Timely Initiation of Complementary Feeding and Associated Factors Among Children aged 6-23 Months in Negelle Arsi District, Southern Ethiopia, 2019: A Community-Based Cross-Sectional Study

Timely Initiation of Complementary Feeding and Associated Factors Among Children aged 6-23 Months in Negelle Arsi District, Southern Ethiopia, 2019: A Community-Based Cross-Sectional Study | 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 Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Timely Initiation of Complementary Feeding and Associated Factors Among Children aged 6-23 Months in Negelle Arsi District, Southern Ethiopia, 2019: A Community-Based Cross-Sectional Study Hajo Denko Kebeto, Gizachew Abdeta, Solomon Tejineh, AmanUrgessa Edaso This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-710966/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: The period of transition from exclusive breastfeeding to family foods, referred to as complementary feeding, covers a child from 6-23 months of age. According to World Health Organization 2015; untimely initiation of complementary feeding has negative effect on child health, growth and development and an important cause of under nutrition in children less than 5 years of age which is an underlying cause of more than 40% of morbidity and mortality. Objective: To assess the Timely Initiation of Complementary Feeding practice and Associated factors among children aged 6-23 Months in Nagelle Arsi District, Southern Ethiopia, 2019. Methods: A community-based cross-sectional study was carried out. Systematic random sampling method was used to select 400 study participants. Data was collected using structured questionnaire using face to face interview. The collected data was coded, entered in to Epi-Info version 7 and then exported to SPSS version 21 for analysis.Descriptive statistics, binary and multiple logistic regressions were used for data analysis at 95% confidence intervals. A p-value <0.05 was considered to declare statistical significance. Results: Out of 398 study participants, the proportion of timely initiated complementary feeding was 296 (74.4%) at 95%CI: (70.14, 78.66). In this study Postnatal care follow up [AOR=2.484; 95% CI: (1.478, 4.176)], ANC follow up [AOR=2.221; 95% CI: (1.276, 3.876)] and maternal counseling about timely initiation of complementary feeding at delivery place were positively associated with timely initiation of complementary feeding practice [AOR=2.362; 95% CI: (1.399, 3.986)]. Conclusion and recommendation: In this study, three-fourth (74.4%) of children were initiated complementary food at six months of age which was lower than the WHO cut-off point of > 80%. ANC follow up, having postnatal care visits and being counseled about timely initiation of complementary feeding at place of delivery were significantly associated with timely initiation of complementary feeding. Therefore promoting ANC follow up, postnatal care visits and counseling about timely initiation of complementary feeding at delivery place were recommended to the concerned bodies to improve the coverage of timely initiation of complementary feeding practice. Nutrition & Dietetics Timely Initiation Complementary Feeding practice Nagelle Arsi District Ethiopia Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Complementary feeding practice is the period when other foods or liquids along with mother’s milk are given to the baby which is started at six months based on the biological and developmental aspects of infants( 2 ). Sub-optimal breast feeding and poor complementary feeding practices leads to mal-nutrition, which is the single biggest contributor to child mortality and the underlying causes of more than half of all deaths among children 6–59 months aged by UNDP 2012( 1 ). The period of transition from exclusive breastfeeding to family foods, referred to as complementary feeding, covers a child from 6–23 months of age( 3 ). Infants and young children are vulnerable to malnutrition because high nutritional requirements for growth and development and particularly begin at six month( 4 ). For an optimal growth of an infant, the World Healt4h Organization recommends exclusive breast feeding for the first 6 months and the timely initiation of complementary feeding (CF) at the age of 6 months( 5 ). Early introduction of complementary feeding is increased morbidity due to gastro-intestinal diseases while Delayed introduction of CF is also negative consequences to the infants’ health( 6 ) .The child 6-23months is the time when malnutrition starts in many infants, contributing to the high prevalence of malnutrition in children under-two years of age. Although deaths in children under 5 years of age have decreased by 50%, i.e., 12.7 million in 1990, 5.9 million died in 2015 mostly because of preventable causes, and under nutrition is the underlying cause in 45% of these deaths globally( 7 ). According to UNICEF estimates, 26% or 165 million children were stunted globally in 2011, and three-quarters of this burden was distributed in South Asia and sub-Saharan Africa( 8 ). Proper feeding of breast milk alone in the first six months could avert about 15% of infant deaths, and optimal complementary feeding could further reduce 6% of all deaths among children under 5years.Timely initiated complementary feeding with enough nutritious and safe foods prevents malnutrition( 9 ).Women are more likely to continue optimal infant and young child feeding practices if they recognize the benefits, believe they can overcome perceived and actual barriers, and feel supported( 10 , 11 ). For infant and young child feeding programs, monitoring focuses on the proportion of mothers with children below 24 months received appropriate infant and young child feeding (IYCF) counseling and current status of feeding practices recommended by WHO the core indicators( 12 ). The main purpose of timely initiation of complementary foods is to fill in the energy and micronutrient gap created after 6 months of age when nutrient needs cannot be met by breast milk alone. Therefore timely initiation of complementary foods to child’s diet is recommended. This means introducing an infant with solid, semi-solid or soft foods at age 6 months and continued breast feeding until two years of age ( 4 , 13 ). The feeding of infants and young children is crucial in determining the health, nutrition, survival, growth and development of the individual ( 14 , 15 ). It is important that mothers understand when to start complementary feeding, what foods to start with, how to feed a child and how to ensure that the food is hygienic and safe, because poor feeding practices coupled with high rates of infection in infancy and early childhood that result in malnutrition contribute to significant morbidity, delayed mental and motor development, poor school performance and reduced productivity in later life( 13 ). This study was focused on the assessment Timely Initiation complementary feeding and associated factors among mothers of 6–23 months Children in Nagelle Arsi district, West Arsi Zone, Oromia Regional State, Ethiopia, 2019. Methods And Materials Study Setting This study was conducted in Nagelle Arsi Woreda West Arsi Zone, Oromia Regional State Ethiopia. Part of the west Arsi zone located in the Great rift valley which is bordered on the south by Shashemane rural, on the south-west by Lake shala which separates it from shala, on the west from the southern nations, nationalities and peoples region, on the north by East Shewa with which it shares the shores of Lakes Abijatta and Langano, and on the east by the Heban Arsi woreda. Its’ an area of 2081.463km 2 that extends between 07°09’00”_07°42’00”N latitudes and 38 0 40’00”- 38°54’00”E longitudes. It has seven health centres, nine private primary clinic and thirty-seven health posts. The district has a total population of 211,059 residing in 36 rural Kebeles administrative with 104,474 male and 106,585 female. Children aged 6_23 months in the district about 8,970 (4.28%) of the population. The livelihood of more than 85 % of the district population is based on farming. Study design and period Community based cross-sectional study design was conducted from October 01–25, 2019 Sample size determination The sample size for the first object was calculated by using single population proportion formula by considering assumption about timely initiation of complimentary feeding practice 61.5% from study in Fiche, North Showa Zone, 2017( 19 ), with assumption of 95% confidence level, non-response rate of 10% and margin of error (5%).The final sample size for the first objective was = 400 The sample size for the second objective was calculated using stat Calc of Epi Info from the study conducted in Mekelle, Northern Ethiopia 2013 ( 30 ), from assumption ni = 188, With 10% non-respondent, final sample size for the second objective was = 199. Therefore, sample sizes were calculated for the first and the second objectives and the largest sample size was found to be 400 from the first objective 400. Generally, sample sizes were calculated for the first and the second objectives and the largest sample size was found to be 568 from the second objective. Sampling procedure Simple random sampling technique was employed to select twelve ( 12 ) Kebeles (33%) of total Kebeles ( 36 ) of Negelle Arsi district. Mothers in each selected Kebele with children aged 6–23 months were listed by using community health information system (CHIS) at health post (Fig. 2 ). The calculated sample size was allocated to each selected Kebele proportional to the size of the population and the first study participant was selected using simple random sampling from first k th interval. Then the study participants were selected using systematic random sampling every k th interval through house number of each household of Kebele by using community health information system at health post. If selected house is closed or mother is absent revisit and if more than one eligible child randomly takes one child. The twelve kebeles that included in the study were: K 1 = CiriLalu, K 2 = Danshe, K 3 = Xurgee, K 4 = Ashoka, K 5 = ShallaBila, K 6 = Gode, K 7 = Kararu, K 8 = DakaHoraKalo, K 9 = GorbiArba, K 10 = Mako Oda,K 11 = Karsa Gara ,K 12 = KarsaMaja. Method of data collection and Tools The quantitative data was collected by face-to-face interview to mothers who had children age 6–23 months through home to home visits. The questionnaires was adapted from WHO standard questions, Indicators for assessing Infant and Young Child Feeding practices part 2 measurement and EDHS 2016 to suit the study setting( 20 , 43 ). The prepared questionnaire includes information on socio demographic characteristics, health system related factors, Childs Characteristics and knowledge about when to start complementary feeding. Training were provided to 6 data collectors and 2 supervisors for one day on the objective, relevance of the study, confidentiality of information, respondent’s right, informed consent, and techniques of interview and on how to use the data collection instruments. Data quality assurance The questionnaire was prepared in English and it was translated to Afan Oromo language and back translated to English by language expert to maintain consistency well. One day training was given to data collectors to be familiar with data collection instruments. The pretest will be made in 40 (10%) mothers who had children aged 6–23 months, outside the study area in the in Heban Arsi district to assess the content and approach of the questionnaire and direct observation to assure the feasibility of study. The collected data were supervised and checked for completeness and quality during data collection by supervisors and principal investigator before data entry. Data processing and analysis The data were checked for completeness, consistencies, cleaned, coded and entered in to Epi-Info version 7software then