ARBA MINCH UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES DEPARTMENT OF

MIDWIFERY.

ASSESEMENT OF KNOWLEDGE, ATTITIUDE AND PRACTICE OF

EXCLUSIVE BREAST FEEDING AMONG LACTATING MOTHERS IN
SHASHAMENE TOWN,OROMIA,ETHIOPIA.

NAME OF STUDENTS;
ADDA ALEMAYEHU
AYNALEM BINIYAM
DUWE DURESA
JALANE TOLSA
JEMAL SEID
TESFAHUN SIMON

APRIL; 2018
ARBA MINCH, ETHIOPIA
 ARBA MINCH UNIVERSITY
COLLEGE OF MEDICINE AND HEALTH SCIENCES DEPARTMENT OF MIDWIFERY.

ASSESEMENT OF KNOWLEDGE, ATTITIUDE AND PRACTICE (KAP) OF EXCLUSIVE

BREAST FEEDING AMONG LACTATING MOTHERS IN SHASHAMENE
TOWN,OROMIA,ETHIOPIA.

NAME OF STUDENTS;
ADDA ALEMAYEHU
AYNALEM BINIYAM
DUWE DURESA
JALAE TOLOSA
JEMAL SEID
TESFAHUN SIMON

NAME OF ADIVISORS; GEBRE SILAS GENDISHA (BSC, MSC/CM)

A RESEARCH THESIS SUBMITTED TO THE DEPARTMENT OF MIDWIFEY,

COLLEGE OF MEDICINE AND HEALHT SCIENCES, ARBA MINCH
UNIVERSITY IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE
DEGREE OF BACHELOR OF SCIENCE IN MIDWIFERY.

APRIL; 2018
ARBA MINCH, ETHIOPIA
ACKNOWLEDGEMENTS
First of all we would like to give thanks to God. We would like to present our heart full gratitude
to Arba Minch University College of medicine and health sciences, Midwifery department for
their encouragement to conduct this study. Secondly we would like give thanks to our advisor
Mr. GebreSilasea Gendisha (BSC, MSC/CM) .Finally, we would like to give thanks to teachers
and other health workers for their advice, motivation and their kindness with us up to end of the
research. We also say thanks all shashamene town and kebele administrator and all study
participant.

I
 Table of Contents
ACKNOWLEDGEMENT ............................................................................................................... I

LIST OF TABLE AND FIGURES ................................................................................................ V

ABSTRACT .................................................................................................................................. VI

CHAPTER ONE: INTRODUCTION ............................................................................................. 1

1.1. Background .......................................................................................................................... 1

1.2. Statement of the problems .................................................................................................... 2

1.3. Significant of the study. ....................................................................................................... 4

CHAPTER 2. Literatures Review ................................................................................................... 5

CHAPTER 3: Objectives of study .................................................................................................. 9

3.1 General objective. .............................................................................................................. 9

3.2. Specific Objectives. .......................................................................................................... 9

CHAPTER 4. METHODS AND MATERIALS .......................................................................... 10

4.1 Study area and period ........................................................................................................ 10

4.2. Study design ....................................................................................................................... 10

4.3 Population............................................................................................................................ 10

4.3.1. Source population ........................................................................................................ 10

4.3.2. Study population .......................................................................................................... 10

4.3.3. Study unit ..................................................................................................................... 10

4.4. Inclusion and exclusion criteria.......................................................................................... 10

4.4.1 Inclusion criteria ........................................................................................................... 10

4.4.2 Exclusion criteria ........................................................................................................ 11

II
 4.5. Sample size determination and sampling technique. ......................................................... 11

4.5.1 Sample size determination. ........................................................................................... 11

4.5.2 Sampling technique and procedures. ............................................................................ 11

4.6 Data collection method...................................................................................................... 13

4.6.1 Data collection instruments. ......................................................................................... 13

4.6.3. Data collection ............................................................................................................. 13

4.7. Variables in study ............................................................................................................. 13

4.8. Operational definition of terms. ......................................................................................... 13

4.9. Data quality assurance ........................................................................................................ 14

4.10. Data processing and analysis............................................................................................ 14

4.11. Ethical consideration. ....................................................................................................... 14

4.13. Dissemination of Data. ..................................................................................................... 14

CHAPTER FIVE; RESULTS ....................................................................................................... 14

5.1 Socio-demographic characteristics ...................................................................................... 14

5.2 Maternal and child health related factors ............................................................................ 16

6. DISCUSSION ........................................................................................................................... 23

7. Limitation of the study .............................................................................................................. 24

8. CONCLUSION ......................................................................................................................... 24

9. Recommendations ..................................................................................................................... 25

CHAPTER 10. REFERENCE ...................................................................................................... 26

ANNEX I: ENGLISH VERSION INFORMED CONSENT ....................................................... 29

ANNEX II. Questionnaire ............................................................................................................ 30

III
ABBREVIATIONS AND ACRONYMS

AMU Arbaminch university

ANC Antenatal care
EBF Exclusive breastfeeding;

EDHS Ethiopian Demographic and Health Survey;

HIV Human Immunodeficiency Virus;

IHRERC Institutional Health Research Ethics Review Committee

KAP Knowledge; Attitude and Practice;

MCH Mother Child health

PNC postnatal care
UNICEF United Nations Children’s Fund

WHO World Health Organization

IV
LIST OF TABLE AND FIGURES
Figure 1.Conceptual framework for assessment of knowledge, attitude and practice of exclusive
breastfeeding. .................................................................................................................................. 8

Fig 2; Sampling procedure of lactating mother in shashamene town April, 24-28; 2018. ........... 12

Table 1: Sociodemographic characteristics of the respondents in shashamene town southeast

Ethiopia, 2018, 𝑛 = 422. ............................................................................................................... 15

Table 2; Maternal and child health related factors of study unit in shashamene town, April 24-28,
2018............................................................................................................................................... 17

Table 3; Knowledge of Study Participants towards Exclusive Breast Feeding shashamene town,
April.24-28.2018. .......................................................................................................................... 18

Table 4.Attitude towards exclusive breastfeeding of the study subjects, shashamene town, April
24-28, 2018. .................................................................................................................................. 20

Table 5; Practice of study subjects towards exclusive breast feeding in shashamene town, April
24-28, 2018. .................................................................................................................................. 21

Table 6 Socio demographic characteristic of mothers, 2018. ..................................................... 31

Table 7 Reproductive health of mother and child characteristics, Shashamene town, 2018. ....... 32

Table 8. Knowledge about exclusive breast feeding (interviewer please don’t read the options on
the columns to the right) lactating mother, Shashmene town, 2018. ............................................ 33

Table 9. Attitude towards exclusive breast feedings (please indicate your feeling towards the
statements indicated below) of lactating mother, Shashmene town, 2018. .................................. 35

Table 10. Practice of exclusive breastfeeding of lactating mother, Shashmene town, 2018. ...... 36

V
ABSTRACT
Background: Breastfeeding is sufficient and beneficial for infant nutrition in the first 6
months of life. It provides nutritional, immunologic, developmental and psychological
advantages with regard to general health, growth and development of an infant and has
dramatically reduced infant deaths in developing countries by reducing diarrhea and
infectious diseases. Breastfeeding immediately after birth also helps the uterus contract, hence
reducing the mother’s postpartum blood loss. So this study interested to encourage and support
mothers for exclusive breast feeding up to 6 month. Study on knowledge, attitude and practice of
EBF was not well documented in shashamene town. Therefore, this study was aimed to assess
the knowledge, attitude and practice on exclusive breastfeeding.

Objectives: To assess knowledge, attitude and practice of Exclusive breast feeding among
lactating mothers in Shashamene town, Oromia, Ethiopia, April 24-28, 2018.

Methods: A community based cross-sectional study was carried out from April 24 – 28, 2018.
Systematic sampling technique was used to select 422 lactating women. Data were collected by
face to face interview using semi-structured questionnaire. Finally, data were tallied analyzed by
scientific calculator.

Result; The majority of mothers, 92.2% knew the importance of exclusive breastfeeding and
89.2% mothers had good attitude and agree that exclusive breastfeeding is advantageous for
infants aged less than six months. Nearly half of the mothers (48.8%) practiced exclusive
breastfeeding for the first six months after delivery based on mean. This study indicated better
understanding and perception of the importance of exclusive breastfeeding and practice to
exclusive breastfeeding for the first six months.

Conclusions; It was concluded that there was high level of knowledge on exclusive
breastfeeding among the respondents and relatively all the respondents have positive attitude
toward exclusive breastfeeding but poor practice compared with EDHS 2016 (58%).

