This document summarizes a study that used multilevel logistic regression to identify individual and community level factors associated with exclusive breastfeeding among infants under six months in Ethiopia. The study used 2016 Ethiopian Demographic and Health Survey data including 1,185 infants. Results found that at the individual level, factors like infant age, sex, health issues, household wealth, and antenatal care were associated with exclusive breastfeeding. At the community level, region, postnatal care visits, and maternal employment were associated factors. Both individual and community factors explained around 47% of the variation in exclusive breastfeeding.
This document provides background information and outlines the objectives and methodology for a study on acute malnutrition among children aged 6-59 months in Ewa district, Afar region, Ethiopia. Specifically:
- It discusses the high prevalence of malnutrition in Ethiopia and Afar region.
- The general objective is to assess the prevalence of acute malnutrition and associated factors, while specific objectives are to determine malnutrition prevalence and identify associated factors.
- A cross-sectional study will be conducted at health centers, collecting data from caregivers and anthropometric measurements of children. Factors like socioeconomics, childcare, maternal health, and environment will be examined.
- 113 children will be sampled proportionally from health centers
[[IAA JSR 10(1)49-60, 2023.Awareness and Practice of Breast Feeding among Mot...PUBLISHERJOURNAL
Breastfeeding is a key tool for nourishing a baby, preventing childhood illnesses like obesity, and hypertension later on in life. In addition, it reduces the cost to the family and the entire country. Uganda to some extent faces a great deal of challenges, particularly in the health sector. The aim of this study was to assess the knowledge, attitude and practices of exclusive breastfeeding in mothers with infants between 1 day to 2 years of age attending the immunization and the pediatric inpatient in Kiryandongo Hospital and to identify factors that affect exclusive breastfeeding (EBF). A cross-section descriptive survey design was used. 187 respondents were selected randomly. The data were collected using a questionnaire and the data was analyzed using descriptive statistics of frequency and percentages. The result of this study showed that 71.2 % knew the correct definition and duration of exclusive breastfeeding, 59.7% exclusively breastfeeds for the first six (6) months of life, 100% gave colostrum to their babies because they believed it provides nutrition and protection to their babies, 87% breastfed on demand. The result also showed that there is a positive attitude of mothers toward exclusive breastfeeding as 86.6% of them agreed that breast milk alone is sufficient to the baby during the first six (6) months of life as well as believed that EBF has benefits to both the infants and the mother. 51% of respondents weaned their babies between 15-18 months and 41% weaned between 19 months to 2 years. It was concluded that there was a high level of knowledge on breastfeeding among the respondents, more than half of the respondents practiced exclusive breastfeeding as recommended and relatively all the respondents had positive attitude toward exclusive breastfeeding.
Keywords: knowledge, attitude, practice, breastfeeding, mothers
This systematic review and meta-analysis will determine the pooled prevalence of stunting and its major determinants among school-age children in Ethiopia. Individual studies on stunting in Ethiopia have reported prevalence ranging from 9.8% to 48.1%, but the national pooled estimate is unknown. The review will search several databases and other sources for relevant studies published until June 2020. Two reviewers will screen studies based on inclusion criteria and extract data, with disagreements resolved through discussion. Study quality will be assessed using a standardized tool. Pooled prevalence will be calculated using random effects models. Subgroup and meta-regression analyses will explore sources of heterogeneity. The determinants of stunting will also be identified. This review aims to inform
The document summarizes a study on factors influencing the use of maternal and child healthcare services in Swaziland. The study used secondary data from Swaziland's 2006-07 Demographic and Health Survey. The study found high rates of antenatal care (97.3%) and delivery care (74.0%), but low rates of postnatal care (20.5%). Childhood immunization rates were over 80%. Factors influencing service use included woman's age, parity, education, wealth, residence, and media exposure. Younger, less educated, higher parity, and rural women had lower rates of service use. The study concluded different factors influence various services and interventions should address age, education, wealth,
Background: Childhood stunting is the most widely prevalent among under-five children in Ethiopia. Despite the
individual-level factors of childhood stunting are well documented, community-level factors have not been given
much attention in the country. This study aimed to identify individual- and community-level factors associated with
stunting among under-five children in Ethiopia.
Methods: Cross-sectional data from the 2016 Ethiopian Demographic and Health Survey was used. A total of 8855
under-five children and 640 community clusters were included in the current analysis. A multilevel logistic
regression model was used at 5% level of significance to determine the individual- and community-level factors
associated with childhood stunting.
Prevalence and determinant factors of overweight and obesity among preschool ...Alexander Decker
This study assessed the prevalence of overweight and obesity among 358 preschool children aged 3-5 years in Hawassa City, Ethiopia. The prevalence of overweight was 7.3% and obesity was 3.4%, for a combined prevalence of overweight and obesity of 10.7%. Children from higher socioeconomic backgrounds had higher odds of being overweight or obese compared to children from lower socioeconomic backgrounds. Risk factors for overweight and obesity included early introduction of formula feeding, consumption of a diverse diet including sweets and fast foods, and higher parental wealth. The study highlights the emerging problem of overweight and obesity among preschool children in Ethiopia as lifestyles become more urbanized.
Higher maternal educational attainment is associated with decreased exclusive breastfeeding and increased use of formula in both urban and rural Peru. Exclusive breastfeeding rates are significantly higher in rural versus urban mothers across all education levels. Urban mothers also report higher use of other fluids in addition to breastfeeding compared to rural mothers. Targeted breastfeeding campaigns should focus on mothers with higher education and those in urban areas to promote exclusive breastfeeding practices.
This document provides background information and outlines the objectives and methodology for a study on acute malnutrition among children aged 6-59 months in Ewa district, Afar region, Ethiopia. Specifically:
- It discusses the high prevalence of malnutrition in Ethiopia and Afar region.
- The general objective is to assess the prevalence of acute malnutrition and associated factors, while specific objectives are to determine malnutrition prevalence and identify associated factors.
- A cross-sectional study will be conducted at health centers, collecting data from caregivers and anthropometric measurements of children. Factors like socioeconomics, childcare, maternal health, and environment will be examined.
- 113 children will be sampled proportionally from health centers
[[IAA JSR 10(1)49-60, 2023.Awareness and Practice of Breast Feeding among Mot...PUBLISHERJOURNAL
Breastfeeding is a key tool for nourishing a baby, preventing childhood illnesses like obesity, and hypertension later on in life. In addition, it reduces the cost to the family and the entire country. Uganda to some extent faces a great deal of challenges, particularly in the health sector. The aim of this study was to assess the knowledge, attitude and practices of exclusive breastfeeding in mothers with infants between 1 day to 2 years of age attending the immunization and the pediatric inpatient in Kiryandongo Hospital and to identify factors that affect exclusive breastfeeding (EBF). A cross-section descriptive survey design was used. 187 respondents were selected randomly. The data were collected using a questionnaire and the data was analyzed using descriptive statistics of frequency and percentages. The result of this study showed that 71.2 % knew the correct definition and duration of exclusive breastfeeding, 59.7% exclusively breastfeeds for the first six (6) months of life, 100% gave colostrum to their babies because they believed it provides nutrition and protection to their babies, 87% breastfed on demand. The result also showed that there is a positive attitude of mothers toward exclusive breastfeeding as 86.6% of them agreed that breast milk alone is sufficient to the baby during the first six (6) months of life as well as believed that EBF has benefits to both the infants and the mother. 51% of respondents weaned their babies between 15-18 months and 41% weaned between 19 months to 2 years. It was concluded that there was a high level of knowledge on breastfeeding among the respondents, more than half of the respondents practiced exclusive breastfeeding as recommended and relatively all the respondents had positive attitude toward exclusive breastfeeding.
Keywords: knowledge, attitude, practice, breastfeeding, mothers
This systematic review and meta-analysis will determine the pooled prevalence of stunting and its major determinants among school-age children in Ethiopia. Individual studies on stunting in Ethiopia have reported prevalence ranging from 9.8% to 48.1%, but the national pooled estimate is unknown. The review will search several databases and other sources for relevant studies published until June 2020. Two reviewers will screen studies based on inclusion criteria and extract data, with disagreements resolved through discussion. Study quality will be assessed using a standardized tool. Pooled prevalence will be calculated using random effects models. Subgroup and meta-regression analyses will explore sources of heterogeneity. The determinants of stunting will also be identified. This review aims to inform
The document summarizes a study on factors influencing the use of maternal and child healthcare services in Swaziland. The study used secondary data from Swaziland's 2006-07 Demographic and Health Survey. The study found high rates of antenatal care (97.3%) and delivery care (74.0%), but low rates of postnatal care (20.5%). Childhood immunization rates were over 80%. Factors influencing service use included woman's age, parity, education, wealth, residence, and media exposure. Younger, less educated, higher parity, and rural women had lower rates of service use. The study concluded different factors influence various services and interventions should address age, education, wealth,
Background: Childhood stunting is the most widely prevalent among under-five children in Ethiopia. Despite the
individual-level factors of childhood stunting are well documented, community-level factors have not been given
much attention in the country. This study aimed to identify individual- and community-level factors associated with
stunting among under-five children in Ethiopia.
Methods: Cross-sectional data from the 2016 Ethiopian Demographic and Health Survey was used. A total of 8855
under-five children and 640 community clusters were included in the current analysis. A multilevel logistic
regression model was used at 5% level of significance to determine the individual- and community-level factors
associated with childhood stunting.
Prevalence and determinant factors of overweight and obesity among preschool ...Alexander Decker
This study assessed the prevalence of overweight and obesity among 358 preschool children aged 3-5 years in Hawassa City, Ethiopia. The prevalence of overweight was 7.3% and obesity was 3.4%, for a combined prevalence of overweight and obesity of 10.7%. Children from higher socioeconomic backgrounds had higher odds of being overweight or obese compared to children from lower socioeconomic backgrounds. Risk factors for overweight and obesity included early introduction of formula feeding, consumption of a diverse diet including sweets and fast foods, and higher parental wealth. The study highlights the emerging problem of overweight and obesity among preschool children in Ethiopia as lifestyles become more urbanized.
Higher maternal educational attainment is associated with decreased exclusive breastfeeding and increased use of formula in both urban and rural Peru. Exclusive breastfeeding rates are significantly higher in rural versus urban mothers across all education levels. Urban mothers also report higher use of other fluids in addition to breastfeeding compared to rural mothers. Targeted breastfeeding campaigns should focus on mothers with higher education and those in urban areas to promote exclusive breastfeeding practices.
- The study assessed the prevalence of vitamin-A deficiency and its determinants among 681 preschool children in Dembia District, Ethiopia.
- The overall prevalence of xerophthalmia (a clinical sign of vitamin-A deficiency) was found to be 8.6%.
- Factors significantly associated with vitamin-A deficiency included non-attendance at antenatal care clinics, being male, and being between 49-59 months of age.
This document provides background information on a proposed research study examining determinants of antenatal corticosteroid utilization among preterm births in Addis Ababa, Ethiopia. It discusses high preterm birth rates globally and in Ethiopia, complications of preterm birth like respiratory distress syndrome, and the recommendation and benefits of antenatal corticosteroid administration. While corticosteroid use is recommended, coverage remains low in low-and middle-income countries. The study aims to assess corticosteroid utilization and associated factors in Addis Ababa hospitals over 4 months in 2016. A literature review found mixed results on corticosteroid trials in developing nations and a range of utilization rates reported in other studies from the
Balancing demand, quality and efficiency in nigerian health care delivery systemAlexander Decker
The document discusses several challenges facing Nigeria's health care system that reduce progress and universal access to health care. Some key issues include inadequate health facilities and infrastructure, poor human resources and management, low government spending on health, and high out-of-pocket costs for citizens. Nigeria's health indicators, such as maternal mortality and child mortality, are among the worst in the world. Many factors contribute to these problems, including a lack of integrated disease prevention and treatment systems, shortages of essential drugs and supplies, and inadequate supervision of health care providers. Overall, the health system in Nigeria faces significant issues that must be addressed to improve quality, access, and efficiency of care.
As part of the IFPRI Egypt Seminar in partnership with the National Nutrition Committee (ASRT affiliated): "100 million healthy lives: Scientific evidence on the double burden of malnutrition in Egypt"
This research identifies the important determinants of child mortality from 2012-2013 G.C in Arba Minch hospital. Logistic regression method was used to determine the impact of child mortality. The results show that among bio-demographic factors, gender of child, mother age and breast feeding are the important determinants for child mortality. However, breast feeding has a significant impact on child mortality. Among Socioeconomic determinants education, household size are the most important determinants for child mortality. Therefore policies should be revised and implement and health intervention program that focus on mothers and children health should be strong to achieve the Millennium Development Goals of child mortality in the remaining years.
