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Applied human nutrition
Thesis and Dissertations
2020-03-11
TIMELY INTRODUCE OF
COMPLEMENTARY FEEDING
PRACTICES AND ASSOCIATED
FACTORS AMONG MOTHERS OF
CHILDREN AGED FROM 6-23
MONTHS IN LAY ARMACHIHO
WOREDA NORTHWEST ETHIOPIA
Gashe, Alsa
http://hdl.handle.net/123456789/10173
Downloaded from DSpace Repository, DSpace Institution's institutional repository
BAHIR DAR UNIVERSITY
BAHIR DAR INSTITUTE OF TECHNOLOGY
SCHOOL OF RESEARCH AND POSTGRADUATE STUDIES
FACULTY OF CHEMICAL AND FOOD ENGINEERING
TIMELY INTRODUCTION OF COMPLEMENTARY FEEDING
PRACTCES AND ASSOCIATED FACTORS AMONG MOTHERS OF
CHILDERN
AGED
6-23
MONTHS
IN
LAY
ARMACHIHO
WOREDA, NORTHWEST, ETHIOPIA
BY ALSA GASHE MANDEFRO
BAHIRDAR UNIVERSTY
BAHIRDAR ETHIOPIA
JUNE , 2019
TIMELY INTRODUCE OF COMPLEMENTARY FEEDING PRACTICES AND
ASSOCIATED FACTORS AMONG MOTHERS OF CHILDREN AGED FROM 6-23
MONTHS IN LAY ARMACHIHO WOREDA NORTHWEST ETHIOPIA
By Alsa Gashe Mandefro
A thesis submitted to the school of research and graduate studies of Bahir Dar Institute of
Technology, BDU in partial fulfillment of the requirements for the degree of master in
Msc Applied Human Nutrition in the faculty of food and chemical engineering.
Advisor Name Amare Tariku (Ass. Professor)
CO-Advisor Jemale Sadik (Ass. Professor)
Bahir Dar University
Bahir Dar Ethiopia
JUNE, 2019
Acknowledgement
First I would like to express my deepest appreciation my advisors, Ass. Professor Amare
Tariku and Sadik Jemale constant encouragement, support, comment and proper guidance
throughout proposal and thesis report development. Second I would like to thank Bahir
Dar University, department of applied human nutrition for giving the chance to prepare
this thesis. Third I would like to extend my gratefulness to the data collectors, supervisor
and all respondents for their willingness to participate in the study and also I would like
to appreciate Lay armachiho Woreda health office administration to give information.
i
ABSTRACT
Back ground: Appropriate nutrient intake and/or complementary feeding in quantity,
bioavailability and timely in infancy period are essential for optimal growth and
development. Initiation of safe and nutritionally adequate complementary foods at 6
month is crucial to achieve optimal growth, development and health. Nutritional
deficiencies during this period can lead stunting which cause to impaired cognitive
development and low economic productivity which become difficult to reverse later in
life.
Objective: To assess of timely introduce of complementary feeding practices and
associated factors among mothers with children aged 6-23months at lay armachiho
woreda Northwest Ethiopia.
Methods: community based cross sectional study was conducted among 564 children
aged 6-23 months. The data were entered Epi-info version 7 and transferred, cleaned,
coded and analyzed using SPSS version 20.Bivariate and multivariate logistic regression
analyses were used to identify factors associated with complementary feeding practices.
Adjusted odd ratio with corresponding 95% interval was calculated to show the strength
of association. A p value of less than 0.05will be used to declare significance of
association.
Result: the prevalence of timely introduce of complementary feeding at six month was
64.4 (95% CI= 60.4, 67.9), Mothers occupation of housewife, antenatal follow up,
institutional delivery and postnatal follow up were found to be independent predictor of
increase timely introduce of complementary feeding practices.
Conclusion: Mothers introduce complementary feeding at six month of child age 64.4%
as recommended. This was relatively lower prevalence than WHO recommendation 80%
and greater 80%. All mothers must be encouraged to make ANC follow up, delivered in
health institution and postnatal care follow up.
Keyword: complementary feeding, timely introduces, practices
ii
Table of Contents
Acknowledgement ............................................................................................................... i
ABSTRACT ........................................................................................................................ ii
List of figure ....................................................................................................................... v
List of table ........................................................................................................................ vi
List of annex ..................................................................................................................... vii
ACRONYMS/ABBREVIATIONS.................................................................................. viii
1.2 Back ground .............................................................................................................. 1
1.2 problem statement ..................................................................................................... 2
1.3 Objectives of the study .............................................................................................. 4
General objective ......................................................................................................... 4
Specific objective ........................................................................................................ 4
1.4 Scope of the study ..................................................................................................... 4
1.5 Significance of study ................................................................................................. 4
2. LITERATURE REVIEW ............................................................................................... 5
2.1 Introduce of solid, semi-solid or soft foods............................................................... 5
2.2 Factors Associated with Complementary Feeding Practices .................................... 7
2.2.1 Socio-demographic and economic factors .......................................................... 7
2.2.2 Maternal knowledge and perceptions ................................................................. 8
2.2.3 Maternal health care service utilization .............................................................. 9
3. METHOD ..................................................................................................................... 11
3.1. Study Setting and Design ....................................................................................... 11
3.2 Source and study population ................................................................................... 11
3.2.1 Source population ............................................................................................. 11
3.2.2 Study population ............................................................................................... 11
3.2.3 Study unit .......................................................................................................... 11
3.3 Inclusion/ Exclusions criteria .................................................................................. 11
3.3.1 Inclusion criteria ............................................................................................... 11
3.3.2 Exclusion criteria .............................................................................................. 12
3.4 Sample Size Determination ..................................................................................... 12
iii
3.5 Sampling procedure................................................................................................. 12
3.6 Variables of the study .............................................................................................. 13
3.6.1 Dependent variable ........................................................................................... 13
3.6.2 Independent variables ....................................................................................... 13
3.7 Operational Definitions ........................................................................................... 14
3.8 Data collection procedure........................................................................................ 15
3.8.1 Data collection tool and procedure ................................................................... 15
3.8.1 Data quality control .......................................................................................... 15
3.8.2 Data analysis ..................................................................................................... 15
3.8.3 Ethical consideration ........................................................................................ 16
3.8.3 Result dissemination ......................................................................................... 16
4 RESULT ........................................................................................................................ 17
4.1 Socio demography characteristics of mothers ......................................................... 17
4.2 Maternal health care related .................................................................................... 19
4.3 Mothers infant and young child feeding practices and knowledge ......................... 20
4.4 Associated factors with introduce of complementary feeding at six month ........... 21
4.5 Discussion ............................................................................................................... 23
6. Conclusion and recommendation .................................................................................. 25
6.1. Conclusion.............................................................................................................. 25
6.2. Recommendation .................................................................................................... 25
Reference .......................................................................................................................... 26
6. Annex ............................................................................................................................ 31
iv
List of figure
Figure 1Conceptual frame work of study ......................................................................... 10
Figure 2 sampling procure ................................................................................................ 13
Figure. 4 seven food groups .............................................................................................. 21
v
List of table
Table 1Socio-demographic and economic characteristics of mothers .............................. 18
Table 2 Maternal health care serves and utilization.......................................................... 19
Table 3Mothers infant and young child feeding practices and knowledge ...................... 20
Table 4Associated factors with timely introduce of complementary feeding at six month.
........................................................................................................................................... 22
vi
List of annex
Annex 1English information Sheet ................................................................................... 31
Annex 2English version Questioners ................................................................................ 32
Annex 3Amharic information’s sheet ............................................................................... 38
Annex 4Amharic’s version questioner.............................................................................. 40
vii
ACRONYMS/ABBREVIATIONS
ANC
Antenatal Care
AOR
Adjusted Odds Ratio
BFP
Breast Feeding Practices
CF
Complementary Feeding
CI
Confidence Interval
COR
Crude Odds Ratio
EDHS
Ethiopia Demographic Health Survey
EBFP
Exclusive Breast Feeding Practices
IYCF
Infant and Young Child Feeding
MOH
Ministry of Health
NGO
Non-Governmental Organization
PNC
Postnatal Care
UNICEF
United Nations Children’s Fund
UN
United Nations
WHO
World Health Organization
viii
1. INTRODUCTION
1.2 Back ground
World health organization recommends early introduce of breast feeding followed by
exclusive breast feeding for the first six month and introducing solid, semi-solid or soft food
timely infant at six month of age with continuing breast feeding up to two years. It should be
adequate in amount, frequency, consistency and using a variety of foods to cover the
nutritional needs of the growing child while maintaining breast feeding, foods should be
prepared and given in safe manner, to minimize the risk of contamination with pathogens.
