Husbands' Involvement in Infant Care Practices and Associated Factors Among Fathers of Infants Under Six Months in Damot Woyde District, Southern Ethiopia

Husbands' Involvement in Infant Care Practices and Associated Factors Among Fathers of Infants Under Six Months in Damot Woyde District, Southern Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Husbands' Involvement in Infant Care Practices and Associated Factors Among Fathers of Infants Under Six Months in Damot Woyde District, Southern Ethiopia Amanuel Kora Moliso, Atinafu Alemu, Haileyesus Worku Fankasho This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8832037/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Breastfeeding is the most effective and cost-efficient intervention for preventing childhood morbidity and mortality. While exclusive breastfeeding and other aspects of infant feeding are commonly taught to mothers, expectant fathers receive little or no education on these topics. Evidence shows that mothers who have supportive husbands are more likely to plan for longer breastfeeding duration. These studies aimed to measure husbands’ involvement in infant care practices, with a focus on breastfeeding support, and identify associated factors among fathers in Damot Woyde District, Southern Ethiopia. Methods A community-based cross-sectional study was conducted among 601 fathers in Damot Woyde District. A two-stage simple random sampling technique was employed. Data were collected using an interviewer-administered structured questionnaire. Data were entered into Epi Data version 4.1 and exported to SPSS version 25 for analysis. Descriptive statistics were calculated, and cross-tabulations were performed to check cell adequacy. Bivariable binary logistic regression was conducted, and variables with p-value < 0.25 were selected as candidates for the final model. Multivariable logistic regression analysis identified factors associated with husbands' involvement, reported using 95% confidence intervals. Variables with p-value < 0.05 were declared statistically significant. Results A total of 592 respondents participated, yielding a response rate of 98.5%. The prevalence of husbands' involvement in infant care practices was 46.1% (95% CI: 42.2, 49.8). The proportion of husbands with good knowledge about breastfeeding practices was 74.2%. Secondary level education (AOR: 2.3; 95% CI: 1.3, 4.0), certificate or higher education (AOR: 1.9; 95% CI: 1.04, 3.8), accompanying wives during ANC visits (AOR: 3.1; 95% CI: 1.9, 4.9), receiving breastfeeding counseling during ANC visits (AOR: 2.7; 95% CI: 1.7, 4.3), good knowledge of breastfeeding practices (AOR: 4.3; 95% CI: 2.4, 7.6), and accompanying wives during delivery (AOR: 2.4; 95% CI: 1.5, 3.7) were identified as significant determinants. Conclusion The prevalence of husbands' involvement in infant care practices was low compared to a previous study in southern Ethiopia. Accompanying wives during ANC visits and delivery increased the likelihood of husbands' involvement. Health interventions should target couples together and emphasize male engagement during antenatal and delivery care. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Risk factors Husband involvement infant care practices breastfeeding support fathers Damot Woyde Ethiopia Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Introduction Breastfeeding is the feeding of an infant or young child with breast milk directly from the female breast [ 1 ]. The World Health Organization (WHO) and UNICEF recommend that all mothers exclusively breastfeed their children for the first six months of life, with the addition of complementary foods at six months and continued breastfeeding until two years or beyond. When followed correctly, this practice can reduce infant mortality and prevent malnutrition, particularly in developing countries [ 2 ]. Children's health reflects the overall health of a community and nation. Diet and feeding patterns significantly impact child health and are crucial predictors of children's development, health, and survival [ 3 ]. Breastfeeding can save the lives of one million children in underdeveloped countries each year. In addition to its nutritional and psychological benefits, breast milk contains antibodies that help protect infants against many common childhood diseases [ 3 ]. Effective breastfeeding, particularly exclusive breastfeeding, is the most important nutritional intervention to combat child death and illness. Ethiopia has adopted the current global development agenda—the Sustainable Development Goals (SDGs)—which includes 17 goals, one of which is to ensure healthy lives and promote well-being for all at all ages [ 4 ]. Breastfeeding is natural; a supportive husband feels proud of a wife who can breastfeed his child, and the mother feels happy to fulfill her roles as mother and wife [ 5 ]. Families play an important role in encouraging mothers to continue providing exclusive breastfeeding for their newborns. A mother's decision to initiate and continue breastfeeding is heavily influenced by her husband's support [ 6 ]. A combination of complex factors influences exclusive breastfeeding decisions, including husbands' involvement, traditions, and support from partners, family members, and the wider community [ 5 ]. Breastfeeding is influenced by various biological and cultural variables. Paternal support has been shown to positively influence women's decisions. Increasing fathers' involvement in child breastfeeding has the potential to contribute to reducing child undernutrition and promoting child development [ 7 ]. Involving husbands during their partners' pregnancy, childbirth, and early infancy has been proposed as a way to promote the father-child relationship from the beginning [ 8 ]. Early encouragement of husbands' involvement in breastfeeding, along with provision of breastfeeding information during antenatal care, helps them become more supportive during breastfeeding [ 9 ]. "Male support" is a form of social support acquired from family members, specifically the husband. When women have appropriate male support, they tend to feel encouraged, driven, and supported, as well as motivated to pursue new opportunities. They believe they must become more careful in their efforts to change and more realistic about the time and work required to accomplish important adjustments in their lives [ 10 ]. Despite this, exclusive breastfeeding and other aspects of infant feeding are mostly taught to mothers and women of reproductive age in various communities, with little or no education provided for expectant husbands. Husbands are the primary agents who enable children to grow into healthy, responsible, and mature adults. Fathers' involvement in their children's development, health, and well-being is critically important. 1.1 Statement of the Problem Over two-thirds of all deaths in children during their first year of life are generally connected to incorrect feeding patterns, particularly inadequate exclusive breastfeeding practices [ 11 ]. Every year, more than 10 million children under the age of five die worldwide, with Sub-Saharan Africa accounting for 41% of these deaths and South Asia accounting for 34%. Inadequate breastfeeding practices, combined with high disease levels, are primary causes of death [ 12 ]. About two-thirds of malnutrition-related deaths are linked to improper feeding habits during the first year of life. Daily, 3,000 to 4,000 infants die in low-income countries from diarrhea and acute respiratory infections resulting from insufficient breast milk [ 13 ]. Evidence suggests that inappropriate breastfeeding practices during infancy are responsible for more than two-thirds of the 60% of under-five mortality caused by malnutrition [ 14 ]. Suboptimal breastfeeding is responsible for 45% of neonatal infectious deaths, 30% of diarrheal deaths, and 18% of acute respiratory infection deaths in children under five worldwide [ 15 ]. In low-income countries, male partners' knowledge of and participation in exclusive breastfeeding can reduce infant mortality by up to 13% [ 10 ]. Involving husbands through breastfeeding education and men's group activities can greatly improve infant feeding and health behaviors. Husbands' involvement in improving breastfeeding is related to the success and continuity of breastfeeding. Exclusive breastfeeding for the first six months of life improves newborn growth, health, and survival [ 16 ]. Optimizing breastfeeding practices through exclusive breastfeeding offers the best chance of improving child survival and contributes to preventing 1.4 million under-five deaths, saving the lives of one million infants in developing countries [ 10 , 17 ]. However, only 48% of infants under six months of age are exclusively breastfed globally [ 18 ], with 39% in developing countries and 35% in Africa [ 19 ]. The WHO set a target of increasing the global rate of exclusive breastfeeding in the first six months to at least 50% by 2025 and at least 70% by 2030 [ 20 ]. However, despite the Ethiopian Health Sector Transformation Plan's goal of increasing the proportion of exclusive breastfeeding to 70% by the end of 2020, only 59.9% of mothers breastfed exclusively in Ethiopia. Suboptimal breastfeeding is estimated to cause 80,000 newborn deaths in Ethiopia per year. Breastfeeding is a critical area for increasing child survival and promoting healthy growth and development. As a result, enhancing husbands' understanding of breastfeeding is required to lower the incidence of infant death and morbidity [ 21 ]. Lack of information and support from household members who wield power over many family activities, including infant feeding decisions, is a fundamental restriction to exclusive breastfeeding in various low- and middle-income countries [ 22 ]. However, while initiatives to promote infant and young child feeding have primarily targeted mothers, husbands are sometimes disregarded. Untargeted husbands' activities can impact mothers' capacity to follow breastfeeding instructions both directly and indirectly. In Misha Woreda, Southern Ethiopia, 72.4% of husbands were involved in breastfeeding practice [ 2 ]. Encouraging outcomes have also been recently reported in husband involvement in maternal and child health, including increased access to antenatal and postnatal care [ 23 ]. Despite the importance of husbands' influence on maternal breastfeeding practices, this has been assessed in only a few African countries [ 24 ]. Gaps in husbands' knowledge and involvement, in addition to socio-cultural and institutional barriers strongly marked by beliefs and myths, influence and compromise infant and young child feeding [ 25 ]. Different studies have reported that husbands' involvement in exclusive breastfeeding is affected by socioeconomic status, family structure, fathers' knowledge and practice of breastfeeding, and maternal occupation. Inadequate information about the importance of breast milk for husbands is one of the main barriers to their involvement. Educating fathers about the importance of breast milk for infant growth and development appears to improve their attachment to breastfeeding mothers. Therefore, this study aimed to assess husbands' involvement in infant care practices (with a focus on breastfeeding support) and associated factors among fathers having children less than six months of age in Damot Woyde District, Southern Ethiopia. 1.2 Significance of the Study Although a few local studies have been conducted in different parts of the country, no sufficient study has assessed husband involvement in infant care practices in the study area. Hence, there is a need for research to document husband engagement in infant care. The findings of this study can help health care providers, the Woreda Health Office, Zonal Health Department, Regional Health Bureau, and non-governmental organizations with relevant information for future planning and intervention to promote and improve husband engagement in infant care practices and associated factors. The findings can also serve as a guide to design effective health education programs on husband involvement. Furthermore, this study makes important contributions for health care providers and others conducting further research. 2. Objectives 2.1 General Objective To assess husbands' involvement in infant care practices (with a focus on breastfeeding support) and associated factors among fathers of children under six months of age in Damot Woyde District, Southern Ethiopia, 2024. 2.2 Specific Objectives 1. To describe the prevalence of husbands' involvement in infant care practices in Damot Woyde District, Southern Ethiopia, 2024. 2. To identify factors associated with husbands' involvement in infant care practices among fathers of children under six months of age in Damot Woyde District, Southern Ethiopia, 2024. 3. Methods and Materials 3.1 Study Area and Period The study was conducted in Damot Woyde District, Wolaita Zone, Southern Ethiopia, from January 5 to February 6, 2024. Damot Woyde District is geographically located at 6°55" to 7°45" North Latitude and 37°50" to 38°0" East Longitude. The district is 26 km from Wolaita Zone and approximately 313 km southwest of Addis Ababa via the Butajira-Halaba road. Based on the 2023 health profile of Damot Woyde, the total population of the district is 114,955 (57,244 males, 57,711 females). The number of infants under six months of age is 2,480, and the total number of households is 23,460. The district has 27 health posts, 4 health centers, and 1 primary hospital. The primary economic activity in the study area is agriculture (mixed farming), consisting of crop production and animal rearing [ 27 ]. 3.2 Study Design A community-based cross-sectional study was conducted among husbands of children under six months of age in Damot Woyde District from January 5 to February 6, 2024. 3.3 Population 3.3.1 Source Population : All husbands whose wives gave birth in the last six months. 3.3.2 Study Population : Husbands whose wives gave birth in the last six months, had a living child, and resided in selected kebeles and town administrations during the study period. 3.3.3 Sample Population : Husbands whose wives gave birth in the last six months, had a living child, and resided in selected kebeles and town administrations from whom data were actually collected during the study period. 3.4 Inclusion and Exclusion Criteria 3.4.1 Inclusion Criteria : Husbands whose wives gave birth in the last six months, resided in the study area, and had been residents of the district for at least six months were included. 3.4.2 Exclusion Criteria : Husbands who were seriously ill, unable to respond, or had an infant who died during the data collection period were excluded. 