3.1 Socio-Economic and demographic characteristics of participants
Total of 366 mothers with an infant aged 0-6 months were participated in the study, making a response rate of 96.3%. The mean age of the respondents was 25.5 years (SD ± 4.4) which was in the range of 25 to 34 years, with a minimum age of 18 and maximum age of 39. Almost all 359 (98.1%) of mothers were married, by religion 136 (37.2%) were protestant, 286 (78.1%) were Oromo in ethnicity. Regarding educational status and occupation, 24 (6.6%) had no formal education while 144 (39.3%) were college and above, 171 (46.7%) were housewives. In terms of wealth status, one-third of them were 122 (33.4%) ranked poor (table 1).
Table 1 Table 2 Socio-demographic characteristics of the mothers with infants-age 0-6 months old, Mettu town, Southwest Ethiopia, 2021
variables (N=366) Category
|
Frequency
|
Percent
|
Age of mother 15-24
24-34
> 35
|
176
176
14
|
48.1
48.1
3.8
|
Marital status Married
Single/divorced
|
359
7
|
98.1
1.9
|
Religion Orthodox
Protestant
Muslim
|
133
136
97
|
36.3
37.2
26.5
|
Maternal education No formal education
Primary education
Secondary education
College and above
|
24
87
111
144
|
6.6
23.8
30.3
39.3
|
Ethnicity Oromo
Amara
Other a
|
286
43
37
|
78.1
11.7
10.1
|
Maternal occupation Housewife
Merchant
Government employee
Private employee
Other b
|
171
65
87
12
31
|
46.7
17.8
23.7
3.3
8.5
|
Wealth index Poor
Medium
Rich
|
122
124
120
|
33.4
33.8
32.8
|
a: Tigre, Gurage and Kaffa , b: Student, un-employed and daily labor
3.2 Maternal health service Utilization and infant related characteristics
Regarding the obstetric experience of the participants, 211 (57.4%) of them were multi-para. Almost all 364 (99.5) were attended ANC service. However, only 58 (15.8%) of them had four and above ANC visits. Regarding infant feeding counseling during ANC, 221 (60.4%) of them were counseled on infant feeding. The majority of the study participants, 339 (92.6) gave birth at public health institutions, and 294 (80.3%) were delivered spontaneously/vaginal. The majority of them, 323 (88.3%) were received postnatal care within 24hrs of their delivery.
All of the infants were breastfed at any time and 280 (76.5%) of mothers were initiated breast within 1 hour of delivery. The mean age of the infants was 3.2 months (SD ± 1.4) with a minimum of 1 month and a maximum of 6 months (table 2).
Table 2 Maternal health service utilization and infant characteristics among mothers with infant 0-6 months old Mettu town, Southwest Ethiopia, 2021
Variable (N= 366)
|
Category
|
Frequency
|
Percent
|
Parity
|
Prim-Para
|
156
|
42.6
|
Multi-Para
|
210
|
57.4
|
ANC follow up
|
Yes
|
364
|
99.5
|
No
|
2
|
0.5
|
Number of visits
|
<4 visit
|
308
|
84.2
|
>4 visit
|
58
|
15.8
|
Counseling on infant feeding
|
Yes
|
221
|
60.4
|
No
|
145
|
39.6
|
Place of delivery
|
Public health institution
|
339
|
92.6
|
Private health institution
|
27
|
7.4
|
Mode of delivery
|
Normal/Vaginal
|
294
|
80.3
|
C/S
|
72
|
19.7
|
PNC care
|
Yes
|
323
|
88.3
|
No
|
43
|
11.7
|
Age of the infant
|
<2 months
|
113
|
30.9
|
2-3 months
|
134
|
36.6
|
4-6 months
|
119
|
32.5
|
Sex of infant
|
Male
|
178
|
48.6
|
Female
|
188
|
51.4
|
Ever breastfed
|
Yes
|
366
|
100
|
No
|
0
|
0
|
Timing of breast milk initiation
|
Within 1 hr.
|
280
|
76.5
|
1-23hrs
|
59
|
16.1
|
After 24 hrs.
|
27
|
7.4
|
ANC: Antenatal Care, PNC: Postnatal care, C/S: Cesarean section
3.3 Maternal knowledge of formula feeding
Regarding knowledge of respondents on infant formula, 298 (81.4%) of them were heard about infant formula and the most common source of information was peer/neighbors 209 (70.1%) followed by TV/radio 127 (42.6%). Among these, 129 (43.3%) of the respondents were replied infant formula increases a baby’s immunity, 181 (60.1%) replied infant formula contributes to a baby’s brain development. 41 (13.8%) of the respondents replied infant formula is more nutritious than breast milk, and 205 (68.8%) respondents do not know the future health impact of formula feeding. The mean score was 2.9 with SD +1.35. Based on the mean knowledge score, the participants were categorized as having poor knowledge 135 (46.1%) while 158 (53.9%) good knowledge (table 3).