Recommendations; Exclusive breastfeeding counselling during antenatal clinic should be more

elaborative with emphasis on its advantages. Women should be taught on how to breastfeed and
support and promote EBF in addition further large scale.

Key words; Exclusive Breastfeeding, Practice, Attitude, Knowledge, Assessment, Southern Ethiopia
VI
CHAPTER ONE: INTRODUCTION
1.1. Background
Breast milk is the only important food for infants for the first year of life and as the main
source of nutrition for the first 6 months. This recommendation was based on the advantages that
breast-feeding use infants, mothers, and society. It also decreases the incidence of diarrhea,
respiratory illnesses, otitis media, bacteremia, bacterial meningitis, and necrotizing enter colitis.
Breastfeeding is also important to mothers by decreasing risk for postpartum hemorrhage, longer
period of amenorrhea, reduced risk of ovarian and premenopausal breast cancers, and possibly a
reduced risk of osteoporosis. Advantages to society include reduced healthcare costs, to lower
incidence of illness in breastfed infants and reduced employee absenteeism for care attributable
to infant illness. It also reduce the incidence of food allergies and eczema. It also contains
protective bacterial and viral antibodies (secretory IgA) and nonspecific immune factors,
including macrophages and nucleotides, which also help to protect infections. The risk of
mortality due to diarrhea and other infections can increase many in infants who are either
partially breastfed or not breastfed at all (1).

Exclusive breastfeeding is also initiating breastfeeding immediately after birth and

consumption of human milk with no supplementation of any type like water, juice, nonhuman
milk, and foods except medications prescribed by health professional that allowed to give for
infant until six months(6).It is strongly recommended by World Health Organization (WHO)
and United Nations Children’s Fund (UNICEF) to achieve optimal growth, development
and health infants should be exclusively breastfeed for the first six months of life.
Thereafter, infants should receive nutritionally adequate and safe complementary foods, while
continuing to breast for up to two years or more (4, 5).

1
1.2. Statement of the problems
Infant and young child feeding practices directly affected the nutritional status of
children under two years of age and, ultimately, impact child survival. Worldwide, more
than 9 million children under five years of age die each year [9]. One in every 17 Ethiopian
children die before the first birthday and one in every 11 children dies before the fifth birthday
[10].

Most of the infant deaths in the first year of life are largely associated with inappropriate
feeding practices. It is estimated that over 7 million children under the age of five die each year
in sub-Saharan Africa and South Asia and it is a major contributor to most of the infant death is
poor feeding practices. In Ghana, there is evidence that 40% of all deaths that occur in the
country before age five are related to malnutrition (severe and moderate malnutrition) (32).
Optimal breastfeeding (Early and exclusive breastfeeding) has potential to prevent over
800,000 deaths (13% of all deaths) in children under five in the developing world.
Whereas, Complementary feeding interventions alone were estimated to prevent almost one fifth
of under five children [9, 10].

In Ethiopia malnutrition is the major cause of child mortality (58.0%). Almost seventy
percent of infants were reported to sub-optimally breastfed and 24% of deaths among
infants were attributed to poor and inappropriate breastfeeding practice. According to 2016
EDHS, at six months of age 58% of infants were exclusively breastfeed. Twenty nine
percent of newborns received pre-lacteal feed and 69.1% of them were put to breast within one
hour .It was also identified that mothers mix other food items and drinks to the infant feeding.
This predisposes the infant to various infectious diseases, resulting high infant morbidly and
mortality (10).

Breast feeding is still Universal phenomena associated with a number of problems in

developing countries. The major concern knowledge, attitude and practice are at what time
breast-feeding initiated after birth, duration of total breast-feeding and exclusive breast-feeding
and its frequency. However, late initiations after birth and decline duration of exclusive breast-
feeding and restriction of total are some of the major problems.

Only 35% of infants world-wide are exclusively breastfed during the first four months of life
and complementary feeding begins either too early or too late with foods which are often
2
nutritionally inadequate and unsafe .Therefore Improving exclusive breastfeeding rates among
the poorest may be particularly important in the reduction of global disparities in child survival
and health(4)

This might be due to maternal knowledge about breastfeeding and its exclusiveness. Even if
there was knowledge; their attitude might not be good enough to breastfeeding practice. Various
factors that can affect the breastfeeding practice. Socio demographic, cultural, biological factors
and health service related factor could also contribute on the maternal knowledge, attitude, and
practice.

Despite few local studies conducted in different part of the country, no sufficient study tried
to identify the knowledge, attitude and practice on exclusive breastfeeding in the study area.
Hence, this study is helpful to determine and show the level of knowledge, attitude and practice
(KAP) of exclusive breast feeding among the study population in the study area. It may also
serves as a background and as references for future studies to be done on this issue in the area.
The result of the study will hope to reveal the true picture of the problem which
enables to undertake preventive activity against them and to decrease the mortality and
morbidity of the breast feeding.

3
1.3. Significant of the study.
It becomes essential to encourage and support mothers for exclusive breast feeding up to 6
month. Lead to development of positive attitude among pregnant women toward exclusive
breastfeeding. Promote further studies on exclusive breastfeeding. The community become
aware of the condition and takes appropriate measure to solve the problem. It is essential for
students to gain knowledge.

4
 CHAPTER 2. Literatures Review
2.1 Overview
Globally, less than 40% of infants under six months of age are exclusively breast-feed, despite
the documented benefit of breast feeding (23).Worldwide, it is estimated that only 34.8% of
infants are exclusively breastfed for the first 6 months of life, with the majority receiving
some other food or fluid in the early months. Exclusive breastfeeding for the first 6 months
of life meets the energy and nutrient needs of the infants.

In addition, only 38% of infants aged less than six months in the developing world, Africa
included exclusively breast-feed (24).Many studies have analyzed the impact of different factor
to show decreasing infant mortality rate by improving breast feeding, for example in Brazil
children whose age less than 1 year didn’t get exclusive breast feeding exhibited 14 times greater
risk of death from diarrhea (25).

2.2 Knowledge about EBF

Study done in Nigeria, majority (88.0%) of the respondents reported to have heard about EBF
and hospital was the source of information [12]. Study done in India total of 70.8% of lactating
mothers had knowledge (29).A study in Bedle, found that majority of mothers, 91.8% knew the
importance of EBF (16). According to study in Jimma town, Southwest Ethiopia, a community
based cross-sectional survey to assess the knowledge, attitude and practice of mothers towards
exclusive breast-feeding showed that among mothers studied, 87% had knowledge about
exclusive breastfeeding, while most (90%)(26). The study conducted on KAP of mothers on EBF
at Assela Town in 2001 Identified although 84% of 360 mothers had knowledge (27). In a study
done in Ambo, 90.8% of mothers were Knowledgeable [21].
According to study done in Mizan Aman Town, Southwestern Ethiopia three hundred and
fourteen mothers with their index child less than 2 years were enrolled. Even though 93.6% of
study participants had heard about EBF only about 34.7% were knowledgeable with
recommended duration. According to wolyita zone, bodit town study most of the respondent
331(94.3%) know what EBF mean and for how long it should be given. Also 193(55%)
knew about contraceptive benefit of EBF and (76.6%) knew as EBF is nutritionally enough for
the first 6month of infant life.