exported to a computer using statistical package for social sciences (SPSS) version 21 for data analysis and present using the descriptive statistics (percentage) for socio-demographic characteristics, maternal health care services and child characteristics. Binary logistic regression used to look for crude association between exposure and outcome variables. Exposure variables with P < 0.25 were considered as candidates for multivariate logistic regressions to control for confounding. Thus we reported Adjusted Odds Ratio (AOR) along with 95% CI for the effect measure for association, and statistical significance was declared at P-value < 0.05. Finally the results of the study were presented using tables, figures and texts based on the data obtained. Results Socio-demographic characteristics of the respondents Among proposed 400 mothers, 398 participated in the study, making the response rate (99.5%). The mean age of mothers was 25.79 (SD ± 4.6) years with the range being from 15 to 45years old. Out of the total mothers 224(40.7 %) were in the age group of 20–24 followed by age group 25–29 years old100 (25.1%). The majority of the participants 390(98%) were married and 337(84.7%) house wife. Concerning respondent’s educational status 210(52.8%), religious 316(79.4%) and ethnicity 373(93.7%) were primary, Muslim followers and Oromo respectively. Among all children in the age of 6–23 months, 193(48.5%) were boys and the rest were girls. Children in the age range of 6–11 months constituted 46% of the rest age groups (Table 1 ). Table 1 Socio Socio-demographic characteristics of the respondents (𝑛 = 398), Negelle Arsi, Oromia Region, Ethiopia, 2019 Variables (n = 398) Frequency Percent (%) Age of respondents 15-194110.3 20–24 162 40.7 25–29 100 25.1 30–34 77 19.3 35 and above 18 4.5 Age of Child 6–11 183 46.0 12–17 134 33.7 18–23 81 20.4 Marital Status of Respondent Single 3 .8 Married 390 98.0 Divorced 5 1.2 Educational Status of Respondent No Formal Education 110 27.6 Primary 210 52.8 Secondary and above 78 19.6 Occupational Status of Respondents House wife 337 84.7 Student 10 2.5 Government Employee Merchant 13 38 3.3 9.5 Religious of respondents Orthodoxy 29 7.3 Muslim 316 79.4 Others 53 13.3 Ethnicity of Respondent Oromo 373 93.7 Amhara 13 3.3 Others 12 3.0 Family Income Less than or equal to 1500 293 73.6 1501 and above 105 26.4 Number of under five children 1 111 27.9 2–3 287 72.1 Maternal health service related factors of the respondents Among the all respondents 361 (86%) reported that they had history of postnatal care follow up, about 368 (92.5%) of respondents had ANC follow up. From this, 153 (38.4%) had ANC follow up three and less than three times during the last pregnancy whereas, the rest 215 (54%) had ANC follow up greater than or equal to four times. More than half of the respondents, 264(66.3%) were heard health information from health extension worker. From those who were delivered at health institution 270 (67.8%), 193(48.5%) of them were counseled on timely initiation of complementary feeding practice (Table 2 ). Table 2 Maternal health service related factors of respondents, Negelle Arsi, District, Oromia Region, Southern Ethiopia, 2019 Variables (n = 398) Frequency Percent (%) Parity 1 52 13.1 2–4 223 56.0 30.9 Greater than 5 123 ANC Follow UP Yes 368 92.5 No 30 7.5 Number of ANC visit 1–3 Visits 215 54.0 ≥ 4 Visits 153 38.4 No Visit 30 7.5 ANC visit advised on Timely Initiation of Complementary Feeding Yes 301 75.6 No 67 16.8 No Visit 30 7.5 PNC Follow UP Yes 219 55.0 No 179 45.0 Number of PNC visit 1–3 196 49.2 4 and above 23 5.8 No Visit 179 45.0 PNC visit advised on Timely Initiation of Complementary Feeding Yes 203 51.0 No 16 4.0 No Visit 179 45.0 HEWs within this last 6month Yes 224 56.3 No 174 43.7 Counseling on Home Visits Yes 201 50.5 No 23 5.8 No Home Visit 174 43.7 Source of Health Information Health Ext/Workers(at HP) 264 66.3 Health Workers (HC, Hospital) 74 18.6 WHDA, Radio/TV, Family, 60 15.1 Place of Delivery At home 128 32.2 Health Facility 270 67.8 Counseling on place of Delivery Yes 208 52.3 No 190 47.7 Complementary feeding practice of respondents Majority of the mothers, 393(98.7%) were started complementary feeding for their child but 5 (1.3%) not started. From those who were started complementary feeding 55(13.8%), 296(74.4%), 47(11.8%) were before six month, at six month and after six month of age respectively. Out of the total mothers 334(85%) were initiate complementary feeding to their child timely by mashed food or fluid (cow milk or Powder milk).The majority of respondents, 388 (97.5%) were continued breast feeding but 10 (2.5%) were stopped breastfed when child age was ≥ 17 month.(Table 3 ). Table 3 Complementary feeding practice of respondents, Negelle Arsi District, Oromia Region, Southern Ethiopia, 2019 Variables (n = 398) Frequency Percent (%) Child breast feeding practices in the past 24hrs Yes 388 97.5 No 10 2.5 Age to stop breast feeding 12–17 23 5.8 18–23 179 45.0 24 and above 196 49.2 Have you introduced complementary feeding Yes 393 98.7.0 No 5 1.3 Source health information when start complementary feeding Health Workers (HC and Hospital) 203 51.0 Health Ext/Workers(at HP) 66 16.6 WHDA, Radio/TV, Family, School 27 6.8 I Do not know 102 25.6 Reason for Timely Initiation of Complementary feeding (n = 296) Not having enough milk 33 8.3 Breast milk alone is no longer sufficient to meet all their nutritional needs 163 41.0 Information acquired when to start complementary feeding 93 23.4 Working mother 5 1.3 Baby should learn how to eat 2 .5 Reason for Untimely Initiation of CF ( n = 102 ) Did not know exactly when to start CF 68 17.1 Mother feels that her milk is not enough for baby 20 5 Mother feels child may not be able to digest it at this age 14 3.5 How do you feed your child by schedule 165 41.5 On the demands of child 216 54.3 When family eat 17 4.3 What do you use to feed your child Bowel and spoon 155 38.9 Bottle feeding 174 43.7 Hand feeding 69 17.3 Factors associated with timely initiation of complementary feeding practice Candidate variables for multivariate logistic regression were identified by using bivariate logistic regression analysis. The criteria was set to P < 0.25 as a yardstick. Accordingly; socio-demographic characteristics such as respondents’ achieved educational status, husbands’ educational status and Family incomes, and maternal health service related characteristics such as PNC follow up, frequency of PNC visits, ANC follow up, frequency of ANC visits, home visits, counseling during recent pregnancy, PNC, place of delivery and home visits were identified as factors associated with initiation of complementary feeding at 6 month and also candidates for multivariate logistic regression. Multiple logistic regressions Analysis Multivariate comparisons of characteristics of timely introduction of complementary feeding practice of mothers of children aged 6–23 months. Adjusting for other variables, attending antenatal care at health facility during pregnancy, Post natal care follow up and Complementary feeding counseling at place were found to be predictors of timely initiation of complementary feeding practice. Mothers who had attended antenatal care follow up were 2.221 times more likely to practice timely initiation of complementary feeding than those mothers who had not attended Antenatal care (AOR: 2.221; 95% CI:1.276–3.865). Mothers who had attended Postnatal care follow up were 2.484 times more likely to practice timely initiation of complementary feeding than those mothers who had not attended postnatal visit (AOR: 2.484; 95% CI:1.478–4.176). Those mothers who had received counseling about complementary feeding at place of delivery were 2.362 more likely to practice timely initiation of complementary feeding than those mothers who did not receive counseling (AOR 2.362 CI: 1.399, 3.986). Having antenatal care and postnatal care visit at health facility and getting counseling related to complementary feeding at place of delivery were identified as predictor of timely initiation of complementary feeding. We applied multivariate logistic regression for controlling possible confounders. Discussion This community based cross-sectional study with the objective of the assessment of the prevalence and factors associated with timely initiation of complementary feeding were conducted in Negelle Arsi District, Oromia Region, Southern Ethiopia. The findings from this study showed that the prevalence of initiation of complementary feeding at 6 months of age was 74.4% in children aged 6–24months in Negelle Arsi district. This finding is lower than WHO recommendation for timely initiation of complementary feeding which was greater than or equal 80 %( 21 ). On the other hand, timely initiated complementary feeding practice in this study was relatively in line with study conducted in Damot sore district (74.2%) in Southern Ethiopia in 2017( 40 ), Sidama (72.2%) in Southern Ethiopia 2013( 39 ).This might be due to the fact that nutrition counseling and other services are provided at the ANC, PNC and delivery service and similar socio demographic factors with study area. However, this finding is higher than studies conducted in rural Soro District(34.3%) in Southern Ethiopia( 36 ),Kamba Woreda, South West Ethiopia (40.4%) ( 32 ), Urban Community in Lagos State Nigeria (47.9%) ( 26 ), Axum town (52.8%) in northern Ethiopia( 31 ), Mekele town (62.8%) in Northern Ethiopia ( 30 ), Lasta district (56.5%) in Amhara region ( 28 ), Tahtay Maichew district 53.4%) in Northern Ethiopia( 34 ), Fiche (61.5%) in Northern Shoa ( 19 ) and Benishangul Gumuz Region (61.8)( 33 ).The higher prevalence of timely initiation of complementary feeding in the study areas could be related to the time of study conducted, improvements in utilization of frequency of ANC visits, PNC visits and counselling at delivery place. Hence, nutrition education and counseling are components of maternal health care services; a higher utilization of these services will bring an added benefit to improve mothers’ awareness on appropriate child feeding practices. This is probably related to the current improvements in the implementation of the Health Extension Program. Health extension workers are making home to home visits on regular bases to support families in accessing basic health services. Among maternal health service factors antenatal follow up, postnatal care follow-up and counseling about timely initiation of complementary feeding at delivery place were independent predictors for the outcome. This study indicated that mothers who had history of postnatal care visit for this child were 2.484 times more likely to timely initiate complementary feeding to infants compared to those who did not attend any postnatal care visit. Similar findings were reported from Soro District in Southern Ethiopia( 36 ), Kamba Woreda, South West Ethiopia( 32 ),Lasta District ( 28 ) in Amhara region, Bensa Sidama zone ( 39 )and Gombora District ( 29 )in Southern Ethiopia. Mothers who had no postnatal care follow up would start complementary feeding earlier (before 6 months) or later (after 6 months) compared to mothers who followed the care. This is explained Mothers who get advice and Health education on complementary feeding during Post natal has favorable impact on the promotion of timely initiation of complementary feeding. A postnatal period could be an ideal time to counsel mothers on timely initiation of complementary feeding practice. This study shows that mothers who had ANC follow up were 2.221 times more likely to initiate timely complementary feeding compared to those mothers who did not receive ANC follow up. This is similar to a study conducted in Mokele town( 30 ), Axum town( 31 ), Bensa District ( 39 ), Gomora District( 29 ) and Sodo town administration( 35 ). This might be due to the fact that nutrition counseling and other services are provided to mother