the baby; otherwise, the baby may refuse food if she does not start early. Recommendations Based on the findings of this study, the following points are recommended: To Oromia Regional Health Bureau and NGOs Train health workers to ensure that they have accurate and up-to-date information on infant feeding in general and breast feeding/EBF in particular, which can help them to have the specific knowledge and skills required to educate and counsel mothers to improve EBF practices. Suitable IEC materials for BFs should be developed to teach mothers at the home and facility levels. Availing family planning at all health facilities for spacing pregnancies can positively impact breastfeeding outcomes, as it allows for optimal maternal health and milk production, increasing the likelihood of successful EBF. To the East Bale Zonal Health Department and District Health Office There is a need to expand and strengthen maternal health services, specifically antenatal and postnatal care services, in line with the expansion of existing health services. To health care providers Maternal health services, specifically ANC and PNC services, should be strengthened and promoted to address all eligible individuals. EBF counselling is an important part of all maternal and child health services, such as ANC, PNC, FP, vaccination and the IMNCI, for providing health education and counselling to mothers to improve their BF knowledge and subsequently improve their EBF practices To Researchers Further analytical studies, especially follow-up studies, are suggested to explore the actual levels of EBF and to further examine variables associated with this practice. Abbreviations ANC: Antenatal Care, AOR: Adjusted Odds Ratio, CL: Confidence Level, COR: Crude Odd Ratio, EBF: Exclusive Breastfeeding, EDHS: Ethiopian Demographic Health Survey, HSDP: Health Sector Development Program, UNICEF: United Nation International Children’s Emergency Fund, WHO: World Health Organization. Declarations Ethical approval and consent to participate The study protocol was approved, and an ethical approval letter was provided by the Ethical Review Board of the Oromia Regional State Health Bureau with reference number IRB/688/15. The study was performed in accordance with the World Medical Association Declaration of Helsinki on medical research. Written consent was obtained from the study participants after the study objectives and procedures were explained, and their right to refuse not to participate in the study at any time was assured. For this purpose, a one-page consent letter was attached to the cover page of each questionnaire stating the general objective of the study and issues of confidentiality, which were also discussed by the data collectors before proceeding with the interview. The confidentiality of the information was ensured by coding. The interviews were privately conducted in an area separated from the others. Only authorized individuals were given access to the raw data collected from the field. Consent for publication Not applicable Data availability statement The original contributions presented in the study are included in the article/supplementary material, and further inquiries can be directed to the corresponding author/s. Competing interests The authors declare that they have no competing interests. Funding The authors received no funding for this research. Author contributions Conceptualisation: D.H. and B.T.O. Data curation: D.H and B.T.O Formal analysis: D.H, S.M.I, B.T, S.M.I, M.S.L and B.B Investigation: Project administration: S.B., D.G, S.M.I, M.S.L, B.B. and R.E.G. Software: S.B., D.G, S.M.I, M.S.L, B.B. and R.E.G. Validation: S.B., D.G., B.B. and R.E.G. Visualisation: D.H. and B.T.O Writing and original draft of manuscript: D.H. and B.T.O Writing, review and editing of manuscript: All authors. Acknowledgement First and foremost, we would like to thank all the study participants for their participation in this study. Second, we would like to acknowledge the Oromia Regional State Health Bureau for the approval of the Ethical clearance for this study. Finally, we also thank the East Bale Zonal Health Office and the Woreda Health Office for providing baseline information. Author details Department of Public Health, Kuyu General Hospital, Oromia Regional Health Bureau, Gerba Guracha, Ethiopia. References WHO, “Breastfeeding : achieving the new normal,” Lancet , vol. 387, no. 10017, p. 404, 2016, doi: 10.1016/S0140-6736(16)00210-5. A. M. Al-binali, “Breastfeeding knowledge , attitude and practice among school teachers in Abha female educational district , southwestern Saudi Arabia,” Int. Breastfeed. J. , vol. 7, no. 1, p. 1, 2019, doi: 10.1186/1746-4358-7-10. Y. Sinshaw, K. Ketema, and M. 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Liben et al. , “Factors associated with exclusive breastfeeding practices among mothers in dubti town, afar regional state, northeast Ethiopia: A community based cross-sectional study,” Int. Breastfeed. J. , vol. 11, no. 1, pp. 1–6, 2017, doi: 10.1186/s13006-016-0064-y. A. Shitie, A. Tilahun, and L. Olijira, “Exclusive breastfeeding practice and associated factors among mothers of infants age 6 to 12 months in Somali region of Ethiopia,” Sci. Rep. , vol. 12, no. 1, p. 19102, 2022, doi: 10.1038/s41598-022-22051-0. A. Shitie, A. Tilahun, and L. Olijira, “Exclusive breastfeeding practice and associated factors among mothers of infants age 6 to 12 months in Somali region of Ethiopia,” Sci. Rep. , no. 0123456789, pp. 1–10, 2022, doi: 10.1038/s41598-022-22051-0. T. G. Woldie, “Assessment of Exclusive Breast Feeding Practice and Associated Factors in Mecha District, North West Ethiopia,” Sci. J. Public Heal. , vol. 2, no. 4, p. 330, 2018, doi: 10.11648/j.sjph.20140204.24. A. Kumala, “Factors Associated with Exclusive Breastfeeding at Primary Health Care in Indonesia,” Pediatr. Ther. , vol. 07, no. 04, 2017, doi: 10.4172/2161-0665.1000337. M. M. Asfaw, M. D. Argaw, and Z. K. Kefene, “Factors associated with exclusive breastfeeding practices in Debre Berhan District, Central Ethiopia: A cross sectional community based study,” Int. Breastfeed. J. , vol. 10, no. 1, pp. 1–9, 2018, doi: 10.1186/s13006-015-0049-2. Z. B. B. Belayneh Kefale Gelaw, “Knowledge and Practice of Mothers towards Exclusive Breastfeeding and Its Associated Factors in Ambo Woreda West Shoa Zone Oromia Region, Ethiopia,” Epidemiol. Open Access , vol. 05, no. 01, p. 7, 2020, doi: 10.4172/2161-1165.1000182. A. Sonko and A. Worku, “Prevalence and predictors of exclusive breastfeeding for the first six months of life among women in Halaba special woreda, Southern Nations, Nationalities and Peoples’ Region/SNNPR/, Ethiopia: A community based cross-sectional study,” Arch. Public Heal. , vol. 73, no. 1, pp. 1–11, 2017, doi: 10.1186/s13690-015-0098-4. B. Adugna, H. Tadele, F. Reta, and Y. Berhan, “Determinants of exclusive breastfeeding in infants less than six months of age in Hawassa, an urban setting, Ethiopia,” Int. Breastfeed. J. , vol. 12, no. 1, pp. 4–11, 2017, doi: 10.1186/s13006-017-0137-6. EDHS, Ethiopia Mini Demographic and Health Survey , no. July. 2019. doi: Internet: www.DHSprogram.com. T. Shifraw, A. Worku, and Y. Berhane, “Factors associated exclusive breastfeeding practices of urban women in Addis Ababa public health centers, Ethiopia: A cross sectional study,” Int. Breastfeed. J. , vol. 10, no. 1, pp. 4–9, 2019, doi: 10.1186/s13006-015-0047-4. M. Hossain, A. Islam, T. Kamarul, and G. Hossain, “Exclusive breastfeeding practice during first six months of an infant’s life in Bangladesh: a country based cross-sectional study,” BMC Pediatr. , vol. 18, no. 1, p. 93, 2018, doi: 10.1186/s12887-018-1076-0. R. A. Alzaheb, “Factors Influencing Exclusive Breastfeeding in Tabuk, Saudi Arabia,” Clin. Med. Insights Pediatr. , vol. 11, p. 117955651769813, 2017, doi: 10.1177/1179556517698136. A. Owais et al. , “Household food security and infant feeding practices in rural Bangladesh,” Public Health Nutr. , vol. 19, no. 10, pp. 1875–1881, 2019, doi: 10.1017/S1368980015003195. M. Ulak, R. K. Chandyo, L. Mellander, P. S. Shrestha, and T. A. Strand, “Infant feeding practices in Bhaktapur, Nepal: A cross-sectional, health facility based survey,” Int. Breastfeed. J. , vol. 7, pp. 1–8, 2018, doi: 10.1186/1746-4358-7-1. P. Saravanakumar, V. V Anantharaman, S. Suresh, and A. K. Rajendran, “Prevalence of Exclusive Breastfeeding Practices among the Irular tribes in Tamil Nadu,” Indian J. Basic Appl. Med. Res. , vol. 6, no. 1, pp. 742–749, 2016, [Online]. Available: http://ijbamr.com/pdf/December 2016 742-749.pdf.pdf O. O. Osibogun, T. F. Olufunlayo, and S. O. Oyibo, “Knowledge, attitude and support for exclusive breastfeeding among bankers in Mainland Local Government in Lagos State, Nigeria,” Int. Breastfeed. J. , vol. 13, no. 1, pp. 1–7, 2018, doi: 10.1186/s13006-018-0182-9. Additional Declarations No competing interests reported. Supplementary Files supplementarymaterial.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4076682","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":279615889,"identity":"f1335e43-6b04-4c4f-98f0-f658badf4787","order_by":0,"name":"Dursa 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Bureau, Ginnir, Ethiopia.","correspondingAuthor":false,"prefix":"","firstName":"Seifu","middleName":"Mohammed","lastName":"Ibrahim","suffix":""},{"id":279615897,"identity":"44c447d5-d723-42af-a42b-38163723b6b3","order_by":8,"name":"Meron Seyoum Lakew","email":"","orcid":"","institution":"Department of Public Health, Ginnir district health office, Oromia Regional Health Bureau, Ginnir, Ethiopia.","correspondingAuthor":false,"prefix":"","firstName":"Meron","middleName":"Seyoum","lastName":"Lakew","suffix":""}],"badges":[],"createdAt":"2024-03-11 16:52:00","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4076682/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4076682/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52785787,"identity":"90e727fe-571c-4911-b4bf-db3e63689c07","added_by":"auto","created_at":"2024-03-15 18:40:09","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":65351,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of exclusive breastfeeding practices among mothers with infants (aged 0-6 months) in the pastoral community of the Sawena district east Bale zone in southeastern Ethiopia, 2023.