Levels and Predictors of Exclusive Breast Feeding Among Rural Mothers with Children Age 0-12 Months in Rural Kebeles of Chencha District, Snnpr, Gamo Gofa Zone, Ethiopia, January 2016
Back ground: Exclusive Breastfeeding has highest life-saving potential and about 13% of child deaths worldwide can be avoided with
optimal breastfeeding. Worldwide 35% of infants breast-fed exclusively during the first four months of life even though 90% and above
is recommended to benefit from the practice.
Objective: To assess Levels and predictors of exclusive breast feeding among mothers with chil-dren 0-12 months in rural Chencha
Method and materials: A community-based cross-sectional study was conducted. Data was col-lected by using designed well-structured
questionnaire and entered into Epi-Data version 3.1 and analyzed by using SPSS window version 20. Bivariate logistic regression was
performed to each independent variable with the outcome variable and variables with a p value < 0.05 were used for multivariate
analysis. P-value less than 0.05 was considered statistically significant.
Result: Two hundred twenty six mothers with babies 0-12 months old were included in this study. The mean age of study participants was
29.1 ± (5.987) years. Mothers ANC follow-up ex-perience was 130(57.5%). The prevalence of exclusive breast feeding was 92(40.7%)
and 144 (63.7%) had good knowledge. Maternal Age 15-24 yrs [AOR=12.02 (1.153, 25.180)]; Family size of 3 were [AOR=2.027
(0.246, 1.715)], Non-Attendance to ANC service [AOR=0.037 (0.005, 0.256)]; Good knowledge [AOR=1.288 (0.038, 5.393)] and
exposure to advice concern-ing breast feeding [AOR=1.277 (0.677, 2.410)] were independent predictors of exclusive breast feeding
Conclusion and recommendation: In this study Practice of exclusive breastfeeding was below the world health organization
recommendation which is 90% or above. Hence it is important to focus interventions towards these factors in order to increase exclusive
Exclusive Breast Feeding, Antenatal Care, Chencha District, Gamo Gofa, Ethiopia
Breast milk is bio-dynamic and species specific. It is a natural,
convenient, hygienic and inexpensive food for babies. Infants
grow and develop at a very rapid rate in early life, yet many of
the infants’ anatomical systems are still immature. Human breast
milk suits for this immaturity because nutrients contained in
breast milk are easily absorbed and exist in bioavailable forms (1).
Human milk contains several major protein components, which
are easy for digestion and other unique proteins like lactoferrin and colostrum, which are protective for the baby (2).
Breastfeeding reduces the risk of physiological reflux; pyloric
stenosis; gastrointestinal infections; respiratory illness; otitis
media; urinary tract infections; bacterial meningitis; necrotising
enterocolitis; atopic disease; some childhood cancers; type 1 and
type 2 diabetes; coeliac disease; inflammatory bowel disease;
cardiovascular disease risk factors; promotes bonding between
mother and infant and keep the baby sufficiently hydrated (3-6).
To optimize growth, development and health, infants should be
exclusively breastfed for the first six months of life and thereafter,
they should receive adequate and safe complementary foods while
breastfeeding continues up to two years of age and beyond. The
coverage of EBF should reach to 90% to be benefited from the
intervention. EBF is one of the most effective interventions for
child survival (7-9).
Lack of exclusive breastfeeding attributes 45% of neonatal
infectious deaths, 30% of diarrheal deaths and 18% of acute
respiratory deaths. EBF can significantly reduce the burden of
under-five death in Africa especially SSA where 41% of global
under five death occur mainly due to inadequate breastfeeding
practices and high levels of disease (10).
In Ethiopia nearly 321,000 under five children die each year from
which malnutrition is the cause for about 57% of deaths primarily
through the exacerbation of other major causes, such as diarrhea
and pneumonia death from which can be significantly prevented
by nutrition interventions such as exclusive breast feeding (11, 12).
Globally only 35% of infants breastfed exclusively during the first
four months of life and complementary feeding begins either too
early or too late with foods which are often
nutritionally inadequate and unsafe. Majority of mothers started to
EBF their infants at birth and the rate declined greatly about two
or more months even though optimal breastfeeding is intervention
with the highest life-saving potential that can avoid 13% of child
deaths worldwide (13-15).
Breastfeeding is common practice in Ethiopia owing to the
enormous benefits of breast milk, however only 52% children
exclusively breastfed and 24% of deaths among infants were
attributed to poor and inappropriate breastfeeding practice. Twenty
nine percent of newborns received pre-lacteal feed and 69.1% of them were put to breast within one hour (16-18).
