Three-fourth of children is received early initiation of Breastfeeding in West Belessa District

Background : The world is now suffering from malnutrition and remains one of the major causes of under-ve mortality. Children from developing countries, including Ethiopia also suffer from undernutrition due to suboptimal breastfeeding practice. Hence, the study aims were to assess early initiation of breastfeeding among children aged less than two years, months in West Belessa district, North West Ethiopia, 2019. Methods: A community-based cross-sectional study was conducted from January to February 2019 in the West Belessa district. A total of 569 Children was selected by a simple random sampling technique. The data were collected by an interviewer-administered structured questionnaire. Data were entered and analyzed by using Epi-Info version 7 and SPPS version 20, respectively. Bi-variable logistic regression analysis was used to check predictor variables associated with the dependent variable. Variables having a p-value of less than 0.20 in the bi-variable analysis were tted into the multivariable model. Multivariable binary logistic regression with a 95% condence interval and Odds Ratio (OR) were computed. Variables having p-value < 0.05 were taken as signicantly associated with the dependent variables. Result : The prevalence of EIBF was 77.7 % (95%CI, 74.3-81.0). Age of the mother (AOR= 2.76, 95%CI (1.21, 6.27)), postnatal Visit (AOR= 1.85, 95%CI (1.03, 3.85)), and Antenatal care (AOR= 2.58, 95%CI (1.18, 9.94)) was signicantly associated with EIBF. Conclusion and Recommendation: We observed, the prevalence of early initiation of Breastfeeding was low in West Belessa District. Age of the mother, Antenatal and postnatal care were associated with EIBF. Hence, improving antenatal and postnatal and providing counseling during this time.

Most of the world neonates will wait too long to start on breastfeeding. Globally; not over 20% of neonates are received timely initiation of breastfeeding in the rst hour of life after birth; they nd off these majorities in low-income countries (6), as the result more than 20 million neonates are not still received early initiation of breastfeeding (9). The prevalence of early initiation reports differs across regions. About, 35% and 65% are found in North Africa Eastern, and Southern Africa, respectively (10). Besides, according to the World Breastfeeding Trends Initiative among 84 counties showed to only 42% of women being put on their neonates within an hour of birth, and 41% where practice exclusive breastfeeding (11). Whereas, reports done among 29 sub-Saharan African counties are from 37.4 to 69.31% (12). In Ethiopia, 47.3-78.8% of neonates are received Early Initiation of Breastfeeding (EIBF) practice (13,14).
Especially, emphasis including implementing the National Nutrition Program (NNP), Community Integrated Management of Childhood Illness (CIMCI), and Infant and Young Child Feeding (IYCF) guidelines have been developed by the government of Ethiopia to considerably decrease neonates, infants and child mortality, morbidity, and undernutrition (21)(22)(23). But, EIBF is still low as per the standard recommendation in Ethiopia, maybe due to the lack of a culturally oriented approach (14). Also, factors of early initiation Breastfeeding are not previously studied in the district, and this nding will address this gap. Hence, the study aims were to assess the factors affecting EIBF among under two children living in Belessa District.

Study Design and Period
A community-based cross-sectional study was conducted from January to February 2019 to assess early initiation of breastfeeding among under two years children in West Belessa District, North West, Ethiopia.
West Belessa District is found in North Gondar Zone, Amhara Regional State, and North West Ethiopia and is located 84 km from central Gondar Zone town-Gondar and 748 km from the capital city of

Source Population and Study Population
All children aged 24 months old with mothers/caregivers who lived in West Belessa district used as the source population. All children aged 24 months living in the selected Kebeles from West Belessa district with mothers/caregivers were the study population.

Sampling techniques and procedures
All children aged 24 months old residing in West Belessa District was entitled to this study. The sample size was determined to apply a single proportion formula by considering the following assumption; the prevalence of early initiation of Breastfeeding 66% for EDHS 2016 in the Amhara region(14), 95% con dence level and 5% of a margin of error. Finally, by considering 10% of non-response rate and 1.5 of design effect 569 nal sample size was obtained. Primarily, District Kebeles were strati ed in urban and rural. Among the total of 30 kebeles, eight (one in urban and 7 in rural) were selected by using the lottery method. Afterward, children living in each Kebeles were drawn from the list of registration in the health posts in the Kebeles. Finally, 569 children were selected using a simple random sampling technique.

Data Collection tool and Procedures
Data was collected through face to face interview based structured questionnaire. The tool was taken from EDHS (2016), and the previous similar published literature with some modi cations. The questionnaire was prepared originally for English and translated into Amharic back to English to keep reliability. A total of six and two data collectors were participated in the data collection process and supervisors, respectively. Two days of training were provided for data collectors and supervisors on how to extract information by using interviewer structured questionnaires. Five percent of pre-tested was done out of the study site. Close supervision was done by the supervisors and the investigator during data collection. Daily data correction was made before the next data collection took place.