during ANC visits. Provision of complementary feeding counseling during pregnancy influences complementary feeding initiation at the appropriate time and promoting continue breastfeeding. Furthermore, this study indicates that mother who had received counseling about timely initiation of complementary feeding at place of delivery were 2.362times more likely to initiate complementary feeding compared to mother who were not received counseling at place of delivery. This is in line with study a conducted in Sodo town administration ( 35 ),Sore District in Southern Ethiopia( 36 ), Tahtay Maichew District in Northern Ethiopia ( 34 ). The possible reason for this finding might be the better health seeking behavior of the mother and the potential of getting advice about exclusive breast feeding and timely initiation of complementary feeding. Strength and Limitation of the study Strength The study used primary data and its response rate was 99.5% which could be reduced nonresponse bias. Limitation Some level of recall bias was expected while interviewing respondents Since the study was cross sectional study it may not shows temporal relationships. Conclusion The study came up with the three-fourth (74.4%) of children were initiated complementary food at six months of age which was lower than the WHO cut-off point of ≥ 80%. ANC follow up, having postnatal care visits and being counseled about timely initiation of complementary feeding at place of deliveries were significantly associated with timely initiation of complementary feeding. Recommendation Negelle Arsi Woreda Health Office should promote rigorous ANC follow up, postnatal care visits, health facility delivery and counseling on appropriate complementary feeding practices. Health professionals who are involved in maternal health services should give focus to advice and counsel mothers on timely initiation of complementary feeding during prenatal and delivery and post natal period. Postnatal care utilization should be strengthened on one hand and it should get due emphasis for counseling mothers on appropriate optimal complementary feeding practices Further research should be conducted by using qualitative study design to understand deeply socio-cultural and behavioral related factors towards initiation of complementary feeding at six month to develop and implement better strategy to improve timely initiation of complementary feeding practice. Acronyms/ Abbreviations AIDS AMIYCN ANC AOR BF CF CFP CHIS. EDHS HHs IYCF MCH MOH OR PI PNC SPSS SRS WHDA WHO Acquired Immune Diseases Syndrome Adolescent Maternal Infant Young Child Nutrition Ante Natal Care Adjusted Odds Ratio Breast Feeding Complimentary Feeding Complimentary Feeding Practice Community Health Information System Ethiopia Demographic Health Survey House Holds Infant Young Child Feeding Maternal and Child Health Minister of Health Odds Ratio Principal Investigator Post Natal Care Statistical Package for the Social Science Simple Random Sampling Women Health Development Army World Health Organization Declarations Ethics approval and consent to participate Ethical clearance was obtained from Research and Ethical Review Committee of Arsi University, College of Health Sciences. A necessary permission was also obtained from Health research Ethical Committee of Oromia Regional Health Bureau, West-Arsi zone health department, Nagelle Arsi district health office and local administrations. An informed verbal consent was obtained from the study participants and the privacy of the participants and confidentiality of the information was assured. Mothers with no and low awareness on when to start complimentary feeding for 6–23-month aged infant young children were informed on the recommended practices. Consent for publication Not applicable for this section. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests No financial and non-financial competing interest between the authors. Funding Not applicable for this section. Authors' contributions All authors have made substantial contributions to design, acquisition of data, analysis and interpretation of data. In addition to this the first and the second authors have been involved in drafting the manuscript and revising it critically for important intellectual content. Authors' information Corresponding author was graduated in BSc Midwifery and MSc in Maternity and Reproductive Health Nursing and he is lecturer and researcher at Madda Walabu University, Ethiopia. The initial author was graduated in BSc Nurse and MPH and he is Maternal and Child Health coordinator at Arsi Nagelle Woreda Health Office, Ethiopia and the second author was graduated in Medical Doctor and Master of Public Health and he is Assistant professor and researcher at Arsi University, Ethiopia. The third co-author was graduated in BSc Public Health and Master of Public Health in Reproductive and he is Assistant professor and researcher at Arsi University, Ethiopia. ACKNOWLEDGEMENTS We would like to extend our deepest gratitude to Arsi University college of Medicine and Health Science, for financial support for this project. Our appreciations and great thanks go to the supervisor and the data collectors for their commitment in carrying out the study. Last but not the least, our gratitude goes to all the study participants for their volunteer participation during the study period. References UNDP. The Nutrition Challenge in Sub-Saharan Africa. 2012. Betal A. Medical position paper on complementary feeding: a commentary by the ESPGHAN Committee on Nutrition 2011;46(1):12. Journal of Pediatrics Gastro enterology Nutrition. 2011;46(1):12. WHO, UNICEF. Global strategy for infant and young child feeding. Geneva2010. WHO. Strengthening action to improve feeding of infants and young children 6–23 months of age in nutrition and child health programmes: in Report of proceedings; 2012. MOH. Training Manual on Infant and Young Child Feeding (IYCF) and Nutrition Sensitive Agriculture (NSA). Ethiopia Federal Ministry of Health. 2015. Hasnan S, Anjum R. Knowledge and practices of mothers for complementary feeding in babies visiting pediatrics outpatient department of Jinnah Hospital. Lahore Biomedical. 2013;20(40):10. WHO. Under Five Mortality-Situation. Geneva2015. UNICEF. Improving Child Nutrition; the Achieveable Imperative for Global Progress. New York, USA.2013. FAO. Community feeding for children aged 6–23 months.. FAO Eropean Union food facility project. 2011:3. USAID. IYCN social and behavior change communication approach. In: PROJECT USAIDSINFYCN, editor. Geneva: WHO: WHO; 2011. WHO. Indicators for assessing infant and young child feeding practices part 2: measurement Geneva, Switzerland: WHO; 2010. Mannan A. Clinical Guidelines on Infant and Young Child Feeding (IYCF. In: Campaign DM, editor. Bangladesh: Mediacom; 2014. MOH. Adolescent, Maternal, Infant & Young Child Nutrition 2ed. Addis Ababa, Ethiopia: MOH; 2014. p. 94. MOH. Policy Guidelines on Infant and Young Child Feeding. The Republic of Uganda2009. p. 13. WHO. Planning Guide for national implementation of the Global Strategy for Infant and Young Child Feeding. Geneva, Swizerland: WHO press; 2007. p. 6. WHO. COMPREHENSIVE IMPLEMENTATION PLAN ON MATERNAL, INFANT AND YOUNG CHILD NUTRITION. Geneva, Switzerland: WHO Press; 2014. p. 2–4. MOH. NATIONAL STRATEGY FOR INFANT AND YOUNG CHILD FEEDING. Addis Ababa, Ethiopia: MOH; 2004. p. 7. MOH. National Guideline on Adolescent, Maternal Infant and Young Child Nutrition. Addis Ababa, Ethiopia: Ministry of Health; 2016. p. 36. Shukure R. Knowledge, Attitude and Practice on Initiation of Complementary Feeding Among Under Two Years. International Journal of Clinical Pediatric Surgery. 2017;3(proper time for starting complementary feeding):11. CSA., ICF. Ethiopia Demographic and Health Survey. Rockville, Maryland,USA: CSA and ICF. 2016. WHO. Global Strategy for Infant and Young Child Feeding. Geneva, Switzerland: World Health Organization; 2010. WHO. Indicators for assessing infant and young child feeding practices part 3:. Geneva, Switzerland: measurement [press release]; 2010. Blaney S. Feeding practices among Indonesian children above six months of age. Asia Pac J Clin Nutr. 2015;24(The critical role of feeding practices):3. Khokhar S, Jatoi H, Lassi Z. Prevalence of Timely Introduction of Complementary Feeding and its Related Factors in Children 6–24 Months of Age in Hyderabad,Pakistan. Nursing and Midwifery Studies. 2017;6(3). alive&thrive. Infant and Young Child Feeding Practices. Mekedela, SOUTH WOLLO, AMHARA, ETHIOPIA: 2015. Adenike F. Complementary Feeding Knowledge, Practices, and Dietary Diversity among Mothers of Under-Five Children in an Urban Community in Lagos State, Nigeria. International Journal of MCH and AIDS. 2017;6:49. CSA. ETHIOPIA Demographic and Health Survey. Addis Ababa, Ethiopia: 2016. Molla M. Complementary Feeding Practice and Associated Factors among Mothers Having Children 6–23 Months of Age. Hindawi. 2016;8. Nuramo A. Compliance to National Infant and Young Child Feeding Recommendation and Associated Factor Among Mothers of Children 6–23 months-of-age.. International Journal of Clinical and Experimental Medical Sciences. 2016;10. Shumey A, Demissie M, Berhane Y. Timely initiation of complementary feeding and associated factors among children aged 6 to 12 months in Northern Ethiopia. BMC Public Health. 2013;13. Yemane S, Awoke T, Gebreslassie M. Timely initiation of complementary feeding practice and associated factors among mothers of children aged from 6 to 24 months in Axum town, north Ethiopia. International Journal of Nutrition and Food Sciences. 2014;3(5):438–42. Agedew E, Demissie M, Misker D, Haftu D. Early Initiation of Complementary Feeding and Associated Factors among 6 Months to 2 Years Young Children, in Kamba Woreda, South West Ethiopia. Nutrition & Food Sciences.4:6. Ayana D. Complementary feeding practices among children aged 6–23 months in Benishangul Gumuz Region, Ethiopia BMC pediatrics. 2017;2. Reda EB, Teferra AS, Gebregziabher M. Time to initiate complementary feeding and associated factors among mothers with children aged 6–24 months in Tahtay Maichew district, northern Ethiopia. BMC research notes. 2019;12(1):17. Tafesse T, SorsaBadacho A, Kuma D. Timely Introduction of Complementary Feeding among Caregivers of Children 6–12 Month Sodo Town, Ethiopia. Health Sci J. 2018;12(1):543. Yohannes B, Ejamo E, Thangavel T, Yohannis M. Timely initiation of complementary feeding to children aged 6–23 months in rural Soro district of Southwest Ethiopia. BMC pediatrics. 2018;18(1):17. Reda EB, Teferra AS, Gebregziabher MG. Time to initiate complementary feeding and associated factors among mothers with children aged 6–24 months in Tahtay Maichew district, northern Ethiopia. BMC research notes. 2019;12(1):17. Chane T, Bitew S, Mekonnen T, Fekadu W. Initiation of complementary feeding and associated factors among children of age 6–23 months in Sodo town, Southern Ethiopia: Cross-sectional study. Pediatric reports. 2017;9(4). Mekbib E. Magnitude and factors associated with appropriate complementary feeding among mothers having children 6–23 months-of-age sidama zone,Southern Ethiopa. Journal of Food and Nutrition Sciences 2013;2. Areja.A, Yohannes.D, Yohannis.M. Determinants of appropriate complementary feeding practice. BMC Nutrition. 2017;3. UNICEF. Conceptual framework of complementary feeding2013. WHO. Comprehensive implementation plan on maternal, infant and young child nutrition. Geneva, Switzerland: WHO Press; 2014. Indicators for assessing infant and young child feeding practices part 2: measurement [press release]. Geneva, Switzerland: WHO2010. Additional Declarations No competing interests reported. Supplementary Files AdditionalTable.