Despite the many benefits of exclusive breast feeding (EBF), poor
breastfeeding practices are still common, both in developing and
developed countries. Especially in developing world like Ethiopia
the practice is lagging behind from WHO target of EBF and the
practice also varies between regions and among countries (9, 20,
Comparative cross-sectional study conducted in Belgium indicates
that, only 65 (16.25%) urban and 58 (15.26%) rural mothers
had practiced exclusive breast feeding till 6 months of age.
Complementary feeds were initiated by 69.20% urban mothers
before the infant was 6 months old and 42.11% rural mothers had
initiated at recommended 6 months(22).
Cross study conducted in chandigahr village showed that the rate
of exclusive breast feeding among the lactating mothers is found
to be 22.7% and 46% of the mothers have some prior knowledge
of breastfeeding. About 55% of the lactating mothers gave Prelacteal
feeds to their children and 56% discarded the colostrums.
It was found that 71% of the respondents started complementary
feeding at the age of 4-5 months(23).
Cross sectional study on the determinants of exclusive breast
feeding in Lebanon indicates that the exclusive breastfeeding rate
was 27.4% (24). Study achieved in rural eastern Uttar Pradesh
India revealed that, 45% mothers initiated breast feeding within
24hrs of birth and exclusive breastfeeding for 6 months was only
Study conducted in Malaysia revealed that, prevalence of EBF
among mothers with infants aged between one and six months was
43.1%. The prevalence of exclusive breastfeeding when stratified
by infant age from one to six months ranged between 32.4% and
63.3% with the highest among one month old infants and lowest
among six month old infants (26).
Cross sectional study conducted in rural area of Jimma zone
indicated that 37% of mothers initiated breastfeeding later than
one hour after delivery. The majority (67.02%) of mothers had no
knowledge about exclusive breastfeeding (27) .
Cohort study conducted in Brazil confirmed that the factors
associated with EBF duration are Mother partner’s appreciation
for breastfeeding, limiting the number of night time feeds at the
breast, presence of cracked nipples and prenatal care provided by
public services were described as determinants of discontinuation
of exclusive breastfeeding (28).
Comparative study in Pakistan showed that as compared to the
not counseled group, the mothers who initiated breastfeeding
immediately after birth were significantly higher in the counseled
group and counseled mothers practiced EBF more than those
not counseled. Antenatal counseling helps in motivating the
mothers for initiation of breastfeeding immediately after birth and
practicing exclusive breastfeeding for first six months of infant’s
The study conducted in Bahir Dar revealed that, Being a housewife,
a young infant age, having a prenatal EBF plan, delivering at a
health institution, delivering vaginally, receiving counseling,
belief of breast milk sufficiency and maternal age of 18-23 were
independently predictors of exclusive breastfeeding among
Study conducted in North West Tigray, showed that 165(65.45%)
had knowledge about EBF and 132(52.2%) mothers reported frequency of breast feeding needed for <6 month of infant. This
study also revealed that 160(66.8%) mothers start breast feeding
with in the first four hours, but 84 (32.2%) started breast feeding
after few hours (31).
Study conducted in Mecha district, North West Ethiopia showed
the prevalence of exclusive breast feeding (EBF) was 47.13%.
This study also revealed that mothers who reported having 3 and
more antenatal visit during pregnancy, who got PNC counselling
on infant feeding,who initiated breast feeding(BF) immediately
after birth with in the first one hour and who have adequate
knowledge on EBF were more likely to exclusively breastfeed
than their counterparts(32).
Study conducted in North West Ethiopia showed that mothers
whose age was ≥ 30 years; delivered at healthcare facility and
those who had antenatal care exclusively breastfed their infants
more than mothers who delivered at home and those who did not
have antenatal care (33).
All mothers surveyed in Dubti town had ever breastfed their index
infant. About 93 % of mothers had initiated breastfeeding within 1
h of birth. Exclusive breastfeeding under 6 months was practiced
by 81.1 % of mothers of infants aged less than 6 months. Moreover,
prelacteal feeding and colostrum avoidance were practiced by
16.8 and 15.6 % of mothers of infants aged less than 6 months,
Study conducted in Debre Markos town showed that overall
prevalence of exclusive breastfeeding was 296 [61.3%] which was
89[55%] in Debre Markos town and 207[64%] in Gozamen district
(rural). This study also revealed that getting counseling about
exclusive breastfeeding during antenatal follow up was significant predictor of exclusive breast feeding practice (35).