Table 3 maternal knowledge of formula feeding among mothers with infant 0-6-months old Mettu town, Southwest Ethiopia, 2021
Question
|
Response
|
Frequency
|
Percent
|
Have you ever heard about infant formula
|
Yes
|
298
|
81.4
|
No
|
69
|
18.9
|
Source information
|
peer/neighbors
|
209
|
70.1
|
TV/Radio
|
127
|
42.6
|
family
|
55
|
18.5
|
Health professional
|
50
|
16.8
|
Does infant formula increase your baby’s immunity?
|
Yes
|
129
|
43.3
|
No
|
169
|
56.7
|
Does formula feeding contribute to child brain development
|
Yes
|
181
|
60.7
|
No
|
117
|
39.3
|
Does formula feeding increase the risk of diarrhea and other infection
|
Yes
|
107
|
35.9
|
No
|
191
|
64.1
|
Does formula feeding increase the risk of childhood obesity
|
Yes
|
131
|
44
|
No
|
167
|
56
|
Does infant formula is more nutritious than breast milk
|
Yes
|
41
|
13.8
|
No
|
257
|
86.2
|
Does formula feeding affect future health status of the baby
|
Yes
|
93
|
31.2
|
No
|
205
|
68.8
|
3.4 Maternal attitude toward formula feeding
Regarding the attitude of respondents toward infant formula, 107 (35.9%) disagreed on formula feeding ensures optimal health for the baby, while 143 (48%) were agreed. 238 (79.9%) of them were disagree that formula feeding is more convenient than breast milk while, 19 (6.4%) agreed. One-third of the respondents 95 (31.9%) disagreed on the idea that infant formula is advised when baby’s growth is sluggish/weak while 131(44%) were agreed. 198 (66.4%) of the participants disagree on the idea that your baby is willing to feed formula milk than breast milk while 26 (8.7%) agreed. 186 (62.4%) of them disagree with the idea that formula feeding gives you more comfort than breastfeeding while 39 (13.1%) agreed.
Based on the summation of the scales, 188 (63.1%) of participants were categorized as having a negative attitude while 37 (12.4%) and 73 (24.5%) were categorized as having neutral and positive attitudes respectively (table 4).
Table 4 Maternal attitude toward formula feeding among mothers with infant 0-6 months of old Mettu town, Southwest Ethiopia, 2021
Variables
|
Responses
|
Disagree
|
Neutral
|
Agree
|
Formula feeding ensures optimal health for the baby
|
107(35.9%)
|
48(16.1%)
|
143(48%)
|
It is more convenient than breast milk
|
238(79.9%)
|
41(13.8%)
|
19(6.4)
|
It is advised when baby’s growth is sluggish/weak
|
95(31.9%)
|
72(24.2)
|
131(44%)
|
Your baby is willing to feed formula milk than breast milk
|
198(66.4%)
|
74(24.8%)
|
26(8.7%)
|
It gives you more comfort than breast feeding
|
186(62.4%)
|
73(24.5%)
|
39(13.1%)
|
It makes your baby smart
|
107(35.9%)
|
144(48.3%)
|
47(15.8%)
|
Rich family feed their baby with formula milk while poor provides only breast milk
|
132(44.3%)
|
110(36.9%)
|
56(18.8)
|
3.5 Formula feeding and related characteristics
Among total study participants, 104 (28.4%) [95% CI 24.0-33.0] were formula-fed their babies. Among respondents practicing formula feeding, 99(95.2%) of them were feeding combination (both breast milk and formula) while only 5 (4.8%) were feeding their babies with only formula milk. The main reason for the initiation of infant formula was breast milk insufficiency 44 (42.3%), busy for work 36 (34.6%) and sluggish growth of baby 24(23.1). The average age of initiating infant formula was 2.3 months S d+1.04 which is found within 2-3 age interval.