5
2.3 Women’s attitude about EBF
Study done in Nigeria more than 50% of the women had positive attitude towards
breastfeeding [12]. A study in Southern Ethiopia found that 56.7% of mothers living with HIV
(Human Immunodeficiency Virus) had positive attitude towards EBF. According to study done
Debre biran about 97.5% of mothers had a positive attitude towards EBF [20]. Study done in
India 55% displayed good attitude and 79.2 %( 29).Study done in bedle 87.3% mothers were had
good attitude and strongly agree that the exclusive breastfeeding is advantageous for infants aged
less than six months (16).
The study conducted on KAP of mothers on EBF at Assela Town in 2001 Identified although
90% have positive attitude (27). A cross sectional study conducted in Axum town, the
composite measure of attitude indicates that 87% mothers had a positive attitude towards
timely initiation as well as exclusive breast feeding, whereas the remaining 13% had a
negative attitude(32).According to study done in Mizan Aman Town, Southwestern Ethiopia
three hundred and fourteen mothers with their index child less than 2 years were enrolled. Even
though about 89.5% of have positive attitude but only 59.3% believe that only EBF is enough for
child up to 6 months and EBF on child less than six months was about 26.4%.
According to study in Jimma town, Southwest Ethiopia, a community based cross-sectional
survey to assess the knowledge, attitude and practice of mothers towards exclusive breast-
feeding showed that among mothers studied, most (90%) had positive attitude towards exclusive
breast-feeding. However, one third (33%) of the mothers still agreed on early introduction of
cow’s milk, as a supplement since they believed it would increase their babies’ weight (26).
2.4 Practice of EBF
According to study done in Saudi Arabia from 384 respondents EBF for 6 months was
reported only by 32 (8.3%) participants [13]. In a study done in Kinshasa, Congo during the
maternity stay, 369 (87.5%) children were exclusively breastfed [11]. Study done in India a total
of 57.5% of gave importance to colostrum and 85% delivered breast milk as the first feed and
15% reported of pre-lacteal feeds as the first feed (29).Study done in Souther Ethiopia nearly half
(48.2%) of mothers exclusively breastfeed their infants [17].A study in Harar, found EBF was
51.8% [18]. A study in Gondar showed EBF rate among respondents was found to be
35.9%.Among the respondents, nearly half (49.4%) of respondents exclusively breastfed for only
6
3 months or less [19].According to study done in Debre Birhan 68.6% of mothers practiced EBF
to six months (20).Study done in beadle 43.6% of mothers practiced exclusive breastfeeding for
the first six months after delivery [16].
In a study done in Ambo, the practice of EBF was 82.2 %( 21). According to study in
Arbaminch, showed that 55.6% were exclusively breastfed their children for 6 months. Three-
hundred forty one (89%) mothers gave colostrum though a small number of mothers considered
colostrum as an expired breast milk and discarded it [15]. A study done in Addis Ababa, found
the practice of EBF less than six months was 29.3% [14]. The study conducted on KAP of
mothers on EBF at Assela Town in 2001 Identified although practiced early supplementation of
cow’s milk because they believed that it increases the babies weight only 40% practiced for the
first 4-6 months (27).
2.5 Justification
The duration of breastfeeding in Ethiopia is long but EBF during the first six months after
birth is not widely practiced. Currently, mothers exclusively breastfeed approximately half of
children less than six months. Among sub-groups the percentage of young children who are
exclusively breastfed decreases sharply from 70% of infants age 0-1 month to 55 percent of
those age 2-3 months and, further, to 32 percent among infants 4-5 months. In addition to breast
milk, 19 percent of infants less than six months are given plain water only, while 14 percent
receive milk in addition to breast milk, and 4 percent are given non-milk liquids and juice [10].
This may be due to the barriers of translating the message of exclusive breast feeding into
practice. Therefore, this study will be designed to investigate the different aspect of
lactating mothers of Shashamene town to assess their knowledge, attitude and practice (KAP) on
exclusive breast feeding. In addition to the above stated aims, this study also used to
collect base line information about current knowledge, attitude and practice related to
feeding of infants with special focus on exclusive breast feeding. The information generated
from this study will be provided to the concerned bodies and can be useful for designing
appropriate strategies for exclusive breast feeding.

7
 Conceptual framework of the study

Socio-demographic characteristics
 Age of the mother
 Marital status
 Religion
 Educational level of mother
 Occupation of the mother
 Average family income

Current BF practices
Ever BF
Knowledge and attitude
 Start BF after child birth
Colostrum feeding  Advantages of BF
Exclusive
for child and mother
 Additional food after first breastfeeding
milk Continuous EBF  BF starting time after
since birth child birth

 Total frequency of BF all  Frequency of BF

day
 BF during sickness
 Timing to BF a child
 Duration of EBF
 BF interruption
 Additional food with
 Ever-giving additional Reproductive health history BF from birth to 6
food months
 No. of child births/alive
 Days of only BF children/birth order  Other foods/drinks
allowed with EBF
 Age & Sex of the last child
 Ever stopping B
 Complementary
 ANC follow-up & counseling feeding time
on EBF
 Delivery service & counseling
 Total BF months
on EBF
 PNC follow-up & counseling exclusive EBF
on EB

Figure 1.Conceptual framework for assessment of knowledge, attitude and practice of exclusive
breastfeeding.

8
CHAPTER 3: Objectives of study
3.1 General objective.
 To assess KAP of Exclusive breast feeding among lactating mothers in
Shashamene town, Oromia, Ethiopia, April 24-28, 2018.

3.2. Specific Objectives.

 To asses knowledge of exclusive breast feeding among lactating mothers.
 To asses attitude of exclusive breast feeding among lactating mothers.
 To asses practice of exclusive breast feeding among lactating mothers.

9
CHAPTER 4. MATERIALS AND MEHTODS
4.1 Study area and period
Shashemene Town is one of central part of Oromia region. Located on the distance of 130
Km from Adama or capital city of region and 248Km from Addis Ababa. The town was
established in 1903 E.C and had total population of 218335.From those 48.9% are females and
51.1% are males. The town consists 10 kebeles with peoples having different language, more
than 18 ethnic group, (Like Oromo, Kanbata, Wolaita, Tigiraye, Gurage, Sidamo, Amahara and
etc.) and foreigners like Rastafarian’s community. It has 74 health institution in number and
among this two governmental hospitals serves as district and referral level, one general private
hospital, three health center, all the rest are health post, private clinics and pharamacis.The town
has two preparatory and three secondary governmental schools, two secondary and four
preparatory non-governmental schools, the rest are primary levels and totally 97 educational
institutions. The study was conducted from April 24-28, 2018.

4.2. Study design

Community based descriptive cross-sectional study design

4.3 Population
4.3.1. Source population

Source population was all lactating mothers in Shashamene town.

4.3.2. Study population

The study population was all lactating mothers from the three selected kebeles.

4.3.3. Study unit

Individual lactating mother who was interviewed from sampled mother.
4.4. Inclusion and exclusion criteria.
4.4.1 Inclusion criteria

 The study has included lactating mothers who have children less than 24 months.

10
 4.4.2 Exclusion criteria

 Mothers with serious illness at the time of data collection were excluded.

4.5. Sample size determination and sampling technique.

4.5.1 Sample size determination

The sample size was determined using single population proportion formula with the
estimated proportion of EBF is 50%. In the determination of the sample size 5% marginal
error, 95% confidence interval and 5% non-response rate was also used.

n= Z (α/2)2 p (1-p) = n= [(1.96)2(0.5) (1-0.5)] = 384

d2 (0.05)2

Where: - n= minimum sample size required for the study

=1.96, (confidence interval 95%)

d= Margin of error 5 %( 0.05)

P= Proportion (50%)

n=422

4.5.2 Sampling technique and procedures.

To obtain a representative sample, firstly three kebeles was selected by simple random
sampling method from the 10 kebeles; from the selected three kebeles proportionate allocation
was used to get number of households per kebele; for each kebele the mother with index infant
aged less than 2 years and currently breastfeeding their infants systematic sampling method was
used to get the desired sample size. With the total number of households N = 1339 in three
kebele and n = 422, an interval of k = N/n=3 was used to determine the number of
households for each kebele.

11
 02 Keble Shashamene town
01 Keble

09 kebele

010 Keble
03 kebele

04 kebele

06 kebele

08 kebele
07 kebele
05 kebele
Simple random lottery sampling method
((
01 Keble (177)

010 Keble (112)

04 kebele(133)

Systematic sampling method

422
Lactating mothers
Fig 2; Sampling procedure of lactating mother in shashamene town April, 24-28; 2018.

12
4.6 Data collection method
4.6.1 Data collection instruments.

Data was collected by using semi structured interview which was prepared in English to
assess mother’s socioeconomic status , KAP and associated factors towards exclusive breast
feeding among lactating mothers and questionnaire would translated to Amharic language
which is a local language in understandable way to exclude misunderstanding.

4.6.2. Pre-testing.

The questionnaires was pretested on 40 subjects who was not included in the study before actual
data collection.

4.6.3. Data collection

Six graduating class BScs midwifery students have collected the data. The face to face
interviews was conduct in the lactating mother.

4.7. Variables in study

The variables were maternal socio demographic characteristics: such as: age, marital status and
education level. Socio-economic characteristics: like: occupation, income. Maternal health
characterizes, maternal knowledge on breastfeeding practices, breastfeeding information, place
of delivery, infant characteristic: infant age in completed months, infant sex.

4.8. Operational definition of terms.

Knowledge –knowledge of exclusive breastfeeding that investigated by using different questions

and the means of write answer.

Attitude – is attitude for exclusive breast feeding that calculated mean based on ten attitude
related questions like breastfeeding’s goodness for the baby and the mother, cosmetics effect of
breastfeeding, organizational maternity leave for breastfeeding, house hold income affect.

Practice – a method, process and rules that mothers implemented on breastfeeding of their
babies regarded as the standards.
13
4.9. Data quality assurance
Data quality was assured by using different approaches. First adequate orientation was provided
for data collectors. Data completeness and consistency checked.

4.10. Data processing and analysis.

After checking the completeness and appropriateness, the data was analyzed by tally and
scientific calculator. The result was presented in the form of frequencies and percentages by
using tables, charts, and text.