Aene project a medium city public students obesity studyCIRINEU COSTA
Identifying undernutrition and obesity on students and propose public policies of health are urgent issues. This paper presents a study with weight and stature from students collected by physical education teachers (PEF) in schools of a city near São Paulo. The PEF collected the data and they were inserted in a program especially developed for each school Department (AENE Project). The datas were analyzed by software and evaluation done based on a World Health Organization (WHO_2007) table, that develops health programs worldwide. The results evaluations were used to raise the students and family, teachers and responsibles for treatment search (when required).
The economic consequences of malnutrition in Cambodia, more than 400 million ...Simon Pfanner
The document discusses the economic consequences of malnutrition in Cambodia. It estimates that malnutrition results in over $400 million in economic losses annually, which amounts to 2.5% of Cambodia's GDP. Around 57% of losses are due to indicators measured in children, while 43% are from factors like maternal nutrition and behaviors that impact children before birth. The losses are estimated to emerge through several pathways, including future lost productivity from child mortality, reduced cognition and school performance from childhood malnutrition, and current reduced productivity in adults and excess healthcare costs. Investing in nutrition programs could offer high returns given the large economic losses from malnutrition.
RESEARCH ARTICLE Open AccessQuality of antenatal care pred.docxrgladys1
RESEARCH ARTICLE Open Access
Quality of antenatal care predicts retention
in skilled birth attendance: a multilevel
analysis of 28 African countries
Adanna Chukwuma1,2* , Adaeze C. Wosu3, Chinyere Mbachu4 and Kelechi Weze1
Abstract
Background: An effective continuum of maternal care ensures that mothers receive essential health packages from
pre-pregnancy to delivery, and postnatally, reducing the risk of maternal death. However, across Africa, coverage of
skilled birth attendance is lower than coverage for antenatal care, indicating mothers are not retained in the
continuum between antenatal care and delivery. This paper explores predictors of retention of antenatal care
clients in skilled birth attendance across Africa, including sociodemographic factors and quality of antenatal care
received.
Methods: We pooled nationally representative data from Demographic and Health Surveys conducted in 28 African
countries between 2006 and 2015. For the 115,374 births in our sample, we estimated logistic multilevel models of
retention in skilled birth attendance (SBA) among clients that received skilled antenatal care (ANC).
Results: Among ANC clients in the study sample, 66% received SBA. Adjusting for all demographic covariates and
country indicators, the odds of retention in SBA were higher among ANC clients that had their blood pressure
checked, received information about pregnancy complications, had blood tests conducted, received at least one
tetanus injection, and had urine tests conducted.
Conclusions: Higher quality of ANC predicts retention in SBA in Africa. Improving quality of skilled care received
prenatally may increase client retention during delivery, reducing maternal mortality.
Keywords: Antenatal, Continuum, Delivery, Birth, Quality, Determinants, Maternal health
Background
Sub-Saharan Africa has the highest regional maternal
mortality ratio in the world with 546 maternal deaths
per 10,000 live births [1]. The risk of maternal death
peaks around the time of birth, when coverage of care is
at its lowest [2]. An effective continuum of skilled ma-
ternal care ensures that mothers receive essential health
packages from pre-pregnancy to delivery, and postna-
tally, reducing the risk of maternal death [2]. However,
across Africa, the proportion of mothers that receive
skilled birth attendance (51%) is lower than the propor-
tion that receives any skilled antenatal care (78%) [3].
Where this difference is due to dropouts from skilled
delivery care represents missed opportunities to reduce
maternal mortality in Africa.
Understanding predictors of retention in the con-
tinuum of care can inform policy and programs to re-
duce maternal mortality. To date, few studies have
characterized the determinants of retention along the
continuum of care in Africa. These include a recent
study of 6 countries (Ethiopia, Malawi, Rwanda, Senegal,
Tanzania, and Uganda) [4] and another study that fo-
cused on Nigeria [5]. These studies focused exclus.
The study assessed knowledge, attitude, and practices regarding emergency contraception among 366 female students in Mekelle, Northern Ethiopia. The key findings were:
1) About 90.7% of respondents had heard of emergency contraception. Three-fourths (75.7%) had good knowledge and over half (64.9%) had a positive attitude.
2) Older age was significantly associated with greater awareness. Those over 18 were more likely to have good knowledge compared to younger students.
3) Age and ethnicity also influenced attitude - younger students and non-Tigre ethnic groups were less likely to have a positive attitude.
4) While knowledge and attitude were high, the study
This study assessed the prevalence of neonatal sepsis and associated risk factors among neonates admitted to neonatal intensive care units (NICUs) at two hospitals in Ethiopia from February 2016 to February 2017. The overall prevalence of neonatal sepsis was found to be 77.9%. Age of neonates, birth asphyxia, and use of oxygen via mask were significantly associated with increased risk of neonatal sepsis. The study recommends focusing prevention efforts on modifiable risk factors to reduce neonatal sepsis.
This document provides an introduction to the Rashtriya Bal Swasthya Karyakram (RBSK) program in India, which aims to screen over 270 million children aged 0-18 for defects, diseases, deficiencies, and developmental delays. It does this through mobile health teams that screen children in anganwadis and schools. Children identified with issues are referred to primary or community health centers, or district early intervention centers for further examination and treatment if needed. The district early intervention centers are located in district hospitals and have medical professionals and facilities to assess children for conditions like hearing, vision, motor and cognitive impairments. The goal of the program is to identify health issues in children early and ensure they receive
This study examined malnutrition among school-aged children in rural and urban areas of two districts in Ethiopia. The researchers collected anthropometric and dietary intake data from 886 children and analyzed differences in stunting and thinness between settings. The prevalence of stunting was higher in rural (42.7%) versus urban (29.2%) areas. In rural areas, factors associated with stunting included recent fever, consumption of animal foods, and family cattle ownership. In urban areas, only older age and the head of household's education were associated with stunting. Thinness was linked to household size and rice farming in rural communities and animal food intake and head of household literacy in urban communities. The study found varying factors impacting malnutrition
Prevalence of malnutrition_and_associated_factors_AmanualNuredin
This study assessed the prevalence of malnutrition and associated factors among children aged 6-59 months in Hidabu Abote district, North Shewa, Oromia, Ethiopia. A cross-sectional study was conducted from September 8-23, 2012 using a multistage sampling method to select 820 children. The analysis revealed that 47.6% of children were stunted, 30.9% were underweight, and 16.7% were wasted. Main factors associated with stunting included child age, family monthly income, receiving butter as a pre-lacteal feeding, and family planning practices. Underweight was associated with number of children in the household and receiving butter as a pre-lacteal feeding
This document discusses unintended pregnancy and family planning. It provides background on family planning and defines unintended pregnancies. Unintended pregnancies are associated with negative health outcomes for both mothers and children. The document then discusses objectives of assessing attitudes toward unintended pregnancy and family planning in two regions of Ethiopia from 2004-2007. It aims to evaluate family planning programs and services, knowledge of methods, partner communication, and approval of family planning. The study seeks to increase skills and knowledge to reduce unintended pregnancies and problems related to lack of family planning. It is limited by time, lack of references, and internet access.
Maternal health care trends in afghanistanIslam Saeed
The document summarizes findings from a 2010 Afghanistan mortality survey on trends in maternal health care. It finds that coverage of antenatal care, deliveries assisted by skilled birth attendants, and postnatal care have increased by about 10% on average. However, this level of progress is not as high as expected given major investments in Afghanistan's basic health package and hospital system aimed at improving maternal and child health. The results indicate efforts to expand access to maternal services have had an impact but more improvement is still needed.
Factors influencing the practice of exclusive breast feeding in rural communi...Alexander Decker
This study aimed to identify factors influencing the practice of exclusive breastfeeding in rural communities in Osun State, Nigeria. The study surveyed 480 nursing mothers across 5 communities. It found that only 20% of respondents practiced exclusive breastfeeding, while 80% did not. Factors found to significantly influence breastfeeding practices included: the mother's age, marital status, occupation, family income, education, and number of children. Mothers with higher incomes, education, and older/more experienced mothers were more likely to practice exclusive breastfeeding. The study concluded that health workers need to address cultural barriers through education to promote exclusive breastfeeding among rural women.
A Longitudinal Study On Feeding Practices And Morbidity Patterns Of Infants I...iosrjce
Background: Feeding practices and illnesses during infancy are of critical importance for growth and
development of children .Though several programs have been implemented by WHO and UNICEF to improve
the health status of newborn and infant, child morbidity and mortality rates in rural area are still higher
compared to urban areas in India.
Objective: To assess the feeding practices and morbidity patterns of infants in a rural field practice area .
Methodology: A longitudinal study was undertaken in field practice area under community medicine
Department, Guntur from Jan 2013 to march 2014.A birth cohort of hundred children born during first 3
months of study period were assessed and followed up till they attained 1year age .Data collected on feeding
practices ,infant illnesses and socio-demographic factors.
Results: The incidence of episodes of morbidity was 2.78 per infant per year. Respiratory Tract Infections are
most common observed illness followed by diarrhea .Majority of the mothers (90%)
Were given colostrum ,50% were breast fed their babies with in 1 hour of delivery,60% were given
EBF(Exclusive Breast Feeding ). The illnesses are less common in first 6 months of infancy compared to
letter half of life .A Significant association between feeding practices and morbidities
Conclusion: Hence focusing education on faulty feeding practices and implementation of IMNCI(integrated
management of newborn and childhood illnesses ) at gross root level by health workers need to be emphasized
The document discusses Sudan's National Nutrition Program and efforts to improve infant and young child feeding practices through various interventions. It analyzes data from nutrition surveys conducted in 2006 and 2010 on indicators such as exclusive breastfeeding rates, introduction of complementary foods, vitamin supplementation, and child malnutrition prevalence across Sudanese states. The 2011 World Breastfeeding Week celebration in Sudan is outlined, with plans to raise public awareness through various communication channels and distribute educational materials on the benefits of breastfeeding.
An analysis of uptake in hiv voluntary counselling and testing services case ...Alexander Decker
This study examined the uptake of voluntary HIV counseling and testing (VCT) services among students at Mount Kenya University in Kenya. The study found that only 18.4% of students had undergone VCT, despite 90% of HIV prevention programs targeting youth. Key reasons for low uptake included fear of positive results and stigma. The study surveyed 283 students and found that 76% had undergone VCT, with curiosity, seeking early treatment, and determining a partner's faithfulness as top reasons for uptake. Fear of positive results, stigma, and low risk perception were top reasons for non-uptake. The study concludes that VCT centers need to be more youth-friendly to improve uptake among university students.
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
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- The study assessed the prevalence of vitamin-A deficiency and its determinants among 681 preschool children in Dembia District, Ethiopia.
- The overall prevalence of xerophthalmia (a clinical sign of vitamin-A deficiency) was found to be 8.6%.
- Factors significantly associated with vitamin-A deficiency included non-attendance at antenatal care clinics, being male, and being between 49-59 months of age.
This document provides background information on a proposed research study examining determinants of antenatal corticosteroid utilization among preterm births in Addis Ababa, Ethiopia. It discusses high preterm birth rates globally and in Ethiopia, complications of preterm birth like respiratory distress syndrome, and the recommendation and benefits of antenatal corticosteroid administration. While corticosteroid use is recommended, coverage remains low in low-and middle-income countries. The study aims to assess corticosteroid utilization and associated factors in Addis Ababa hospitals over 4 months in 2016. A literature review found mixed results on corticosteroid trials in developing nations and a range of utilization rates reported in other studies from the
Balancing demand, quality and efficiency in nigerian health care delivery systemAlexander Decker
The document discusses several challenges facing Nigeria's health care system that reduce progress and universal access to health care. Some key issues include inadequate health facilities and infrastructure, poor human resources and management, low government spending on health, and high out-of-pocket costs for citizens. Nigeria's health indicators, such as maternal mortality and child mortality, are among the worst in the world. Many factors contribute to these problems, including a lack of integrated disease prevention and treatment systems, shortages of essential drugs and supplies, and inadequate supervision of health care providers. Overall, the health system in Nigeria faces significant issues that must be addressed to improve quality, access, and efficiency of care.
