Gynecology & Obstetrics
Open Access
ISSN: 2161-0932
ISSN: 2161-0932
Research - (2021)Volume 11, Issue 7
Background: Complementary feeding is the introduction of solid or semi-solid foods at six months of age with small amounts and increasing the quantity as the child gets older while maintaining frequent breastfeeding. The target range for complementary feeding is generally taking to be 6-24 months while breastfeeding continues for up to two years of age or beyond. Inappropriate initiation of complementary feeding practices is a major obstacle in attaining and maintaining child health.
Objective: To assess the prevalence of timely initiation of complementary feeding practice among mothers of children aged from 6 to 24 months living in Goba town, Bale zone, southeast Ethiopia from April 20 to June 20, 2019.
Methodology: Community-based cross-sectional study was conducted among 346 mothers or caregivers who have children 6-24 months of age living in 03 kebele, Goba town, selected by simple random sampling technique. Data were collected by a trained interviewer using semi-structured questionnaires filled for respondents after data collection, all collected data were analyzed by SPSS software version 20.
Result: A total of 346 mothers who had children 6 to 24 months of age were responded to the questionnaire. Ethnic composition shows that Oromo175 (50.6%), Amharic accounts for, 151 (43.6%), Others12 (3.5%) and Tigre 8 (2.3%). Regarding religion Orthodox237 (68.5%), Muslim 89 (25.7), and protestant religion 20 (5.8%). Among the respondent's occupational status, 230 (66.5%) were housewives, 59 (17.1%) merchants, 47 (13.6%) governmental workers, and students are the least dominant. Marital status mother and caregiver 340 (98.3%) married and 4 (1.2%) and 2 (0.6%) of mother and caregiver were single and divorced respectively. About 292 (84.4%) mothers had started complementary feeding at the right time, that is 6 months of age, while 35 (10.1%) of a mother had started in the age of before six months, and the rest 19 (5.5%) mothers started by the age of after six months.
Conclusion: In this study, initiation of complementary feeding at the recommended time of six months was seen in the majority of children. Inadequate let down of breast milk, due to medical illness, and breast problem were some of the reasons mentioned by mothers who initiated early whereas lack of knowledge was they started complementary feeding, immature stomach, and the advice of family members were the reasons for late initiation of CF.
Complementary feeding is the introduction of solid or semi-solid foods at six months of age with small amounts and increasing the quantity as the child gets older while maintaining frequent breastfeeding. The target range for complementary feeding is generally taking to be 6-23 months while breastfeeding continues for up to two years of age or beyond [1]. Timely initiation of appropriate nutrient intake, in quantity, bioavailability, and timing in infancy is essential for optimal growth and development. Complementary food is food other than breast milk, infant formula, or follow-on formula was given to infants and these can be liquids, semi-liquids, and solids [1,2].
Appropriate complementary feeding depends on accurate information and skilled support from the family, community, and health care system. Inadequate knowledge about appropriate foods and feeding practices is often a greater determinant of malnutrition than the lack of food. Moreover, diversified approaches are requiring ensuring access to foods that will adequately meet the energy and nutrient needs of growing children. Appropriate complementary feeding is measured entails; introduction of complementary foods at 6 months with continued breastfeeding up to at least 2 years and beyond, correct feeding frequency for age, and consumption of a diverse diet [2].
In addition, low-cost complementary foods, prepared with locally available ingredients using suitable small-scale production technologies in community settings, can help to meet the nutritional needs of older infants and young children [3-25].
The global rate of exclusive breastfeeding remains low and is not improving-indeed in some of the largest countries IYCF results are deteriorating. high stunting rates persist in many countries, with feeding and maternal nutrition receiving little attention many countries do not implement effective, comprehensive, and largescale IYCF programmers and only allocate a very small proportion of available nutrition resources [23].
World health organization recommends exclusive breastfeeding and delaying the introduction of solid foods to an infant’s diet until 6 months post-partum [22]. This practice will displace breastfeeding and place the baby to develop diseases and finally malnutrition. However, in many countries, this recommendation this followed by few mothers, and earlier complementary feeding onto solid is a commonly reported global practice a prospective, observational study in Ireland revealed that among 401 pregnant women only one mother (0.2%) complied with the WHO recommendation to exclusive breastfeeding up to 6 months. ninety-one (22.6%) infants were prematurely complemented onto solid at 12 weeks [24].
Inadequate complementary feeding practices result in undernutrition which suffers millions of children globally. Inappropriate initiation of complementary feeding practices is a major obstacle in attaining and maintaining child health. It is a major cause of malnutrition which directly or indirectly results in 60% of the 10.9 million deaths annually among children under five Well over two-thirds of these deaths, which are often associated with inappropriate feeding practices, occur during the first year of life. No more than 35% of infants worldwide are exclusively breastfed during the first four months of life; complementary feeding frequently begins too early or too late, and foods are often nutritionally inadequate and unsafe [4].