3.6 Factors associated with formula feeding
On multivariable logistic regression analysis, prim-para mothers (AOR=3.2 95 CI: 1.71-6.27), delivery by caesarian section (AOR=2.62 95% CI: 1.28-5.35), initiation of breast milk after 24 hrs. (AOR=3.5.95 CI: 1.27-10.05), employed mothers (AOR= 2.4, 95% CI: 1.29-4.09), poor knowledge of formula feeding (AOR= 2.6 95% CI: 1.49-4.81) and positive attitude toward formula feeding (AOR=2.4 95 CI: 1.49-4.73) were significantly associated with formula feeding (table 5).
Table 5 Multivariable analysis of factors associated with formula feeding among mothers with infant 0-6-month-old Mettu town, Southwest Ethiopia, 2021
Variable
|
Formula feeding
|
|
|
P-value
|
|
Yes (%)
|
No (%)
|
COR (95%CI)
|
AOR (95%CI)
|
Age of mother
15-24
25-34
35 above
|
34(19.3)
64(36.4)
6(42.9)
|
142(80.7)
112(63.6)
8(57.1)
|
0.31(0.104-0.98)
0.762(0.25-2.29)
1
|
0.4(0.09-1.71)
1.2(0.28-4.82)
|
0.23
0.8
|
Maternal education
No formal education
Primary education
Secondary
College/above
|
2(8.3)
22((25.3)
30(27)
50(34.7)
|
22(91.7)
65(74.7)
81(73)
94(65.3)
|
1
3.7(0.80-17.12)
4.2 (0.90-18.38)
5.8(1.32-25.90)
|
3.5(0.65-19.81)
4.5(0.83-24.81)
2.3(0.39-13.58)
|
0.14
0.08
0.04
|
Employment status
un employed
employed
|
60(22.5)
44(44.4)
|
207(77.5)
55(55.6)
|
1
2.7(1.69-4.50)
|
2.4(1.29-4.19) **
|
0.005
|
Wealth status
poor
medium
rich
|
22(18.9)
38(30.6)
43(35.80
|
99(81.1)
86(69.4)
77(64.2)
|
1
1.9(1.05-3.44)
2.4(1.33-4.32)
|
1.18(0.55-2.52)
2(0.93-4.43)
|
0.06
0.07
|
Parity
Primipara
multipara
|
55(35.3)
49(23.3)
|
101(64.7)
161(76.7)
|
1.8(1.02-2.83)
1
|
3.27(1.71-6.27)**
|
>0.001
|
Frequency of ANC visit
<4 visits
> 4 visits
|
94(30.5)
10(17.2)
|
214(69.5)
48(82.8)
|
2.1(1.02-4.34)
1
|
2(0.84-5.33)
|
0.09
|
Mode of delivery
Spontaneously
C/s
|
62(21.1)
42((58.3)
|
232(78.9)
30(41.7)
|
1
5.2(3.03-9.04)
|
2.62(1.28-5.35)**
|
0.008
|
Timing of breast milk initiation
Within 1 hour
1-23 hour
After 24 hrs.
|
64(22.9)
24(40.70
16(59.3)
|
216(77.1)
35(59.3)
11(40.7)
|
1
2.3(1.28-4.17)
4.9(2.16-11.11)
|
1.5(0.74-3.18)
3.5(1.74-10.0)**
|
0.24
0.018
|
Sex of infant
male
female
|
61(34.3)
43(22.9)
|
117(65.7)
145(77.1)
|
1.6(1.05-2.82)
1
|
1.5(0.87-2.82)
|
0.2
|
Age of infant
> 2 months
2-3 months
4-6 months
|
22(19.5)
42(31.3)
40(33.6)
|
91(80.5)
92(68.7)
79(66.4)
|
1
1.8(1.04-3.41)
2.2(1.14-3.82)
|
1.3(0.6-2.72)
2(0.9-4.56)
|
0.46
0.051
|
Knowledge
Poor
Good
|
60(44.4)
44(27.8)
|
75(55.6)
114(72.2)
|
2(1.27-3.37)
1
|
2.6(1.27-4.74)**
|
0.001
|
Attitude
Negative
Neutral
Positive
|
58(30.9)
13(35.1)
33(45.2)
|
130(69.1)
24(64.9)
40(54.8)
|
1
1.4(0.57-2.57)
1.8(1.06-3.22)
|
1.7(0.74-4.07)
2.4(1.49-4.74)**
|
0.201
0.007
|
Note: ** denote statistically significant variables in multivariable logistic regression at p-value <0.05, COR: Crude Odds Ratio, AOR: Adjusted Odds Ratio