Journal of Health Care Communications Open Access

Prevalence of Bottle Feeding Practice and Its Associated Factors among Mothers of Infants Less than Six Months at Addis Ababa Public Health Centers, Addis Ababa, Ethiopia, 2022

Gedifaw Birhan^1*, Shikur Mohammed², Sisay Tenia², Amanual Alem², Amlaku Alemante² and Abebe Belyneh^{2 1}Department of Nursing, Addis Ababa University, Addis Ababa, Ethiopia
²Department of Public Health, Saint Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
^*Correspondence: Gedifaw Birhan, Department of Nursing, Addis Ababa University, Addis Ababa, Ethiopia, Tel: 918530728, Email:

Received: 29-Jun-2023, Manuscript No. IPJHCC-23-16770; Editor assigned: 03-Jul-2023, Pre QC No. IPJHCC-23-16770 (PQ); Reviewed: 17-Jul-2023, QC No. IPJHCC-23-16770; Revised: 05-Mar-2024, Manuscript No. IPJHCC-23-16770 (R); Published: 12-Mar-2024, DOI: 10.36648/2472-1654.9.2.9012

Abbreviations

AOR: Adjusted Odds Ratio; ANC: Antenatal Care; BF: Bottle Feeding; CSA: Central Statistics Agency; CI: Confidence Interval; COR: Crud Odds Ratio; ETB: Ethiopian Birr; EC: Ethiopian Calendar; EDHS: Ethiopian Demographic and Healthy Survey; EPI: Expanded Program of Immunization; HR: Hazards Ratio; HC: Health Center; IYCF: Infant and Young Child Feeding; NGO: Non- Governmental Organization; RR: Relative Risk; SRS: Simple Random Sampling; SPSS: Statistical Package for Social Science; WHO: World Health Organization.

Introduction

Adequate nutrition during the first two years of a child’s life is essential to lower morbidity and mortality, reduce the risk of chronic diseases, normal development and the future wellbeing of the child [1]. The World Health Organization (WHO) recommends optimal infant and young child feeding practices which includes early initiation of breastfeeding within an hour of birth, exclusive breastfeeding up to six months of age, introduction of complementary feeding at six months and continuing breast feeding up to 2 years or beyond and ensuring proper use of breast milk substitutes [2].

Bottle feeding is an infant feeding modality that has been in existence since ancient times and currently a significant number of infants are being fed via a bottle with either breast milk or breast milk substitutes (formula) [3]. Globally, 59% of infants and around 85% of infants within Australia by five months of age are being fed with either breast milk or formula using bottles [4]. Breastfeeding is declining in almost all over the world despite its nutritional and immunological advantages. Improper breastfeeding practices may significantly compromise the health, development and survival of infants, children, and mothers [5]. Worldwide it causes 820,000 children and 20,000 maternal deaths in a year. It has been also found that non-exclusive breast feeding (bottle feeding) in the first 6 months of life results in 1.4 million deaths and 10% of the disease burden in children younger than 5 years [6].

Bottle feeding practices in infancy and childhood led to the high prevalence of malnutrition, increased morbidity and mortality in children in the developing world. Malnutrition accounts for around two-thirds of all deaths among children under the age of five worldwide. Each year more than 10 million children die as a result of malnutrition; 98% of these deaths occur in underdeveloped countries. Death rates in third world countries are lower among breastfed babies and breastfed babies have lower infections than formula fed babies [7].

In Ethiopia suboptimal breastfeeding practices are the most contributor around 70,000 infant deaths per year; 24% of the total infant death annually and that be significantly prevented by nutrition interventions such as exclusive breastfeeding [8]. Bottle feeding is one of the major causes of diarrhea among the infants. The rate of bottle feeding practice keeps on increasing among the mothers with infants older than four months due to early weaning [9]. The major reasons for bottle-feeding practice include insufficient breast milk, the need to go back to work, maternal work load and illness, delayed ANC follow up, caesarean section mode of delivery and improper birth spacing [10,11].

