Factors associated with the early termination of exclusive breastfeeding among mother-infant dyads in Samara-Logia, Northeastern Ethiopia

Breastfeeding provides young infants with the nutrients for growth, development, and health [1]. Human milk is uniquely suited to the infant, both in its nutritional composition and in the non-nutritive bioactive factors, which include cells, anti-infectious, and anti-inflammatory agents and growth factors that promote child survival and healthy child development [2].

International organizations such as the United Nations International Children’s Emergency Fund (UNICEF) and the World Health Organization (WHO) recommend infants should be exclusively breastfed in the first 6 months, and thereafter be given nutritious complementary foods coupled with continued breastfeeding up to the age of 2 years or beyond [3]. Exclusive breastfeeding (EBF) is an infant’s breast milk consumption without supplementation of any type of foods and/or drinks (including water), except for vitamins, minerals and necessary medications up to the age of 6 months [1].

EBF is adequate in quality as well as quantity in terms of the nutrients required by the baby [4]. It eliminates contamination which makes it especially important in resource-poor setting communities [5]. Lack of EBF is associated with infant and childhood morbidity and mortality including lifelong impact on school performance, productivity, and intellectual development [6], and overall health during adolescence and adulthood [7]. Hence, breastfeeding in general, EBF in particular, is among the best interventions in the first 1000 days [8, 9].

Globally, about 40% of infants received exclusively breastfeeding in the first 6 months [10]. In Ethiopia, breastfeeding is nearly universal; about 97% of children are ever breastfeed. However, 58% of infants receive breast milk exclusively with a median duration of 3.1 months. This is lower than the health sector transformation plan of Ethiopia [11], and international recommendations [12].

The government of Ethiopia emphasizes on EBF and has declared ‘the annual exclusive breastfeeding day’ [13]. The health extension program aims at improving proper infant and young child nutrition, for instance, the promotion of EBF in Ethiopia [14]. Besides, nongovernmental organizations are working towards the improvement of optimal breastfeeding in the country [15].

In Ethiopia, particularly in Samara-Logia, there is no adequate evidence on the factors associated with early termination of EBF. Furthermore, health information on child feeding practices is limited among pastoral communities. Therefore, this study aimed to investigate the predictors of EBF duration in Samara-Logia city administration, Afar National Regional State, Ethiopia.

This study revealed that the median duration of EBF was 6 months which is similar to the international recommendation [3]. The cumulative survival probability of EBF to 4 months and 6 months was declined by 13 and 20%, respectively, from birth. In Ethiopia, traditional postpartum care is given at home by their family members in the first 6 to 12 weeks after delivery [21]. This condition increases the likelihood of mothers and infants to stay together at home which might decrease the hazard of early termination of EBF. In addition, the current study showed that the cumulative survival probability of EBF to 6 months was 64.5%. This finding is lower than the findings from previously conducted studies in Ethiopia [22‐24]. This difference may be due to the age of the study participants.

In this study, partner educational status significantly affected the duration of EBF. Women whose partners had attended formal education were at lower hazard of terminating EBF as compared to those who had no formal education. This may be partners without formal education might enforce their wives to give additional foods early as compared to those with formal education. Similar findings were found in Gondar town where women who receive social support were more likely to practice EBF as compared to those without support [13]. This is also consistent with the finding in Australia [25, 26].

This study revealed that counseling on infant feeding at ANC check-up was significantly associated with the duration of EBF. Women who received counseling on infant feeding at ANC check-up were less likely to terminate EBF compared to those who did not receive counseling. This finding is consistent with the previous studies in Ethiopia [18, 19, 27], and Tanzania [28]. This shows that antenatal check-up is an appropriate time to provide essential messages about proper infant feeding practices. Furthermore, the initiation of an urban health extension program in Afar has a great contribution to the access of ANC services including breastfeeding counseling.

Women who delivered a baby in health facilities were less likely to cease EBF as compared to those who delivered a baby at home. Similar findings were reported from different parts of Ethiopia [29‐32]. This may be explained in such a way that institutional delivery provides a favorable environment for the early initiation of breastfeeding. This is a key factor that could favor exclusive breastfeeding.

Furthermore, early initiation of breastfeeding was associated minimum hazard of EBF termination as compared to late initiation of breastfeeding. This finding is consistent with the previous Ethiopian studies [17, 20, 23, 27, 33]. This is because initiating breastfeeding within 1 h may lead to increased newborn-mother bonding and sufficient breast milk secretion. This may, in turn, lead to late initiation of additional foods other than breast milk.

Compared to women who perceived inadequacy of breast milk for the first 6 months, those who perceived adequate were less likely to cease EBF. In line with this finding, in the Gurage zone, mothers who perceived adequacy of breast milk were less likely to cease EBF earlier as compared to those who perceived inadequate [24].

The study could be subjected to recall bias. Besides, the study is conducted in the urban area, therefore, might not be a true reflection of the entire Afar community.

The cumulative survival probability of EBF to 6 months was 64.5%. Women whose partners had formal education, received counseling on infant feeding at ANC check-up, gave birth in a health institution, initiated breastfeeding early, and perceived breast milk adequate for the first 6 months were less likely to terminate EBF before 6 months. Therefore, health promotion interventions should be targeted at educating fathers and involve them in breastfeeding decisions. It is also important to encourage fathers to support their partners and participate in ANC check-ups. Furthermore, strengthening infant feeding counseling both at community and institution level, encouraging institutional delivery, and educating mothers about the importance of early initiation of breastfeeding is important to improve the duration of EBF in pastoralist communities of Ethiopia.