In developing countries total of 152 million, 101 million, and 51 million children under the age of five are estimated to be stunted, underweight, and wasted, respectively which is resulted from late initiation complementary feeding practices. Over one-third of under-five mortality is caused by malnutrition related to inadequate complementary feeding [2].
In general, inappropriate and poor initiation of complementary feeding practices means that many children continue to be vulnerable to irreversible outcomes of stunting, poor cognitive development, and significantly increased risk of infectious diseases leading to gastroenteritis, diarrhea, and acute respiratory infection [5].
Infant formula supplementation at any age is uncommon in Ethiopia. Among breastfeeding Children under age two, very few (2 percent) consume infant formula. However, a much higher proportion (18%) receives other milk or other liquids. The introduction of other liquids, such as water, juice, and formula, takes place earlier than the recommended introduction at age six months [21].
Inappropriate initiation of complementary feeding practice is a major cause of malnutrition in Ethiopia. Nationally, 10% of Ethiopian children are wasted, and 3% are severely wasted and 44% of children under age five are stunted, and 21% of children are severely stunted.
Study area, design, and period
A community-based cross-sectional study was conducted from April 20, 2019-June20, 2019.
The study was conducted in Goba town, Bale zone, Oromia regional state, southeast Ethiopia. Goba town is located 445 km from Addis Ababa this town has a latitude and longitude of 7°0′N 39°59′E and an elevation of 2,743 meters above sea level. The total population is estimated to be over 32,000 in the area of the city (Ethiopia, 13 November 2011) among this population 15182 are male, 16843 female and 4710 children were under five. Regarding religion distribution orthodox the dominant religion which accounts 68.84% and Muslim and protestant accounts 23.12% and 5.4% respectively. The two largest ethnic groups reported were the Oromo 63.13%, and Amhara 33.3%; all other ethnic groups made up 3.5% of the population. Goba town has five kebele among this 03 was selected for this study and all children age 6-24 months whose randomly selected were included.
Sample size determination
The sample size for the study was calculated using single population proportion formula by Considering p=71.2% prevalence of timely initiation of complementary feeding in a study done in Wolaita Sodo town, southern Ethiopia and 95% confidence level, Margin of error, assumed to be 5%. By considering a 10% non-response rate the final sample size was 346.
Sampling technique and procedure
A simple random and systematic sampling technique was employed for this study. The primary sampling unit was selected from all Goba towns, then the town divided 5 kebele among five kebele 03 kebele was selected by simple random sampling technique and 346 mothers were selected by systematic sampling technique. Therefore all mothers of children aged 6-24 months in selected kebele were included in this study.
Data collection tools
Data were collected by semi-structured questionnaire is from literature, early initiation of complementary feeding, and associated factors among infants and young children, which is used to ass’s timely initiation of complementary feeding and associated factors. The questionnaire was arranged and modified to address based on the objectives. Therefore, the questionnaire was divided into two parts: the first part addressing the socio-demographic characteristics of the mother or guardian and the infant followed by the second part which covers maternal reproductive history, health service utilization, and complementary feeding. The questionnaire originally is prepared in English then translated to the local language orally to“Afan Oromo and Amharic” during an interview with the help of language translators in order to create a better understanding for the respondents.
Data quality control
The principal investigators that mean who collect data and undergo quality assessment had ongoing supervision each day during data collection to ensure the quality of data by checking filled format for their completeness and consistency. The data collectors (investigators) were trained for one day by the supervisor before they are assigned to collect the data. The data was checked daily for its completeness and those with more than one incomplete data were discarded.
Before actual data collection, the questionnaire was pre-tested for validity and reliability on 5% mothers; thereby possible adjustment or modification was made accordingly. The pretest was done in Hasasa town among mothers having children aged 6-24 months.
Data processing and analysis
After ensuring the completeness of each questionnaires data was entered into the computer and analyzed, processed using and SPSS software version 20 for window package, and the descriptive statistic was used, then finally summarized and compiled in frequencies, percent, texts, tables, charts, and graphs.
Operational definitions
Early initiation of complementary feeding: It is the initiation of additional food other than breast milk for a young child before six months of age.
Family planning utilization: Use of birth control for child spacing for better growth of the child.
Kebele: Is the smallest administrative unit of Ethiopia.
Late initiation of complementary feeding: This is the introduction of solid and semisolid foods after completed 6 months (180 days) of age according to WHO guild lines [1].
