Optimal breastfeeding practice and associated factors among mothers of children 24-36 months of age in Tehuledere District, Northeast Ethiopia

Optimal breastfeeding practice and associated factors among mothers of children 24-36 months of age in Tehuledere District, Northeast Ethiopia | 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 Optimal breastfeeding practice and associated factors among mothers of children 24-36 months of age in Tehuledere District, Northeast Ethiopia Osman Seid, Ahmed Tadesse, Nigusie Tadesse Abegaz, Endalew Minwuye Andargie This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4343238/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 among the best and effective ways to promote optimal development of children in early childhood and maternal health. Recent estimates suggested that optimal breastfeeding could prevent around 12% of deaths in under-5 children every year, representing around 800,000 lives in low- and middle-income countries. Objectives The aim of this study was to assess the prevalence of optimal breastfeeding practice and associated factors among mothers of children 24–36 months of age in Tehuledere District, North East Ethiopia, 2020. Methods A community-based cross-sectional study was conducted among 522 mothers of children 24–36 months of age from March 01–26/2020.Multistage sampling technique was used to select the study participants. Interviewer administered structured questionnaire was used to collect data from the study participants. Data were entered using epi data version 3.1 and analyzed by using SPSS version 20.0. Binary logistic regression analysis was computed. Results The prevalence of optimal breastfeeding was 44.3%.Access to media (AOR = 2.547[95% CI = 1.203, 5.395]), having male child (AOR = 2.697[95% CI = 1.492, 4.874]), child birth weight < 2.5kg (AOR = 4.864[95% CI = 1.240, 19.080]) and 1–3 times antenatal care(ANC) visits (AOR = .282[95% CI = .154, .518]) were the factors significantly associated with optimal breast feeding practice. Conclusions and Recommendations In this study, the prevalence of optimal breastfeeding practice was low. Access to media, sex of the child, weight of the child and number antenatal care visits were significantly associated. Therefore, enhancing the access to information on optimal breast feeding, minimizing sex preference in child care and strengthening focused ANC by health professionals, district health offices and partners is important in order to improve optimal breastfeeding practice. Children Optimal Breastfeeding practice Mothers Tehuledere District Figures Figure 1 Figure 2 Figure 3 Background Optimal breastfeeding practice is an early initiated breastfeeding within one hour of birth, exclusively breastfed for 6 months and timely started safe and nutritious complementary food at 6 months, on demand breast feeding, giving colostrum and continued breastfeeding up to 24months of age. Optimal breastfeeding plays a key role in improving the health and development of children under-5 years, and have been shown to be associated with decreased risk of childhood diarrhea, and respiratory tract infections as well as reductions in childhood mortality ( 1 , 2 ). There is increasingly expanding evidence on the health benefits of breastfeeding, both for the mother and for the child as well as the economic benefits that this reaps into society. The National Breastfeeding Policy and Action Plan 2015–2020 recognizes the right that all mothers have for receiving clear and impartial information so as to be able to make a fully informed choice on how to feed their baby ( 3 ) Recent estimates suggested that optimal breastfeeding could prevent around 12% deaths in under-5 children every year, representing around 800,000 lives in low- and middle-income countries ( 4 ).In spite of these facts, only 45% of the world’s newborns are put to the breast within 1 hour of birth and 43% of infants aged 6 months or less are exclusively breastfed, and(46% %) of children are continued breastfeeding until 24 months of age ( 5 , 6 ). A number of Socio-cultural, health-system and commercial factors, as well as poor knowledge about breast feeding result in inadequate rates of exclusive breastfeeding ( 7 ).Exclusive breastfeeding is the recommended nutrition for newborns ( 8 ). Optimal breast feeding is a practice that many countries are rallying around but is challenging to improve without concerted efforts and substantive support for mothers ( 9 ).About 10% of the global burden of disease among children under-five years in developing countries resulted from suboptimal breastfeeding practice ( 1 ). In 2016, a Lancet series on breastfeeding estimated that globally 823,000 deaths of children under the age of five years could be prevented every year through optimal breast feeding practices ( 10 ). Despite its benefit, Exclusive breast feeding (EBF) practice is low throughout the world ( 11 ), while timely initiation of breastfeeding varied globally, higher in high-income countries than in low and middle income nations ( 12 ).Children aged 6–23 months who were not breastfed had higher risk of all-cause and infection-related mortality ( 4 ). Studies arround the glob evidenced that poor breastfeeding practices could be influenced by low education levels, occupation of mothers, poor maternal knowledge, maternal age, parity, antenatal care service utilization and place of delivery ( 13 ). In sub-Saharan countries including Ethiopia breast feeding practices gap is highly increasing with early and abrupt cessation of breastfeeding followed by an introduction of dirty, unsound artificial feeding of infants with very dilute milk products is common ( 1 , 14 ). In Ethiopia, many sub-national reports in 2019 indicated that early initiation of breast feeding (66.5%) and EBF is (60.1%). All in all, breastfeeding is one of the foundations of child health, development and survival. For these reasons, WHO recommends that breastfeeding should be initiated within the first hour after birth and that infants should exclusively breastfeed for the first 6 months; on demand breast feeding (breastfeeds frequently day and night at least 8 times per day); and complementary foods should then be introduced, with continued breastfeeding until 24 months of age or older ( 14 ). Children continue to suffer from malnutrition and its related complications despite efforts by policy makers and health care service providers ( 15 ). Despite the reduced global under-five mortality, the rate of malnutrition, rate of stunting and rate of underweight ( 16 ), the rate of EBF has stagnated and fallen short of the health sector transformation plan, and maternal and child survival program. As part of optimal infant and young child feeding (IYCF) practices, early and exclusive breastfeeding are critical to prevent all forms of malnutrition during the first 2 years of life ( 17 ). Hence, this study was therefore aimed in assessing factors associated with optimal breastfeeding practice among Mothers of children 24–36 months of age in Tehuledere District. Thus, the study finding will provide an insight to policy makers, programmers, stake holders, and non-government organizations (NGOs) for future planning and interventions of appropriate strategies to promote and maintain breastfeeding practice. Clinicians, nurses and midwifes who work at the grass root level will get proper information in order to provide health education for mothers to wards optimal breastfeeding practice. The finding of this study will also help as a baseline data for future researchers who are interested in carrying out further research with this regard. METHODS AND MATERIALS Study design and period A Community-based cross-sectional study was carried out from March 01–26/2020 Study area The study was carried out in Tehuledere District, North East Ethiopia. It is situated at a distance of 430 km far away from Addis Ababa. The capital town of the district is Haik which is located at 450 km far away from Bahir Dar, the capital city of Amhara national regional state ( 18 ).The district has 19 rural and 7 urban kebeles (the smallest administrative units). The total population of the district was 145,625 of which females consist 47%. The district has 1 governmental primary hospital, 5 health centers, 23 health posts, and 26 private clinics (9 medium&17 primary clinics) ( 19 ).The total number of households and children 24–36 months of age in the District were 29,000 and 6378 respectively ( 20 ). Population Source population All mothers with children 24–36 months of age who were permanent residents of Tehuledere District, 2020 Study population All mothers with children 24–36 months of age in selected kebeles and resided for six or more months in Tehuledere District during the study period Sampling unit All selected households of the selected Kebeles were used as sampling unit. Study unit All selected mothers with children 24–36 months of age from selected households during the data collection period were used as study unit. Inclusion and exclusion criteria Inclusion criteria All mothers with children 24–36 months of age resided for six months or more during data collection were included in the study. Exclusion criteria Mothers with children 24–36 months of age who were unable to respond or seriously ill and mothers who do not live with their child were excluded from the study. Study variables Dependent variable Optimal Breastfeeding Practice Independent variables Socio-demographic factors Marital Status, maternal education level, husband education level, family size, having partner and family support, number of under-five children, maternal occupation, occupation of husband, family monthly income, ownership of house, having BF information, information source and a ccess to media Maternal related factors Maternal age at birth of the child, parity, birth interval, number of ANC visits, number of PNC visits and maternal knowledge Child related factors Age of child, sex of child, child weight at birth Health service-related factors Place of delivery, mode of delivery, breastfeeding counseling during ANC and breastfeeding counseling during PNC Operational definitions Optimal breastfeeding practice refers to early initiated breastfeeding within one hour of birth, exclusively breastfed for 6 months and timely started safe and nutritious complementary food at 6 months, on demand breast feeding(allow the baby to breastfeed as often as he/she wants) This means feeding every 2–3 hours (8–12 times per 24 hours or more frequently if needed, especially in the early months),giving colostrum and continued breastfeeding up to 2 years of age ( 1 – 3 , 13 , 21 – 23 ). Suboptimal breastfeeding practice when the study subjects have not practiced either of the following; initiated breastfeeding within one hour of birth, giving colostrum, breastfeeds frequently day and night (on demand), giving infant only breast milk for the first 6 months, starting complementary feeding by the age of six months and continuing breastfeeding until the child is two years of age or older(late initiation of breast feeding, not giving colostrum, not exclusive breast feeding and early cessation of breast feeding) ( 22 ). Knowledge of optimal breastfeeding Knowledge of mothers on breastfeeding was measured by asking breastfeeding knowledge questions developed based on Infant and Young child feeding (IYCF) recommendations. For knowledge assessment, 14 questions were provided. The total knowledge score for each respondent was obtained by adding the responses (scores) of each question related to optimal breastfeeding practice. Then, the total score was dichotomized into good knowledge (if respondent’s score is ≥ 7.74) and poor knowledge (if respondent’s score is < 7.74) taking the mean score of 7.74 as a cutoff- point. Each knowledge question had three categorical responses of “yes,” “no,” or “not sure.” A correct response was scored as “1,” and a wrong and or “not sure” response scored a “0” ( 21 , 24 , 25 ). Early initiated breastfeeding is the initiation of breast feeding within one hour of birth ( 1 , 13 , 26 ). Exclusive breastfeeding is the practice of feeding breast milk only, including expressed breast milk, to infants and excluding water, other liquids, breast milk substitutes, and solid foods. Vitamin drops, minerals, oral rehydrating solution and medicines may be given ( 1 , 26 ). Complementary feeding practice is the gradual prolusion of soft food, semisolid and solid food starting from children aged 6 months ( 1 , 26 ). Predominant breastfeeding Infants and children less than 6 months old who received breast milk as predominant feeding within 24 hours period ( 1 , 13 , 26 ). Minimum dietary diversity feeding of infants and young child feeding at least 4 food groups out of 7 food groups within 24 hours (grain, legumes, dairy products, egg, meat, fruits, and vegetables) ( 27 ). Sample size and sampling methods Sample size To determine the sample size, outcome variable and various factors significantly associated with the outcome variable were considered. Both for the first and the second objectives the sample size was calculated; then, the larger sample size was used for this study. For the first objective, the required sample was calculated by using single population proportion formula with the assumption of 95% confidence interval, 5% margin of error(d),and prevalence of optimal breast feeding from previous study (P = 43.1%) was used ( 28 ). n= \(\frac{\left[\left(\frac{\text{Z}\text{ɑ}}{2}\right)2 \times \text{P} \left(1-\text{P}\right)\right]}{\text{d}2 }=\frac{\left(1.96\right)2\times 0.431(1-0.431) }{0.5)\times 0.5}\) = 377 Where; n = required sample size Z (α/2) = the desired level of confidence interval 95% (1.96 at α = 0.05) P = Prevalence of optimal breastfeeding practice taken from previous study in Ethiopia. d = desired precision (5% margin of error). For the second specific objective, the sample size was determined by considering various factors that were significantly associated with the outcome variable. Two-sided confidence interval using double population proportion formula with the assumptions of 95% CI, 5% margin of error, 80% power and exposed to unexposed ratio 1:1 using Epi Info version 7.1 stat calc, by taking the above assumptions the following results were revealed ( Table 1 ). Table 1 Sample size calculation for associated factors of optimal breastfeeding practice in Tehuledere district, North East Ethiopia, March 2020 (n = 522) Variables CI Power Ratio (exposed: unexposed) % of outcome unexposed AOR Sample size Ownership of house ( 29 ) 95 80 1:1 72.1 .5 316 Maternal Knowledge on BF ( 39 ) 95 80 1:1 44.3 2.1 254 Under 5 OPD visit ( 27 ) 95 80 1:1 53.2 .44 214 The maximum calculated sample size 316 As it is seen on the table above, the