They are developmentally ready to introduce complementary food, which is necessary to meet
their extra energy and micro nutrient requirement (WHO2014).
Infants and young children are at increased risk of malnutrition starting from six months,
when breast milk alone is no longer sufficient to meet all the nutritional requirements of infant
(Vossenar M, & Solomon NW 2012). Inappropriate complementary feeding practices such as
untimely introduction of complementary food, improper feeding frequency and low dietary
diversities are increasing the risk of under nutrition, micro nutrient deficiencies, growth
retardation, diarrhea and other infections. Diarrhea is a major cause of morbidity and mortality
among infants and young children in developing countries (Victora CG et al., 2008).
Malnutrition is one of the most common causes of morbidity and mortality among children
throughout the world. It has been estimated 60% out of 10.9 million deaths annually among
children under five. Over two- thirds of these deaths, which are often associated with
inappropriate feeding practices, occur during the first two years of life (R.E Black et al.,
2003).
1
1.2 problem statement
At the age of 6 months an infant’s need for energy and nutrients starts to exceed what
provided by breast milk. Therefore, complementary foods fill the gap between the total
nutritional needs of the child and the amounts provided by breast milk. Despite the
recommended time, complementary foods are introduced at different age in many of
developing countries (Muchina and Waithaka, 2010).
Globally 171 million children below five years of age are stunted annually, 115 million
underweight and 20 million are wasted (WHO2012).
Similarly in Ethiopia under nutrition is major health problem for infants and young children,
National rates of stunting, underweight and wasting among children aged less than 5 years
were 38%, 24% and 10% respectively (EDHS2016). In Amhara region stunting, wasting and
underweight were found as 46.3%, 9.8% and 28% (EDHS2011) and in Gondar town stunting
(45.7%), underweight (15.3%) and wasting (6.8%) (Zegeye Abebe et al.2017) Children who
received timely complementary foods had normal status based on weight for height than
children who did not receive timely complementary foods even after controlling for maternal,
child and health factors (Ekerette E et al 2016).
Studies have demonstrated that early introduction of solid foods is a risk factor for infection,
early end of breast feeding and increased consumption of fatty or sugary foods at 1year of age,
Sub optimal breast feeding and poor complementary feeding practices leads to malnutrition
which is one of biggest contributor to child mortality and the underlying causes of more than
half of all deaths among children 6-59 month age (Grummer- Strawnetal., 2008).The period
from birth to two years of age is the critical window for the promotion of optimal growth,
health and development of child. The success of worldwide coverage of optimal breast
feeding could prevent 13% of death occurring in less than five years children, while
appropriate complementary feeding practice would result in additional 6% reduction in under
five mortality (R.E Black et al 2008).
2
Too early or too late introduction of complementary foods is not appropriate feeding practice
as it carries many risks which contributes to persistent child malnutrition. It is reported before
six month introduction of complementary food, breast milk replaces by food which is usually
less nutritious, stress the immature gut, kidneys and infants to reduced protective benefits of
the breast milk and morbidity due to diarrhea. Diarrhea is major cause of morbidity and
mortality among infants and young children in developing countries, Introduce of
complementary foods too late results in an inadequate intake of energy and protein leading to
poor growth and stunting as well as iron and other nutrient deficiency (WHO 2011). Stunting
is irreversible and can have long term effects on cognitive development, school achievement,
and economic productivity in adult hood (Guide lines for enhancing optimal and young child
feeding practice2013).
Ethiopia health minister promote ANC follow up and institution delivery, develop health
extension workers (policy) to provide nutrition counseling and promote exclusive breast
feeding and timely introduce of complementary feeding practices, mobilize to people about
nutrition through different medias and posters, accept NGOs that works on nutrition under
five years, draft the education curriculum and start implement, Although several surveys
documented on infant and young child feeding practices in different areas were vary, timely
introduction of CF was only 56 percent nationally (EDHS2016) , 35 percent in
Amhara(EDHS2011)and in north Gondar Dabat district 54 percent (Bikset al 2018) which are
lower than WHO recommendation. Therefore the aim of this study is to assess prevalence of
timely introduction of complementary feeding practices and associated factors with some
selected variables among mother of children aged 6-23 months in Lay Armachiho Woreda.
3
1.3 Objectives of the study
General objective
Assess the magnitude of timely introduction complementary feeding practices and associated
factors among children aged 6-23 months at Lay Armachiho Woreda Northwest Ethiopia.
Specific objective
 To determine timely introduction complementary feeding practice among mothers
with children aged of 6-23months.
 To identify factors associated with timely introduction of complementary feeding
practices among mothers with children aged of 6-23 months.
1.4 Scope of the study
The scope of this study was restricted in Lay Armachiho woreda by including the rural
mothers/caregivers with children aged 6 to 23 months who at least six month live. This
research was restricted to 6 kebeles and 564 mothers/ caregiver with children aged 6-23
month. The study was not involved mothers/caregiver with children aged 6-23 months more
than one child in one house hold.
1.5 Significance of study
The first two years of life are critical window for ensuring optimal child growth and
development (WHO, 2008a). Introduction of complementary foods which is not timely is
inappropriate feeding practices which risk of child malnutrition, mortality and infection. The
prevalence of all forms of malnutrition is high in Amhara region; especially stunting which is
resulted from inappropriate complementary feeding practices (EDHS2011). There was
inadequate scientific data on timely introduction of complementary feeding practices and
nutritional status of children aged 6-23 months was no complementary feeding study has
already conducted in the woreda. Therefore study would be use as a reference of other future
studies.
4
2. LITERATURE REVIEW
2.1 Introduce of solid, semi-solid or soft foods
According WHO recommends exclusively breast feeding infants for the first 6 months of life,
followed by introduction of adequate complementary foods. This recommendation used
infants living in developing and developed countries (WHO, 2010). In healthy infants
introducing complementary feeding must be delayed until 6 months as WHO recommends
exclusive breast feeding for this to confer several benefits to the infant and mother.
In Nepal showed that about a quarter of child start consuming solid or semi-solid food at the
age of 4-5 months. About 57% children are fed according to recommended infant and young
child feeding practices IYCF (Pandey et al., 2010). study assessed complementary feeding
practices among mother- infant pairs from the middle and lower socioeconomic families in
Sari, Iran more than two third of mothers (83.6%) started complementary feeding at ideal age
of 6 months which is recommended by WHO. Only 32(16.4%) mothers in this study introduce
complementary feeding soon before 6 months reported by (Abdollahi F.et al., 2013).In India
77.5% mothers had started complementary feeding at the recommended time and 24(12%)
children had delayed (Rao S et al., 2011).Study conducted in Bangladesh 71% of infants were
consuming soft, semi-solid and solid food by 6-8 months of age (Kabir.I et al., 2012). A cross
country comparison study done in south Asia countries of selected infant and young child
feeding indicators and associated factors in south Asian countries in June 2010 results shows
considerable proportion of infant under six months of age had been given complementary
foods at timely ranged from 23.5% in India to 56.3% in Srilanka and Nepal reported by lowest
3.5% of timely complementary feeding practices (Dibley MJ, Roy et al., 2010).
In urban Nigeria among 374 studied mothers of children 0-24 month’s age about 23%, 30.5%
and 13% of them were started CF before 4 months, 4-5 months, at 6 months and above 6
months respectively (Ogunba Bo Agwo 2013). Study in Nigeria result showed that only 25%
of the mothers started complementary foods at the age of 6 months, while majority had begun
complementary foods at the age of before 6 months (73.5%) and the rest delayed more than 6
5
month (1.5%) children who received timely complementary foods had normal status based on
weight for height than children who did not receive timely complementary foods even after
controlling for maternal, child and health factors (Ekerette E et al., 2016). A study done in
Ghana by Solomon Sika-Bright (2010) revealed that 55% of the mothers had introduced other
foods aside breast milk within the ages of 3-4 months. However, 37.7% mothers introduced
foods within the 5th and 6th months of their infants. In Uganda indicated that three fourth of
mothers were introduce complementary feeding around 4-6 months partial weaning (Ashmika
M, et al., 2014).
