Exclusive breast-feeding is one of the elements of optimal infant and young child feeding which is defined as giving infants less than six-month only human breast milk including expressed human milk (1-3). World Health Organization (WHO) suggest that infant less than six month should be Exclusively breast feed as it is safe and sufficient mode of feeding to prevent infections, chronic disease and growth impairment it also helps to increase infant survival (1, 3-8). Globally around 70 % of infants less than six month were not exclusively breastfeed In 2014 (9). In Africa, the Prevalence of interruption of exclusive breast-feeding is 68 % while in Ethiopia it was nearly 50%, according to Ethiopia Demographic and Health Survey (EDHS) 2011 (10, 11). Among the 10.9 million worldwide child deaths 60 % of death is due to malnutrition directly or indirectly out of this 60 % of deaths are during the infancy period due to inappropriate feeding (1). Only in sub Saharan Africa 1.16 million infants die in their first month of life, but if we do not miss the opportunities at home and at health facility for example EBF, we could have saved 800,000 infant deaths. In Africa the leading cause of infant mortality were 28 % infection, 3% diarrhea, 25 % prematurity, which are easily avertable by immunization and EBF(12). The global strategy of World Health Organization on infant and young child feeding (IYCF) was implementing program like Baby Friendly Hospital Initiative (BFHI) universal coding. However, the improvement was slight (13). In refugee camps, which were found in Ethiopia IYCF practices was implemented only in three of 24 camps (14, 15).
In Refugee, setting social service were not established due to lack of infrastructure and adequate health care service mother and infant face many health related problems, like interruption of EBF(15). Hence, care full attention should have given to IYCF especially protecting and supporting breastfeeding, which is important not just for the time of emergency only, but it have lifelong impacts on child health and on women's future preference on type of feeding (16, 17).
Therefore, it is very important to assess factors that may leads to the interruption of exclusive breastfeeding in accordance with the context of population type, because, it is difficult to apply the finding from community-based studies in host population. In addition, there is no specific study in Ethiopia on refugees setting. Moreover, the findings of this study will help aid organization and policy makers to set priority intervention plan for the problem, and it will help other researchers, as base line data.
Determinant Factors for Interruption of Exclusive Breastfeeding
The determinant factors for interruption of EBF has been outlined in number of literature in stable population but this factors are not well studied in emergency situation like refugee camps. In emergencies, appropriate and safe IYCF practices are less likely than under stable conditions. Bottle feeding comes with increased risks; poor water quality, an inability to sterilize the bottle/nipple, artificial ingredients in breast milk substitutes (BMS) (18). Evidences shows the a positive influence of maternal socio demographic characteristics on EBF for example as the age of the mother increase the chance of the infant being exclusively breastfeed increased (19, 20). Educational status affects early interruption of EBF positively (20). Mother working outside the home is inversely associated with interruption of EBF (21-26). Income was also another determine interruption of breast-feeding (27).
From obstetric factors, significant determinants of interruption of EBF includes utilization of antenatal care (ANC) and postnatal care (PNC) service, it is associated with reduced interruption of EBF (19, 20, 27, 28). Following ANC and PNC service, guidance on EBF given to the mother about appropriate type of feeding was another protective factor against interruption of EBF. Mother who give birth in health institution were less likely to interrupt EBF than those who give birth at home (21). Type and place of delivery was also another factor which determine early interruption of EBF (22). Timely initiation of breast feeding is also another determinant for interruption of EBF in infant who were not initiated EBF within first one hour of delivery were at greater risk for interruption of EBF (28-30). Breast feeding problem of the mother like cracked nipple cause pain to the mother during breast-feeding which lead the mother to interrupt EBF early (20, 21). Lack of prior breastfeeding experience in prim mothers risks them for early interruption of EBF (21). In addition to the obstetric factors, Knowledge of the mother on IYCF practice is also another determinant of interruption of EBF (22, 28).
Factors related to the child that is defiantly important after the birth of the child like pre-lacteal that is giving infant anything before breast milk at any time after delivery favor interruption of EBF though how it does this is still debating (20, 22, 31). Male sex and increasing age of infant (19) was risk factor for interruption of EBF (20, 22, 23, 25, 27). Infant who are feed the first breast milk were less likely to interrupt EBF (21, 32, 33). Mothers limited Night time breast feeding was also associated with increased risk with interruption of EBF (21).