Even though, WHO recommends avoidance of bottle feeding, there is a current shift from traditional feeding practice(bottle feeding) towards shorter breast feeding and introduction of bottle feeding in developed countries and urban communities of developing countries [12]. Practice of bottle feeding and associated factors are rarely addressed in urban community of Ethiopia including Addis Ababa. So, this study aimed to fill this gap and assess the prevalence of bottle feeding practice and associated factors among mothers of infants less than six month in Addis Ababa, Ethiopia.

Materials and Methods

Study Area and Period

The study was conducted from July 1, 2022 to July 30, 2022 in public health centers of Addis Ababa, Ethiopia. Addis Ababa has almost 4 percent of the Ethiopian populations with 11 per cent of under five years children [13]. The total population of Addis Ababa is 3,602,000; 1,134,150 are under five children according to 2019 projection based on the 2007 census [14]. In Addis Ababa there are around 116 health centers in eleven sub cites [15].

Study design: An institutional based cross sectional study design was conducted.

Study Population and Eligible Criteria

All mothers who have infants less than six months in Addis Ababa were considered in the study. Those mothers who have infants less than six months at selected health center were included in the study. Mothers who have repeated visits during the study period will be excluded from the study.

Sample Size Determination

The sample size required for the study is calculated using epi info application or the formula of simple proportion estimation:

n=n=(Z_α/2)² (p) (1-p)/d²

Where; n=The minimum sample size required. P=Proportion of bottle feeding associated factor in study done at woldia hospital, maternal age 35-50 years (23.4%) [16]. Zα2⁄=Standard normal value at (1-α) 95. Confidence level=95%. Margin of error (d)=5%. Design effect (de)=1.5 is used.

The sample size “n” for associated factor of bottle feeding =(1.96)2(0.234) (1-0.234)/(0.05)2=275, since study uses multi stage sampling, 1.5 design effect was used then the sample size would be 414. The final sample size after addition of 10% non-response rate was 456.

Sampling Technique

Multi stage sampling technique was employed to include study participants in to the research. First from a total of 11 sub cities three sub cities were selected using simple random sampling technique. Since 20% to 30% of the study population represents the total population, average 25% of Sub Cities (SC) was used to represent the population.

In the first stage of sampling, 25% of eleven sub cities (three sub cities) Areda, Kolife Karanio and Nifas silk lafito sub cities were selected by using simple random sampling technique. These three sub cities have a total of 27 health centers (Areda=7, Kolife Karanio=9 and Nifas silk lafito=11); 25% of 27 (seven) were used to allocate study participants in each selected sub cities. The seven Health Centers (HC) (Areda=2, Kolife Karanio=3, Nifas silk lafito=3) are allocated according to the number of health centers in each sub cities.

In stage second sampling, Beta and Simegn Kebede health center from Areda sub city, woreda 1, 3 and 4 health center from Kolife Karanio sub city and woreda 2, 5 and 10 HC from Nifas silk lafito sub city were selected by lottery method.

The registration of mothers who have infant less than 6 months on expanded program of immunization register was used to get list of children from each health centers. Sample from each health center was determined by using proportion allocation to the sample size.

Finally, systematic random sampling technique was used to select a representative population in the immunization unit. The sampling interval (K) was established by dividing the average number of women who visited the immunization unit in the previous two months before data collection (average n=2660) by the sample size, which produced K=2660/456=6. Women were recruited daily by simple random sampling technique using the lottery method, and the next respondent was selected by adding a sampling interval to the number of the selected women. The same procedure was done on subsequent days until the required sample size was reached.

Proportional Allocation

In three selected sub cities there were 2660 children less than 6 months of age. Out of this 335 in Beta health center, 277 in Simegn Kebede health center from Areda sub city, 360 in woreda 1 health center, 431 in woreda 3 health center and 245 from woreda 4 health center of Kolife Karanio sub city and 365 in woreda 2 health center, 347 woreda 10 health center and 300 from woreda 5 health center of Nifas silk lafito sub city.

Based on proportional allocation to size, 456 study subjects were distributed to Beta health center (57), Simegn Kebede health center (47) from Areda sub city; woreda 1 health center (42), woreda 3 health center (74) and woreda 4 health center (62) of Kolife Karanio sub city and woreda 2 health center (63), woreda 10 health center (60) and 300 from woreda 5 health center (51) of Nifas silk lafito sub city.