According to (EDHS2016) indicate that, age 6-8 months only half (56%) of children received
complementary food. About 12% of children continue to be exclusively breastfed at this stage,
16% received plain water in addition to breast milk, 6% consumed water based liquids and
5% consumed cow’s milk and the prevalence of exclusive breast feeding before the age of six
months was found to be 58%. In Mekelle town revealed that timely introduce of
complementary feeding is 62% with the median age of six months, 19.7% of mothers
introduce complementary feeding before the age of six months and about 17.54% mothers had
introduce complementary feeding beyond six months(Shumey A et al., 2013). The study was
carried out in Aby-Adi town shows that in Northwest Mekelle approximately 79.7% of
mothers introduced complementary feeding at six months age of the children as
recommended. Only 9 (2.1%) mothers introduced complementary feeding early before 6
month, 68(15.9%) mothers initiated late after 6 month and 10 (2.3%)mothers did not start
complementary feeding at all (Mekbib E, et.al 2014).Cross sectional study conducted in Arsi
Negele Woreda southern Ethiopia to determine the prevalence of appropriate complementary
feeding and its associated factors among children aged 6-23 months, the practices of timely
introduce of complementary feeding, minimum meal frequency and minimum dietary
diversity were 72.5, 67.3 and 18.8% among mothers of 6–23 months aged children,
respectively (Kassa T et al., 2016). In Hiwot Fana specialized hospital, Harar town, showed
that two third of the mothers had given exclusive breast to their child until six months and
35% of mothers introduce complementary feeding early ( before six months) where one out of
every five woman started between 4-6 months. About 121(60.5%) of the women introduce
6
complementary feeding timely (Agumasie S et al., 2014). Study revealed that in Gununo
town, Damot sore woreda, wolaita zone, 20% started complementary breast feeding less than
six months, 45% at 6 months and 29% greater than six months, frequency of feeding shows
20.5% of them feed two times a day and 49.6% three times a day 25.2% four times a day.
Most respondents 175(74.8%) know with what kind of food to start with; 58(33,1%) cow
milk, followed by cereal based food, 35(20%) fruits and vegetables,13(7.4%) infant formula
and 8(4.6%) butter.194(82.9%) know when to stop breastfeeding(TeshomeGetal.,2016).The
prevalence of timely introduce of complementary feeding in Lalibela district was 63%. One
hundred eighteen children (28%) started complementary feeding after six month, while
twenty-eight (6.7%) were introduce before they reached the sixth month and ten children
(2.3%) were offered no additional food since they have been born (Sisay W et al., 2016).
2.2 Factors Associated with Complementary Feeding Practices
2.2.1 Socio-demographic and economic factors
Study assessed complementary feeding practices among mother infant pairs from the middle
and lower socioeconomic families in sari, infants from high educated fathers had a high rate
of ideal introduce feeding time than the infant from low educated fathers (Abdollahi et al.,
2013).Study conduct by Sawadogo et al., (2010) in Burkina Faso also found that late
introduction of complementary food to be more frequent in mothers aged less than 25 years. A
study based on the analysis of secondary data of NDHS 2006 in Nepal found that
complementary feeding of children age 6-9 months were associated with mothers better
education and women who have completed school leaving certificate (SLC) or a higher
education are found to be slightly more likely to introduce complementary feeding at the age
of six months (pandey et al., 2010). Cross-sectional study conducted in Rupandehi district of
Western Nepal, only 57 % of mothers initiated complementary feeding at the age of 6 months.
The workload of mothers was another important factor that affected timely initiation of
complementary feeding. Increasing workload is a challenge for mothers to initiate and sustain
proper infant feeding practices (Gautam et al. 2016).
7
Study by Elizabeth W Kimani-Murage, et al., 2011 found in Nairobi Kena exclusive breast
feeding for the first six months was rare as only about 2% of infants were exclusive breast fed
for six months. Factors associated with sub optimal infant breast feeding and feeding practices
in these settings include child’s sex mother’s marital status, ethnicity, education level, family
planning (pregnancy desirability), health seeking behavior(place of delivery) and
neighborhood(slum of residence).
Study conduct in south Ethiopia maternal education, household family size and child’s age are
the variables found to be associated with appropriate complementary feeding practices among
children aged 6-23 months (Kassa T et al., 2016). Finding in Lasta district showed that 56.5%
of children aged 6-23 months received appropriate complementary feeding occupation of
mothers, exposure to public media (like radio, television) and mothers decision making role
on family income were predictors of complementary feeding practices (Molla M et al., 2017)
Study was conducted in Kemba woreda house wife mothers are more likely start
complementary feeding timely since they stay in home with their child and have sufficient
time for frequent breast feeding (Agedew E, et al., 2014).
2.2.2 Maternal knowledge and perceptions
A study assessing feeding practices of children in an urban slum of Kolkata in India by Roy
(2009) showed that children below 6 months of age were introduced to complementary foods
due to a perceived lack of knowledge on sufficient breast milk by their mothers. A study by
Siegel et al., (2006) in Nepal established that mothers were less likely to give animal source
foods to infants under one year of age due to a misperception that they cannot digest animal
source foods. A study conduct in rural communities of Jimma Arjo the majority of mothers
early introduce complementary feeding, since they believed that breast milk was insufficient
and influences from social beliefs(Dessalegn T, et al., 2013).Study conducted by(Agumasie S,
et al.,2014) less than a quarter of the women introduce complementary feeding early between
4-6 months, the main reason given by the mothers for early introduce of complementary
feeding was lack of knowledge and perceive inadequate breast milk production by mothers
8
2.2.3 Maternal health care service utilization
In Bangladesh the most consistent determinants of inappropriate complementary feeding were
in adequate antenatal care, mode of delivery and lack of postnatal contacts by health workers
were among predictors of inappropriate feeding (Mihrshahi S, et al., 2004).
History of maternal health care service utilization has a positive impact on timely introduce of
complementary feeding, study done in Axum town show that mothers who attended ANC
follow were 3.87 times more likely to introduce timely complementary feeding than whom
did not attend. In addition, mothers who delivered at home were 66% times less likely to
introduce timely complementary feeding than whom delivered at health institution (Yemane
S, et al., 2014). The study conducts in Abyi-Adi town mothers who have no postnatal follow
up for their child in health service organization were significantly associated with
complementary feeding practices (Mekbib E, et al., 2014). The source of information about
the benefit of EBF revealed that most of the mothers (47%)got advice from health extension
workers,30% from health professionals, 27% from mass media and 18% from their mothers
which shows the contribution of health extension workers and health professionals are high
(Teshome G, et al., 2016). Study was conducted in Kamba Woreda, start complementary
feeding early before six months who have no postnatal, child growth monitoring follow up in
health institution were start early complementary feeding as compared to mothers who have
follow up. Mothers who had ANC follow up and institutional delivery were significantly
associated with timely introduce of complementary feeding (Sisay W, et al 2016).
