Timely initiation of complementary feeding to children aged 6–23 months in rural Soro district of Southwest Ethiopia: a cross-sectional study

This study was aimed to determine the proportion of timely initiated complementary feeding practice of women to their infants in rural Soro district. It was a community based crossectional study among mothers who had children aged 6–23 months. The study was carried out in rural community of Soro district in South Ethiopia from August to September in 2015. The total census projected population in the district was estimated to be 239,058 which compose 15.6% children under age 5 years, 8.3% under age 3, and 3.5% infants and young children (6–23 months). About 55,700(23.3%) women in reproductive age group were expected to live in the district [14].

A sample size of 543 mothers was computed by using OpenEPi software with the assumptions for the design. The assumptions were 31% anticipated proportion of the outcome [13], 95% confidence level, 5% marginal error, and 6% for none-response [15]. First, out of the 46 rural residential kebeles (administrative units in the area) in the district 14 were selected by simple random sampling. Then sample size of study participant was allocated for each of the 14 units by proportion to population size. Then lists of mothers who had children 6–23 months of age in the each selected kebeles were obtained health posts in each kebele. In rural health posts in the area there family demographic and health profile registration folders (Family Folders). Thus we registered eligible mothers from these folders. Finally the study eligible mothers to child pairs were selected from each kebele by systematic random sampling technique.

Data was collected by face-to-face interview to mothers (caregivers) who had children aged 6–23 months through home to home visits. The questionnaire was adapted from WHO standard questions and indicators for assessing IYCF practices to suit the study setting [1, 16].

We used a structured questionnaire which was originally prepared in English and then translated to local Hadiya language and back to English by two people to keep consistency. The data collection tool was pretested to 27 mothers in villages which were not included in the study to validate content and language. Data was collected by fourteen nurses under supervision of 2 degree level trained health officers. The field team was trained for two on modules of the tool and field methods. The modules include; the study objective, relevance of the study, contents of the questionnaire, and ethics.

Sociodemographic factors: Age, sex, marital status, respondents’ educational status, educational status of husbands, occupation of the mother, family size.

Infant’s demographic related factors: age and sex of the child.

Household socioeconomic factors: house hold income.

Maternal health related characteristics: ANC follow up, child birth order, birth preparedness, type of delivery assistance and place of birth.

Data were checked for completeness and inconsistencies in the field on spot and corrections made. Then data were, entered in EPI info version 3.5.4 statistical software and exported to SPSS. It was cleaned and analysed by using SPSS version 16. Descriptive statistics was carried out for univariate results. Measures of central tendency and dispersion were used for describing the data. Binary logistic regression used to look for crude association between exposure and outcome variables. Exposure variables with P < 0.25 were considered as candidates for multivariate logistic regressions to control for confounding. Thus we reported Adjusted Odds Ratio (AOR) along with 95% CI for the effect measure for association, and statistical significance was declared at P-value < 0.05.

A total of 543 respondents having children aged 6–23 months were interviewed. Among the respondents 539(99.3%) were biological mothers and only 4 (0.7%) were other caregivers. The median (IQR) age of mothers was 28 years (26, 30). The majority of the respondents were Protestant 502(92.4%), and married 537 (98.9%). The median (IQR) age of the child age was 8(9, 17) in months and more than half of the children were male 283 (52.1%). Mothers’ who attended formal education was 243 (44.7%) and 330 (60.7%) husbands also attended school. The majority of mothers, 409 (75.3%), were housewives and husbands of 404 (75%) mothers were farmers by occupation. The median family size of the study households was six in number. Of the total households about 84.6% earn an average family monthly income ≤ 1000 Ethiopian Birr. Among the households 434 (79.9%) obtained food from farming followed by small scale business 73(13.4%) and formal employment 12(2.2%). Only 3 (0.6%) households had television and 152 (28%) had radio. It was found that, 22(4.1%) mothers read newspaper, 59(10.9%) mothers listened radio and 5(0.9%) mothers watched Television at least once a week (Table 1).

Among the respondents, 445 (82%), mothers had antenatal care follow up at least once during the last pregnancy. Only 134(30.2%) of mothers had at least 4 visits. Almost all of those who had ANC follow up 423 (95.1%) made the first their visit for the service (ANC 1) after second trimester or later. About 439(80.8%) mothers gave their recent child birth at home. Only106 (19.5%) mothers had received postnatal care (PNC) and 298 (54.9%) had complementary feeding counselling during recent pregnancy (Table 2).

Nearly all children541 (99.6%) in this study had ever been breastfed and more than half 301(55.4%) were been initiated to breastfeed timely that is within one hour of birth. Some 501(92.1%) children were continued with breastfeeding at the period of study. Some 42 mothers (7.9%) stopped breast feeding before the child reaches 23 month of age.

Majority of mothers 541 (99.6%) ever practiced breastfeeding. About 9 in 10 of all mothers 485(89.3%) who had breastfeeding experience had started complementary feeding at the time of the interview. Out of which 48(9.9%) were initiated before six month, 336(69.3%) at six and 101(20.8%) after six month of age. Among the respondents 410(75.5%) had introduced solid, semi solid or soft foods as complementary feeding at the time of the interview. Some 353 reported (65.0%) initiating complementary feeding after the infant’s eight months of age.

The result of this study shows the proportion of timely initiated complementary feeding in the study area was 34.3% 95% CI (30.31, 38.29) (Table 3).

The findings of this study show mothers who had secondary school and above education were 2 folds more likely to timely initiate complementary feeding to their infants compared to those who did not attend formal education(AOR = 2.25 at 95% CI: 1.17, 4.30). Mothers living with their husbands trained to the level ability to read and write had also above 2 folds greater odds of timely initiating complementary foods to their infants compared to those who did not have formal education and were not able to read and write(AOR = 2.33 at 95%CI: 1.06, 5.14). On the other hand those mothers who had postnatal care were about 2 times more likely to timely initiate complementing food to their infants(AOR = 1.94 at 95%CI: 1.19, 3.16) compared to those who did not use the service (Table 4).