3.5 Sample Size Determination A single population proportion formula was used to estimate the sample size. From a study conducted in Misha Woreda, the prevalence of husband involvement in breastfeeding was 72.4% [ 2 ]. Using a 95% confidence level, 5% margin of error, design effect of 2, and adding 10% for non-response, the final total sample size was 601. Calculation : · n = (Zα/2)² p(1-p)/d² · n = (1.96)² × 0.724 × 0.276 / (0.05)² = 307 · Adjustment for population < 10,000 (N = 2,480): n/(1 + n/N) = 307/(1 + 307/2480) = 273 · Design effect (2-stage sampling) = 273 × 2 = 546 · Non-response (10%) = 546 + 55 = 601 3.5.1 Sample Size for Second Objective Sample sizes were also calculated using Epi-Info version 4.1 based on factors associated with husband involvement from a study in Misha Woreda [ 2 ]. Table 1 Sample Size Calculation for Second Objective Variable CI (95%) Proportion Adjusted OR Initial Sample Design Effect 10% 10% Non response Total Sample Reference Number of children owned by father 0.337, 1.376) 82.8% 0.681 192 2 38 422 [ 2 ] Father's educational status (2.010, 8.414) 92% 4.113 105 2 21 231 [ 2 ] Father's health facility visit (2.703, 12.64) 93.5% 5.846 88 2 18 194 [ 2 ] The largest sample size (601) was selected for the study. 3.6 Sampling Technique and Procedure A multi-stage sampling method was used. In the first stage, eight kebeles were randomly selected from the 24 kebeles in Damot Woyde District using a simple random sampling (lottery) method. The selected eight kebeles were included in the study. The health post community health information system (CHIS) registration of mothers with children under six months, maintained by local health extension workers, was used to obtain the list of children in each kebele. The sample from each kebele was determined using proportional allocation to size (PAS) based on the number of children under six months (or fathers of each child) in the kebele. After proportionally allocating the sample size to the selected kebeles, study subjects were selected using simple random sampling (lottery method). The names and addresses of husbands with infants under six months were identified in collaboration with kebele health extension workers and health development army leaders. If an eligible husband was absent at the time of data collection, one revisit was conducted. If still absent, they were considered non-respondents. If more than one father with an infant under six months resided in the same household, the father with the youngest child was selected. The lottery method was used if fathers had children of the same age. 3.7 Study Variables 3.7.1 Dependent Variable: Husbands' involvement in infant care practices (measured using a 9-item scale; see operational definition). 3.7.2 Independent Variables : · Paternal factors: Age, residence, marital status, educational status, occupation, knowledge about breastfeeding, exposure to information, health facility visit · Infant factors: Age, sex, birth order, birth interval, timely initiation of breastfeeding, colostrum feeding, pre-lacteal feeding status, infant health · Obstetric and health service factors: Parity, ANC attendance, breastfeeding counseling during pregnancy, place of delivery, mode of delivery, PNC attendance · Family and socio-economic factors: Mother's occupation, mother's educational status, household income, family type, cultural support, organizational support 3.8 Data Collection Tools and Procedures Quantitative data were collected using a pretested, structured, interviewer-administered questionnaire translated into the Wolaytatto language. Data were collected by three diploma nurses, and the data collection process was supervised by two health officers. The questionnaire was adapted from previous studies [ 28 ]. It included sections on socio-demographic characteristics, questions assessing involvement, and determinant factors of husbands' involvement in infant care. The questions assessing husbands' involvement were adopted from a previous study [ 2 ]. A pretest was conducted on 5% of the total sample size (30 participants) in a kebele not selected as a study area. The questionnaire was assessed for clarity, and necessary corrections were made accordingly. Before conducting interviews, data collectors explained the purpose of the study, its goals, potential risks and benefits, fathers' rights to refuse participation, and confidentiality measures. 3.9 Data Quality Assurance Data quality was maintained through careful design of the questionnaire. Two days of training were provided to data collectors on the study's aim, questionnaire content, definitions of terms, and issues of confidentiality and privacy. Explanations and clarifications were provided before data collection. Regular meetings were held among data collectors, supervisors, and the principal investigator throughout the data collection period. Collected data were reviewed and checked for completeness before entry; incomplete data were excluded from analysis. The pretest was conducted on 30 husbands (5% of total sample size) in Damot Woyde District, and necessary modifications were made. 3.10 Data Processing and Analysis Data were coded, cleaned, modified, and entered into Epi Data version 4.1 before being exported to SPSS version 25 for analysis. Descriptive statistics were calculated, and cross-tabulations were performed to check cell adequacy. Bivariable binary logistic regression was conducted, and variables with p-value < 0.25 were selected as candidate variables for the final multivariable model. Multivariable logistic regression analysis was used to identify factors associated with husbands' involvement in infant care practices. Results were reported using 95% confidence intervals. Multicollinearity among independent variables was assessed using the variance inflation factor (VIF), with VIF > 5 indicating collinearity. No significant multicollinearity was detected (mean VIF = 1.42). Model fit was evaluated using the Hosmer-Lemeshow goodness-of-fit test (χ² = 8.23, df = 8, p = 0.412), indicating good model fit. Variables with p-value < 0.05 in the multivariable analysis were declared statistically significant. 3.11 Operational Definitions Exclusive Breastfeeding Feeding infant only breast milk (with the exception of medicines and vitamins prescribed by health professionals) in the 24 hours before the survey [ 11 ]. Husband's Knowledge : The average of responses on 12 knowledge questions assessing: (1) recommended time for breastfeeding initiation, (2) importance of colostrum feeding, (3) whether colostrum should be discarded, (4) exclusive breastfeeding duration, (5) whether water should be given during the EBF period, (6) whether pre-lacteal feeding is acceptable, (7) breastfeeding on demand vs. schedule, (8) continued breastfeeding after introducing solids, (9) breast milk adequacy for the first six months, (10) expressed breast milk storage, (11) signs of proper attachment, and (12) the relationship between breastfeeding and birth spacing [ 21 ]. Good Knowledge Answering six or more of the 12 knowledge questions correctly [ 21 ]. Husband's Involvement : The act or process of taking part in infant care practices, measured using 9 questions addressing: (1) encouraging seeking advice on infant diet from health workers, (2) taking the baby for growth monitoring, (3) accompanying wife during baby health checkups, (4) helping change diapers, (5) caring for the baby when the wife is absent, (6) assisting with cleaning/bathing the baby, (7) providing psychological support to the breastfeeding wife, (8) directly caring for the child, and (9) performing household chores to allow the wife to breastfeed [ 2 ]. The internal consistency of the 9-item scale was acceptable (Cronbach's α = 0.78). Good Husband Involvement A husband has good involvement if his score is at or above the mean score of the 9-item scale [ 2 ]. Poor Husband Involvement A husband has poor involvement if he answers fewer than four of the nine involvement questions positively [ 2 ]. 3.12 Ethical Considerations Before collecting data, ethical clearance was obtained from the College of Health Science and Medicine, Wolaita Sodo University Ethical Review Committee (Approval Number: CHSM/ERC/01/15). The study's benefits and objectives were explained to study participants. Prior to each individual interview, the purpose of the study was outlined. Written informed consent was obtained from each participant. Due to low literacy levels in the study area, verbal informed consent was also obtained, and the ethics committee approved the use of verbal consent procedures. To maintain privacy, a comfortable environment was selected based on the interviewee's willingness. Items seeking personal identifying information (name, phone number, etc.) were not included in the questionnaire. Participants who were unwilling to continue the interview could withdraw at any time; this was explained before data collection. 3.13 Dissemination of Results The final report, after being defended at Wolaita Sodo University, will be submitted to the School of Public Health. As deemed necessary, it will also be presented at scientific conferences and submitted for publication to a relevant scientific journal. Government organizations, non-governmental organizations, and researchers may use the findings in the future. 4. Results In this study, a total of 592 respondents participated, yielding a response rate of 98.5%. 4.1 Socio-Demographic Characteristics of Husbands According to this study, 99.8% of participants were of Wolaita ethnicity. Regarding educational status, 30.4% had completed informal education only, while 14.4% had completed certificate or higher level education. Regarding occupation, 36.8% were merchants and 32.9% were househusbands. More than half (51.2%) were Orthodox Christian followers, while 1.7% were Catholic. Regarding mass media exposure, 65.5% reported having access to radio, television, or other media. Table 2 Socio-Demographic Characteristics of Husbands Variable Category Frequency Percentage Age Age < 35 years 110 18.6 110 18.6 36–45 years 333 56.3 333 56.3 45 years 149 25.2 149 25.2 Education Informal education only Informal education only 180 30.4 Completed grades 1–6 161 27.2 Completed grades 7–12 166 28.0 Certificate and above 85 14.4 Occupation Student 84 14.2 Government employee 95 16.0 Merchant/daily laborer 218 36.8 Househusband 195 32.9 Monthly income < 1000 ETB 319 53.9 1000–1500 ETB 199 33.6 1500 ETB 74 12.5 Religion Orthodox 303 51.2 Protestant 266 44.9 Catholic 10 1.7 Others (Muslim, traditional) 13 2.2 Mass media exposure Yes 204 34.5 No 388 65.5 4.2 Husbands' Accompaniment of Wives during Maternal and Child Health Service Utilization Regarding obstetric characteristics, 30.4% of respondents reported accompanying their wives during ANC visits, while 69.6% had not. Regarding breastfeeding counseling, 74.5% of women received counseling about breastfeeding during ANC visits, while 25.5% did not. Regarding accompaniment during delivery of the last child, 36.1% of respondents did not accompany their wives, while 63.9% did. In this study, 16.6% of husbands reported that the mode of delivery for the last child was cesarean section (Table 3 ). Table 3 Obstetric and Health Service Characteristics Variable Category Frequency Percentage Accompanied wife during ANC visit No 412 69.6 yes 180 30.4 Breastfeeding counseling during ANC No 441 74.5 yes 151 25.5 Accompanied wife during delivery No 214 36.1 yes 278 63.9 Mode of delivery Normal spontaneous vaginal delivery Normal spontaneous vaginal delivery 494 83.4 Cesarean section 98 16.6 PNC visit within 45 days after delivery No 372 62.8 yes 220 37.2 4.3 Knowledge of Breastfeeding Practices among Husbands In this study, nearly three-fourths (74.2%) of participants were knowledgeable about breastfeeding practices, while 25.8% had poor knowledge (Fig. 3 ). Regarding colostrum feeding, 81.6% reported that the infant received first milk (colostrum), while 18.4% reported it was not given. Regarding breastfeeding initiation, 74.2% reported that mothers started breastfeeding immediately within one hour of birth, while 25.8% reported initiation after one hour. In the last 24 hours before the survey, only 38.3% of infants were fed breast milk only, while 61.7% received additional food or fluids. Table 4 Knowledge of Breastfeeding Practices among Husbands Variables Category Frequency Percentages Breast feeding initiation time After one hour 153 25.8 Immediately within one hour 439 74.2 First milk (Colostrums) feeding Yes 483 81.6 No 109 18.4 Infant feeding the last 24 hours Additional meals 365 61.7 Breast milk only 227 38.3 4.4 Prevalence of Husbands' Involvement in Infant Care Practices According to this study, the prevalence of good husband involvement in infant care practices was 46.1% (95% CI: 42.2, 49.8) (Fig. 4 ). This means that 273 of 592 husbands scored at or above the mean on the 9-item involvement scale. 