As part of the IFPRI Egypt Seminar in partnership with the National Nutrition Committee (ASRT affiliated): "100 million healthy lives: Scientific evidence on the double burden of malnutrition in Egypt"
This research identifies the important determinants of child mortality from 2012-2013 G.C in Arba Minch hospital. Logistic regression method was used to determine the impact of child mortality. The results show that among bio-demographic factors, gender of child, mother age and breast feeding are the important determinants for child mortality. However, breast feeding has a significant impact on child mortality. Among Socioeconomic determinants education, household size are the most important determinants for child mortality. Therefore policies should be revised and implement and health intervention program that focus on mothers and children health should be strong to achieve the Millennium Development Goals of child mortality in the remaining years.
Aene project a medium city public students obesity studyCIRINEU COSTA
Identifying undernutrition and obesity on students and propose public policies of health are urgent issues. This paper presents a study with weight and stature from students collected by physical education teachers (PEF) in schools of a city near São Paulo. The PEF collected the data and they were inserted in a program especially developed for each school Department (AENE Project). The datas were analyzed by software and evaluation done based on a World Health Organization (WHO_2007) table, that develops health programs worldwide. The results evaluations were used to raise the students and family, teachers and responsibles for treatment search (when required).
The economic consequences of malnutrition in Cambodia, more than 400 million ...Simon Pfanner
The document discusses the economic consequences of malnutrition in Cambodia. It estimates that malnutrition results in over $400 million in economic losses annually, which amounts to 2.5% of Cambodia's GDP. Around 57% of losses are due to indicators measured in children, while 43% are from factors like maternal nutrition and behaviors that impact children before birth. The losses are estimated to emerge through several pathways, including future lost productivity from child mortality, reduced cognition and school performance from childhood malnutrition, and current reduced productivity in adults and excess healthcare costs. Investing in nutrition programs could offer high returns given the large economic losses from malnutrition.
RESEARCH ARTICLE Open AccessQuality of antenatal care pred.docxrgladys1
RESEARCH ARTICLE Open Access
Quality of antenatal care predicts retention
in skilled birth attendance: a multilevel
analysis of 28 African countries
Adanna Chukwuma1,2* , Adaeze C. Wosu3, Chinyere Mbachu4 and Kelechi Weze1
Abstract
Background: An effective continuum of maternal care ensures that mothers receive essential health packages from
pre-pregnancy to delivery, and postnatally, reducing the risk of maternal death. However, across Africa, coverage of
skilled birth attendance is lower than coverage for antenatal care, indicating mothers are not retained in the
continuum between antenatal care and delivery. This paper explores predictors of retention of antenatal care
clients in skilled birth attendance across Africa, including sociodemographic factors and quality of antenatal care
received.
Methods: We pooled nationally representative data from Demographic and Health Surveys conducted in 28 African
countries between 2006 and 2015. For the 115,374 births in our sample, we estimated logistic multilevel models of
retention in skilled birth attendance (SBA) among clients that received skilled antenatal care (ANC).
Results: Among ANC clients in the study sample, 66% received SBA. Adjusting for all demographic covariates and
country indicators, the odds of retention in SBA were higher among ANC clients that had their blood pressure
checked, received information about pregnancy complications, had blood tests conducted, received at least one
tetanus injection, and had urine tests conducted.
Conclusions: Higher quality of ANC predicts retention in SBA in Africa. Improving quality of skilled care received
prenatally may increase client retention during delivery, reducing maternal mortality.
Keywords: Antenatal, Continuum, Delivery, Birth, Quality, Determinants, Maternal health
Background
Sub-Saharan Africa has the highest regional maternal
mortality ratio in the world with 546 maternal deaths
per 10,000 live births [1]. The risk of maternal death
peaks around the time of birth, when coverage of care is
at its lowest [2]. An effective continuum of skilled ma-
ternal care ensures that mothers receive essential health
packages from pre-pregnancy to delivery, and postna-
tally, reducing the risk of maternal death [2]. However,
across Africa, the proportion of mothers that receive
skilled birth attendance (51%) is lower than the propor-
tion that receives any skilled antenatal care (78%) [3].
Where this difference is due to dropouts from skilled
delivery care represents missed opportunities to reduce
maternal mortality in Africa.
Understanding predictors of retention in the con-
tinuum of care can inform policy and programs to re-
duce maternal mortality. To date, few studies have
characterized the determinants of retention along the
continuum of care in Africa. These include a recent
study of 6 countries (Ethiopia, Malawi, Rwanda, Senegal,
Tanzania, and Uganda) [4] and another study that fo-
cused on Nigeria [5]. These studies focused exclus.
The study assessed knowledge, attitude, and practices regarding emergency contraception among 366 female students in Mekelle, Northern Ethiopia. The key findings were:
1) About 90.7% of respondents had heard of emergency contraception. Three-fourths (75.7%) had good knowledge and over half (64.9%) had a positive attitude.
2) Older age was significantly associated with greater awareness. Those over 18 were more likely to have good knowledge compared to younger students.
3) Age and ethnicity also influenced attitude - younger students and non-Tigre ethnic groups were less likely to have a positive attitude.
4) While knowledge and attitude were high, the study
This study assessed the prevalence of neonatal sepsis and associated risk factors among neonates admitted to neonatal intensive care units (NICUs) at two hospitals in Ethiopia from February 2016 to February 2017. The overall prevalence of neonatal sepsis was found to be 77.9%. Age of neonates, birth asphyxia, and use of oxygen via mask were significantly associated with increased risk of neonatal sepsis. The study recommends focusing prevention efforts on modifiable risk factors to reduce neonatal sepsis.
This document provides an introduction to the Rashtriya Bal Swasthya Karyakram (RBSK) program in India, which aims to screen over 270 million children aged 0-18 for defects, diseases, deficiencies, and developmental delays. It does this through mobile health teams that screen children in anganwadis and schools. Children identified with issues are referred to primary or community health centers, or district early intervention centers for further examination and treatment if needed. The district early intervention centers are located in district hospitals and have medical professionals and facilities to assess children for conditions like hearing, vision, motor and cognitive impairments. The goal of the program is to identify health issues in children early and ensure they receive
This study examined malnutrition among school-aged children in rural and urban areas of two districts in Ethiopia. The researchers collected anthropometric and dietary intake data from 886 children and analyzed differences in stunting and thinness between settings. The prevalence of stunting was higher in rural (42.7%) versus urban (29.2%) areas. In rural areas, factors associated with stunting included recent fever, consumption of animal foods, and family cattle ownership. In urban areas, only older age and the head of household's education were associated with stunting. Thinness was linked to household size and rice farming in rural communities and animal food intake and head of household literacy in urban communities. The study found varying factors impacting malnutrition
Prevalence of malnutrition_and_associated_factors_AmanualNuredin
This study assessed the prevalence of malnutrition and associated factors among children aged 6-59 months in Hidabu Abote district, North Shewa, Oromia, Ethiopia. A cross-sectional study was conducted from September 8-23, 2012 using a multistage sampling method to select 820 children. The analysis revealed that 47.6% of children were stunted, 30.9% were underweight, and 16.7% were wasted. Main factors associated with stunting included child age, family monthly income, receiving butter as a pre-lacteal feeding, and family planning practices. Underweight was associated with number of children in the household and receiving butter as a pre-lacteal feeding
This document discusses unintended pregnancy and family planning. It provides background on family planning and defines unintended pregnancies. Unintended pregnancies are associated with negative health outcomes for both mothers and children. The document then discusses objectives of assessing attitudes toward unintended pregnancy and family planning in two regions of Ethiopia from 2004-2007. It aims to evaluate family planning programs and services, knowledge of methods, partner communication, and approval of family planning. The study seeks to increase skills and knowledge to reduce unintended pregnancies and problems related to lack of family planning. It is limited by time, lack of references, and internet access.
Maternal health care trends in afghanistanIslam Saeed
The document summarizes findings from a 2010 Afghanistan mortality survey on trends in maternal health care. It finds that coverage of antenatal care, deliveries assisted by skilled birth attendants, and postnatal care have increased by about 10% on average. However, this level of progress is not as high as expected given major investments in Afghanistan's basic health package and hospital system aimed at improving maternal and child health. The results indicate efforts to expand access to maternal services have had an impact but more improvement is still needed.
Factors influencing the practice of exclusive breast feeding in rural communi...Alexander Decker
This study aimed to identify factors influencing the practice of exclusive breastfeeding in rural communities in Osun State, Nigeria. The study surveyed 480 nursing mothers across 5 communities. It found that only 20% of respondents practiced exclusive breastfeeding, while 80% did not. Factors found to significantly influence breastfeeding practices included: the mother's age, marital status, occupation, family income, education, and number of children. Mothers with higher incomes, education, and older/more experienced mothers were more likely to practice exclusive breastfeeding. The study concluded that health workers need to address cultural barriers through education to promote exclusive breastfeeding among rural women.
A Longitudinal Study On Feeding Practices And Morbidity Patterns Of Infants I...iosrjce
Background: Feeding practices and illnesses during infancy are of critical importance for growth and
development of children .Though several programs have been implemented by WHO and UNICEF to improve
the health status of newborn and infant, child morbidity and mortality rates in rural area are still higher
compared to urban areas in India.
Objective: To assess the feeding practices and morbidity patterns of infants in a rural field practice area .
Methodology: A longitudinal study was undertaken in field practice area under community medicine
Department, Guntur from Jan 2013 to march 2014.A birth cohort of hundred children born during first 3
months of study period were assessed and followed up till they attained 1year age .Data collected on feeding
practices ,infant illnesses and socio-demographic factors.
Results: The incidence of episodes of morbidity was 2.78 per infant per year. Respiratory Tract Infections are
most common observed illness followed by diarrhea .Majority of the mothers (90%)
Were given colostrum ,50% were breast fed their babies with in 1 hour of delivery,60% were given
EBF(Exclusive Breast Feeding ). The illnesses are less common in first 6 months of infancy compared to
letter half of life .A Significant association between feeding practices and morbidities
Conclusion: Hence focusing education on faulty feeding practices and implementation of IMNCI(integrated
management of newborn and childhood illnesses ) at gross root level by health workers need to be emphasized
The document discusses Sudan's National Nutrition Program and efforts to improve infant and young child feeding practices through various interventions. It analyzes data from nutrition surveys conducted in 2006 and 2010 on indicators such as exclusive breastfeeding rates, introduction of complementary foods, vitamin supplementation, and child malnutrition prevalence across Sudanese states. The 2011 World Breastfeeding Week celebration in Sudan is outlined, with plans to raise public awareness through various communication channels and distribute educational materials on the benefits of breastfeeding.
An analysis of uptake in hiv voluntary counselling and testing services case ...Alexander Decker
This study examined the uptake of voluntary HIV counseling and testing (VCT) services among students at Mount Kenya University in Kenya. The study found that only 18.4% of students had undergone VCT, despite 90% of HIV prevention programs targeting youth. Key reasons for low uptake included fear of positive results and stigma. The study surveyed 283 students and found that 76% had undergone VCT, with curiosity, seeking early treatment, and determining a partner's faithfulness as top reasons for uptake. Fear of positive results, stigma, and low risk perception were top reasons for non-uptake. The study concludes that VCT centers need to be more youth-friendly to improve uptake among university students.
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The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdfVedanta A
Air Ambulance Services In Rewa works in close coordination with ground-based emergency services, including local Emergency Medical Services, fire departments, and law enforcement agencies.
More@: https://tinyurl.com/2shrryhx
More@: https://tinyurl.com/5n8h3wp8
The Importance of Black Women Understanding the Chemicals in Their Personal C...bkling
Certain chemicals, such as phthalates and parabens, can disrupt the body's hormones and have significant effects on health. According to data, hormone-related health issues such as uterine fibroids, infertility, early puberty and more aggressive forms of breast and endometrial cancers disproportionately affect Black women. Our guest speaker, Jasmine A. McDonald, PhD, an Assistant Professor in the Department of Epidemiology at Columbia University in New York City, discusses the scientific reasons why Black women should pay attention to specific chemicals in their personal care products, like hair care, and ways to minimize their exposure.
Emotional and Behavioural Problems in Children - Counselling and Family Thera...PsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
The story of Dr. Ranjit Jagtap's daughters is more than a tale of inherited responsibility; it's a narrative of passion, innovation, and unwavering commitment to a cause greater than oneself. In Poulami and Aditi Jagtap, we see the beautiful continuum of a father's dream and the limitless potential of compassion-driven healthcare.