Mothers who had no postnatal, child growth monitoring follow up in health institution were
start early complementary feeding as compared to mothers who have follow up, mothers who
get advice and health education on complementary feeding during postnatal and growth
monitoring has favorable impact on the promotion of timely introduce of complementary
feeding (Agedew E, et al., 2014).Prevalence of timely initiation of complementary feeding
was 61.8%, mothers’ postnatal check up and urban residence were significantly associated
with timely initiation of complementary feeding Amare Tariku, et al,. (2017).Women who
had history of antenatal care during their youngest child pregnancy period were initiate
9
complementary feeding timely than their counter parts 68.3% and 42.6% respectively. Among
women who give their both at health institution, 71.1% of them were initiate complementary
feeding timely. Women who had post natal visit were more likely initiate complementary
feeding timely (Agumasie S et al., 2014)
2.2.4 Conceptual frame work of the study
This framework is timely, given the recognized need to strengthen the complementary feeding
component of infant and young child feeding (IYCF) programmers, However complementary
feeding cannot be addressed in isolation from the promotion of exclusive breast feeding
during the first 6 months (critical for survival and the foundation of healthy growth in early
infancy) and continued breastfeeding (to age 2 years or beyond). Considerable progress has
been made towards development and implementation of policies and programmers designed
to protect, promote and support breastfeeding over the past several decades (WHO &
UNICEF 2009) (figure 1)
Economic factor
 Income
 Radio ownership
Socio demography
 Age of child
 sex of child
 Maternal age
 Maternal marital
status
 Family size
 Religion
 Maternal &father
education status
 Maternal &father
occupation status

Health care service
utilization
Timely
Introduce of
Complementary
Feeding
Figure 1Conceptual frame work of study
10
 ANC
 FANC
 Place of
delivery
 PNC
 Knowledge
 Birth interval
 Birth order
3. METHOD
3.1. Study Setting and Design
Community-based cross-sectional study design used to study timely introduce of
complementary feeding practices of children aged 6-23 months at Lay Armachiho Woreda ,
Northwest Ethiopia from October 20 to November 28/ 2018, Lay Armachiho Woreda has 29
rural kebeles. According of woreda health office administrative report, the woreda has a total
population 140417 of these 70911 are females, 19421 under five children and 7243 under two
children and also 9,092 population live in urban. The total population in the six selected
kebeles was 23685 of which 1141 were children 6-23 months. The Woreda has 6 health
centers, 25 health posts and 60 health extension workers. The woreda has 62 school (59
elementary and 3 high school), of the total elementary school (59), 11 schools supported by
save the children.
3.2 Source and study population
3.2.1 Source population
The source of population for the study all mothers/care givers with children aged 6-23 months
who live in Lay Armachiho Woreda for at least 6 months.
3.2.2 Study population
Mothers/care givers with children aged 6-23 months and live in the randomly selected kebeles
Lay Armachiho Woreda.
3.2.3 Study unit
Mothers/care givers with children aged 6-23 months who were to participate in the study.
3.3 Inclusion/ Exclusions criteria
3.3.1 Inclusion criteria
11
Mothers/caregivers with children aged 6-23 months old who are living in the six selected
kebeles for at least 6 months were invited to participate in the study.
3.3.2 Exclusion criteria
Mothers/caregivers who have children 6-23 months old who have serious illnesses at the time
of data collection and/or difficulty to communicate were exclude in from the study.
3.4 Sample Size Determination
Sample size determined by using single population proportion formula by assuming the
prevalence of timely introduce of complementary feeding as 63%( Sisay W, et al., 2016).
Also, 95% confidence interval, 5% margin of error and a design effect of 1.5 are considered in
sample size calculation.
n (sample size)=(Zα/2)2P (1-P)
d2
Z=the standard normal value at 95% confidence level (1.96):
P= prevalence (0.63)
d2 = desired level of precision (0.05), thus the total sample size will be= 358
Design effect=1.5 and 5%non response rate, the final sample size is 564
3.5 Sampling procedure
From total rural kebeles six kebeles selected through lottery method. According to the health
extension workers reports, a total population size in the six selected kebeles was 23685, of
which 1141 were children aged 6-23 months. The study participants from six kebeles selected
by using proportional allocation formula,
𝐧𝐢 =
𝐧
× 𝐍𝐢
𝐍
12
Where n= total sample size to be selected, N= total population, Ni= total population of each
selected kebeles and ni= sample size from each kebeles. Systematic random sampling
technique used to select households with an eligible study participant (Figure2).
29 rural kebeles
Simple random sampling method
Janikaw
Alleg
Ch/Led
Jaha
Giramt
G/me
198
159
194
200
197
193
97
95
Proportional allocation method
98
79
96
99
Systematic sampling method
564
Figure 2 sampling procure
3.6 Variables of the study
3.6.1 Dependent variable
Timely introduce of complementary feeding practices (yes/no).
3.6.2 Independent variables
The independent variables for the study were identified by reviewing different literatures.
These exposure variables were grouped into thematic areas as described below:Socio-demographic characteristics and economic factor (age &sex of child, age, educational
status, occupation & marital status of mother, family size, relationship of care giver to the
child, father education status & occupation, religion, radio ownership, and income).
13
Health care service utilization & mother’s IYCF knowledge (ANC,PNC, place of delivery,
birth space and number of health extension visits, perception about sufficiency of breast milk,
knowledge and perception on complementary feeding).
3.7 Operational Definitions
Complementary feeding practices: - were assessed according to the key indicators
recommended by (WHO2008a).
Accordingly, to ascertain timely introduce of complementary feeding, mother/care giver asked
to report introducing time she gives additional food to her child. Mother introduce
complementary feeding at the age of six months with continuous of breast feeding, this is
timely introduce of complementary feeding which is coded by 0 and untimely introduce of
complementary feeding is when the mother introduce complementary feeding early or late the
age of six months and also coded by 1.
Minimum dietary diversity: - children 6-23 months of age who receive foods from food four
or more food groups during the previous day. Asked the mother/care giver, what type of food
feeds for her children for the last 24 hrs before the survey? The food items were categorized
into seven food groups as grains, roots and tubers; legumes and nuts; dairy products; flesh
foods (meat, fish); egg; vitamin A rich fruits and vegetables; and other fruits and vegetables.
Considering the standardized minimum acceptable DDS (UNICEF 2009), a child with DDS of
>= 4 was categorized as having good dietary diversity, while participant with a DDS of <4
were deemed to have poor dietary diversity.
Minimum meal frequency:-breast feeding and non-breast feeding children 6-23 months of age
who receive solid, semi-solid or soft foods the minimum number of times or more ( minimum
is defined as two times for breastfed infants 6-8 months; three times for breastfed children 923 months and four times for non-breastfed children 6-23 months) in the previous day.
14
3.8 Data collection procedure
3.8.1 Data collection tool and procedure
Complementary feeding practices were assessed according to the key indicators recommended
by (WHO2008a). Data were collected using face to face interview during house to house visit
from mothers who had 6-23 months age children using structured questionnaire. The
questionnaire were originally prepared in English then translated to Amharic language. The
questionnaire comprises four parts; the first part is about background characteristics of
mothers and children, the second includes maternal health related practices, the third includes
feeding practices of the child and the last mother’s knowledge on IYCF. Twenty four hour
recall method used to assess dietary diversity and meal frequency. Woreda health office and
local health posts were contacted for permission to conduct the interviews. Six twelve
complete student and two diploma nurses selected to act as data collectors and supervisors
respectively.
3.8.1 Data quality control
Training was given to data collectors and supervisor for two days on the objective of the
study, how to collect quality data, confidentiality of information, respondents right, consent
and interview technique. All questioners were checked by the supervisor for completeness and
the principal investigator was monitored overall quality of the data collection. Pretest was
done 5% (28) out of selected kebeles. During the pretest, the acceptability and applicability of
the procedures and tools were evaluated, but the result of the pretest was not included for
analysis.
3.8.2 Data analysis
The collected data were entered in the Epi-info version 7 and transferred, coded, and analyzed
using Statistical package for Social Science (SPSS) version 20. Descriptive statistics
(frequency, mean, standard deviation and percentage) used to describe variables. A binary
logistic regression was used to identify the factors associated with timely introduce of
complementary feeding. In the bivariate analysis, P-value less than 0.2 were entered in to
multivariable logistic regression. The adjusted odds ratio with 95% confidence interval used
15
to assess the strength of association and P-value less than 0.05 used to declare the statically
significance in the multivariable analysis.
3.8.3 Ethical consideration
Ethical clearance was obtained from Faculty of Chemical and food engineering, Department
of Applied Human Nutrition Bahir Dar University and permission from Formal letter was
obtained Lay Armachiho Woreda health office and the selected kebeles. Names or any
personal identifiers were not recorded. Respondents were told about the study and the
validity of information need to them. They had a chance to ask any thing about the study and
make free to stop or refuse the interview at any movement they want, if that will be their
choice.
3.8.3 Result dissemination
The study result will be submitted to Faculty of Chemical and food engineering Applied
Human Nutrition Bahir Dar University and Lay Armachiho Woreda health office.