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-710966","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":46550726,"identity":"a70cfe39-973f-4f5a-bc8f-cd404c7bc1fd","order_by":0,"name":"Hajo Denko Kebeto","email":"","orcid":"","institution":"Nagelle Arsi Woreda Health Office","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hajo","middleName":"Denko","lastName":"Kebeto","suffix":""},{"id":46550727,"identity":"fb4f1165-21a3-412b-8292-8c2956135fc4","order_by":1,"name":"Gizachew Abdeta","email":"","orcid":"","institution":"Arsi University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Gizachew","middleName":"","lastName":"Abdeta","suffix":""},{"id":46550728,"identity":"50697f79-29cf-4be3-8d64-55b89c1cf828","order_by":2,"name":"Solomon Tejineh","email":"","orcid":"","institution":"Arsi University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Solomon","middleName":"","lastName":"Tejineh","suffix":""},{"id":46550729,"identity":"91bb057a-0270-412f-abdf-447812191d46","order_by":3,"name":"AmanUrgessa Edaso","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYJAD9h8fKoAUM3MD8XokZ5wBaWEkQYs0bxuIIqCFf9rhZ49599TKyfcffmDMO682mr8dqOVHxTacWiRup5kb8zw7bmxwI80gce6247kzDjM2MPacuY3bmtsJZtI8B44lbpBgMDjwdtux3AagFmbGNtxa5G+nfwNpqZ/ff/xjA++cY7nzCWkxuJ0DsqUmgeFAjjEjb0NN7gZCWgxv55RJzjlwwHDDjZwyxhnHDuRuBGo5iM8vcrfTt0m8OVAnL99/fBvDh5q63HnnDx988KMCj/ch4DAq4wAh9UBQh8EYBaNgFIyCUQAHAJsUYKiuXZpTAAAAAElFTkSuQmCC","orcid":"","institution":"Shashemane Campus Madda Walabu University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"AmanUrgessa","middleName":"","lastName":"Edaso","suffix":""}],"badges":[],"createdAt":"2021-07-12 13:59:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-710966/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-710966/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":12576630,"identity":"6b4efa70-4751-4625-8a79-8c4bf230a6b1","added_by":"auto","created_at":"2021-08-19 13:39:23","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":30721,"visible":true,"origin":"","legend":"Conceptual framework for the determinants of timely initiation of CF among mothers of children aged 6-23 months in Negelle Arsi District, Southern Ethiopia, 2019. Source: Adapted from Sampling procedure for the Study","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-710966/v1/1055f666dd34632b244a2701.png"},{"id":12576631,"identity":"6b274890-ac0c-4171-bc52-4fe9efcb5442","added_by":"auto","created_at":"2021-08-19 13:39:23","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":39576,"visible":true,"origin":"","legend":"Schematic presentation of sampling procedures for mothers of children aged 6-23 month in Nagelle Arsi, Oromia region, Southern Ethiopia, 2019","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-710966/v1/1aaa84388d8e4b3846a8ac9e.png"},{"id":12576777,"identity":"03e7aa74-0c84-4f4b-897d-57034a711bb5","added_by":"auto","created_at":"2021-08-19 13:42:23","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":24191,"visible":true,"origin":"","legend":"Age at which mothers who have children age 6-23 month initiate complementary feeding to their child, Negelle Arsi District, Oromia Region, Southern Ethiopia, 2019","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-710966/v1/46cb77e852d6ff51fe94035d.png"},{"id":12576776,"identity":"f4c04813-2646-4891-9f4b-ef39c16ad0a1","added_by":"auto","created_at":"2021-08-19 13:42:23","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":32220,"visible":true,"origin":"","legend":"Reason for timely initiation of complementary feeding practice to their child, Negelle Arsi District, Oromia Region, Southern Ethiopia, 2019","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-710966/v1/4dc6287a7991ee307c4cea78.png"},{"id":13710293,"identity":"65bc3908-ca63-4fc0-ba1b-24d6c352f9cb","added_by":"auto","created_at":"2021-09-17 14:17:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":797231,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-710966/v1/b237e416-edff-4fc6-932e-a69573505451.pdf"},{"id":12576634,"identity":"1fbf90ba-76e2-4ee0-b9d9-e7d7cb1f6ea2","added_by":"auto","created_at":"2021-08-19 13:39:23","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":23955,"visible":true,"origin":"","legend":"","description":"","filename":"AdditionalTable.docx","url":"https://assets-eu.researchsquare.com/files/rs-710966/v1/b185cfd7f072cd54828e7f4d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eTimely Initiation of Complementary Feeding and Associated Factors Among Children aged 6-23 Months in Negelle Arsi District, Southern Ethiopia, 2019: A Community-Based Cross-Sectional Study\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eComplementary feeding practice is the period when other foods or liquids along with mother\u0026rsquo;s milk are given to the baby which is started at six months based on the biological and developmental aspects of infants(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Sub-optimal breast feeding and poor complementary feeding practices leads to mal-nutrition, which is the single biggest contributor to child mortality and the underlying causes of more than half of all deaths among children 6\u0026ndash;59 months aged by UNDP 2012(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The period of transition from exclusive breastfeeding to family foods, referred to as complementary feeding, covers a child from 6\u0026ndash;23 months of age(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Infants and young children are vulnerable to malnutrition because high nutritional requirements for growth and development and particularly begin at six month(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). For an optimal growth of an infant, the World Healt4h Organization recommends exclusive breast feeding for the first 6 months and the timely initiation of complementary feeding (CF) at the age of 6 months(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEarly introduction of complementary feeding is increased morbidity due to gastro-intestinal diseases while Delayed introduction of CF is also negative consequences to the infants\u0026rsquo; health(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) .The child 6-23months is the time when malnutrition starts in many infants, contributing to the high prevalence of malnutrition in children under-two years of age. Although deaths in children under 5 years of age have decreased by 50%, i.e., 12.7\u0026nbsp;million in 1990, 5.9\u0026nbsp;million died in 2015 mostly because of preventable causes, and under nutrition is the underlying cause in 45% of these deaths globally(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). According to UNICEF estimates, 26% or 165\u0026nbsp;million children were stunted globally in 2011, and three-quarters of this burden was distributed in South Asia and sub-Saharan Africa(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eProper feeding of breast milk alone in the first six months could avert about 15% of infant deaths, and optimal complementary feeding could further reduce 6% of all deaths among children under 5years.Timely initiated complementary feeding with enough nutritious and safe foods prevents malnutrition(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).Women are more likely to continue optimal infant and young child feeding practices if they recognize the benefits, believe they can overcome perceived and actual barriers, and feel supported(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). For infant and young child feeding programs, monitoring focuses on the proportion of mothers with children below 24 months received appropriate infant and young child feeding (IYCF) counseling and current status of feeding practices recommended by WHO the core indicators(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe main purpose of timely initiation of complementary foods is to fill in the energy and micronutrient gap created after 6 months of age when nutrient needs cannot be met by breast milk alone. Therefore timely initiation of complementary foods to child\u0026rsquo;s diet is recommended. This means introducing an infant with solid, semi-solid or soft foods at age 6 months and continued breast feeding until two years of age (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe feeding of infants and young children is crucial in determining the health, nutrition, survival, growth and development of the individual (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIt is important that mothers understand when to start complementary feeding, what foods to start with, how to feed a child and how to ensure that the food is hygienic and safe, because poor feeding practices coupled with high rates of infection in infancy and early childhood that result in malnutrition contribute to significant morbidity, delayed mental and motor development, poor school performance and reduced productivity in later life(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). This study was focused on the assessment Timely Initiation complementary feeding and associated factors among mothers of 6\u0026ndash;23 months Children in Nagelle Arsi district, West Arsi Zone, Oromia Regional State, Ethiopia, 2019.\u003c/p\u003e"},{"header":"Methods And Materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Setting\u003c/h2\u003e \u003cp\u003eThis study was conducted in Nagelle Arsi Woreda West Arsi Zone, Oromia Regional State Ethiopia. Part of the west Arsi zone located in the Great rift valley which is bordered on the south by Shashemane rural, on the south-west by Lake shala which separates it from shala, on the west from the southern nations, nationalities and peoples region, on the north by East Shewa with which it shares the shores of Lakes Abijatta and Langano, and on the east by the Heban Arsi woreda. Its\u0026rsquo; an area of 2081.463km\u003csup\u003e2\u003c/sup\u003e that extends between 07\u0026deg;09\u0026rsquo;00\u0026rdquo;_07\u0026deg;42\u0026rsquo;00\u0026rdquo;N latitudes and 38\u003csup\u003e0\u003c/sup\u003e 40\u0026rsquo;00\u0026rdquo;- 38\u0026deg;54\u0026rsquo;00\u0026rdquo;E longitudes. It has seven health centres, nine private primary clinic and thirty-seven health posts. The district has a total population of 211,059 residing in 36 rural Kebeles administrative with 104,474 male and 106,585 female. Children aged 6_23 months in the district about 8,970 (4.28%) of the population. The livelihood of more than 85 % of the district population is based on farming.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and period\u003c/h2\u003e \u003cp\u003eCommunity based cross-sectional study design was conducted from October 01\u0026ndash;25, 2019\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSample size determination\u003c/h2\u003e \u003cp\u003eThe sample size for the first object was calculated by using single population proportion formula by considering assumption about timely initiation of complimentary feeding practice 61.5% from study in Fiche, North Showa Zone, 2017(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), with assumption of 95% confidence level, non-response rate of 10% and margin of error (5%).The final \u003cb\u003esample size for the first objective was =\u0026thinsp;400\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe sample size for the second objective was calculated using stat Calc of Epi Info from the study conducted in Mekelle, Northern Ethiopia 2013 (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), from assumption ni\u0026thinsp;=\u0026thinsp;188, With 10% non-respondent, final sample size for the second objective was =\u0026thinsp;199.\u003c/p\u003e \u003cp\u003eTherefore, sample sizes were calculated for the first and the second objectives and the largest sample size was found to be 400 from the first objective 400.\u003c/p\u003e \u003cp\u003eGenerally, sample sizes were calculated for the first and the second objectives and the largest sample size was found to be 568 from the second objective.