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4076682/v1/6c7c07424658f4e5332ec3ff.png"},{"id":52786170,"identity":"bc038d47-1aa2-40df-aa6f-aad8eef9cd87","added_by":"auto","created_at":"2024-03-15 18:49:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":791299,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4076682/v1/7cad7ca4-59a0-4bd0-9618-c05fb6ef9c5a.pdf"},{"id":52785788,"identity":"956cfb9b-d35b-4ad1-b0df-b4a3aeeabac0","added_by":"auto","created_at":"2024-03-15 18:40:09","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":51554,"visible":true,"origin":"","legend":"","description":"","filename":"supplementarymaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-4076682/v1/85080a54074c0b3e21921db9.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exclusive Breastfeeding Practice and Associated Factors among Mothers Having Infants (Aged 0-6 Months) in the Pastoral Community of Sawena District, Bale Zone Oromia, Ethiopia, 2023","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eExclusive breastfeeding (EBF) is defined as giving a baby just breast milk for the first six months of its life, without any additional food, drink, or water\u0026mdash;aside from prescription drugs or vitamin and mineral supplements [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The World Health Organization (WHO) and the United Nation Children\u0026rsquo;s Fund (UNICEF) recommend initiation of breastfeeding within the first hour after birth; EBF should be done from the first six months of age and breastfeeding should continue until two years old or beyond, with adequate complementary foods [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEBF is an important public health strategy for improving children\u0026rsquo;s and mother\u0026rsquo;s health by reducing child morbidity and mortality and helping to control healthcare costs in society [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Moreover, one of the main tactics supporting the most well-known and successful intervention for preventing early childhood deaths is EBF [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In addition to its positive impact on the mother-child bond, breastfeeding reduces the risk of a number of childhood diseases, including pneumonia, ear infections, diabetes mellitus, diarrhea, and sudden infant death syndrome [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe World Health Assembly (WHA) has set a global target in order to increase the rate of EBF for infants aged 0\u0026ndash;6 months up to at least 50% in 2012\u0026ndash;2025 [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Adherence to these guidelines varies globally, only 38% of infants are exclusively breastfed for the first six months of life [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. High-income countries such as the United States (19%), United Kingdom (1%), and Australia (15%) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. have a shorter breastfeeding duration than nations with middle-class and lower-class incomes. Only 37% of newborns under six months old are exclusively breastfed, even in low- and middle-income nations [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. According to recent papers in the sub-Saharan Africa region, only 53.5% of infants in east African countries were EBF for six months which is way below the WHO target of 90% [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Ethiopia approximately half (52%) of children less than six months old are exclusively breastfed. The practice of EBF at age 0\u0026ndash;1 month is 70%, 55% at 2\u0026ndash;3 months and 32% among 4\u0026ndash;5-month-old infants [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Despite all the recognized benefits and efforts to promote EBF, practice is still far from recommended levels. In Ethiopia out of 97% of breastfeeding, only 58% of mothers exclusively breastfeed. This number drops to 36% in infants aged 4\u0026ndash;5 months [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Several associated factors have been identified with exclusive breastfeeding practices. Sociodemographic, environmental, and health facility-related factors are among the frequently cited factors[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Ethiopian government has taken several steps to improve exclusive breastfeeding practices. The National Strategy on Infant and Young Child Nutrition, National Nutrition Program I and II, has been developed by the Government of Ethiopia to promote and improve the practice of exclusive breastfeeding during the first six months of life in collaboration with various stakeholders [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In addition, non-governmental organizations are also addressing the issue of optimal breastfeeding in different parts of the country through advocacy, community mobilization and the press [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePastoralists comprise a significant part of Ethiopia\u0026rsquo;s population, but the promotion of exclusive breastfeeding less than 6 months of age and its importance is poorly understood in pastoral communities [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Moreover, there is little information on the practice and factors associated with EBF less than 6 months of age in pastoral communities. In addition, information on the implementation and determinants of EBF in pastoral communities, especially pastoral areas are lacking and needs to be planned and intervened accordingly. To promote the benefits of EBF to the community, as well as to apply EBF properly to reduce the health impact, morbidity of infants and influence on economic grows due to not use of EBF properly. Therefore, the aim of this study was to assess the prevalence of EBF and associated factors among women who have a child aged\u0026thinsp;\u0026lt;\u0026thinsp;6 months in the study area.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e \u003cb\u003eStudy design, period, and setting\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA community-based cross-sectional study design was employed from March 01 to April 2023. In pastoral communities in the Sawena district, Bale Zone, Oromia Region, Southeast Ethiopia, among mothers of infants aged 0\u0026ndash;6 months were included. The Sawena district is approximately 675 KMs Southeast east of Addis Ababa, with a latitude and longitude of \u003csup\u003e7\u0026deg;\u003c/sup\u003e 23\u003csup\u003e\u0026rsquo;\u003c/sup\u003e N \u003csup\u003e41\u0026deg;\u003c/sup\u003e 16\u0026rsquo; E and an elevation of 1161 meters. The estimated population size is 98751, 46,518 (47%) of which are males and 52,233 (53%) of which are females. Approximately 4% (2089) of the total female women had babies less than 6 months old, and approximately 37% (17211) had babies. This district has 30 kebeles, 5 health centers, 32 health posts, 4 primary clinics, and 2 private drug stores. Different obstetric services, such as FP, ANC, delivery services, PNC, and counselling services, were provided at those health facilities. The majority of the climate conditions are dry (kola), 1/3 of the area is temperate (woynadaga), and Khat, peppers, fruits, Teff, and wheat are important cash crops for this woreda. Regarding occupation, the majority of the people in rural areas are pastoralists, and farmers dominate in rural areas.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePopulation\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAll mothers who had infants (aged 0\u0026ndash;6 months) in the Sawena district pastoral community were the source of the population. The study population consisted of randomly selected mothers who fulfilled the inclusion criteria. For the qualitative part, health care professionals from maternal and child health care delivery, health extension workers, traditional birth attendants (TBAs), and developmental health armies were purposively selected.\u003c/p\u003e \u003cp\u003e \u003cb\u003eInclusion and Exclusion Criteria\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eInclusion criteria\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eAll mothers who had infant (aged 0\u0026ndash;6 months) and had been residents of the study areas for more than six months during the data collection period.\u003c/p\u003e \u003cp\u003e \u003cb\u003eExclusion criteria\u003c/b\u003e \u003c/p\u003e \u003cp\u003eChildren with evidence of chronic health problems and mothers who were unable to communicate or were seriously ill and unable to provide information were excluded from the study.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSample size determination\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe sample size was determined using the single population proportion formula for the Epi Info STAT CALC cohort. version 7.2.4 Based on the assumptions of a 95% confidence level (CL), a 52% proportion of EBF practices[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], and 5% marginal error from the study conducted among mothers who had infant (aged 0\u0026ndash;6 months) in the Somalia Region, Ethiopia, a 10% nonresponse and a 1.5 design effect, the final sample size was 631 mother\u0026ndash;infant pairs.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSampling procedure\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA multistage, simple random sampling technique was used to select the study participants. In the first stage, nine kebeles were selected randomly from 30 kebeles in the districts. In the second stage, from the selected kebeles, a list of all eligible mothers with their households (HHs) in each selected kebele was obtained from the kebele health post by using family folders collaborating with health extension workers (HEWs). The sample size for each selected kebele was determined proportionally to the number of eligible HHs within each selected kebele. Finally, a simple random sampling technique was used to select the required number of eligible mothers from each kebele by using the HH listed as a sampling frame, which was obtained from family folders. If eligible mothers were not present at the time of data collection, a return visit was arranged a minimum of three times during the time of the HH survey.\u003c/p\u003e \u003cp\u003e \u003cb\u003eData collection procedures (tools, techniques and personnel)\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA structured, closed-ended questionnaire developed from different kinds of literature [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] was used. The questionnaires consisted of six parts: sociodemographic factors, household food security status, infant and maternal health service utilization, knowledge about breastfeeding, attitudes towards EBE, and EBF practices. The data were collected through face-to-face interviews. Seven data collectors and one supervisor participated in the data collection process.