4.11. Ethical consideration.

This study was carry out after the proposal got approval by the Institutional Health Research
Ethics Review Committee (IHRERC) and School of graduate studies Arba minch University and
an official letter was written from Department of Midwifery to Shashamene town Health office
for cooperation. Permission to collect data was obtained from the Administrator of Shashamene,
the head of health Office and the Kebele leader (lowest administrative level).Informed written or
thumb print consent will required from the respondents who were selected to take part in the
study. The purpose of the study was explained to all concern bodies and study participants; they
were also informed that all of their responses were confidential and anonymous. Ethical approval
was issued by Shashmene town bureau administration.

4.13. Dissemination of Data.

The final report of the study will presented to AMU, College of Health Sciences. Result of the
study will also disseminated to Shashmene town Health Bureau and other relevant organizations
working around MCH.

CHAPTER FIVE; RESULTS

5.1 Socio-demographic characteristics
A total of 422 mothers having children whose age is <24 months were included in this study.
The majority of the respondents were age from 20-30 years 297(70.3%). Most of them were
married, 397 (94.07%) and Oromo, 240 (56.87%) by ethnicity followed. Large proportion of the
14
respondents were Muslims 188 (44.5%). The majority of the respondent occupation was house
wives, 241 (57.1%). Concerning Educational status, about 125(29.6%) were primary level.
Among 422 about 299 (70.85%) had monthly income above 1500 birr. / (Table 1 below).

Table 1: Socio demographic characteristics of the respondents in Shashamene town southeast

Ethiopia, 2018, 𝑛 = 422.
Characteristic Frequency Percent (%)

Age <20 51 12.08

20-30 297 70.3

31-40 74 17.5

>40 0 0

marital status 1 Single 5 1.1

2. Married 397 94.07

3. . Divorced 11 2.6

4. Widow 6 1.4

educational level of 1. Uneducated 47 11.1

mother
2. Read and write only 81 19.2

3. Elementary (1-8 grades) 125 29.6

4. Secondary (9-10 grades) 103 24.4

5.above 66 15.6

religion 1. Orthodox 112 26.2

2. Muslim 188 44.5

3. Protestant 97 23.1

4. .Other, 25 5.9

15
current occupation 1. Student 28 6.6

2. House wife 241 57.1

3. Daily laborer 41 9.7

4. Merchant 52 12.3

5.Government organization 40 9.4

6.others 16 3.79

average monthly <500 birr 7 1.6

income of the
501-1000 birr 35 8.3
household
1001-1500 birr 81 19.2

Above 1501 birr 299 70.8

Ethnicity Amhara 41 9.7

Tigray 30 7.1

Oromo 240 56.87

Other 111 26.3

5.2 Maternal and child health related factors

Among 422 participants, who have 1-3 children were 262(62%. The majority of mothers
349(82.7%) had given birth by spontaneous vaginal delivery. Age of the last child is found to be
majorly within 6 to 12 month 201(47.5%) and those <6 month were 117(28%). Majority of the
mothers 386 (91.5%) had Antenatal care (ANC) follow-up for the last pregnancy and 275
(65.16%) had 4 ANC visits. Of those that had ANC follow-up for their last pregnancy, 184
(47.6%) reported that they have been counseled about EBF. Majority of respondent had given

16
birth in hospital 235(55.7%).Among delivered in health institution 390(98.9%) were not
counseled/advised about breast feeding during delivery.

Table 2; Maternal and child health related factors of study unit in shashamene town, April 24-28,
2018.
Variables Percentage
Frequency

Number of child birth 1-3 262 62%

4-7 140 33.2%

8-11 20 4.74%

Number of alive children 1-2 223 52.84%

3-4 150 35.5%

5+ 49 11.6%

Number of birth order of the last child Operation 73 17.29%

SVD 349 82.7%

Age of child <6months 117 28%

6-12months 201 47.6%

12-24months 104 24.64%

Sex of child Male 226 53.6%

Female 196 46.4%2

ANC follow up during pregnancy. Yes 386 91.5%

No 36 8.5%

Number of ANC follow up 1 3 0.71%

2 23 5.95%

3 68 17.6%

4 275 71.2%

5+ 22 5.7%

counseled/adviced about breast feeding in Yes 104 26.9%

your ANC follow up visits
No 282 73.1%

Place of give birth last child Health center 141 33.4%

Hospital 235 55.7%

Private clinic 18 4.26%

17
 Home 28 6.64%

counseled/advised about breast feeding during Yes 4 1.1%

delivery
No 390 98.9%

PNC follow up visit Yes 127 32.094%

No 295 74.87%
counseled/advised breast feeding during PNC Yes 80 20.3%
follow up visits
No 47 79.7%

5.3 Knowledge of Study Participants about Exclusive Breast Feeding

From participant 389 (92%) knew about EBF and their major source of information was health
institutions 284(73%). Three hundred ninety seven (94.07%) have knew about right time to give
breast milk to a child after birth. Two hundred ninety-eight (70.6%) of the respondents knew to
give the first milk (colostrum) to the newborn. The majority 384 (90.99%) knew that breast milk
alone is enough for infants less than 6 months. Among 422 participants knew that EBF prevents
diarrheal and respiratory diseases was 297(70.37%), and total length of breastfeed in months
288(68.24%) saying 24 month. as it is shown in Table 2.

Table 3; Knowledge of Study Participants towards Exclusive Breast Feeding shashamene town,
April.24-28.2018.
Variables frequen %
cy
Know EBF 1.Yes 389 92.18

2.no 33 7.81
Source of Information 1.friends 16 4.1

2.Mass media 284 73.00

3.Health institution 89 22.8

breast feeding initiated 1.immediately within one hour 397 94.07

2.after one hour 21 4.97

3.within 6 hour 4 0.94

first milk or colostrum 1.Discard 124 29.4

2.feed immediately 298 70.6

Frequency of breastfeed per day less than 8 times 7 1.65

18
 8-12 times 372 88.15

greater than 12 43 10.2

Right time of starting complementary foods 4 month 80 18.95

6 month 307 72.74

7 month or above 35 8.3

lengths of breastfeed only (in month) 4 month 80 18.95

6 month 307 72.74

7month or above 35 8.3

Other additional foods or drinks should a Nothing 384 90.99
child be fed from birth up to six months in
addition to breast milk plain water 3 0.7

water with sugar 8 1.8

cow’s milk 20 4.7

formula milk 7 1.64

Exclusive breastfeeding for the first six Yes 297 70.37

months used to prevent diarrheal and
respiratory disease for infants No 45 10.66

don’t know 80 18.95

Total length of breastfeed in months <24 months 43 10.18

24 months 288 68.24

>24 months 91 21.56

19
5.4 Attitude of Study Participants towards Exclusive Breast Feeding.
Among participant 89.2% had positive attitude based on mean value of participant. From
study participants, 417 (98.8%) were agreed breast milk is good or child, 405(95.97%) was
disagree to the opinion discarding colostrum (first milk) is important, 272(64.45%) was disagree
to breast feeding has cosmetically affect. Among 422 participant 382(90.5%) was disagree on
opinion of breast milk is not sufficient before 6 month, 410 (97.15%) agreed on within one hour
breast feeding is important. For the opinion that starting complementary foods before 6 months
is important, 335(79.38%) was disagree, 83 (19.66%) was agree and 4(0.9%) was not now. The
household economic capacity determining the mother’s EBF practice was not agreed by
272(64.4%) mothers (Table 2).

Table 4.Attitude towards exclusive breastfeeding of the study subjects, shashamene town, April
24-28, 2018.
Variable Frequency Percent (%)

breast milk is the best food for the child

Agree 414 98.1
Don’t agree 5 1.2

Don’t know 3 0.7

cosmetically affects the mother’s shape

Agree 35 8.3

Do not agree 380 90.01

Not know 7 1.6

Giving BM for a newborn immediately within an hour is important
Agree 407 96.4
Do not agree 10 2.4
Not know 5 1.2
The household economic capacity determines the mother breastfeeding
practice
Agree 137 32.4
Do not agree 272 64.4
Not know 13 3.08

20
Discarding the first milk or colostrum is important
Agree 14 3.3
Do not agree 405 96
Not know 3 0.7
Breast feeding the baby helps the child to grow well
Agree 415 98.3
Do not agree 7 1.7
Not know 0 0
Only BM may not be sufficient for 6 months’ child
Agree 32 7.5
Do not agree 382 90.5
Not know 8 1.8
Starting complementary foods before 6 months is important
Agree 82 19.3
Do not agree 335 79.4
Not know 5 1.2

Attitude Positive 376 89.2%

5.5 Practice of study subjects about exclusive breast feeding

On this study total EBF practice is 48.8% based on mean of the given positive questions.
Among Breastfeeding of last child 363(90.7%) mothers were started breast feeding immediately
after delivery.

