Breast milk is the very irreplaceable food to a newborn baby; it uses the baby to grow properly, protect the newborn from infection because it has antibodies. This study revealed that the prevalence of exclusive breastfeeding was 77.5%(95%CI:73.5,81.5%). Despite its need, the prevalence of exclusive breastfeeding in this study was not as satisfactory. However, it was higher compared to the Ethiopian demographic health survey (EDHS) 16 data (58%) (10), the global EBF estimate 35%, and in developing countries such as; Motta town, Ethiopia (17), Nigeria (20%), Brazil (58%), Bangladesh (34.5%)(1, 4, 11, 19). In contrast, this result was comparable with the study in Addis Ababa (81%)(24), Ethiopian HSDP IV target level of 70% (25), and Debre Markos, Ethiopia 60.8% (21).
Initiation of EBF during an hour after delivery is recommended to prevent 13% of child death(7), protect infants from otitis media for at least four months (26). In this study, the higher prevalence (65.8%) of mothers was initiated breastfeeding within one hour after delivery. This result was congruent with the studies in Amhara (60%), Oromia (77%), and Southern Ethiopia (50%)(27). Whereas, it was higher compared to a study in Dabat, Gondar (23.2%)(13), and lower from a study in Tigray (99.1%)(16). These variations might be due to incomparable sample size, study designs used and study setting (community based and institutional) difference of the study areas.
Concerning factors associated with breastfeeding practices like mother’s level of education, marital status, occupation, ANC, place of delivery, and counseling about breastfeeding practice during ANC visit were the variables that significantly associated with exclusive breastfeeding practice.
The study showed that the odds of exclusive breastfeeding among mothers having an educational level unable to read and write 89% less likely than mothers who have secondary and above educational levels. This is a discordant result when compared to study determinants of exclusive breastfeeding in Ethiopia(28).
After controlling the confounding variables, unemployed(housewife) mothers practiced EBF better than employed mothers. Employed mothers were about 78% less practiced exclusive breastfeeding than housewife mothers. This result is similar to studies in Malaysia (29, 30), Cameroon (31), Ghana (32, 33), Awi Zone, Ethiopia (34), Northwest Ethiopia(35), and Debre Markos, Ethiopia(21). This might because women spent their time at home are more frequently in contact with their child.
This study revealed that mothers who had antenatal care had four times more likely of practicing exclusive breastfeeding practice. This is supported by a nested case-control study in Northwest, Ethiopia(36), Jima, Ethiopia (37), and breastfeeding guidelines(38, 39). However, it has no association with EBF practice according to a study in Motta town, Ethiopia(17). This might be attributed to the study year (the former is conducted five years back), and the study population included.
Mothers who gave birth in a health institution were more likely to practice exclusive breastfeeding compared with those who gave birth at home. This finding had in agreement with the studies done at Bahir Dar, Ethiopia(33) and Ghana(32). This could be due to the fact that mothers who give birth in institution have more opportunities to be counseled about the benefit of breastfeeding by health care providers. In contrast to this, study done in Motta, Ethiopia indicated that birth place do not associate with exclusive breast feeding practice. This discrepancy might be due to the study period, study populations and sociocultural difference.
In this study breastfeeding counseling during antenatal care service was found to facilitate exclusive breastfeeding practice. This is parallel with studies done with low income Latinos in United states (40), Nigeria(41), and Debre Markos, Ethiopia(21). This could be health education and counseling increases mothers’ knowledge about the need and benefits of EBF.
Culture was one of the independent predictor of exclusive breastfeeding in this study. The study showed that mothers who had a culture of giving different prelacteal foods (like; water, coffee, fresh butter, etc.) were around 80% less likely practicing of exclusive breastfeeding. This was in line with studies in Afar, Ethiopia(42), avoidance of prelacteal practice in rural Ethiopia(43), and a study exclusive breast feeding measurements and indicators in Israel (44). This might be the fact that, most Ethiopian mothers believe that their child will be affected by the devil if they did not make their child test a portion of food that the mothers tested (visual witness from elders).
Although a cross-sectional study design was used, this study had a strength of inclusion of large study areas. However, the limitations of this study were unable to assess qualitative aspects; like the attitude of both parents towards exclusive breastfeeding, factors related to health institutions, and detailed cultural factors like ingesting fresh butter to the infant at birth. Likewise, since this study included mothers with up to two years of a child, recall bias might under/overestimate the prevalence of exclusive breastfeeding.