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStudy variables\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eDependent variable\u003c/b\u003e \u003c/p\u003e \u003cp\u003eExclusive breastfeeding practice\u003c/p\u003e \u003cp\u003e \u003cb\u003eIndependent variable\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eSociodemographic factors\u003c/b\u003e (maternal age, marital status, maternal education level, Mom\u0026rsquo;s occupation, and maternal knowledge of breastfeeding).\u003c/p\u003e \u003cp\u003e \u003cb\u003eFactors related to obstetrics and health services\u003c/b\u003e (parity, prenatal care, breastfeeding advice during pregnancy, place of birth, and how to give birth).\u003c/p\u003e \u003cp\u003e \u003cb\u003eInfant-related factors\u003c/b\u003e (infant age, infant sex, birth spacing)\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEconomic factor\u003c/strong\u003e \u003cp\u003ewealth index.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eHousehold Food Security Status\u003c/p\u003e \u003cp\u003eAttitudes toward \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eEBF\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eOperational definition\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eExclusive breastfeeding\u003c/strong\u003e \u003cp\u003emeans feeding your baby only breast milk, not any other foods or liquids (including infant formula or water), except for medications or vitamin and mineral supplements [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eWealth Index\u003c/b\u003e: The wealth index was computed for owner ships of different assets, house characteristics and types of animals. The resulting wealth indices were categorized into three categories: lowest, middle, and highest [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePractice of EBF\u003c/strong\u003e \u003cp\u003e- If a mother gives her only breast milk for her infant for the full 6 months, no other liquids or solids except vitamins, mineral supplements, or medicines until she is born for 6 months [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eData quality assurance\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe questionnaire was pretested on 5% of the sample at Micha Kebele. The questionnaire was modified to enhance the consistency of understanding by the respondents as well as by the data collector. The data collectors were trained by the principal investigator about the general purpose of the study and the data collection procedures. The structured questionnaire was prepared first in English and then translated to the local language (Afan Oromo) by language experts. Finally, the data were checked for completeness before being entered into computer software for analysis.\u003c/p\u003e \u003cp\u003eFor the qualitative part, in-depth interviews and key informant interviews were facilitated by the moderator, and adequate field notes were taken by experienced note-takers. The interviews were tape-recorded and transcribed daily word by word. Furthermore, before deployment in the field, the completeness, accuracy, and clarity of the collected data were checked carefully. Any ambiguity or incompleteness encountered was addressed on the following day before starting the next day activities.\u003c/p\u003e \u003cp\u003e \u003cb\u003eData processing and analysis\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe data were entered, cleaned and edited using EPI-data 4.6 and subsequently transferred to SPSS version 26 for further analysis. Descriptive statistics such as frequency, percentage, mean and standard deviation were calculated. Binary logistic regression was performed to assess the crude relationship between the independent variables and the dependent variable. All variables with a P value\u0026thinsp;\u0026lt;\u0026thinsp;0.25 were candidates for multivariate logistic regression to control for possible confounding effects.\u003c/p\u003e \u003cp\u003eThe multicollinearity was checked with variance inflation factors (VIFs) and tolerance tests, which had VIFs less than 5 and tolerance tests less than 1; these values were used as cut-off points for diagnosing multicollinearity. Model fitness was checked using the Hosmer and Lemeshow goodness-of-fit model, and the results were fitted (p value\u0026thinsp;=\u0026thinsp;0.5). The final results of the associations are presented as AORs with 95% CIs, and a p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered to indicate statistical significance.\u003c/p\u003e \u003cp\u003e Qualitative field notes were taken during the data collection session in addition to the tape recorder, after which the notes from all in-depth interviews were compiled and labelled according to participant type. The qualitative data were analysed using thematic analysis. The analysis started by transcribing into Afan Oromo from records and then translating the results to the English language. The transcribed data were read carefully, categorized, and summarized manually.\u003c/p\u003e \u003cp\u003e \u003cb\u003eEthical considerations\u003c/b\u003e \u003c/p\u003e \u003cp\u003e The study protocol was approved, and an ethical approval was provided by the Ethical Review Board of the Oromia Regional State Health Bureau (reference number IRB/688/15). The study was performed in accordance with the World Medical Association Declaration of Helsinki on medical research. Written informed consent was obtained from every study subject before the data collection. All the information collected from the study participants was handled confidentially by omitting their identification.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e \u003cb\u003eSociodemographic Characteristics of Hypertensive Patients\u003c/b\u003e \u003c/p\u003e \u003cp\u003eOut of the 631 eligible mothers, 625 participated in this study, for a response rate of 99.0%. The age of the mothers included in this study ranged between 17 and 40 years, with a mean age of 26.7 (SD\u0026thinsp;=\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2) years. Concerning ethnicity, 542 (86.7%) study participants were Oromo, while the majority (576; 92.2%) were religious Muslims. Regarding the educational status of mothers, the majority (64.2%) of them could not read or write. Almost all of the mothers, 615 (98.4%), were legally married. The majority of the respondents (225; 36.0%) were in the second wealth quintile group (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of mothers with infants (aged 0\u0026ndash;6 months) in the pastoral community of the Sawena district east bale zone Oromia southeastern Ethiopia, 2023.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of mother (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026ndash;19\u003c/p\u003e \u003cp\u003e20\u0026ndash;24\u003c/p\u003e \u003cp\u003e25\u0026ndash;29\u003c/p\u003e \u003cp\u003e30\u0026ndash;34\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003cp\u003e172\u003c/p\u003e \u003cp\u003e275\u003c/p\u003e \u003cp\u003e132\u003c/p\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003cp\u003e27.5\u003c/p\u003e \u003cp\u003e44.0\u003c/p\u003e \u003cp\u003e21.1\u003c/p\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003cp\u003eSeparated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e615\u003c/p\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98.4\u003c/p\u003e \u003cp\u003e1.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEthnicity of mother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOromo\u003c/p\u003e \u003cp\u003eSomali\u003c/p\u003e \u003cp\u003eAmara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e542\u003c/p\u003e \u003cp\u003e80\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86.7\u003c/p\u003e \u003cp\u003e12.8\u003c/p\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligion of mother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003cp\u003eOrthodox\u003c/p\u003e \u003cp\u003eProtestant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e476\u003c/p\u003e \u003cp\u003e38\u003c/p\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92.2\u003c/p\u003e \u003cp\u003e6.1\u003c/p\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational status mother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnable to read and write\u003c/p\u003e \u003cp\u003ePrimary education\u003c/p\u003e \u003cp\u003eSecondary education\u003c/p\u003e \u003cp\u003eCollege and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e401\u003c/p\u003e \u003cp\u003e161\u003c/p\u003e \u003cp\u003e31\u003c/p\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.2\u003c/p\u003e \u003cp\u003e25.8\u003c/p\u003e \u003cp\u003e5.0\u003c/p\u003e \u003cp\u003e5.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation of husband (n\u0026thinsp;=\u0026thinsp;615)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnable to read and write\u003c/p\u003e \u003cp\u003ePrimary education\u003c/p\u003e \u003cp\u003eSecondary education\u003c/p\u003e \u003cp\u003eCollege and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e221\u003c/p\u003e \u003cp\u003e270\u003c/p\u003e \u003cp\u003e59\u003c/p\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.9\u003c/p\u003e \u003cp\u003e4.9\u003c/p\u003e \u003cp\u003e9.6\u003c/p\u003e \u003cp\u003e10.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWealth Index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHighest\u003c/p\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003cp\u003eLowest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e212\u003c/p\u003e \u003cp\u003e225\u003c/p\u003e \u003cp\u003e188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.9\u003c/p\u003e \u003cp\u003e36.0\u003c/p\u003e \u003cp\u003e30.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eHousehold Food Security Status\u003c/b\u003e \u003c/p\u003e \u003cp\u003eBased on the calculated household food security, a total of 341 (54.6%) of the sample households were food secure, and a total of 284 (45.4%) of the sample households were food insecure in the study area (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHousehold food security status in the pastoral community of the Sawena district East Bale Zone Oromia, southeastern Ethiopia, 2023.