Health Tech Market Intelligence Prelim Questions -Gokul Rangarajan
The Ultimate Guide to Setting up Market Research in Health Tech part -1
How to effectively start market research in the health tech industry by defining objectives, crafting problem statements, selecting methods, identifying data collection sources, and setting clear timelines. This guide covers all the preliminary steps needed to lay a strong foundation for your research.
This lays foundation of scoping research project what are the
Before embarking on a research project, especially one aimed at scoping and defining parameters like the one described for health tech IT, several crucial considerations should be addressed. Here’s a comprehensive guide covering key aspects to ensure a well-structured and successful research initiative:
1. Define Research Objectives and Scope
Clear Objectives: Define specific goals such as understanding market needs, identifying new opportunities, assessing risks, or refining pricing strategies.
Scope Definition: Clearly outline the boundaries of the research in terms of geographical focus, target demographics (e.g., age, socio-economic status), and industry sectors (e.g., healthcare IT).
3. Review Existing Literature and Resources
Literature Review: Conduct a thorough review of existing research, market reports, and relevant literature to build foundational knowledge.
Gap Analysis: Identify gaps in existing knowledge or areas where further exploration is needed.
4. Select Research Methodology and Tools
Methodological Approach: Choose appropriate research methods such as surveys, interviews, focus groups, or data analytics.
Tools and Resources: Select tools like Google Forms for surveys, analytics platforms (e.g., SimilarWeb, Statista), and expert consultations.
5. Ethical Considerations and Compliance
Ethical Approval: Ensure compliance with ethical guidelines for research involving human subjects.
Data Privacy: Implement measures to protect participant confidentiality and adhere to data protection regulations (e.g., GDPR, HIPAA).
6. Budget and Resource Allocation
Resource Planning: Allocate resources including time, budget, and personnel required for each phase of the research.
Contingency Planning: Anticipate and plan for unforeseen challenges or adjustments to the research plan.
7. Develop Research Instruments
Survey Design: Create well-structured surveys using tools like Google Forms to gather quantitative data.
Interview and Focus Group Guides: Prepare detailed scripts and discussion points for qualitative data collection.
8. Sampling Strategy
Sampling Design: Define the sampling frame, size, and method (e.g., random sampling, stratified sampling) to ensure representation of target demographics.
Participant Recruitment: Plan recruitment strategies to reach and engage the intended participant groups effectively.
9. Data Collection and Analysis Plan
Data Collection: Implement methods for data gathering, ensuring consistency and validity.
Analysis Techniques: Decide on analytical approaches (e.g., statistical
The Ultimate Guide in Setting Up Market Research System in Health-TechGokul Rangarajan
How to effectively start market research in the health tech industry by defining objectives, crafting problem statements, selecting methods, identifying data collection sources, and setting clear timelines. This guide covers all the preliminary steps needed to lay a strong foundation for your research.
"Market Research it too text-booky, I am in the market for a decade, I am living research book" this is what the founder I met on the event claimed, few of my colleagues rolled their eyes. Its true that one cannot over look the real life experience, but one cannot out beat structured gold mine of market research.
Many 0 to 1 startup founders often overlook market research, but this critical step can make or break a venture, especially in health tech.
But Why do they skip it?
Limited resources—time, money, and manpower—are common culprits.
"In fact, a survey by CB Insights found that 42% of startups fail due to no market need, which is like building a spaceship to Mars only to realise you forgot the fuel."
Sudharsan Srinivasan
Operational Partner Pitchworks VC Studio
Overconfidence in their product’s success leads founders to assume it will naturally find its market, especially in health tech where patient needs, entire system issues and regulatory requirements are as complex as trying to perform brain surgery with a butter knife. Additionally, the pressure to launch quickly and the belief in their own intuition further contribute to this oversight. Yet, thorough market research in health tech could be the key to transforming a startup's vision into a life-saving reality, instead of a medical mishap waiting to happen.
Example of Market Research working
Innovaccer, founded by Abhinav Shashank in 2014, focuses on improving healthcare delivery through data-driven insights and interoperability solutions. Before launching their platform, Innovaccer conducted extensive market research to understand the challenges faced by healthcare organizations and the potential for innovation in healthcare IT.
Identifying Pain Points: Innovaccer surveyed healthcare providers to understand their difficulties with data integration, care coordination, and patient engagement. They found widespread frustration with siloed systems and inefficient workflows.
Competitive Analysis: Analyzed competitors offering similar solutions in healthcare analytics and interoperability. Identified gaps in comprehensive data aggregation, real-time analytics, and actionable insights.
Regulatory Compliance: Ensured their platform complied with HIPAA and other healthcare data privacy regulations. This compliance was crucial to gaining trust from healthcare providers wary of data security issues.
Customer Validation: Conducted pilot programs with several healthcare organizations to validate the platform's effectiveness in improving care outcomes and operational efficiency. Gathered feedback to refine features and user interface.
nursing management of patient with Empyema pptblessyjannu21
prepared by Prof. BLESSY THOMAS, SPN
Empyema is a disease of respiratory system It is defines as the accumulation of thick, purulent fluid within the pleural space, often with fibrin development.
Empyema is also called pyothorax or purulent pleuritis.
It’s a condition in which pus gathers in the area between the lungs and the inner surface of the chest wall. This area is known as the pleural space.
Pus is a fluid that’s filled with immune cells, dead cells, and bacteria.
Pus in the pleural space can’t be coughed out. Instead, it needs to be drained by a needle or surgery.
Empyema usually develops after pneumonia, which is an infection of the lung tissue. it is mainly caused due in infectious micro-organisms. It can be treated with medications and other measures.
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPTblessyjannu21
Prepared by Prof. BLESSY THOMAS, VICE PRINCIPAL, FNCON, SPN.
Emphysema is a disease condition of respiratory system.
Emphysema is an abnormal permanent enlargement of the air spaces distal to terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
Emphysema of lung is defined as hyper inflation of the lung ais spaces due to obstruction of non respiratory bronchioles as due to loss of elasticity of alveoli.
It is a type of chronic obstructive
pulmonary disease.
It is a progressive disease of lungs.
Enhancing Hip and Knee Arthroplasty Precision with Preoperative CT and MRI Im...Pristyn Care Reviews
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This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...Media Logic
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2. (Continued from previous page)
Conclusion and recommendation: Our study showed that both individual and community level determinants were
significantly associated with EBF practice. Based on our findings it is strongly recommended to promote and enhance
antenatal and postnatal care services utilization of mothers and more emphasis should be given for infants with comorbid
conditions and those who live in the pastoralist regions.
Keywords: Exclusive breastfeeding, Determinants, Under-six infants, Multi-level analysis, Ethiopia
Background
All necessary nutrients essential for survival, growth, and
development as well as immunologic, antimicrobial and
anti-inflammatory factors are obtained from breast milk
for the first six months of life [1, 2]. The World Health
Organization (WHO) defines exclusive breastfeeding
(EBF) as when ‘an infant receives only breast milk, no
other liquids or solids are given not even water, with the
exception of oral rehydration solution, or drops/syrups of
vitamins, minerals or medicines’ [3, 4]. World Health
Organization recommends EBF for the first six months of
life, followed by continued breast feeding with appropriate
complementary foods until two years and above [5]. Breast
feeding reduces the risk of acquiring gastrointestinal
(GIT) and respiratory tract infections. In later life it also
helps to prevent the risk of developing breast and uterine
cancer, obesity, osteoporosis, and type 2 diabetes mellitus
[4, 6, 7].
Globally in 2017 around 41% of under-six infants were
exclusively breastfed [8]. In low and middle income
countries, about 37% of infants were exclusively breast-
fed [7]. Studies also reported the magnitude of exclusive
breast feeding ranged from 19 to 65% in African context
[9–12]. In the globe more than 1.4 deaths were reported
due to non-exclusive breast feeding in the first six
months of life where 41% in SSA (sub-Saharan Africa)
and 34% in south Asia (SA) [3, 5, 8].
Improved breast feeding practices can save about 1.5
million infants each year [8]. EBF can prevent up to 61
and 63% of admission secondary to pneumonia and diar-
rheal diseases respectively. It can also decrease type 1
diabetes [6].
Breast feeding education and information during ante-
natal and postnatal visits were methods to improve ex-
clusive breast feeding [13]. In addition, implementation
of international code of breast milk marketing substi-
tutes, community based promotion and support, advo-
cacy, and training were also strategies to enhance EBF
exclusive breast feeding practices [1].
Even if the government of Ethiopia tried to promote
and implement exclusive breast feeding practice for in-
fants under six months of age but still there is poor im-
provement [14]. This could be due several contributing
factors including low level of educational status, maternal
employment, operative delivery, late initiation of breast
feeding, low antenatal and postnatal visits, increased pro-
duction of formula foods and poor counseling of mother
regarding EBF [10, 15–18]. Furthermore, EBF was also in-
fluenced by community level factors including place of
residence, contextual region, community level of maternal
education, community level of ANC and PNC utilization,
community level of employment, and community level of
media exposure [19–21].
Despite studies on exclusive breastfeeding practice
were done previously in different parts of Ethiopia, most
of them were focused on individual level factors using
basic logistic regression model covering limited areas
with small sample size [15–21]. But exclusive breast
feeding practice was influenced by both individual and
community level factors since the behavior of individual
towards EBF practice are not only attributed by individ-
ual factors but also by community level factors and indi-
vidual infants were nested within the communities. The
independence assumption among individuals within the
same cluster and the equal variance assumption across
clusters are violated in case of nested data. As EDHS
data has a hierarchical nature and violate the independ-
ent assumption of basic logistic regression, considering
clustering effect is preferred. Thus, this study aimed to
identify individual level and community level factors as-
sociated with exclusive breastfeeding practice among in-
fants under-six months of age using multilevel logistic
regression analysis.
Methods
Study setting
This study was done in Ethiopia, which is located in the
North Eastern part of Africa. Contextually, the country
is categorized as agrarian, pastoralists and city based
population. It has a total of 104,957,000 populations, of
which 36,296,657 were women [22]. Majority of the
population about, 83.6% living in rural areas and 16.7%
of the population reside in urban areas. The average
household size in national level is 4.7 persons [14, 23].
The country has fertility rate of 4.6, infant mortality rate
(per 1000 live births) of 48, and child mortality rate (per
1000 live births) of 67 [14].
Tsegaw et al. Italian Journal of Pediatrics (2021) 47:106 Page 2 of 13
3. Data source and population
This study used data from the 2016 EDHS (Ethiopia
Demographic and health survey) which was conducted
from January 18 to June 27, 2016. Thus, a community
based cross-sectional study was employed to identify in-
dividual level and community level factors affecting EBF
among under-six month infants [14].
The source populations for this study were all infants
under-six months of age living in Ethiopia and all infants
under-six months of age in the selected enumeration
areas during the data collection period were the study
population. Accordingly, a total of 1185 infants under
six months of age which fulfill the eligibility criteria were
included in the study using a stratified two stage cluster
sampling technique. Where, Enumeration areas (EAs)
and households were the primary and secondary sam-
pling units respectively. The detail sampling procedure
was published elsewhere [14, 24].
We extracted the outcome and explanatory variables
from the EDHS 2016 kids data after getting permission
from Measure DHS International Program. A structure
and pretested questionnaire was used for data collection
during the survey. Comprehensive information about the
2016 EDHS data collection procedure has been found
elsewhere [14, 24, 25].
Variables of the study and operational definition
The outcome variable of the study was Exclusive Breast-
feeding (EBF) among under-six month infants in Ethiopia.
Infant related variables (Age of the infant¸ sex of the in-
fant, birth order, birth weight, birth interval, infant comor-
bidities, and time of breastfeeding initiation), Maternal
socio-demographic variables (Age of the mother, marital
status, educational status of mother, occupational status of
mother, house hold wealth index, media exposure, num-
ber of under-five children, and household family size), and
Obstetric and Health care associated variables (ANC
utilization, PNC utilization, place of delivery, mode of de-
livery, delivery assistance, and parity) were individual level
predictors of the study. In addition, community level vari-
ables included in the study were place of residence, con-
textual region, community media exposure, community
wealth index, community women education, community
ANC utilization, community level of employment, and
community PNC utilization.
The World Health Organization (WHO) defines exclu-
sive breastfeeding (EBF) as when ‘an infant receives only
breast milk, no other liquids or solids are given not even
water, with the exception of oral rehydration solution, or
drops/syrups of vitamins, minerals or medicines’ [4]. It
was measured using a 24-h recall among mothers with
infants under 6 months of age [4].