total sample size to identify factors that contribute to optimal breastfeeding practices was 316. Finally, by comparing the sample size of the first objective (377) and the sample size of the second objective (316), the maximum sample size (377) was used. By using finite population correction formula (N < 10,000); nf = n/ (1 + n/N); nf = 377/ (1 + 377/2083) = 319. Multiplying 319 by design effect 1.5 ( 29 , 30 ), it gives 478.5 and after adding 10% non-response rate (47.85), the final sample size was 527. Sampling methods In this study a multi-stage sampling technique (Fig. 1) was used to select the study participants. Firstly, ten kebeles (Bededo, Sulula, Haik 03, Haik 05, Hitecha, Hara, Hardibo, Gobeya, Jari, and Wahelo) were selected by using lottery method. Secondly, proportional sample size allocation was done to each kebele based on the number of mothers of 24–36 months children. Thirdly, households with children 24–36 months of age were identified from recorded documents of health extension workers in the selected kebeles. Finally, study participants were drawn from the sampling unit by using systematic random sampling technique (K = 2083/527 = 4). The sample size was proportionally allocated to the selected kebeles using the formula: na= (Na/N) n Where, na = sample size for kebele ‘a’; Na = number of eligible children in kebele ‘a’ N = the total eligible children in all selected kebeles ; n = the total sample size Survey instruments and Procedures An interviewer administered structured questionnaire adapted from related literatures ( 2 , 3 , 23 , 24 , 26 – 28 , 31 , 32 ) was used to collect data from the study participants. The questionnaire was developed in English, translated to local language (Amharic), and back translated to English. The questionnaire contained five parts namely: socio-demographic, maternal, child, health service-related factors and optimal breastfeeding practice. Three health extension workers and one BSc nurse from the district health office were used as data collectors and supervisor respectively. Data management and analysis The data were entered using Epi Data version 3.1, then exported to SPSS version 20.0 and cleaned for analysis. Descriptive analysis was conducted to summarize the data. Binary logistic regression analysis was executed to see the association between predictor and outcome variables. All predictor variables associated with outcome variable with a p value ≤ 0.2 were entered into multivariable logistic regression analysis. A p-value of ≤ 0.05 was considered as statistically significant. Model fitness was checked by Hosmer-Lemeshow test of goodness of fit; then, the model fitted the data at p-value = 0.283. Data Quality assurance The quality of the data was assured by properly designing and pre-testing the questionnaire on 5% of participants at Kosero kebele (outside the selected kebele). Proper categorization, coding and skipping patterns of questions were used. Two days training was given to three health extension workers as data collectors and one BSc nurse supervisor before the actual data collection on general objective of the study, contents of the tool, how to approach the study participants and keep their confidentiality. Data from each household were reviewed and checked for completeness, accuracy, clarity and consistency by the principal investigator and the supervisors on a daily basis. Data cleanup and cross checking were done before analysis. Dissemination of findings The result of the study will be submitted to, Bahir Dar University, College of Medicine and Health Sciences, Department of Pediatrics and Child Health Nursing, Tehuledere District Health Office and to Ethiopian Public Health Institute. It will also be presented in different workshops/seminars. Finally, an effort also will be made to publish in an internationally peer reviewed journal. RESULTS Socio-Demographic Characteristics From the total calculated sample size (n = 527), 522 mothers had participated in the study making the response rate of 99%. Above three quarter, 380(72.8%) and 316(60.5%) of the study participants were married and had attended primary education respectively. The current study revealed that 435(83.3%) of the study participants were housewives by occupation. The findings of the study also indicated that 421(80.7%) of the respondents’ husbands had attended primary education and 384(73.6%) were farmers by occupation. Most of the respondents 403(77.2%) were rural dwellers, and 356(68.2%) of the study participants had 5 and above family sizes. More than half, 345(66.1%) of the respondents had 2 and above years old under five children. From those mothers interviewed, only 126(24.1%) had family support about breastfeeding, and more than three fourth, 377(72.2%) of mothers earn an average monthly income of less than 1000 Birr and 446(85.4%) of them were owners of the houses. Majority, 310(59.4%) of mothers had breastfeeding information. In addition to these, 271(51.9%) of the respondents had access to media ( Table 2 ). The highest and the lowest sources of information received were 192(61.9%) from health professionals and 16(5.2%) from mass media ( Fig. 2 ). Table 2 Socio-demographic characteristics of respondents regarding optimal breastfeeding practice in Tehuledere district, North East Ethiopia, March 2020 (n = 522) VariableCategory Frequency Percent Marital status Married 380 72.8 Divorced 78 14.9 Separated 64 12.3 Educational status of mother Unable to read and write 188 36.0 Primary education 316 60.5 Secondary and above 18 3.4 Educational status of father Unable to read and write 66 12.6 Primary education 421 80.7 Secondary and above 35 6.7 Residence of respondent Urban 112 21.5 Rural 403 77.2 Family size < 5 166 31.8 5 and above 356 68.2 Number of under five children 1 177 33.9 2 and above 345 66.1 Family support Yes 126 24.1 No 396 75.9 Maternal occupation House wife 435 83.3 Government employed 56 10.7 Daily laborer 31 5.9 Occupation of husband Government employed 41 7.9 Farmer 384 73.6 Daily laborer 97 18.6 Family income in ETB < 1000.00 377 72.2 1000.00-2500.00 67 12.8 2501.00 and above 78 14.9 Ownership of house Yes 446 85.4 No 76 14.6 Had breastfeeding information Yes 310 59.4 No 212 40.6 Access to media Yes 271 51.9 No 251 48.1 Maternal, Child, and Health Service-Related Characteristics Out of the total study subjects interviewed, three hundred forty-eight (66.7%) received ANC visits, and three hundred fifty-three (67.6%) received PNC services for the current child. From those respondents 304(58.2%) of mothers were between 20–29 years of age, 275(52.7%) of mothers had good knowledge (Fig. 4). The median age of mothers was 28( ± 7) years. From the total respondents, 345(66.1%) were multiparous, 241(69.9%) had 2–3 years of birth interval between the index and elderly child. Out of the total respondents interviewed, 246(47.1%) started complementary feeding for their children at 6th month. The median age of children who started complementary feeding was 6 ± 1months ( Table 3 ). Table 3 Maternal, child, and health service related characteristics of respondents in Tehuledere district, North East Ethiopia, 2020 (n = 522) Variable Category Frequency Percent ANC visit Yes 348 66.7 No 174 33.3 Number of ANC visit(n = 348) 1-3times 235 67.5 4times& above 113 32.5 PNC visit Yes 353 67.6 No 169 32.4 Number of PNC visits (n = 353) 1-2days 141 39.9 > 2 days 212 60.1 Maternal age(years) at birth of index child 15–19 63 12.1 20–29 304 58.2 30 and above 155 29.7 Parity Primiparous 177 33.9 Multiparous 345 66.1 Birth interval(n = 345) 1 year 34 9.9 2–3 years 241 69.9 4years& above 70 20.3 Age of the child (in month) at initiation of complementary feeding 0–5 months 123 23.6 At 6th month 246 47.1 7–23 months 153 29.3 Sex of the child Male 301 57.7 Female 221 42.3 Child birth weight ≥ 4.0 kg 143 27.4 2.5–3.99 kg 345 66.1 < 2.5 kg 34 6.5 Place of delivery Home 77 14.8 Health Center 312 59.8 Public hospitals& private health facility 133 25.5 Mode of delivery Cesarean delivery 128 24.5 Normal vaginal delivery 394 75.5 Breastfeeding counseling during ANC Yes 309 59.2 No 213 40.8 Breastfeeding counseling during PNC Yes 298 57.1 No 224 42.9 Under-five OPD visits Yes 266 51.0 No 256 49.0 The current finding illustrated that 301(57.7%) of respondents’ index children are males and 345(66.1%) of the index children had 2.5-3.99kg of body weight. The median weight of children was 3 ± 1kg. In this study, three hundred twelve (59.8%) of mothers delivered their current child in health center, three hundred ninety four (75.5%) of mothers delivered their current child by normal vaginal delivery. The majority, 309 (59.2%) received breastfeeding counseling during ANC and 298(57.1%) received breastfeeding counseling during PNC visits respectively. More than half (51.0%) of the respondents had under five OPD visits due to infant and young children illness ( Table 3 ). Breastfeeding Practice of Respondents The finding indicated that, 242(46.4%) of mothers initiated breastfeeding within one hour after delivery, 283(54.2%) gave colostrum, 265(50.8%) exclusively breastfed their children up to six months of age, 248(47.5%) breastfed ≥ 8 times per 24 hours, 246(47.1%) timely started complementary feeding, and 239(45.8%) of mothers continued breast feeding their children up to 2 years. The prevalence of optimal breastfeeding practice of respondents was 231(44.3%) ( Table 4 ). Table 4 Breastfeeding practice of respondents in Tehuledere District, North East Ethiopia, 2020 (n = 522) Variables Category Frequency (%) Time of breastfeeding initiation within 1 hour 242(46.4) after 1 hour 280(53.6) Colostrum given Yes 283(54.2) No 239(45.80 Type of prelacteal feeding (n = 124) Water 61(49.2) Butter 33(26.6) cow milk 30(24.2) Exclusively breast feed Yes 265(50.8) No 257(49.2) Breastfeeding frequency < 8 times 244(46.7) ≥ 8 times 248(47.5) Do not remember 30(5.7) Bottle-feeding Yes 102(19.5) No 420(80.5) Predominant breastfeeding(n = 102) Yes 43(42.2) No 59(57.8) Timely started complementary feeding Yes 246(47.1) No 276(52.9) Ingredients of complementary feeding started at 6th month(n = 246) Cow's milk 28(11.4) Greenleafy vegetables 1(.4) Soup 194(78.9) Formula milk 7(2.8) Porridge 16(6.5) Food groups used for feeding per day at 6 months and above Grains and legumes only 419(80.3) Grains, legumes dairy products, egg 74(14.2) Do not remember 29(5.6) Continued breast feeding up to 2 years(n = 522) Yes 239(45.8) No 283(54.2) Time of cessation of breastfeeding (in completed months) (n = 283) Before 6 months 4(1.4) 6–11 months 6(2.1) 12–23 months 273(96.5) Reason to stop breast feeding(n = 283) No breast milk 82(29.0) Mother sick 47(16.6) Child Sick 83(29.3) Breast disease 71(25.1) Breastfeeding practice(n = 522) Sub-optimal 291(55.7) Optimal 231(44.3) Factors associated with optimal Breastfeeding Practice Bivariable and multivariable logistic regressions were computed to identify factors associated with optimal breast-feeding practice. In bi-variable logistic regression analysis, marital status, educational status of father, residence, family size, family support, maternal occupation, husband occupation, family income, ownership of house, having BF information, access to media, child sex, child birth weight, number of ANC visit, PNC visit, U5 OPD visits, place of delivery, breastfeeding counseling during ANC, and breastfeeding counseling during PNC visits were associated with optimal breast feeding practice. In multi variable logistic regression analysis, access to media, child’s sex, child birth weight and number of ANC visits were statistically associated. The odds of optimal breast-feeding practice among respondents who had access to media were about 3 times (AOR = 2.55[95%CI = 1.20, 5.40]) higher than those do not have access to media. Mothers who had male children were about 3 times (AOR = 2.697[1.49, 4.87]), and children’s birth weight < 2.5kg were about 5 times (AOR = 4.86[1.24, 9.08]) positively associated with optimal breastfeeding practice than mother who had female children and children’s weight 2.5-3.99kg. On the other hand, mothers who have history of ANC visits 1–3 times were approximately 72% (AOR = .282[.15, .52]) less likely to practice optimal breastfeeding than mothers with ANC visits > = 4 times ( Table 5 ). Table 5 Socio-demographic, Maternal, Child, and Health service-related factors versus optimal breastfeeding practice among mothers of children aged 24 up to 36 months in Tehuledere District, North East Ethiopia, 2020 (n = 522) Variable Optimal N (%) Sub-optimal N (%) COR [95% C.I] AOR [95% C.I] Marital status Married 169(34.4) 211(40.4) 1 1 Divorced 54(10.3) 24(4.6) 2.81[1.67,4.73]*** 1.76[.65,4.72] Separated 8(1.5) 56(10.7) .18[.083,.38]*** .39[.10,1.45] Educational status of father Unable to read and write 50(9.6) 16(3.1) 1 1 Primary education 171(32.8) 250(47.9) 7.81[3.10,19.69]*** .46[.15,1.43] Secondary and above 10 (1.9) 25(4.8) 1.71[.80,3.65] .54[.09, 3.35] Residence Urban 39(7.5) 80(15.3) .54[.35,.82]** .30[.05,1.75] Rural 192 (36.8) 211 (40.4) 1 1 Family size < 5 61 (11.7) 105 (20.1) .64[.436,.928]* .71[.29,1.73] 5 and above 170 (32.6) 186 (35.6) 1 1 Family support Yes 75 (14.4) 51 (9.8) 2.26[1.50,3.41]*** 2.65[.98,7.18] No 156 (29.9) 24 (46.0) 1 1 Maternal occupation House wife 201 (38.5) 234 (44.8) 3.58[1.44,8.90]** .97[.24,3.96] Government employed 24 (4.6) 32 (6.1) 3.13[1.11,8.81] .35[.07,1.72] Daily laborer 6 (1.1) 25 (4.8) 1 1 Occupation of husband Government employed 23 (4.4) 18(3.4) 1 1 Farmer 178 (34.1) 206 (39.5) .68[.35,1.29] .45[.14,1.48] Daily laborer 30 (5.7) 67 (12.8) .35[.17,.74]** .20[.04,1.11] Family income in ETB < 1000.00 176 (33.7) 201 (38.5) 1 1 1000.00-2500.00 30 (5.7) 37 (7.1) .93[.55,1.56] 1.02[.33,3.10] 2501.00 and above 25 (4.8) 53 (10.2) .54[.32,.90]* 1.93[.42,8.89] Ownership of house Yes 211 (40.4) 235 (45.0) 2.51[1.46,4.33]* 2.19[.75,6.37] No 20 (3.8) 56 (10.7) 1 1 Having BF information Yes 160 (30.7) 150 (28.7) 2.12[1.47,3.04]*** .58[.20,1.67] No 71 (13.6) 141(27.0) 1 1 Access to media Yes 143 (27.4) 128 (24.5) 2.07[1.45,2.94]*** 2.55[1.20,5.40]* No 88 (16.9) 163(31.2) 1 1 Maternal age(years) 15–19 33 (6.3) 30 (5.7) 1.74[.97,3.14] 2.27[.55,9.27] 20–29 138 (26.4) 166 (31.8) 1.32[.89,1.95] 1.55[.77,3.10] 30 and above 60 (11.5) 95 (18.2) 1 1 Maternal knowledge Poor knowledge 118 (22.6) 129 (24.7) 1 1 Good knowledge 113 (21.6) 162 (31.1) .76[.54,1.08] .99[.56,1.75] Child sex Male 163 (31.2) 138 (26.4) 2.66[1.85,3.83]*** 2.70[1.49,4.87]** Female 68 (13.0) 153 (29.3) 1 1 Child birth weight ≥ 4.0 kg 50 (9.6) 93 (17.8) 1 1 2.5–3.99 kg 163 (31.2) 182 (34.9) 1.67[1.11,2.50]* .97[.50,1.93] < 2.5 kg 18 (3.4) 16 (3.1) 2.09[.98,4.46] 4.86[1.24,19.08]* Number of ANC visit 1-3times 81 (23.3) 154 (44.3) .27[.17,.43]*** .28[.154,.52]*** 4 times and above 75 (21.6) 38 (10.9) 1 1 PNC visit Yes 170 (32.6) 183 (35.1) 1.65[1.13,2.40]* 1.92[.83,4.43] No 61 (11.7) 108 (20.7) 1 1 U5 OPD visits Yes 140 (26.8) 126 (24.1) 2.02[1.42,2.86]*** 1.01[.53,1.92] No 91 (17.4) 165 (31.6) 1 1 Place of delivery Home 45 (8.6) 32 (6.1) 1 1 Health Center 127 (24.3) 185 (35.4) .49[.29,.81]* .66[.31,1.38] Public hospitals & private-health facility 59 (11.3) 74 (14.2) .57[.32,1.00] .54[.20,1.48] Breastfeeding counseling during ANC Yes 163 (31.2) 146 (28.0) 2.38[1.65,3.43]*** 1.13[.42,3.08] No 68 (13.0) 145 (27.8) 1 1 Breastfeeding counseling during PNC Yes 158 (30.3) 140 (26.8) 2.33[1.63,3.35]*** 1.95[.71,5.35] No 73 (14.0) 151 (28.9) 1 1 *P-Value ≤ 0.05, P-Value ≤ 0.01, P-Value ≤ 0.001; COR- crude odds ratio; AOR- Adjusted odds ratio; CI = confidence interval NB:- P- values listed in the table are bi-variable logistic regression analysis outputs. DISCUSSION This study revealed that optimal breastfeeding practice was 44.3% (95%CI = 40.1, 48.1) which is consistent with the study done in rural communities of Hula District(n = 634 mothers) (43.1%) ( 28 ) and the study conducted in Indonesia (47.1%) ( 13 ). But, it is higher than a study conducted in Ethiopia (35.6%) ( 24 ).This higher rate of breastfeeding could be due to the difference in sample size and study period. The prevalence of timely initiation of breastfeeding in this study was 242 (46.4%) (95%CI = 42.2, 50.8). This finding is consistent with the global prevalence (45%) ( 33 ).This finding is below the study in Ethiopia (57.2%),(83.1%), (82.5%), (83.7%), (67.5%) and (66.5%), WHO goal(70%), in Afghanistan (54.3%), Nepal (57%) ( 16 , 26 , 29 – 31 , 34 – 37 ); On the contrary, the finding is higher than the study in Nigeria (38%), Afganistan(40.9%) and India (10%) ( 1 , 26 , 38 ).This discrepancy might be due to the difference in the study period, study design, study setting and sample size. In the current study, 54.2% (95%CI = 50.0,58.2)of mothers gave colostrum to their baby which is lower than the study done in Jimma district in Ethiopia (91.2%) ( 39 ). The reason for this difference could be due to difference in the study setting and study period. This study showed that the prevalence of exclusive breastfeeding 50.8% (95%CI = 46.6,54.6).This finding is consistent with the global nutrition target 2025–2030(50%), South Australian Health and Medical Research Institute in 2017, 22% (1996) to 54%(2012), Latin America and the Caribbean (excluding Brazil, and Mexico) 30–51% ( 5 , 40 ).This result is by far higher than the study in Nigeria in 2014(6.7%) and 2015(13%), global prevalence in 2016 (38%), and 2017 (43%), Cameroon(45.2%) and the study in Italy(33.3%) ( 1 , 25 , 40 , 41 ); This higher rate of exclusive breastfeeding is due to the difference in sample size, in the study setting, study design and period. But, this study is lower when compared with the findings from a study done by sub-Saharan Africa, East Asia/Pacific,(excluding China) 27% (1996) to 57% (2012),Ethiopia in 2013(67.2%),in 2018(60.5%) and in 2019(among 409 mothers (60.1%),Central Statistical Agency (CSA) [Ethiopia] and ICF: Ethiopia demographic and health survey in 2016(58%) ( 14 , 23 , 35 , 39 ). This lower prevalence might indicate that health care providers who care for mothers should increase their efforts to promote breastfeeding and that there is a need for public policies which that ensure the living and working conditions of women are compatible with breastfeeding. While, the prevalence of on demand breastfeeding was 47.5% (95% CI = 43.1,51.5) which is higher than the result in Ethiopia in 2016 among 409 mothers (12.5%) and in 2017 among 634 mothers (25.9%) ( 27 , 28 ). This difference might be due to the difference in the study period, sample size and study setting. Prevalence of timely initiation of complementary feeding at 6 months of age was 47.1% (95%CI = 42.5,51.1) which is consistent with the global prevalence in 2017(46%), in Nepal (43%), ( 5 , 32 ),but, slightly higher than a study in Ethiopia 2016 among 409 mothers (37.2%) ( 27 ).This slight difference could be due to the difference in sample size, study setting, study design and period. The prevalence of continued breastfeeding at two years in this study was 45.8% (95%CI = 41.4,49.8), which was much lower than the result from a meta-analysis done in Afghanistan (58.6%), Bangladesh and Nepal (85%), India (72%), and Pakistan (60%) ( 26 ).This is due to the difference in socio-cultural and socio-economic difference, study population, sample size, sampling procedure, study design, period, and settings. In this study, the multivariable logistic regression analysis revealed that respondents who had access to media were nearly 3 times higher to experience optimal breastfeeding than those respondents who had no access to media. This result is different from the study conducted in Ethiopia,2017 (n = 634) in those mothers who had no access to media were 1.21 times more likely to breastfed optimally (AOR = 1.21(.74,1.96)( 28 )and an another study done in Ethiopia(n = 383 mothers in 2013) (AOR = .56(95% CI = .33,.95) ( 37 ). This difference might be due to the difference in sample size, study period and sampling technique. The odds of optimal breastfeeding practice of mothers who had male children were nearly 3 times higher than mothers who had female children. This result is agreed with the studies in Nepal, mothers having male children were 1.7 times more likely to breastfed (AOR = 1.7 [95% CI = 1.1–2.7) than mothers who have female children ( 32 ), and in Ethiopia, male children were 1.31 times more likely to TIBF than female children (AOR = 1.31[95% CI = 1.01–1.68]) and in South Asia in which female children were 20% less likely breastfed than male infants (AOR = .80 (95% CI = .66- 0.97) ( 26 ).But, This finding disagreed with the study in Cameroon in which female children were 1.80 times more likely to breastfed (AOR = 1.80 [95%CI = 1.00-3.22]) than mothers who had male children ( 41 ). The possible explanation for this disagreement could be due to gender preference may vary region to region. In those respondents, the odds of optimal breastfeeding practice of mothers having < 2.5kg birth weight children were nearly 5 times higher than those ≥ 4.0 kg birth weight. This finding disagreed with the study in South Asia,<2.5kg birth size was 44% less likely to make optimal breastfeeding (AOR = .55[95%CI = .35–.86]) in Afghanistan, India, and Pakistan ( 26 ).This disagreement could be due to health extension workers deployed in rural areas might be responsible for wide practice of breastfeeding in the study area in Ethiopia. In this study, the odds of optimal breastfeeding practice of mothers who had 1–3 times ANC visits were 71.8% lower than those mothers who had 4 times and above ANC visits. This result is congruent with the finding in South Asia, those having four or more ANC visits were 1.63 times more likely to breastfed optimally(AOR = 1.63[95%CI = 1.46-1.82]) than those who had 1–3 times ANC visits ( 26 ), and in a rural part of Ethiopia in which mothers with 1–3 times ANC visits were 2.4 times more likely to breastfed their children sub-optimally(AOR = 2.40[95% CI = 1.68, 3.43]) than those mothers who had 4 times and above ANC visits ( 28 ).But, this result is incongruent with a study in Nigeria in 2015 in which mothers who have frequent antenatal visits 4 times and above were 22% less likely breastfed their babies (AOR = .78, 95% CI: .63,.97;P = .027) compared to mothers who made 1–3 times ANC visits ( 1 ). This incongruence is due to the reason that currently in Ethiopia intensive heath education is provided by health extension workers about breastfeeding at the time of antenatal care visit for the mothers according to the focused antenatal care guideline ( 37 ). LIMITATIONS OF THE STUDY It was a cross-sectional study; the cause effect relationship of different variables with optimal breastfeeding could not be assessed. Maternal skills of breastfeeding practice (positioning and attachment) were not measured. Socioeconomic status was assessed simply by asking monthly income which would not be good to compute wealth index. In order to generate more information from the study participants, it would have been good if qualitative data collection approaches were considered besides the quantitative one. CONCLUSIONS This study showed that the prevalence of optimal breastfeeding practice was low. Access to media, sex of the child, weight of the child and number of antenatal care visits were significantly associated. Therefore, enhancing the access to information on optimal breast feeding, minimizing sex difference in child care and strengthening focused ANC by health professionals, district health offices and partners is important in order to improve optimal breastfeeding practice. RECOMMENDATIONS Based on the study findings the following recommendations are forwarded: The result suggested on educational programs at health institutions and in the community-level aimed to correct traditional inappropriate breastfeeding practice. The study suggested coordination, strengthening and sustaining of the existing strategies, and approaches for further improvement of optimal breastfeeding practice. Also, the study suggested health information dissemination to bring behavioral change about optimal breastfeeding practice using accessible means such as mass media and public meeting places. Advocacy efforts targeting the extension of maternity leave up to the first six months after delivery should be practiced to improve optimal breastfeeding and to prevent associated factors among children. In addition to these, strengthening the capacity of health extension workers and health professionals, district health offices and partners is important to focus on improving optimal breastfeeding practice. Furthermore, further studies that mainly address all areas of associated factors that may significantly affect optimal breastfeeding practice are needed in the study area and in the region at large. Abbreviations ANC Antenatal Care EBF Exclusive Breast Feeding EIBF Early Initiation of Breast Feeding KMC Kangaroo Mother Care NGOs Nongovernmental Organizations PNC Postnatal Care SPSS Statistical Package for Social Science TIBF Timely Initiation of Breast Feeding Declarations Ethical approval and consent to participate Ethical clearance letter was obtained from Institutional Ethical Review Board (IRB) of College of Medicine and Health Sciences with protocol number 0059/2020. Support letter was obtained from the respective stake holders and the district health office. Then, the respondents were informed about the purpose of the study, and their verbal consent was obtained. The respondents’ right to refuse or withdraw from participating in the interview was fully maintained and the information provided by each respondent was kept strictly confidential. The study was conducted in accordance with the Declaration of Helsinki, 2008. The manuscript has included items for reporting cross-sectional studies according to STROBE 2007 (S1.Table). Consent for publication Not applicable Availability of data and materials The data set is available on a reasonable request from the corresponding author. Competing interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Authors’ contributions All authors contributed to the preparation of the manuscript. OS conceived and designed the research. OS and EMA performed the analysis and fully participated in the write up of the paper. NTA and AT revised the final draft of the paper. OS, EMA, NTA, and AT prepared the first draft of the manuscript. All authors read and approved the final manuscript for publication. 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2020\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4343238/v1/05639a0d991cba01b434fb3c.png"},{"id":56412327,"identity":"3f5ff047-6729-4a26-b47e-05c60cff4238","added_by":"auto","created_at":"2024-05-13 20:36:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1298117,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4343238/v1/85856d0c-c69f-4d2d-b27d-41ab9522d86a.pdf"},{"id":56410529,"identity":"afc377a6-29e0-4947-85c6-0c254caf4fab","added_by":"auto","created_at":"2024-05-13 20:20:49","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":29577,"visible":true,"origin":"","legend":"","description":"","filename":"STROBECheklistforCrosssectionalStudy.docx","url":"https://assets-eu.researchsquare.com/files/rs-4343238/v1/518ea80c81c0b36ff18ef2de.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Optimal breastfeeding practice and associated factors among mothers of children 24-36 months of age in Tehuledere District, Northeast Ethiopia","fulltext":[{"header":"Background","content":"\u003cp\u003eOptimal breastfeeding practice is an early initiated breastfeeding within one hour of birth, exclusively breastfed for 6 months and timely started safe and nutritious complementary food at 6 months, on demand breast feeding, giving colostrum and continued breastfeeding up to 24months of age. Optimal breastfeeding plays a key role in improving the health and development of children under-5 years, and have been shown to be associated with decreased risk of childhood diarrhea, and respiratory tract infections as well as reductions in childhood mortality (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). There is increasingly expanding evidence on the health benefits of breastfeeding, both for the mother and for the child as well as the economic benefits that this reaps into society. The National Breastfeeding Policy and Action Plan 2015\u0026ndash;2020 recognizes the right that all mothers have for receiving clear and impartial information so as to be able to make a fully informed choice on how to feed their baby (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eRecent estimates suggested that optimal breastfeeding could prevent around 12% deaths in under-5 children every year, representing around 800,000 lives in low- and middle-income countries (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).In spite of these facts, only 45% of the world\u0026rsquo;s newborns are put to the breast within 1 hour of birth and 43% of infants aged 6 months or less are exclusively breastfed, and(46% %) of children are continued breastfeeding until 24 months of age (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). A number of Socio-cultural, health-system and commercial factors, as well as poor knowledge about breast feeding result in inadequate rates of exclusive breastfeeding (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).Exclusive breastfeeding is the recommended nutrition for newborns (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOptimal breast feeding is a practice that many countries are rallying around but is challenging to improve