16
4 RESULT
4.1 Socio demography characteristics of mothers
Of the 564 sample mothers, 561 were interviewed (99.5% response rate). From all participants
548 (97.2%) of them were biological mothers. The mean age of mother/caregiver was 26.7
years with ±5.3 standard deviation. Majority (96%) was Orthodox Christianity followers
(96%) and 315 (56%) were unable read & write. The majority (87.4%) were married and
284(50.4%) were housewife by occupation. An average monthly income of 240(42.6%) was
less than 1000 Ethiopian birr, 230(40.8%) 1000-2000 birr, 41(7.3%) 2001-3000 and 50(8.9%)
greater than 3000 birr. From five hundred sixty one children, the mean age of children was
14.3 months ± 5.32standard deviation. A total of 561 infant and young children 6 to 23 month
were participated in the study 16.7% 6-8 month, 18.3% 9-11 month, 29.6% 12-17 month and
34.6% 18-23month (table 1).
17
Table 1Socio-demographic and economic characteristics of mothers
Variable
age of mother
16-20
21-25
26-30
>30
Religion
Orthodox
Muslim
education of mother
unable read &write
Frequency
%
83
167
205
106
14.7
29.6
36.3
18.8
542
19
96.1
3.4
315
175
71
55.9
31
12.6
able to read& write
primary school
occupation of mother
277
Farmer
284
house wife
mother marital status
493
Married
17
Single
46
Divorced
5
Widowed
husband education
unable read & write 321
able to read& write 131
45
primary school
occupation of husband
8
Merchant
471
Farmer
18
Daily labor
monthly income
240
<1000
230
1000-2000
41
2001-3000
50
>3000
family size
119
2-4
5-7
359
83
>=8
sex of child
Male
267
294
Female
age of child
94
6-8 month
103
9-11 month
167
12-17 month
18- 23 month
195
number of under-five child
148
One
390
Two
23
three and above
do you have radio
Yes
244
317
No
55.9
50.4
87.4
0.3
8.2
0.9
56.9
23.2
8
1.4
83.5
3.2
42.6
40.8
7.3
8.9
21.1
63.6
14.8
18
47.3
52.1
16.7
18.3
29.6
34.6
26.2
69.1
4.1
43.3
56.2
4.2 Maternal health care related
Among the study subject 279(49.5%) reported that they had at least one history of antenatal
follow up out of these 65(11.5%) of mothers had at least four times visits as recommended.
Moreover, 180 (31.9%) of the study participant gave birth in health institutions and three
hundred eighty seven (68.6%) of mothers had postal follow up, In addition to this 230
(40.8%) and 362(64.2) had antenatal & postnatal counseling about IYCFP (table2).
Table 2 Maternal health care serves and utilization
Variable
frequency
ANC follow up
Yes
279
No
282
frequency of ANC
1-3
214
>=4
65
obtained education IYCFP
Yes
230
No
46
place of delivery
health institution
180
Home
381
birth assist
Nurse
176
health extension worker
101
trained traditional birth
189
untrained traditional birth
95
birth interval
no birth interval
103
1 yrs
83
2-3 yrs
331
>=4 yrs
43
have you attend PNC
Yes
387
No
174
obtained information about CFP
Yes
362
No
30
%
where was obtained information
about CFP
health institution
259
Community
79
Radio
35
who give information
about CFP
health extension worker
345
voluntary public health
workers
19
Relative
6
49.5
50
38
11.5
40.8
8.2
31.9
67.6
31.2
17.9
33.5
16.8
18.3
14.7
58.7
7.7
68.6
30.9
64.8
5.3
19
45.9
14
6.2
61.2
3.4
1.1
4.3 Mothers infant and young child feeding practices and knowledge
All children 561 in this study had ever been breastfed and majority (97%) of children were
breast fed at a time of data collection. The knowledge mothers about the appropriate time
weaning was known by 525(93.1%) respondents but only 363(64.4%) of mothers introduce
complementary feeding at six months age of the children as per recommended. 259 (45.9%)
mothers obtained information about IYFP from health extension workers (table 3).
Table 3Mothers infant and young child feeding practices and knowledge
Variable
frequency Percentage
introduce of complementary feeding
timely introduce(at six month)
363
64.4
early introduce(before six month)
180
32
late introduce( after six month)
14
2.5
introducing CF for the 1st time to their child
Gruel
236
42
Porridge
90
16
cow milk
183
32.4
family diet
36
6.4
Meal frequency
two time
150
26.6
three time
260
46.1
four time/more
136
24.2
Dietary diversity
good dietary diversity
86
15.3
poor dietary diversity
477
84.7
breast feeding status during the survey
Yes
547
97
No
14
2.5
Bottle feeding practices is good
Yes
20
3.5
No
520
92.2
I do not know
21
3.7
Mothers reason for early/late introducing of complementary feeding practices 94(16.7%) work
loading, 80(14.5%) inadequate breast milk production, 14(2.5%) misunderstanding and 6
(1.1%) due to smelling of food wants to eat (figure 3).
20
The rate of different food groups offered during the past 24 hours were uniformly lower
among children aged with 6-23 month, from the total respondents 86(15.3%) mothers offered
four or more food groups to their child meeting the minimum dietary diversity criteria on the
day preceding, the date of survey. In the study grain 529(93.8%), dairy products 281(49.8%),
Vit.A rich fruits &vegetable 74(13.1%), legumes & nut 245(43.4%), other fruits & vegetable
104 (18.4%), meat 179 (31.7%) and egg 170 (30.1%) were consumed by children (figure 4).
100
80
60
40
20
0
93.8
86.4
56.1
43.4
50 49
5.7
81.1
18.4
13.1
67.8
31.7
69.4
30.1
yes
no
Figure. 3 seven food groups
4.4 Associated factors with introduce of complementary feeding at six month
By using Binary logistic regression model, bivariate and multivariate analysis was done to
identify the factors associated with timely introduce of complementary feeding. Bivariate
analysis showed that educational status of mother, occupation of mother, place of delivery,
ANC and PNC follow up were significantly associated with time introduce of complementary
feeding practices. In multivariate analysis occupation of mother housewife (not work outside
of the home), place of delivery, ANC and PNC follow up were the factors found to increase
timely introduce of complementary feeding. Mother occupation farmers were 33% times less
likely initiation of complementary feeding practices than house wife (AOR= 0.671, 95% CI
0.455, 0.989). Mothers who had antenatal follow up were AOR=1.837(1.246, 2.709) times
more likely increases introduce complementary feeding at six months than who had no attend.
Mothers who delivered at health institution 1.842 more likely to timely introduce of
complementary feeding than whom delivered at home AOR=1.842(1.205, 2.815).Postnatal
care follow up mothers were AOR= 4.247(2.858, 6.312) times more likely to timely introduce
21
of complementary feeding to their infants compared to those who did not follow up the
service (table 4).
Table 4Associated factors with timely introduce of complementary feeding at six month.
Variable
introduce of CF timely
Yes
no
COR(95%CI)
AOR(95%CI)
education status of mothers
unable to read &write
191 124 0.523(0.293, 0.935) *
able to read & write
119
primary school
53
56 0.725(0.491, 1.070)
18
1
occupation of mother
Farmer
168 109 0.703(0.497,0.996) *
Housewife
195
89
Yes
198
81 1.733(1.221,2.461*
No
165 117
0.671(0.455, 0.989) **
1
1
ANC follow up
1.837(1.246, 2.709) **
1
1
place of delivery
health institution
133
47
Home
230 151
1.86(1.257, 2.746) *
1.842(1.205, 2.815) **
1
1
PNC follow up
Yes
No
291
95 4.382(2.997, 6.407) *
72 103
4.247(2.858, 6.312) **
1
(COR 95 CI)=P*<0.2and (AOR 95 CI) =P**<0.05)
22
1
4.5 Discussion
Our study revealed that timely introduce of complementary feeding among mothers with
children aged from 6-23 months was 64.4 %( 95% CI =60.4, 67.9). This finding is higher than
studies conducted in Srilanka 56.3% (Dibley MJ, Roy et al.,2010), in Nepal 57 (Pandey et.al
2010),in Kemba woreda 40.6 (Agedew E et al., 2014), EDHS2016 (56%) . On the other hand
the prevalence of complementary feeding timing was almost similar with the finding in
Northern Ethiopia 63%Shumey A, et al.,(2013),Lalibela district 63 %( Sisay W, et al., 2016),
Benishangul
Gumuz
Region62%Amare Tariku,
et
al,.(2017)
and
Easter
Ethiopia
61%Agumasie Semahegn & Gezahegn Tesfaye(2014), However the result is relatively lower
than WHO recommendation for timely introduce of complementary feeding which is greater
than or equal 80 % (WHO 2003) & This finding was also lower than the study conducted in
Bangladesh 71% (Kabir.I, et al., 2012),Sarilanka 83.6% (Abdollahi F, et al., 2013), south
India 77.5%(Rao S, et al., 2011), Arsi Negele 72.5%(Kassa T et al., 2016) and Abyi-Adi town
79.7%(Mekbib E, et al., 2014).%.This difference might be due to low socio-economic status,
study time of year, develop health extension workers(policy), mobilize to people about
nutrition through different Medias and health extension workers are making home to home
visits on regular bases to support families in accessing basic health services, to provide
nutrition counseling ,promote exclusive breast feeding
and timely introduce
of
complementary feeding practices.