Study conducted in Mizan Aman town among 314 breastfeeding
mothers with their index child less than 2 years 93.6% of study
participants had heard about EBF, only 34.7 % were knowledgeable
about the recommended duration and only 59.3% believed that
only EBF is enough for child up to six months and 26.4% of children were exclusively breastfed for six months (36).
Study conducted in Dilla Zuria District, Gedeo Zone revealed
that mother belongs to family of 4 and less family size were 2.25
times (p = 0.01) higher to practices EBF as compared to family
size above 4 members and Those mothers followed ANC were
5.9 times (0.004) higher to practices EBF as compared to mother
didn’t visit ANC(37).
Different studies identified factors predicting EBF practice in
Ethiopia. However these factors tend to vary between peoples
with different socio-demographic and cultural factors and there
is no study conducted with similar topic in study area. Owing to
this alarming practice gap addressing socio-cultural and maternal
factors predicting EBF practices has much importance especially
in rural areas of developing countries. Therefore, this study was
designed to identify levels and predictors of exclusive breastfeeding
practices among mother-infant pairs in rural communities of chencha district.
Method and material:
Study area and period:
The study was conducted from September 15 to October 15, 2016
at Chencha district, Gamo Gofa Zone, Southern Ethiopia. Chencha
district is one of 13 districts in Gamo Gofa Zone which is located
at 250 Km South of Hawassa; and 480 km South East of the capital
city of Ethiopia, Addis Ababa. According to the data obtained
from the district health office, 2015/2016 projected population
of the district is around 142,062 and the number of women in child bearing age is 27, 812. There are 1 district hospital, 7 health
centers, 5 private clinics, two drug venders and 49 health posts
with 2 health extension workers in each Kebeles. It has 50 Kebeles
with estimated area of 445km2 and divided into 45 rural kebeles
and 5 urban dwellers associations (38).
A community based cross-sectional study design employing
quantitative method was used.
All mothers who lived in the woreda for at least 6 months prior to
All mothers in selected kebeles who had a child aged 0-12 months
at the time of the survey
Mothers who had a child age 0-12 months and living in the study
area for more than 6 months were included.
Mothers who were not able to communicate due to serious illness
at the time of data collection and unwilling to respond and HIV
positive mothers were excluded.
Sample size and Sampling Technique:
Sample size determination:
A sample of 226 mothers with children aged 0- 12 months,
were selected from already registered Health extension workers’
To calculate sample size using the single proportion population
formula was used. The proportion of exclusive breastfeeding was
81.1% from study conducted in Dubti town (34). The value of Z =
1.96 at α=0.05 two sided confidence level of 95%. Finally, 5% of
the sample size was added for non-respondents and a total of 248
samples were taken.
5% non-response rate= 236.5.2+11.8=248
n= required sample size
p= estimate of prevalence rate of premarital sexual practice
= standard normal variable at 95% confidence level
(95%=1.96 from table)
d= margin of sample error tolerated =0.05
Five rural kebeles were randomly selected from 45 rural kebeles
by lottery method. All mother infant pairs having children 0-12
months from health extension register in each kebele were
enumerated. There are 893 eligible mothers-infant pairs in these
selected kebeles and proportional to size allocation was done to
get the required sample from each Kebele. During visit to houses,
if there was no child of 0-12 months, next house satisfying this
criterion was included. Verbal consent was obtained after the
participants were informed about the study objectives.
Dependent variable: Exclusive Breastfeeding practices
In dependent variables
Educational status; Income; Occupation; Age of mothers
Knowledge of mothers on?
ANC, PNC, Place of delivery; Family support; Mode
of delivery; Sex of child; Age of child; Health worker support;
Parity; Family size; Medical complication of mothers and Media
Data Collection Tool:
Structured questionnaire adapted from the Ethiopian Health and
Demographic Survey (EDHS), and from different literatures (12,
13). It was initially prepared in English and then translated into
Amharic, by fluent speakers of both languages, and it was back
translated into English to check for consistency. This questionnaire
was pre-tested on 5% (12) of actual sample size among eligible
mothers in nearby kebele in the district to test the precision
of the questions and the time needed to conduct an interview.