without concerted efforts and substantive support for mothers (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).About 10% of the global burden of disease among children under-five years in developing countries resulted from suboptimal breastfeeding practice (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In 2016, a Lancet series on breastfeeding estimated that globally 823,000 deaths of children under the age of five years could be prevented every year through optimal breast feeding practices (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Despite its benefit, Exclusive breast feeding (EBF) practice is low throughout the world (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), while timely initiation of breastfeeding varied globally, higher in high-income countries than in low and middle income nations (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).Children aged 6\u0026ndash;23 months who were not breastfed had higher risk of all-cause and infection-related mortality (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStudies arround the glob evidenced that poor breastfeeding practices could be influenced by low education levels, occupation of mothers, poor maternal knowledge, maternal age, parity, antenatal care service utilization and place of delivery (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In sub-Saharan countries including Ethiopia breast feeding practices gap is highly increasing with early and abrupt cessation of breastfeeding followed by an introduction of dirty, unsound artificial feeding of infants with very dilute milk products is common (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In Ethiopia, many sub-national reports in 2019 indicated that early initiation of breast feeding (66.5%) and EBF is (60.1%). All in all, breastfeeding is one of the foundations of child health, development and survival. For these reasons, WHO recommends that breastfeeding should be initiated within the first hour after birth and that infants should exclusively breastfeed for the first 6 months; on demand breast feeding (breastfeeds frequently day and night at least 8 times per day); and complementary foods should then be introduced, with continued breastfeeding until 24 months of age or older (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eChildren continue to suffer from malnutrition and its related complications despite efforts by policy makers and health care service providers (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Despite the reduced global under-five mortality, the rate of malnutrition, rate of stunting and rate of underweight (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), the rate of EBF has stagnated and fallen short of the health sector transformation plan, and maternal and child survival program. As part of optimal infant and young child feeding (IYCF) practices, early and exclusive breastfeeding are critical to prevent all forms of malnutrition during the first 2 years of life (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Hence, this study was therefore aimed in assessing factors associated with optimal breastfeeding practice among Mothers of children 24\u0026ndash;36 months of age in Tehuledere District.\u003c/p\u003e \u003cp\u003eThus, the study finding will provide an insight to policy makers, programmers, stake holders, and non-government organizations (NGOs) for future planning and interventions of appropriate strategies to promote and maintain breastfeeding practice. Clinicians, nurses and midwifes who work at the grass root level will get proper information in order to provide health education for mothers to wards optimal breastfeeding practice. The finding of this study will also help as a baseline data for future researchers who are interested in carrying out further research with this regard.\u003c/p\u003e"},{"header":"METHODS AND MATERIALS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and period\u003c/h2\u003e \u003cp\u003eA Community-based cross-sectional study was carried out from March 01\u0026ndash;26/2020\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy area\u003c/h2\u003e \u003cp\u003eThe study was carried out in Tehuledere District, North East Ethiopia. It is situated at a distance of 430 km far away from Addis Ababa. The capital town of the district is Haik which is located at 450 km far away from Bahir Dar, the capital city of Amhara national regional state (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).The district has 19 rural and 7 urban kebeles (the smallest administrative units). The total population of the district was 145,625 of which females consist 47%. The district has 1 governmental primary hospital, 5 health centers, 23 health posts, and 26 private clinics (9 medium\u0026amp;17 primary clinics) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).The total number of households and children 24\u0026ndash;36 months of age in the District were 29,000 and 6378 respectively (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePopulation\u003c/h2\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eSource population\u003c/h2\u003e \u003cp\u003eAll mothers with children 24\u0026ndash;36 months of age who were permanent residents of Tehuledere District, 2020\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eAll mothers with children 24\u0026ndash;36 months of age in selected kebeles and resided for six or more months in Tehuledere District during the study period\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSampling unit\u003c/h2\u003e \u003cp\u003eAll selected households of the selected Kebeles were used as sampling unit.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStudy unit\u003c/h2\u003e \u003cp\u003eAll selected mothers with children 24\u0026ndash;36 months of age from selected households during the data collection period were used as study unit.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eInclusion and exclusion criteria\u003c/h2\u003e \u003cdiv id=\"Sec11\" class=\"Section4\"\u003e \u003ch2\u003eInclusion criteria\u003c/h2\u003e \u003cp\u003eAll mothers with children 24\u0026ndash;36 months of age resided for six months or more during data collection were included in the study.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eExclusion criteria\u003c/h2\u003e \u003cp\u003eMothers with children 24\u0026ndash;36 months of age who were unable to respond or seriously ill and mothers who do not live with their child were excluded from the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStudy variables\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003eDependent variable\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eOptimal Breastfeeding Practice\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eIndependent variables\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eSocio-demographic factors\u003c/strong\u003e \u003cp\u003eMarital Status, maternal education level, husband education level, family size, having partner and family support, number of under-five children, maternal occupation, occupation of husband, family monthly income, ownership of house, having BF information, information source and \u003cb\u003ea\u003c/b\u003eccess to media\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eMaternal related factors\u003c/strong\u003e \u003cp\u003eMaternal age at birth of the child, parity, birth interval, number of ANC visits, number of PNC visits and maternal knowledge\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eChild related factors\u003c/strong\u003e \u003cp\u003eAge of child, sex of child, child weight at birth\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHealth service-related factors\u003c/strong\u003e \u003cp\u003ePlace of delivery, mode of delivery, breastfeeding counseling during ANC and breastfeeding counseling during PNC\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eOperational definitions\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eOptimal breastfeeding practice\u003c/strong\u003e \u003cp\u003erefers to early initiated breastfeeding within one hour of birth, exclusively breastfed for 6 months and timely started safe and nutritious complementary food at 6 months, on demand breast feeding(allow the baby to breastfeed as often as he/she wants) This means feeding every 2\u0026ndash;3 hours (8\u0026ndash;12 times per 24 hours or more frequently if needed, especially in the early months),giving colostrum and continued breastfeeding up to 2 years of age (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSuboptimal breastfeeding practice\u003c/strong\u003e \u003cp\u003ewhen the study subjects have not practiced either of the following; initiated breastfeeding within one hour of birth, giving colostrum, breastfeeds frequently day and night (on demand), giving infant only breast milk for the first 6 months, starting complementary feeding by the age of six months and continuing breastfeeding until the child is two years of age or older(late initiation of breast feeding, not giving colostrum, not exclusive breast feeding and early cessation of breast feeding) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eKnowledge of optimal breastfeeding\u003c/strong\u003e \u003cp\u003eKnowledge of mothers on breastfeeding was measured by asking breastfeeding knowledge questions developed based on Infant and Young child feeding (IYCF) recommendations. For knowledge assessment, 14 questions were provided. The total knowledge score for each respondent was obtained by adding the responses (scores) of each question related to optimal breastfeeding practice. Then, the total score was dichotomized into good knowledge (if respondent\u0026rsquo;s score is \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;7.74) and poor knowledge (if respondent\u0026rsquo;s score is \u0026lt;\u0026thinsp;7.74) taking the mean score of 7.74 as a cutoff- point. Each knowledge question had three categorical responses of \u0026ldquo;yes,\u0026rdquo; \u0026ldquo;no,\u0026rdquo; or \u0026ldquo;not sure.\u0026rdquo; A correct response was scored as \u0026ldquo;1,\u0026rdquo; and a wrong and or \u0026ldquo;not sure\u0026rdquo; response scored a \u0026ldquo;0\u0026rdquo; (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEarly initiated breastfeeding\u003c/strong\u003e \u003cp\u003eis the initiation of breast feeding within one hour of birth (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eExclusive breastfeeding\u003c/strong\u003e \u003cp\u003eis the practice of feeding breast milk only, including expressed breast milk, to infants and excluding water, other liquids, breast milk substitutes, and solid foods. Vitamin drops, minerals, oral rehydrating solution and medicines may be given (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eComplementary feeding practice\u003c/strong\u003e \u003cp\u003eis the gradual prolusion of soft food, semisolid and solid food starting from children aged 6 months (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePredominant breastfeeding\u003c/strong\u003e \u003cp\u003eInfants and children less than 6 months old who received breast milk as predominant feeding within 24 hours period (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eMinimum dietary diversity feeding of infants and young child\u003c/strong\u003e \u003cp\u003efeeding at least 4 food groups out of 7 food groups within 24 hours (grain, legumes, dairy products, egg, meat, fruits, and vegetables) (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eSample size and sampling methods\u003c/h2\u003e \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e \u003ch2\u003eSample size\u003c/h2\u003e \u003cp\u003eTo determine the sample size, outcome variable and various factors significantly associated with the outcome variable were considered. Both for the first and the second objectives the sample size was calculated; then, the larger sample size was used for this study.\u003c/p\u003e \u003cp\u003eFor the first objective, the required sample was calculated by using single population proportion formula with the assumption of 95% confidence interval, 5% margin of error(d),and prevalence of optimal breast feeding from previous study (P\u0026thinsp;=\u0026thinsp;43.1%) was used (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003en= \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\frac{\\left[\\left(\\frac{\\text{Z}\\text{ɑ}}{2}\\right)2 \\times \\text{P} \\left(1-\\text{P}\\right)\\right]}{\\text{d}2 }=\\frac{\\left(1.96\\right)2\\times 0.431(1-0.431) }{0.5)\\times 0.5}\\)\u003c/span\u003e\u003c/span\u003e = 377\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cb\u003eWhere; n\u0026thinsp;=\u003c/b\u003e\u0026thinsp;required sample size\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eZ (α/2)\u0026thinsp;=\u0026thinsp;the desired level of confidence interval 95% (1.96 at α\u0026thinsp;=\u0026thinsp;0.05)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cb\u003eP\u0026thinsp;=\u003c/b\u003e\u0026thinsp;Prevalence of optimal breastfeeding practice taken from previous study in Ethiopia.\u003c/p\u003e\u003cp\u003e \u003cb\u003ed\u0026thinsp;=\u003c/b\u003e\u0026thinsp;desired precision (5% margin of error).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eFor the second specific objective, the sample size was determined by considering various factors that were significantly associated with the outcome variable. Two-sided confidence interval using double population proportion formula with the assumptions of 95% CI, 5% margin of error, 80% power and exposed to unexposed ratio 1:1 using Epi Info version 7.1 stat calc, by taking the above assumptions the following results were revealed \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\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\u003eSample size calculation for associated factors of optimal breastfeeding practice in Tehuledere district, North East Ethiopia, March 2020 (n\u0026thinsp;=\u0026thinsp;522)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\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\u003eCI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePower\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRatio (exposed: unexposed)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e% of outcome unexposed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSample size\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOwnership of house (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1:1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e316\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal Knowledge on BF (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1:1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e44.