In this study, infant comorbidities was generated by ag-
gregating variables (diarrhea, cough, fever, and shortness
of breath of infants under six months of age) in the last
two weeks preceding the survey, subsequently if at least
one of the comorbid was found the response coded as
“Yes” otherwise the response coded as “No”. Occupational
status of mother was generated by using occupation of the
respondent and categorized as currently working (includes
all types of work) and currently not working.
Community level variables were generated by aggregat-
ing the individual characteristics in a cluster since EDHS
did not collect data that can directly describe the charac-
teristics of the clusters except place of residence. The ag-
gregates were computed using the proportion of a given
variables’ subcategory. Since the aggregate value for all
generated variables not normally distributed, it was cate-
gorized into groups based on the national median values
and based on previous related studies [24, 25].
Community ANC utilization was the proportion of
mothers within specific cluster who visited ANC for
some number of times. It was categorized using national
level quartiles in to low ANC utilized community
(when≤25% of women are utilizing ANC), middle (when
25–75% of women are utilizing ANC), and high (when
> 75% of women are utilizing ANC) [25].
Community level of PNC utilization was the propor-
tion of women within specific cluster who visit PNC for
some number of times. It was categorized as low
(when≤50% of women utilized PNC) and high (when>
50% of women utilized PNC) [25].
Community level of media exposure was an aggregate
respondent level of exposure for different types of media
categorized as “<25% = Low”, “25%-50% = Moderate”
and “>50% = high media utilized communities” [25].
Community level of poverty was an aggregate wealth
index categorized as “<25% = High”, 25–50% = Moder-
ate” and “>50% = Low poverty communities” [25].
Contextual region Ethiopia is demarcated for ad-
ministrative purpose into 11 regions, which are classi-
fied as agrarian, pastoralist and city based according
to the living status of the population. The regions
Tigray, Amhara, Oromia, SNNP, Gambella, and
Benshangul Gumuz were categorized as agrarian. So-
mali and Afar regions were grouped to form pastoral-
ist region and Harari region, Addis Ababa and Dire
Dawa city administrations were grouped to form city
based populations [14, 25].
Community level of women education was the proportion
of women in the community who have primary or higher
education, which was categorized as low (when≤25% of
women were educated), middle (when 25–75% of women
were educated) and high ((when > 75% of women were edu-
cated) [25].
Community level of employment status was the pro-
portion of women who were employed (had work) in the
specific cluster. It was categorized as low (when≤50% of
Tsegaw et al. Italian Journal of Pediatrics (2021) 47:106 Page 3 of 13
4. mothers employed) and high (when> 50% of mothers
were employed) [24, 25].
Data management and analysis
Data cleaning was done to check for consistency. Sample
weight was used in order to compensate for the unequal
probability of selection between the strata that were geo-
graphically defined, as well as for non-responses. Weighing
of individual interview produces the proper representation of
exclusive breastfeeding and related factors. Coding, recoding
and exploratory analysis was performed. Categorization was
done for continuous variables using information from differ-
ent literatures and re-categorization was done for categorical
variables accordingly. For data analysis STATA version 14.1
was used. Descriptive statistics was used to present frequen-
cies, with percentages in tables and using texts.
Four models were considered in the multilevel analysis
to determine the model that best fits the data; Model
one (Null model) without explanatory variable was de-
veloped to evaluate the null hypothesis that there is no
cluster level difference in exclusive breast feeding prac-
tice that specified only the random intercept and it pre-
sented the total variance in exclusive breastfeeding
practice among clusters. Model two adjusted for individ-
ual variable which assume cluster level difference of ex-
clusive breastfeeding practice is zero. Model three to
evaluate community level factors by aggregate cluster
difference of exclusive breastfeeding practice. Model four
included both adjusted individual and community level
factors.
The log of the probability of Exclusive breast feeding
was modeled using two-level multilevel model as follows
[26, 27]:
Log
Πij
1−Πij
¼ β0 þ β1 Xij þ B2 Zij þ μj þ eij
Where, i and j are the level 1 (individual) and level 2
(community) units, respectively; X and Z refer to indi-
vidual and community-level variables, respectively; πij is
the probability of exclusive breastfeeding for the ith
in-
fant in the jth
community; the β’s is the fixed coefficients.
Whereas, β0 is the intercept-the effect on the probability
of exclusive breastfeeding use in the absence of influence
of predictors and uj showed the random effect (effect of
the community on exclusive breastfeeding) for the jth
community and eij showed random errors at the individ-
ual levels. By assuming each community had different
intercept (β0) and fixed coefficient (β), the clustered data
nature and the within and between community varia-
tions was taken in to account.
Multilevel logistic regression analysis was used to
analyze the data since it is appropriate for DHS data as it
had a hierarchical nature. Multilevel modeling was
providing unexplained variation in exclusive breast feeding
due to unobserved cluster factors called random effect. All
models included a random intercept at the cluster level to
capture the heterogeneity among clusters.
The measures of association (fixed-effects) estimate
the association between likelihood of infants to exclu-
sively breast feeding as the AOR with 95% CI of various
explanatory variables were expressed. The crude associ-
ation between independent variables and dependent
variable was done independently and variables having
p ≤ 0.2 in Bi-variable analysis were used to select to fit
multivariable analysis model. At multivariable analysis
variables with p ≤ 0.05 with confidence interval not in-
cluding the null value (OR = 1) were considered as statis-
tically significant variables with EBF practice.
The measures of variation (random-effects) were re-
ported using Intra-cluster correlation (ICC), Median Odds
Ratio (MOR) and Proportional Change in Variance (PCV).
ICC was used to explain cluster variation while MOR is a
measure of unexplained cluster heterogeneity [27]. The
ICC shows the variation in exclusive breastfeeding of in-
fants under-six months of age due to community charac-
teristics. The higher the ICC (ICC 5%), the more
relevant was the community characteristics for under-
standing individual variation in exclusive breastfeeding of
infants. The ICC can be calculated as follows:
[ICC= δ2
u
δ2
uþδ2
e
] where δ2
u = between group variation,
δ2
e = with in group variation OR [ICC= δ2
δ2þπ2
3
], where δ2
is the estimated variance of clusters [26]. The STATA
software command can also compute the ICC value of
each model.
MOR is defined as the median value of the odds ratio
between the area at highest likelihood and the area at low-
est likelihood of exclusive breastfeeding when randomly
picking out two areas and it measures the unexplained
cluster heterogeneity; the variation between clusters by
comparing two persons from two randomly chosen differ-
ent clusters. MOR can be calculated using the formula
[MOR = exp.(
ffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
2xδ2
þ 0:6745
p
) ≈ exp(0.95δ)] [26].
In this study MOR shows the extent to which the indi-
vidual probability of being exclusively breast fed is deter-
mined by residential area. The proportional change in
variance [PCV= (VA − VB)/VA) *100] where VA = Vari-
ance of initial model and VB=Variance of model with
more terms measures the total variation attributed by in-
dividual level and community level factors in the multi-
level model [26]. PCV was computed for each model
with respect to the empty model as a reference to show
power of the factors in the model explains exclusive
breastfeeding practice.
Log likelihood test, Deviance Information Criteria
(DIC) and Akaike Information Criteria (AIC) were used
Tsegaw et al. Italian Journal of Pediatrics (2021) 47:106 Page 4 of 13
5. to estimate the goodness of fit of the adjusted final
model in comparison to the preceding models (individ-
ual and community level models), the model with the
highest value of Log likelihood test and with lowest
values of DIC and AIC was considered to be the best fit
model.
We have checked the presence of multi-collinearity
between explanatory variables using standard Error (SE),
Variance inflation factor (VIF), variance correlation esti-
mator (VCE) and goodness of fit (gof). VIF 7.5, VCE
0.8, gof 0.05, and SE in the range ± 2 were considered
as no multicollinearity among independent variable. All
of the results showed that no multicollinearity among
independent variables.
Ethical consideration
Ethical clearance was obtained from the Ethical Review
Committee of College of Medicine and Health Sciences,
Wollo University with approval and supporting letter. Per-
mission to access the data set was obtained from Measure
DHS International Program. The data was only used for
purpose of this study and not shared to the third party.
All data used in this study were anonymous publicly avail-
able and aggregated secondary data with not having any
personal identity. The data was fully available in the full
DHS website (www.measuredhs.com).
Results
Infant characteristics
A total of 1092 infants under six months of age were in-
cluded in the 2016 EDHS survey. But after weighting the
sample size became 1185, and all of them were included
in the analysis. The mean age of respondents was 2.54
months (SD ± 0.51). The highest proportion of infants,
about 418(35.26%) were in the age group of 4–5 months
and 605(51.07%) were females. Regarding breast feeding
initiation majority, about 817 (68.95%) of the infants
were initiated breastfeeding immediately after birth
(Table 1).
Maternal socio-demographic and socioeconomic factors
Among 1185 infants under six months in 2016 EDHS
survey, the highest proportion, about 573 (48.41%) of
the mothers were in the age group of 25–34 years old.
Regarding educational status of the mothers, more than
half, 698(60.9%) of them had no formal education. Simi-
larly majority of mothers, about 1141(96.3%) of them
were in marital union at the time of the survey.
Table 1 Characteristics of infants under six months of age in Ethiopia, 2016 (N = 1185)
Variables Categories Weighted
frequency
(%)
EBF prevalence
No (%) Yes (%)
Age of infant 0–1 month 388 (32.78) 101 (25.78) 288 (74.22)
2–3 months 378 (31.96) 136 (35.89) 243 (64.11)
4–5 months 418 (35.26) 267 (64.02) 150 (35.98)
Sex of infant Male 580 (48.93) 248 (42.75) 331 (57.25)
Female 605 (51.07) 255 (42.14) 350 (57.85)
Birth interval No previous birth 278 (23.43) 137 (49.28) 141 (50.71)
24 months 118 (9.92) 53 (45.29) 64 (54.71)
≥24 months 790 (66.65) 314 (39.74) 476 (60.26)
Birth order First 278 (23.43) 137 (49.45) 141 (50.54)
2–3 335 (28.27) 131 (39.10) 204 (60.89)
4+
572 (48.29) 236 (41.25) 336 (58.74)
Infant Comorbidities* Yes 296 (24.99) 162 (54.72) 134 (45.27)
No 885 (74.64) 342 (38.64) 543 (61.36)
TimeofBF initiation** Immediatelyafter birth 817 (68.95) 317 (38.80) 500 (61.20)
Within hours 284 (23.92) 126 (44.36) 158 (55.64)
Within days 60 (5.06) 36 (60.00) 24 (40.00)
Birth weight Low 24 (2.02) 14 (58.34) 10 (41.66)
Normal 165 (13.93) 69 (41.82) 96 (58.18))
Macrosomia 21.27 (1.80) 10 (47.62) 11 (52.38)
Didn’t weighted 841 (70.97) 365 (43.40) 476 (56.6)
Don’t know 134 (11.24) 46 (34.32) 88 (65.68)
* Infant comorbidities missing (N = 4), **Breast feeding initiation missing (N = 24)
Tsegaw et al. Italian Journal of Pediatrics (2021) 47:106 Page 5 of 13
6. More than half of mothers about, 738(62.28%) of them
were not working and about 781(65.91%) of them had
no media exposure about EBF. The highest proportion
of mothers, about 291(24.56%) of them were from the
poorest house hold wealth index (Table 2).
Obstetric and health care related factors
Regarding antenatal care visit the majority, about
770(64.95%) of mothers had ANC visit. Similarly more
than half of mothers, about 732(61.8%) of them were de-
livered at home. About 35 (2.95%) of mothers were de-
livered by caesarian section and more than half of
mothers 74(6.23%) had PNC visit in the last 2 months
before the survey (Table 3).
Community level factors
In our study, most of the respondents, about 1048(88.44%)
of them were rural residents and about 1086(91.66%) of
them were from agrarian regions. The highest proportion,
about 495(41.77%) of respondents were from low poverty
level of the community and about 840(70.89%) of them had
low community media utilization. Regarding community
postnatal care utilization about, 1168 (98.56%) of the mothers
had low community postnatal care utilization. Similarly ma-
jority of the mothers, about 840 (70.85%) and 838(70.73%) of
them belongs to low community educational level and low
community employment status respectively (Table 4).
In this study the prevalence of exclusive breastfeeding
among infants under-six months of age was 58% with
95% CI of (54.6, 60.2).
Individual and community level determinants of exclusive
breastfeeding practice
Fixed effects (measures of association)
Bi-variable multilevel logistic analysis computed and p-
value up to 0.2 was selected to fit multi-variable multi-
level logistic regression model to control confounding.