Then amendments were done based on findings. Mothers
knowledge on exclusive breast feeding was assessed by using
6 questions designed for it and Data on breastfeeding practices
was asked retrospectively; mothers were asked to report previous
breastfeeding experience, and the initiation of breast-feeding after
delivery, the frequency of breast-feeding in the 24 hours was also
asked, duration of exclusive breastfeeding, reasons for stopping
exclusive breastfeeding during the first 6 months following
delivery. Breastfeeding support of husbands, other family
members, and relatives was also assessed.
Data collection Technique and Quality Assurance:
Five health extension workers working in the selected kebeles
for data collection and two Nurses working in the district for
supervision were selected and one day training was given on
data collection tools and principles during data collection. Health
extension workers were assigned to collect data from different
kebele (i.e. not their working kebele) to reduce desirability bias.
The questionnaires were checked daily during data collection for
completeness and consistencies by supervisor and data collectors.
Then proper correction and adjustment was made.
Data processing and Analysis:
The questionnaire was checked manually for completeness and
consistencies, and the principal investigator and supervisors
supervised the data collection regularly and checked for any
inconsistency or data incompleteness. The complete data verified
for field level quality were further entered, cleaned and edited by
researcher using Epi data software version 3.1 and exported to
SPSS for window version 20 for analysis. Prevalence of exclusive
breastfeeding practice was determined. To identify factors
associated with exclusive breastfeeding practice, binary logistic
regression was performed to each independent variable with
the outcome variable and variables with a p value <0.05 was
included in the final model (multivariable logistic regression)
to identify independent predictors of exclusive breast feeding
practice. Su-group analysis was done to identify factors predicting
EBF among mothers with ANC follow-up and those with no
ANC follow-up. Strength of association was measured using
odds ratio, and with 95% confidence intervals. A statistically
significant level was considered when P-value was less than 0.05.
Exclusive breastfeeding: Infant feeding only breast milk,
and no other liquids or solids with the exception of oral
rehydration solution, supplements or medicines to the child age
before 6 month of age.
Good knowledge: mothers were labeled as having good knowledge
on exclusive breast feeding if they respond greater than or equal to
80% of questions designed to determine knowledge and otherwise
On-demand breastfeeding: mothers recognize when their babies
are hungry and
feed their babies as often and for as long as the babies want or
Partial breastfeeding- an infant receives breast milk and any food
or liquids including non-human milk and formula.
Pre-lacteal foods: non-breast milk feeds given before breastfeeding
Two hundred twenty six mothers with babies 0-12 months old
were participated in this study providing response rate of 92%. The
mean age of study participants was 29.1± (5.987) years. Majority
of study participants 155(68.6%) were orthodox followed by
protestant 59(26.1%); most of them 210(92.9%) were Gamo by
ethnicity and 205 (90.7%) were married. With regard to family
monthly income 66 (29.2%) of families earned 1000-2000 ETB
with mean income of 3054.69 ±(1656.51) Birr (Table 1).
Factors related to mothers Experience on Exclusive
About three forth 171(75.7%) of mothers had two under five
children and 178(78.8%) of children were in age group 0-6 months
and majority 171(75.7%) were females. Mothers ANC followup
experience was 130(57.5%); however only below one third
41(31.5%) had four times follow-up. Normal vaginal delivery
accounted 145(64.2%) of all deliveries followed by assisted
delivery 44 (19.5%); Institutional delivery was 165(73%) and
PNC follow-up was 115(50.9%). The prevalence of exclusive
breast feeding was 92(40.7%) even though 172 (86.0%) of mothers
initiated breast feeding within one hour of delivery and the major reason for delay were 15(53.6%) delayed milk production followed
by 6(21.4%) cesarean section. Majority 190 (84.1%) of mothers
reported that they breast feed colostrum to their baby (Table 2).
Concerning the major reasons for delaying breast feeding more
than one hour were, delayed milk secretion 54%, Cesarean section
delivery 21%; baby was sick 14% (Figure 3). The major reason for
stopping breast feeding were weaning age 10 (38.5%), child was
sick 6(23.1%) followed by heath condition of the mother 8(23.5%)
Knowledge on exclusive breast feeding:
Mothers were asked series of questions regarding breast feeding
and majority 202(89.4%) reported that colostrum feeding protect
against disease; 144(63.7%) said breast feeding alone is sufficient
for 0-6 months; majority 151(66.8%) reported babies should breast
feed on demand; with regard to appropriate to start complimentary
feeding 106 (46.9%) of mothers reported 6 months. With respect
to advantage of breast feeding for baby and mothers 110(48.7%)
provides perfect nutrition and 102(45.1%) prevents pregnancy.
The overall knowledge on exclusive breast feeding was 144
(63.7%) (Table 3).