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e254\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnder 5 OPD visit (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1:1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e214\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eThe maximum calculated sample size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e316\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\u003eAs it is seen on the table above, the total sample size to identify factors that contribute to optimal breastfeeding practices was 316. Finally, by comparing the sample size of the first objective (377) and the sample size of the second objective (316), the maximum sample size (377) was used. By using finite population correction formula (N\u0026thinsp;\u0026lt;\u0026thinsp;10,000); nf\u0026thinsp;=\u0026thinsp;n/ (1\u0026thinsp;+\u0026thinsp;n/N); nf\u0026thinsp;=\u0026thinsp;377/ (1\u0026thinsp;+\u0026thinsp;377/2083)\u0026thinsp;=\u0026thinsp;319.\u003c/p\u003e \u003cp\u003eMultiplying 319 by design effect 1.5 (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), it gives 478.5 and after adding 10% non-response rate (47.85), the final sample size was 527.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eSampling methods\u003c/h2\u003e \u003cp\u003eIn this study a multi-stage sampling technique \u003cb\u003e(Fig.\u0026nbsp;1)\u003c/b\u003e was used to select the study participants. Firstly, ten kebeles (Bededo, Sulula, Haik 03, Haik 05, Hitecha, Hara, Hardibo, Gobeya, Jari, and Wahelo) were selected by using lottery method. Secondly, proportional sample size allocation was done to each kebele based on the number of mothers of 24\u0026ndash;36 months children. Thirdly, households with children 24\u0026ndash;36 months of age were identified from recorded documents of health extension workers in the selected kebeles. Finally, study participants were drawn from the sampling unit by using systematic random sampling technique (K\u0026thinsp;=\u0026thinsp;2083/527\u0026thinsp;=\u0026thinsp;4).\u003c/p\u003e \u003cp\u003eThe sample size was proportionally allocated to the selected kebeles using the formula: na= (Na/N) n\u003c/p\u003e \u003cp\u003eWhere, na\u0026thinsp;=\u0026thinsp;sample size for kebele \u0026lsquo;a\u0026rsquo;; Na\u0026thinsp;=\u0026thinsp;number of eligible children in kebele \u0026lsquo;a\u0026rsquo;\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;the total eligible children in all selected kebeles ; n\u0026thinsp;=\u0026thinsp;the total sample size\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eSurvey instruments and Procedures\u003c/h2\u003e \u003cp\u003eAn interviewer administered structured questionnaire adapted from related literatures (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) was used to collect data from the study participants. The questionnaire was developed in English, translated to local language (Amharic), and back translated to English. The questionnaire contained five parts namely: socio-demographic, maternal, child, health service-related factors and optimal breastfeeding practice. Three health extension workers and one BSc nurse from the district health office were used as data collectors and supervisor respectively.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eData management and analysis\u003c/h2\u003e \u003cp\u003eThe data were entered using Epi Data version 3.1, then exported to SPSS version 20.0 and cleaned for analysis. Descriptive analysis was conducted to summarize the data. Binary logistic regression analysis was executed to see the association between predictor and outcome variables. All predictor variables associated with outcome variable with a p value\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;0.2 were entered into multivariable logistic regression analysis. A p-value of \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;0.05 was considered as statistically significant. Model fitness was checked by Hosmer-Lemeshow test of goodness of fit; then, the model fitted the data at p-value\u0026thinsp;=\u0026thinsp;0.283.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eData Quality assurance\u003c/h2\u003e \u003cp\u003eThe quality of the data was assured by properly designing and pre-testing the questionnaire on 5% of participants at Kosero kebele (outside the selected kebele). Proper categorization, coding and skipping patterns of questions were used. Two days training was given to three health extension workers as data collectors and one BSc nurse supervisor before the actual data collection on general objective of the study, contents of the tool, how to approach the study participants and keep their confidentiality.\u003c/p\u003e \u003cp\u003eData from each household were reviewed and checked for completeness, accuracy, clarity and consistency by the principal investigator and the supervisors on a daily basis. Data cleanup and cross checking were done before analysis.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eDissemination of findings\u003c/h2\u003e \u003cp\u003eThe result of the study will be submitted to, Bahir Dar University, College of Medicine and Health Sciences, Department of Pediatrics and Child Health Nursing, Tehuledere District Health Office and to Ethiopian Public Health Institute. It will also be presented in different workshops/seminars. Finally, an effort also will be made to publish in an internationally peer reviewed journal.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003eSocio-Demographic Characteristics\u003c/h2\u003e \u003cp\u003eFrom the total calculated sample size (n\u0026thinsp;=\u0026thinsp;527), 522 mothers had participated in the study making the response rate of 99%. Above three quarter, 380(72.8%) and 316(60.5%) of the study participants were married and had attended primary education respectively. The current study revealed that 435(83.3%) of the study participants were housewives by occupation. The findings of the study also indicated that 421(80.7%) of the respondents\u0026rsquo; husbands had attended primary education and 384(73.6%) were farmers by occupation. Most of the respondents 403(77.2%) were rural dwellers, and 356(68.2%) of the study participants had 5 and above family sizes. More than half, 345(66.1%) of the respondents had 2 and above years old under five children. From those mothers interviewed, only 126(24.1%) had family support about breastfeeding, and more than three fourth, 377(72.2%) of mothers earn an average monthly income of less than 1000 Birr and 446(85.4%) of them were owners of the houses. Majority, 310(59.4%) of mothers had breastfeeding information. In addition to these, 271(51.9%) of the respondents had access to media \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\u003eThe highest and the lowest sources of information received were 192(61.9%) from health professionals and 16(5.2%) from mass media \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\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\u003eSocio-demographic characteristics of respondents regarding optimal breastfeeding practice in Tehuledere district, North East Ethiopia, March 2020 (n\u0026thinsp;=\u0026thinsp;522)\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=\"left\" 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\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariableCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\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\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e380\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeparated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEducational status of mother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnable to read and write\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e316\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEducational status of father\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnable to read and write\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e421\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResidence of respondent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e403\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFamily size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e356\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNumber of under five children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFamily support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e396\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMaternal occupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHouse wife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e435\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovernment employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDaily laborer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eOccupation of husband\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovernment employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDaily laborer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eFamily income in ETB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1000.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1000.00-2500.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2501.00 and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOwnership of house\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHad breastfeeding information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e310\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAccess to media\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e271\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.1\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 \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eMaternal, Child, and Health Service-Related Characteristics\u003c/h2\u003e \u003cp\u003eOut of the total study subjects interviewed, three hundred forty-eight (66.7%) received ANC visits, and three hundred fifty-three (67.6%) received PNC services for the current child. From those respondents 304(58.2%) of mothers were between 20\u0026ndash;29 years of age, 275(52.7%) of mothers had good knowledge (Fig.\u0026nbsp;4). The median age of mothers was 28(\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;7) years. From the total respondents, 345(66.1%) were multiparous, 241(69.9%) had 2\u0026ndash;3 years of birth interval between the index and elderly child. Out of the total respondents interviewed, 246(47.1%) started complementary feeding for their children at 6th month. The median age of children who started complementary feeding was 6\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;1months \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\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\u003eMaternal, child, and health service related characteristics of respondents in Tehuledere district, North East Ethiopia, 2020 (n\u0026thinsp;=\u0026thinsp;522)\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=\"left\" 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\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\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\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eANC visit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e348\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNumber of ANC visit(n\u0026thinsp;=\u0026thinsp;348)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1-3times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4times\u0026amp; above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePNC visit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e353\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNumber of PNC visits (n\u0026thinsp;=\u0026thinsp;353)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1-2days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;2 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMaternal age(years) at birth of index child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimiparous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMultiparous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eBirth interval(n\u0026thinsp;=\u0026thinsp;345)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;3 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e241\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4years\u0026amp; above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge of the child (in month) at initiation of complementary feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;5 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAt 6th month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e246\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u0026ndash;23 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex of the child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eChild birth weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;4.0 kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.5\u0026ndash;3.99 kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2.5 kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePlace of delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth Center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e312\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePublic hospitals\u0026amp; private health facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMode of delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCesarean delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal vaginal delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e394\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBreastfeeding counseling during ANC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e309\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBreastfeeding counseling during PNC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eUnder-five OPD visits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\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\u003eThe current finding illustrated that 301(57.7%) of respondents\u0026rsquo; index children are males and 345(66.1%) of the index children had 2.5-3.99kg of body weight. The median weight of children was 3\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;1kg. In this study, three hundred twelve (59.8%) of mothers delivered their current child in health center, three hundred ninety four (75.5%) of mothers delivered their current child by normal vaginal delivery. The majority, 309 (59.2%) received breastfeeding counseling during ANC and 298(57.1%) received breastfeeding counseling during PNC visits respectively. More than half (51.0%) of the respondents had under five OPD visits due to infant and young children illness \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eBreastfeeding Practice of Respondents\u003c/h2\u003e \u003cp\u003eThe finding indicated that, 242(46.4%) of mothers initiated breastfeeding within one hour after delivery, 283(54.2%) gave colostrum, 265(50.8%) exclusively breastfed their children up to six months of age, 248(47.5%) breastfed\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;8 times per 24 hours, 246(47.1%) timely started complementary feeding, and 239(45.8%) of mothers continued breast feeding their children up to 2 years. The prevalence of optimal breastfeeding practice of respondents was 231(44.3%) \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e).