Table 5; Practice of study subjects towards exclusive breast feeding in Shashamene town, April
24-28, 2018.
Variables Frequen %
cy
Breastfeeding of last child Yes 403 95.52
No 19 4.5
Time of start breastfeeding last child Within 1 hour of delivery 183 45.41

21
 within 6 hours of delivery 152 37.72
after 6 hours of delivery-24 hours 68 16.87
feed last child the first milk(colostrum) Yes 217 53.8
no 186 46.2
give for last child other additional foods Yes 16 7.4
or drinks after the first milk
No 201 92.6
Types of other additional foods or Water 5 31.25
drinks given for last child after the first
milk cow milk 7 43.75
formula milk 3 18.75
Other 1 6.25
frequency of breastfeed per day less than 8 197 48.9
between 8-12 131 32.5
greater than 12 75 18.6
Situation of breastfeed child Baby needs 206 51.1
Baby cries 103 25.6
mother needs 56 13.89
On schedule 38 9.43
stopped breastfeeding last child Yes 134 33.25
No 269 66.75
Time of stop breastfeeding last child <one month 67 50
one months 51 38.06
greater than 2 months 16 11.94
reason that stopped breastfeeding absence of breast milk 39 29.1
sickness of breast 64 47.76
mother sickness 19 14.18
child sickness 12 9
mother starting work 0 00
started complimentary 0 00

22
6. DISCUSSION
The dominance of breast-milk over any other nourishment to infant and young children is
clearly recognized, and over the years it has become more and more evident that it is the most
ideal, safe and complete food that a mother can provide for her child. Breastfeeding will have the
intended outcome if it is initiated timely, exclusively given for the first six months ,pre-lacteal
feed discouraged and colostrum provide d to the neonate and continue on demand feeding up to
two years.

This study shows that mothers who have good knowledge towards EBF are 92.18% which is
higher than a study conducted in Thrissur district of Kerala, India 70.5 (28), Saudi Arabi was
55.5 %(29). The finding of the study 92.18% was compared to, studies done in: Bahirdar
Ethiopia (49.1%), Arbaminch Ethiopia (46.5%), villages of kangemi Kenya (45.5%) and East
Malaysia (44.3%) much greater than them. This difference may be due to study area, sample size
and researcher factors. In this study, 22.18% of study participants have information about EBF
and their source of information was health institutions. This is less than the study conducted in
Mizan Aman town, Southwestern Ethiopia, which was 62.7%, while it is much less than the
study conducted in Kigali, Rwanda, that was 74.4. And from this study, 72.74% mothers stated
that babies before 6 months should receive BM. This is much more than the study conducted in
Tanzania, which was 37.5% [15].

In the current study, the knowledge of initiation of breast feeding is 94.07% which is higher
than that from a study conducted in Mizan Aman town of Ethiopia that was 73.3% [8] while it is
much higher than that in a study conducted in Odisha which was 52.78% [14] as well as
Tanzania which was 58.8% [15]. Knowledge of respondents on colostrum in this study is 70.4%.
This is less than a study conducted in Mangalore which was 86.6% and greater than in a study
conducted in Mizan Aman town of Ethiopia that was 60.2%.

In this study majority 90.5% believe that only EBF is enough up to 6 months, was
higher than a study in Bedele, Ethiopia which found that majority of mothers( 87.3%) had
good attitude and agree that the EBF is advantageous for infants aged less than six
months [16]. While the findings of this study showed higher number of mothers with
favorable attitude towards EBF in comparison with a study in Southern Ethiopia which found

23
that 56.7% of mothers had favorable attitude towards EBF [12] and a study done in Tanzania in
which more than 50% of the women had positive attitude towards breastfeeding [8].

In this study based on the attitudinal, 89.2% of the respondents have positive attitude towards
EBF.The finding is greater than reports done in Rwanda, Kigali, which was 71.1% [30] and in
Jima town in Ethiopia that was 73.9%. However, the finding was less than a study result made in
Mizan Aman town, which is 89.5% in Ethiopia [31]. The disagreement among these study results
might be attributed to these dissimilarities due to the differences of study settings.

In this study showed that the practice of EBF for infants less than six months was 48.8%.
This is better when compared with the finding of prevalence of EBF of a study conducted in
Mecha District, Amhara region (2014)47.2% (33) and in Klang ,Malaysia (2006) 32.8%(36),a
study conducted in rural Papua New Guinea (2013) (14), Nigeria (2013) and Abha Female
Educational District, Saudi Arabia(2012) (15) EBF prevalence was low 17%, 28.9% and 8.3%
respectively. But less than study done in Arba Minch Zuria (2013)55.6 %( 15) and in Bahir Dar
city (2013)49.1 %( 35). EBF prevalence of this study was less when compared to the national
(EDHS 2016) EBF prevalence (58%) (5) .The reason of better EBF prevalence of this study
might be the result of the current policy implementation on the use of health extension worker in
study area for promotion of breastfeeding and also using mass media for promotion of optimal
breastfeeding.

7. Limitation of the study

This study shares the limitation of a cross-sectional study design. Additionally this study may
introduce recall bias since mothers with infants of up to 2 years old were included. This study
was also supplemented descriptive only.

8. CONCLUSION
In conclusion this study has showed that the majority lactating mothers of study area had
knowledge and attitude but poor practice regarding exclusive breastfeeding. Some of the
respondent lacks confidence on BF is an ideal source of nutrient and there is also discrepancy
between knowledge, attitude and practice. Finally, improving health education on the importance
of EBF and improving quality of service on creating awareness regarding EBF for shashamene

24
community would greatly benefit in reduction of child mortality and in the prevention of
unwanted pregnancy in the society as a whole.

In this study even though majority of mothers were knowledgeable about EBF and have
positive attitude towards EBF, knowledge with recommended duration of EBF, attitude of
mothers towards sufficiency of EBF and EBF for 6 months was found , but poor practice to
EBF for the first six months among lactating women.

Based on this conclusion, health care workers who work in the areas of MCH clinic are better
to give appropriate information about EBF to mothers who follow ANC, PNC, and delivery and
for those who come to immunization. In addition, health care providers who work in the areas of
MCH should evaluate mothers’ knowledge and attitude for every visit by asking questions
related to EBF, health care officials may play their role by actively following activities of health
care providers of MCH, and health project implementers shall support and arrange training
program for health care providers of MCH to improve mother’s knowledge, attitude and practice
towards exclusive breast feeding.

9. Recommendations
Strengthening and promoting ANC ,delivery and PNC visits with adequate counseling
and discussion about breastfeeding issues focusing EBF for the first six month, on the
adequateness and balanced nature of breast-milk for infants. Health information dissemination to
bring behavioral change about EBF practice using accessible means such as mass media and
public meeting places. Promotion of exclusive breastfeeding through creating an enabling
breastfeeding friendly working environment for mothers. Strengthening the capacity of health
professionals to regularly counsel clients on the importance of exclusive breastfeeding.
Further study is proposed to ascertain effective intervention in the study area and in the region at
large.

25
CHAPTER 10. REFERENCE
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Gynecology 2009; 2(4):222–231.
2) World Health Organization. Exclusive breastfeeding for six months best for babies
everywhere. 2011 Retrieved from http://www.who.int.
3) Batal M, Boulghourjian C, Abdullah A and A__ R: breast-feeding and feeding
practices of infants in a developing country: a national survey in Lebanon, public
health nutrition 2005; 9(3):313-319.
4) WHO: Global strategy for infant and young child feeding. Geneva: Switzerland; 2003.
5) UNICEF, breast feeding nutrition, available online at:
http://www.unicef.org/Nutrition/index_24824.html updated 4 August 2014.
6) WHO. Indicators for assessing infant and young child feeding practice part 3. WHO,
Geneva; 2010.
7) Al-saira M, Al-dallal Z and khairya M. Breast feeding patterns and practices in the
kingdom of Bahrain (children aged 0-24). 2002. Bahrain Nutrition Prole-Nutrition and
Consumer Protection Division, FAO, 2007.
8) Ali, H. M., (2012).Exclusive breastfeeding: mothers’ awareness and health care
providers practice during antenatal visits in Mvomero, Tanzania.
9) CARE (2010) Infant and Young Child Feeding Practices. Collecting and Using Data: A
Step-by-Step Guide: Cooperative for Assistance and Relief Everywhere, Inc.