4.5 Factors Associated with Husbands' Involvement In bivariable analysis, the following variables had p-value < 0.25 and were entered into the multivariable model: education, mass media exposure, monthly income, breastfeeding counseling during ANC visit, accompaniment during ANC visit, mode of delivery, accompaniment during delivery, postnatal care visit, infant feeding in the last 24 hours, and knowledge. In the final multivariable model, the following variables were identified as statistically significant determinants (p < 0.05): educational status, knowledge about breastfeeding practices, receiving breastfeeding counseling during ANC visits, accompaniment during ANC visits, and accompaniment during delivery. Education: Husbands who completed grades 7–12 had 2.3 times higher odds of good involvement compared to those with informal education only (AOR: 2.3; 95% CI: 1.3, 4.0). Husbands with certificate or higher education had 1.9 times higher odds of good involvement (AOR: 1.9; 95% CI: 1.04, 3.8).ccompaniment during ANC: Husbands who accompanied their wives during ANC visits had 3.1 times higher odds of good involvement compared to those who did not (AOR: 3.1; 95% CI: 1.9, 4.9). Breastfeeding counseling during ANC: Husbands whose wives received breastfeeding counseling during ANC had 2.7 times higher odds of good involvement (AOR: 2.7; 95% CI: 1.7, 4.3). Knowledge: Husbands with good knowledge about breastfeeding practices had 4.3 times higher odds of good involvement compared to those with poor knowledge (AOR: 4.3; 95% CI: 2.4, 7.6). Accompaniment during delivery: Husbands who accompanied their wives during delivery had 2.4 times higher odds of good involvement compared to those who did not (AOR: 2.4; 95% CI: 1.5, 3.7) (Table 5 ). Table 5 Determinants of Husbands' Involvement in Infant Care Practices Variable Category Husband Involvement COR (95% CI) AOR (95% CI) Poor n (%) Good n (%) Education Informal education 125 (69.4) 55 (30.6) 1 Grades 1–6 108 (67.1) 53 (32.9) 1.1 (0.7, 1.7) Grades 7–12 50 (30.1) 116 (69.9) 5.2 (3.3, 8.3)* Certificate+ 36 (42.4) 49 (57.6) 3.1 (1.8, 5.2)* Monthly income < 1000 ETB 183 (57.4) 136 (42.6) 1 1000–1500 ETB 106 (53.3) 93 (46.7) 1.2 (0.8, 1.7) 1500 ETB 30 (40.5) 44 (59.5) 1.9 (1.2, 3.3)* Accompanied during ANC No 276 (67.0) 136 (33.0) 1 yes 43 (23.9) 137 (76.1) 6.4 (4.3, 9.6)* Breastfeeding counseling during ANC No 106 (70.2) 45 (29.8) 1 yes 213 (48.3) 228 (51.7) 2.5 (1.7, 3.7)* Accompanied during delivery No 137 (64.0) 77 (36.0) 1 yes 182 (48.1) 196 (51.9) 1.9 (1.3, 2.7)* Knowledge about breastfeeding Poor knowledge 132 (86.3) 21 (13.7) 1 Good knowledge 187 (42.6) 252 (57.4) 8.4 (5.1, 13.9)* *Statistically significant (p < 0.05) 5. Discussion This study aimed to determine the prevalence of husbands' involvement in infant care practices (with a focus on breastfeeding support) and associated factors among husbands of infants under six months in Damot Woyde District, Southern Ethiopia. The study found that the prevalence of good husband involvement was 46.1%, and significant determinants included educational status, knowledge about breastfeeding, accompaniment during ANC visits, breastfeeding counseling during ANC, and accompaniment during delivery. Prevalence of Husbands' Involvement The prevalence of husbands' involvement (46.1%) was lower than a study conducted in Misha District, Southern Ethiopia, which reported 72.4% involvement [ 2 ]. This difference may be due to variations in sample size, study population characteristics, study period, or differences in the measurement tools used. Notably, the Misha study used a 7-item involvement scale, while the present study used a 9-item scale, which may partially explain the discrepancy. Conversely, this finding was higher than a study conducted in Nigeria (33.6%) [ 10 ]. This difference may be attributed to the larger sample size in the present study (592 vs. 155 participants) and potential cultural differences in paternal involvement between Ethiopia and Nigeria. Knowledge of Breastfeeding Practices The proportion of husbands with good knowledge about breastfeeding practices was 74.2%. This finding was higher than a study conducted in Gurage Zone, Ethiopia (58.3%) [ 21 ]. This discrepancy may be explained by differences in educational levels between study populations. In the Gurage Zone study, only 18.6% of participants had secondary level education, compared to 28% in the present study. Higher educational attainment is generally associated with better health knowledge. This finding was also higher than a study in Nigeria, which reported 58% knowledge [ 10 ]. Determinants of Husbands' Involvement Education: Husbands' educational level was a significant determinant of involvement. This finding is consistent with studies from Kogi State, Nigeria [ 10 ], Iran [ 29 ], and Southern Ethiopia [ 2 ]. Higher education likely improves health-seeking behavior and awareness of the importance of paternal involvement in infant care. This finding underscores the need to strengthen and expand educational opportunities at the community level. Accompaniment during ANC: Husbands who accompanied their wives during ANC visits had significantly higher odds of involvement. This may be because husbands who attend ANC are exposed to health messages about breastfeeding and infant care, which in turn increases their involvement. This finding is supported by studies from Gamo Zone, Ethiopia [ 30 ], Sidama Region, Ethiopia [ 31 ], and Bangladesh [ 32 ]. The 2016 WHO ANC model recommends a minimum of eight ANC contacts to reduce perinatal mortality and improve women's experience of care [ 33 ]. Our findings suggest that these contacts also provide opportunities for male engagement. Breastfeeding Counseling during ANC: Receipt of breastfeeding counseling during ANC was associated with higher husband involvement. This finding aligns with studies from Mekele, Ethiopia (where men who received breastfeeding information during ANC were more likely to support their partners' breastfeeding) [ 9 ] and Motta Town, East Gojjam Zone, Ethiopia [ 11 ]. This finding highlights the importance of comprehensive ANC that includes both partners in health education. Accompaniment during Delivery: Husbands who accompanied their wives during delivery had higher odds of involvement. This may be because delivery attendance provides husbands with direct exposure to breastfeeding education and immediate postpartum care practices. This finding is supported by studies from Nono, Western Ethiopia [ 34 ] and Tigray, Ethiopia [ 19 ]. A study from Debre Tabor Town reported that husband involvement increased institutional delivery by 66-fold [ 35 ]. Knowledge about Breastfeeding: Husbands with good knowledge about breastfeeding had four-fold higher odds of involvement compared to those with poor knowledge. This finding is consistent with studies from Bangladesh [ 32 ], Southern Brazil [ 7 ], Kisumu, Kenya [ 36 ], and Ankpa, Kogi State, Nigeria [ 10 ]. A qualitative study in Tanzania found that men expressed a need for better information on breastfeeding practices to become more involved [ 24 ]. Therefore, investing in husbands' knowledge and awareness can be an effective strategy for increasing their involvement in infant care. 5.1 Strengths and Limitations Strengths: This study addresses a gap in the literature by providing evidence on husband involvement in infant care practices in an understudied area of Southern Ethiopia. The community-based design and high response rate (98.5%) enhance the representativeness of the findings. Limitations : 1. Cross-sectional design: This study cannot establish causal relationships between independent and dependent variables. 2. Recall bias: Some variables (e.g., accompaniment during ANC visits, breastfeeding counseling) relied on retrospective self-report, which may be subject to recall error. 3. Social desirability bias: Husbands may have over-reported their involvement due to perceived social expectations. 4. Self-report limitation: There was no objective validation of reported involvement practices. 5. Generalizability: Findings may not be generalizable to urban settings or other regions of Ethiopia with different cultural contexts. 6. Measurement scope: The involvement scale measured general infant care practices rather than breastfeeding-specific support exclusively, which may limit direct comparison with studies focused solely on breastfeeding involvement. 5.2 Conclusion and Recommendations Conclusion The prevalence of husbands' involvement in infant care practices in Damot Woyde District was low (46.1%) compared to a previous study in southern Ethiopia. Significant determinants included educational status, knowledge about breastfeeding, accompaniment during ANC visits, breastfeeding counseling during ANC, and accompaniment during delivery. Policymakers and stakeholders should focus on improving husbands' knowledge and involvement, as many infant care decisions are influenced by male partners. Recommendations : 1. For the education sector: Expand educational opportunities for community members, as 30% of husbands had only informal education. Higher education is associated with greater involvement in infant care. 2. For the health sector: Strengthen male involvement strategies as recommended by WHO for health promotion. Specifically: · Implement couple-focused antenatal education sessions that explicitly teach husbands about breastfeeding support, including recognizing hunger cues, assisting with positioning, and managing common breastfeeding challenges. · Ensure that all ANC visits include breastfeeding counseling for both the mother and her husband/partner. · Encourage and facilitate husbands' accompaniment of wives during ANC visits and delivery. 3. for the communication and media office: Collaborate with the health sector to promote breastfeeding and paternal involvement through mass media channels, as more than one-third of participants had no mass media exposure. 4. for health professionals: Provide comprehensive ANC content, including breastfeeding counseling, to pregnant women and their husbands during all ANC visits. 5. for researchers: Conduct longitudinal studies to establish causal relationships and qualitative studies to explore cultural barriers and facilitators of husband involvement in infant care. Abbreviations ANC Antenatal Care AOR Adjusted Odds Ratio CI Confidence Interval COR Crude Odds Ratio CSA Central Statistical Agency EBF Exclusive Breastfeeding EDHS Ethiopian Demographic and Health Survey ERC Ethical Review Committee ETB Ethiopian Birr IYCF Infant and Young Child Feeding LMICs Low- and Middle-Income Countries MCH Maternal and Child Health NGO Non-Governmental Organization PNC Postnatal Care SDGs Sustainable Development Goals SNNPR Southern Nations, Nationalities, and Peoples' Region SPSS Statistical Package for Social Sciences UNICEF United Nations International Children's Emergency Fund WHO World Health Organization WSU Wolaita Sodo University Declarations 1. Ethics Approval Statement This study was reviewed and approved by the Wolaita Sodo University Review Board/Ethics Committee (Approval Number: CHSM/ERC/01/15). All procedures performed in this study were conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. 2. Consent to Participate Written informed consent was obtained from all individual participants included in the study. Participants were informed about the purpose of the study, the voluntary nature of participation, their right to withdraw at any time, and the measures taken to ensure confidentiality. Verbal informed consent was also obtained from all participants due to low literacy levels in the study area. The ethics committee approved the use of verbal consent procedures. 3. Consent to Publish Participants provided consent for anonym zed data and direct quotations to be published in reports, manuscripts, and related dissemination materials. No identifying information is included in the publication. 4. Availability of Data and Materials The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. 5. Competing Interests The authors declare that they have no competing interests. 6. Funding This research received no external funding. 7. Authors' Contributions Amanuel Kora Moliso designed the study, collected data, analyzed results, and drafted the manuscript. Atinafu Alemu and Haileyesus Worku Fankasho reviewed the manuscript. All authors approved the final version. 8. Acknowledgements The authors thank Wolaita Sodo University for ethical approval, the Damot Woyde District Health Office for facilitating the research, the data collectors and supervisors for their diligent work, and all study participants for their time and willingness to participate. References Solomon Shitu, D. A., Yeshaneh, H. A. A. M. A. & Beyene, B. Haile Workye. Knowledge of breastfeeding practice and associated factors among fathers whose wife delivered in last one year in Gurage Zone (Ethiopia. PLOS ONE, 2021). M. A. and T. W. M. A. Fathers' Involvement in Breast Feeding Practices and Associated Factors among Households having Children Less than Six Months in Southern Ethiopia: A Cross sectional study. Pediatrics & Therapeutics. (2017). Prasanna Mithra, B. U., Kumar, R. T. N., Holla, R. & Rathi, P. Module intervention to improve involvement and practices of fathers towards infant and young child feeding (IYCF) in Coastal South India - a randomized controlled trial. F1000 Research. (2022). Gedion, A. & Azeze, K. A. G. Natnael Atnafu Gebeyehu, Molalegn Mesele Gesese, Taklu Marama Mokonnon. Exclusive Breastfeeding Practice and Associated Factors among Mothers in Boditi Town, Wolaita Zone, Southern Ethiopia, 2018: A Community-Based Cross-Sectional Study. Int. J. Pediatr. 2019 , 11 (2018). Bustamante, S. F. M. I. C. Husbands' Feelings Toward Their Wives' Breastfeeding in Public Places in Yogyakarta. Indonesian Nurs. J. Educ. Clin. (INJEC) ;6. (2021). Setyowati, H. Husband's Support in Giving Exclusive Breastfeeding during the Covid-19 Pandemic. ; 25 :3303–3309. (2021). Susin, L. R. O. & Giugliani, E. R. J. P., and PhD. Inclusion of Fathers in an Intervention to Promote Breastfeeding: Impact on Breastfeeding Rates. J. Hum. Lact OnlineFirst (2008). Faye Forbes, K. W. B. M. Z. a. J. F. Fathers' involvement in perinatal healthcare in Australia: experiences and reflections of Ethiopian-Australian men and women. BMC Health Serv. Res. (2021). Kidane Gebremariam, O. Z. A. M. A cross-sectional comparison of breastfeeding knowledge, attitudes, and perceived partners' support among expectant couples in Mekelle, Ethiopia. Int. Breastfeed. J. 6 , 1–8 (2021). Onuche Knowledge of and Involvement of Male in Exclusive Breastfeeding practices in Tertiary Educational Institutions in Ankpa (Kogi State, 2021). Tilahun Tewabe, A. M., Gualu, T., Alem, G., Mekuria, G. & Zeleke, H. Exclusive breastfeeding practice and associated factors among mothers in Motta town, East Gojjam zone, Amhara Regional State, Ethiopia, 2015: a cross-sectional study. Int. Breastfeed. J. (2017). Bahre Teka, H. A. a. K. H. Prevalence and determinant factors of exclusive breastfeeding practices among mothers in Enderta woreda, Tigray, North Ethiopia: a cross-sectional study. Int. Breastfeed. J. (2015). Desalegn, S. L. H. M. M. T. T. A. M. S. A. D. A. S. A. Infant and Young Child Feeding Practice Status and Its Determinants in Kalu District, Northeast Ethiopia: Community-Based Cross-Sectional Study (Nutrition and Dietary Supplements, 2021). Tesfaye Setegn, T. B., Gerbaba, M., Deribe, K., Deribew, A. & Sibhatu Biadgilign.. Factors associated with exclusive breastfeeding practices among mothers in Goba district, south east Ethiopia: a cross-sectional study. Int. Breastfeed. J. (2012). Ayalew, T. Exclusive breastfeeding practice and associated factors among first-time mothers in Bahir Dar city, North West Ethiopia: A community based cross sectional study. Heliyon (2020). Ekanem, I. A. E. A. P. Attitude of Working Mothers to Exclusive Breastfeeding in Calabar Municipality, Cross River State, Nigeria. J. Food Res. (2012). Jahdiel Kossou, W. A. H. Jaures Lokonon Cl. Factors influencing exclusive breastfeeding practices in rural areas in south Benin. E3S Web of Conferences 319. (2021). Felix, A., Ogbo, B. J. A., Kedir, Y. & Ahmed, Abdon, G. Rwabilimbo. Breastfeeding in the Community—How Can Partners/Fathers Help? A Systematic Review. Int. J. Environ. Res. Public Health (2020). Tadesse, D. H. a. A. W. Prevalence and factors associated with exclusive breastfeeding among rural mothers of infants less than six months of age in Southern Nations, Nationalities, Peoples (SNNP) and Tigray regions, Ethiopia: a cross-sectional study (Hagos and Tadesse International Breastfeeding Journal, 2020). Gizachew, G. & Mekebo, A. S. A. Factors influencing exclusive breastfeeding practice among under-six months infants in Ethiopia. BMC Pregnancy Childbirth (2022). Solomon Shitu, D. A., Mose, H. A. A., Yeshaneh, A., Beyene, B. & Workye, H. Knowledge of breastfeeding practice and associated factors among fathers whose wife delivered in last one year in Gurage Zone, Ethiopia (PLOS ONE, 2021). Jennifer, M., Yourkavitch, J. L. A., Debra, M., Prosnitz, J. C. & Thomas Engaging men to promote and support exclusive breastfeeding: a descriptive review of 28 projects in 20 low- and middle-income countries from 2003 to 2013. J. Health Popul. Nutr. (2017). Furaha August, A. B. P., Mpembeni, R. & Axemo, P. Elisabeth Darj. Community health workers can improve male involvement in maternal health: evidence from rural Tanzania. Global Health Action (2016). Janeth Bulemela, H. M., Snelgrove-Clarke, E. & MacDonald, N. Robert Bortolussi. Supporting breastfeeding: Tanzanian men's knowledge and attitude towards exclusive breastfeeding. Int. Breastfeed. J. (2019). Bógusb, E. S. C. M. The participation of men in infant feeding: is this a new step towards gender equity? 