Magnitude and determinants of early initiation and exclusive breastfeeding at six weeks postpartum: evidence from the PMA Ethiopia longitudinal survey.

BACKGROUND: Early initiation and exclusive breastfeeding are crucial in preventing child morbidity and mortality. Despite the importance of these practices, rates of timely initiation of breastfeeding and exclusive breastfeeding remain suboptimal in many sub-Saharan countries, including Ethiopia. This paper aimed to estimate the prevalence and identify determinants of breastfeeding initiation within the first hour after birth and exclusive breastfeeding in Ethiopia. METHODS: Data from the Performance Monitoring for Action Ethiopia project, a national survey conducted from August 2019 to September 2020, were used. The analytical sample comprises 2564 postpartum women and their children; data reported at baseline during enrollment and six weeks postpartum were used in this analysis. A multi-level binary logistic regression model was employed to identify determinant factors linked with initiation breastfeeding and exclusive breastfeeding. RESULTS: Of the 2564 mothers, 77.8% of infants breastfed within the first hour of birth and 68.4% of women practiced exclusive breastfeeding at six weeks postpartum with significant variation across regions. In the multivariate analysis, mothers who had cesarean delivery were less likely to initiate early breastfeeding as compared to mothers with vaginal delivery (AOR 0.27; 95% CI 0.17, 0.41). The odds of early initiation of breastfeeding were higher for mothers whose baby cried immediately after birth (AOR 3.31; 95% CI 1.95, 5.62) and who had skilled assisted delivery (AOR 2.13; 95% CI 1.01, 4.48). Other factors that were significantly associated with early initiation of breastfeeding were obstetric complication(s), parity, immediate mother-to-baby skin-to-skin contact, immediate postnatal care and the region. Similarly, mothers whose babies had a good neonatal birth status (AOR 1.81; 95% CI 1.09, 2.99) were more likely to exclusively breastfeed their child at six weeks postpartum. CONCLUSIONS: Early initiation of breastfeeding and exclusive breastfeeding is sub-optimal in Ethiopia. Nutrition programmers should consider regional variations in designing intervention programs to enhance breastfeeding practices. Healthcare providers should give special attention to women at risk such as those giving birth through cesarean section and having obstetric complications during delivery.

The effect of mothers and caregivers' fasting status on the dietary diversity of children 6-23 months: A longitudinal study in Debrebirhan, Ethiopia.

BACKGROUND: There are various religions in Ethiopia, of which the Orthodox Tewahido Christian accounts for 44% of the population. According to the Ethiopian Orthodox Tewahido practice close to 200 days annually are dedicated to fasting. During this time, all followers who are above seven years old are expected to abstain from all types of food, including animal source foods and water for up to some hours daily. It is possible that such practice by mothers or caregivers could affect children's dietary practice. However, whether mothers/caregivers' fasting status influences dietary diversity of children during these periods remained uninvestigated. METHODS: A community-based longitudinal study was conducted in Debrebirhan, North Shewa Zone, Ethiopia in seven randomly selected kebeles. We collected data in a sample of 218 mothers/caregivers, from January 29 to February 25, 2019 in the pre-fasting period and from March 18 to April 10, 2019, during fasting period on same participants. Data was entered on Epi-Data version 4.4.2.1 and analyzed using STATA 15 software. Children's dietary diversity was measured using the World Health Organization (WHO) standardized questionnaire for infant and young child feeding. The McNemar paired test was used for comparison of baseline and end line measurements. Statistical significance was set at p<0.05. RESULT: A total of 218 and 216 mothers/caregivers with children 6-23 months participated in the study before and during fasting season with a response rate of 100.0% and 99.0% respectively. The median age of children was 14 months. The proportion of children who met the minimum dietary diversity before the fasting season was significantly higher (23.4%) compared to during the fasting period (5.5%). (P<0.001). The proportion of children who consumed dairy product was significantly higher (55.5%) before the fasting period compared to consumption during the fasting period (42.6%) (p<0.001). Similarly, consumption of flesh food was significantly higher before the fasting period (17.9%) compared to consumption during the fasting period (0.46%) (P<0.001). CONCLUSION: The study revealed that mothers/caregivers' fasting status negatively affect the dietary diversity of children aged 6-23 months in the household by decreasing their consumption of animal source food. Intervention strategies in promoting children's dietary diversity should be designed in a way that considers Ethiopian Orthodox Tewahido Christian mothers/caregivers' fasting practice.