Mother occupation farmers were 33% less likely introduce of complementary feeding
practices than house wife. This might be house wife mothers usually stay at home with their
child have sufficient time for frequent breast feeding and would not be obligated like farmer
mothers to wean their child early to go to work. Workload of mothers was factor that affected
timely introduce of complementary feeding. This is similar study was conducted by (Gautam
et al. 2016) and (Shumey A et al., 2013). Mothers who had antenatal follow up were 1.837
more likely increases introduce complementary feeding at six months than who had no attend.
Therefore, ANC was very important to messages to women delivery health institution and
other maternal health related. This is similar study was conducted by (Yemmen W et al.,
2014),(Sisay W et al., 2016),(Agumasie S et al., 2014) and (Shumey A et al., 2013). Mothers
23
who delivered at health institution 1.842 more likely increases timely introduce of
complementary feeding than whom delivered at home. Institutional delivery were
significantly associated with timely introduce of complementary feeding. This might be
nutrition counseling and other services are provided at the delivery service. Similarly, home
delivered mothers would not have sufficient information about recommended child feeding
practices. This is line with study in other places (Sisay W et al., 2016), (Agumasie S et al.,
2014) and (Yemmen W et al., 2014).
Postnatal care follow up mothers were 4.247 more likely to timely introduce of
complementary feeding to their infants compared to those who did not follow up the service.
Mothers who had no postnatal care follow up would start complementary feeding earlier
(before 6 months) or later (after 8 months) compared to mothers who followed the care. A
postnatal period could be an ideal time to counsel mothers on optimal complementary feeding
practice. Similar finding was reported by (Agedew E et al., 2014), (Agumasie S et al., 2014)
and (Elizabeth W Kimani-Murage, et al., 2011).
Recall-bias during interview of the mothers could be the possible limitation of the study
24
6. Conclusion and recommendation
6.1. Conclusion
Nearly two third of mothers introduce of complementary feeding on time. Mother occupation,
ANC follow up, place of delivery and PNC follow up were significantly associated with
timely introduction of complementary feeding.
6.2. Recommendation
For mothers who work outside at home need more attention their Childs to improve infant
child feeding practices.
For health professional: -should give focus to advice and counsel mothers on timely introduce
of complementary feeding during prenatal, delivery and postnatal period.
Health extension workers: - are making home to home visits on regular bases to support
families in accessing basic health services and to give home based health education as well as
other promotion services, including promotion of appropriate IYCF.
25
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6. Annex
Annex 1English information Sheet
Title of the research project: Factors Associated with Complementary Feeding Practice,
among Mothers having Children 6-23 Months of Age, at L/Armachiho woreda, Amhara
Region, Northwest Ethiopia, 2018
Principal investigator: Alsa Gashe
Name of the organization: Bahir Dar University Department of Applied Human Nutrition,
School of chemical and food engineering
Sponsor: Self
Introduction
My name is Alsa Gashe and student at university of Bahir dar for master degree. I am doing
research on children among 6-23 months of age as a part of my study course. I am going to
give you information and invite you to be part of this research. Before you decide to be part of
the research you can talk to anyone you feel comfortable with about the research. If there is
any word that you don’t understand while I am giving the information, please stop me and ask
me and I will explain.
Purpose of Research Project: The purpose of this research is to assessing factors associated
with complementary feeding and to determine prevalence of complementary feeding among
children aged 6-23 months at L/Armachiho woreda. The study will help to assist and provide
evidence for the health system and different take holders who are working on child nutrition,
to plan appropriate and the most effective nutrition intervention in the study setting and also
used as a baseline for subsequent studies.
Procedure: In order to collect the data, we invite you to take part in our project.
If you are willing, you need to understand and sign the consent form. We will ask
Some questions about your life style, resources and the people in this household and feeding
practice of your children.
Risk/Discomfort: By participating in this research project you may feel some discomfort
especially on sacrifice your time otherwise no risk in participating in this study.
31
Benefits: If you are participating in this research project, the output of the study will have
both direct and indirect benefit to you, as well as your family and the community at large will
get appropriate education and services in the future on complementary feeding.
Incentives: You will not be provided any incentives or payment to take part in this project.
Confidentiality: The information collected from this research project will kept confidential
and information about you that will be collected by this study will be stored in a file,
without your name, but a code number assigned to it.
Right to refuse or withdraw: You have full right to refuse from participating in this
research. You can choose not to respond to some or all questions if you do not want to give
your response. You have also the full right to withdraw from this study at anytime.
Consent form (Certificate)
Factors Associated with Complementary Feeding Practice, among Mothers having
Children 6-23 Months of Age, at L/Armachiho woreda, Amhara Region, Northwest
Ethiopia, 2018
Dear madam good morning/good afternoon; my name is----------. I am the member of the
team for the study conducting by Alsa Gashe, as partial fulfillment for the requirement of
Applied Human Nutrition, under the University of Bahir Dar Department of Applied
Human Nutrition School of chemical and food engineering.
The main aim of this study is to assessing factors associated with complementary feeding
among children aged 6to23 months. The results of the study will be used as base line
information to design appropriate intervention strategies. You are one of the women selected
to participate in this study; therefore you are kindly requested to participate. Your name will
not be written and all the information you will give to me will be kept confidential, your
participation is voluntary based and you are not obliged to answer any question if you do not
want to answer it. So you are kindly requested to provide your genuine answers to the
questions. If you have any question, don’t hesitate to ask at anytime. The interview will not
take more than25minutes.
Do I have your permission continue?
If yes thanks and continue.
If No thanks and go to next participant
Annex 2English version Questioners
32
Data collector name-----------------------------signature-------------date of interview---------Code of interviewer------------kebeles--------Supervisor name----------------------------------signature------------------Instructions: Fill in the blank space or circle the appropriate answer. Do not omit any
item of information.
Part One: Socio-Economic and Demographic Variables
No
101
Question
Response
How old are you;
Completed years in Age__
102
1.Orthodox
2.Muslim
3.Protestant
4.Catholic
5.Othersspecify
What is your religion?
103
1.Single
2.Married
3.Divorced
4.Widowed
5.Other specify
What is your current marital
Status?
104
1.mother
2.grand mother
3.care giver
4.other specify
1.unable to read & write
2.able to read & write
3.primary school (1-8)
4.secondary school (9-12)
5.certificate & above
Relation of mother with child
105
Educational status of mother
or care giver
106
Educational status of father
107
Occupation of mother
1.unable to read & write
2.able to read & write
3. primary school (1-8)
4. secondary school (9-12)
5.certificate & above
1.Merchant
2.Farmer
3. House wife
4. Student
5.Government employee
6. Private employee
5.Other Specify
33
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to
108
Occupation of father
109
1. Merchant
2. farmer
3.dailylabor
4.student
5.Governmentemployee
6.Privateemployee
7.Otherspecify-----------
Average House hold income
Per month(in ETB birr)
(-----------)birr
110
House hold size
(------------)number
111
sex of index child
1. Male
2. Female
112
Age of child in Months
(------------- )months
113
114
How many children do you
have under five?