\u003c/b\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\u003eBreastfeeding practice of respondents in Tehuledere District, North East Ethiopia, 2020 (n\u0026thinsp;=\u0026thinsp;522)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\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 \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\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTime of breastfeeding initiation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ewithin 1 hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e242(46.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eafter 1 hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e280(53.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eColostrum given\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e283(54.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e239(45.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eType of prelacteal feeding (n\u0026thinsp;=\u0026thinsp;124)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWater\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61(49.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eButter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33(26.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ecow milk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30(24.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eExclusively breast feed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e265(50.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e257(49.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eBreastfeeding frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;8 times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e244(46.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;8 times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e248(47.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDo not remember\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30(5.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBottle-feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102(19.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e420(80.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePredominant breastfeeding(n\u0026thinsp;=\u0026thinsp;102)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43(42.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59(57.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTimely started complementary feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e246(47.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e276(52.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eIngredients of complementary feeding\u003c/p\u003e \u003cp\u003estarted at 6th month(n\u0026thinsp;=\u0026thinsp;246)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCow's milk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28(11.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGreenleafy vegetables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSoup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e194(78.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFormula milk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(2.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePorridge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(6.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eFood groups used for feeding\u003c/p\u003e \u003cp\u003eper day at 6 months and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrains and legumes only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e419(80.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrains, legumes dairy products, egg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74(14.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDo not remember\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29(5.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eContinued breast feeding up to 2 years(n\u0026thinsp;=\u0026thinsp;522)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e239(45.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e283(54.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTime of cessation of breastfeeding (in completed months) (n\u0026thinsp;=\u0026thinsp;283)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore 6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(1.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;11 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(2.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u0026ndash;23 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e273(96.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eReason to stop breast feeding(n\u0026thinsp;=\u0026thinsp;283)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo breast milk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82(29.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMother sick\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47(16.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChild Sick\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83(29.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBreast disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71(25.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreastfeeding practice(n\u0026thinsp;=\u0026thinsp;522)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-optimal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e291(55.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOptimal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e231(44.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with optimal Breastfeeding Practice\u003c/h2\u003e \u003cp\u003eBivariable and multivariable logistic regressions were computed to identify factors associated with optimal breast-feeding practice. In bi-variable logistic regression analysis, marital status, educational status of father, residence, family size, family support, maternal occupation, husband occupation, family income, ownership of house, having BF information, access to media, child sex, child birth weight, number of ANC visit, PNC visit, U5 OPD visits, place of delivery, breastfeeding counseling during ANC, and breastfeeding counseling during PNC visits were associated with optimal breast feeding practice.\u003c/p\u003e \u003cp\u003eIn multi variable logistic regression analysis, access to media, child\u0026rsquo;s sex, child birth weight and number of ANC visits were statistically associated. The odds of optimal breast-feeding practice among respondents who had access to media were about 3 times (AOR\u0026thinsp;=\u0026thinsp;2.55[95%CI\u0026thinsp;=\u0026thinsp;1.20, 5.40]) higher than those do not have access to media. Mothers who had male children were about 3 times (AOR\u0026thinsp;=\u0026thinsp;2.697[1.49, 4.87]), and children\u0026rsquo;s birth weight\u0026thinsp;\u0026lt;\u0026thinsp;2.5kg were about 5 times (AOR\u0026thinsp;=\u0026thinsp;4.86[1.24, 9.08]) positively associated with optimal breastfeeding practice than mother who had female children and children\u0026rsquo;s weight 2.5-3.99kg. On the other hand, mothers who have history of ANC visits 1\u0026ndash;3 times were approximately 72% (AOR\u0026thinsp;=\u0026thinsp;.282[.15, .52]) less likely to practice optimal breastfeeding than mothers with ANC visits\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;4 times \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cb\u003e).\u003c/b\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\u003eSocio-demographic, Maternal, Child, and Health service-related factors versus optimal breastfeeding practice among mothers of children aged 24 up to 36 months in Tehuledere District, North East Ethiopia, 2020 (n\u0026thinsp;=\u0026thinsp;522)\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\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOptimal N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSub-optimal N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCOR [95% C.I]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAOR [95% C.I]\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e169(34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e211(40.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54(10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24(4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.81[1.67,4.73]***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.76[.65,4.72]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeparated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56(10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.18[.083,.38]***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.39[.10,1.45]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEducational status of father\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnable to read and write\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50(9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16(3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e171(32.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e250(47.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.81[3.10,19.69]***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.46[.15,1.43]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25(4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.71[.80,3.65]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.54[.09, 3.35]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39(7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80(15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.54[.35,.82]**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.30[.05,1.75]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e192 (36.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e211 (40.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFamily size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e105 (20.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.64[.436,.928]*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.71[.29,1.73]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e170 (32.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e186 (35.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFamily support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75 (14.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51 (9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.26[1.50,3.41]***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.65[.98,7.18]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e156 (29.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (46.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMaternal occupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHouse wife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e201 (38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e234 (44.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.58[1.44,8.90]**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.97[.24,3.96]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovernment employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.13[1.11,8.81]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.35[.07,1.72]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDaily laborer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eOccupation of husband\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovernment employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18(3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e178 (34.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e206 (39.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.68[.35,1.29]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.45[.14,1.48]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDaily laborer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67 (12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.35[.17,.74]**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.20[.04,1.11]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eFamily income in ETB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1000.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e176 (33.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e201 (38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1000.00-2500.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.93[.55,1.56]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.02[.33,3.10]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2501.00 and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53 (10.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.54[.32,.90]*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.93[.42,8.89]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOwnership of house\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e211 (40.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e235 (45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.51[1.46,4.33]*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.19[.75,6.37]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56 (10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHaving BF information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e160 (30.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e150 (28.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.12[1.47,3.04]***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.58[.20,1.67]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e141(27.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAccess to media\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e143 (27.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e128 (24.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.07[1.45,2.94]***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.55[1.20,5.40]*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88 (16.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e163(31.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMaternal age(years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.74[.97,3.14]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.27[.55,9.27]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e138 (26.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e166 (31.