Belachew et al.

BMC Res Notes (2018) 11:768

https://doi.org/10.1186/s13104-018-3877-5 BMC Research Notes

RESEARCH NOTE Open Access

Prevalence of exclusive breastfeeding

practice and associated factors among mothers
having infants less than 6 months old, in Bahir
Dar, Northwest, Ethiopia: a community based
cross sectional study, 2017
Amare Belachew*, Tilahun Tewabe, Adino Asmare, Desta Hirpo, Banchialem Zeleke and Desalegn Muche

Abstract 
Background:  Breast milk provides all the energy and nutrients that the infant needs for the first 6 months of life. Sub-
optimal breastfeeding especially lacks exclusive breastfeeding increase risk of severe acute malnutrition by 3.2-fold
and major contributory factor for infant child mortality. Therefore, the objective of this study was to assess the preva-
lence of exclusive breastfeeding practice and associated factors among mothers having infants less than 6 months
old in Bahir Dar city, Northwest, Ethiopia, 2017.
Result:  The prevalence of exclusive breastfeeding practice 1 day before the survey was 86.4%. Mothers who; have
young infant aged 0–1 month old [AOR = 5.702 (1.747, 18.613)], house wife [AOR = 2.995 (1.557, 5.690)] and are not
influenced by culture [AOR = 11 (3.449, 35.165)] were more likely to practice exclusive breastfeeding than their
counterparts.
Keywords:  Exclusive breastfeeding practice, Prevalence, Bahir Dar, Northwest Ethiopia

Background status and survival. Every year, around 10 million deaths

Exclusive breastfeeding means giving infants only breast of children younger than 5  years old are caused by due
milk and no other liquids or foods with the exception of to the direct or indirect consequence of the malnutrition
vitamins, minerals, and medicines for the first 6 months [3]. Moreover, a 3.2-fold increased risk of severe acute
of infant’s life [1]. Breast milk is a natural food that serves malnutrition is observed in non exclusively breastfed
as a complete source of infant nutrition for the first children compared to those who are exclusive breast-
6  months of life. It has all components of nutrients and feeding. This is the reason why WHO and UNICEF
minerals which protects both the mothers and the child have formulated the global recommendation of optimal
against illnesses and diseases with its immunological breastfeeding for infants less than 6 months old and con-
property [2]. tinued up to 2  years of age [2, 4, 5]. In the developing
Exclusive breastfeeding for the first 6 months of life can world, more than 40% of the infants under 6 months old
reduce around 13% of infant mortality [2]. Breastfeeding are benefited from the practice of exclusive breastfeed-
and exclusive breastfeeding in a particular, is one of the ing and these is particularly low in Africa, where less than
measurement strategies to improve infant’s nutritional one third of the infants under 6 months of age are exclu-
sively breastfeeding [6].
In Ethiopia, nearly 321,000 under five children died
*Correspondence: [email protected]; [email protected] in each year from which malnutrition is the cause for
Department of Nursing, College of Medicine and Health Science, Bahir 57% deaths primarily through the exacerbation of other
Dar University, Bahir Dar, Ethiopia

© The Author(s) 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License
(http://creat​iveco​mmons​.org/licen​ses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium,
provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creat​iveco​mmons​.org/
publi​cdoma​in/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Belachew et al. BMC Res Notes (2018) 11:768 Page 2 of 6