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorried about household would not have enough food (the past month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eOften\u003c/p\u003e \u003cp\u003eRarely\u003c/p\u003e \u003cp\u003eSometime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003cp\u003e5\u003c/p\u003e \u003cp\u003e376\u003c/p\u003e \u003cp\u003e160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.4\u003c/p\u003e \u003cp\u003e0.8\u003c/p\u003e \u003cp\u003e60.2\u003c/p\u003e \u003cp\u003e25.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold member not able to eat the kinds of foods you preferred (the past month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eRarely\u003c/p\u003e \u003cp\u003eSometime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89\u003c/p\u003e \u003cp\u003e376\u003c/p\u003e \u003cp\u003e160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.2\u003c/p\u003e \u003cp\u003e60.2\u003c/p\u003e \u003cp\u003e25.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold members have to eat a limited variety of foods due to a lack of resources (the past)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eOften\u003c/p\u003e \u003cp\u003eRarely\u003c/p\u003e \u003cp\u003eSometime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e121\u003c/p\u003e \u003cp\u003e6\u003c/p\u003e \u003cp\u003e313\u003c/p\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.4\u003c/p\u003e \u003cp\u003e1.0\u003c/p\u003e \u003cp\u003e50.1\u003c/p\u003e \u003cp\u003e29.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold members have to eat some foods that they did not want to eat (the past month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eRarely\u003c/p\u003e \u003cp\u003eSometime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e131\u003c/p\u003e \u003cp\u003e314\u003c/p\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.0\u003c/p\u003e \u003cp\u003e50.2\u003c/p\u003e \u003cp\u003e28.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold members have to eat a smaller meal than they felt you needed (the past month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eOften\u003c/p\u003e \u003cp\u003eRarely\u003c/p\u003e \u003cp\u003eSometime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e124\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e346\u003c/p\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.8\u003c/p\u003e \u003cp\u003e0.5\u003c/p\u003e \u003cp\u003e55.4\u003c/p\u003e \u003cp\u003e24.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold members have to eat fewer meals in a day (the past month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eOften\u003c/p\u003e \u003cp\u003eRarely\u003c/p\u003e \u003cp\u003eSometime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e196\u003c/p\u003e \u003cp\u003e11\u003c/p\u003e \u003cp\u003e285\u003c/p\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.4\u003c/p\u003e \u003cp\u003e1.8\u003c/p\u003e \u003cp\u003e45.6\u003c/p\u003e \u003cp\u003e21.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo food to eat of any kind in your household (the past month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eOften\u003c/p\u003e \u003cp\u003eRarely\u003c/p\u003e \u003cp\u003eSometime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e526\u003c/p\u003e \u003cp\u003e9\u003c/p\u003e \u003cp\u003e5\u003c/p\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84.2\u003c/p\u003e \u003cp\u003e1.4\u003c/p\u003e \u003cp\u003e0.8\u003c/p\u003e \u003cp\u003e13.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold members go to sleep at night hungry (the past month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eOften\u003c/p\u003e \u003cp\u003eRarely\u003c/p\u003e \u003cp\u003eSometime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e554\u003c/p\u003e \u003cp\u003e7\u003c/p\u003e \u003cp\u003e6\u003c/p\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88.6\u003c/p\u003e \u003cp\u003e1.1\u003c/p\u003e \u003cp\u003e1.0\u003c/p\u003e \u003cp\u003e9.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold members go a whole day and night without eating anything (the past month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eRarely\u003c/p\u003e \u003cp\u003eSometime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e550\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88.0\u003c/p\u003e \u003cp\u003e0.5\u003c/p\u003e \u003cp\u003e11.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall household food security status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFood secure\u003c/p\u003e \u003cp\u003eFood in secured\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e317\u003c/p\u003e \u003cp\u003e308\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.7\u003c/p\u003e \u003cp\u003e49.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eInfant and Maternal Health Service Utilization Characteristics\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe majority (579; 92.6%) of the mothers had ANC visits during their recent pregnancy and were counselled about breastfeeding. The majority (524, 83.8%) of the mothers gave birth to their last child in health facilities (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The qualitative findings proved that the majority of the interviewees mentioned the ideal desire for exclusive breastfeeding, and most of the women interviewers mentioned, \u0026ldquo;Breastfeeding is our culture\u0026rdquo;. However, they perceived mixed feeding rather than exclusive breastfeeding. A 34-year-old breastfeeding mother said, \u003cem\u003e\u0026ldquo;We have been informed by health professionals that giving cow\u0026rsquo;s milk and other foods, even water, to infants less than six months old is unnecessary\u0026rdquo;\u003c/em\u003e. \"Even though most mothers receive breastfeeding counselling and antenatal care, they did not apply exclusive breastfeeding practices properly,\" the women interviewees confirmed. The MCH focal person described exclusively breastfed babies as having higher intelligence, being physically stronger, and being protected from illness. Babies who were exclusively breastfed were said to be much healthier than those who began consuming extra meals or liquids before the age of six months.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInfant and maternal health service utilization characteristics of study participants in the pastoral community of the Sawena district in the eastern Bale zone in southeastern Ethiopia, Oromia, 2023.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny breastfeeding problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e265\u003c/p\u003e \u003cp\u003e360\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.4\u003c/p\u003e \u003cp\u003e57.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat was the problem (n\u0026thinsp;=\u0026thinsp;265)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbscess.\u003c/p\u003e \u003cp\u003eMastitis\u003c/p\u003e \u003cp\u003eSore/cracked nipples\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003cp\u003e116\u003c/p\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.6\u003c/p\u003e \u003cp\u003e43.8\u003c/p\u003e \u003cp\u003e33.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2\u003c/p\u003e \u003cp\u003e3\u0026ndash;5\u003c/p\u003e \u003cp\u003e6\u0026ndash;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e227\u003c/p\u003e \u003cp\u003e360\u003c/p\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.3\u003c/p\u003e \u003cp\u003e57.6\u003c/p\u003e \u003cp\u003e6.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth order of infant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst\u003c/p\u003e \u003cp\u003eSecond\u003c/p\u003e \u003cp\u003eThird\u003c/p\u003e \u003cp\u003eFourth and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003cp\u003e167\u003c/p\u003e \u003cp\u003e178\u003c/p\u003e \u003cp\u003e228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003cp\u003e26.7\u003c/p\u003e \u003cp\u003e28.5\u003c/p\u003e \u003cp\u003e36.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth interval (years) (n\u0026thinsp;=\u0026thinsp;573)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2\u003c/p\u003e \u003cp\u003e3\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e549\u003c/p\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95.8\u003c/p\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eANC services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e579\u003c/p\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92.6\u003c/p\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCounselled about breastfeeding during ANC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e579\u003c/p\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92.6\u003c/p\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlace of birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth facility\u003c/p\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e524\u003c/p\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83.8\u003c/p\u003e \u003cp\u003e16.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMode of delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eC/S\u003c/p\u003e \u003cp\u003eVaginal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003cp\u003e608\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003cp\u003e97.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostnatal care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e364\u003c/p\u003e \u003cp\u003e261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.2\u003c/p\u003e \u003cp\u003e41.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of infant (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2\u003c/p\u003e \u003cp\u003e3\u0026ndash;4\u003c/p\u003e \u003cp\u003e5\u0026ndash;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e259\u003c/p\u003e \u003cp\u003e288\u003c/p\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.4\u003c/p\u003e \u003cp\u003e46.1\u003c/p\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex of infant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMales\u003c/p\u003e \u003cp\u003eFemales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e402\u003c/p\u003e \u003cp\u003e223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.3\u003c/p\u003e \u003cp\u003e35.