Mekonen et al. International Breastfeeding Journal (2018) 13:17 https://doi.org/10.1186/s13006-018-0160-2 RESEARCH Open Access Timely initiation of breastfeeding and associated factors among mothers of infants under 12 months in South Gondar zone, Amhara regional state, Ethiopia; 2013 Liyew Mekonen1*, Wubareg Seifu2 and Zemenu Shiferaw1 Abstract Background: Timely initiation of breastfeeding is defined as putting the newborn to the breast within one hour of birth. Significant benefits in reducing neonatal mortality and morbidity can be attained with effective promotion of timely initiation of breastfeeding and exclusive breastfeeding during the first months of life. Therefore, this study was conducted to assess timely initiation of breastfeeding and associated factors among mothers in South Gondar, Amhara regional state, Northern Ethiopia. Methods: A community based cross-sectional study was employed. A multistage stratified sampling technique was used to select the sample of 845 mothers with 97.4% response rate. Moreover, data were collected by face to face interview using a semi structured questionnaire. Result: The prevalence of timely initiation of breastfeeding was 48.7% (54.7% in urban and 25.1% in rural areas). The odds of initiation of breastfeeding within one hour was higher for urban mothers (Adjusted Odds Ratio [AOR] 2.1; 95% Confidence Interval [CI] 1.4, 3.3), multiparous mothers (AOR 2.8; 95% CI 2.0, 3.8), mothers who had antenatal care (AOR 3.2; 95% CI 2.0, 5.2), mothers delivered in health institution (AOR 3.1; 95% CI 2.2, 4.6) and mothers delivered vaginally (AOR 4.1; 95% CI 1.7, 9.8) than their respective counterparts. Conclusion: This study depicts the rate of timely initiation of breastfeeding was low in south Gondar zone. Factors which were positively associated with timely initiation of breastfeeding include urban residence, multiparity, having antenatal care, mother deliver in health institution and vaginal mode of delivery. Therefore, South Gondar health office and healthcare providers have to provide breastfeeding information during antenatal care by giving special emphasis to rural and primiparous mothers in which timely initiation of breastfeeding is poorly practiced. Further study is needed to assess the implementation of policies on timely initiation of breastfeeding. Keywords: Timely initiation, Breastfeeding, Associated factors, South Gondar, Ethiopia Background promotion of timely initiation of breastfeeding and exclu- Timely initiation of breastfeeding is defined as putting the sive breastfeeding during the first months of life [3]. newborn to the breast within one hour of birth [1]. It was The World Health Organization (WHO) and United one the ten steps to successful breastfeeding on which the Nation Children’s Fund (UNICEF) recommend initiation of Baby Friendly Hospital Initiative was based and launched breastfeeding within the first hour after birth and exclusive in 1992 [2]. Substantial benefits in reducing neonatal breastfeeding for the first six months followed by continued mortality and morbidity can be achieved with effective breastfeeding to age two years or beyond along with appropri- ate complementary feeding [4]. Despite these recommenda- tions, only 39% of newborns in the developing world are put * Correspondence: [email protected] 1College of Medicine and Health Sciences, Public Health Department, to the breast within one hour of birth, and only 37% of in- Reproductive Health and Nutrition Unit, Jigjiga University, Jigjiga, Ethiopia fants less than six months of age are exclusively breastfed [5]. Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Mekonen et al. International Breastfeeding Journal (2018) 13:17 Page 2 of 8 The Ethiopian government developed national infant ðÞZa=2 2 Â PðÞ1−P and young child feeding guidelines in 2004 and has n ¼ d2 tried behaviour change communications on breast- feeding. There are considerable variations by region on timely initiation of breastfeeding, 60% in Amhara region where South Gondar Zone is found and the ðÞ: Â : ðÞ−o: n ¼ 1 96 2 0 51 5 highest in Dire Dawa regions and Harari (90.5% and ðÞ0:05 2 89.4%, respectively) [6, 7]. Therefore, this study addressed the issue of timely ini- n ¼ ðÞ384 tiation of breastfeeding practice and associated factors in South Gondar Zone. The finding of this study can pro- Given 2 design effect and 10% non-response rate, the vide relevant information for future planning and inter- final sample size was 845. ventions of appropriate strategies to promote the timely initiation of breastfeeding practices. Sampling procedure A multistage random sampling technique was used for selecting mothers. There were 12 districts in South Gondar Methods zone and from these