2021. Hasina Rakotomanana, C. N. W. & Joel, J. Komakech. Fathers' involvement in child care activities: Qualitative findings from the highlands of Madagascar. PLOS ONE (2021). Damot Woyde District Health Bureau. HIT Department. (2023). Gultie, T., Estifanos, T. Z., Boti, W. & de Courten, N. Husbands' participation in birth preparedness and complication readiness plan in Kucha district, Gamo Zone, Southern Ethiopia. PLoS ONE . 16 (12), e0261936 (2021). Farideh Panahi, F. R. F. & Nazarpour, S. Educating fathers to improve exclusive breastfeeding practices: a randomized controlled trial. BMC Health Serv. Res. (2022). Gultie, T., Estifanos, T. Z., Boti, W. & de Courten, N. Husbands' participation in birth preparedness and complication readiness plan in Kucha district, Gamo Zone, Southern Ethiopia. PLoS ONE . 16 (12), e0261936 (2021). Deressa, T. a. Husbands' involvement in antenatal care and its association with women's utilization of skilled birth attendants in Sidama zone, Ethiopia: a prospective cohort study. BMC Pregnancy and Childbirth 18:315. 2018. (2018). Rahman, A. E. et al. Knowledge and involvement of husbands in maternal and newborn health in rural Bangladesh. BMC Pregnancy and Childbirth 18:247. 2018. (2018). World Health Organization. WHO ANC Model. (2016). Girma, G. F. T. S. Exclusive breastfeeding practice and its associated factors among mothers with infants aged less than six months in Nono (A cross-sectional study, 2021). Tessema, K. M., Mengesha, M. K., Nigussie, E. W. & Wondie, A. A. The association between male involvement in institutional delivery and women's use of institutional delivery in Debre Tabor town, North West Ethiopia: Community based survey. PLoS ONE . 16 (4), e0249917 (2021). Dinga, L. A. & Kyallo, F. M. K. B., and The Participation of Fathers in Breastfeeding Process: Knowledge, Beliefs, and Practices in Kisumu, Kenya. Afr. J. Food Agric. Nutr. Dev. (2018). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 27 Apr, 2026 Reviewers agreed at journal 20 Apr, 2026 Reviewers invited by journal 14 Apr, 2026 Submission checks completed at journal 14 Apr, 2026 First submitted to journal 14 Apr, 2026 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. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8832037","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":625994276,"identity":"90027370-6378-4055-ab0a-82ad649bc26e","order_by":0,"name":"Amanuel Kora Moliso","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYBACCQSTufnBhwoQzdxArBbGNsMZZ0BaGInX0iDN2QZh4NUi2d778MPPHLs8g+ONDcaM82qj+duBWn5UbMOpRZrnuLFk77bkYoMzBxseF247njvjMGMDY8+Z2zi1yEmkMUjwbmNO3HAjscF45rZjuQ1ALcyMbXi1MP/8u60+ccP9hw3SvHOO5c4npEVaIo1NmnfbYaAtQO/zNtTkbiCkRbLnGJu17LbjiTPPJAID+diB3I1ALQfx+UXieBvzzbfbqhP7jh8+/OBDTV3uvPOHDz74UYFbCzo4DCYPEK0eCOpIUTwKRsEoGAUjBAAAfHVhTON+/O8AAAAASUVORK5CYII=","orcid":"","institution":"[Wolaita Sodo University]","correspondingAuthor":true,"prefix":"","firstName":"Amanuel","middleName":"Kora","lastName":"Moliso","suffix":""},{"id":625994279,"identity":"52ce8c8f-5781-47bc-a998-859cf0df3610","order_by":1,"name":"Atinafu Alemu","email":"","orcid":"","institution":"[Wolaita Sodo University]","correspondingAuthor":false,"prefix":"","firstName":"Atinafu","middleName":"","lastName":"Alemu","suffix":""},{"id":625994281,"identity":"1c6b6275-9b65-462a-8d4a-8caf615390a2","order_by":2,"name":"Haileyesus Worku Fankasho","email":"","orcid":"","institution":"[Wolaita Sodo University]","correspondingAuthor":false,"prefix":"","firstName":"Haileyesus","middleName":"Worku","lastName":"Fankasho","suffix":""}],"badges":[],"createdAt":"2026-02-09 15:24:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8832037/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8832037/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107705606,"identity":"8badb072-c330-4308-b0bc-892330f353b9","added_by":"auto","created_at":"2026-04-24 09:13:49","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":30847,"visible":true,"origin":"","legend":"\u003cp\u003eConceptual framework\u003c/p\u003e","description":"","filename":"fig.png","url":"https://assets-eu.researchsquare.com/files/rs-8832037/v1/2d27b3e3270748f5fc865bb6.png"},{"id":107500611,"identity":"25821ef6-a0b9-45b8-8797-d4723b45809a","added_by":"auto","created_at":"2026-04-22 05:48:45","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":31557,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic Presentation of Sampling Procedure\u003c/p\u003e","description":"","filename":"fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-8832037/v1/bb5b367e7c0d0dd6a03bfa54.png"},{"id":107705830,"identity":"c5e2e9c8-734b-4960-a0f8-0b319a7d3e70","added_by":"auto","created_at":"2026-04-24 09:15:27","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":17095,"visible":true,"origin":"","legend":"\u003cp\u003eLevel of Knowledge about Breastfeeding Practices Among Husbands\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8832037/v1/3c22ef0fa29cb5797fcf1f0b.png"},{"id":107705304,"identity":"ef51dde0-2de4-4ca9-b1dc-7a5e372e4b2f","added_by":"auto","created_at":"2026-04-24 09:11:16","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":17611,"visible":true,"origin":"","legend":"\u003cp\u003eLevel of Husbands' Involvement in Infant Care Practices\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8832037/v1/32c09b5696d5c626c01e5c76.png"},{"id":107708931,"identity":"bc03fa2c-6b59-4c4f-8bbf-5ea9ad3ae942","added_by":"auto","created_at":"2026-04-24 09:33:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":542136,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8832037/v1/2d9d7250-4803-41ae-9ee8-393981cd490e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Husbands' Involvement in Infant Care Practices and Associated Factors Among Fathers of Infants Under Six Months in Damot Woyde District, Southern Ethiopia","fulltext":[{"header":"1. Introduction","content":" \u003cp\u003eBreastfeeding is the feeding of an infant or young child with breast milk directly from the female breast [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The World Health Organization (WHO) and UNICEF recommend that all mothers exclusively breastfeed their children for the first six months of life, with the addition of complementary foods at six months and continued breastfeeding until two years or beyond. When followed correctly, this practice can reduce infant mortality and prevent malnutrition, particularly in developing countries [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eChildren's health reflects the overall health of a community and nation. Diet and feeding patterns significantly impact child health and are crucial predictors of children's development, health, and survival [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Breastfeeding can save the lives of one million children in underdeveloped countries each year. In addition to its nutritional and psychological benefits, breast milk contains antibodies that help protect infants against many common childhood diseases [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEffective breastfeeding, particularly exclusive breastfeeding, is the most important nutritional intervention to combat child death and illness. Ethiopia has adopted the current global development agenda\u0026mdash;the Sustainable Development Goals (SDGs)\u0026mdash;which includes 17 goals, one of which is to ensure healthy lives and promote well-being for all at all ages [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBreastfeeding is natural; a supportive husband feels proud of a wife who can breastfeed his child, and the mother feels happy to fulfill her roles as mother and wife [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Families play an important role in encouraging mothers to continue providing exclusive breastfeeding for their newborns. A mother's decision to initiate and continue breastfeeding is heavily influenced by her husband's support [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA combination of complex factors influences exclusive breastfeeding decisions, including husbands' involvement, traditions, and support from partners, family members, and the wider community [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Breastfeeding is influenced by various biological and cultural variables. Paternal support has been shown to positively influence women's decisions. Increasing fathers' involvement in child breastfeeding has the potential to contribute to reducing child undernutrition and promoting child development [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInvolving husbands during their partners' pregnancy, childbirth, and early infancy has been proposed as a way to promote the father-child relationship from the beginning [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Early encouragement of husbands' involvement in breastfeeding, along with provision of breastfeeding information during antenatal care, helps them become more supportive during breastfeeding [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e\"Male support\" is a form of social support acquired from family members, specifically the husband. When women have appropriate male support, they tend to feel encouraged, driven, and supported, as well as motivated to pursue new opportunities. They believe they must become more careful in their efforts to change and more realistic about the time and work required to accomplish important adjustments in their lives [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite this, exclusive breastfeeding and other aspects of infant feeding are mostly taught to mothers and women of reproductive age in various communities, with little or no education provided for expectant husbands. Husbands are the primary agents who enable children to grow into healthy, responsible, and mature adults. Fathers' involvement in their children's development, health, and well-being is critically important.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Statement of the Problem\u003c/h2\u003e \u003cp\u003eOver two-thirds of all deaths in children during their first year of life are generally connected to incorrect feeding patterns, particularly inadequate exclusive breastfeeding practices [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Every year, more than 10\u0026nbsp;million children under the age of five die worldwide, with Sub-Saharan Africa accounting for 41% of these deaths and South Asia accounting for 34%. Inadequate breastfeeding practices, combined with high disease levels, are primary causes of death [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAbout two-thirds of malnutrition-related deaths are linked to improper feeding habits during the first year of life. Daily, 3,000 to 4,000 infants die in low-income countries from diarrhea and acute respiratory infections resulting from insufficient breast milk [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Evidence suggests that inappropriate breastfeeding practices during infancy are responsible for more than two-thirds of the 60% of under-five mortality caused by malnutrition [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSuboptimal breastfeeding is responsible for 45% of neonatal infectious deaths, 30% of diarrheal deaths, and 18% of acute respiratory infection deaths in children under five worldwide [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In low-income countries, male partners' knowledge of and participation in exclusive breastfeeding can reduce infant mortality by up to 13% [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Involving husbands through breastfeeding education and men's group activities can greatly improve infant feeding and health behaviors. Husbands' involvement in improving breastfeeding is related to the success and continuity of breastfeeding.\u003c/p\u003e \u003cp\u003eExclusive breastfeeding for the first six months of life improves newborn growth, health, and survival [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Optimizing breastfeeding practices through exclusive breastfeeding offers the best chance of improving child survival and contributes to preventing 1.4\u0026nbsp;million under-five deaths, saving the lives of one million infants in developing countries [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, only 48% of infants under six months of age are exclusively breastfed globally [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], with 39% in developing countries and 35% in Africa [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe WHO set a target of increasing the global rate of exclusive breastfeeding in the first six months to at least 50% by 2025 and at least 70% by 2030 [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, despite the Ethiopian Health Sector Transformation Plan's goal of increasing the proportion of exclusive breastfeeding to 70% by the end of 2020, only 59.9% of mothers breastfed exclusively in Ethiopia. Suboptimal breastfeeding is estimated to cause 80,000 newborn deaths in Ethiopia per year. Breastfeeding is a critical area for increasing child survival and promoting healthy growth and development. As a result, enhancing husbands' understanding of breastfeeding is required to lower the incidence of infant death and morbidity [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLack of information and support from household members who wield power over many family activities, including infant feeding decisions, is a fundamental restriction to exclusive breastfeeding in various low- and middle-income countries [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, while initiatives to promote infant and young child feeding have primarily targeted mothers, husbands are sometimes disregarded. Untargeted husbands' activities can impact mothers' capacity to follow breastfeeding instructions both directly and indirectly. In Misha Woreda, Southern Ethiopia, 72.4% of husbands were involved in breastfeeding practice [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEncouraging outcomes have also been recently reported in husband involvement in maternal and child health, including increased access to antenatal and postnatal care [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Despite the importance of husbands' influence on maternal breastfeeding practices, this has been assessed in only a few African countries [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Gaps in husbands' knowledge and involvement, in addition to socio-cultural and institutional barriers strongly marked by beliefs and myths, influence and compromise infant and young child feeding [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDifferent studies have reported that husbands' involvement in exclusive breastfeeding is affected by socioeconomic status, family structure, fathers' knowledge and practice of breastfeeding, and maternal occupation. Inadequate information about the importance of breast milk for husbands is one of the main barriers to their involvement. Educating fathers about the importance of breast milk for infant growth and development appears to improve their attachment to breastfeeding mothers.