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eAttitudes toward exclusive breastfeeding practice\u003c/b\u003e \u003c/p\u003e \u003cp\u003e Of the 625 respondents, 609 (97.4%) agreed that EBF is necessary for their baby. In addition, 20 (3.2%) of the respondents considered breastfeeding to have cosmetically affected mothers\u0026rsquo; shape. The majority of them (22) (35.8%) considered household economic capacity to determine mothers\u0026rsquo; breastfeeding practices. The overall attitudes of the study participants showed that 319 (51.0%) of the respondents had positive attitudes toward EBF practices (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAttitudes toward exclusive breastfeeding among mothers with infants aged less than six months in the pastoral community of the Sawena district in the eastern Bale zone in southeastern Ethiopia, Oromia, 2023.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreastfeeding is good for my baby\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003cp\u003e5\u003c/p\u003e \u003cp\u003e609\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003cp\u003e0.8\u003c/p\u003e \u003cp\u003e97.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreastfeeding is not good because cosmetically affects the mother\u0026rsquo;s shape.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e551\u003c/p\u003e \u003cp\u003e54\u003c/p\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88.2\u003c/p\u003e \u003cp\u003e8.6\u003c/p\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternity leave of three months is enough to successful breastfeeding.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e520\u003c/p\u003e \u003cp\u003e65\u003c/p\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83.2\u003c/p\u003e \u003cp\u003e10.4\u003c/p\u003e \u003cp\u003e6.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe household economic capacity determines the mother Breastfeeding practice.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e214\u003c/p\u003e \u003cp\u003e187\u003c/p\u003e \u003cp\u003e224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.2\u003c/p\u003e \u003cp\u003e29.9\u003c/p\u003e \u003cp\u003e35.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreast-feeding has an advantage to the mother because it prevents pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88\u003c/p\u003e \u003cp\u003e69\u003c/p\u003e \u003cp\u003e468\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.1\u003c/p\u003e \u003cp\u003e11.0\u003c/p\u003e \u003cp\u003e74.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreast-feeding the baby helps the child to grow well.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88\u003c/p\u003e \u003cp\u003e23\u003c/p\u003e \u003cp\u003e514\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.1\u003c/p\u003e \u003cp\u003e3.7\u003c/p\u003e \u003cp\u003e82.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYour husband support is needed for you to breastfeed your child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e319\u003c/p\u003e \u003cp\u003e25\u003c/p\u003e \u003cp\u003e281\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.0\u003c/p\u003e \u003cp\u003e4.0\u003c/p\u003e \u003cp\u003e45.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYour family members support is needed for you to breastfeed your child?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e315\u003c/p\u003e \u003cp\u003e151\u003c/p\u003e \u003cp\u003e159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.4\u003c/p\u003e \u003cp\u003e24.2\u003c/p\u003e \u003cp\u003e25.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall attitudes score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive attitude\u003c/p\u003e \u003cp\u003eNegative attitude\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e319\u003c/p\u003e \u003cp\u003e306\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.0\u003c/p\u003e \u003cp\u003e49.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eExclusive breastfeeding practice\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe prevalence of exclusive breastfeeding practice was 53.8%, within the 95% CI (49.8\u0026ndash;57.4%). Among mothers who did not exclusively breastfeed their infant, the main reasons mentioned were that the perception of breast milk alone was not sufficient for 323 infants (51.2%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBreastfeeding practices of mothers with infants aged less than six months in the pastoral community of the Sawena district in the eastern Bale zone in southeastern Ethiopia, Oromia, 2023.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfant feeding practice one day before the survey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExclusively breastfeeding\u003c/p\u003e \u003cp\u003eMixed breastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e336\u003c/p\u003e \u003cp\u003e289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53.8\u003c/p\u003e \u003cp\u003e46.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtra liquid/solid food given for their child in the previous 24 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003cp\u003e599\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.1\u003c/p\u003e \u003cp\u003e94.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMentioned what they gave (n\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eButter\u003c/p\u003e \u003cp\u003eSugar with water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81.3\u003c/p\u003e \u003cp\u003e18.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe reason of giving additional food to infant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBreast milk only not sufficient\u003c/p\u003e \u003cp\u003eBreast produce less milk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81.3\u003c/p\u003e \u003cp\u003e18.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe qualitative findings proved that the majority of the interviewees mentioned that breastfeeding is important for the infant, but breastfeeding alone may not be sufficient for the infant until 6 months. Therefore, the mother should give additional food to her baby; otherwise, the baby should be starved, and the baby may refuse to consume food if he/she does not start early.\u003c/p\u003e \u003cp\u003e \u003cem\u003eAn old woman from the health developmental army states that \u0026ldquo;mothers must care for their children by giving breast milk and other additional food after 4 months unless the baby may refuse food after 6 months if she/he didn\u0026rsquo;t start food early for her baby\u0026rdquo;.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eA 28-year-old from the health developmental army said that \u003cem\u003e\u0026ldquo;only breast milk may not be sufficient for the baby until 6 months, so giving additional food and water after 4 months is important for the baby\u0026rdquo;.\u003c/em\u003e Some of the interviewees \u003cem\u003ementioned that early initiation and exclusive breast feeding are important for the baby and the mother, so the baby must consume only breast milk until 6 months, but after 6 months, the baby should consume additional food because after 6 months, only breast milk may not be sufficient\u0026rdquo;.\u003c/em\u003e An old TBA said that \u003cem\u003e\u0026ldquo;As soon as the child is delivered, breast milk giving is necessary. The infant should only consume breast milk from birth to six months of age\u0026rdquo;\u003c/em\u003e. A 28-year-old multiparous woman interviewer states that \u003cem\u003e\u0026ldquo;I had never practised EBF in two of my babies because I believe the breast milk is not sufficient but for the third baby, I gave only breast milk for 6 months because the doctor told me to give only breast milk for 6 months\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eAnother 34-year-old interviewer said, \u003cem\u003e\u0026ldquo;I understand that the child should be breastfed for 6 months without mixing, but the problem is that he may refuse to take other food after 6 months\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eFactors associated with exclusive breast feeding\u003c/b\u003e \u003c/p\u003e \u003cp\u003eVariables associated with a significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.25 in the bivariate analysis were considered candidates for the final multivariate analysis to determine their significant association with the practice of EBF. The independent predictors of EBF status included maternal educational status, household food security status, knowledge about EBF, number of children, birth order, birth interval, ANC follow-up, counselling about EBF during ANC service, place of birth, counselling about EBF during PNC service, attitudes toward EBF, and wealth index status.\u003c/p\u003e \u003cp\u003eThe final predictors of EBF practices were household food security status, ANC follow-up during pregnancy, counselling about EBF during ANC services, number of children, and attitudes toward EBF. Mothers with a household food security status were 1.6 times more likely to practice good EBF than were those who were food insecure [AOR\u0026thinsp;=\u0026thinsp;1.6, 95% CI (1.1\u0026ndash;2.2)]. Mothers who had ANC follow-up data were 5.3 times more likely to practice EBF than women who had no ANC follow-up data [AOR\u0026thinsp;=\u0026thinsp;5.3, 95% CI (2.4\u0026ndash;11.9)]. Additionally, mothers who received counselling about EBF during ANC follow-up were 5 times more likely to practice EBF than mothers who did not receive such counselling (AOR\u0026thinsp;=\u0026thinsp;5; 95% CI (2.1\u0026ndash;11.7)) (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBivariate and multivariate logistic regression analyses showing factors associated with EBF practices among mothers of infants aged (0\u0026ndash;6 months) in the pastoral community of the Sawena district in the eastern Bale zone in southeastern Ethiopia, Oromia, 2023.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eEBF Practice\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eMother\u0026rsquo;s Educational level\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnable to read and write\u003c/p\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003cp\u003eCollege and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e138(41.1)\u003c/p\u003e \u003cp\u003e154(45.8)\u003c/p\u003e \u003cp\u003e19(5.7)\u003c/p\u003e \u003cp\u003e25(7.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e263(91.0)\u003c/p\u003e \u003cp\u003e8(2.8)\u003c/p\u003e \u003cp\u003e11(3.8)\u003c/p\u003e \u003cp\u003e7(2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e37.0[0.01\u0026ndash;0.06]\u003c/p\u003e \u003cp\u003e3.3[0.1\u0026ndash;0.6]\u003c/p\u003e \u003cp\u003e6.9[0.1\u0026ndash;0.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e0.02[0.01\u0026ndash;1.5]\u003c/p\u003e \u003cp\u003e0.2[0.07\u0026ndash;1.4]\u003c/p\u003e \u003cp\u003e1.1[0.06\u0026ndash;2.