Accordingly, Age of infant, sex of infant, birth weight,
birth interval, birth order, infant comorbidities, breast-
feeding initiation, marital status, maternal occupation,
maternal education, household family size, number of
under-five children, wealth index, parity, ANC visit,
Table 2 Maternal socio-demographic and socioeconomic characteristics in Ethiopia, 2016 (n = 1185)
Variables Categories Weighted
frequency
(%)
EBF prevalence
No (%) Yes (%)
Age of the mother (years) 15–24 397 (33.49) 166 (41.81) 231 (58.19)
25–34 573 (48.41) 246 (42.85) 328 (57.15)
35–49 215 (18.11) 92 (42.99) 122 (57.01)
Marital status Not in union 44 (3.70) 22 (50.00) 22 (50.00)
Currently in union 1141 (96.30) 482 (42.24) 659 (57.76)
Maternal education No formal education 698 (60.96) 298 (42.69) 400 (57.31)
Primary 368 (31.01) 152 (41.30) 216 (58.70)
Secondary and above 119 (10.07) 54 (45.37) 65 (54.63)
Maternal occupation Currently Not working 738 (62.28) 332 (44.98) 406 (55.01)
Currently Working 447 (37.72) 172 (38.47) 275 (61.53)
household family size 5 312 (26.31) 130 (41.66) 182 (58.34)
5–6 401 (33.87) 153 (38.15) 248 (61.85)
7–8 320 (27.03) 150 (46.88) 170 (52.12)
≥9 152 (12.78) 70 (46.35) 81 (53.65)
Number of under five children 0–1 401 (33.87) 168 (41.89) 233 (58.10)
2 504 (42.52) 203 (40.27) 301 (49.73)
3 278 (23.61) 133 (47.50) 147 (52.50)
Wealth index Poorest 291 (24.53) 131 (45.01) 160 (54.09)
Poorer 277 (23.40) 101 (36.46) 176 (63.54)
Middle 217 (18.35) 98 (45.16) 119 (54.84)
Richer 215 (18.18) 114 (52.77) 102 (47.23)
Richest 184 (15.53) 61 (33.15) 123 (66.84)
Media exposure No 781 (65.92) 324 (41.48) 457 (58.51)
Yes 404 (34.08) 180 (44.55) 224 (55.45)
Tsegaw et al. Italian Journal of Pediatrics (2021) 47:106 Page 6 of 13
7. caesarian delivery, PNC visit, residence, contextual re-
gion, community ANC utilization, community PNC
utilization, community media exposure, community level
of poverty, community level of employment status and
community level of women education pass Bi-variable
multilevel logistic regression model at p value≤0.2.
Four models were fitted hierarchically in this multi-level
logistic regression analysis. Model one or Null model
(without predictors), model two (only individual level fac-
tors), model three (only community level factors) and
model four (both individual and community level factors).
Finally, p-value ≤0.05 and odds ratio not including the null
Table 3 Maternal Obstetric and health care related characteristics in Ethiopia, 2016 (n = 1185)
Variables Categories Weighted
N (%)
EBF prevalence
No (%) Yes (%)
Parity Nulliparous 278 (23.43) 137 (49.3) 141 (50.7)
Multiparous 907 (76.57) 367 (40.46) 540 (59.53)
ANC visit* No 412 (34.80) 195 (47.33) 217 (52.67)
Yes 770 (64.95) 309 (40.12) 461 (59.87)
Place of delivery Home 732 (61.80) 318 (43.44) 414 (56.56)
Health institution 453 (38.20) 186 (41.05) 267 (58.95)
Caesarian delivery No 1150 (97.06) 486 (42.26) 664 (57.74)
Yes 35 (2.94) 18 (51.42) 17 (48.58)
Delivery assistance Professionals 741 (62.52) 323 (43.58) 418 (56.42)
TBAs 444 (37.48) 181 (40.76) 263 (59.23)
PNC visit No 1111 (93.77) 465 (41.85) 646 (58.15)
Yes 74 (6.23) 39 (52.70) 35 (47.29)
*ANC follow up missed (N = 3)
Table 4 Community level determinants of Exclusive breast feeding in Ethiopia, 2016 (N = 1185)
Variables Categories Weighted
frequency
N (%)
EBF prevalence
No (%) Yes (%)
Residence Urban 137 (11.56) 58 (42.33) 79 (57.67)
Rural 1048 (88.44) 446 (42.55) 602((57.45)
Contextual region Agrarian 1086 (91.66) 451 (41.52) 635 (58.47)
Pastoralist 65 (5.50) 38 (58.46) 27 (41.54)
City based 34 (2.84) 15 (44.11) 19 (55.89)
Community ANC utilization Low 253 (21.37) 109 (43.09) 144 (56.91)
Moderate 719 (60.70) 304 (42.29) 415 (57.71)
High 213 (17.93) 112 (43.07) 148((56.92)
Community PNC utilization Low 1168 (98.56) 498 (42.63) 670 (57.37)
High 17 (1.44) 6 (35.30) 11 (64.70)
Community poverty level High 344 (29.01) 143 (41.70) 200 (58.30)
Moderate 346 (29.22) 149 (43.06) 197 (56.93)
Low 495 (41.77) 211 (42.63) 284 (57.37)
Community media utilization Low 840 (70.89) 346 (41.19) 494 (58.80)
Moderate 217 (18.29) 96 (44.23) 121 (55.76)
High 128 (10.82) 63 (49.22) 65 (50.78)
Community women Low 840 (70.85) 359 (42.73) 481 (57.26)
education Moderate 244 (20.62) 90 (36.89) 154 (63.11)
High 101 (8.52) 55 (54.45) 46 (45.54)
Community maternal employment status Low 838 (70.73) 377 (44.99) 461 (55.01)
High 347 (29.27) 127 (36.70) 220 (63.40)
Tsegaw et al. Italian Journal of Pediatrics (2021) 47:106 Page 7 of 13
8. value (OR = 1) was used to select variables which had sta-
tistically significant association with EBF practice in the
final model.
As shown in Table 5 below, our study finding showed
that age of infants, sex of infants, infant comorbidities,
wealth index, antenatal care visit, contextual region,
community postnatal care visit and community level of
employment status were statistically significant determi-
nants of exclusive breastfeeding in the final model.
Age of the infant was negatively associated with exclu-
sive breastfeeding. Those infants whose age group was
between 2 and 3 months were 60.9% [AOR = 0.39, 95%
CI: (0.23, 0.65)] and 4–5 months were 95.8% [AOR =
0.04, 95% CI: (0.02, 0.07)] less likely to exclusive breast-
feed as compared to infants whose age was up to one
month.
Sex of the infant was significantly associated with EBF.
Female infants were 2.5 [AOR = 2.51, 95% CI: (1.61,
3.91)] times more likely to exclusively breastfeed as com-
pared to male infants.
Infant comorbidities were negatively associated with
EBF. Those infants who had comorbidities were 66%
[AOR = 0.34, 95%CI: (0.21, 0.57)] less likely to exclu-
sively breastfeed as compared to infants who had no
comorbidities.
Household wealth index was positively associated with
exclusive breastfeeding. Those infants from richest fam-
ily wealth index were 10 times [AOR = 10.34, 95% CI:
(4.407, 56.54)] more likely exclusive breastfeeding as
compared to those infants from the poorest family
wealth index.
Maternal antenatal visit was also positively associated with
exclusive breastfeeding. Those infants whose mothers had
ANC visit were 2.25 times [AOR = 2.25, 95%CI: (1.323,
3.82)] more likely to exclusively breastfeed compared to
those infants whose mothers had no ANC visits.
Contextual region was significantly associated with exclu-
sive breastfeeding practice. Consequently, infants who live in
pastoralist regions were 70% less likely to exclusively breast-
feeding [AOR = 0.30, 95% CI: (0.104, 0.86)] as compared to
those infants who live in the agrarian regions.
Community level of postnatal care utilization was sig-
nificantly associated with exclusive breastfeeding. As a
result, those infants who live in community who had
high level of PNC utilization were 2.8 [AOR = 2.77, 95%
CI: 1.26, 6.58)] times more likely to exclusively breast-
feed compared to infants with live in community who
had low level of PNC service utilization.
Community level of employment status was positively as-
sociated with exclusive breastfeeding practice. Thus, infants
who live in community with high level of employment were
2.8 [AOR = 2.81, 95% CI: (1.20, 6.47)] times more likely to
exclusive breastfeed compared to those infants who live in
community with low level of employment.
Random effects (measures of variation)
This study also aimed to show if the characteristics of
the clusters where under- 6 infants resided would have
an effect on exclusive breastfeeding practice. Model with
lowest DIC, the lowest AIC and the highest log likeli-
hood ratio was selected which was model four that bet-
ter explain exclusive breastfeeding practice. At the
empty model, the ICC was 0.141 (ICC 5%) and the
variance was 0.54 with 95% CI: 0.25–0.75) at p-value of
0.001, which indicates about 14.1% of the variation in
exclusive breastfeeding was linked to community-level
factors and there was a significant variation in exclusive
breastfeeding practice across the communities (clusters).
The full model, after adjusting for individual and com-
munity level factors, showed that the variation in exclu-
sive breast feeding across communities remained
statistically significant (ICC = 8.77% and variance = 0.32).
In this study, the full model showed up with higher
PCV; that is, 46.8% of variation of exclusive breastfeed-
ing was explained by the combined factors at the indi-
vidual and community levels. The median odds ratio of
the null model (MOR = 2.01) and the final model
(MOR = 1.71) were significant. The MOR at a cluster
where high proportion of non- exclusive breastfeeding
was 2.01 times higher compared to a cluster with low
proportion of non- exclusive breastfeeding at the null
model, whereas the MOR at a cluster where high pro-
portion of non-exclusive breastfeeding was 1.71 times
higher compared to a cluster with low proportion of
non- exclusive breastfeeding at the final model. This in-
dicates that 0.3 (30%) of the heterogeneity was explained
by both individual and community level factors, but still
there is residual effect not explained by individual and
community level variables at the final full model
(MOR = 1.71) (Table 6).
Key
Model 1 (null model) = without independent variables,
Model 2 = only individual level variables, Model 3 = only
community level variables, Model 4 = both individual
and community level variables, PCV = proportional
change in variance, ICC = intra class correlation, MOR =
median odds ratio, AIC = Akaike Information Criteria,
DIC = Deviance information criteria.