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10) Central Statistical Agency [Ethiopia] and ICF International (2012) Ethiopia
demographic and health survey, 2011. Addis Ababa, Ethiopia and Calverton,
Maryland, USA.
11) PélagieB, Philippe D, Pierre A, Nathalis M, Emile O (2015) Predictors of discontinuing
exclusive breastfeeding before six months among mothers in Kinshasa: a prospective
study. Infant Breastfeed J 10: 19.
12) Mbada CE, Olowookere AE, Faronbi JO, Oyinlola-Aromolaran FC, Faremi FA, et
al. (2013) Knowledge, attitude and techniques of breastfeeding among Nigerian
mothers from a semi-urban community.BMC Res Notes 6: 552
13) Al-Binali AM (2012) Breastfeeding knowledge, attitude and practice among school
teachers in Abha female educational district, southwestern Saudi Arabia. Int Breastfeed J
7: 10.
14) Tigest S, Amare W, Yemane B (2015) Factors associated with exclusive
breastfeeding practices of urban women in Addis Ababa public health centers,
Ethiopia: a cross sectional study. International Breastfeeding Journal 10: 22.
15) Dessalegn T, Shikur M (2013) Maternal knowledge of optimal breastfeeding
practices and associated factors in rural communities of Arba minch Zuriya.
International Journal of Nutrition and Food Sciences 3: 122-129.
16) Tsedeke W, Gadisa D, Ababa W, Genet M, Girma N, et al. (2014) Knowledge,
Attitude and Practice of Exclusive Breast Feeding Among Lactating Mothers in
Bedelle Town, Southwestern Ethiopia: Descriptive Cross Sectional Study. Researcher
6: 11.
17) Kassa E, Negash W (2015) Attitude and Practice Towards Exclusive Breast Feeding and
It’s Associated Factors Among HIV Positive Mothers in Southern Ethiopia.
American Journal of Health Research 2: 105-115.
18) Abera K (2012) Infant and Young Child Feeding Practices among Mothers Living
in Harar, Ethiopia. Harar Bulletin of Health Sciences 4:66-78.
19) Barium A, Berhanu B (2014) Breastfeeding practice and associate factors among
female nurses and midwives at North Gondar Zone,Northwest Ethiopia: a cross
sectional institution based study.International Breastfeeding Journal 9: 11.
20) MaezaM, Mesele A, Zelalem K (2015) Factors associated with exclusive breastfeeding
practices in Debre Berhan District, Central Ethiopia: a cross sectional community based
study. International Breastfeeding Journal 10:23.
21) Zenebu B, Belayneh K, Alayou G, Ahimed A, Bereket C, et.al (2015) Knowledge
And Practice Of Mothers Towards Exclusive Breastfeeding And Its Associated
Factors In Ambo Woreda West Shoa Zone Oromia Region, Ethiopia. IJRDPL 3:
1590-1597.
22) Central statistical agency Addis Ababa, Ethiopia. ICC international Calverton, Maryland,
USA, Ethiopia Demographic and Health survey, 2016.
23) Ten facts on breast-feeding, World Health Organization, July 2012.
27
24) European journal of public health volume. 16 no 2 by oxford press page 142

25) Breast feeding: impact on child survival and global situation, United Nation
children’s Fund, January 2005.

26) Tema T; Knowledge, Attitude and practice towards exclusive breast-feeding in Jimma.
Ethiopian J Health Sci; 10 (1): 7-13; 2000, Ethiopia.80

27) Addis A; Socio –cultural factors related to breast-feeding in Jimma town: A thesis paper.
2006, A. Ababa.

28) Knowledge, Attitude and Practice Towards Breasfeeding among Lactating Mothers in
Rural Areas of Thrissur District of Kerala, India,Apri 14,2017.
29) KNOWLEDGE, ATTITUDE AND PRACTICE REGARDING EXCLUSIVE
BREASTFEEDING AMONG MOTHERS ATTENDING PRIMARY HEALTH CARE
CENTERS IN ABHA CITY Adil Ali Nassir Ayed 2014.

30) G. J. Bahemuka et al., “knowledge, Attitude and practice of exclusive breast feeding of
infants aged 0-6 months by urban refugee women in Kigali: a descriptive cross sectional
study,”Rwanda Medical Journal,vol.70,no.1,2013

31) N. Tadele and F. Habta, “Knowledge, Attitude and Practice towards Exclusive
Breastfeeding among Lactating Mothers, Mizan Aman Town, Southwestern Ethiopia:
DescriptiveCrossSectionalStudy,”JournalofHealthEducationResearch&Development,
vol.03, no.03, 2015.
32) Atindanbila, ET al.2014; Mahmoud N, 2014

33) Tesfa Getanew Welde, Addisu Workneh Kassa , Melkie Edris .Assessment of Exclusive
Breastfeeding Practice and Associated Factors in Mecha District, North West Ethiopia.
Science Journal of Public Health. Vol.2, no4, 2014, pp.330-336.

34) Yalew WA, Abitew DB, Breastfeeding practices of mothers of under five years old
children in Bahir Dar City, Ethiopia: A descriptive cross-sectional community based
study. Int J med sci Public Health 2014; 2:532-536

35) Abay sefene, Dereje Birhanu, Worku Aweke, Tesfaye Taye. Determinants of exclusive
breastfeeding practice among mothers of children age less than 6 months in Bahir Dar
City Administration , North west Ethiopia ; A community Based cross-sectional survey.
Science Journal of Clinical Medicine 2013; 2(6):153-159. Available from
(http://www.sciencepublishinggroup.com/j/sjcm). Accessed on December 2/2014

36) Tan KL, knowledge, attitude and practice of breastfeeding in Klang, Malaysia.
Available on line at:journals.iium,edu.my/imjm/index.php/eimj/article/view/58/56

28
ANNEX I: ENGLISH VERSION INFORMED CONSENT
Informed consent;

My name is _______________. I am a data collector in a research on assessment of

knowledge, attitude and practice of exclusive breastfeeding among lactating mothers in
Shashmene town. The purpose of this research is to assess knowledge, attitude and identify those

29
factors that are associated with exclusive breastfeeding practices among lactating mothers. The
interview will take about 20 minutes only. Your name will not be collected. We will only use
codes to identify different study participants. We assure you that the information you are going
to provide us will only be used for the purpose of this research and will not be made
available to anyone outside of the research team and will not bring any harm to you or your
family. It is also your right to withdraw any time from the process when you feel uncomfortable.

Do you have any questions?

If you have any additional concerns or questions about this research, please contact: mobile
number 0926333898 and email address tesfu.2633@gmail.com.

Are you willing to participate in the study? (Circle their response)

Yes => Continue

No => Stop collecting consent and thanks.

Name and signature of the interviewer__________________________________

Date of interview _______________

ANNEX II. Questionnaire

Assessment of knowledge, attitude and practice of exclusive breastfeeding among lactating
mothers in Shashmene town, Ethiopia; Questionnaire for mothers.

30
Table 6 Socio demographic characteristic of mothers, in shashamene town, April
24-28, 2018.
No Question Responses Instructions

101 How old are you?

102 What is your current marital status? 1. Single

2. Married

3. Divorced

4. Widow

103 What is your educational level? 1. Uneducated

2. Read and write only

3. Elementary

4. Secondary

5.above

104 What religion do you follow? 1. Orthodox

2. Muslim

3. Protestant

4.Other

105 What is your current occupation? 1. Student

2. House wife

3. Daily laborer

4. Merchant

5.Government employee

6. Other

31
106 What is the average monthly income of 1.<500 birr
the household?
2.501-1000 birr

3.1001-1500 birr

4.Above 1501 birr

107 Ethnicity 1. Amhara

2. Tigray
3. oromo
4. Other

Table 7 Reproductive health of mother and child characteristics, Shashamene

town, 2018.
S.no Question Response Instruction

201 How many children did you give birth to? [___]

202 How many children do you have now? [___]

203 What is the birth order of your last child? 1. Operation

2. Vaginal
204 How old is your child? (in months) [___] months

205 What is the sex of your child? 1. Male

2. Female

206 Did you have ANC follow-up visits in any 1. Yes If No, go to
health facility while you were pregnant for 2. No Q209
the last child?

207 How many ANC follow-up visits did you [___]

attend?

32
208 Were you counseled/advised about breast 1. Yes
feeding in your ANC follow-up visits?
2. No

209 Where did you give birth to your last 1. Home

child?
2.health center

3.hospital

4. Private health facility

210 Were you counseled/advised about breast 1. Yes

feeding during delivery?
2. No

211 Following your last delivery did you have 1. Yes

PNC follow-up visit?
2. No

212 Were you counseled/advised about breast 1. Yes

feeding in your PNC follow-up visits?
2. No

Table 8. Knowledge about exclusive breast feeding (interviewer please don’t read
the options on the columns to the right) lactating mother, Shashmene town, 2018.
301 Do you know about exclusive
breast feeding?
1. Yes
2. No

302 Source of information? 1. Friends

2. Mass media
3. Health institution

33
303 When child should

Breast feeding be started?