major causes, such as diarrhea and pneumonia, which Measurement

can be easily prevented through exclusive breastfeeding Data were collected using an interviewer administered
[7, 8]. Currently, the practice of exclusive breastfeeding questionnaire. The questionnaire was adopted from
in Ethiopia is low, and according to EDHS, 2016 report, previous researches done on similar topics [9, 11, 12]
only 58% of mothers with infants less than 6 months old and modifying accordingly. A 1  day (24  h) infant diet
breastfeed them exclusively [9]. Unfortunately, for all recall method was used to assess exclusive breast-
the recognized advantages and efforts deployed to pro- feeding. Training was given for data collectors and
mote exclusive breastfeeding; the practice of exclusive of supervisors for 2  days on methods of extracting the
breastfeeding among 2–3  months old infants were 64% information through interviewing, how to fill the infor-
and it decreased to 36% when infant’s age increased to mation on a structured questionnaire and the ways of
4–5 months [9]. approaching to the respondents.
Even though the government of Ethiopia developed
the infant and young child feeding guideline, there is the Statistical analysis
varying level of intervention were being given both at the The data was cleaned, coded, entered into Epi Data
community level and health institutions. The efforts were software version 3.5.4 and transferred into SPSS ver-
not organized at the level of practice and this is due low sion 20 for analysis. Descriptive statistics were used to
number of studies to explore exclusive breastfeeding in describe the distributions of variables. Logistic regres-
Ethiopia. Therefore, the aim of this study was to assess sion was used to assess the relation between depend-
the prevalence of exclusive breastfeeding practice and ent and predictor variables. First bivariate analysis was
associated factors among mother having infants less than done to examine the associations of single independent
6 months old in Bahir Dar city, Ethiopia. variable with exclusive breastfeeding practice. Inde-
pendent variables with a P-value ≤ 0.05 in bivariate
Methods analysis were entered into the multivariate analysis.
Study setting and period Association between dependent and predictor variables
A community based cross sectional study was conducted was assessed using AOR and 95% CI. Statistical signifi-
in Bahir Dar city from April 15 to May 3, 2017. Bahir Dar cance was declared when the P-value was less than 0.05.
is the capital city of Amhara regional state. It is 565 km
away from Addis Ababa which is the capital city of Ethi- Operational definition
opia. The estimated population of the city is 221,991 Exclusive breastfeeding practice: If a mother feed only
among them 49% were males and 51% were females. breast milk to her infant 1 day (24 h) before the survey
The city has nine sub cities, one public specialized refer- conducted [9, 11].
ral hospital, one district hospitals, two private hospitals,
ten health centers, nine health posts, private clinics, and Result
private pharmacy which gives serves to the town and the Socio‑demographic characteristics
surrounding people. From all 499 eligible mothers, 472 were participated in
this study which made a response rate of 94.6%. One
Sample size and sampling techniques hundred sixty eight (34.5%) mothers were between the
The sample size was determined by using single popula- age of 25–29  years, 96.4% were Amhara by ethnicity,
tion proportion formula with considering the following 75.2% were orthodox Christian, 22.9% attend primary
assumptions: prevalence (P) = 82% proportion of exclu- education, 53.45% were house wives by occupation
sive breastfeeding practice in Ambo [10], confidence and 40.5% mothers earn greater than 300 ETB per
level (Cl) = 95%, margin of error (W) = 5%, and by using month. More than a half (63.1%) of mothers lived in a
design effect of two (Bahir Dar city—sub cities—kebeles- nuclear family. More than half (59.3%) of children were
households) and after adding 10% non response rate the between 91–180 days of age. Regards infant sex, 54.7%
final sample size was 499. Bahir Dar city has nine sub were females (Table 1).
cities and out of them three sub cities were selected by
using a lottery method. In the selected sub cities, nine Exclusive breast feeding practice
kebeles with a total of 1497 households having less than About 86.4% of mothers exclusively breastfeed their
6 months old infants were taken from local health exten- infant 1  day before the survey. Majority of moth-
sion workers. Finally, 499 households were selected by ers (75.4%) initiated breastfeeding within 1  h. Three
simple random sampling technique i.e. lottery method. hundred ninety six (83.9%) infants fed colostrum and
Reviewing the birth date certificate and asking the moth- 74.6% infants were not fed prelacteal feeding. The main
ers were used to determine the actual age of infants.
Belachew et al. BMC Res Notes (2018) 11:768 Page 3 of 6

Table 1 Socio-demographic characteristics of  mothers Table 1  (continued)