Mother's knowledge on complementary feeding: Assessing the mothers whether they know or not know the exact time when complementary feeding is started.
Post-natal care: Care given to mother from delivery to 42 days.
Timely initiation of complementary Feeding: It is the initiation of additional food other than breast milk for a young child at sixth months of age along with continued breastfeeding.
Before the actual data collection, and ethical clearance letter was obtained from the student research program of Madda Walabu University College of medicine and health sciences. The respondents were informed about the purpose of the study, and their oral consent was obtained. The respondents’ right to refuse or withdraw from participating in the interview was fully maintained and the information collected was not being described in relation to individuals’ names. Moreover, a letter of permission was being issued from Madda Walabu University Goba referral hospital school of Health Sciences research & community service directorate, before the actual data collection.
Socio-demographic characteristics
A total of 346 mothers who had children 6 to 24 months of age were responded to the questionnaire generating a response rate of 100%. Ethnic composition shows that Oromo and Amhara account for 175 (50.6%), and 151 (43.6%) respectively. with the least dominant ethnic group was Tigre with the frequency of 8 (2.3%) respectively. Regarding religion, most of them were orthodox religion followers with a frequency of 237 (68.5%), and the least dominant religion is protestant religion with a frequency of 20 (5.8%). Regarding the educational status of the respondent, most of them about 151 (43.6 %) are a primary school, 72 (20.8%) secondary, 42 (12.1%) above secondary, and 51 (14.7%) were not read and write. Among the entire respondent around 230 (66.5%) they were housewife which is the most dominant, and around 59 (17.1%) of the respondent are merchants, 47 (13.6%) of respondents are government workers and students are the least dominant. Around 340 (98.3%) that is the majority of the respondent are married and 4 (1.2%) and 2 (0.6%) of mothers and caregivers are single and divorced respectively (Table 1).
| Variable | Category | Frequency | Percent |
|---|---|---|---|
| Maternal age | 15-24 25-34 Above 35 |
103 176 67 |
29.7 49.9 19.4 |
| Educational status | Not read and write Read and write Primary Secondary Above secondary |
51 30 151 72 42 |
14.7 8.7 43.6 12.1 20.9 |
| Ethnicity | Oromo Amhara Tigre Others |
175 151 8 12 |
50.6 43.6 2.3 3.5 |
| Religion | Orthodox Muslim Protestant |
237 89 20 |
68.5 25.7 5.8 |
| Marital status | Married Single Divorced |
340 4 2 |
98.3 1.2 0.6 |
| Economic status | Below 500 ETB 500-1500 ETB 1501-2000 ETB More than 2000 |
59 133 132 22 |
17.1 38.4 38.2 6.4 |
| Age during marriage | 15-19 20-24 25-29 Above 29 |
209 95 28 14 |
60.4 27.5 8.1 4.1 |
| Occupational status | House wife Governmental workers Merchants Students |
230 47 59 5 |
66.5 13.6 17.1 1.4 |
Table 1: Socio-demographic characteristic and feeding practice of study participants.
Child characteristics and feeding patterns
Children 6-24 months were included in the study. 167 (48.3%) were 6-10months and 63 (18.2%) children were 11-15 months of age. From this age group, 172 (49.7%) and 174 (50.3%) were male and female respectively. About 292 (84.4%) mothers had started complementary feeding (Figures 1-3)at the right time, that is 6 months of age, while 35 (10.1%) of a mother had started in the age of before six months, and the rest 19 (5.5%) mothers started by the age of after six months. 18 (51%) mothers who started early believed that milk was not enough, 6 (17.5%) due to medical illness, 5 (14%)due to breast problem, other mothers practice it and cultural background accounts about 6 (17.5%). Among mothers started lately (35.7%) said didn’t know when to start, (12.9%) stomach is not matured, (40%) breast milk is enough, (11.4%) advice of family and other mother practice it (Table 2).
Figure 1: Time of introducing complementary feeding among child and caregiver of a child aged 6-24 months.
Figure 2: Source of knowledge on timely introducing of complementary feeding.