304 What do you do with the first 1. Discard

milk or colostrum? 2. Feed immediately

305 How many times the child should

be breastfeed per day?

306 Right time to start complementary 1.4 months

foods 2.6months
3.7months or above

307 How long should child be only [___] months

breastfeed?

(in months)

308 What other additional foods or 1. Nothing

drinks should a child be fed under
2. Plain water
six months in addition to breast
milk? 3. Cow’s milk

4. Formula milk

5. Other

309 Is exclusive breastfeeding for the

first 6 months used to prevent
1. Ye s
diarrheal and respiratory diseases
2. No
for the infant?
3. I do not know
310 How long in total should a child 1. <24month
be breastfeed? In months 2. 24month
3. >24 month

34
Table 9. Attitude towards exclusive breast feedings (please indicate your feeling towards the
statements indicated below) of lactating mother, Shashmene town, 2018.
S.no Question Response Instruction

401 Breastfeeding is good for baby because 1. Agree

breast milk is the best food for the child.
2. Don’t agree

3. Don’t know

402 Breastfeeding is not good because 1. Agree

cosmetically affects the mother’s shape.
2. Don’t agree

3. Don’t know

403 Giving BM for a newborn immediately 1. Agree

within an hour is important.
2. Don’t agree

3. Don’t know

404 The household economic capacity 1. Agree

determines the mother breastfeeding
2. Don’t agree
practice.
3. Don’t know

405 Discarding the first milk or colostrum is 1.Agree

important.
2.Don’t agree

3.Don’t know

406 Breast feeding the baby helps the child to 1.Agree

grow well.
2..Don’t agree

3.Don’t know

35
407 Only BM may not be sufficient for 6 1.Agree
months’ child.
2.Don’t agree

3.Don’t know

408 Starting complementary foods before 6 1. Agree

months is important.
2.Don’t agree

3.Don’t know

Table 10. Practice of exclusive breastfeeding of lactating mother, Shashmene town, 2018.
501 Have you ever breastfeed your last 1. Yes
child?
2. No

502 If yes when did you start breastfeeding 1. Within one hour of delivery
your last child?
2.Within six hours of delivery

3. After six hours of delivery

but within 24 hours

503 Did you feed your last child the first milk 1. Yes
(colostrum)?
2. No

504 Did you give your last child other 1. Yes If No, go
additional foods or drinks after the first to Q506
2. No
milk?

36
505 If yes what other additional foods or 1. Plain water
drinks did you give your last child after
2. Water
the first milk?
3. Cow’s milk

4. Formula milk

5. Other

506 How frequent did you breastfeed your 1. <8*

child per day? 2. 8-12*
3. >12*

507 When do you breastfeed your child? 1. child needs or cries

2. mother needs

3. on schedule

508 Did you ever stop breastfeeding your last 1. Yes

child?
2. No

509 If yes when you stop breastfeeding your

last child [___] month

510 What was the reason that you stopped 1. No breast milk

Breast feeding your child? 2. Breast sickness

3. The mother was sick (other)

4. The child was sick

5. The mother started work

6. Started other milk products

Thank you for your responses and the time you spent.

37
 አርባ ምንጭ ዩኒቨርሲቲ

ጤና ሳይንስ ኮሌጅ ሚድዋይፍሪ ትመህርት ክፍል

በሻሼመኔ ከተማ ለሚኖሩ አጥቢ እናቶች የተዘጋጀ መጠይቅ

ስሜ____________________ይባላል፡፡ በአርባ ምንጭ ዩኒቨርስቲ የሚድዋይፈሪ ትምህርት ክፍል

እየተካሄደ ለሆነዉ ጥናታዊ ዳሰሳ መረጃ ሰብሳቢ ነኝ፡፡ ከስድስት ወር በታች ላሉ ህፃናት የእናት ጡት
ወተት አሰጣጥ ሁኔታን ለማወቅ ቃለ መጠይቅ እያደረግን ሲሆን፤ አላማውም ትክክለኛ የሆነ የእናት ጡት
ወተት አሰጣጥን ለማጠናከር የሚጠቅም መረጃ ለማግኘት ነው፡፡ ይህንን ዓላማ ለማሳካት ለተዘጋጁ
ጥያቄዎች የሚሰጡን እውነተኛና በጣም ጠቃሚ ለሆኑት መልስዎት በቅድሚያ ልናመሰግንዎት
እንወዳለን፡፡ ይህንን መረጃ ለመስጠት ከእኔ ጋር 20 ደቂቃ ሊወስድብዎ ይችላል፡፡ የሚሰጡን መረጃ ሙሉ
በሙሉ በሚስጥር የሚጠበቅ ሲሆን ስምዎንም መግለፅ አያስፈልግም፡፡ የእርስዎም ተሳትፎ በፍላጎት ላይ
የተመሰረተ ነው፡፡ በመሆኑም የማይፈልጉትን ጥያቄ እዲመልሱ አይገደዱም፡፡
ጥያቄዉን እንድንቀጥል ፈቃድኛነዎት?
መሌሱ አዎ ከሆነ ወደሚቀጥለዉ
38
አልፈልግም ከሆነ አመስግነህ/ነሽ መጠይቁን አቋርጥ/ጪ፡፡
የተጠያቂዋን እናት ፍቃደኝነት በማያረጋገጥ የመረጃው ስብሳቢ ፉርማ …………….
መጠይቁ የተካሄደበት ቀን_________ወር__________ዓ.ም____________
ጥያቄ ካለዎት አሁን ወይንም ሌላ ጊዜ ሉጠይቁ ይችላሉ፡፡ ሌላ ጊዜ ለመጠየቅ ቢፈልጉ ከዚህ በታች
የተጠቀሱትን ግለሰብ ማነጋገር ይችላሉ፡፡
ተስፋሁን ስሞን ስልክ ቁጥር 0926333898 ( email- tesfu.2633@gmail.com]

አርባ ምንጭ ዩኒቨርሲቲ

ጤና ሳይንስ ኮሌጅ ሚድዋይፍሪ ትመህርት ክፍል

የእናቶችን የጡት ወተት ስለማጥባት እዉቀት ፤ፍላጎትና፤ተግባርን ለመዳሰስ የተዘጋጀ መጠይቅ

I. የማህበራዊ እና ኢኮኖሚያዊ ሁኔታ

ተ.ቁ ጥያቄ መልስ ትእዛዝ

101
እድሜዎ ስንት ነው?

102 የጋብቻ ሁኔታ? 1.ያላገባች

2..ያገባች

3የተፋታች

4 ባሉ የሞተባት

39
103 የርስዎ የትምህርት ደረጃ ምን ያህለ ነዉ ? 1.ያል ተማረ

2.ማንበብና መፃፍብቻ

3.የመጀመሪያ ደረጃ

4.የሁለተኛ ደረጃ

6 above

104 ሀይማኖትዎ ምንድን ነው? 1. ኦርቶዶክስ

2. ሙስሊም
3. ፕሮቴስታንት
4. ካቶሊክ
5. ሌላ ካለ ይግለፁ፡፡
105 ስራዎ ምንድን ነው? 1. ተማሪ
2. የቤት እመቤት
3. የቀን ሰራተኛ
4. ነጋዴ
5. የመንግስት ሰራተኛ
6. ሌላ ካለ ይግለፁ
106 አማካይ የቤተሰብዎ ወርሀዊ ገቢ ስንት ነው? 1.0-500 ብር

2.501-1000 ብር

3.1001-1500 ብር

4.ከ1501ብር በሊይ

107 የትኛዉ ብሄረሰብ ተወላጅ ነሽ ? 1.አማራ

2.ትግሬ

3.ኦሮሞ

4.other

II. የእናቶች እና የስነ-ተዋልዶ ጤና ሁኔታን የሚመለከት

ተ.ቁ ጥያቄ መልስ ትእዛዝ

40
201 ስንት ልጆች ወልደዋል ? [___]
202 ስንት ልጆች አልዎት በህይወት ያሉ ?
[---]
203 የመጨረሻ ልጅዎን በምንድን ነዉ የወለዱት? 1.በቀዶ-ህክምና

2.በማህጸን

204 የህፃኑ እድሜ ስንት ነው? (በወር) [___] ወር

205 የህጻኑ ጾታዉ ምንድን ነዉ ? 1.ወንድ

2.ሴት

206 በእርግዝና ወቅት የቅድመ ወሊድ ክትትል 1.አዎ መልሱ አይ ከሆነ ወደ

አድርገው ነበር?
2. አይ ተ.ቁ 209

207 ስንት ጊዜ ክትትል አድርገዋል? [___]

208 በእርግዝና ክትትልዎ ወቅት ስለ ጡት ማጥባት 1.አዎ

ምክር ተሰቶዎት ነበር?
2አይ

209 ህፃኑ የተወለደው የት ነው ? 1.ቤት

2.የመንግስት ጤና ጣቢያ

3.የመንግስት ስፒታል

4.የግል ጤና ጣቢያ

5.ሌላ ካለ ይግለፁ
210 የወሊድ አገልግሎት በሚያገኙበት ወቅት ስለ 1.አዎ
ጡት ማጥባት ምክር ተሰቶዎት ነበር ?
2. አይ
211 ከወለዱ ቡኋላ የድህረ ወሊድ ክትትል አድርገው 1.አዎ
ነበር?
2አይ
የድህረ ወሊድ ክትትል ስንት ጊዜ አድርገዋሌ?