four districts (Farta district, Estie dis- Study setting trict, Dera district, Fogera district) were selected by using a The study was conducted in South Gondar Zone simple random sampling technique (lottery method). The which is found in Amhara regional state located at sample size was proportionally allocated to the urban and 664 km from the capital city Addis Ababa. Based on rural kebeles based on the number of mothers who had the 2007 Census conducted by the Central Statistical infantslessthan12months.Thesamplingframewaspre- Agency of Ethiopia, this zone had a total population pared for both the urban and rural kebeles by doing census of 2,051,738, of whom 1,041,061 were men and prior to the actual data collection period. Based on the 1,010,677 were women. A total of 468,238 households census result there were 718 and 3235 mothers with infants were counted in this zone, which results in an aver- less than 12 month in the rural and urban respectively. age of 4.38 persons to a household. There were 3953 Finally 179 and 666 mothers who had infants less than mothers who had children aged less than 12 months 12 months were selected from rural and urban by using a at the time of the survey. computer-based generated random number respectively. Data collection and instrument Study design and sample Data were collected using structured and pretested inter- A community based cross-sectional study was conducted view questionnaires prepared from Ethiopian Demo- among randomly selected 845 mothers of infants under graphic Health Survey and Linkage Project. Data 12 months in South Gondar Zone, Amhara Regional State, collectors were given two days training for the question- Ethiopia from March to May 2013. Mothers of infants naires and interviewing techniques. The questionnaires under 12 months who were permanent residents were were initially prepared for English and then have been included. Mothers who were not available during data translated into the local language, Amharic and again it collection who were unconscious, critically ill and unable was translated back into English to check its accuracy. to respond were excluded from this study. The questionnaires were pretested and modified before the actual data collection. Four supervisors checked each completed questionnaire and principal investigator mon- Sample size determination itored the overall quality of the data collection. The required sample size was determined using single population proportion formula with the following Operational definitions assumptions: Early (timely) breastfeeding is defined as putting the newborn to the breast within one hour of birth. Level of confidence = 95% Prelacteal feeding is feeding to an infant with some- Type I error (α) = 0.05 thing other than breast milk after birth to three days 5% margin of error whereas ever breastfeeding is defined as mothers breast- Design effect = 2(Multi stage sampling) feed their index baby. Employed mothers defined as mothers that were Based on the assumption the prevalence of timely ini- employed in governmental, non governmental and pri- tiation of breastfeeding is 50%. vate organization. Mekonen et al. International Breastfeeding Journal (2018) 13:17 Page 3 of 8 Formal education defined as a person who attended Table 1 Sociodemographic characteristics of mothers with primary or more education. children less than 12 months in South Gondar Zone, Amhara No formal education defined as a person who might regional state, Ethiopia, May 2013 (n = 823) able to write or read but did not attend primary or more Variables Frequency Percent education. Age of mothers (year) Marital status not in union comprised single, divorced, < = 20 years 109 13.2 widow, cohabited and separated. 21–34 years 619 75.2 Information access if the mother read books, listen > = 35 years 95 11.5 radio or watches a television program. Residence Urban 656 79.7 Data processing and analysis Data were cleaned, edited, and entered onto Epidata version Rural 167 20.3 3.2.1 and exported to the statistical packages for social Marital status sciences (SPSS) version 20 statistical software for further Union 765 93.0 analysis. Frequency distribution and cross tabulation were Not in unionc 58 7.0 done against the variables of interest. Bivariate analyses Religion were done to assess the association between explanatory Christian 690 83.8 variables and outcome variable of the study. All variables with a p - value of < 0.25 at the bivariate analysis were Muslim 133 16.2 included into multivariable logistic regression model in Ethnicity which odds ratio with 95% confidence intervals were esti- Amhara 819 99.5 mated to identify independent predictors of timely initi- Tigray 4 0.5 p ation of breastfeeding.