Data Collection Procedure

Data was collected by face to face interview using semistructured pretested questionnaire. The questionnaire was administered through face to face interview by five (5) trained data collectors (diploma nurse) and the data collection was supervised by two BSC health workers.

The questionnaire was constructed by adopting and modifying from previous studies. First, the questionnaire was prepared in English then translated into Amharic (local language) and then back to English to check consistency.

The quality of the data collection process was monitored, and clear uniform instructions were given to all data collectors. All data collected as a part of this study was checked by the principal investigator.

Operational Definitions

Exclusive breastfeeding: A mother gives to infant only breast milk.

Maternal illness: Mothers difficulty to breastfeed an infant due to illness (breast illness related problem).

Mixed breastfeeding: If an infant took breast milk with addition of liquid foods like cow milk and formula milk and soft foods.

Adequate knowledge: If a mother answers half and above correctly from questions which are asked to measure bottle feeding knowledge.

Inadequate knowledge: If a mother answers below half correctly from questions which are asked to measure bottle feeding knowledge [17]. Late initiation of breastfeeding: Initiation of breast milk after one hour after delivery.

Bottle feeding: Mother uses bottle for Brest milk and or breast milk substitutes (formula or others) [18].

Data Quality Control

In order to assure the quality of the data; a pre-test was conducted on 5% of the sample size at Abinet health center from mothers’ infants visiting for immunization before the actual data collection to ensure the completeness and consistency. In addition, one day training was given to data collectors and the supervisor about the aim of the study, about the data collection tools, and how to obtain information [19]. The principal investigator undergoes quality assessment on ongoing supervision each day during data collection to ensure quality of data by checking filled format for their completeness’s and consistency. Data reliability was checked by considering the Cronbach alpha which is greater than or equal to 0.5 and multicollinearity between variables was also checked by considering Variance Inflation Factor (VIF) which is less than 2 which indicates there is no correlation between independent variables [20].

Data Management and Analysis

Data obtained from institution based survey was checked for completeness and inconsistencies, then coded, entered and cleaned in the Epi info version 7.1 and Microsoft excel and analyzed using Statistical Package for Social Sciences (SPSS) version 26. After categorizing and defining variables, descriptive analysis was carried out for each of the independent variables using frequencies, cross tabulation and percentages: Then presented by text, tables and chart.

Binary logistic regression analysis model was used to assess the association between bottle feeding and associated factors [21]. Variables with p-value <0.2 in bivariable binary logistic regression analysis were entered to multivariable binary logistic regression analysis. Finally, variables with p-value <0.05 in multivariable logistic regression were taken as significant factor. Adjusted odds ratio with 95% CI was used to show the strength of association between the dependent and independent variables. Model fitness was tested with Hosmer and Leme show goodness of fit test and fit with a pvalue= 0.440. In addition, there was no problem of multicollinearity among explanatory variables, with variance inflation factor <3 for all variables [22].

Results

Socio-demographic Characteristics

In this study, a total of 451 study participants were included with a response rate of 98.9%. Among the study participants most of the study participants, 444 (98.4%) were married. Regards to religion more than half 235 (52.1%) were orthodox. Related to occupation, 202 (44.8%) of mothers were house wife (Table 1) [23].

Table 1: Socio-demographic characteristics mothers (respondents) who have infants less than six months old, in Addis Ababa: Ethiopia, 2022.

Obstetric and Health Service Utilization Factors

In this study, 449 (99.6%) mothers had antenatal care in their previous pregnancy. During their antenatal care follow up, 87 (19.6%) of women did not receive counseling about infant feeding practice. The majority of the respondents 437 (96.9%) were give birth at health institution and 14 (3.1%) were give birth at home. From 356 (78.9%) of mothers received postnatal care, 289 (69.2%) had received counseling on infant feeding up to six months (Table 2).

Table 2: Obstetric and health service utilization characteristics of study participants in Addis Ababa, Ethiopia, 2022.

Prevalence of Bottle Feeding Practice

Prevalence of bottle feeding practice was 39% (95% CI 35, 44). The following Figure shows the prevalence of bottle feeding practice among mothers who have infants less than six month (Figure 1). Among respondents who used bottles for feeding, 103 (58.9%) used formula, 30 (20.8%) used expressed breast milk and 5(3.5%) used caws milk. In this study in luential bodies of mothers to start bottle fed were health professional 67 (30.7%), husbands 40 (18.3%) and mothers 17 (7.8%) (Table 3).