Figure 3: Type of food to start complementary feeding.
| Variable | Category | Frequency | Percentage |
|---|---|---|---|
| Age of child | 6-10 months 11-15 months 16-20 months 21-24 months |
167 63 14 102 |
48.3 18.2 4.0 29.5 |
| Sex of child | Male Female |
172 174 |
49.7 50.3 |
| Age category for time to initiate complementary feeding | at 6 months | 292 | 84.4 |
| <6 months | 35 | 10.1 | |
| >6 Months | 19 | 5.5 | |
| Time to initiate complementary | Timely | 292 | 84.4 |
| Reasons to initiate complementary feeding early | my breast milk is not sufficient | 18 | 51 |
| due to breast problem | 5 | 14 | |
| due to medical illness | 6 | 17.5 | |
| other mothers practice it | 3 | 8.75 | |
| this is our culture | 3 | 8.75 | |
| Reasons to initiate complementary feeding lately |
Breast milk is enough Didn’t know when to start The advice of family members and another mother The child may not able to digest it |
8 6 2 3 |
40 35.7 11.4 12.9 |
Table 2: Child characteristics and feeding patterns in Goba town, south Eastern Ethiopia.
Maternal characteristics and medical history of children
Among the study participants interviewed, all 346 (100%) were biological mothers of the children. 58.2% of mothers had three to four antenatal care visits during the last pregnancy and 20.8% had 4 and more visits. From all interviewed mothers171 (49.4%) mothers attend delivery at the hospital, health center 104 (30.1%), and 71 (20.5%) at home. The mean total family size was 1.6387 ± 0.74569 (SD) and about 171 childbirth intervals were two years and 132 above two (Table 3).
| Variable | Category | Frequency | Percent |
|---|---|---|---|
| Maternal ANC follow up | One times Two times Three times Four and above |
67 201 71 7 |
19.5 58.2 20.8 1.6 |
| Place of delivery | Hospital Health center Home delivery |
171 104 71 |
49.4 30.1 20.5 |
| PNC follow up of mother | Yes No |
210 136 |
60.7 39.3 |
| Numbers of children in the house | 0-3 children 4-6 children 7-10 children Above 10 |
177 121 44 4 |
51.2 35 12.7 1.2 |
| Birth interval | <2 years 2 year >2 year |
43 171 32 |
12.6 49.1 38.4 |
| Child immunization history | Yes No |
305 39 |
88.1 11.9 |
| Child immunization certificate | Yes No |
207 139 |
59.8 40.2 |
| Family planning utilization | Yes No |
246 100 |
71.1 28.9 |
Table 3: Maternal characteristics and medical history of children 6-24 months of age in Goba town, Eastern Ethiopia.
In this study, the prevalence of timely initiation of complementary feeding was 84.4% which is higher than the study done in India found that more than three fourth of mothers had started complementary feeding at 6 months [12]. In the present study, the median age of starting complementary feeding was six months. Whereas in a country like China 76% of mothers were introduced to complimentary food to their infant between 4 and 6 months of age and Timely complementary feeding was 41.6% [10]. Studies from the UK, Belgium, and Sweden highlight that a large proportion of infants are prematurely complemented at, 4 months of age [25]. However, in our study, only 10.1% prematurely started complementary feeding. The prevalence of timely initiation of complementary feeding in this study is much higher than the national prevalence of timely initiation of complementary feeding (62.5) and also higher than the study done in Kamba Woreda Southwest Ethiopia revealed that among 392 respondents, 59.6% mothers start complementary feeding early before six months and 40.4% started complementary feeding at six months and relatively higher than the study done in northern Ethiopia, in mekele the prevalence of timely initiated complementary feeding at the age of six months was 62.8%. This relatively higher prevalence of timely initiation of complementary feeding at six months could be due to the communities’ awareness towards the time of initiation of complementary feeding by different health information providers like health professional workers, HEW providing information which has contributed to high coverage of health institutional delivery and postnatal care. Media has also a great role in awareness creation to initiate complementary feeding on time in Goba town.
In this study, initiation of complementary feeding at the recommended time of six months was seen in the majority of children. High institutional delivery accompanied with higher ANC follow-up contributes to this finding. The inadequate let down of breast milk, increased appetite to eat, and other information sources were some of the. Reasons mentioned by mothers who initiated early whereas immature stomach and the perception that breastfeeding is enough were the reasons for late initiation of CF.
Not applicable.
Data will be available upon request.
The authors have no competing interests and all have agreed on the manuscript for publication.
This study has no specific funding. The authors have no competing interests and all have agreed on the manuscript for publication.
The authors are grateful to Madda Walabu University for supporting this study. We are also very grateful to data collectors for their cooperation to undertake this study.
Citation: Alemayehu Y, Ermeko T, Hussen A, Lette A, Gudisa T, Abdi H, et al. (2021) Timely Initiation of Complementary Feeding Practice Among Mothers and Care Givers of Children Age 6 to 24 Months in Goba Town, Southeast Ethiopia. Gynecol Obstet (Sunnyvale) 11:564.
Received: 24-Jun-2021 Accepted: 10-Jul-2021 Published: 30-Jul-2021
Copyright: © 2021 Alemayehu Y, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.