(respondents) who have infants less  than  6  months old,
Variable Category (n = 472) Frequency Percent
in Bahir Dar town, North West, Ethiopia, 2017 (%)
Variable Category (n = 472) Frequency Percent
Household income ≤ 1000 59 12.5
(%)
1001–2000 160 33.9
Infant sex Male 214 45.3 2001–3000 62 13.1
Female 258 54.7 > 3000 191 40.5
Infant age 0–30 days 71 15 ANC follow up Yes 370 78.4
31–90 days 140 29.7 No 102 21.6
91–180 days 261 55.3 Ways of delivery Normal 287 60.8
Age of mothers 15–19 30 6.4 C/s 185 39.2
20–24 119 25.2 Place of delivery Home 119 25.2
25–29 163 34.5 Health institution 353 74.8
30–34 98 20.8
35 and above 62 13.1
Religion Orthodox 355 75.2
Muslim 94 20 reasons of mothers for not practicing exclusive breast-
Protestant 12 2.5 feeding were; shortage of time to practice EBF (15.6%)
Catholic 11 2.3 and perceived as human milk is not sufficient for their
Ethnicity Amhara 455 96.4 infant (27%) (Table 2).
Tigre 6 1.3 Majority of mothers (89.4%) know as the infant should
Oromo 6 1.3 be put on breastfeeding immediately within 1  h, 89.6%
Others 5 1 know as breast milk is enough without water and other
Level of education No education 86 18.2 liquids for the first 6 months (Table 2).
of mothers Able to read and write 55 11.7
Primary school (1–8) 108 22.9 Factors associated with exclusive breastfeeding practice
Secondary 86 18.2 In bivariate analysis, the factors found to be significantly
Higher 137 29
associated with exclusive breastfeeding practice were;
Occupational status Housewife 252 53.4
Infant age, occupational status of mother, colostrums
of mother’s Governmental 108 22.9
feeding, maternal age and cultural influences.
employee Finally, mother of infant age 0–1  month old, unem-
Private employee 46 9.7 ployed mother and mothers who are not influenced by
Merchant 38 8.1 culture was the predictor of exclusive breastfeeding.
Daily labor 28 5.9 Age of infant was significantly associated with exclusive
Marital status of Single 36 7.6 breastfeeding practice. Mothers with young infant (aged
mother Married 409 86.7 0–1  month old) were 5.7 times more likely to practice
Widowed 6 1.3 exclusive breastfeeding than mothers with infant aged
Divorced 21 4.4 4–6 months old [AOR = 5.702 (1.747, 18.613)].
Husband educa- No education 30 7.3 Mother’s occupational status was a determinant factor
tional level (409) Able to read and write 51 12.5 for exclusive breastfeeding practice. House wife mothers
Primary school (1–8) 103 25.1 were around three times more likely to practice exclusive
Secondary 85 20.80 breastfeeding than mothers having additional duties or
Higher 140 34.3 jobs [AOR = 2.995 (1.557, 5.690)].
Husband occupa- Govt employee 118 28.9 Mother’s traditional or cultural belief towards initiation
tion (409) Private employee 77 18.8 of first breast milk was a significant factor for exclusive
Merchant 116 28.4 breastfeeding practice. Mothers who were not influenced
Daily labor 64 15.6 by culture/belief towards breast milk were 11 times more
Farmer and driver 34 8.3 likely to practice exclusive breastfeeding than mother
Type of family Nuclear family 298 63.1 influenced by culture/belief [AOR = 11 (3.449, 35.165)]
Extended family 174 36.9 (Table 3).
Belachew et al. BMC Res Notes (2018) 11:768 Page 4 of 6