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e0.1\u003c/p\u003e \u003cp\u003e0.11\u003c/p\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ehousehold food security status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFood secured\u003c/p\u003e \u003cp\u003eFood in secured\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e184(54.8)\u003c/p\u003e \u003cp\u003e152(45.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e133(46.0)\u003c/p\u003e \u003cp\u003e156(19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.4[1.1\u0026ndash;1.9] \u003csup\u003e\u003cb\u003e\u0026#128953;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.6[1.1\u0026ndash;2.2]\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.008\u003c/b\u003e\u003csup\u003e\u003cb\u003e\u0026#128953;\u0026#128953;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKnowledge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledgeable\u003c/p\u003e \u003cp\u003eNot knowledgeable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99(29.5)\u003c/p\u003e \u003cp\u003e237(70.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99(34.3)\u003c/p\u003e \u003cp\u003e190(65.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8[0.6\u0026ndash;1.1]\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2[0.8\u0026ndash;1.7]\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of children\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e2\u0026ndash;4\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133(39.6)\u003c/p\u003e \u003cp\u003e181(53.9)\u003c/p\u003e \u003cp\u003e22(6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94(32.5)\u003c/p\u003e \u003cp\u003e179(69.9)\u003c/p\u003e \u003cp\u003e16(5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.03[1.0-1.9] \u003csup\u003e\u003cb\u003e\u0026#128953;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e0.73[0.5\u0026ndash;2.1]\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.6[1.1\u0026ndash;2.3]\u003c/p\u003e \u003cp\u003e1.1[0.5\u0026ndash;2.4]\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003csup\u003e\u003cb\u003e\u0026#128953;\u0026#128953;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e0.637\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBirth order of infant\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst\u003c/p\u003e \u003cp\u003eSecond\u003c/p\u003e \u003cp\u003eThird\u003c/p\u003e \u003cp\u003eFourth and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22(6.5)\u003c/p\u003e \u003cp\u003e102(30.5)\u003c/p\u003e \u003cp\u003e104(30.9)\u003c/p\u003e \u003cp\u003e108(32.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30(10.4)\u003c/p\u003e \u003cp\u003e120(41.5)\u003c/p\u003e \u003cp\u003e65(22.5)\u003c/p\u003e \u003cp\u003e74(25.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5[0.4\u0026ndash;1.5]\u003c/p\u003e \u003cp\u003e0.6[0.3\u0026ndash;0.9]\u003c/p\u003e \u003cp\u003e1.1[0.3-1.0]\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.3[0.6\u0026ndash;2.6]\u003c/p\u003e \u003cp\u003e1.2[0.8\u0026ndash;2.1]\u003c/p\u003e \u003cp\u003e0.7[0.4\u0026ndash;1.2]\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003cp\u003e0.37\u003c/p\u003e \u003cp\u003e0.16\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBirth interval\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;2\u003c/p\u003e \u003cp\u003e3\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e305(97.1)\u003c/p\u003e \u003cp\u003e9(2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e244(94.2)\u003c/p\u003e \u003cp\u003e15(5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.1[1.1\u0026ndash;4.9]\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.7[0.1\u0026ndash;12.8]\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eANC service\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e321(95.5)\u003c/p\u003e \u003cp\u003e15(4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e258(89.3)\u003c/p\u003e \u003cp\u003e31(10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.6[1.4\u0026ndash;4.9] \u003csup\u003e\u003cb\u003e\u0026#128953;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.3[2.4\u0026ndash;11.9]\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e\u0026#128953;\u0026#128953;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCounselled about breastfeeding during ANC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33(9.8)\u003c/p\u003e \u003cp\u003e303(90.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(4.5)\u003c/p\u003e \u003cp\u003e276(95.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e2.3[1.2\u0026ndash;4.9] \u003csup\u003e\u003cb\u003e\u0026#128953;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e5.0[2.1\u0026ndash;11.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e\u0026#128953;\u0026#128953;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlace of birth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth facility\u003c/p\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e286(85.1)\u003c/p\u003e \u003cp\u003e50(14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e238(82.4)\u003c/p\u003e \u003cp\u003e51(17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2[0.8\u0026ndash;1.9]\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.1[0.5\u0026ndash;2.4]\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAttitudes towards EBF\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive attitude\u003c/p\u003e \u003cp\u003eNegative attitude\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e186(55.4)\u003c/p\u003e \u003cp\u003e150(44.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120(41.5)\u003c/p\u003e \u003cp\u003e169(58.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.8[1.3\u0026ndash;2.4] \u003csup\u003e\u003cb\u003e\u0026#128953;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.8[1.4\u0026ndash;2.6]\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e\u0026#128953;\u0026#128953;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWealth index\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuintile 1\u003c/p\u003e \u003cp\u003eQuintile 2\u003c/p\u003e \u003cp\u003eQuintile 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e119(35.4)\u003c/p\u003e \u003cp\u003e123(36.6)\u003c/p\u003e \u003cp\u003e94(28.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93(32.2)\u003c/p\u003e \u003cp\u003e102(35.3)\u003c/p\u003e \u003cp\u003e94(32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.3[0.7\u0026ndash;1.5]\u003c/p\u003e \u003cp\u003e1.2[0.9\u0026ndash;1.9]\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.9[1.1\u0026ndash;3.2]\u003c/p\u003e \u003cp\u003e0.9[0.5\u0026ndash;1.6]\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003cp\u003e0.87\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe purpose of this study was to assess EBF practices and associated factors among exclusive breastfeeding mothers during the first six months of life. This study revealed that the prevalence of EBF in the pastoral community of Sawena District was 53.8%, within a 95% CI (49.8\u0026ndash;57.4%). These findings are similar to those of studies conducted in North West Ethiopia Mecha district (47.1%); Somalia region (52.0%); and other countries, such as Tanzania which had a prevalence of 55.0%, and Indonesia (51.2%) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] respectively.\u003c/p\u003e \u003cp\u003eThis percentage was lower than that reported in Debrebirhan (68.8%), Ambo (82.2%), Halaba (70.5%), Hawassa (60.9%) and Dubti afar (81.1%) respectively [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. It was also lower than that reported in the 2019 mini-EDHS results, which was 59%, [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and that reported in other countries, such as West Mamprusi District in Northern Ghana (84.3%) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Conversely, this number was greater than that reported in studies performed in Addis Ababa (29.3%).[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] Bangladesh (35.9%) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] and Saudi Arabia (31.1%) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Variations in healthcare coverage and health service accessibility may be the cause of this disparity. Another explanation can be the differences in the researchers' study time and design. Disparities in health care service utilization, sociocultural backgrounds, and economic status may have contributed to these variations both nationally and internationally.\u003c/p\u003e \u003cp\u003eAmong the variables identified in the multivariate analysis, household food security status, ANC follow-up during pregnancy, counselling about EBF during ANC, number of children and attitudes towards EBF were significantly associated with EBF. The present study revealed that mothers with a household food security status were 1.6 times more likely to practice good EBF than mothers who were food insecure. This study is supported by other studies conducted in Ethiopia [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] and Bangladesh [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA possible explanation may be that when a household is food secure, meaning that it has consistent access to an adequate quantity and quality of food, it can positively impact a mother's ability to exclusively breastfeed her child. Food security ensures that the mother has the necessary nutrition to sustain her own health and produce breast milk of sufficient quality and quantity to meet her infant's needs. In contrast, households experiencing food insecurity may face challenges in providing adequate nutrition for both the mother and the infant, which can potentially impact the practice of exclusive breastfeeding.\u003c/p\u003e \u003cp\u003eAnother factor that was shown to have a significant association with EBF is the number of children. Mothers who had only one child were 1.6 times more likely to EBF their infants than were those who had five or more children. This finding is similar to those of studies conducted in Debre Markos, Northwest Ethiopia [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], the Mecha district, Northwest Ethiopia [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] and other regions, such as Tanzania [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and Nepal [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. This may be due to time and attention, which means that mothers with only one child may have more time and attention available to focus on breastfeeding and caring for their infant. With fewer children to whom to attend, they may have fewer competing demands and more flexibility to dedicate themselves to EBF.