Figure 1: Percent distribution of prevalence bottle feeding practice' among mothers who have infant less than six months old in Addis Ababa, Ethiopia, 2022.

Table 3: Bottle feeding related practices of mothers who have infants less than six months old in Addis Ababa: Ethiopia, 2022.

Bottle Feeding Related Factors

All mothers have breastfeed their current infant for a certain period of time. From total, 122 (27.1%) mothers initiated breast milk to infant immediately within one hour of birth and 131 (29%) mothers initiated breast milk to infant after one hour of birth, whereas 103 (22.8%) initiates breast feeding after mother feels comfort after delivery. In this study, Influential bodies of mothers to start bottle feeding were health professional 67 (30.7%), husbands 40 (18.3%) and mothers 17 (7.8%).

The following diagram also shows the reason why mother who have infants less than six month practice bottle feeding (n=209) (Figure 2).

Figure 2: Percent distribution of reasons to practice' bottle feeding among mothers who have infant less than six months old in Addis Ababa, Ethiopia, 2022.

Mothers’ Knowledge and Information Source of Bottle Feeding

Around two third (61.4%) of mother's who have infant less than six month have adequate knowledge on bottle feeding, whereas 38.6% of mother's who have infant less than six month haven’t adequate knowledge on bottle feeding [24].

Regarding to information about bottle feeding 352 (78.3%) mothers was informed about bottle feeding from different sources (Table 4).

Table 4: Information and source information on bottle feeding among mothers who have infants less than six months old in Addis Ababa: Ethiopia, 2022.

Factors Associated with Bottle Feeding Practice

Binary logistic regression model was used to determine the association between independent variables with dependent variable. Variables which were associated with bottle feeding practice in the bivariable binary logistic regression analysis (p<0.2) were; gender of infant, initiation of breast milk, mothers education, place of delivery, mode of delivery, monthly household income, infant hospitalization, information herd about bottle feeding and mothers knowledge about bottle feeding. Variables which were associated in bivariable binary logistic regression analysis were tested in the final multivariable binary logistic regression analysis to see their significant association with bottle feeding practice.

By using backward likelihood ratio method multivariable logistic regression analysis; infant gender, infant hospitalization, mode of delivery, heard about bottle feeding and initiation of breast milk were remained significant in the final model. Model fitness was tested with Hosmer and Lemeshow Goodness of fit test and fit with a p-value =0.440. In addition, there was no problem of Multicollinearity among explanatory variables, with variance inflation factor <3 for all variables. After adjusting confounding variables the finding of this study revealed that the odds of bottle feeding practice among mothers having infants less than six months who had male infant were 59% less likely to bottle feed than infants of female gender AOR=0.589 (95% CI: 0.381, 0.911).

Mode of delivery was significantly associated with bottle feeding practice. mothers who gave birth through cesarean section were 2.8 times more likely to practice bottle feed than mothers give birth via spontaneous delivery AOR=2.817 (95% CI: 1.764, 4.494). Similarly, infant hospitalization after delivery is significant for mothers to bottle feed an infant. Infants who were hospitalized after delivery were almost 2 times more likely to practice bottle feeding than infants who were not hospitalized AOR=2.114 (95% CI: 1.246, 3.588). In addition, time of initiation breast feed was significantly associated with bottle feeding practice. Mothers who initiate breast fed after one hour were 5.5 times more likely to practice bottle feeding than mothers who initiate breast feed immediately after birth (within one hour) AOR=5.526 (95% CI: 3.121, 9.786). Furthermore, mothers who have no information on bottle feeding were significantly associated with bottle feeding practice. Lastly, mothers not having information about bottle feeding were 4 times more likely to practice than mothers not having information about bottle feeding AOR=4.131 (95% CI: 2.208, 7.729) (Table 5).

Table 5: Bivariable and multivariable logistic regression analysis for factors associated with bottle feeding practice among mothers having infant less than 6 months at Addis Ababa health centers, Addis Ababa, Ethiopia, 2022.