Table 2 Breastfeed and  related practice among  mothers Table 2  (continued)

who have infant less  than  6  months, in  Bahir Dar city,
Variable Frequency Percent (%)
North West, Ethiopia, 2017 (n = 472)
 Infants start complementary feeding at 6 month and continue BF up
Variable Frequency Percent (%)
to 2 years and beyond
Breastfeeding experience of current infant   Yes 436 92.4
 Yes 461 97.7   No 36 7.6
 No 11 2.3
Timely initiation of breastfeed within 1 h
 yes 356 75.4
Discussion
 No 116 24.6 EBF is recommended in the first 6 months of infant’s life.
Colostrums feeding The prevalence of exclusive breastfeeding practice 1 day
 Yes 396 83.9 before the survey conducted in the study area was 86.4%.
 No 76 16.1 This result is comparable with studies done in Ambo
Prelacteal feeding 82.2% [10], Sri Lanka 85% [13], Dubti town, afar regional
 Yes 120 25.4 state 81.1% [14], and near to WHO recommendations
 No 352 74.6 90% by 2020. This finding is greater than studies done in;
Infant feeding 1 day before survey Motta 50.1% [11], 2011 Ethiopian EDHS report 52% [9],
 Exclusively BF 408 86.4 East Gojjam, Gozamin district 74.1% [15], Debremarkos
 In addition to breast milk water, 64 13.6 60.8% [16], SNNPR 64.8% [17] and Goba district 71.3%
sugar solution, tea, soft foods
[12]. This may be due to differences in maternal socio
Reasons for not exclusively BF (64)
demographic characteristics like educational status of
 Culture/tradition 17 26.7
mothers and house hold income, culture/belief, aware-
 Not sufficient for infant 19 29.7
ness of mother and commitments of community health
 Infant becomes thirsty 5 7.8
extension workers in the study area and other studies.
 Lack of time/work over load 12 18.7
Mother with young infant aged 0–1  month old was
 Maternal illness 9 14.1
5.7 times more likely to practice exclusive breastfeeding
 Lack of information’s 2 3
than mother with infant aged 4–6 months old. This result
Who influence you to give other feeding (64)
is consistent with finding in; Motta [11], Debre Markos
 Husband 29 45.3
[16], Gozamin District [15], Debre Tabor [18], Bale Goba
 My mother 18 28
[12] and Djibouti [14]. This may be due to mother per-
 Mother in law 10 15.6
ception that; breast milk is not sufficient as age of the
 Health worker 4 6.3
infant increases makes the infant thirsty of water and
 My own decision 2 3.2
they perceived that giving water or other liquids in addi-
Knowledge about breastfeeding practice
tion to breast milk alleviates abdominal cramps of the
 BF is important for infant health
infant.
  Yes 472 100
Occupational status of mother was associated with
  No 0
exclusive breastfeeding practice. House wife mothers
 BF is important for maternal health
were around three times more likely to practice exclusive
  Yes 324 68.6
breastfeeding than mothers having additional jobs out-
  No 148 31.4
side the home. This finding is similar with studies done
 Put immediately after birth
in Ethiopia; Ambo [10], Motta [11], Gozamen district
  Yes 422 89.4 [15], Gobba district [12] and Awi Zone [19]; similarly this
  No 50 10.6 study is also consistent with studies done in Ghana [20],
 Colostrums should be given to an infant Netherlands [21] and Cameroon [22]. This may be due to
  Yes 423 89.6 employed mothers; passed more than 8 h on work, lack
  No 49 10.4 private room for breastfeeding, remoteness of the work
 Prelacteal feeding is needed before start BF area from the home, lack of organizational support, short
  Yes 62 13.1 period of maternity leave, inflexible work schedule and
  No 410 86.9 low availability of day care centers.
 EBF for 6 months Mother’s traditional or cultural belief was the determi-
  Yes 423 89.6 nant factor for exclusive breastfeeding practice. Mothers
  No 49 10.4 who were not influenced by culture/tradition were 11
Belachew et al. BMC Res Notes (2018) 11:768 Page 5 of 6

Table 3 Factors that  affect EBF practice among  mothers of  infants age less  than  6  months using bivariate
and multivariate logistic regression analysis model, Bahir dar, Ethiopia, 2017
Variables EBF practice
Yes (n & %) No (N & %) COR (95% CL) AOR (95% CL)