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.32[.89,1.95]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.55[.77,3.10]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60 (11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMaternal knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e118 (22.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e129 (24.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e113 (21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e162 (31.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.76[.54,1.08]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.99[.56,1.75]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eChild sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e163 (31.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e138 (26.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.66[1.85,3.83]***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.70[1.49,4.87]**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e153 (29.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eChild birth weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;4.0 kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93 (17.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.5\u0026ndash;3.99 kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e163 (31.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e182 (34.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.67[1.11,2.50]*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.97[.50,1.93]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2.5 kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.09[.98,4.46]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.86[1.24,19.08]*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNumber of ANC visit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1-3times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81 (23.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e154 (44.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.27[.17,.43]***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.28[.154,.52]***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 times and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75 (21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (10.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePNC visit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e170 (32.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e183 (35.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.65[1.13,2.40]*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.92[.83,4.43]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108 (20.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eU5 OPD visits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e140 (26.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e126 (24.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.02[1.42,2.86]***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.01[.53,1.92]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91 (17.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e165 (31.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePlace of delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth Center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e127 (24.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e185 (35.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.49[.29,.81]*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.66[.31,1.38]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePublic hospitals \u0026amp; private-health facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (11.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74 (14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.57[.32,1.00]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.54[.20,1.48]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBreastfeeding counseling during ANC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e163 (31.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e146 (28.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.38[1.65,3.43]***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.13[.42,3.08]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e145 (27.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBreastfeeding counseling during PNC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e158 (30.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e140 (26.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.33[1.63,3.35]***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.95[.71,5.35]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73 (14.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e151 (28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e*P-Value\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;0.05, P-Value\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;0.01, P-Value\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;0.001; COR- crude odds ratio; AOR- Adjusted odds ratio; CI\u0026thinsp;=\u0026thinsp;confidence interval\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNB:- P- values listed in the table are bi-variable logistic regression analysis outputs.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study revealed that optimal breastfeeding practice was 44.3% (95%CI\u0026thinsp;=\u0026thinsp;40.1, 48.1) which is consistent with the study done in rural communities of Hula District(n\u0026thinsp;=\u0026thinsp;634 mothers) (43.1%) (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) and the study conducted in Indonesia (47.1%) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). But, it is higher than a study conducted in Ethiopia (35.6%) (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).This higher rate of breastfeeding could be due to the difference in sample size and study period.\u003c/p\u003e \u003cp\u003eThe prevalence of timely initiation of breastfeeding in this study was 242 (46.4%) (95%CI\u0026thinsp;=\u0026thinsp;42.2, 50.8). This finding is consistent with the global prevalence (45%) (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).This finding is below the study in Ethiopia (57.2%),(83.1%), (82.5%), (83.7%), (67.5%) and (66.5%), WHO goal(70%), in Afghanistan (54.3%), Nepal (57%) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan additionalcitationids=\"CR35 CR36\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e); On the contrary, the finding is higher than the study in Nigeria (38%), Afganistan(40.9%) and India (10%) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).This discrepancy might be due to the difference in the study period, study design, study setting and sample size.\u003c/p\u003e \u003cp\u003eIn the current study, 54.2% (95%CI\u0026thinsp;=\u0026thinsp;50.0,58.2)of mothers gave colostrum to their baby which is lower than the study done in Jimma district in Ethiopia (91.2%) (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). The reason for this difference could be due to difference in the study setting and study period.\u003c/p\u003e \u003cp\u003eThis study showed that the prevalence of exclusive breastfeeding 50.8% (95%CI\u0026thinsp;=\u0026thinsp;46.6,54.6).This finding is consistent with the global nutrition target 2025\u0026ndash;2030(50%), South Australian Health and Medical Research Institute in 2017, 22% (1996) to 54%(2012), Latin America and the Caribbean (excluding Brazil, and Mexico) 30\u0026ndash;51% (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).This result is by far higher than the study in Nigeria in 2014(6.7%) and 2015(13%), global prevalence in 2016 (38%), and 2017 (43%), Cameroon(45.2%) and the study in Italy(33.3%) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e); This higher rate of exclusive breastfeeding is due to the difference in sample size, in the study setting, study design and period. But, this study is lower when compared with the findings from a study done by sub-Saharan Africa, East Asia/Pacific,(excluding China) 27% (1996) to 57% (2012),Ethiopia in 2013(67.2%),in 2018(60.5%) and in 2019(among 409 mothers (60.1%),Central Statistical Agency (CSA) [Ethiopia] and ICF: Ethiopia demographic and health survey in 2016(58%) (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). This lower prevalence might indicate that health care providers who care for mothers should increase their efforts to promote breastfeeding and that there is a need for public policies which that ensure the living and working conditions of women are compatible with breastfeeding. While, the prevalence of on demand breastfeeding was 47.5% (95% CI\u0026thinsp;=\u0026thinsp;43.1,51.5) which is higher than the result in Ethiopia in 2016 among 409 mothers (12.5%) and in 2017 among 634 mothers (25.9%) (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). This difference might be due to the difference in the study period, sample size and study setting.\u003c/p\u003e \u003cp\u003ePrevalence of timely initiation of complementary feeding at 6 months of age was 47.1% (95%CI\u0026thinsp;=\u0026thinsp;42.5,51.1) which is consistent with the global prevalence in 2017(46%), in Nepal (43%), (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e),but, slightly higher than a study in Ethiopia 2016 among 409 mothers (37.2%) (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).This slight difference could be due to the difference in sample size, study setting, study design and period.\u003c/p\u003e \u003cp\u003eThe prevalence of continued breastfeeding at two years in this study was 45.8% (95%CI\u0026thinsp;=\u0026thinsp;41.4,49.8), which was much lower than the result from a meta-analysis done in Afghanistan (58.6%), Bangladesh and Nepal (85%), India (72%), and Pakistan (60%) (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).This is due to the difference in socio-cultural and socio-economic difference, study population, sample size, sampling procedure, study design, period, and settings.\u003c/p\u003e \u003cp\u003eIn this study, the multivariable logistic regression analysis revealed that respondents who had access to media were nearly 3 times higher to experience optimal breastfeeding than those respondents who had no access to media. This result is different from the study conducted in Ethiopia,2017 (n\u0026thinsp;=\u0026thinsp;634) in those mothers who had no access to media were 1.21 times more likely to breastfed optimally (AOR\u0026thinsp;=\u0026thinsp;1.21(.74,1.96)(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)and an another study done in Ethiopia(n\u0026thinsp;=\u0026thinsp;383 mothers in 2013) (AOR\u0026thinsp;=\u0026thinsp;.56(95% CI\u0026thinsp;=\u0026thinsp;.33,.95) (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). This difference might be due to the difference in sample size, study period and sampling technique.\u003c/p\u003e \u003cp\u003eThe odds of optimal breastfeeding practice of mothers who had male children were nearly 3 times higher than mothers who had female children. This result is agreed with the studies in Nepal, mothers having male children were 1.7 times more likely to breastfed (AOR\u0026thinsp;=\u0026thinsp;1.7 [95% CI\u0026thinsp;=\u0026thinsp;1.1\u0026ndash;2.7) than mothers who have female children (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), and in Ethiopia, male children were 1.31 times more likely to TIBF than female children (AOR\u0026thinsp;=\u0026thinsp;1.31[95% CI\u0026thinsp;=\u0026thinsp;1.01\u0026ndash;1.68]) and in South Asia in which female children were 20% less likely breastfed than male infants (AOR\u0026thinsp;=\u0026thinsp;.80 (95% CI\u0026thinsp;=\u0026thinsp;.66- 0.97) (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).But, This finding disagreed with the study in Cameroon in which female children were 1.80 times more likely to breastfed (AOR\u0026thinsp;=\u0026thinsp;1.80 [95%CI\u0026thinsp;=\u0026thinsp;1.00-3.22]) than mothers who had male children (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). The possible explanation for this disagreement could be due to gender preference may vary region to region.\u003c/p\u003e \u003cp\u003eIn those respondents, the odds of optimal breastfeeding practice of mothers having\u0026thinsp;\u0026lt;\u0026thinsp;2.5kg birth weight children were nearly 5 times higher than those\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;4.0 kg birth weight. This finding disagreed with the study in South Asia,\u0026lt;2.5kg birth size was 44% less likely to make optimal breastfeeding (AOR\u0026thinsp;=\u0026thinsp;.55[95%CI\u0026thinsp;=\u0026thinsp;.35\u0026ndash;.86]) in Afghanistan, India, and Pakistan (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).This disagreement could be due to health extension workers deployed in rural areas might be responsible for wide practice of breastfeeding in the study area in Ethiopia.\u003c/p\u003e \u003cp\u003eIn this study, the odds of optimal breastfeeding practice of mothers who had 1\u0026ndash;3 times ANC visits were 71.8% lower than those mothers who had 4 times and above ANC visits. This result is congruent with the finding in South Asia, those having four or more ANC visits were 1.63 times more likely to breastfed optimally(AOR\u0026thinsp;=\u0026thinsp;1.63[95%CI\u0026thinsp;=\u0026thinsp;1.46-1.82]) than those who had 1\u0026ndash;3 times ANC visits (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), and in a rural part of Ethiopia in which mothers with 1\u0026ndash;3 times ANC visits were 2.4 times more likely to breastfed their children sub-optimally(AOR\u0026thinsp;=\u0026thinsp;2.40[95% CI\u0026thinsp;=\u0026thinsp;1.68, 3.43]) than those mothers who had 4 times and above ANC visits (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).But, this result is incongruent with a study in Nigeria in 2015 in which mothers who have frequent antenatal visits 4 times and above were 22% less likely breastfed their babies (AOR\u0026thinsp;=\u0026thinsp;.78, 95% CI: .63,.97;P\u0026thinsp;=\u0026thinsp;.027) compared to mothers who made 1\u0026ndash;3 times ANC visits (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). This incongruence is due to the reason that currently in Ethiopia intensive heath education is provided by health extension workers about breastfeeding at the time of antenatal care visit for the mothers according to the focused antenatal care guideline (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eLIMITATIONS OF THE STUDY\u003c/h3\u003e\n\u003cp\u003eIt was a cross-sectional study; the cause effect relationship of different variables with optimal breastfeeding could not be assessed. Maternal skills of breastfeeding practice (positioning and attachment) were not measured. Socioeconomic status was assessed simply by asking monthly income which would not be good to compute wealth index. In order to generate more information from the study participants, it would have been good if qualitative data collection approaches were considered besides the quantitative one.