Discussion

The aim of this study was to assess the prevalence of bottle feeding practice and associated factors among infants less than six months in Addis Ababa public health centers. In this study, the prevalence of bottle-feeding practice was 39% (95% CI: 35-44). This result is consistent with the studies done at East Africa (Comoros), Sudan and Woldia, Ethiopia. On the other hand, the result of this study is higher compared to the national prevalence reported in the 2019 EDHS 22%, studies conducted at Mettu town, Namibia, Nine East and South East Asian countries and Nigeria. The possible reason for this difference might be attributed to study period variation, as there has been increasing advocacy for using formula in this region recently and urbanization. In contrast, the prevalence of bottle feeding in this study is lower than studies conducted at Debrelibanos Ethiopia, Pakistan and Nine East and South East Asian countries (Philippines). The difference might be due to methodological variations between studies, dissimilarities in infant and maternal socio-demographic characteristics and other differences in sociocultural, economical, health and health service utilization characteristics between respondents of the referenced areas and the study place.

The main reasons mentioned by mothers for bottle feeding in this study are insufficient breast milk production for infants (30.6%), short maternity leave (22%), and maternal work load in house and outside house to breast feed (17.2%), maternal illness (17.7%) and infant refusal to breast feed due to childhood illness (13.40%). These results are consistent with other studies done in Holata, Agaro, Namibia, Benghazi Libya, Mauritius and Pakistan.

Short maternal leave (3 months) makes mothers prompted to resort to the supplementation of infant formula before 3 months so that their infants familiarize to bottle feeding during their absence, resumption of work, perception of breast milk insufficiency and infants sucking problem are factors that hiders breast feeding and facilitates for choosing bottle feeding.

According to this study, mothers who gave birth through cesarean section were 2.8 times more likely to practice bottle feed than mothers give birth via spontaneous delivery. This result is in line with studies conducted at Namibia, Libya, Pakistan and India. This resulted due to delayed initiation of breast feeding because of mothers take long time to recover from anesthesia and additional discomfort. Similarly, gender of the infant was significantly associated with bottle feeding practice. An infant who is male was 59% less likely to bottle feed than infants of female gender. This result is similar with studies done in India this is due to mothers belief of males high nutritional requirement construction of gender influence to increase bottle feeding.

Among the various obstetric and health service utilization factors assessed, infant hospitalization was significantly associated with bottle feeding practice. Infants who were hospitalized after delivery were almost 2 times more likely to practice bottle feeding than infants who were not hospitalized. This result is similar with studies done in India, Kassel, eastern Sudan and Ethiopia particularly Holeta and Agaro towns. This may result due infants sucking problem as result of childhood illness that makes them to admit to hospital [25].

Late initiation breast feed was significantly associated with bottle feeding practice. Mothers who initiate breast fed after one hour were 5.5 times more likely to practice bottle feeding than mothers who initiate breast feed immediately after birth (within one hour). This result is in line with studies done in Wuhan, China, Hula (Sidama Ethiopia) and Debra Birhan, Ethiopia. This might be due maternal illness (pain full breast experience), delayed milk secretion, caesarean section mode of delivery, infant inability to suck breast and low counseling service during ANC and PNC.

Access to information seems to affect a mother’s decision on infant and young child feeding. Mothers who have no information on bottle feeding was significantly associated with bottle feeding practice. Mothers who haven’t information about risk of bottle feeding were 4 times more likely to practice bottle fed than mothers having information about bottle feeding AOR=4.131( 95% CI: 2.208, 7.729). This study supports study conducted in in Benghazi, Libya. This may be resulted due to lack of information about benefits of breastfeeding for mother and child and risks followed after bottle feeding like diarrhea and other botte sanitation related infections. Finally, lack of indication on seasonal variation of bottle feeding, inclusion of only governmental health centers and qualitative method of study was limitation this study [26].

Conclusion

The overall prevalence of bottle feeding practice high in the study area (39%) as compared to national prevalence (22%). male infant, infant hospitalized, cesarean section delivery and late initiation of breastfeeding. infant hospitalization and late initiation of breast feeding and not having information on bottle feeding were significant factors associated with bottle feeding practice. Therefore, increasing breast feeding practice and avoid bottle feeding practice, provide continuous breastfeeding education, training of health care workers to strengthen maternal and child health services increase maternity leave are recommendations of the study.