\u003c/p\u003e \u003cp\u003eTherefore, this study aimed to assess husbands' involvement in infant care practices (with a focus on breastfeeding support) and associated factors among fathers having children less than six months of age in Damot Woyde District, Southern Ethiopia.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2 Significance of the Study\u003c/h2\u003e \u003cp\u003eAlthough a few local studies have been conducted in different parts of the country, no sufficient study has assessed husband involvement in infant care practices in the study area. Hence, there is a need for research to document husband engagement in infant care. The findings of this study can help health care providers, the Woreda Health Office, Zonal Health Department, Regional Health Bureau, and non-governmental organizations with relevant information for future planning and intervention to promote and improve husband engagement in infant care practices and associated factors.\u003c/p\u003e \u003cp\u003eThe findings can also serve as a guide to design effective health education programs on husband involvement. Furthermore, this study makes important contributions for health care providers and others conducting further research.\u003c/p\u003e \u003c/div\u003e"},{"header":"2. Objectives","content":" \u003ch2\u003e2.1 General Objective\u003c/h2\u003e\n \u003cp\u003eTo assess husbands\u0026apos; involvement in infant care practices (with a focus on breastfeeding support) and associated factors among fathers of children under six months of age in Damot Woyde District, Southern Ethiopia, 2024.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2.2 Specific Objectives\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1. To describe the prevalence of husbands\u0026apos; involvement in infant care practices in Damot Woyde District, Southern Ethiopia, 2024.\u003c/p\u003e\n \u003cp\u003e2. To identify factors associated with husbands\u0026apos; involvement in infant care practices among fathers of children under six months of age in Damot Woyde District, Southern Ethiopia, 2024.\u003c/p\u003e"},{"header":"3. Methods and Materials","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1 Study Area and Period\u003c/h2\u003e\n \u003cp\u003eThe study was conducted in Damot Woyde District, Wolaita Zone, Southern Ethiopia, from January 5 to February 6, 2024. Damot Woyde District is geographically located at 6\u0026deg;55\u0026quot; to 7\u0026deg;45\u0026quot; North Latitude and 37\u0026deg;50\u0026quot; to 38\u0026deg;0\u0026quot; East Longitude. The district is 26 km from Wolaita Zone and approximately 313 km southwest of Addis Ababa via the Butajira-Halaba road. Based on the 2023 health profile of Damot Woyde, the total population of the district is 114,955 (57,244 males, 57,711 females). The number of infants under six months of age is 2,480, and the total number of households is 23,460. The district has 27 health posts, 4 health centers, and 1 primary hospital. The primary economic activity in the study area is agriculture (mixed farming), consisting of crop production and animal rearing [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2 Study Design\u003c/h2\u003e\n \u003cp\u003eA community-based cross-sectional study was conducted among husbands of children under six months of age in Damot Woyde District from January 5 to February 6, 2024.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3 Population\u003c/h2\u003e\n \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.3.1 Source Population\u003c/strong\u003e: All husbands whose wives gave birth in the last six months.\u003c/p\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003e3.3.2 Study Population\u003c/strong\u003e: Husbands whose wives gave birth in the last six months, had a living child, and resided in selected kebeles and town administrations during the study period.\u003c/p\u003e\n \u003c/span\u003e \u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003e3.3.3 Sample Population\u003c/strong\u003e: Husbands whose wives gave birth in the last six months, had a living child, and resided in selected kebeles and town administrations from whom data were actually collected during the study period.\u003c/p\u003e\n \u003c/span\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003e3.4 Inclusion and Exclusion Criteria\u003c/h2\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003e3.4.1 Inclusion Criteria\u003c/strong\u003e: Husbands whose wives gave birth in the last six months, resided in the study area, and had been residents of the district for at least six months were included.\u003c/p\u003e\n \u003c/span\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003e3.4.2 Exclusion Criteria\u003c/strong\u003e: Husbands who were seriously ill, unable to respond, or had an infant who died during the data collection period were excluded.\u003c/p\u003e\n \u003c/span\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003e3.5 Sample Size Determination\u003c/h2\u003e\n \u003cp\u003eA single population proportion formula was used to estimate the sample size. From a study conducted in Misha Woreda, the prevalence of husband involvement in breastfeeding was 72.4% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Using a 95% confidence level, 5% margin of error, design effect of 2, and adding 10% for non-response, the final total sample size was 601.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCalculation\u003c/strong\u003e:\u003c/p\u003e\n \u003cp\u003e\u0026middot; n = (Z\u0026alpha;/2)\u0026sup2; p(1-p)/d\u0026sup2;\u003c/p\u003e\n \u003cp\u003e\u0026middot; n = (1.96)\u0026sup2; \u0026times; 0.724 \u0026times; 0.276 / (0.05)\u0026sup2; = 307\u003c/p\u003e\n \u003cp\u003e\u0026middot; Adjustment for population\u0026thinsp;\u0026lt;\u0026thinsp;10,000 (N\u0026thinsp;=\u0026thinsp;2,480): n/(1\u0026thinsp;+\u0026thinsp;n/N)\u0026thinsp;=\u0026thinsp;307/(1\u0026thinsp;+\u0026thinsp;307/2480)\u0026thinsp;=\u0026thinsp;273\u003c/p\u003e\n \u003cp\u003e\u0026middot; Design effect (2-stage sampling)\u0026thinsp;=\u0026thinsp;273 \u0026times; 2\u0026thinsp;=\u0026thinsp;546\u003c/p\u003e\n \u003cp\u003e\u0026middot; Non-response (10%)\u0026thinsp;=\u0026thinsp;546\u0026thinsp;+\u0026thinsp;55\u0026thinsp;=\u0026thinsp;601\u003c/p\u003e\n \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\n \u003ch2\u003e3.5.1 Sample Size for Second Objective\u003c/h2\u003e\n \u003cp\u003eSample sizes were also calculated using Epi-Info version 4.1 based on factors associated with husband involvement from a study in Misha Woreda [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\n \u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSample Size Calculation for Second Objective\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eCI (95%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eProportion\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eAdjusted OR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eInitial Sample\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eDesign Effect 10%\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e10% Non response\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eTotal Sample\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c9\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eNumber of children owned by father\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e0.337, 1.376)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e82.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.681\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\n \u003cp\u003e422\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cp\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eFather\u0026apos;s educational status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e(2.010, 8.414)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e92%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e4.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\n \u003cp\u003e231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cp\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eFather\u0026apos;s health facility visit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e(2.703, 12.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e93.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e5.846\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\n \u003cp\u003e194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cp\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003eThe largest sample size (601) was selected for the study.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003e3.6 Sampling Technique and Procedure\u003c/h2\u003e\n \u003cp\u003eA multi-stage sampling method was used. In the first stage, eight kebeles were randomly selected from the 24 kebeles in Damot Woyde District using a simple random sampling (lottery) method. The selected eight kebeles were included in the study.\u003c/p\u003e\n \u003cp\u003eThe health post community health information system (CHIS) registration of mothers with children under six months, maintained by local health extension workers, was used to obtain the list of children in each kebele. The sample from each kebele was determined using proportional allocation to size (PAS) based on the number of children under six months (or fathers of each child) in the kebele.\u003c/p\u003e\n \u003cp\u003eAfter proportionally allocating the sample size to the selected kebeles, study subjects were selected using simple random sampling (lottery method). The names and addresses of husbands with infants under six months were identified in collaboration with kebele health extension workers and health development army leaders. If an eligible husband was absent at the time of data collection, one revisit was conducted. If still absent, they were considered non-respondents. If more than one father with an infant under six months resided in the same household, the father with the youngest child was selected. The lottery method was used if fathers had children of the same age.\u003c/p\u003e\n \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003e3.7 Study Variables\u003c/h2\u003e\n \u003cp\u003e3.7.1 Dependent Variable: Husbands\u0026apos; involvement in infant care practices (measured using a 9-item scale; see operational definition).\u003c/p\u003e\n \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e\n \u003ch2\u003e\u003cstrong\u003e3.7.2 Independent Variables\u003c/strong\u003e:\u003c/h2\u003e\n \u003cp\u003e\u0026middot; Paternal factors: Age, residence, marital status, educational status, occupation, knowledge about breastfeeding, exposure to information, health facility visit\u003c/p\u003e\n \u003cp\u003e\u0026middot; Infant factors: Age, sex, birth order, birth interval, timely initiation of breastfeeding, colostrum feeding, pre-lacteal feeding status, infant health\u003c/p\u003e\n \u003cp\u003e\u0026middot; Obstetric and health service factors: Parity, ANC attendance, breastfeeding counseling during pregnancy, place of delivery, mode of delivery, PNC attendance\u003c/p\u003e\n \u003cp\u003e\u0026middot; Family and socio-economic factors: Mother\u0026apos;s occupation, mother\u0026apos;s educational status, household income, family type, cultural support, organizational support\u003c/p\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003e3.8 Data Collection Tools and Procedures\u003c/h2\u003e\n \u003cp\u003eQuantitative data were collected using a pretested, structured, interviewer-administered questionnaire translated into the Wolaytatto language. Data were collected by three diploma nurses, and the data collection process was supervised by two health officers.\u003c/p\u003e\n \u003cp\u003eThe questionnaire was adapted from previous studies [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. It included sections on socio-demographic characteristics, questions assessing involvement, and determinant factors of husbands\u0026apos; involvement in infant care. The questions assessing husbands\u0026apos; involvement were adopted from a previous study [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003eA pretest was conducted on 5% of the total sample size (30 participants) in a kebele not selected as a study area. The questionnaire was assessed for clarity, and necessary corrections were made accordingly.\u003c/p\u003e\n \u003cp\u003eBefore conducting interviews, data collectors explained the purpose of the study, its goals, potential risks and benefits, fathers\u0026apos; rights to refuse participation, and confidentiality measures.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003ch2\u003e3.9 Data Quality Assurance\u003c/h2\u003e\n \u003cp\u003eData quality was maintained through careful design of the questionnaire. Two days of training were provided to data collectors on the study\u0026apos;s aim, questionnaire content, definitions of terms, and issues of confidentiality and privacy. Explanations and clarifications were provided before data collection. Regular meetings were held among data collectors, supervisors, and the principal investigator throughout the data collection period. Collected data were reviewed and checked for completeness before entry; incomplete data were excluded from analysis. The pretest was conducted on 30 husbands (5% of total sample size) in Damot Woyde District, and necessary modifications were made.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n \u003ch2\u003e3.10 Data Processing and Analysis\u003c/h2\u003e\n \u003cp\u003eData were coded, cleaned, modified, and entered into Epi Data version 4.1 before being exported to SPSS version 25 for analysis. Descriptive statistics were calculated, and cross-tabulations were performed to check cell adequacy.