41
212 በድህረ ወሊድ ክትትል ወቅት ስለ ጡት ማጥባት 1.አዎ
ምክር ተሰቶዎት ነበር ?
2. አይ

III. እናቶች ስለ ጡት ማጥባት ያላቸዉ እዉቀት የሚመለከት

ተ.ቁ ጥያቄ መልስ ትእዛዝ

301 አዲስ የተወለደ ህጻን 6 ወር በተከታታይየ እናትን 1.አዎ መልሱ አይ ከሆነ ወደ ተ.ቁ
ጡት ብቻ መጥባት እነዳለበት ያዉቃሉ ? 303
2.አይ
302 መረጃዉን ከየት አገኙት? 1.ከጉደኛ
2.ከመገናኛ ብዙሀን
3.ከጤና ተ
303 የእናት ጡት ወተት ልጅ ከወለዱ በኋላ መቼ (------)
መጀመር አለበት?

304 ከወለዱ በኃላ በመጀመሪያ ግዜ በእናት ጡት 1.አስወገዱት

ዉስጥ የሚገኘዉን ወተት /እንገር ምን አደረጉት ?
2.ወዲያዉኑ አጠቡት
305 ኣንድ ህፃን የእናቱን ጡት በቀን ምን ያክል ግዜ (----)
መጥባት አለበት ?

306 አንድ ህፃን ተጨማሪ ምግብ የሚጀምረው በስንተኛ 1.በ 3 ወር

ወር ነው?
2.በ 4 ወር
3. .በ 6 ወር
4 በ7 ወር እና ከዚያ በላይ

307 ህፃኑ የእናት ጡት ወተት ብቻ ለምን ያክል ጊዜ [___] ወራት

መሰጠት ይገባል ?

308 ከእናት ጡት ወተት በተጨማሪ ህፃኑ ከተወለደ 1.ምንም

እስከ 6 ወር ድረስ ምን መሰጠት ይገባል?
2.ውሃ

3.የውሃና ስኳር/ጨው ውህድ

4.የከብት ወተት

5.የዱቄት ወተት

42
 6. ሌላ ካለ ይግለፁ

309 ለተከታታይ 6 ወራት የእናትን ጡት ብቻ ማጥባት 1.አዎ

በ ህፃናት ላይ የሚከሰትን የተቅማጥ በሽታን እና
የመተነፈሻ አካላት ህመምን ይከላከላልን ? 2.አይ
3.አላዉቅም

310 በአጠቃላይ አንድ ህፃን የእናት ጡት ወተት ለምን 1.<24 ወር

ያክል ጊዜ መውሰድ/መመገብ አለበት ?
2.24 ወር
3.>24 ወር

Iv . እናቶች ስለጡት ወተት መስጠት ያላቸዉን አመለካከት የሚመለከት

ተ.ቁ ጥያቄ መልስ ትእዛዝ

401 ጡት ማጥባት ለልጄ ጥሩ ነው ምክንያቱም የጡት ወተት 1.እስማማለሁ

ለልጆች ምርጥ ምግብ ስለሆነ
2.አልስማማም

3.አላውቅም

402 ጡት ማጥባት የእናትን ቅርፅ ያበላሻል/ይጎዳል፤ስለዚህ 1.እስማማለሁ

ጥሩ አይደለም
2.አልስማማም

3.አላውቅም

403 ልጁ ከተወለደ በኃላ በአንድ ሰአት ዉስጥ የእናትን ጡት 1.እስማማለሁ

ማጥባት ጠቃሚ ነዉ
2.አሌስማማም

3.አላውቅም

404 የቤተሰብ ገቢ የጡት ማጥባት ልምድ ላይ ተፅእኖ አለው 1.እስማማለሁ

2አልስማማም

3.አላውቅም

405 በእናት ጡት ዉስጥ የሚገኘዉን የመጀመሪያዉን ወተት / 1.እስማማለሁ

እንገር ማስወገድ ጠቃሚ ነዉ
2.አልስማማም

3.አላውቅም

43
406 1.አእሰማማለሁ
ለህፃናት የእናት ጡትን ማጥባት ለልጅነት እድገት 2.አልስማማም
ጠቀሜታ አለዉ
3.አላዉቅም

407 ለተከታታይ 6 ወራት የእናትን ጡት ብቻ ማጥባት 1.እስማማለሁ

አይበቃም
2. አልስማማም
3.አላዉቅም

408 ከ 6 ወር በፊት ለህፃኑ ተጨማሪ ምግብ ማስጀመር 1.አሰማማለሁ

ጠቀሜታ አለዉ
2. አልሰማማም
3.አላዉቅም

V. እናቶች ሰለጡት ማጥባት ያላቸዉን የተግባር ዳሰሳ የሚመለከት መጠይቅ

ተ.ቁ ጥያቄ መልስ ትእዛዝ
501 የመጨረሻ ልጅዎን የእናቱን ጡት ያጠባሉ 1.አዎ
2.አይ

502 መልሱ አዎ ከሆነ ህፃኑ እንደተወለደ ጡት መጥባት 1.በተወለደ በ1 ሰዓት ውስጥ

የጀመረው መቼ ነው 2.በተወለደ በ6 ሰዓት ውሰጥ
3.ከተወለደ ከ6 እስከ 24 ሰዓት

503 ለህጻኑ ከጡትዎ የወጣውን የመጀመሪያ ፈሳሽ 1.አዎ

ወተት(እንገር)እንዲጠባ አድርገውታል?
2. አይ

504 ህፃኑ እንደተወለደ የመጀመሪያው የጡት ወተት(እንገር) 1.አዎ መሌሱ አይ ከሆነ

ከጠባ በኋላ ለሌጅዎ የሚበላ/የሚጠጣ ሰጥተውታል ? ወደ, ጥ.ቁ 506
2. አይ

505 መሌሱ አዎ ከሆነ ምን አይነት ተጨማሪ ምግብ ወይም 1.ውሃ

ፈሳሽ ሰጥተውታሌ?
2.የውሃና ስኳር/ጨው ውህድ
3.የከብት ወተት
4.የዱቄት ወተት
5..ሌላ ካለ ይግለፁ

44
506 በ አንድ ቀን ዉስጥ ለሌጅዎ የጡት ወተት ስንት ጊዜ 1.ከ 8 ጊዜ በታች
ሰጥተውታል?
2.ከ 8 እስከ 12 ጊዜ
3.ከ 12 ጊዜ በላይ
4.አላዉቀዉም

507 ለሌጅዎ የጡት ወተት የሚሰጡት መቼ ነው? 1.ሲፈልግ/ስትፈልግ

2.ሲያለቅስ/ስታለቅስ
3.ጡትዎ በጣም ሲያግት
4.ሌላ ካለ ይግለፁ

508 ለመጨረሻ ልጅዎ የጡት ወተት መስጠትዎን አቁመው 1.አዎ

ያውቃሉ?
2. አይ

509 መልሱ አዎ ከሆነ ጡት ማጥባት ያቆሙት መቼ ነው [___]

510 ጡት ማጥባትዎን ያቆሙበት ምክንያት ምንድን ነው? 1.የጡት ወተት ባለመኖሩ

2.የጡት ህመም
3.በእናትየው ህመም ምክንያት
4.በህፃኑ ህመም ምክንያት
5.በእናትየው ስራ መጀመር
6.ለልጁ የወተት ምረቶችን
በመጀመር
7.ሌላ ካለ ይግለፁ __________

ጥያቀዉን እዚህ ላይ ጨርሽያለሁ ጊዜዎን መስዋዕት አድርገው ላደረጉልኝ ትብብር አመሰግናለሁ ፡፡

45
Well done

46