Study area and Setting
This study was conducted in Bahir Dar city administration from March to April, 2016. Bahir Dar city is located 578 kilometers northwest of Addis Ababa, the capital city of Ethiopia. According to the 2007 Census conducted by the Central Statistical Agency of Ethiopia, Bahir Dar city has a total population of 221,991, of whom 49% are men and 51% are women. From female population, around 66% were reproductive age groups. During the study period, a total of 2500 primi-gavida mothers were living in in Bahir Dar City. The city has nine administrative sub cities. It has one public specialized referral hospital, one public general hospital, two private hospitals, ten health centers which give services for the population of the city[22].
Study Design and Population
A community-based, cross-sectional study design was used to determine the rate of colostrum avoidance among primigavida mothers living in Bahir Dar city. Randomly selected primigavida mothers between the age of 15 and 49 years of age, with infants younger than six months of age, and who live at list for six months in Bahir Dar city were included. Primigavida mothers who lived less than six months in Bahir Dar city, who are critically ill or unable to communicate, who were under 16 years old without parents or guardians were excluded.
Sample size and Sampling procedure
A total sample of 400 mothers was calculated using Yamane’s formula (n=N/1+N (e2) by considering the following assumptions; P=0.5, a 95% level of confidence, N=2500(population size) and e=±5%(level of precision)[23]. First, a total of 2500 mother-infant dyads of primi-gavida mothers were accessed and listed from Health Information System (HIS) of Bahir Dar city health bureau in collaboration with the local health extension workers of the city administration. Then, mothers were sorted and listed in their respective sub-city. Besides, the total sample size (n=400) was proportionally allocated to size to each sub-city. Finally, the study participants were selected by using simple random sampling method from each sub-city. Data on infants were gained from infants’ mothers and by reviewing birth certificate of infants.
Data collection and data quality assurance
Data were collected using a pre-tested, structured, and interviewer-administered questionnaire which was adopted from previous studies [24-26]. Mothers were interviewed at their households. The English version of the questionnaire was prepared first. Then, language experts translated it to the local language (Amharic) and back to the English to check consistency and accuracy. Three diploma nurses and two Bachelor of Science nurses were recruited as data collectors and supervisors respectively. To ensure data quality, training was given for data collectors and supervisors for two consecutive days on the overall content of the questionnaire, how to approach participants, and the data collection process. Assigned supervisors closely managed the data collection process. A pre-test was done on 10% of the calculated sample size of women out of study area and readjustment was done on the questionnaire.
Measurement
Variables
The dependent variable in this study was colostrum avoidance and the independent variables were socio-demographic characteristics, maternal health care service utilization, breastfeeding-related factors, and other factors.
Operational definitions
Colostrum avoidance: Colostrum avoidance includes: delayed initiation of breast-feeding; pumping and discarding colostrum; and/or wet nursing [3].
Pre-lacteal feeding: If an infant during the first three days of life took something other than breast milk[27].
Timely initiation of breastfeeding: If an infant within one hour of birth is put on the mother‘s breast to feed[28] .
Exclusive breastfeeding: Infant fed on only breast milk (with the exception ordered medicines and vitamins by health professionals one day (24 hrs.) before the survey was conducted [25].
Husband support: Husband who supports, encourages, and promotes the mother’s breastfeeding practice[29].
Statistical Analysis
The collected data were checked for completeness and consistency and then, coded and entered into EpiData 3.1 and exported to SPSS version 20 for analysis. Bivariate logistic regression was performed to each independent variable with the dependent variables. Then, variables with p-value < 0.25 were included in multivariate logistics regression analyses. The strength of association was measured using odds ratio and 95% confidence intervals. Statistical significance was declared at P-value ≤0.05.
Ethics approval and consent to participate: Ethical approval was obtained from the research review ethical committee of the Addis Ababa University, and permission letter was obtained from Bahir Dar city mayor’s office. Data collectors informed each respondent about the study. Written and verbal consent was obtained from each study participants and confidentiality was assured for all information provided by not exposing to third body. Moreover, personal identifiers were not included in the questionnaire.