Advice and Support of Breast Feeding Practice:
About one half 122(54.0%) of mothers had exposure to advise on
exclusive breast feeding and mothers were the major source of
advice 34(27.9%) and influencer of breast feeding practice. Most
217(96.0%) reported that husbands support breast feeding practice
and the reported role of husbands were giving advice 131(60.4%)
and providing economic support 86 (39.6%) (Table 4).
Predictors of Exclusive breast feeding:
Binary logistic regression showed that; Age of the mother, family
size, attendance of ANC service, mode of delivery, knowledge on
exclusive breast feeding, exposure to advise on breast feeding and
source of advice were factors affecting exclusive breast feeding.
Multi variable logistic regression model was used to identify
independent predictors of EBF practice. It showed that, Age of the
mother 15-24 years were 12 times [AOR=12.02 (1.153, 25.180)]
more likely to exclusively breast feed their baby than those in age
range 35-44 years; family size of three were 2 times [AOR=2.027
(0.246, 1.715)] more likely to EBF than those having family size
six, mothers not Attended ANC service were [AOR=0.037 (0.005,
0.256)] less likely to exclusively breast feed their baby than ANC
attendants; mothers with good knowledge on breast feeding were
1.2 times [AOR=1.288 (0.038, 5.393)] more likely to exclusively
breast feed their baby than those with poor knowledge and mothers
who had exposure to advice concerning breast feeding were 1.2
times [AOR=1.277 (0.677, 2.410)] more likely to exclusively
breast feed their baby than those who had no advice (Table 5).
Two hundred twenty six mothers with children 0-12 months old
were included in this study. The prevalence of exclusive breast
feeding in this study was 92(40.7%). This is higher than findings
from study conducted in Belgium16.25% (22); study conducted in
chandigahr village 22.7%(23); study conducted in Lebanon 27.4% (24) and Study conducted rural eastern Uttar Pradesh India 21%
(25). However this is lower than national EDHs data that is 52%
of infants were exclusively breastfeed (18). Study conducted in
Mecha district, the prevalence of exclusive breast feeding (EBF)
was 47.13%. This variation could be explained by difference in
socio-demographic characteristics of study population and study
Table 2: Distribution of Mothers Experience on Breast feeding in Chencha district southern Ethi-opia 2016 (n=226)
Figure 1: schematic presentation of sampling technique
Figure 2: Reason of delaying breast feeding for more than 1hr breastfeeding practice in Chencha district southern Ethiopia 2016 (n=28)
Figure 3: Reported Reason of stopping exclusive breastfeeding practice in Chencha district southern Ethiopia 2016(n=26)
Table 3: Mothers Knowledge on exclusive breast feeding practice in Chencha district southern Ethiopia 2016 (n=226)
Table 4: Advice and Support of BF Practice in Chencha district southern Ethiopia 2016 (n=226)
Table 5: Multivariable logistic regression of factors predicting the likelihood of exclusive breast feeding among mother having children
0-12 months old at rural Kebeles in Chncha district, Southern Ethiopia, September 2016, (n=226).
This study showed that majority 182 (83.5%) of mothers reported
that they breast feed colostrum to their baby. This is higher than
study conducted in chandigahr village 56% of mothers discarded
the colostrum (23).This could be probably due socio-cultural
support of breast feeding and presence of health extension workers
in each kebeles working to improve maternal and child health of
Mothers 15-24 years old were 12 times [AOR=12.02 (1.153,
25.180)] more likely to exclusively breast feed their baby than
those in age range 35-44 years. This is in line with study conducted
in Bahir Dar maternal age of 18-23 was independently predictors
of exclusive breastfeeding among mothers (31).
Mothers with family size 3 were 2 times [AOR=2.027 (.0246,
01.715)] more likely to exclusively breast feed their baby than
those with family size of six. This could be explained by economic
nature. This is similar with study conducted in Dilla Zuria which
revealed that mother belongs to family of 4 and less family size
were 2.25 times (p = 0.01) higher to practices EBF as compared to
family size above 4 members. This may be due to small family size
associated improvement in maternal nutrition and health.
This study explored that mothers knowledge on exclusive breast
feeding was 144 (63.7%) and mothers with good knowledge
on breast feeding were 1.2 times [AOR=1.288 (0.038, 5.393)]
more likely to exclusively breast feed their baby than those with
poor knowledge. Similar with study conducted in Mecha district
mothers who have adequate knowledge on BF (AOR=2.06; 95%
CI: 1.47-2.88) were more likely to exclusively breastfeed than
their counterparts (32).