(----------)number
Do you have radio?
1. yes
2. no
Part Two: About Maternal Health Care Service Utilization
No
Question
Response
201 Have you attend antenatal care in 1.Yes
any health facility while you
were
2.No
Pregnant with the last child?
(-------)number
202
If, yes, How many times
203
1.yes
Did you get health education
2.no
regarding complementary
feeding
ANCwas
visit the
204 Ifpractice
yes at
what
1.EBFshouldbepracticed
information that you acquired
For the 1st 6months
during your visit(more than one 2.complementaryfeedig
answer is possible)
3.Introduction times of
complementary feeding
practice
4. Other ….
34
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Skip205
205
Where did you give birth to this
child?
206
Who
207
208
assist
with delivery?
Birth order index child in the
Family
Birth interval between the
index child and his or her
1.Home
2.Hospital
3. Health center
4. health post
5. others
1. doctors
2. nurse
3. Health extension workers
4. trained traditional birth
attendance
5.untrainedtraditionalbirth
Attendance
6.family, friends &relative
[
]
[
] numbers
immediate elder
209 Did you visited Postnatal care
follow up after delivery for
index
210
child?
If yes basedonq.209 did you
receive advice or information on
infants & young child feeding
Practice eat visit?
211
1.yes
2.no
1.yes
2.no
1. Health institution
If based on q.209, where did you 2. community
Have child feeding information? 3. Relative
4. mass media
5.others specify
212
If based onq.209,who gave you
information of child feeding
practice?
1. HEW
2.Voluntary public health
workers
3.trained traditional
birth attendance
4. mass media
5.others specify
Part Three: Infant &Child Feeding Practices
No_
Question
Response
35
Skip Cod
to
e
301
302
303
304
305
Have you ever breast-fed you
baby after he/she was born?
1.Yes
2.No
Have you still breasting feeding?
1.Yes
2.NO
How many months did you
feed child with breast milk only?
(--------)month
Did you offered additional diet to
1.Yes
Your child?
2. No
If ,yes, at what age did you first start
complementary feeding your index
child (semi-solid or solid) other than
( ---------------)month
breast milk to the baby?
306
1.Right time weaning
2. Return to work
3.othersspecify
Why do you start complementary
feeding for the child?
307
What type of food at first time
introducing?
1. Gruel
2.Porridge
3.Cowmilk
4.Powdermilk
5. Other……………
309 What the Children that Individual
Types of foods that has been
fed over the past 24 hours, from
or groups has been fed food groups sunrise yesterday to sunrise
today.
Yes No
Grains, roots and tubers (millet (sorghum, maize, rice,
wheat...
Dairy products (milk, yogurt, cheese, ,formula, cow milk
Vitamin A rich fruits and vegetable (bananas, tomatoes
apples, avocados, mango, Papaya and fruit juice...)
Legumes and nuts ( Peas, beans, oil, fat or butter, nuts,
,
Other
fruits and vegetables
peanuts)
Flesh foods(meat, fish ...
Eggs
36
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to
315
308
Most of time what materials did you
use to feed mashed or fluid foods.
310
How many times did you feed
Solid and/or semi-solid food
between sunrise yesterday and
sunrise today?
311
If answer toQ302 is“ No” What
Was your reason to delay to give
additional food?
1. Spoon
2. Cup
3. plate
4. Bottle
5. Other
1. One times
2. Two times
3. Three times
4. Four times
5. Five time &above
1.I did not know exactly when
to start complementary feeding
2.My breast milk is
enough for the baby
3.People tell me not to give
before one year
4.I think child may not able to
digest it
5.Otherspecify-----
Part Four: Mother knowledge on Infants and young feeding knowledge
Questions
No_
401
Question
When is appropriate time of initiation
Complementary feeding practice in months?
402
Response
(
) months
1. Yes
After six months complementary feeding practice
along with breast feeding was important for
child growth and development?
2. No
3. I don’t
know
403
How many times your child did take meals in
preceding 24 hours before the assessment?
( ) numbers
404
What is the minimum