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSampling procedure\u003c/h2\u003e \u003cp\u003eSimple random sampling technique was employed to select twelve (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) Kebeles (33%) of total Kebeles (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) of Negelle Arsi district. Mothers in each selected Kebele with children aged 6\u0026ndash;23 months were listed by using community health information system (CHIS) at health post (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The calculated sample size was allocated to each selected Kebele proportional to the size of the population and the first study participant was selected using simple random sampling from first k\u003csup\u003eth\u003c/sup\u003e interval. Then the study participants were selected using systematic random sampling every k\u003csup\u003eth\u003c/sup\u003e interval through house number of each household of Kebele by using community health information system at health post. If selected house is closed or mother is absent revisit and if more than one eligible child randomly takes one child. The twelve kebeles that included in the study were:\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eK\u003csub\u003e1\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;CiriLalu, K\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;Danshe, K\u003csub\u003e3\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;Xurgee, K\u003csub\u003e4\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;Ashoka,\u003c/p\u003e \u003cp\u003eK\u003csub\u003e5\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;ShallaBila, K\u003csub\u003e6\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;Gode, K\u003csub\u003e7\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;Kararu, K\u003csub\u003e8\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;DakaHoraKalo,\u003c/p\u003e \u003cp\u003eK\u003csub\u003e9\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;GorbiArba, K\u003csub\u003e10\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;Mako Oda,K\u003csub\u003e11\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;Karsa Gara ,K\u003csub\u003e12\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;KarsaMaja.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eMethod of data collection and Tools\u003c/h2\u003e \u003cp\u003eThe quantitative data was collected by face-to-face interview to mothers who had children age 6\u0026ndash;23 months through home to home visits. The questionnaires was adapted from WHO standard questions, Indicators for assessing Infant and Young Child Feeding practices part 2 measurement and EDHS 2016 to suit the study setting(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). The prepared questionnaire includes information on socio demographic characteristics, health system related factors, Childs Characteristics and knowledge about when to start complementary feeding. Training were provided to 6 data collectors and 2 supervisors for one day on the objective, relevance of the study, confidentiality of information, respondent\u0026rsquo;s right, informed consent, and techniques of interview and on how to use the data collection instruments.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData quality assurance\u003c/h2\u003e \u003cp\u003eThe questionnaire was prepared in English and it was translated to Afan Oromo language and back translated to English by language expert to maintain consistency well. One day training was given to data collectors to be familiar with data collection instruments. The pretest will be made in 40 (10%) mothers who had children aged 6\u0026ndash;23 months, outside the study area in the in Heban Arsi district to assess the content and approach of the questionnaire and direct observation to assure the feasibility of study. The collected data were supervised and checked for completeness and quality during data collection by supervisors and principal investigator before data entry.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData processing and analysis\u003c/h2\u003e \u003cp\u003e The data were checked for completeness, consistencies, cleaned, coded and entered in to Epi-Info version 7software then exported to a computer using statistical package for social sciences (SPSS) version 21 for data analysis and present using the descriptive statistics (percentage) for socio-demographic characteristics, maternal health care services and child characteristics. Binary logistic regression used to look for crude association between exposure and outcome variables. Exposure variables with P\u0026thinsp;\u0026lt;\u0026thinsp;0.25 were considered as candidates for multivariate logistic regressions to control for confounding. Thus we reported Adjusted Odds Ratio (AOR) along with 95% CI for the effect measure for association, and statistical significance was declared at P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Finally the results of the study were presented using tables, figures and texts based on the data obtained.\u003c/p\u003e"},{"header":"Results","content":"\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003eSocio-demographic characteristics of the respondents\u003c/h2\u003e\n\u003cp\u003eAmong proposed 400 mothers, 398 participated in the study, making the response rate (99.5%). The mean age of mothers was 25.79 (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6) years with the range being from 15 to 45years old. Out of the total mothers 224(40.7 %) were in the age group of 20\u0026ndash;24 followed by age group 25\u0026ndash;29 years old100 (25.1%). The majority of the participants 390(98%) were married and 337(84.7%) house wife. Concerning respondent\u0026rsquo;s educational status 210(52.8%), religious 316(79.4%) and ethnicity 373(93.7%) were primary, Muslim followers and Oromo respectively. Among all children in the age of 6\u0026ndash;23 months, 193(48.5%) were boys and the rest were girls. Children in the age range of 6\u0026ndash;11 months constituted 46% of the rest age groups (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSocio Socio-demographic characteristics of the respondents (𝑛 = 398), Negelle Arsi, Oromia Region, Ethiopia, 2019\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"5\" align=\"left\"\u003e\n\u003cp\u003eVariables (n\u0026thinsp;=\u0026thinsp;398)\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Frequency Percent (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge of respondents\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e15-194110.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20\u0026ndash;24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e162\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25\u0026ndash;29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30\u0026ndash;34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e77\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35 and above\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge of Child\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u0026ndash;11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e183\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e46.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12\u0026ndash;17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e134\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e18\u0026ndash;23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e81\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMarital Status of\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRespondent\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eSingle\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eMarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e390\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e98.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eDivorced\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEducational Status of Respondent\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eNo Formal Education\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e110\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003ePrimary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e210\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e52.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eSecondary and above\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e78\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOccupational Status of Respondents\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eHouse wife\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e337\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e84.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eStudent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGovernment Employee\u003c/p\u003e\n\u003cp\u003eMerchant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003cp\u003e38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.3\u003c/p\u003e\n\u003cp\u003e9.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eReligious of respondents\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eOrthodoxy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eMuslim\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e316\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e79.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eOthers\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e53\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEthnicity of Respondent\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eOromo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e373\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e93.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eAmhara\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eOthers\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFamily Income\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eLess than or equal to 1500\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e293\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e73.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1501 and above\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e105\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNumber of under five children\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e111\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e2\u0026ndash;3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e287\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e72.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003eMaternal health service related factors of the respondents\u003c/h2\u003e\n\u003cp\u003eAmong the all respondents 361 (86%) reported that they had history of postnatal care follow up, about 368 (92.5%) of respondents had ANC follow up. From this, 153 (38.4%) had ANC follow up three and less than three times during the last pregnancy whereas, the rest 215 (54%) had ANC follow up greater than or equal to four times. More than half of the respondents, 264(66.3%) were heard health information from health extension worker. From those who were delivered at health institution 270 (67.8%), 193(48.5%) of them were counseled on timely initiation of complementary feeding practice (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMaternal health service related factors of respondents, Negelle Arsi, District, Oromia Region, Southern Ethiopia, 2019\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eVariables (n\u0026thinsp;=\u0026thinsp;398)\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Frequency Percent (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eParity\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u0026ndash;4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e223\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e56.0\u003c/p\u003e\n\u003cp\u003e30.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGreater than 5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e123\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eANC Follow UP\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e368\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e92.