\u003c/p\u003e\n \u003cp\u003eBivariable binary logistic regression was conducted, and variables with p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.25 were selected as candidate variables for the final multivariable model. Multivariable logistic regression analysis was used to identify factors associated with husbands\u0026apos; involvement in infant care practices. Results were reported using 95% confidence intervals.\u003c/p\u003e\n \u003cp\u003eMulticollinearity among independent variables was assessed using the variance inflation factor (VIF), with VIF\u0026thinsp;\u0026gt;\u0026thinsp;5 indicating collinearity. No significant multicollinearity was detected (mean VIF\u0026thinsp;=\u0026thinsp;1.42). Model fit was evaluated using the Hosmer-Lemeshow goodness-of-fit test (\u0026chi;\u0026sup2; = 8.23, df\u0026thinsp;=\u0026thinsp;8, p\u0026thinsp;=\u0026thinsp;0.412), indicating good model fit.\u003c/p\u003e\n \u003cp\u003eVariables with p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in the multivariable analysis were declared statistically significant.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\n \u003ch2\u003e3.11 Operational Definitions\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003eExclusive Breastfeeding\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eFeeding infant only breast milk (with the exception of medicines and vitamins prescribed by health professionals) in the 24 hours before the survey [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eHusband\u0026apos;s Knowledge\u003c/strong\u003e: The average of responses on 12 knowledge questions assessing: (1) recommended time for breastfeeding initiation, (2) importance of colostrum feeding, (3) whether colostrum should be discarded, (4) exclusive breastfeeding duration, (5) whether water should be given during the EBF period, (6) whether pre-lacteal feeding is acceptable, (7) breastfeeding on demand vs. schedule, (8) continued breastfeeding after introducing solids, (9) breast milk adequacy for the first six months, (10) expressed breast milk storage, (11) signs of proper attachment, and (12) the relationship between breastfeeding and birth spacing [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eGood Knowledge\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAnswering six or more of the 12 knowledge questions correctly [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eHusband\u0026apos;s Involvement\u003c/strong\u003e: The act or process of taking part in infant care practices, measured using 9 questions addressing: (1) encouraging seeking advice on infant diet from health workers, (2) taking the baby for growth monitoring, (3) accompanying wife during baby health checkups, (4) helping change diapers, (5) caring for the baby when the wife is absent, (6) assisting with cleaning/bathing the baby, (7) providing psychological support to the breastfeeding wife, (8) directly caring for the child, and (9) performing household chores to allow the wife to breastfeed [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The internal consistency of the 9-item scale was acceptable (Cronbach\u0026apos;s \u0026alpha;\u0026thinsp;=\u0026thinsp;0.78).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eGood Husband Involvement\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eA husband has good involvement if his score is at or above the mean score of the 9-item scale [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePoor Husband Involvement\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eA husband has poor involvement if he answers fewer than four of the nine involvement questions positively [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\n \u003ch2\u003e3.12 Ethical Considerations\u003c/h2\u003e\n \u003cp\u003eBefore collecting data, ethical clearance was obtained from the College of Health Science and Medicine, Wolaita Sodo University Ethical Review Committee (Approval Number: CHSM/ERC/01/15). The study\u0026apos;s benefits and objectives were explained to study participants. Prior to each individual interview, the purpose of the study was outlined. Written informed consent was obtained from each participant. Due to low literacy levels in the study area, verbal informed consent was also obtained, and the ethics committee approved the use of verbal consent procedures.\u003c/p\u003e\n \u003cp\u003eTo maintain privacy, a comfortable environment was selected based on the interviewee\u0026apos;s willingness. Items seeking personal identifying information (name, phone number, etc.) were not included in the questionnaire. Participants who were unwilling to continue the interview could withdraw at any time; this was explained before data collection.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e\n \u003ch2\u003e3.13 Dissemination of Results\u003c/h2\u003e\n \u003cp\u003eThe final report, after being defended at Wolaita Sodo University, will be submitted to the School of Public Health. As deemed necessary, it will also be presented at scientific conferences and submitted for publication to a relevant scientific journal. Government organizations, non-governmental organizations, and researchers may use the findings in the future.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"4. Results","content":"\u003cp\u003eIn this study, a total of 592 respondents participated, yielding a response rate of 98.5%.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Socio-Demographic Characteristics of Husbands\u003c/h2\u003e \u003cp\u003eAccording to this study, 99.8% of participants were of Wolaita ethnicity. Regarding educational status, 30.4% had completed informal education only, while 14.4% had completed certificate or higher level education. Regarding occupation, 36.8% were merchants and 32.9% were househusbands. More than half (51.2%) were Orthodox Christian followers, while 1.7% were Catholic. Regarding mass media exposure, 65.5% reported having access to radio, television, or other media.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-Demographic Characteristics of Husbands\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026lt;\u0026thinsp;35 years 110 18.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u0026ndash;45 years 333 56.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e333\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e56.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 years 149 25.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducation Informal education only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInformal education only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCompleted grades 1\u0026ndash;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCompleted grades 7\u0026ndash;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCertificate and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovernment employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMerchant/daily laborer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHousehusband\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMonthly income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1000 ETB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1000\u0026ndash;1500 ETB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1500 ETB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOrthodox\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProtestant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCatholic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers (Muslim, traditional)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMass media exposure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e388\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e65.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Husbands' Accompaniment of Wives during Maternal and Child Health Service Utilization\u003c/h2\u003e \u003cp\u003eRegarding obstetric characteristics, 30.4% of respondents reported accompanying their wives during ANC visits, while 69.6% had not. Regarding breastfeeding counseling, 74.5% of women received counseling about breastfeeding during ANC visits, while 25.5% did not. Regarding accompaniment during delivery of the last child, 36.1% of respondents did not accompany their wives, while 63.9% did. In this study, 16.6% of husbands reported that the mode of delivery for the last child was cesarean section (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eObstetric and Health Service Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAccompanied wife during ANC visit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e69.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBreastfeeding counseling during ANC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e441\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e74.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAccompanied wife during delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e63.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMode of delivery Normal spontaneous vaginal delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal spontaneous vaginal delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e494\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e83.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePNC visit within 45 days after delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e372\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Knowledge of Breastfeeding Practices among Husbands\u003c/h2\u003e \u003cp\u003eIn this study, nearly three-fourths (74.2%) of participants were knowledgeable about breastfeeding practices, while 25.8% had poor knowledge (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Regarding colostrum feeding, 81.6% reported that the infant received first milk (colostrum), while 18.4% reported it was not given. Regarding breastfeeding initiation, 74.2% reported that mothers started breastfeeding immediately within one hour of birth, while 25.8% reported initiation after one hour. In the last 24 hours before the survey, only 38.3% of infants were fed breast milk only, while 61.7% received additional food or fluids.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKnowledge of Breastfeeding Practices among Husbands\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentages\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBreast feeding initiation time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter one hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImmediately within one hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e439\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e74.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFirst milk (Colostrums) feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e483\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e81.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInfant feeding the last 24 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdditional meals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e365\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e61.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBreast milk only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Prevalence of Husbands' Involvement in Infant Care Practices\u003c/h2\u003e \u003cp\u003e According to this study, the prevalence of good husband involvement in infant care practices was 46.1% (95% CI: 42.2, 49.8) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e4\u003c/span\u003e). This means that 273 of 592 husbands scored at or above the mean on the 9-item involvement scale.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003e4.5 Factors Associated with Husbands' Involvement\u003c/h2\u003e \u003cp\u003eIn bivariable analysis, the following variables had p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.25 and were entered into the multivariable model: education, mass media exposure, monthly income, breastfeeding counseling during ANC visit, accompaniment during ANC visit, mode of delivery, accompaniment during delivery, postnatal care visit, infant feeding in the last 24 hours, and knowledge.\u003c/p\u003e \u003cp\u003eIn the final multivariable model, the following variables were identified as statistically significant determinants (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05): educational status, knowledge about breastfeeding practices, receiving breastfeeding counseling during ANC visits, accompaniment during ANC visits, and accompaniment during delivery.\u003c/p\u003e \u003cp\u003eEducation: Husbands who completed grades 7\u0026ndash;12 had 2.3 times higher odds of good involvement compared to those with informal education only (AOR: 2.3; 95% CI: 1.3, 4.0). Husbands with certificate or higher education had 1.9 times higher odds of good involvement (AOR: 1.9; 95% CI: 1.04, 3.8).ccompaniment during ANC: Husbands who accompanied their wives during ANC visits had 3.1 times higher odds of good involvement compared to those who did not (AOR: 3.1; 95% CI: 1.9, 4.9).\u003c/p\u003e \u003cp\u003eBreastfeeding counseling during ANC: Husbands whose wives received breastfeeding counseling during ANC had 2.7 times higher odds of good involvement (AOR: 2.7; 95% CI: 1.7, 4.3). Knowledge: Husbands with good knowledge about breastfeeding practices had 4.3 times higher odds of good involvement compared to those with poor knowledge (AOR: 4.3; 95% CI: 2.4, 7.6).\u003c/p\u003e \u003cp\u003eAccompaniment during delivery: Husbands who accompanied their wives during delivery had 2.4 times higher odds of good involvement compared to those who did not (AOR: 2.4; 95% CI: 1.5, 3.7) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDeterminants of Husbands' Involvement in Infant Care Practices\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHusband Involvement COR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAOR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePoor n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGood n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInformal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e125 (69.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55 (30.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrades 1\u0026ndash;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108 (67.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53 (32.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.1 (0.7, 1.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrades 7\u0026ndash;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (30.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e116 (69.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.2 (3.3, 8.3)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCertificate+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (42.4) 49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(57.6) 3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(1.8, 5.2)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMonthly income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1000 ETB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e183 (57.