Age of child in months 0–1 67 (94.4) 4 (5.6) 3.679 (1.278,10.58) 5.702 (1.747, 18.613)*
2–3 127 (90.7) 13 (9.3) 2.146 (1.118, 4.119) 2.778 (1.279, 6.032)*
4–6 214 (82) 47 (18) 1 1
Occupational status Unemployed 229 (90.9) 23 (9.1) 2.281 (1.321, 3.940) 2.995 (1.557, 5.690)*
Employed 179 (81.4) 41 (18.6) 1 1
Colostrums feeding Yes 345 (88.5) 45 (11.5) 2.706 (1.455, 5.033) .899 (0.379, 2.133)
No 51 (73.9) 18 (26.1) 1 1
Maternal age 15–29 years 262 (84) 50 (16) 1
≥ 30 years 146 (91.2) 14 (8.8) 1.99 (1.064, 3.723) 1.664 (0.833,3.323)
Cultural influence Yes 10 (58.8) 7 (41.2) 1 1
No 398 (87.5) 57 (12.5) 4.88 (1.789, 13.352) 11.01 (3.449, 35.16)*
1 = reference, * = p value less than 0.05, N = number, % = percent

times more likely to practice exclusive breastfeeding than Authors’ contributions

AB, TT, AA, DH, BZ, and DM, contributed to the design of this study. Authors
those mother who were influenced by culture/tradition. conceived and designed study, collected, analyzed and interpreted data. AB
This finding is consistent with studies done in Kenya [23] drafted the manuscript for important intellectual content. All authors read and
and Hindus [24]. This is may be due to the false percep- approved the final manuscript.
tion of mother’s i.e. first milk as dirty milk and transmit
abdominal cramps to their infants. Additionally, mother Acknowledgements
of the infant may believe that they inherently unable to Our first deepest gratitude to Bahir Dar University College of Medicine and
Health Science, Nursing School for giving the chance to conduct this research.
produce enough milk when their ancestors were not pro- We also thank Bahir Dar city administrations to their permission and commu-
duce enough milk. nity members to give necessary information to conduct the research. Finally,
we would like to acknowledge our friends who were very interested, encour-
aged and helped us to do these research project.
Conclusion
Competing interests
Majority of mothers practiced exclusive breastfeeding. The author declared that there is no any competing interest.
Infant age, mother occupation, and traditional or cultural
influences were the determinant factors for exclusive Availability of data and materials
The date of this study will not be shared publically due to the presence of
breastfeeding practice. Recommendations to increase sensitive (confidential) participants’ information.
EBF were: health extension workers who are work-
ing, participating and educating the community should Consent to publish
Not applicable.
change the false perception of mothers, family, and the
community as a whole on breastfeeding and related tra- Ethics approval and consent to participate
ditional practices like milking and throwing colostrums, Ethical approval of the study was obtained from Bahir Dar University, college
of medicine and health science department of nursing ethical review commit-
giving water to relieve thirsty and abdominal cramp and tee. The ethical letter was submitted to Bahir Dar health bureau and permis-
early introduction of complementary feeding. sion was obtained to conduct the study. To ensure confidentiality of patient’s
information was kept and was not exposed to third body. Verbal consent was
taken and it was approved by ethical review committee.
Limitations Funding
The study did not assessed qualitative aspects of exclu- Not applicable.
sive breastfeeding Using a 24  h diet recall method may
overestimated the magnitude of exclusive breastfeeding. Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in pub-
lished maps and institutional affiliations.
Abbreviations
BFHI: Babies friendly Hospital Initiation; DHS: Demographic Health Survey; Received: 23 August 2018 Accepted: 24 October 2018
EBF: exclusive breast feeding; ICMBMS: International Code of Marketing Brest
Milk Substitute; IYCF: infant and young child feeding; UNICEF: United Nation
International; WHO: World Health Organization.
Belachew et al. BMC Res Notes (2018) 11:768 Page 6 of 6

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