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThis study showed that the prevalence of optimal breastfeeding practice was low. Access to media, sex of the child, weight of the child and number of antenatal care visits were significantly associated. Therefore, enhancing the access to information on optimal breast feeding, minimizing sex difference in child care and strengthening focused ANC by health professionals, district health offices and partners is important in order to improve optimal breastfeeding practice.\u003c/p\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003eRECOMMENDATIONS\u003c/h2\u003e \u003cp\u003eBased on the study findings the following recommendations are forwarded: The result suggested on educational programs at health institutions and in the community-level aimed to correct traditional inappropriate breastfeeding practice. The study suggested coordination, strengthening and sustaining of the existing strategies, and approaches for further improvement of optimal breastfeeding practice. Also, the study suggested health information dissemination to bring behavioral change about optimal breastfeeding practice using accessible means such as mass media and public meeting places.\u003c/p\u003e \u003cp\u003eAdvocacy efforts targeting the extension of maternity leave up to the first six months after delivery should be practiced to improve optimal breastfeeding and to prevent associated factors among children. In addition to these, strengthening the capacity of health extension workers and health professionals, district health offices and partners is important to focus on improving optimal breastfeeding practice. Furthermore, further studies that mainly address all areas of associated factors that may significantly affect optimal breastfeeding practice are needed in the study area and in the region at large.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.355704697986578%\" valign=\"top\"\u003e\n \u003cp\u003eANC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.64429530201342%\" valign=\"top\"\u003e\n \u003cp\u003eAntenatal Care\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.355704697986578%\" valign=\"top\"\u003e\n \u003cp\u003eEBF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.64429530201342%\" valign=\"top\"\u003e\n \u003cp\u003eExclusive Breast Feeding\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.355704697986578%\" valign=\"top\"\u003e\n \u003cp\u003eEIBF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.64429530201342%\" valign=\"top\"\u003e\n \u003cp\u003eEarly Initiation of Breast Feeding\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.355704697986578%\" valign=\"top\"\u003e\n \u003cp\u003eKMC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.64429530201342%\" valign=\"top\"\u003e\n \u003cp\u003eKangaroo Mother Care\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.355704697986578%\" valign=\"top\"\u003e\n \u003cp\u003eNGOs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.64429530201342%\" valign=\"top\"\u003e\n \u003cp\u003eNongovernmental Organizations\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.355704697986578%\" valign=\"top\"\u003e\n \u003cp\u003ePNC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.64429530201342%\" valign=\"top\"\u003e\n \u003cp\u003ePostnatal Care\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.355704697986578%\" valign=\"top\"\u003e\n \u003cp\u003eSPSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.64429530201342%\" valign=\"top\"\u003e\n \u003cp\u003eStatistical Package for Social Science\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.355704697986578%\" valign=\"top\"\u003e\n \u003cp\u003eTIBF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.64429530201342%\" valign=\"top\"\u003e\n \u003cp\u003eTimely Initiation of Breast Feeding\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance letter was obtained from Institutional Ethical Review Board (IRB) of College of Medicine and Health Sciences with protocol number 0059/2020. Support letter was obtained from the respective stake holders and the district health office. Then, the respondents were informed about the purpose of the study, and their verbal consent was obtained. The respondents\u0026rsquo; right to refuse or withdraw from participating in the interview was fully maintained and the information provided by each respondent was kept strictly confidential. The study was conducted in accordance with the Declaration of Helsinki, 2008. The manuscript\u0026nbsp;has\u0026nbsp;included items for reporting cross-sectional studies according to STROBE 2007 (S1.Table).\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\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data set is available on a reasonable request from the corresponding author.\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.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the preparation of the manuscript. OS conceived and designed the research. OS and EMA performed the analysis and fully participated in the write up of the paper. NTA and AT revised the final draft of the paper. OS, EMA, NTA, and AT prepared the first draft of the manuscript. All authors read and approved the final manuscript for\u0026nbsp;publication.\u003c/p\u003e\n\u003cp\u003eAcknowledgments\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe authors would like to acknowledge College of Medicine and Health Sciences, Bahir Dar University, the data collectors and study participants who devoted their time to provide genuine information for this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOgbo FA AK. Determinants of suboptimal breastfeeding practices in Nigeria : . evidence from the 2008 demographic and health survey,2015. 2015:Page A 1\u0026ndash;12. .\u003c/li\u003e\n\u003cli\u003eSankar MJ SB, Chowdhury R, Bhandari N, Taneja S, Martines J, et al. 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UNICEF for every child;. 2017.\u003c/li\u003e\n\u003cli\u003eI. B. Fifth World Congress on Neonatology and Pediatrics World Congress on Nursing Research and Evidence Based Practice Notes,. Journal of Nursing Research and Practice,. 2019;3.\u003c/li\u003e\n\u003cli\u003eHabtewold TD. Multidimensional factors predicting exclusive breastfeeding in Ethiopia: evidence from a meta-analysis of studies in the past 10 years,. bioRxiv;. 2019.\u003c/li\u003e\n\u003cli\u003eSmith JS, Libby Baker, Phillip. World Breastfeeding Week: Conflicts of Interest in Infant and Young Child Feeding,. PLOS Blogs: Translational Global Health http://blogs plos org;. 2016.\u003c/li\u003e\n\u003cli\u003eCastillo H SI, Matijasevich A. . Maternal pre-pregnancy BMI , gestational weight gain and breastfeeding,. European Journal of Clinical Nutrition,. 2016. (August 2015)(Available from: http://dx.doi.org/10.1038/ejcn.2015.232;):1\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eUSAID. 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The Effect of Suboptimal Breastfeeding on Preschool Overweight/Obesity: A Model in profiles for Country-Level Advocacy,. Technical brief: Food and Nutrition Technical Assistance III Project November 2016.\u003c/li\u003e\n\u003cli\u003eCSA/ICF. Central Statistical Agency (CSA) [Ethiopia] and ICF. Ethiopia Demographic and Health Survey,. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: CSA and ICF,. 2016.\u003c/li\u003e\n\u003cli\u003eYeshambel T N, Netsanet Worku, . Optimal breastfeeding practice and associated factors amongst working mothers,. East African journal of public health;. 2015. (September 2014).\u003c/li\u003e\n\u003cli\u003eCascone D TD, Napolitano F, Giuseppe G Di. . Evaluation of Knowledge , Attitudes , and Practices about Exclusive Breastfeeding among Women in Italy,. International Journal of Environmental Research and Public Health,. 2019.\u003c/li\u003e\n\u003cli\u003eBenedict RK CH, Torlesse H, Stoltzfus RJ, Foundation MG. . Trends and predictors of optimal breastfeeding among children 0 \u0026ndash; 23 months , South Asia : Analysis of national survey data, . Maternal and Child Nutrition,. 2018;14:1\u0026ndash;16.\u003c/li\u003e\n\u003cli\u003eAsrat Hailu Dagne et al. Appropriate complementary feeding practice and associated factors among mothers having children aged 6\u0026ndash;24 months in Debre Tabor Hospital, North West Ethiopia, . BMC Res Notes,. 2016.\u003c/li\u003e\n\u003cli\u003eShibru Hoche BM, Negash Wakgari. Sub-Optimal Breastfeeding and Its Associated Factors in Rural Communities of Hula District , Southern Ethiopia : A Cross-Sectional Study, . Ethiop J Health Sci. 2017;28(1 ):49.\u003c/li\u003e\n\u003cli\u003eBeyene MG GN, Habtewold TD, Assen ZM. . Early initiation of breastfeeding among mothers of children under the age of 24 months in Southern Ethiopia, . Int Breastfeed J,. 2017;10\u0026ndash;1.\u003c/li\u003e\n\u003cli\u003eHailemariam TW AE, Sufa A. . Predictors of early breastfeeding initiation among mothers of children under 24 months of age in rural part of West Ethiopia Global health, . BMC Public Health,. 2015;15(1):1\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eBhandari MS MP, Tamrakar D. . Practice of Breastfeeding and its Barriers among Women Working in Tertiary Level Hospitals,. J Nepal Med Association,. 2019 57(215):8\u0026ndash;13.\u003c/li\u003e\n\u003cli\u003eAcharya D SJ, Kandel R, Park J, Yoo S, Lee K. . Maternal Factors and the Utilization of Maternal Care Services Associated with Infant Feeding Practices among Mothers in Rural Southern Nepal, . International Journal of Environmental Research and Public Health,. 2019:1\u0026ndash;15.\u003c/li\u003e\n\u003cli\u003eWHO. Infant and Young Child Feeding, . Geneva: WHO;. 2014.\u003c/li\u003e\n\u003cli\u003eHabtewold TD SN, Alemu SM,. Effect of gender of new-born, antenatal care and postnatal care on breastfeeding practices in Ethiopia: Evidence from systematic review and meta-analysis of national studies,. bioRxiv preprint first posted online Sep 5,. 2018.\u003c/li\u003e\n\u003cli\u003eAlemu SM AY, Habtewold TD. Association of age and colostrum discarding with exclusive breastfeeding in Ethiopia : systematic review and meta-analyses,. bioRxiv preprint first posted online Sep 5,. 2018.\u003c/li\u003e\n\u003cli\u003eT. G. Determinants of suboptimal breastfeeding practice in Debre Berhan town , Ethiopia : a cross sectional study, . Int Breastfeed J. 2016:1\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eDessalegn Tamiru SM. Maternal knowledge of optimal breastfeeding practices and associated factors in rural communities of Arba Minch Zuria, . International Journal of Nutrition and Food Sciences. 2013; 2(3):pp. 122-9.\u003c/li\u003e\n\u003cli\u003eRao M.V.A FN. A critical analysis of factors for delayed initiation of breast feeding in a district level hospital, . International Journal of Reproduction, Contraception, Obstetrics and Gynecology,. 2018;7(12):4840\u0026ndash;4.\u003c/li\u003e\n\u003cli\u003eWubareg Seifu GAaGE. Prevalence of Exclusive Breast Feeding and its Predictors Among Infants Aged Six Months in Jimma, . Journal of Pediatrics \u0026amp; Neonatal Care;. 2014;1(3):1\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eBlack RE MM, Ong KK (eds),. Complementary Feeding: Building the Foundations for a Healthy Life, . Nestle Nutrition Institute,. 2017;87(183196(10.1159/000448966);).\u003c/li\u003e\n\u003cli\u003eAyuk TB BC, Nyobe C. . Trends in General Practice The determinants of exclusive breastfeeding in Cameroon , Sub-Saharan Africa,. Open Access Text,. 2018.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"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":"Children, Optimal Breastfeeding practice, Mothers, Tehuledere District","lastPublishedDoi":"10.21203/rs.3.rs-4343238/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4343238/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBreastfeeding is among the best and effective ways to promote optimal development of children in early childhood and maternal health. Recent estimates suggested that optimal breastfeeding could prevent around 12% of deaths in under-5 children every year, representing around 800,000 lives in low- and middle-income countries.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe aim of this study was to assess the prevalence of optimal breastfeeding practice and associated factors among mothers of children 24–36 months of age in Tehuledere District, North East Ethiopia, 2020.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA community-based cross-sectional study was conducted among 522 mothers of children 24–36 months of age from March 01–26/2020.Multistage sampling technique was used to select the study participants. Interviewer administered structured questionnaire was used to collect data from the study participants. Data were entered using epi data version 3.1 and analyzed by using SPSS version 20.0. Binary logistic regression analysis was computed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of optimal breastfeeding was 44.3%.Access to media (AOR = 2.547[95% CI = 1.203, 5.395]), having male child (AOR = 2.697[95% CI = 1.492, 4.874]), child birth weight \u0026lt; 2.5kg (AOR = 4.864[95% CI = 1.240, 19.080]) and 1–3 times antenatal care(ANC) visits (AOR = .282[95% CI = .154, .518]) were the factors significantly associated with optimal breast feeding practice.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions and Recommendations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, the prevalence of optimal breastfeeding practice was low. Access to media, sex of the child, weight of the child and number antenatal care visits were significantly associated. Therefore, enhancing the access to information on optimal breast feeding, minimizing sex preference in child care and strengthening focused ANC by health professionals, district health offices and partners is important in order to improve optimal breastfeeding practice.\u003c/p\u003e","manuscriptTitle":"Optimal breastfeeding practice and associated factors among mothers of children 24-36 months of age in Tehuledere District, Northeast Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-13 20:20:44","doi":"10.21203/rs.3.rs-4343238/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":"ad825381-9e46-4efc-9a54-96b3a16876d1","owner":[],"postedDate":"May 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-05-13T20:20:47+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-13 20:20:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4343238","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4343238","identity":"rs-4343238","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}