Ethical Approval

The study was conducted after getting ethical clearance from the institutional review board of Saint Paul hospital millennium medical collage ethical review committee (reference number PML3/757, on 9/6/2022) and Addis Ababa health bureau public health research and emergency management department(reference number A/A/16172/227, on 23/6/2022). In addition, letters of authorization was obtained from Areda sub city health office, Kolife Karanio sub city and Nifas silk Lafto sub cities before contacting the participants. The participants were then fully briefed about the study’s purpose and benefits in their local language and obtained informed written consent for both data collection and publication. Confidentiality was maintained through anonymity and privacy measures were taken to preserve the right of the participants throughout the research work including publication. Finally, the selected participants were asked about their willingness to join the study. Any study participant willing to engage in the study and those who wanted to stop an interview at any time were allowed to do so. This study was conducted in accordance with the declaration of Helsinki.

Consent for Publication

Not applicable.

Availability of Data and Materials

The datasets analyzed during the current study are available from the corresponding author upon reasonable request.

Competing Interest

The authors declare that they have no competing interest.

Funding

There were no external organizations that funded this research.

Authors' Contribution

GB developed the project, manage resource, and perform supervision and investigation. GB, ST, SM, AA3, BM and AB, participated in the methodology. GB, SM, ST, AA2, AA3 in data analysis and conceptualization (developing the initial drafts of the manuscript) and revising subsequent drafts. GB, AA2 and SM prepared the final draft of the manuscript. All authors read and approved the final manuscript.

Acknowledgment

We would like to thank Saint Paul hospital millennium medical college to support this research project. The authors would also like to extend their gratitude to Addis Ababa health centers, data collectors and supervisor for their valuable contribution.

References

1. Rahman A, Akter F (2019) Reasons for formula feeding among rural Bangladeshi mothers: A qualitative exploration. PLoS One. 14(2):e0211761.

   [Crossref] [Google Scholar] [PubMed]

2. Kebebe T, Assaye H (2017) Intention, magnitude and factors associated with bottle feeding among mothers of 0-23 months old children in Holeta town, Central Ethiopia: A cross sectional study. BMC Nutr. 3(1):1-8.

   [Crossref] [Google Scholar] [PubMed]

3. Wu H, Zhao M, Magnussen CG, Xi B (2021) Global prevalence of WHO infant feeding practices in 57 LMICs in 2010-2018 and time trends since 2000 for 44 LMICs. EClinical Medicine. 37:100971.

   [Crossref] [Google Scholar] [PubMed]

4. Kotowski J, Fowler C, Hourigan C, Orr F (2020) Bottle-feeding an infant feeding modality: An integrative literature review. Matern Child Nutr. 16(2):e12939.

   [Crossref] [Google Scholar] [PubMed]

5. Tewabe T (2015) Assessment of exclusive breast feeding practice and associated factors among mothers in Motta town, East Gojam zone, Amhara reginal state. Addis Ababa University. 2:1-15.

   [Google Scholar]

6. Dibley MJ, Senarath U, Agho KE (2010) Infant and young child feeding indicators across nine East and Southeast Asian countries: An analysis of national survey data 2000-2005. Public Health Nutr. 13(9):1296-1303.

   [Crossref] [Google Scholar] [PubMed]

7. Kera AM, Zewdie A, Akafu W, Kidane R, Tamirat M (2003) Formula feeding and associated factors among mothers with infants 0-6 months old in Mettu town, Southwest Ethiopia. Food Sci Nutr. 11(7):4136-4145.

   [Crossref] [Google Scholar] [PubMed]

8. Federal M (2004) National strategy for infant and young child feeding. Int J Innov Sci Res Technol. 1504–1510.
9. Makwana DN (2020) Determinants of bottle feeding among 0-24 months children. Pediatr Rev: Int J Pediatr Res. 7(1):14-21.

   [Google Scholar]

10. Seid SS, Muluneh E, Sinbirro IA, Moga TT, Haso TK, et al. (2019) Utilization of bottle feeding practices and associated factors among mothers who have infant less than 12 months of age in Agaro town, Jimma zone South West Ethiopia, 2018. Health Sci J. 13(1):1-10.