Discussion
Age of the infant was negatively associated with exclusive
breastfeeding. This finding was similar with studies done in
Bahir Dar, Hawassa, Jigjiga, Zimbabwe and India [19, 20, 25,
28, 29]. The possible justification could be as age of the in-
fant increases mothers initiate additional food due to the per-
ception that breast milk alone is not enough to meet water
and nutritional demands of their infants. Another possible
explanation may be related with the perception of mothers
Tsegaw et al. Italian Journal of Pediatrics (2021) 47:106 Page 8 of 13
9. Table 5 Multilevel logistic regression analysis of both individual and community level factors associated with exclusive breastfeeding among
infants under 6 months of age in Ethiopia, 2016 (N = 1185)
Variables Categories Model one Model two
AOR (95%CI)
Model three
AOR (95%CI)
Model four
AOR (95%CI)
Age of infant 0–1 month 1 1
2–3 months 0.34 (0.21,0.56)*** 0.39 (0.23, 0.65) ***
4–5 months 0.05 (0.02,0.08)*** 0.042(.02, 0.07) ***
Sex of infant Male 1 1
Female 2.43 (1.61,3.65) *** 2.51 (1.61, 3.91) ***
Birth interval No previous birth 1 1
24 months 4.27 (1.36, 13.39)* 3.44 (0 1.19, 9.92)
= 24 months 2.73 (1.00, 7.41) 1.84 (0.74, 4.54)
Birth order First 1 1
2–3 2.71 (0.99, 7.34) 1.821 (0.15, 2.86)
4+
3.32 (0.93,11.87) 1.46 (0.97, 2.18)
Infant comorbidities No 1 1
Yes 0.34 (0.19, 0.56)*** 0.35 (0 .21, 0.57)***
Time of BF initiation Immediately after birth 1 1
Within hours 1.05 (0.63, 1.76) 1.96 (0 .68, 5.65)
Within days 0.57 (0.19, 1.71) 2.02 (0 .66, 6.15)
Birth weight Low 1 1
Normal 4.40 (0.67,28.74) 2.91 (0.49, 17.20)
Macrosomia 2.72 (0.23, 31.39) 2.28 (0.21, 24.30)
Didn’t weighted 2.64 (0.39, 17.77) 1.86 (0.30, 11.49)
Don’t know 2.05 (0.30, 13.95) 1.67 (0 .271, 10.360)
Marital status Not in union 1 1
Currently in union 2.36 (0.93, 6.04) 1.98 (0.75, 5.21)
Maternal education No formal education 1 1
Primary 1.18 (0.64, 2.17) 1.50 (0.84, 2.70)
= Secondary 0.50 (0.15,1.66) 0.90 (0.30, 2.69)
Maternal occupation Currently not working 1 1
Currently Working 0.58 (0.32,1.02) 0.65 (0 .37, 1.12)
Number of household members 5 1 1
5–6 2.20 (1.11,4.36) 0.84 (0 .36, 1.97)
7–8 0.61 (0.26,1.42) 1.27 (0.623, 2.60)
= 9 1.16 (0.427,3.16) 0.48 (0.23, 0.96)
Number of under five children 0–1 1 1
2 1.052 (0.49,2.22) 1.65 (0.72, 3.82)
= 3 0.876 (0.36,2.09) 1.52 (0 .86, 2.69)
Wealth index Poorest 1 1
Poorer 1.99 (1.01, 3.93)* 1.72 (0.90, 3.31)
Middle 1.33 (0.58, 3.05) 1.37 (0 .61, 3.07)
Richer 0 .90 (0.34,2.36) 0.94 (0.37, 2.39)
Richest 15.79 (4.2, 59.39)*** 10.34 (3.14, 34.03)***
Parity Nuliparous 1 1
Multiparous 1.61 (1.11, 2.33)* 2.21 (0.95, 5.11)
ANC visit No 1 1
Tsegaw et al. Italian Journal of Pediatrics (2021) 47:106 Page 9 of 13
10. that breast milk production decreased through time which is
not sufficient for the growth of the infant alone. In addition,
it could be related with poor knowledge of mothers about
the importance of exclusive breastfeeding and the adverse
consequences of initiation of complementary feeding before
six months of age. Furthermore this could be related that
employed mothers returned back to their work as the age of
the infant increases which have no enough time to exclusive
breastfeeding their infants [19, 20, 25, 28].
Sex of the infant was also one of the individual level
factors significantly associated with exclusive breastfeed-
ing. Being female infants was positively associated with
Table 5 Multilevel logistic regression analysis of both individual and community level factors associated with exclusive breastfeeding among
infants under 6 months of age in Ethiopia, 2016 (N = 1185) (Continued)
Variables Categories Model one Model two
AOR (95%CI)
Model three
AOR (95%CI)
Model four
AOR (95%CI)
Yes 2.75 (1.53, 4.94)** 2.25 (1.32, 3.82)**
Caesarian delivery No 1 1
Yes 0.53 (0.14, 2.04) 0.47 (0 .128, 1.73)
PNC visit in 2 months No 1 1
Yes 0.10 (0.03, 0.30) * 0.15 (0 .054, 1 .45)
Residence Urban 1 1
Rural 0.85 (0.36, 2.027) 3.414 (0 .82, 14.109)
Contextual region Agrarian 1 1
Pastoralist 0.38 (0.17, 0.85)* 0.30 (0 .10, 0.86)*
City based 0.99 (0.32 3.00) 0.56 (0 .12, 2.52)
Community ANC utilization Low 1 1
Moderate 0.97 (0.51, 1.87) 1.07 (0 .56, 2.02)
High 1.09 (0.46, 2.56) 1.30 (0 .62, 2.71)
Community PNC utilization Low 1 1
High 1.42 (0.34, 5.97) 2.77 (1.26, 6.58)*
Community poverty level High 1 1
Moderate 0.79 (0.39, 1.60) 0.97 (0.33, 2.84)
Low 0.83 (0.42,1.62) 0.99 (0.31, 3.10)
Community media utilization Low 1 1
Moderate 0.83 (0.45, 1.53) 0.86 (0 .351, 2.13)
High 0.60 (0.26, 1.42) 0.84 (0.23, 3.02)
Community women education Low 1
Moderate 1.16 (0.63, 2.14) 1.13 (0 .454, 2.83)
High 0.52 (0.22,1.21) 0.53 (0.13, 2.06)
Community employment status Low 1 1
High 1.536 (0.91, 2.59) 2.81 (1.207, 6.47)*
Model one: empty model, CI Confidence interval, AOR adjusted odds ratio, 1: Reference category *p 0.05 **p 0.01 ***p 0.001
Table 6 Measure of variations and model fitness
Characters Model 1 Model 2 Model 3 Model 4
Random effect Variance 0.54 0.45 0.31 0.32
Measure of variation ICC 14.08% 12.13% 8.64% 8.77%
PCV Reference 20.77% 42.3% 46.8%a
MOR 2.01 1.83 1.69 1.71a
Model diagnostics Log-likelihood − 750.82 − 593.21 −745.80 − 571.89a
DIC 1501.64 1186.42 1491.6 1183.78a
AIC 1505.64 1248.41 1511.60 1235.77a
a
Model four is selected based on fitted statistics of log-likelihood ratio
Tsegaw et al. Italian Journal of Pediatrics (2021) 47:106 Page 10 of 13
11. exclusively breastfeeding. The finding was consistent
with studies done in Kenya, Cameroon, Angola and
Ghana [10, 30–32]. The study showed that female in-
fants were more likely to be exclusively breastfed com-
pared to male infants i.e. male infants were more likely
to start complementary feeding earlier compared to fe-
males. This may be related with the perception that
breast milk alone does not meet their nutritional re-
quirements and the belief that male infants have more
voracious appetite and needs additional food intake than
female infants that leads early initiation of complemen-
tary foods for male infants. The other reason may be the
belief that female infants were considered as good breast
suckers so breast milk alone may be enough to satisfy
their feeding requirement so that additional feeding may
not be initiated early [10, 30, 33].
Infant comorbidity was negatively associated with ex-
clusive breastfeeding. This is concurrent with studies
done in Bahr-Dar [34] and Egypt [9] that showed infants
with comorbidities were less likely to be exclusively
breastfed compared to healthy infants. The possible jus-
tification might be when the infant became sick; mothers
may perceive that additional diet is essential to boost the
energy and immunity of the infant. Furthermore, they
also perceive additional foods may also be used as treat-
ment option for the sick infant [9]. This implies that
close follow up of the sick infant is essential to improve
exclusive breastfeeding.
Similarly, household wealth index showed positive as-
sociation with exclusive breastfeeding. This is similar
with studies done in Ghana, India and Australia [17, 20,
35]. The possible reasons may be increased uptake of
breastfeeding related information and better skills in ne-
gotiating flexible work place hours even can stay at
home that creates opportunities for exclusive breastfeed-
ing [20]. Similarly, the low practice of exclusive breast-
feeding among the poorest wealth index could be related
with poor awareness of EBF practice, stressful living situ-
ation to overcome the hardship of living. In addition, it
can also be suggested that mothers from the poorest
wealth index group might consider themselves as produ-
cing inadequate breast milk to satisfy their infant’s de-
mand that makes them to initiate additional foods [17].
Thus, mothers in the richest wealth index families do
not need to go work during lactation so they have
enough time to breastfeed their infants [36].
Among individual level factors, maternal antenatal
care visit was also positively associated with exclusive
breastfeeding. This finding was concurrent with studies
done in India, Ghana, and different parts of Ethiopia [17,
19–21, 30, 37]. The possible justification could be that
antenatal visit is the appropriate time of breastfeeding
education and information that may improve exclusive
breastfeeding later after birth of the infant. Accordingly,
breastfeeding counseling during antenatal periods sig-
nificantly improves exclusive breastfeeding practice [19,
25, 37]. This implies that antenatal care coverage must
be enhanced accordingly in order to improve exclusive
breastfeeding practice.
Contextual region, community level of PNC utilization
and community level of employment status were com-
munity level variables showed statistically significant
with EBF practice among infants under- six months of
age in Ethiopia.
In this study contextual region was significantly associ-
ated with EBF practice. Infants who live in pastoralist
regions were less likely to exclusive breastfeeding as
compared to infants found in agrarian regions. The re-
gional variation of exclusive breastfeeding was also
observed in previous studies Ghana [17] and Malawi
[38]. The variation in this study could be related that
pastoralists were not well informed about the import-
ance of exclusive breastfeeding due to the weak health
care system and low women empowerment in the area.
In addition, pastoralists have mobile type of life style so
they might not give attention for exclusive breastfeeding
of their infants rather they may initiate cow milk early
[25]. Furthermore, there may be regional differences in
some background characteristics such as culture, reli-
gion, living condition, availability and accessibility of ma-
ternal and child health services.
Community level of post natal care utilization was posi-
tively associated with exclusive breastfeeding practice. This
finding was concurrent with studies done in India, Ghana,
and different parts of Ethiopia [16, 17, 19, 37, 39]. The pos-
sible explanation may be that post natal care utilization is the
best opportunity to increase knowledge and attitude of
mothers towards exclusive breastfeeding through counseling
and health education since it is the appropriate period of
counseling and educating mothers about essential feeding
practices including exclusive breastfeeding. Thus, as the
number of women who visited post natal care in the com-
munity increases the more likely to practice exclusive breast-
feeding [18, 19].
In the current study, community level of maternal employ-
ment status was positively associated with exclusive breast-
feeding practice. This may be due to the reason that
employed community was at higher educational level that
lead them to have good information exchange about benefits
of exclusive breast feeding through different media. In
addition, arrangement of breastfeeding time for the em-
ployees was one of the alarming mechanisms that may lead
to improve exclusive breast feeding. The other reason may
be that promotion and implementation of maternity leave
according to international labor organization conventions
and support of working mothers to exclusively breastfeed
until 6 months of age [40]. But this finding is contrary to
studies done in Bahir Dar [34], Hawassa [28], Tanzania [41],
Tsegaw et al. Italian Journal of Pediatrics (2021) 47:106 Page 11 of 13
12. and Australia [20]. This may be due to the reason that stud-
ies might be done before the implementation of proclama-
tions for maternal leave and they may also use breast milk
substitutes early before six months to compensate infant
feeding during working time.
The study used nationally representative data and con-
ducted using multilevel approach to identify individual
and community level determinants of exclusive breast-
feeding that provided information to design interven-
tions strategies at the respective levels. Appropriate
estimation adjustments like weighting and accounting
for sample design were applied for analysis in order to
represent national population. In spite of its strengths,
this study has its own limitations. The data used for this
analysis was from a cross sectional survey, consequently
only associations were examined and it was difficult to
draw conclusion about causality and it also brought re-
call bias. This study used 24 h recall method to measure
exclusive breastfeeding and also the participants were in-
fants under 6 months of age, no evidence to continue ex-
clusive breastfeeding after the survey. In addition, this
study was limited only to the variables collected by
EDHS; some important variables were not included like
health status of the mother, maternal knowledge and at-
titude towards exclusive breastfeeding. Furthermore,
community level factors of exclusive breastfeeding were
not addressed previously that makes difficult to compare
and contrast the study findings.
Conclusion
In this study, both individual and community level vari-
ables were significantly associated with exclusive breast-
feeding among infants under-six months in Ethiopia.
Thus, age of the infants, sex of the infants, infant comor-
bidities, wealth index and antenatal care visit were indi-
vidual level factors significantly associated with exclusive
breastfeeding. Accordingly, being female sex, higher
house hold wealth index, and ANC visit associated with
increased exclusive breastfeeding practice, whereas, age
of the infant and infant comorbidities showed negative
association with exclusive breastfeeding. Contextual re-
gion, community level of PNC utilization and commu-
nity level of employment status were community level
variables showed statistical significant association with
exclusive breastfeeding. Thus, infants from higher level
of community PNC utilization and employment status
associated with increased exclusive breastfeeding,
whereas, infants from pastoralist region were less likely
to exclusive breastfeeding.
Implications of the study
Exclusive breastfeeding is one of the core indicators of infant
and young child feeding, among strategies of reducing infant
mortality and morbidity. It determines future growths and
developments of the infants both in physical and mental.
The study demonstrates that addressing individual and com-
munity level factors associated with exclusive breast feeding
practice through policies and programs was essential to im-
prove exclusive breastfeeding practice. Therefore, emphasis
should be given on encouraging women to have ANC and
PNC follow ups, where they may get information and educa-
tion that will improve exclusive breastfeeding. The infants
with comorbid conditions need attention since they have low
exclusive breastfeeding tendency. Since maternal employ-
ment and wealth status have higher likelihood of exclusive
breastfeeding, empowering women both economically and in
their employment status is implicated. Therefore, interven-
tions on individuals and community levels were demanded
for saving lives of the infants and reduction of economic
losses of a country.
