This study revealed that optimal breastfeeding practice was 44.3% (95%CI = 40.1, 48.1) which is consistent with the study done in rural communities of Hula District(n = 634 mothers) (43.1%) (28) and the study conducted in Indonesia (47.1%) (13). But, it is higher than a study conducted in Ethiopia (35.6%) (24).This higher rate of breastfeeding could be due to the difference in sample size and study period.
The prevalence of timely initiation of breastfeeding in this study was 242 (46.4%) (95%CI = 42.2, 50.8). This finding is consistent with the global prevalence (45%) (33).This finding is below the study in Ethiopia (57.2%),(83.1%), (82.5%), (83.7%), (67.5%) and (66.5%), WHO goal(70%), in Afghanistan (54.3%), Nepal (57%) (16, 26, 29–31, 34–37); On the contrary, the finding is higher than the study in Nigeria (38%), Afganistan(40.9%) and India (10%) (1, 26, 38).This discrepancy might be due to the difference in the study period, study design, study setting and sample size.
In the current study, 54.2% (95%CI = 50.0,58.2)of mothers gave colostrum to their baby which is lower than the study done in Jimma district in Ethiopia (91.2%) (39). The reason for this difference could be due to difference in the study setting and study period.
This study showed that the prevalence of exclusive breastfeeding 50.8% (95%CI = 46.6,54.6).This finding is consistent with the global nutrition target 2025–2030(50%), South Australian Health and Medical Research Institute in 2017, 22% (1996) to 54%(2012), Latin America and the Caribbean (excluding Brazil, and Mexico) 30–51% (5, 40).This result is by far higher than the study in Nigeria in 2014(6.7%) and 2015(13%), global prevalence in 2016 (38%), and 2017 (43%), Cameroon(45.2%) and the study in Italy(33.3%) (1, 25, 40, 41); This higher rate of exclusive breastfeeding is due to the difference in sample size, in the study setting, study design and period. But, this study is lower when compared with the findings from a study done by sub-Saharan Africa, East Asia/Pacific,(excluding China) 27% (1996) to 57% (2012),Ethiopia in 2013(67.2%),in 2018(60.5%) and in 2019(among 409 mothers (60.1%),Central Statistical Agency (CSA) [Ethiopia] and ICF: Ethiopia demographic and health survey in 2016(58%) (14, 23, 35, 39). This lower prevalence might indicate that health care providers who care for mothers should increase their efforts to promote breastfeeding and that there is a need for public policies which that ensure the living and working conditions of women are compatible with breastfeeding. While, the prevalence of on demand breastfeeding was 47.5% (95% CI = 43.1,51.5) which is higher than the result in Ethiopia in 2016 among 409 mothers (12.5%) and in 2017 among 634 mothers (25.9%) (27, 28). This difference might be due to the difference in the study period, sample size and study setting.
Prevalence of timely initiation of complementary feeding at 6 months of age was 47.1% (95%CI = 42.5,51.1) which is consistent with the global prevalence in 2017(46%), in Nepal (43%), (5, 32),but, slightly higher than a study in Ethiopia 2016 among 409 mothers (37.2%) (27).This slight difference could be due to the difference in sample size, study setting, study design and period.
The prevalence of continued breastfeeding at two years in this study was 45.8% (95%CI = 41.4,49.8), which was much lower than the result from a meta-analysis done in Afghanistan (58.6%), Bangladesh and Nepal (85%), India (72%), and Pakistan (60%) (26).This is due to the difference in socio-cultural and socio-economic difference, study population, sample size, sampling procedure, study design, period, and settings.
In this study, the multivariable logistic regression analysis revealed that respondents who had access to media were nearly 3 times higher to experience optimal breastfeeding than those respondents who had no access to media. This result is different from the study conducted in Ethiopia,2017 (n = 634) in those mothers who had no access to media were 1.21 times more likely to breastfed optimally (AOR = 1.21(.74,1.96)(28)and an another study done in Ethiopia(n = 383 mothers in 2013) (AOR = .56(95% CI = .33,.95) (37). This difference might be due to the difference in sample size, study period and sampling technique.
The odds of optimal breastfeeding practice of mothers who had male children were nearly 3 times higher than mothers who had female children. This result is agreed with the studies in Nepal, mothers having male children were 1.7 times more likely to breastfed (AOR = 1.7 [95% CI = 1.1–2.7) than mothers who have female children (32), and in Ethiopia, male children were 1.31 times more likely to TIBF than female children (AOR = 1.31[95% CI = 1.01–1.68]) and in South Asia in which female children were 20% less likely breastfed than male infants (AOR = .80 (95% CI = .66- 0.97) (26).But, This finding disagreed with the study in Cameroon in which female children were 1.80 times more likely to breastfed (AOR = 1.80 [95%CI = 1.00-3.22]) than mothers who had male children (41). The possible explanation for this disagreement could be due to gender preference may vary region to region.
In those respondents, the odds of optimal breastfeeding practice of mothers having < 2.5kg birth weight children were nearly 5 times higher than those ≥ 4.0 kg birth weight. This finding disagreed with the study in South Asia,<2.5kg birth size was 44% less likely to make optimal breastfeeding (AOR = .55[95%CI = .35–.86]) in Afghanistan, India, and Pakistan (26).This disagreement could be due to health extension workers deployed in rural areas might be responsible for wide practice of breastfeeding in the study area in Ethiopia.
In this study, the odds of optimal breastfeeding practice of mothers who had 1–3 times ANC visits were 71.8% lower than those mothers who had 4 times and above ANC visits. This result is congruent with the finding in South Asia, those having four or more ANC visits were 1.63 times more likely to breastfed optimally(AOR = 1.63[95%CI = 1.46-1.82]) than those who had 1–3 times ANC visits (26), and in a rural part of Ethiopia in which mothers with 1–3 times ANC visits were 2.4 times more likely to breastfed their children sub-optimally(AOR = 2.40[95% CI = 1.68, 3.43]) than those mothers who had 4 times and above ANC visits (28).But, this result is incongruent with a study in Nigeria in 2015 in which mothers who have frequent antenatal visits 4 times and above were 22% less likely breastfed their babies (AOR = .78, 95% CI: .63,.97;P = .027) compared to mothers who made 1–3 times ANC visits (1). This incongruence is due to the reason that currently in Ethiopia intensive heath education is provided by health extension workers about breastfeeding at the time of antenatal care visit for the mothers according to the focused antenatal care guideline (37).
LIMITATIONS OF THE STUDY
It was a cross-sectional study; the cause effect relationship of different variables with optimal breastfeeding could not be assessed. Maternal skills of breastfeeding practice (positioning and attachment) were not measured. Socioeconomic status was assessed simply by asking monthly income which would not be good to compute wealth index. In order to generate more information from the study participants, it would have been good if qualitative data collection approaches were considered besides the quantitative one.