Study setting, design and period
This study was conducted in Jinka Town, South Omo Zone and is situated 755 Km away from Addis Ababa and 525 Km from Hawassa. The Town has an estimated population size of 31226 living in 6 kebeles (the smallest administration unit in Ethiopia). Out of total population 15582 are males and 15644 are females. Out of all female population 6076 are women in the reproductive age group (15-49yr). About 997 of the total population are accounted by children less than one years of age. The Town has 1 hospital, 1 health center and 6 health posts providing health services including maternal and child health care. The town also has 12 private clinic and 13 drug vendors  . The study period was from March 1 to 30, 2019.
A community based cross-sectional study was conducted to determine the prevalence of colostrum avoidance and associated factors among mothers of children aged less than 12 months in Jinka Town, South Omo Zone, Ethiopia.
All mothers of children aged less than 12 months in Jinka Town, South Omo Zone.
All mothers of children aged less than 12 months in the selected kebeles of Jinka Town during data collection period.
Inclusion criteria: All mothers/caregivers of children aged less than 12 months and mothers who had lived for at least for 6 months in the study area.
Exclusion criteria: Those mothers who was seriously ill or unable to give the required information during data collection period.
Sample Size and Sampling Technique
In this study, the sample size is determined by using single population proportion formula. Considering the prevalence of colostrum avoidance practices of 20.3% obtained from previous study conducted in Motta Town , 95% certainty and maximum discrepancy of 5% between the sample size and the underlining population. The following single population formula:
By using design effect of 1.5 and by adding 15% of non-response rate, total sample size is
Systematic sampling technique was employed to select study participants. From total of 6 kebeles of Jinka Town 4 Kebeles was selected by Lottery Method. In order to obtain the sample size from each selected kebeles proportional allocation to sample size was done. First, numbering of all households of selected kebeles with mothers of children aged less than 12 months was conducted, and then systematic sampling technique was applied for selection of study participants. Finally, every Mother from each house hold of the selected Kebele’s was identified until the required sample size fulfilled and the starting household was selected using a lottery method. At the time of survey, from each household unit one eligible mother who had a child aged less than 12 months was selected. In scenarios where there was more than one potential respondent in a household, simple random sampling was done to select one.
Colostrum avoidance practices
Socio-demographic factors: age of the mother, educational status of the mother, educational status of father of index child, marital status, religion, ethnicity, occupation of the mother, household’s wealth status, family size and sex of the index child. Maternal health service utilization: ANC visit, BF counseling during ANC visit, place of delivery of index child, mode of delivery of index child and postnatal care. Breast feeding history: delayed initiation of BF and prelacteal feeding practices. Knowledge: mother’s knowledge on BF. Maternal health related factors: medical conditions and breast problem
Operational definition and terms
Colostrum avoidance: is the failure to feed infants the first, thick and yellowish milk that is produced in the first 3 days after birth. Avoiding colostrum was coded as ‘1’, while colostrum feeding was coded as ‘0’ for regression analysis .
Prelacteal feeding: If an infant within the first three days of life feed something other than breast milk .
Delayed initiation of BF: Initiation of breastfeeding after one hour of birth .
Good knowledge of breastfeeding practice: If a mother answered four questions out of seven on breastfeeding knowledge correctly .
Data Collection Tools and Procedure
A semi-structured interviewer administered questionnaire was used to collect data from mothers of a child. The questionnaire was constructed by adapting from previous literature [20, 25-27, 36] and contextualized to fit the research objective accordingly. The questionnaire was initially prepared in English and then translated into Amharic version (local language) by different fluent speakers of both languages and then to English to check its consistency. The questionnaire mainly addressed socio-demographic, infant feeding, maternal health services utilization, maternal health related and maternal knowledge on breast feeding practices. The data were collected by four trained diploma nurses who are fluent speaker in the local language and supervised by two BSc public health professionals. Face-to-face interview technique was conducted at the study participants’ house. The study participants were properly oriented on the purpose, objectives and usefulness of the study and then questionnaire was provided to respondents after getting written consent from each participant.
Data quality control
To assure the quality of data, properly designed data collection instruments was provided after
appropriate training for data collectors and supervisors. The questionnaire was initially prepared in English and then translated into Amharic version (local language) by different fluent speakers of both languages and then to English to check its consistency. The questionnaire was pretested prior to the actual data collection on 5 % of the sample size in nearby Town, Key Afer in order to check clarity and consistency of data collection instruments. During pre-testing an effort was made to check for consistency in the interpretation of questions and to identify ambiguous items. The collected data was checked for consistency, completeness and relevance on a daily basis during the entire data collection by the supervisors and principal investigator.
Data Processing and Analysis
The collected data was coded and entered by EPIDATA 3.1 and exported to statistical package for social science (SPSS) version 23.0 for analysis. Then data cleaning, editing recoding and management were carried out. Descriptive statistics; mean, standard deviation and proportion were done. The household wealth index was computed by considering properties, like selected household assets. The wealth index of participants household was computed by Principal component (PCA). Assumptions for factor analysis were checked. Finally, household wealth status was ranked into three categories (poor, middle and rich). Binary logistic regression analysis was employed to examine the statistical association between the colostrum avoidance practices and independent variables. Variables which have p value < 0.25 during bivariate analysis were entered into multivariable logistic regression to identify statistically significant variables. The model goodness of fit was tested by Hosmer-Lemeshow statistic which is not significant P-value = 0.264. Multi co linearity test was carried out to see the correlation between all multivariate independent variables using collinearity statistics which is tolerance > 0.1 and variance inflation factor < 10. An Adjusted odds ratio (AOR) with 95% CI at a p-value < 0.05 was estimated to identify statistically significant variables. The data were presented by tables, frequencies and graphs.