Abbreviations
AIC: Akaike Information Criteria; ANC: Antenatal Care; BF: Breast Feeding;
BIC: Bayesian information criteria; CI: Confidence interval; CSA: Central Statics
Agency; DIC: Deviance Information Criteria; EBF: Exclusive Breast Feeding;
EDHS: Ethiopian Demographic and Health Survey; EFMoH: Ethiopian Federal
Ministry of Health; ICC: Intra cluster correlation; ICYF: Infant and Young Child
Feeding; MCH: Maternal and Child Health; MOR: Median Odds Ratio;
PCV: Proportional Change in Variance; PNC: Postnatal Care; VIF: Variance
Inflation Factor; WHO: World Health Organization
Acknowledgments
We would like to thank measure DHS program for their permission to access
the data. We would also acknowledge all individuals who are involved for
the accomplishment of this work.
Authors’ contributions
SAT: conceptualization, methodology, investigation and data extraction. YAD
and ETA performed statistical analysis, methodology, supervision and drafted
the manuscript. All authors read and approved the final manuscript.
Funding
The authors received no specific funding for this work.
Availability of data and materials
The data set used for final analysis will be availableupon corresponding
author request.
Declarations
Ethics approval and consent to participate
Ethical clearance was obtained from the Ethical Review Committee of
College of Medicine and Health Sciences, Wollo University with approval and
supporting letter. Permission to access the data set was obtained from
Measure DHS International Program. The data was only used for purpose of
this study and not shared to the third party.
Consent for publication
Not applicable.
Competing interests
The authors declared that they have no competing interest.
Author details
1
Department of Public health, Dessie Health science college, Dessie, Ethiopia.
2
Department of Nutrition, school of Public Health, College of Medicine and
Health Sciences, Wollo University, Dessie, Ethiopia. 3
Department of
Epidemiology and Biostatistics, School of Public Health, College of Medicine
and Health Sciences, Wollo University, Dessie, Ethiopia.
Tsegaw et al. Italian Journal of Pediatrics (2021) 47:106 Page 12 of 13
13. Received: 19 August 2020 Accepted: 27 April 2021
References
1. WHO. Protecting, promoting and supporting breastfeeding in facilities
providing maternity and newborn services. 2017.
2. Thomas JV. Barriers to exclusive breastfeeding among mothers during the
first four weeks postpartum; 2016.
3. UNICEF. Breastfeeding: achieving the new normal. Lancet. 2016;387(10017):404.
4. WHO U. Increasing commitment to breastfeeding through funding and improved
policies and programmes: global breastfeeding scorecard 2019. 2019.
5. Nussbaumer-Streit B, Gartlehner G. WHO Guideline: Counselling of women
to Improve Breastfeeding Practices. Gesundheitswesen (Bundesverband der
Arzte des Offentlichen Gesundheitsdienstes (Germany)); 2019.
6. Hanieh S, Ha TT, Simpson JA, Thuy TT, Khuong NC, Thoang DD, et al.
Exclusive breast feeding in early infancy reduces the risk of inpatient
admission for diarrhea and suspected pneumonia in rural Vietnam: a
prospective cohort study. BMC Public Health. 2015;15(1):1166. https://doi.
org/10.1186/s12889-015-2431-9.
7. Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, et al.
Breastfeeding in the 21st
century: epidemiology, mechanisms, and lifelong
effect. Lancet. 2016;387(10017):475–90. https://doi.org/10.1016/S0140-6736(1
5)01024-7.
8. UNICEF. Infant and young child feeding, Improving Exclusive Breastfeeding
Practices Communication for Development in Infant and Young Child
Feeding Programmes, 2018. Dostupno na: https://data unicef org/topic/
nutrition/infant-and-young-child-feeding/(0909 2018). 2017.
9. Kandeel W, Rabah T, Zeid D, El-Din E, Metwally A, Shaalan A, et al.
Determinants of exclusive breastfeeding in a sample of Egyptian infants.
Open Access Maced J Med Sci. 2018;6(10):1818–23. https://doi.org/10.3889/
oamjms.2018.359.
10. Tambe BA, Mimboe CS, Nchung JA, Bakwo CB, Nyobe EC, Pauline N, et al.
The determinants of exclusive breastfeeding in Cameroon, Sub-Saharan
Africa. 2018.
11. Egenti N, Adamu D, Chineke H, POU A. Exclusive breastfeeding among
women in rural suburbs of Federal Capital Territory, Abuja, Nigeria. Int J
Med Res Health Sci. 2018;7(1):57–64.
12. Indongo N, Mutorwa K. The practice of exclusive breastfeeding in Namibia.
Int J Sci. 2017;36(1):159–69.
13. L-l S, Chong Y-S, Chan Y-H, Chan Y-S, Fok D, Tun K-T, et al. Antenatal
education and postnatal support strategies for; 2017. p. 1–7.
14. ICF C. Ethiopia Demographic and Health Survey 2016, Addis Ababa,
Ethiopia, and Rockville, Maryland, USA: CSA and ICF DF-1.6; 2016.
15. Kelaye T. Assessment of Prevalence of Exclusive Breast Feeding Practice and
Associated Factors among Under Six-Month-Old Children Selected Woreda
South Nation Nationality of People Regional State, Ethiopia, 2016. J Nutr
Health Food Sci. 2017;27:1–7.
16. Kaushal A, Singh M, Sharma P, Chander V, Raina SK. Determinants of
exclusive breastfeeding among lactating women in sub-Himalayan region.
Trop J Med Res. 2017;20(1):70.
17. Manyeh AK, Amu A, Akpakli DE, Williams JE, Gyapong M. Estimating the rate
and determinants of exclusive breastfeeding practices among rural mothers
in southern Ghana. Int Breastfeed J. 2020;15(1):7. https://doi.org/10.1186/s13
006-020-0253-6.
18. Azeze GA, Gelaw KA, Gebeyehu NA, Gesese MM, Mokonnon TM. 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;2019:1483024.
19. Musse O. Determinants of exclusive breast feeding practices among
mothers of infants aged under six months in Jigjiga town, eastern Ethiopia:
a cross-sectional study. Int J Sci. 2019;46(2):62–74.
20. Ogbo FA, Dhami MV, Awosemo AO, Olusanya BO, Olusanya J, Osuagwu UL,
et al. Regional prevalence and determinants of exclusive breastfeeding in
India. Int Breastfeed J. 2019;14(1):20. https://doi.org/10.1186/s13006-019-
0214-0.
21. Tariku A, Alemu K, Gizaw Z, Muchie KF, Derso T, Abebe SM, et al. Mothers’
education and ANC visit improved exclusive breastfeeding in Dabat Health
and Demographic Surveillance System Site, northwest Ethiopia. PLoS ONE.
2017;12(6):e0179056; 1-13. https://doi.org/10.1371/journal.pone.0179056.
22. Horn IOD. UNICEF Annual. Report. 2017;2017:1–69.
23. FDRE Pacc. Summary and staetistical report of the 2007 population and
housing census: population size by age and sex, Federal Democratic
Republic of Etrhiopia: Federal Democratic Republic of Ethiopia, Population
Census Commission; 2008.
24. Tesfahunegn A, Hagos A, Tsadik M, Bekele A. Individual and community-
level factors influencing optimal breastfeeding: a multilevel analysis from a
national survey study in Ethiopia; 2019.
25. Belachew AB, Kahsay AB, Abebe YG. Individual and community-level factors
associated with introduction of prelacteal feeding in Ethiopia. Archiv Public
Health. 2016;74(1):6. https://doi.org/10.1186/s13690-016-0117-0.
26. Hox JJ, Moerbeek M, Van de Schoot R. Multilevel analysis: techniques and
applications: Routledge; 2010.
27. Merlo J, Chaix B, Yang M, Lynch J, Råstam L. A brief conceptual tutorial of
multilevel analysis in social epidemiology: linking the statistical concept of
clustering to the idea of contextual phenomenon. J Epidemiol Community
Health. 2005;59(6):443–9. https://doi.org/10.1136/jech.2004.023473.
28. Adugna B, Tadele H, Reta F, Berhan Y. Determinants of exclusive breastfeeding
in infants less than six months of age in Hawassa, an urban setting, Ethiopia.
Int Breastfeed J. 2017;12(1):45. https://doi.org/10.1186/s13006-017-0137-6.
29. Pamela MT. Socio-demographic factors associated with exclusive
breastfeeding among mothers with children less than six months of age in
Zimbabwe. Int Breastfeed J. 2017;10(1):1–9.
30. Dalcastagnê SV, Giugliani ERJ, Nunes LN, Hauser L, Giugliani C. Practice of
exclusive breastfeeding and its associated factors in a suburban area in
Angola: a cross-sectional study. Sao Paulo Med J. 2018;136(6):533–42.
https://doi.org/10.1590/1516-3180.2018.0262161118.
31. Mututho LN, Kiboi WK, Mucheru PK. Factors associated with exclusive breastfeeding
in Kenya: a systematic review. Int J Commun Med Public Health. 2017;4(12):4358–62.
https://doi.org/10.18203/2394-6040.ijcmph20175305.
32. Issaka AI, Agho KE, Renzaho AM. Prevalence of key breastfeeding indicators
in 29 sub-Saharan African countries: a meta-analysis of demographic and
health surveys (2010–2015). BMJ Open. 2017;7(10):e014145. https://doi.org/1
0.1136/bmjopen-2016-014145.
33. Raman S, Srinivasan K, Kurpad A, Razee H, Ritchie J. ‘‘Nothing Special,
Everything Is Maamuli’’: Socio-Cultural and Family Practices Influencing the
Perinatal Period in Urban India. PLoS ONE. 2014;9(11):e111900. 1-8. https://
doi.org/10.1371/journal.pone.0111900.
34. Ewnetu Bazie ABEG. Exclusive breast feeding prevalence and associated
factors an institutional based cross sectional study in Bahir dar Northwest
Ethiopia. Int J Homeopathy Nat Med. 2019;5(1):42–29. https://doi.org/10.11
648/j.ijhnm.20190501.17.
35. Singh KJ, Govindu MD. Prevalence of exclusive breastfeeding practices and its
associated factors in Maharashtra: a spatial and multivariate analysis. Asian Pac J
Health Sci. 2017;4(1):145–51. https://doi.org/10.21276/apjhs.2017.4.1.24.
36. Ruan Y, Zhang Q, Li J, Wan R, Bai J, Wang W, et al. Factors associated with
exclusive breast-feeding: A cross-sectional survey in Kaiyuan, Yunnan,
Southwest China. PLoS ONE. 2019;14(10):e0223251; 1–11. https://doi.org/1
0.1371/journal.pone.0223251.
37. Lenja A, Demissie T, Yohannes B, Yohannis M. Determinants of exclusive
breastfeeding practice to infants aged less than six months in Offa district,
southern Ethiopia: a cross-sectional study. Int Breastfeed J. 2016;11(1):32.
https://doi.org/10.1186/s13006-016-0091-8.
38. Nkoka ONP, Kanje V, Milanzi EB, Arora A. Determinants of timely initiation of
breast milk and exclusive breastfeeding in Malawi: a population-based
cross-sectional study. Int Breastfeed J. 2019;14(1):27–43.
39. Agedew Getahun DHH. Genet Gedamu Kassie. Exclusive breast feeding
practice and associated factors in Kemba Woreda, southern Ethiopia, a
community based cross-sectional study. Int J Sci Technol Soc. 2017;5(4):55–
61. https://doi.org/10.11648/j.ijsts.20170504.11.
40. FMoH. National Nutrition program II (2016-2020) progress analysis. Evidence for
the upcoming Food and Nutrition Strategy Development. 2020:1–42. https://
www.moh.gov.et/ejcc/sites/default/files/2020-10/NNPII_Progress_analysis.pdf.
41. Hussein TH, Mgongo M, Uriyo JG, Damian DJ, Stray-Pedersen B, Msuya SE,
et al. Exclusive breastfeeding rates and factors associated with exclusive
breastfeeding practices in northern Tanzania: measurement using two
different methodologies 24 hours recall and recall since birth. Int J MCH
AIDS. 2019;8(1):32–43. https://doi.org/10.21106/ijma.258.
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