Exclusive breast-feeding is one of the elements of optimal infant and young child feeding which is defined as giving infants less than six-month only human breast milk including expressed human milk (1-3). World Health Organization (WHO) suggest that infant less than six month should be Exclusively breast feed as it is safe and sufficient mode of feeding to prevent infections, chronic disease and growth impairment it also helps to increase infant survival (1, 3-8). Globally around 70 % of infants less than six month were not exclusively breastfeed In 2014 (9). In Africa, the Prevalence of interruption of exclusive breast-feeding is 68 % while in Ethiopia it was nearly 50%, according to Ethiopia Demographic and Health Survey (EDHS) 2011 (10, 11). Among the 10.9 million worldwide child deaths 60 % of death is due to malnutrition directly or indirectly out of this 60 % of deaths are during the infancy period due to inappropriate feeding (1). Only in sub Saharan Africa 1.16 million infants die in their first month of life, but if we do not miss the opportunities at home and at health facility for example EBF, we could have saved 800,000 infant deaths. In Africa the leading cause of infant mortality were 28 % infection, 3% diarrhea, 25 % prematurity, which are easily avertable by immunization and EBF(12). The global strategy of World Health Organization on infant and young child feeding (IYCF) was implementing program like Baby Friendly Hospital Initiative (BFHI) universal coding. However, the improvement was slight (13). In refugee camps, which were found in Ethiopia IYCF practices was implemented only in three of 24 camps (14, 15).
In Refugee, setting social service were not established due to lack of infrastructure and adequate health care service mother and infant face many health related problems, like interruption of EBF(15). Hence, care full attention should have given to IYCF especially protecting and supporting breastfeeding, which is important not just for the time of emergency only, but it have lifelong impacts on child health and on women's future preference on type of feeding (16, 17).
Therefore, it is very important to assess factors that may leads to the interruption of exclusive breastfeeding in accordance with the context of population type, because, it is difficult to apply the finding from community-based studies in host population. In addition, there is no specific study in Ethiopia on refugees setting. Moreover, the findings of this study will help aid organization and policy makers to set priority intervention plan for the problem, and it will help other researchers, as base line data.
Determinant Factors for Interruption of Exclusive Breastfeeding
The determinant factors for interruption of EBF has been outlined in number of literature in stable population but this factors are not well studied in emergency situation like refugee camps. In emergencies, appropriate and safe IYCF practices are less likely than under stable conditions. Bottle feeding comes with increased risks; poor water quality, an inability to sterilize the bottle/nipple, artificial ingredients in breast milk substitutes (BMS) (18). Evidences shows the a positive influence of maternal socio demographic characteristics on EBF for example as the age of the mother increase the chance of the infant being exclusively breastfeed increased (19, 20). Educational status affects early interruption of EBF positively (20). Mother working outside the home is inversely associated with interruption of EBF (21-26). Income was also another determine interruption of breast-feeding (27).
From obstetric factors, significant determinants of interruption of EBF includes utilization of antenatal care (ANC) and postnatal care (PNC) service, it is associated with reduced interruption of EBF (19, 20, 27, 28). Following ANC and PNC service, guidance on EBF given to the mother about appropriate type of feeding was another protective factor against interruption of EBF. Mother who give birth in health institution were less likely to interrupt EBF than those who give birth at home (21). Type and place of delivery was also another factor which determine early interruption of EBF (22). Timely initiation of breast feeding is also another determinant for interruption of EBF in infant who were not initiated EBF within first one hour of delivery were at greater risk for interruption of EBF (28-30). Breast feeding problem of the mother like cracked nipple cause pain to the mother during breast-feeding which lead the mother to interrupt EBF early (20, 21). Lack of prior breastfeeding experience in prim mothers risks them for early interruption of EBF (21). In addition to the obstetric factors, Knowledge of the mother on IYCF practice is also another determinant of interruption of EBF (22, 28).
Factors related to the child that is defiantly important after the birth of the child like pre-lacteal that is giving infant anything before breast milk at any time after delivery favor interruption of EBF though how it does this is still debating (20, 22, 31). Male sex and increasing age of infant (19) was risk factor for interruption of EBF (20, 22, 23, 25, 27). Infant who are feed the first breast milk were less likely to interrupt EBF (21, 32, 33). Mothers limited Night time breast feeding was also associated with increased risk with interruption of EBF (21).