\u003c/p\u003e \u003cp\u003eThis study also revealed that mothers who had ANC follow-up practices EBF better than mothers who did not. This finding is similar to those of studies performed in Northwest Ethiopia [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], Ambo [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] Halaba [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]and Dubti afar.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] Moreover, in other countries, such as Tamandu, India [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], and Indonesia [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], this could be because mothers who attended ANC visits may receive different nutritional and other health-related education from health professionals during their follow-up appointments, which could have a significant impact on EBF. This effect might be attributed to the counselling provided to mothers regarding the importance of breastfeeding in health facilities during service delivery.\u003c/p\u003e \u003cp\u003eMothers who received counselling about breastfeeding during ANC were 5 times more likely to exclusively breastfeed their infants than were those who did not receive counselling. Similar findings were observed in Dubti town, afar regional state, northeast Ethiopia, Somali region of Ethiopia, Mecha District, North West Ethiopia [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and in other counties, such as Tanzania, Bangladesh, Nigeria and India [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. A possible explanation may be that since ANC follow-up is a continuing process, mothers could receive much information, and this information may increase the knowledge and attitudinal changes regarding neonatal feeding practices, as well as the nutritional benefits of breast milk for the health of mothers and newborns.\u003c/p\u003e \u003cp\u003eMothers who had positive attitudes toward EBF were more likely to practice EBF than were those who had negative attitudes. This study is supported by other studies conducted in Ghana, a systematic review conducted in East Africa and Nigeria [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Possible reasons for this association may be that beliefs and perceptions of EBF-related attitudes reflect beliefs about the benefits and importance of breastfeeding for the health and well-being of both mothers and infants. Mothers who hold positive attitudes may have stronger beliefs about the nutritional value, bonding benefits, and immune-boosting properties of breast milk. These beliefs can motivate them to prioritize and commit to practicing EBF.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStrengths and limitations of the study\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eStrength of the Study\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe data were collected through both quantitative and qualitative research approaches, which adds value to strengthen the study design. The study was conducted in a general population that may be representative of other rural communities or pastoral communities in Ethiopia.\u003c/p\u003e \u003cp\u003e \u003cb\u003eLimitations of the study\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAs a cross-sectional study, a cause-and-effect relationship cannot be established to identify an actual predictor. Since the data were self-reported, there may be social desirability bias and recall bias.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe prevalence of EBF found in this study was lower than the WHO recommended level.\u0026nbsp;This figure is also lower than the national figure reported by the 2019 mini-EDHS. Household food security status, ANC follow-up during pregnancy, counselling about breastfeeding during ANC, number of children and attitude toward EBF practice were significantly associated with EBF. Most of the interviewees believed that breastfeeding is important for the baby, but they thought it was not sufficient for the baby until 6 months. The most common reason for not practising EBF is due to differences in perception of the community; for example, if only the breast is not sufficient, babies might be thirsty unless they drink water, give water decreases or cause infantile colic, give only breastmilk to the baby to affect the mother, and waste the baby; otherwise, the baby may refuse food if she does not start early.\u003c/p\u003e\n\u003ch2\u003eRecommendations\u003c/h2\u003e\n\u003cp\u003eBased on the findings of this study, the following points are recommended:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTo Oromia Regional Health Bureau and NGOs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTrain health workers to ensure\u0026nbsp;that they have accurate and up-to-date information on infant feeding in general and breast feeding/EBF in particular,\u0026nbsp;which can help them to have\u0026nbsp;the specific knowledge\u0026nbsp;and skills\u0026nbsp;required to educate and counsel mothers to improve EBF\u0026nbsp;practices.\u003c/p\u003e\n\u003cp\u003eSuitable\u0026nbsp;IEC materials\u0026nbsp;for BFs should be developed\u0026nbsp;to teach mothers at\u0026nbsp;the home and facility\u0026nbsp;levels.\u0026nbsp;Availing family planning at all health\u0026nbsp;facilities\u0026nbsp;for spacing pregnancies can positively impact breastfeeding outcomes, as it allows for optimal maternal health and milk production, increasing the likelihood of successful EBF.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTo\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ethe East Bale Zonal Health Department and\u0026nbsp;District Health\u0026nbsp;Office\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is a need\u0026nbsp;to expand and strengthen maternal health services,\u0026nbsp;specifically antenatal and postnatal care services,\u0026nbsp;in line with the\u0026nbsp;expansion of existing health\u0026nbsp;services.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTo health care providers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMaternal\u0026nbsp;health services,\u0026nbsp;specifically ANC and PNC services, should be strengthened and promoted\u0026nbsp;to address all eligible individuals.\u003c/p\u003e\n\u003cp\u003eEBF counselling\u0026nbsp;is an important part of all maternal and child health services,\u0026nbsp;such as ANC, PNC, FP, vaccination and\u0026nbsp;the IMNCI,\u0026nbsp;for providing\u0026nbsp;health education and counselling\u0026nbsp;to\u0026nbsp;mothers\u0026nbsp;to\u0026nbsp;improve their BF knowledge\u0026nbsp;and subsequently\u0026nbsp;improve their EBF\u0026nbsp;practices\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTo Researchers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFurther analytical studies, especially follow-up studies, are suggested to explore the actual levels of EBF and to further examine variables associated with this practice.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eANC: Antenatal Care, AOR: Adjusted Odds Ratio, CL: Confidence Level, COR: Crude Odd Ratio, EBF: Exclusive Breastfeeding, EDHS: Ethiopian Demographic Health Survey, HSDP: Health Sector Development Program, UNICEF: United Nation International Children’s Emergency Fund, WHO: World Health Organization.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cstrong\u003eand consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved,\u0026nbsp;and\u0026nbsp;an ethical approval letter\u0026nbsp;was\u0026nbsp;provided by the Ethical Review\u0026nbsp;Board of the Oromia Regional State Health Bureau\u0026nbsp;with reference number IRB/688/15.\u0026nbsp;The study was performed in\u0026nbsp;accordance\u0026nbsp;with the World Medical Association Declaration of Helsinki on medical research.\u0026nbsp;Written consent was obtained from\u0026nbsp;the\u0026nbsp;study participants after the study objectives and procedures\u0026nbsp;were explained, and their right to refuse not to participate in the study\u0026nbsp;at\u0026nbsp;any time was assured. For this purpose, a one-page consent letter was attached to the cover page of each questionnaire stating the general objective of the study and issues of confidentiality, which were also discussed by the data collectors before proceeding with the interview.\u0026nbsp;The confidentiality\u0026nbsp;of the information was ensured by coding. The\u0026nbsp;interviews were\u0026nbsp;privately\u0026nbsp;conducted\u0026nbsp;in an area separated from\u0026nbsp;the\u0026nbsp;others. Only authorized individuals were given access to the raw data collected from the field.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe original contributions presented in the study are included in the article/supplementary material, and further inquiries can be directed to the corresponding author/s.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no funding for this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualisation: D.H.\u0026nbsp;and\u0026nbsp;B.T.O.\u0026nbsp;Data curation: D.H and B.T.O Formal analysis: D.H, S.M.I, B.T, S.M.I, M.S.L\u0026nbsp;and B.B Investigation: Project administration: S.B., D.G, S.M.I, M.S.L, B.B. and R.E.G. \u0026nbsp;Software: S.B., D.G, S.M.I, M.S.L, B.B. and R.E.G. \u0026nbsp;Validation: S.B., D.G., B.B. and R.E.G. Visualisation: D.H.\u0026nbsp;and\u0026nbsp;B.T.O\u0026nbsp;Writing and original draft of manuscript: D.H. and B.T.O Writing, review and editing of manuscript: All authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFirst and foremost, we would like to thank all the study participants for their participation in this study. Second, we would like to acknowledge the Oromia Regional State Health Bureau for the approval of the Ethical clearance for this study. Finally, we also thank the East Bale Zonal Health Office and the Woreda Health Office for providing baseline information.\u003c/p\u003e\n\u003ch2\u003eAuthor details\u003c/h2\u003e\n\u003cp\u003eDepartment of Public Health, Kuyu General Hospital, Oromia Regional Health Bureau, Gerba Guracha, Ethiopia.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWHO, \u0026ldquo;Breastfeeding : achieving the new normal,\u0026rdquo; \u003cem\u003eLancet\u003c/em\u003e, vol. 387, no. 10017, p. 404, 2016, doi: 10.1016/S0140-6736(16)00210-5.\u003c/li\u003e\n\u003cli\u003eA. M. Al-binali, \u0026ldquo;Breastfeeding knowledge , attitude and practice among school teachers in Abha female educational district , southwestern Saudi Arabia,\u0026rdquo; \u003cem\u003eInt. Breastfeed. J.