Data Processing and Analysis
All returned questionnaires were checked for completeness and consistency of responses manually. The cleaned data were entered and analyzed by using EPI info version 7 and SPSS version 20, respectively. Early initiation of breastfeeding is dichotomous variables which can be calci ed as 1 and 0 as early initiations of Breastfeeding and none-early initiation of breastfeeding, respectively. Descriptive and summary statistics were carried out. Logistic regression analysis was used to check variables associated with each dependant variable. Hosmer-Lemeshow goodness of t test used to test the adequacy of the model. A P-value ≤ 0.20 was considered statistically signi cant in the bivariate and a P-value in the multivariate regression less than 0.05 was taken as statistically signi cant with EIBF.

Variable Measurnemts
Early initiation of breastfeeding: the ration of neonates born in the past 24 months who have been put on the breast within 1 hour of birth (25).
The household wealth index was determined by using the Principal Component Analysis (PCA) considering the household properties, for instance the amount of cereal products, house, livestock and agricultural land ownership. Initial, variables were dichotomized as 0 and 1. Then after, the coded variables entered and analyzed using PCA, and those variables having a communality value of greater than 0.5 were used to produce factor scores. Finally, the factor scores were summed and ranked into Poor, medium and rich.
Regarding Dietary Diversity (DDS) was calculated according to world food organization 2008 seven food groups possible to take in the preceding 24 hours recall period. After collecting the food group, the number of different food groups consume by the children within 24 hours. Then, it was classi ed as adequate if ≥ four food groups were consumed, and inadequate if < four food groups were consumed during the speci ed period (25).

Result
Socio demographic characteristics of the participants A total of 569 participants have participated in this study. Nearly, two-thirds (60.8%) of the caregivers were in the age range of 20-34 years old. Almost all (91%) of the participants were Orthodox by religion and employed. The majority (84.7%) of the mothers were married and unable to read and write. More than three-fourth (78.9%) of the participants were living in a rural residence. More than one-third (32.2%) of the caregivers had to live in poor house quintiles and received adequate dietary diversity, respectively (Table 1). More than half (53%) of the children were male. Nearly, two-thirds (65.73%) of the children are in the age range of 12-24 months. Three-fourth, (73.1%) of the children was received exclusive breastfeeding.
Nearly two -thirds (64.1%) and (64.5%) of children have started their complementary feeding in the recommended time and birth weight in the age range of 2.5 -4.0 kg. Three-fourth (77.2%) of the mother has had all types of ANC visits during their last pregnancy and more than half (57.5%) of the mother was give birth at health institution ( Table 2).

Factors affecting early initiation of Breastfeeding
As showed in Table 3, after adjusting the confounder variables in the multivariate age of the mother, ANC visits and numbers of ANC visits were had signi cantly associated with the outcome variable.
Mothers having age thrifty-ve and above was 2.76 times more initiate breastfeeding within one hour [AOR: 2.76; 95% CI (1.21, 6.27)] as compared with mothers having less than twenty years old.
Mothers having ANC visits during pregnancy period was 5 times more initiate breastfeeding within one hour [AOR: 2.58; 95%CI (1. 18, 9.94)] as the contrast with mother without ANC visit and ANC visits having one up to three were 1.85 times more initiate breastfeed within one hour [AOR: 1.85; 95%CI (1.03, 3.35) as compared with mothers haven't any ANC contact (Table 3).

Discussion
Putting newborns to the breast within the rst hour after birth gives them the best chance to survive, grow and develop to their full potential, but efforts to improve breastfeeding practice has not made signi cantly, especially early initiation of breastfeeding, because of poorly integrated action including government, private, community, and households. Hence, the aim of this study was to assess the prevalence and factors affecting the early initiation of breastfeeding practice among children aged 24 months old in the West Belessa District.  (31). The difference might be attributed to cultural differences, beliefs and myths on colostrums, and EIBF among these countries.
Mothers having age thrifty-ve and above was 2.76 times more initiate breastfeeding within one hour as compared with mothers having less than twenty years old. This report is consistent that of Nigeria. The possible explanation might be when age increase there is the chance of women having more than one child is reported to begin breastfeeding earlier than women having a rst child (32). In addition, at an early age, there may be unwanted pregnancy which hinders early initiation of breastfeeding (33,34). Furthermore, the mother with age may increase have the chance to gain experience of starting the early initiation of breastfeeding.
ANC and PNC follow up had more likely to early initiation of breastfeeding their infants than their counterparts. This nding is similar to the report of India (35), Nigeria (36), Uganda (37), pocket area study of Ethiopia (13,38,39). The possible explanation might be due to a mother having attended in critical time might be obtained counseling and support service about recommended feeding practices for neonatal and Infants by the health development army, health extension workers, health professionals from health posts, maternal and child health clinic might be the possible explanation for this. In addition, ANC and PNC are also recommended improving mothers' awareness and bene ts of early initiation of breastfeeding and improve behavioral change to conquered cultural barriers of infant and child feeding practices (40). However, the study has some limitation for instance; recall bias was one the limitation of this since we were included mothers having children less 24 months. In addition, social desirability was another to count dietary diversity score among children.
Conclusion the prevalence of early initiation of Breastfeeding was low in West Belessa District. Age of the mother, Antenatal and postnatal care were associated with EIBF. Hence, improving antenatal and postnatal care services through increase accessibility and providing counseling during this contact time.