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNumber of ANC visit\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u0026ndash;3 Visits\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e215\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;4 Visits\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e153\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e38.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo Visit\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eANC visit advised on Timely Initiation of Complementary\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFeeding\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e301\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e75.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e67\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo Visit\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePNC Follow UP\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e219\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e179\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNumber of PNC visit\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u0026ndash;3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e196\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e49.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 and above\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo Visit\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e179\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePNC visit advised on Timely Initiation of Complementary\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFeeding\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e203\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e51.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo Visit\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e179\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHEWs within this last 6month\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e224\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e56.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e174\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eCounseling on Home Visits\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e201\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo Home Visit\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e174\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSource of Health Information\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHealth Ext/Workers(at HP)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e264\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e66.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHealth Workers (HC, Hospital)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWHDA, Radio/TV, Family,\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePlace of Delivery\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAt home\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e128\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHealth Facility\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e270\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e67.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eCounseling on place of Delivery\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e208\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e52.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e190\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e47.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003ch2\u003eComplementary feeding practice of respondents\u003c/h2\u003e\n\u003cp\u003eMajority of the mothers, 393(98.7%) were started complementary feeding for their child but 5 (1.3%) not started. From those who were started complementary feeding 55(13.8%), 296(74.4%), 47(11.8%) were before six month, at six month and after six month of age respectively. Out of the total mothers 334(85%) were initiate complementary feeding to their child timely by mashed food or fluid (cow milk or Powder milk).The majority of respondents, 388 (97.5%) were continued breast feeding but 10 (2.5%) were stopped breastfed when child age was \u003cspan class=\"Underline\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;17 month.(Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eComplementary feeding practice of respondents, Negelle Arsi District, Oromia Region, Southern Ethiopia, 2019\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eVariables (n\u0026thinsp;=\u0026thinsp;398)\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Frequency Percent (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eChild breast feeding practices in the past 24hrs\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e388\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e97.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge to stop breast feeding\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12\u0026ndash;17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18\u0026ndash;23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e179\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24 and above\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e196\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e49.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHave you introduced complementary feeding\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e393\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e98.7.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSource health information when start complementary feeding\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHealth Workers (HC and Hospital)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e203\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e51.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHealth Ext/Workers(at HP)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e66\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWHDA, Radio/TV, Family, School\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eI Do not know\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e102\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eReason for Timely Initiation of Complementary feeding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(n\u0026thinsp;=\u0026thinsp;296)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNot having enough milk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBreast milk alone is no longer sufficient to meet all their nutritional needs\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e163\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInformation acquired when to start complementary feeding\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e93\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWorking mother\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBaby should learn how to eat\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eReason for Untimely Initiation of CF\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e( n\u0026thinsp;=\u0026thinsp;102 )\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDid not know exactly when to start CF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMother feels that her milk is not enough for baby\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMother feels child may not be able to digest it at this age\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHow do you feed your child\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eby schedule\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e165\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOn the demands of child\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e216\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWhen family eat\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eWhat do you use to feed your child\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBowel and spoon\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e155\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e38.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBottle feeding\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e174\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHand feeding\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n\u003ch2\u003eFactors associated with timely initiation of complementary feeding practice\u003c/h2\u003e\n\u003cp\u003eCandidate variables for multivariate logistic regression were identified by using bivariate logistic regression analysis. The criteria was set to P\u0026thinsp;\u0026lt;\u0026thinsp;0.25 as a yardstick. Accordingly; socio-demographic characteristics such as respondents\u0026rsquo; achieved educational status, husbands\u0026rsquo; educational status and Family incomes, and maternal health service related characteristics such as PNC follow up, frequency of PNC visits, ANC follow up, frequency of ANC visits, home visits, counseling during recent pregnancy, PNC, place of delivery and home visits were identified as factors associated with initiation of complementary feeding at 6 month and also candidates for multivariate logistic regression.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n\u003ch2\u003eMultiple logistic regressions Analysis\u003c/h2\u003e\n\u003cp\u003eMultivariate comparisons of characteristics of timely introduction of complementary feeding practice of mothers of children aged 6\u0026ndash;23 months. Adjusting for other variables, attending antenatal care at health facility during pregnancy, Post natal care follow up and Complementary feeding counseling at place were found to be predictors of timely initiation of complementary feeding practice. Mothers who had attended antenatal care follow up were 2.221 times more likely to practice timely initiation of complementary feeding than those mothers who had not attended Antenatal care (AOR: 2.221; 95% CI:1.276\u0026ndash;3.865). Mothers who had attended Postnatal care follow up were 2.484 times more likely to practice timely initiation of complementary feeding than those mothers who had not attended postnatal visit (AOR: 2.484; 95% CI:1.478\u0026ndash;4.176). Those mothers who had received counseling about complementary feeding at place of delivery were 2.362 more likely to practice timely initiation of complementary feeding than those mothers who did not receive counseling (AOR 2.362 CI: 1.399, 3.986). Having antenatal care and postnatal care visit at health facility and getting counseling related to complementary feeding at place of delivery were identified as predictor of timely initiation of complementary feeding.\u003c/p\u003e\n\u003cp\u003eWe applied multivariate logistic regression for controlling possible confounders.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis community based cross-sectional study with the objective of the assessment of the prevalence and factors associated with timely initiation of complementary feeding were conducted in Negelle Arsi District, Oromia Region, Southern Ethiopia. The findings from this study showed that the prevalence of initiation of complementary feeding at 6 months of age was 74.4% in children aged 6\u0026ndash;24months in Negelle Arsi district. This finding is lower than WHO recommendation for timely initiation of complementary feeding which was greater than or equal 80 %(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOn the other hand, timely initiated complementary feeding practice in this study was relatively in line with study conducted in Damot sore district (74.2%) in Southern Ethiopia in 2017(\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e), Sidama (72.2%) in Southern Ethiopia 2013(\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e).This might be due to the fact that nutrition counseling and other services are provided at the ANC, PNC and delivery service and similar socio demographic factors with study area.