    [Google Scholar]

11. Science F (2014) Determinants of child feeding practices in Pakistan; secondary data analysis of demographic and health survey 2006-07. J Med Nutr Nutrac. 3(2):78.

    [Google Scholar]

12. Andea F, Nida H, Jira C (2003) Infant bottle feeding practice, Agaro town, Southwest Ethiopia. Ethiop J Heal scince. 13(1):51-58.

    [Google Scholar]

13. Hassan AA, Taha Z, Abdulla MA, Ali AAA, Adam I (2019) Assessment of bottle feeding practices in Kassala, Eastern Sudan: A community-based study. Open Access Maced J Med Sci. 7(4):651-656.

    [Crossref] [Google Scholar] [PubMed]

14. UNICEF (2019) Situation analysis of children and women: Addis Ababa. UNICEF.

    [Google Scholar]

15. Mihret Y, Endalew F, Almaw H, Linger M (2020) Sociodemographic factors associated with bottle feeding practices in infants under two years of age: A hospital based study in Woldia, Ethiopia. Cent Asian J Glob Health. 9(1):e440.

    [Crossref] [Google Scholar] [PubMed]

16. Ekubagewargies DT, Mekonnen HS, Siyoum TM (2019) Assessment of knowledge, attitude, and practice of HIV positive mothers on antiretroviral treatment towards infant feeding in Gondar town health institutions, North West Ethiopia, 2017. Int J Pediatr. 2019:9107989.

    [Crossref] [Google Scholar] [PubMed]

17. Birhan TY, Birhan NA, Alene M (2021) Pooled prevalence and determinants of prelacteal feeding practice in Eastern Africa evidence from demographic and health survey data: A multilevel study. Risk Manag Healthc Policy. 14:1085-1095.

    [Crossref] [Google Scholar] [PubMed]

18. EPHI (2021) Ethiopia mini demographic and health survey. Ethiopian Public Health Institute. 1-25.
19. Berde AS (2018) Factors associated with bottle feeding in Namibia: Findings from Namibia 2013 demographic and health survey. J Trop Pediatr. 64(6):460-467.

    [Crossref] [Google Scholar] [PubMed]

20. Akinyinka MR, Olatona FA, Oluwole EO (2016) Breastfeeding knowledge and practices among mothers of children under 2 years of age living in a military barrack in Southwest Nigeria. Int J MCH AIDS. 5(1):1-13.

    [Crossref] [Google Scholar] [PubMed]

21. Mekonnen M, Kinati T, Bekele K, Tesfa B, Hailu D, et al. (2021) Infant and young child feeding practice among mothers of children age 6 to 23 months in Debrelibanos district, North Showa zone, Oromia region, Ethiopia. PloS One. 16(9):e0257758.

    [Crossref] [Google Scholar] [PubMed]

22. Motee A, Ramasawmy D, Pugo-Gunsam P, Jeewon R (2013) An assessment of the breastfeeding practices and infant feeding pattern among mothers in Mauritius. J Nutr Metab. 2013:243852.

    [Crossref] [Google Scholar] [PubMed]

23. Abdulmalek LJ (2018) Factors affecting exclusive breast feeding practices in Benghazi, Libya. Libyan J Sci Techno. 7(1):36-38.

    [Google Scholar]

24. Huang L, Xu S, Chen X, Li Q, Lin L, et al. (2020) Delayed lactogenesis is associated with suboptimal breastfeeding practices: A prospective cohort study. J Nutr. 150(4):894-900.

    [Crossref] [Google Scholar] [PubMed]

25. Hoche S, Meshesha B, Wakgari N (2018) Sub-optimal breastfeeding and its associated factors in rural communities of Hula district, Southern Ethiopia: A cross-sectional study. Ethiop J Health Sci. 28(1):49-62.

    [Crossref] [Google Scholar] [PubMed]

26. Gultie T, Sebsibie G (2016) Determinants of suboptimal breastfeeding practice in Debre Berhan town, Ethiopia: A cross sectional study. Int Breastfeed J. 11:5.

    [Crossref] [Google Scholar] [PubMed]