\u003c/em\u003e, vol. 7, no. 1, p. 1, 2019, doi: 10.1186/1746-4358-7-10.\u003c/li\u003e\n\u003cli\u003eY. Sinshaw, K. Ketema, and M. 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Abesig, and J. Luo, \u0026ldquo;Knowledge, attitude, and practice of exclusive breastfeeding among mothers in East Africa: A systematic review,\u0026rdquo; \u003cem\u003eInt. Breastfeed. J.\u003c/em\u003e, vol. 15, no. 1, pp. 1\u0026ndash;18, 2020, doi: 10.1186/s13006-020-00313-9.\u003c/li\u003e\n\u003cli\u003eO. Jahanpour, S. E. Msuya, J. Todd, B. Stray-pedersen, and M. Mgongo, \u0026ldquo;Increasing trend of exclusive breastfeeding over 12 years period ( 2002 \u0026ndash; 2014 ) among women in Moshi , Tanzania,\u0026rdquo; \u003cem\u003eBMC Pregnancy Childbirth\u003c/em\u003e, vol. 7, no. 18, pp. 1\u0026ndash;8, 2018, doi: 10.1186/s12884-018-2104-7.\u003c/li\u003e\n\u003cli\u003eC. G. Victora \u003cem\u003eet al.\u003c/em\u003e, \u0026ldquo;Association between breastfeeding and intelligence , educational attainment , and income at 30 years of age : a prospective birth cohort study from Brazil,\u0026rdquo; \u003cem\u003eLancet Glob. Heal.\u003c/em\u003e, vol. 3, no. 4, pp. e199\u0026ndash;e205, 2021, doi: 10.1016/S2214-109X(15)70002-1.\u003c/li\u003e\n\u003cli\u003eM. A. Asemahagn, \u0026ldquo;Determinants of exclusive breastfeeding practices among mothers in azezo district, northwest Ethiopia,\u0026rdquo; \u003cem\u003eInt. Breastfeed. J.\u003c/em\u003e, vol. 11, no. 1, pp. 1\u0026ndash;7, 2018, doi: 10.1186/s13006-016-0081-x.\u003c/li\u003e\n\u003cli\u003eH. G. Mengesha, H. Vatanparast, C. Feng, and P. Petrucka, \u0026ldquo;Modeling the predictors of stunting in Ethiopia: analysis of 2016 Ethiopian demographic health survey data (EDHS),\u0026rdquo; \u003cem\u003eBMC Nutr.\u003c/em\u003e, vol. 6, no. 1, p. 52, 2020, doi: 10.1186/s40795-020-00378-z.\u003c/li\u003e\n\u003cli\u003eG. Mekuria and M. Edris, \u0026ldquo;Exclusive breastfeeding and associated factors among mothers in Debre Markos, Northwest Ethiopia: A cross-sectional study,\u0026rdquo; \u003cem\u003eInt. Breastfeed. 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Rep.\u003c/em\u003e, no. 0123456789, pp. 1\u0026ndash;10, 2022, doi: 10.1038/s41598-022-22051-0.\u003c/li\u003e\n\u003cli\u003eT. G. Woldie, \u0026ldquo;Assessment of Exclusive Breast Feeding Practice and Associated Factors in Mecha District, North West Ethiopia,\u0026rdquo; \u003cem\u003eSci. J. Public Heal.\u003c/em\u003e, vol. 2, no. 4, p. 330, 2018, doi: 10.11648/j.sjph.20140204.24.\u003c/li\u003e\n\u003cli\u003eA. Kumala, \u0026ldquo;Factors Associated with Exclusive Breastfeeding at Primary Health Care in Indonesia,\u0026rdquo; \u003cem\u003ePediatr. Ther.\u003c/em\u003e, vol. 07, no. 04, 2017, doi: 10.4172/2161-0665.1000337.\u003c/li\u003e\n\u003cli\u003eM. M. Asfaw, M. D. Argaw, and Z. K. Kefene, \u0026ldquo;Factors associated with exclusive breastfeeding practices in Debre Berhan District, Central Ethiopia: A cross sectional community based study,\u0026rdquo; \u003cem\u003eInt. Breastfeed. J.\u003c/em\u003e, vol. 10, no. 1, pp. 1\u0026ndash;9, 2018, doi: 10.1186/s13006-015-0049-2.\u003c/li\u003e\n\u003cli\u003eZ. B. B. Belayneh Kefale Gelaw, \u0026ldquo;Knowledge and Practice of Mothers towards Exclusive Breastfeeding and Its Associated Factors in Ambo Woreda West Shoa Zone Oromia Region, Ethiopia,\u0026rdquo; \u003cem\u003eEpidemiol. Open Access\u003c/em\u003e, vol. 05, no. 01, p. 7, 2020, doi: 10.4172/2161-1165.1000182.\u003c/li\u003e\n\u003cli\u003eA. Sonko and A. Worku, \u0026ldquo;Prevalence and predictors of exclusive breastfeeding for the first six months of life among women in Halaba special woreda, Southern Nations, Nationalities and Peoples\u0026rsquo; Region/SNNPR/, Ethiopia: A community based cross-sectional study,\u0026rdquo; \u003cem\u003eArch. Public Heal.\u003c/em\u003e, vol. 73, no. 1, pp. 1\u0026ndash;11, 2017, doi: 10.1186/s13690-015-0098-4.\u003c/li\u003e\n\u003cli\u003eB. Adugna, H. Tadele, F. Reta, and Y. Berhan, \u0026ldquo;Determinants of exclusive breastfeeding in infants less than six months of age in Hawassa, an urban setting, Ethiopia,\u0026rdquo; \u003cem\u003eInt. Breastfeed. J.\u003c/em\u003e, vol. 12, no. 1, pp. 4\u0026ndash;11, 2017, doi: 10.1186/s13006-017-0137-6.\u003c/li\u003e\n\u003cli\u003eEDHS, \u003cem\u003eEthiopia Mini Demographic and Health Survey\u003c/em\u003e, no. July. 2019. doi: Internet: www.DHSprogram.com.\u003c/li\u003e\n\u003cli\u003eT. Shifraw, A. Worku, and Y. Berhane, \u0026ldquo;Factors associated exclusive breastfeeding practices of urban women in Addis Ababa public health centers, Ethiopia: A cross sectional study,\u0026rdquo; \u003cem\u003eInt. Breastfeed. J.\u003c/em\u003e, vol. 10, no. 1, pp. 4\u0026ndash;9, 2019, doi: 10.1186/s13006-015-0047-4.\u003c/li\u003e\n\u003cli\u003eM. Hossain, A. Islam, T. Kamarul, and G. Hossain, \u0026ldquo;Exclusive breastfeeding practice during first six months of an infant\u0026rsquo;s life in Bangladesh: a country based cross-sectional study,\u0026rdquo; \u003cem\u003eBMC Pediatr.\u003c/em\u003e, vol. 18, no. 1, p. 93, 2018, doi: 10.1186/s12887-018-1076-0.\u003c/li\u003e\n\u003cli\u003eR. A. Alzaheb, \u0026ldquo;Factors Influencing Exclusive Breastfeeding in Tabuk, Saudi Arabia,\u0026rdquo; \u003cem\u003eClin. Med. Insights Pediatr.\u003c/em\u003e, vol. 11, p. 117955651769813, 2017, doi: 10.1177/1179556517698136.\u003c/li\u003e\n\u003cli\u003eA. Owais \u003cem\u003eet al.\u003c/em\u003e, \u0026ldquo;Household food security and infant feeding practices in rural Bangladesh,\u0026rdquo; \u003cem\u003ePublic Health Nutr.\u003c/em\u003e, vol. 19, no. 10, pp. 1875\u0026ndash;1881, 2019, doi: 10.1017/S1368980015003195.\u003c/li\u003e\n\u003cli\u003eM. Ulak, R. K. Chandyo, L. Mellander, P. S. Shrestha, and T. A. Strand, \u0026ldquo;Infant feeding practices in Bhaktapur, Nepal: A cross-sectional, health facility based survey,\u0026rdquo; \u003cem\u003eInt. Breastfeed. J.\u003c/em\u003e, vol. 7, pp. 1\u0026ndash;8, 2018, doi: 10.1186/1746-4358-7-1.\u003c/li\u003e\n\u003cli\u003eP. Saravanakumar, V. V Anantharaman, S. Suresh, and A. K. Rajendran, \u0026ldquo;Prevalence of Exclusive Breastfeeding Practices among the Irular tribes in Tamil Nadu,\u0026rdquo; \u003cem\u003eIndian J. Basic Appl. Med. Res.\u003c/em\u003e, vol. 6, no. 1, pp. 742\u0026ndash;749, 2016, [Online]. Available: http://ijbamr.com/pdf/December 2016 742-749.pdf.pdf\u003c/li\u003e\n\u003cli\u003eO. O. Osibogun, T. F. Olufunlayo, and S. O. Oyibo, \u0026ldquo;Knowledge, attitude and support for exclusive breastfeeding among bankers in Mainland Local Government in Lagos State, Nigeria,\u0026rdquo; \u003cem\u003eInt. Breastfeed. J.\u003c/em\u003e, vol. 13, no. 1, pp. 1\u0026ndash;7, 2018, doi: 10.1186/s13006-018-0182-9.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Exclusive breastfeeding practice, infants aged 0-6 months, associated factors, Sawena district.","lastPublishedDoi":"10.21203/rs.3.rs-4076682/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4076682/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e:\u003cstrong\u003e \u003c/strong\u003eBreastfeeding is the easiest, healthiest, and most cost-effective feeding method forinfants. Despite the promotion of exclusive breastfeeding, its importance is poorly understood in pastoral communities. Little information is available on the practices and factors underlyingexclusive breastfeeding, especially in pastoral communities in the Sawena district, Bale zone, Oromia region, and Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThis study aimed to assess the prevalence of and factors associated with exclusive breastfeeding among mothers with infant (aged 0-6 months) in pastoral communities in the Sawena district, Bale Zone, Oromia Region, SoutheastEthiopia, 2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eA community-based cross-sectional study design was employed from March 01 to April 2023. A total of 631 women were selected using simple random sampling. The data were collected through face-to-face interviews. The collected data were entered into Epi Data software version 4.6 and subsequently exported into SPSS version 26 for analysis. Variables with a P value \u0026lt; 0.25 in the bivariate analysis were included in the multivariable logistic regression model. The degree of association was expressed using adjusted odds ratios (AOR) with a 95% confidence interval (CI) of \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Out of 631 eligible mothers, 625 participated in this study, for a response rate of 99.0%. The prevalence of exclusive breastfeeding (EBF) practices among mothers in the study area was 53.8% (95% CI; 49.8%–57.4%). Household food security status [AOR=1.6, 95% CI (1.1-2.2)], ANC follow-up during pregnancy, [AOR = 5.3, 95% CI (2.4-11.9)], counselling about EBF during ANC visits[AOR=5; 95% CI (2.1-11.7)], number of children [AOR =1.6, 95% CI (1.1-2.3)] and attitudes toward EBF [AOR= 1.8; 95% CI (1.4-2.6)] were significantly associated with EBF.\u003c/p\u003e\n\u003cp\u003eThe majority of interviewees explained that there were various reasons why exclusive breastfeeding was not practiced, including beliefs that breast milk was insufficient, giving babies water would reduce colic, and fears of food refusal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe prevalence of exclusive breastfeeding practices in the study area was lower than the country-recommended level. Household food security status, ANC follow-up during pregnancy, counselling about breastfeeding during ANC, number of children and attitude toward EBF practice were significantly associated with EBF. BF counselling during ANC services can be provided to mothers to improve their BF knowledge and subsequently improve their EBF practices.\u003c/p\u003e","manuscriptTitle":"Exclusive Breastfeeding Practice and Associated Factors among Mothers Having Infants (Aged 0-6 Months) in the Pastoral Community of Sawena District, Bale Zone Oromia, Ethiopia, 2023","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-15 18:40:04","doi":"10.21203/rs.3.rs-4076682/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d4f9e18c-505f-4299-863a-5a128a4a539f","owner":[],"postedDate":"March 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-03-15T18:40:04+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-15 18:40:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4076682","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4076682","identity":"rs-4076682","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}