\u003c/p\u003e \u003cp\u003eHowever, this finding is higher than studies conducted in rural Soro District(34.3%) in Southern Ethiopia(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e),Kamba Woreda, South West Ethiopia (40.4%) (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), Urban Community in Lagos State Nigeria (47.9%) (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), Axum town (52.8%) in northern Ethiopia(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), Mekele town (62.8%) in Northern Ethiopia (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), Lasta district (56.5%) in Amhara region (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), Tahtay Maichew district 53.4%) in Northern Ethiopia(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), Fiche (61.5%) in Northern Shoa (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) and Benishangul Gumuz Region (61.8)(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).The higher prevalence of timely initiation of complementary feeding in the study areas could be related to the time of study conducted, improvements in utilization of frequency of ANC visits, PNC visits and counselling at delivery place. Hence, nutrition education and counseling are components of maternal health care services; a higher utilization of these services will bring an added benefit to improve mothers\u0026rsquo; awareness on appropriate child feeding practices. This is probably related to the current improvements in the implementation of the Health Extension Program. Health extension workers are making home to home visits on regular bases to support families in accessing basic health services.\u003c/p\u003e \u003cp\u003eAmong maternal health service factors antenatal follow up, postnatal care follow-up and counseling about timely initiation of complementary feeding at delivery place were independent predictors for the outcome. This study indicated that mothers who had history of postnatal care visit for this child were 2.484 times more likely to timely initiate complementary feeding to infants compared to those who did not attend any postnatal care visit. Similar findings were reported from Soro District in Southern Ethiopia(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), Kamba Woreda, South West Ethiopia(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e),Lasta District (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) in Amhara region, Bensa Sidama zone (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e)and Gombora District (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)in Southern Ethiopia. Mothers who had no postnatal care follow up would start complementary feeding earlier (before 6 months) or later (after 6 months) compared to mothers who followed the care. This is explained Mothers who get advice and Health education on complementary feeding during Post natal has favorable impact on the promotion of timely initiation of complementary feeding. A postnatal period could be an ideal time to counsel mothers on timely initiation of complementary feeding practice. This study shows that mothers who had ANC follow up were 2.221 times more likely to initiate timely complementary feeding compared to those mothers who did not receive ANC follow up. This is similar to a study conducted in Mokele town(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), Axum town(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), Bensa District (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e), Gomora District(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) and Sodo town administration(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). This might be due to the fact that nutrition counseling and other services are provided to mother during ANC visits. Provision of complementary feeding counseling during pregnancy influences complementary feeding initiation at the appropriate time and promoting continue breastfeeding.\u003c/p\u003e \u003cp\u003eFurthermore, this study indicates that mother who had received counseling about timely initiation of complementary feeding at place of delivery were 2.362times more likely to initiate complementary feeding compared to mother who were not received counseling at place of delivery. This is in line with study a conducted in Sodo town administration (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e),Sore District in Southern Ethiopia(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), Tahtay Maichew District in Northern Ethiopia (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). The possible reason for this finding might be the better health seeking behavior of the mother and the potential of getting advice about exclusive breast feeding and timely initiation of complementary feeding.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eStrength and Limitation of the study\u003c/h2\u003e \u003cp\u003e \u003cb\u003eStrength\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe study used primary data and its response rate was 99.5% which could be reduced nonresponse bias.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eLimitation\u003c/span\u003e \u003c/p\u003e \u003cp\u003eSome level of recall bias was expected while interviewing respondents\u003c/p\u003e \u003cp\u003eSince the study was cross sectional study it may not shows temporal relationships.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study came up with the three-fourth (74.4%) of children were initiated complementary food at six months of age which was lower than the WHO cut-off point of \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;80%. ANC follow up, having postnatal care visits and being counseled about timely initiation of complementary feeding at place of deliveries were significantly associated with timely initiation of complementary feeding.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eRecommendation\u003c/span\u003e \u003c/p\u003e \u003cp\u003eNegelle Arsi Woreda Health Office should promote rigorous ANC follow up, postnatal care visits, health facility delivery and counseling on appropriate complementary feeding practices.\u003c/p\u003e \u003cp\u003eHealth professionals who are involved in maternal health services should give focus to advice and counsel mothers on timely initiation of complementary feeding during prenatal and delivery and post natal period. Postnatal care utilization should be strengthened on one hand and it should get due emphasis for counseling mothers on appropriate optimal complementary feeding practices\u003c/p\u003e \u003cp\u003eFurther research should be conducted by using qualitative study design to understand deeply socio-cultural and behavioral related factors towards initiation of complementary feeding at six month to develop and implement better strategy to improve timely initiation of complementary feeding practice.\u003c/p\u003e"},{"header":"Acronyms/ Abbreviations","content":"\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAIDS\u003c/p\u003e \u003cp\u003eAMIYCN\u003c/p\u003e \u003cp\u003eANC\u003c/p\u003e \u003cp\u003eAOR\u003c/p\u003e \u003cp\u003eBF\u003c/p\u003e \u003cp\u003eCF\u003c/p\u003e \u003cp\u003eCFP\u003c/p\u003e \u003cp\u003eCHIS.\u003c/p\u003e \u003cp\u003eEDHS\u003c/p\u003e \u003cp\u003eHHs\u003c/p\u003e \u003cp\u003eIYCF\u003c/p\u003e \u003cp\u003eMCH\u003c/p\u003e \u003cp\u003eMOH\u003c/p\u003e \u003cp\u003eOR\u003c/p\u003e \u003cp\u003ePI\u003c/p\u003e \u003cp\u003ePNC\u003c/p\u003e \u003cp\u003eSPSS\u003c/p\u003e \u003cp\u003eSRS\u003c/p\u003e \u003cp\u003eWHDA\u003c/p\u003e \u003cp\u003eWHO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcquired Immune Diseases Syndrome\u003c/p\u003e \u003cp\u003eAdolescent Maternal Infant Young Child Nutrition\u003c/p\u003e \u003cp\u003eAnte Natal Care\u003c/p\u003e \u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e \u003cp\u003eBreast Feeding\u003c/p\u003e \u003cp\u003eComplimentary Feeding\u003c/p\u003e \u003cp\u003eComplimentary Feeding Practice\u003c/p\u003e \u003cp\u003eCommunity Health Information System\u003c/p\u003e \u003cp\u003eEthiopia Demographic Health Survey\u003c/p\u003e \u003cp\u003eHouse Holds\u003c/p\u003e \u003cp\u003eInfant Young Child Feeding\u003c/p\u003e \u003cp\u003eMaternal and Child Health\u003c/p\u003e \u003cp\u003eMinister of Health\u003c/p\u003e \u003cp\u003eOdds Ratio\u003c/p\u003e \u003cp\u003ePrincipal Investigator\u003c/p\u003e \u003cp\u003ePost Natal Care\u003c/p\u003e \u003cp\u003eStatistical Package for the Social Science\u003c/p\u003e \u003cp\u003eSimple Random Sampling\u003c/p\u003e \u003cp\u003eWomen Health Development Army\u003c/p\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eEthical clearance was obtained from Research and Ethical Review Committee of Arsi University, College of Health Sciences. A necessary permission was also obtained from Health research Ethical Committee of Oromia Regional Health Bureau, West-Arsi zone health department, Nagelle Arsi district health office and local administrations. An informed verbal consent was obtained from the study participants and the privacy of the participants and confidentiality of the information was assured. Mothers with no and low awareness on when to start complimentary feeding for 6\u0026ndash;23-month aged infant young children were informed on the recommended practices.\u003c/p\u003e\n\u003ch3\u003eConsent for publication\u003c/h3\u003e\n\u003cp\u003eNot applicable for this section.\u003c/p\u003e\n\u003ch3\u003eAvailability of data and materials\u003c/h3\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eCompeting interests\u003c/h3\u003e\n\u003cp\u003eNo financial and non-financial competing interest between the authors.\u003c/p\u003e\n\u003ch3\u003eFunding\u003c/h3\u003e\n\u003cp\u003eNot applicable for this section.\u003c/p\u003e\n\u003ch3\u003eAuthors\u0026apos; contributions\u003c/h3\u003e\n\u003cp\u003eAll authors have made substantial contributions to design, acquisition of data, analysis and interpretation of data. In addition to this the first and the second authors have been involved in drafting the manuscript and revising it critically for important intellectual content.\u003c/p\u003e\n\u003ch3\u003eAuthors\u0026apos; information\u003c/h3\u003e\n\u003cp\u003eCorresponding author was graduated in BSc Midwifery and MSc in Maternity and Reproductive Health Nursing and he is lecturer and researcher at Madda Walabu University, Ethiopia.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe initial author was graduated in BSc Nurse and MPH and he is Maternal and Child Health coordinator at Arsi Nagelle Woreda Health Office, Ethiopia and the second author was graduated in Medical Doctor and Master of Public Health and he is Assistant professor and researcher at Arsi University, Ethiopia. The third co-author was graduated in BSc Public Health and Master of Public Health in Reproductive and he is Assistant professor and researcher at Arsi University, Ethiopia.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eACKNOWLEDGEMENTS\u003c/h3\u003e\n\u003cp\u003eWe would like to extend our deepest gratitude to Arsi University college of Medicine and Health Science, for financial support for this project.\u003c/p\u003e\n\u003cp\u003eOur appreciations and great thanks go to the supervisor and the data collectors for their commitment in carrying out the study. Last but not the least, our gratitude goes to all the study participants for their volunteer participation during the study period.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUNDP. The Nutrition Challenge in Sub-Saharan Africa. 2012.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBetal A. Medical position paper on complementary feeding: a commentary by the ESPGHAN Committee on Nutrition 2011;46(1):12. Journal of Pediatrics Gastro enterology Nutrition. 2011;46(1):12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO, UNICEF. Global strategy for infant and young child feeding. Geneva2010.