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e136 (42.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1000\u0026ndash;1500 ETB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e106 (53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93 (46.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2 (0.8, 1.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1500 ETB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (40.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44 (59.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.9 (1.2, 3.3)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAccompanied during ANC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e276 (67.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e136 (33.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (23.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e137 (76.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.4 (4.3, 9.6)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBreastfeeding counseling during ANC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e106 (70.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45 (29.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e213 (48.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e228 (51.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.5 (1.7, 3.7)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAccompanied during delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e137 (64.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77 (36.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e182 (48.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e196 (51.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.9 (1.3, 2.7)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eKnowledge about breastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e132 (86.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (13.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e187 (42.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e252 (57.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.4 (5.1, 13.9)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*Statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"5. Discussion","content":"\u003cp\u003eThis study aimed to determine the prevalence of husbands\u0026apos; involvement in infant care practices (with a focus on breastfeeding support) and associated factors among husbands of infants under six months in Damot Woyde District, Southern Ethiopia. The study found that the prevalence of good husband involvement was 46.1%, and significant determinants included educational status, knowledge about breastfeeding, accompaniment during ANC visits, breastfeeding counseling during ANC, and accompaniment during delivery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence of Husbands\u0026apos; Involvement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of husbands\u0026apos; involvement (46.1%) was lower than a study conducted in Misha District, Southern Ethiopia, which reported 72.4% involvement [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This difference may be due to variations in sample size, study population characteristics, study period, or differences in the measurement tools used. Notably, the Misha study used a 7-item involvement scale, while the present study used a 9-item scale, which may partially explain the discrepancy.\u003c/p\u003e\n\u003cp\u003eConversely, this finding was higher than a study conducted in Nigeria (33.6%) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This difference may be attributed to the larger sample size in the present study (592 vs. 155 participants) and potential cultural differences in paternal involvement between Ethiopia and Nigeria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKnowledge of Breastfeeding Practices\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe proportion of husbands with good knowledge about breastfeeding practices was 74.2%. This finding was higher than a study conducted in Gurage Zone, Ethiopia (58.3%) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This discrepancy may be explained by differences in educational levels between study populations. In the Gurage Zone study, only 18.6% of participants had secondary level education, compared to 28% in the present study. Higher educational attainment is generally associated with better health knowledge. This finding was also higher than a study in Nigeria, which reported 58% knowledge [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeterminants of Husbands\u0026apos; Involvement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEducation: Husbands\u0026apos; educational level was a significant determinant of involvement. This finding is consistent with studies from Kogi State, Nigeria [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], Iran [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], and Southern Ethiopia [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Higher education likely improves health-seeking behavior and awareness of the importance of paternal involvement in infant care. This finding underscores the need to strengthen and expand educational opportunities at the community level.\u003c/p\u003e\n\u003cp\u003eAccompaniment during ANC: Husbands who accompanied their wives during ANC visits had significantly higher odds of involvement. This may be because husbands who attend ANC are exposed to health messages about breastfeeding and infant care, which in turn increases their involvement. This finding is supported by studies from Gamo Zone, Ethiopia [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], Sidama Region, Ethiopia [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], and Bangladesh [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. The 2016 WHO ANC model recommends a minimum of eight ANC contacts to reduce perinatal mortality and improve women\u0026apos;s experience of care [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Our findings suggest that these contacts also provide opportunities for male engagement.\u003c/p\u003e\n\u003cp\u003eBreastfeeding Counseling during ANC: Receipt of breastfeeding counseling during ANC was associated with higher husband involvement. This finding aligns with studies from Mekele, Ethiopia (where men who received breastfeeding information during ANC were more likely to support their partners\u0026apos; breastfeeding) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] and Motta Town, East Gojjam Zone, Ethiopia [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This finding highlights the importance of comprehensive ANC that includes both partners in health education.\u003c/p\u003e\n\u003cp\u003eAccompaniment during Delivery: Husbands who accompanied their wives during delivery had higher odds of involvement. This may be because delivery attendance provides husbands with direct exposure to breastfeeding education and immediate postpartum care practices. This finding is supported by studies from Nono, Western Ethiopia [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] and Tigray, Ethiopia [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. A study from Debre Tabor Town reported that husband involvement increased institutional delivery by 66-fold [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eKnowledge about Breastfeeding: Husbands with good knowledge about breastfeeding had four-fold higher odds of involvement compared to those with poor knowledge. This finding is consistent with studies from Bangladesh [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], Southern Brazil [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], Kisumu, Kenya [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], and Ankpa, Kogi State, Nigeria [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. A qualitative study in Tanzania found that men expressed a need for better information on breastfeeding practices to become more involved [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Therefore, investing in husbands\u0026apos; knowledge and awareness can be an effective strategy for increasing their involvement in infant care.\u003c/p\u003e\n\u003cdiv id=\"Sec31\" class=\"Section2\"\u003e\n \u003ch2\u003e5.1 Strengths and Limitations\u003c/h2\u003e\n \u003cp\u003eStrengths: This study addresses a gap in the literature by providing evidence on husband involvement in infant care practices in an understudied area of Southern Ethiopia. The community-based design and high response rate (98.5%) enhance the representativeness of the findings.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e:\u003c/p\u003e\u003cspan\u003e\n \u003cp\u003e1. Cross-sectional design: This study cannot establish causal relationships between independent and dependent variables.\u003c/p\u003e\n \u003c/span\u003e \u003cspan\u003e\n \u003cp\u003e2. Recall bias: Some variables (e.g., accompaniment during ANC visits, breastfeeding counseling) relied on retrospective self-report, which may be subject to recall error.\u003c/p\u003e\n \u003c/span\u003e \u003cspan\u003e\n \u003cp\u003e3. Social desirability bias: Husbands may have over-reported their involvement due to perceived social expectations.\u003c/p\u003e\n \u003c/span\u003e \u003cspan\u003e\n \u003cp\u003e4. Self-report limitation: There was no objective validation of reported involvement practices.\u003c/p\u003e\n \u003c/span\u003e \u003cspan\u003e\n \u003cp\u003e5. Generalizability: Findings may not be generalizable to urban settings or other regions of Ethiopia with different cultural contexts.\u003c/p\u003e\n \u003c/span\u003e \u003cspan\u003e\n \u003cp\u003e6. Measurement scope: The involvement scale measured general infant care practices rather than breastfeeding-specific support exclusively, which may limit direct comparison with studies focused solely on breastfeeding involvement.\u003c/p\u003e\n \u003c/span\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec32\" class=\"Section2\"\u003e\n \u003ch2\u003e5.2 Conclusion and Recommendations\u003c/h2\u003e\n\u003c/div\u003e\n\u003ch3\u003eConclusion\u003c/h3\u003e\n\u003cp\u003eThe prevalence of husbands\u0026apos; involvement in infant care practices in Damot Woyde District was low (46.1%) compared to a previous study in southern Ethiopia. Significant determinants included educational status, knowledge about breastfeeding, accompaniment during ANC visits, breastfeeding counseling during ANC, and accompaniment during delivery. Policymakers and stakeholders should focus on improving husbands\u0026apos; knowledge and involvement, as many infant care decisions are influenced by male partners.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendations\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e1. For the education sector: Expand educational opportunities for community members, as 30% of husbands had only informal education. Higher education is associated with greater involvement in infant care.\u003c/p\u003e\n\u003cp\u003e2. For the health sector: Strengthen male involvement strategies as recommended by WHO for health promotion. Specifically:\u003c/p\u003e\n\u003cp\u003e\u0026middot; Implement couple-focused antenatal education sessions that explicitly teach husbands about breastfeeding support, including recognizing hunger cues, assisting with positioning, and managing common breastfeeding challenges.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Ensure that all ANC visits include breastfeeding counseling for both the mother and her husband/partner.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Encourage and facilitate husbands\u0026apos; accompaniment of wives during ANC visits and delivery.\u003c/p\u003e\n\u003cp\u003e3. for the communication and media office: Collaborate with the health sector to promote breastfeeding and paternal involvement through mass media channels, as more than one-third of participants had no mass media exposure.\u003c/p\u003e\n\u003cp\u003e4. for health professionals: Provide comprehensive ANC content, including breastfeeding counseling, to pregnant women and their husbands during all ANC visits.\u003c/p\u003e\n\u003cp\u003e5. for researchers: Conduct longitudinal studies to establish causal relationships and qualitative studies to explore cultural barriers and facilitators of husband involvement in infant care.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eANC Antenatal Care\u003c/p\u003e\n\u003cp\u003eAOR Adjusted Odds Ratio\u003c/p\u003e\n\u003cp\u003eCI Confidence Interval\u003c/p\u003e\n\u003cp\u003eCOR Crude Odds Ratio\u003c/p\u003e\n\u003cp\u003eCSA Central Statistical Agency\u003c/p\u003e\n\u003cp\u003eEBF Exclusive Breastfeeding\u003c/p\u003e\n\u003cp\u003eEDHS Ethiopian Demographic and Health Survey\u003c/p\u003e\n\u003cp\u003eERC Ethical Review Committee\u003c/p\u003e\n\u003cp\u003eETB Ethiopian Birr\u003c/p\u003e\n\u003cp\u003eIYCF Infant and Young Child Feeding\u003c/p\u003e\n\u003cp\u003eLMICs Low- and Middle-Income Countries\u003c/p\u003e\n\u003cp\u003eMCH Maternal and Child Health\u003c/p\u003e\n\u003cp\u003eNGO Non-Governmental Organization\u003c/p\u003e\n\u003cp\u003ePNC Postnatal Care\u003c/p\u003e\n\u003cp\u003eSDGs Sustainable Development Goals\u003c/p\u003e\n\u003cp\u003eSNNPR Southern Nations, Nationalities, and Peoples\u0026apos; Region\u003c/p\u003e\n\u003cp\u003eSPSS Statistical Package for Social Sciences\u003c/p\u003e\n\u003cp\u003eUNICEF United Nations International Children\u0026apos;s Emergency Fund\u003c/p\u003e\n\u003cp\u003eWHO World Health Organization\u003c/p\u003e\n\u003cp\u003eWSU Wolaita Sodo University\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e1. Ethics Approval Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was reviewed and approved by the Wolaita Sodo University Review Board/Ethics Committee (Approval Number: CHSM/ERC/01/15). All procedures performed in this study were conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from all individual participants included in the study. Participants were informed about the purpose of the study, the voluntary nature of participation, their right to withdraw at any time, and the measures taken to ensure confidentiality. Verbal informed consent was also obtained from all participants due to low literacy levels in the study area. The ethics committee approved the use of verbal consent procedures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Consent to Publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants provided consent for anonym zed data and direct quotations to be published in reports, manuscripts, and related dissemination materials. No identifying information is included in the publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4. Availability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5. Competing Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6. Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e7. Authors\u0026apos; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmanuel Kora Moliso designed the study, collected data, analyzed results, and drafted the manuscript. Atinafu Alemu and Haileyesus Worku Fankasho reviewed the manuscript. All authors approved the final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e8. Acknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank Wolaita Sodo University for ethical approval, the Damot Woyde District Health Office for facilitating the research, the data collectors and supervisors for their diligent work, and all study participants for their time and willingness to participate.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSolomon Shitu, D. A., Yeshaneh, H. A. A. M. A. \u0026amp; Beyene, B. \u003cem\u003eHaile Workye. Knowledge of breastfeeding practice and associated factors among fathers whose wife delivered in last one year in Gurage Zone\u003c/em\u003e (Ethiopia. PLOS ONE, 2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eM. A. and T. W. M. A. Fathers' Involvement in Breast Feeding Practices and Associated Factors among Households having Children Less than Six Months in Southern Ethiopia: A Cross sectional study. Pediatrics \u0026amp; Therapeutics. (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrasanna Mithra, B. U., Kumar, R. T. N., Holla, R. \u0026amp; Rathi, P. Module intervention to improve involvement and practices of fathers towards infant and young child feeding (IYCF) in Coastal South India - a randomized controlled trial. F1000 Research. (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGedion, A. \u0026amp; Azeze, K. A. G. Natnael Atnafu Gebeyehu, Molalegn Mesele Gesese, Taklu Marama Mokonnon. Exclusive Breastfeeding Practice and Associated Factors among Mothers in Boditi Town, Wolaita Zone, Southern Ethiopia, 2018: A Community-Based Cross-Sectional Study. \u003cem\u003eInt. J. Pediatr.\u003c/em\u003e \u003cb\u003e2019\u003c/b\u003e, 11 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBustamante, S. F. M. I. C. Husbands' Feelings Toward Their Wives' Breastfeeding in Public Places in Yogyakarta. \u003cem\u003eIndonesian Nurs. J. Educ. Clin. (INJEC)\u003c/em\u003e ;6. (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSetyowati, H. Husband's Support in Giving Exclusive Breastfeeding during the Covid-19 Pandemic. ;\u003cb\u003e25\u003c/b\u003e:3303\u0026ndash;3309. (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSusin, L. R. O. \u0026amp; Giugliani, E. R. J. P., and PhD. Inclusion of Fathers in an Intervention to Promote Breastfeeding: Impact on Breastfeeding Rates. \u003cem\u003eJ. Hum. Lact OnlineFirst\u003c/em\u003e (2008).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFaye Forbes, K. W. B. M. Z. a. J. F. Fathers' involvement in perinatal healthcare in Australia: experiences and reflections of Ethiopian-Australian men and women. \u003cem\u003eBMC Health Serv. Res.\u003c/em\u003e (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKidane Gebremariam, O. Z. A. M. A cross-sectional comparison of breastfeeding knowledge, attitudes, and perceived partners' support among expectant couples in Mekelle, Ethiopia. \u003cem\u003eInt. Breastfeed. J.\u003c/em\u003e \u003cb\u003e6\u003c/b\u003e, 1\u0026ndash;8 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOnuche \u003cem\u003eKnowledge of and Involvement of Male in Exclusive Breastfeeding practices in Tertiary Educational Institutions in Ankpa\u003c/em\u003e (Kogi State, 2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTilahun Tewabe, A. M., Gualu, T., Alem, G., Mekuria, G. \u0026amp; Zeleke, H. Exclusive breastfeeding practice and associated factors among mothers in Motta town, East Gojjam zone, Amhara Regional State, Ethiopia, 2015: a cross-sectional study. \u003cem\u003eInt. Breastfeed. J.\u003c/em\u003e (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBahre Teka, H. A. a. K. H. Prevalence and determinant factors of exclusive breastfeeding practices among mothers in Enderta woreda, Tigray, North Ethiopia: a cross-sectional study. \u003cem\u003eInt. Breastfeed. J.\u003c/em\u003e (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDesalegn, S. L. H. M. M. T. T. A. M. S. A. \u003cem\u003eD. A. S. A. Infant and Young Child Feeding Practice Status and Its Determinants in Kalu District, Northeast Ethiopia: Community-Based Cross-Sectional Study\u003c/em\u003e (Nutrition and Dietary Supplements, 2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTesfaye Setegn, T. B., Gerbaba, M., Deribe, K., Deribew, A. \u0026amp; Sibhatu Biadgilign.. Factors associated with exclusive breastfeeding practices among mothers in Goba district, south east Ethiopia: a cross-sectional study. \u003cem\u003eInt. Breastfeed. J.\u003c/em\u003e (2012).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAyalew, T. Exclusive breastfeeding practice and associated factors among first-time mothers in Bahir Dar city, North West Ethiopia: A community based cross sectional study. \u003cem\u003eHeliyon\u003c/em\u003e (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEkanem, I. A. E. A. P. Attitude of Working Mothers to Exclusive Breastfeeding in Calabar Municipality, Cross River State, Nigeria. \u003cem\u003eJ. Food Res.\u003c/em\u003e (2012).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJahdiel Kossou, W. A. H. Jaures Lokonon Cl. Factors influencing exclusive breastfeeding practices in rural areas in south Benin. E3S Web of Conferences 319. (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFelix, A., Ogbo, B. J. A., Kedir, Y. \u0026amp; Ahmed, Abdon, G. Rwabilimbo. Breastfeeding in the Community\u0026mdash;How Can Partners/Fathers Help? A Systematic Review. \u003cem\u003eInt. J. Environ. Res. Public Health\u003c/em\u003e (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTadesse, D. H. \u003cem\u003ea. A. W. Prevalence and factors associated with exclusive breastfeeding among rural mothers of infants less than six months of age in Southern Nations, Nationalities, Peoples (SNNP) and Tigray regions, Ethiopia: a cross-sectional study\u003c/em\u003e (Hagos and Tadesse International Breastfeeding Journal, 2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGizachew, G. \u0026amp; Mekebo, A. S. A. Factors influencing exclusive breastfeeding practice among under-six months infants in Ethiopia. \u003cem\u003eBMC Pregnancy Childbirth\u003c/em\u003e (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSolomon Shitu, D. A., Mose, H. A. A., Yeshaneh, A., Beyene, B. \u0026amp; Workye, H. \u003cem\u003eKnowledge of breastfeeding practice and associated factors among fathers whose wife delivered in last one year in Gurage Zone, Ethiopia\u003c/em\u003e (PLOS ONE, 2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJennifer, M., Yourkavitch, J. L. A., Debra, M., Prosnitz, J. C. \u0026amp; Thomas Engaging men to promote and support exclusive breastfeeding: a descriptive review of 28 projects in 20 low- and middle-income countries from 2003 to 2013. \u003cem\u003eJ. Health Popul. Nutr.\u003c/em\u003e (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFuraha August, A. B. P., Mpembeni, R. \u0026amp; Axemo, P. Elisabeth Darj. Community health workers can improve male involvement in maternal health: evidence from rural Tanzania. \u003cem\u003eGlobal Health Action\u003c/em\u003e (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJaneth Bulemela, H. M., Snelgrove-Clarke, E. \u0026amp; MacDonald, N. Robert Bortolussi. Supporting breastfeeding: Tanzanian men's knowledge and attitude towards exclusive breastfeeding. \u003cem\u003eInt. Breastfeed. J.\u003c/em\u003e (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eB\u0026oacute;gusb, E. S. C. M. The participation of men in infant feeding: is this a new step towards gender equity? 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHasina Rakotomanana, C. N. W. \u0026amp; Joel, J. Komakech. Fathers' involvement in child care activities: Qualitative findings from the highlands of Madagascar. \u003cem\u003ePLOS ONE\u003c/em\u003e (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDamot Woyde District Health Bureau. HIT Department. (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGultie, T., Estifanos, T. Z., Boti, W. \u0026amp; de Courten, N. Husbands' participation in birth preparedness and complication readiness plan in Kucha district, Gamo Zone, Southern Ethiopia. \u003cem\u003ePLoS ONE\u003c/em\u003e. \u003cb\u003e16\u003c/b\u003e (12), e0261936 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFarideh Panahi, F. R. F. \u0026amp; Nazarpour, S. Educating fathers to improve exclusive breastfeeding practices: a randomized controlled trial. \u003cem\u003eBMC Health Serv. Res.\u003c/em\u003e (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGultie, T., Estifanos, T. Z., Boti, W. \u0026amp; de Courten, N. Husbands' participation in birth preparedness and complication readiness plan in Kucha district, Gamo Zone, Southern Ethiopia. \u003cem\u003ePLoS ONE\u003c/em\u003e. \u003cb\u003e16\u003c/b\u003e (12), e0261936 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeressa, T. a. Husbands' involvement in antenatal care and its association with women's utilization of skilled birth attendants in Sidama zone, Ethiopia: a prospective cohort study. BMC Pregnancy and Childbirth 18:315. 2018. (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRahman, A. E. et al. Knowledge and involvement of husbands in maternal and newborn health in rural Bangladesh. BMC Pregnancy and Childbirth 18:247. 2018. (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. WHO ANC Model. (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGirma, G. F. T. S. \u003cem\u003eExclusive breastfeeding practice and its associated factors among mothers with infants aged less than six months in Nono\u003c/em\u003e (A cross-sectional study, 2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTessema, K. M., Mengesha, M. K., Nigussie, E. W. \u0026amp; Wondie, A. A. The association between male involvement in institutional delivery and women's use of institutional delivery in Debre Tabor town, North West Ethiopia: Community based survey. \u003cem\u003ePLoS ONE\u003c/em\u003e. \u003cb\u003e16\u003c/b\u003e (4), e0249917 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDinga, L. A. \u0026amp; Kyallo, F. M. K. B., and The Participation of Fathers in Breastfeeding Process: Knowledge, Beliefs, and Practices in Kisumu, Kenya. \u003cem\u003eAfr. J. Food Agric. Nutr. Dev.\u003c/em\u003e (2018).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Husband involvement, infant care practices, breastfeeding support, fathers, Damot Woyde, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-8832037/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8832037/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eBreastfeeding is the most effective and cost-efficient intervention for preventing childhood morbidity and mortality. While exclusive breastfeeding and other aspects of infant feeding are commonly taught to mothers, expectant fathers receive little or no education on these topics. Evidence shows that mothers who have supportive husbands are more likely to plan for longer breastfeeding duration. These studies aimed to measure husbands\u0026rsquo; involvement in infant care practices, with a focus on breastfeeding support, and identify associated factors among fathers in Damot Woyde District, Southern Ethiopia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA community-based cross-sectional study was conducted among 601 fathers in Damot Woyde District. A two-stage simple random sampling technique was employed. Data were collected using an interviewer-administered structured questionnaire. Data were entered into Epi Data version 4.1 and exported to SPSS version 25 for analysis. Descriptive statistics were calculated, and cross-tabulations were performed to check cell adequacy. Bivariable binary logistic regression was conducted, and variables with p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.25 were selected as candidates for the final model. Multivariable logistic regression analysis identified factors associated with husbands' involvement, reported using 95% confidence intervals. Variables with p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were declared statistically significant.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 592 respondents participated, yielding a response rate of 98.5%. The prevalence of husbands' involvement in infant care practices was 46.1% (95% CI: 42.2, 49.8). The proportion of husbands with good knowledge about breastfeeding practices was 74.2%. Secondary level education (AOR: 2.3; 95% CI: 1.3, 4.0), certificate or higher education (AOR: 1.9; 95% CI: 1.04, 3.8), accompanying wives during ANC visits (AOR: 3.1; 95% CI: 1.9, 4.9), receiving breastfeeding counseling during ANC visits (AOR: 2.7; 95% CI: 1.7, 4.3), good knowledge of breastfeeding practices (AOR: 4.3; 95% CI: 2.4, 7.6), and accompanying wives during delivery (AOR: 2.4; 95% CI: 1.5, 3.7) were identified as significant determinants.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe prevalence of husbands' involvement in infant care practices was low compared to a previous study in southern Ethiopia. Accompanying wives during ANC visits and delivery increased the likelihood of husbands' involvement. Health interventions should target couples together and emphasize male engagement during antenatal and delivery care.\u003c/p\u003e","manuscriptTitle":"Husbands' Involvement in Infant Care Practices and Associated Factors Among Fathers of Infants Under Six Months in Damot Woyde District, Southern Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-22 05:48:40","doi":"10.21203/rs.3.rs-8832037/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-27T11:40:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"108903567291465773679866780349837106640","date":"2026-04-20T05:42:39+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-14T13:01:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-14T12:49:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-04-14T11:45:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1d74f4f7-8d84-4163-948f-241807bb21a7","owner":[],"postedDate":"April 22nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":66620527,"name":"Health sciences/Diseases"},{"id":66620528,"name":"Health sciences/Health care"},{"id":66620529,"name":"Health sciences/Medical research"},{"id":66620530,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-04-22T05:48:41+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-22 05:48:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8832037","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8832037","identity":"rs-8832037","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}