One hundred thirty (57.5%) of mothers had ANC follow-up and
mother with no ANC follow-up history were [AOR=0.037 (0.005,
0.256)] less likely to exclusively breast feed their baby than those
ANC follow-up. This similar with study conducted in dilla zuria
district which showed that mothers followed ANC were 5.9 times
(0.004) higher to practices EBF as compared to mother didn’t
visit ANC (37); Study conducted in North West Ethiopia mothers
who had three and more ANC visit were 1.7 time more likely to
exclusively breast feed for 6 month as compared to those who have
no ANC visit during pregnancy (32).
Mothers who were advised by their friends and neighbors about
breast feeding were [AOR=0.006 (0.001, 0.062)] less likely to
exclusively breast feed than those who were advised by health
workers. This is in line with a comparative study in Pakistan on the
effect of antenatal counseling on exclusive breastfeeding shows
that as compared to the not counseled group, the mothers who
initiated breastfeeding immediately after birth were statistically
significantly higher (p<0.046) in the counseled group (84%
and 96% respectively) (29). This could be due to health worker ability to explain advantage of breast feeding practice to infants
and mothers which could influence level of knowledge on breast
feeding which is independent predictor is of exclusive breast
The limitations of this study are:
The findings of this study should be used in light of its limitations.
The findings of this study cannot be generalized to urban
The recall bias was a concern since experiences with EBF practices
were based on self-report
Desirability bias due to mothers intention to report what is right
regarding EBF not their actual practice.
Below two third of mothers had ANC follow-up experience and
about one third had four times visited and less than half of mothers
exclusively breast feed their babies for 6 months and majority had
good knowledge. Level of EBF in this study is much lower than
WHO recommendation. Age of the mother 15-24 years; family
size three and four, ANC service follow-up; good knowledge on
breast feeding and mothers who had exposure to advice concerning
breast feeding were predictors of EBF practice.
Based on the results of the study, the following recommendations
were made to different bodies;
Health institutions and families: should Counsel mothers specially
those above 25 years of age on EBF practices
Health institutions: should Improve ANC follow-up which would
improve the knowledge of EBF and hence EBF practice
Health extension workers and health institutions:
FP programs to limit family size that would enhance EBF practice
Woreda Health department and health institutions:
educational strategies to improve Behavioural change so as to
avoid pre-lacteal feeding.
ANC: Antenatal care
AOR: Adjusted Odds Ratio
BM: Breast milk
COR: Crude Odds Ratio
CS: Cesarean section
EBF: Exclusive Breast Feeding
EDHS: Ethiopian Health and Demographic Survey
HIV: Human immune virus
HSDG: Health Sector Development Goal
IYCF: Infant and Young Child Feeding
MDG: Millennium Development Goal
MOH: Ministry of Health
PNC: Post-natal care
SNNPR: Southern nations, nationalities and peoples region
SSA: Sub-Saharan Africa
UNICEF: United Nations Children’s Fund
WHO: World Health Organization
Ethical Approval and consent to participate:
The ethical approval and clearance was obtained from Ethical
clearance committee of Arba Minch College of health sciences.
Permission was also obtained from the concerned bodies of Gamo
Gofa Zonal Health Department and Chencha Woreda Health
Office. Before each interview, clear explanation was given about
the aim of the study which was neither to evaluate the performance
of the individual nor to blame anyone for weakness but to gather
information and opinions that may lead to eventual improvement
in the situation. Interview was carried out only with full consent of
the mother being interviewed.
Availability of data:
Data used for the article is available at author’s data package and
please do not hastate to contact the author for data sharing.
Contribution of researcher:
Mende Mensa is senior researchers who conceived the study and
prepared the proposal; analyzed the data and presented the work
for responsible bodies analyzed and interpreted the findings of this
study and he also prepared this document for publication.
Conflicts of interest:
I have no conflict of interest during conducting this study or
developing the manuscript. All expenses regarding this paper were
from out of pocket of the researcher.
First of all I want to thank the Almighty God. Next I would like
to express my deepest gratitude and appreciation to my families
Sister melkenesh Nigatu my wife for her unreserved support since
proposal development through manuscript writing. My children
Kalkidan Mende and Mikiyas Mende for their valuable time which
they shared for me conduct analysis. Furthermore, I would like
to thank Habitamu Samuel research and publication core process
owner at Arba Minch College of Health Sciences.
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