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. Strengthening action to improve feeding of infants and young children 6\u0026ndash;23 months of age in nutrition and child health programmes: in Report of proceedings; 2012.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMOH. Training Manual on Infant and Young Child Feeding (IYCF) and Nutrition Sensitive Agriculture (NSA). Ethiopia Federal Ministry of Health. 2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHasnan S, Anjum R. Knowledge and practices of mothers for complementary feeding in babies visiting pediatrics outpatient department of Jinnah Hospital. Lahore Biomedical. 2013;20(40):10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. Under Five Mortality-Situation. Geneva2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUNICEF. Improving Child Nutrition; the Achieveable Imperative for Global Progress. New York, USA.2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFAO. Community feeding for children aged 6\u0026ndash;23 months.. FAO Eropean Union food facility project. 2011:3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUSAID. IYCN social and behavior change communication approach. In: PROJECT USAIDSINFYCN, editor. Geneva: WHO: WHO; 2011.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. Indicators for assessing infant and young child feeding practices part 2: measurement Geneva, Switzerland: WHO; 2010.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMannan A. Clinical Guidelines on Infant and Young Child Feeding (IYCF. In: Campaign DM, editor. Bangladesh: Mediacom; 2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMOH. Adolescent, Maternal, Infant \u0026amp; Young Child Nutrition 2ed. Addis Ababa, Ethiopia: MOH; 2014. p.\u0026nbsp;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMOH. Policy Guidelines on Infant and Young Child Feeding. The Republic of Uganda2009. p.\u0026nbsp;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. Planning Guide for national implementation of the Global Strategy for Infant and Young Child Feeding. Geneva, Swizerland: WHO press; 2007. p.\u0026nbsp;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. COMPREHENSIVE IMPLEMENTATION PLAN ON MATERNAL, INFANT AND YOUNG CHILD NUTRITION. Geneva, Switzerland: WHO Press; 2014. p.\u0026nbsp;2\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMOH. NATIONAL STRATEGY FOR INFANT AND YOUNG CHILD FEEDING. Addis Ababa, Ethiopia: MOH; 2004. p.\u0026nbsp;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMOH. National Guideline on Adolescent, Maternal Infant and Young Child Nutrition. Addis Ababa, Ethiopia: Ministry of Health; 2016. p.\u0026nbsp;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShukure R. Knowledge, Attitude and Practice on Initiation of Complementary Feeding Among Under Two Years. International Journal of Clinical Pediatric Surgery. 2017;3(proper time for starting complementary feeding):11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCSA., ICF. Ethiopia Demographic and Health Survey. Rockville, Maryland,USA: CSA and ICF. 2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. Global Strategy for Infant and Young Child Feeding. Geneva, Switzerland: World Health Organization; 2010.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. Indicators for assessing infant and young child feeding practices part 3:. Geneva, Switzerland: measurement [press release]; 2010.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlaney S. Feeding practices among Indonesian children above six months of age. Asia Pac J Clin Nutr. 2015;24(The critical role of feeding practices):3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhokhar S, Jatoi H, Lassi Z. Prevalence of Timely Introduction of Complementary Feeding and its Related Factors in Children 6\u0026ndash;24 Months of Age in Hyderabad,Pakistan. Nursing and Midwifery Studies. 2017;6(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ealive\u0026amp;thrive. Infant and Young Child Feeding Practices. Mekedela, SOUTH WOLLO, AMHARA, ETHIOPIA: 2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdenike F. Complementary Feeding Knowledge, Practices, and Dietary Diversity among Mothers of Under-Five Children in an Urban Community in Lagos State, Nigeria. International Journal of MCH and AIDS. 2017;6:49.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCSA. ETHIOPIA Demographic and Health Survey. Addis Ababa, Ethiopia: 2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMolla M. Complementary Feeding Practice and Associated Factors among Mothers Having Children 6\u0026ndash;23 Months of Age. Hindawi. 2016;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNuramo A. Compliance to National Infant and Young Child Feeding Recommendation and Associated Factor Among Mothers of Children 6\u0026ndash;23 months-of-age.. International Journal of Clinical and Experimental Medical Sciences. 2016;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShumey A, Demissie M, Berhane Y. Timely initiation of complementary feeding and associated factors among children aged 6 to 12 months in Northern Ethiopia. BMC Public Health. 2013;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYemane S, Awoke T, Gebreslassie M. Timely initiation of complementary feeding practice and associated factors among mothers of children aged from 6 to 24 months in Axum town, north Ethiopia. International Journal of Nutrition and Food Sciences. 2014;3(5):438\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgedew E, Demissie M, Misker D, Haftu D. Early Initiation of Complementary Feeding and Associated Factors among 6 Months to 2 Years Young Children, in Kamba Woreda, South West Ethiopia. Nutrition \u0026amp; Food Sciences.4:6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAyana D. Complementary feeding practices among children aged 6\u0026ndash;23 months in Benishangul Gumuz Region, Ethiopia BMC pediatrics. 2017;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReda EB, Teferra AS, Gebregziabher M. Time to initiate complementary feeding and associated factors among mothers with children aged 6\u0026ndash;24 months in Tahtay Maichew district, northern Ethiopia. BMC research notes. 2019;12(1):17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTafesse T, SorsaBadacho A, Kuma D. Timely Introduction of Complementary Feeding among Caregivers of Children 6\u0026ndash;12 Month Sodo Town, Ethiopia. Health Sci J. 2018;12(1):543.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYohannes B, Ejamo E, Thangavel T, Yohannis M. Timely initiation of complementary feeding to children aged 6\u0026ndash;23 months in rural Soro district of Southwest Ethiopia. BMC pediatrics. 2018;18(1):17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReda EB, Teferra AS, Gebregziabher MG. Time to initiate complementary feeding and associated factors among mothers with children aged 6\u0026ndash;24 months in Tahtay Maichew district, northern Ethiopia. BMC research notes. 2019;12(1):17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChane T, Bitew S, Mekonnen T, Fekadu W. Initiation of complementary feeding and associated factors among children of age 6\u0026ndash;23 months in Sodo town, Southern Ethiopia: Cross-sectional study. Pediatric reports. 2017;9(4).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMekbib E. Magnitude and factors associated with appropriate complementary feeding among mothers having children 6\u0026ndash;23 months-of-age sidama zone,Southern Ethiopa. Journal of Food and Nutrition Sciences 2013;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAreja.A, Yohannes.D, Yohannis.M. Determinants of appropriate complementary feeding practice. BMC Nutrition. 2017;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUNICEF. Conceptual framework of complementary feeding2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. Comprehensive implementation plan on maternal, infant and young child nutrition. Geneva, Switzerland: WHO Press; 2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIndicators for assessing infant and young child feeding practices part 2: measurement [press release]. Geneva, Switzerland: WHO2010.\u003c/span\u003e\u003c/li\u003e\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":"Timely Initiation, Complementary, Feeding practice, Nagelle Arsi District, Ethiopia ","lastPublishedDoi":"10.21203/rs.3.rs-710966/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-710966/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThe period of transition from exclusive breastfeeding to family foods, referred to as complementary feeding, covers a child from 6-23 months of age. According to World Health Organization 2015; untimely initiation of complementary feeding has negative effect on child health, growth and development and an important cause of under nutrition in children less than 5 years of age which is an underlying cause of more than 40% of morbidity and mortality. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eTo assess the Timely Initiation of Complementary Feeding practice and Associated factors among children aged 6-23 Months in Nagelle Arsi District, Southern Ethiopia, 2019.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA community-based cross-sectional study was carried out. Systematic random sampling method was used to select 400 study participants. Data was collected using structured questionnaire using face to face interview. The collected data was coded, entered in to Epi-Info version 7 and then exported to SPSS version 21 for analysis.Descriptive statistics, binary and multiple logistic regressions were used for data analysis at 95% confidence intervals. A p-value \u0026lt;0.05 was considered to declare statistical significance. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eOut of 398 study participants, the proportion of timely initiated complementary feeding was 296 (74.4%) at 95%CI: (70.14, 78.66). In this study Postnatal care follow up [AOR=2.484; 95% CI: (1.478, 4.176)], ANC follow up [AOR=2.221; 95% CI: (1.276, 3.876)] and maternal counseling about timely initiation of complementary feeding at delivery place were positively associated with timely initiation of complementary feeding practice [AOR=2.362; 95% CI: (1.399, 3.986)].\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion and recommendation: \u003c/strong\u003eIn this study, three-fourth (74.4%) of children were initiated complementary food at six months of age which was lower than the WHO cut-off point of \u003cu\u003e\u0026gt;\u003c/u\u003e80%. ANC follow up, having postnatal care visits and being counseled about timely initiation of complementary feeding at place of delivery were significantly associated with timely initiation of complementary feeding. Therefore promoting ANC follow up, postnatal care visits and counseling about timely initiation of complementary feeding at delivery place were recommended to the concerned bodies to improve the coverage of timely initiation of complementary feeding practice.\u003c/p\u003e","manuscriptTitle":"Timely Initiation of Complementary Feeding and Associated Factors Among Children aged 6-23 Months in Negelle Arsi District, Southern Ethiopia, 2019: A Community-Based Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-08-19 13:39:21","doi":"10.21203/rs.3.rs-710966/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":"d08ebfa4-c07b-4e9d-a3f5-e6922eef591b","owner":[],"postedDate":"August 19th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":6559049,"name":"Nutrition \u0026 Dietetics"}],"tags":[],"updatedAt":"2021-08-20T05:29:10+00:00","versionOfRecord":[],"versionCreatedAt":"2021-08-19 13:39:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-710966","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-710966","identity":"rs-710966","version":["v1"]},"buildId":"oE6Zbj460LM0Up2FdVbMZ","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}