dietary diversity in one day(for infants=6months)
( ) numbers
405
Infant feeding using bottle feeding is important?
Thanks for your cooperation!!!
37
1. Yes
2. No
3. I don’t
know
Skip to Code
Annex 3Amharic information’s sheet
የምርምሩ/የጥናቱ ርዕስ:
በላ/አራጭሆ ወረዳ ውስጥ በሚገኙ እድሜያቸው ከ6-23 ወር ያሉ ህጻናት በተጨማሪ
ምግብ ላይ ተፅዕኖ ፋጣሪ ጉዳዮች በተመለከተና ተያያዥ ጉዳዮች፡፡
የዋና ተመራማሪው ስም፡ኤልሳጋሸ
የድርጅቱ ስም: ባህርዳርዩኒቨርሲ የስርዐተ-ምግብ፣ ኬሚካልና ምግብ ምርምር ክፍል
ወጪውን የሚሸፍ ነው አካል፡በራሱ በተመራማሪው
መግቢያ:
ይህ የመረጃና የስምምነት ውል ቅፅ የተዘጋጀው ላ/አረማጭሆ ወረዳ ውስጥ በሚገኙ
እድሜያቸው ከ6-23 ወር ላሉ ህጻናት እና ወላጅእናቶቻቸዉ(ተንከባካቢ) ነው፡፡
ዋና ዓላማዉም ስለምርምሩ ዓላማ፣ ስለመረጃ አሰባሰቡ እንዲሁም ጥናቱን ለማካሄድ
ፈቃድ ለማግኘት ከላይ የተገለፁትን አካላት ግልፅ እንዲሆንላቸዉ ለማድረግ ነዉ፡፡
የጥናት ፕሮጀክቱ የሚካሄድበ ትምክንያት :
የጥናቱ ዓላማ በላ/አረማጭሆ ወረዳ በሚገኙ እድሜያቸው ከ6-23 ወር ያሉ ህጻናት ላይ
በተጨማሪ ምግብ ላይ ተፅዕኖ ፋጣሪ ጉዳዮች በተመለከተና ሌሎች ተያያዥ ነገሮች
ለማጥናት ታቅዶ የተዘጋጀ ነዉ፡፡ የጥናቱ ግኝት ችግሩን ለመፍታት በተለይም ደግሞ
ጥናቱ በሚካሄድበት ቦታ ትክክለኛ የሆነ የመፍትሄ አቅጣጫ ለመቅረፅ እንደመነሻ
መሠረት ያገለግላል፡፡
አተገባበር: የጥናቱን አላማ ለማሳከት በላ/አረማጭሆ ወረዳ ውስጥ በሚገኙ እድሜያቸው
ከ6-23 ወር ላሉ ህጻናት እና ወላጅ እናቶቻቸዉ (ተንከባካቢዎች) ያካትታል፡፡
ሊገጥም የሚችልችግር/አለመመቸት
በዚህ ጥናት ላይ ምንም የሚደርስባቸዉ ጉዳት የለም፡፡ ነገር ግን መረጃቸዉ ለጥናቱ
በጣም አስፈላጊ ነዉ፡፡
ጥቅሞች:
በዚህ ጥናት ተሳታፊ የሚሆኑት እናቶች በቀጥታ ሊያገኙት የሚችሉት ጥቅም ባይኖርም
መረጃቸዉ ግን በተጨማሪ ምግብ ላይ ተፅዕኖ ፋጣሪ ጉዳዮች ለማጥናት ይጠቅማል፡፡
የተሳትፎ ክፍያዎች፡
በጥናቱ በመካፈልዎ የሚሰጥ ክፍያ የለም፡፡
ሚስጥር ስለመጠበቅ፤ ለዚህ ጥናት የሚሰበሰብ መረጃ በሚስጥር ይጠበቃል፡፡ የሚሰበሰበዉ
መጠይቅ የእርስዎ ለመሆኑ መለያ አይኖረዉም፡፡ መረጃዉ በዋና ተመራማሪዉ ድብቅ
ፋይል ተደርጎ በቁልፍ የሚቀመጥ በመሆኑ ሌላ ሰዉ ሊያገኘዉ አይችልም፡፡
በጥናቱ ያለመሳተፍ ወይም ራስን ከጥናቱ የማግለል መብት፡
በጥናቱ ላለመሳተፍ ከፈለጉ በዚህ ጥናት ያለመሳተፍ ሙሉ መብት አለዎት፡፡ ከመጠይቁ
ዉስጥ የተዎሰኑ ጥያቄዎችን ወይም በሙሉ አለመመለስ ይችላሉ፡፡
ሊገናኙዋቸዉ የሚችሉ ሰዎች የትኛዉም ዓይነት ጥያቄ ቢኖርዎት ከዚህ ቀጥሎ
የተጠቀሱትን ግለሰቦች ማግኘትና በማንኛዉም ጊዜ መጠየቅ ይችላሉ፡፡
ኤልሳ ጋሸ የሞባይል ስልክ ቁጥር:+251918067425
38
Amharic consent form
በላ/አረማጭሆ
ወርዳ
ውስጥ
በሚገኙ
እድሜያቸው
ከ6-23
ወር
ያሉ
ህጻናት
ላይ
በተጨማሪ ምግብ ላይ ተፅዕኖ ፋጣሪ ጉዳዮች አስመልክቶ የተዘጋጀ መጠይቅ
መግቢያ
ሠላም እንደ ምን አሉ? ስሜ------ እባላለሁ:: ከዚህ የመጣሁት ይህንን ጥናት የሚያካሂደው
ባህርዳር ዩንቨርስቲ ስነምግብ፣ ኬሚካልና ምግብ ምርምር ተማሪ የሆኑት የኤልሳ ጋሸ
የጥናት ቡድን አባል ሆኜ ነው:: ከዚህ በመቀጠል ዕድሜቸው ከ6-23
ወር ያሉ ህጻናት
ላይ በተጨማሪ ምግብ ላይ ተፅዕኖ ፋጣሪ ጉዳዮች ሌሎች ተያያዥ ጉዳዮች በተመለከተ
የተወሰኑ
ጥያቄወችን
ሁኔታ(ችግር)
ማካሄድ
ከማሳየቱ
ነዉ
በተጨማሪ
የዚህ
ችግሩን
ምርምር
ውጤት
ለመፍታት
ያለውን
ትልቅ
ዕገዛ
የአመጋገብ
ይኖረዋል::
ለምጠይቀወት ጥያቄዎች የዕርስዎ ትክክለኛ መልስ በጣም አስፈላጊ ነው:: በጥያቄዎች
ዙሪያ ጥርጣሬ ካደረብዎት ጠያቂውን እንደገና መጠየቅ ይችላሉ:: ከእርስዎ የምናገኘውን
ማንኛውንም መልስ በሚስጥር እንጠብቃለን ከዚህ ጥናት ጋር በተያያዘ በማንኛውም ቦታ
እና ጊዜ ስምዎ እንዳይ መዘገብና እንደማይጠቀስ ልንገልፅልዎ እንወዳለን::
ለጥናቱ
የምናሳትፍዎ
የእርስዎ
ሙሉ
ፈቃደኝነት
ስናገኝ
ብቻ
ነው፡፡
በመጠይቁ
ያለመሳተፍ ወይም በመጠየቁ ሂደት ሊመልሱት የማይፈልጉትን ጥያቄ ያለመመለስ
መብትዎ የተጠበቀ ነው፡፡ መጠይቅ ከ25 ደቂቃ በላይ አይፈጅም፡፡
በመጠይቁ ለመሳፍ ፈቃደኛ ነዎት?
1. አዎ ፈቃደኛ ነኝ መጠይቁ ይቀጥል
2.የለም ፈቃደኛ አይደለሁም በማመስገን ወደ ሌላ ተሳታፊ መሻገር
39
Annex 4Amharic’s version questioner
የመረጃ ሰብሳቢ ስም……………… ፊርማ ……መጠይቁ የተሞላበት ቀን ……………
ኮድ………….ቀበሌ ……………………
የተቆጣጣሪው ስም…………………………………ፊርማ…………………
ትዕዛዝ ከተሰጠው አማራጭ አግባብት ያለውን ይክበቡ፡፡ ወይም ክፍት ቦታው ላይ
የሚያገኙትን ምላሽ ይሙሉ፡፡
ክፍል 1፡- መሰረታዊና ማህበረዊ ኤኮኖሜ ጉዳዩች በተመለከተ ለህጻኑ እናት
የተዘጋጀ ጥያቄ
ተ.ቁ
ጥያቄ
ምላሺ
እ ለፍ ስያሜ
ቁ
ድሜዎት ስንተ አመት ነው?
-------------አመት
101
102 የሚከተሉት ሃይማኖት ምንድን 1. ኦርቶዶክስ
ነዉ?
2. ሙስሊም
3. ፕሮቴስታንት
4. ካቶሊክ
5. ሌላካለይጠቀስ-------1 103
1
104
1.
በአሁን ያለዎት የጋብቻ ሁኔታ 2.
እንዴ ነዉ?
3.
4.
5.
ያላገባች
ያገባች
የፈታች
ባሏየሞተባት
ሌላካለይጠቀስ----
እናት ወይም ዐሳዳጊዋ
1. እናት
ከሕፃኑጋር ያላት ዝምድና 2. አያት
3. ሞግዜት
4.4.ሌላካለይጠቀስ
105
የርስዎየትምህርትደረጃ
1.ማንበብናመጻፍየማልችል
2.ማንበብናመጻፍየምችል
3.አንደኛደረጃያጠናቀቁ(1-8)
4.ሁለተኛደረጃያጠናቀቁ(9-12)
5.ሰርትፊከትናከዚህያበላይ
40
106
የባለቤቷ የትምህርት ደረጃ
1.ማንበብናመጻፍ የማይችል
2.ማንበብናመጻፍ የሚችል
3.አንደኛ ደረጃ ያጠናቀቀ(1-8)
4.ሁለተኛ ደረጃ ያጠናቀቀ(9-12)
5.ሰርትፍከትናከዚህያ በላይ
1
107
የርስዎየስራሁኔታ
108
የባለቤትዎ የስራ ሁኔታ
1.ነጋዴ
2.ገበሬ
3.የቤትእመቤት
4.ተማሪ
5.የመንግስት ሰራተኛ
6.የግልሰራ
7. 7.ሌላካለይገለፅ --------1.ነጋዴ
2. ገበሬ
3. የቀንሰራተኛ
4. ተማሪ
5. የመንግስት ሰራተኛ
6. የግልሰራ
7.7. ሌላ ካለይ ገለፅ -------
1
109
የወር ገቢ ብር
(……..) ብር
1
110
የቤተሰብ ብዛት
(…….) በቁጥር
1
111
የሕጻንዎ ጾታ
1.ወንድ2.ሴት
112
የሕጻንዎ እድሜ
ስንት ነው?
(- (-----------)ወር
1
113
ስንት ልጅ አለዎት?
(- (----------)በቁጥር
1
114
ሬዲዮ አለዎት ?
1. አዎ2. የለም
ክ ክፍል2፡- የእናቶችናህጻናት ጤና አገልግሎት የሚዳስስ ጥያቄዎች
ተ.ቁ
ጥያቄ
201
እርጉዝ በነበሩ ጊዜ ቅድመ ወሊድ
ክትትል አድርገው ነብር?
ምላሺ
እ
ስ
ይለፍ ስያሜ
1.አዎ
2.የለም
202 በእርግዝና ወቅት ወደ ጤና ድርጅት (-------------)በቁጥር
በመሄድ ለስንት ጊዜ አድርገዋል?
41
ወደ205
ይለፍ
ቅድመ ወሊድ ክትትል1.አዎ
በሚያደረጉት ጊዜ ስለሕጻናት2.የለም
አመጋገብ የጤና ትምህርት
ተሰጥተው ያውቃል?
203
204
ያ
የ
205
2
ምን ዓይነት የጤና ትምህርት ነው 1.ለመጀመሪየ 6 ወራት
ያገኙት?
የ የእናትጡትብቻ መስጠ
2.ስለህጻናትተጨማሪ
ምግቦች
3. 3.ሕጻናት ተጨማሪ
ምግብ የሚጅመሩበት ጊዜ
4.ሌላካለይጠቀስ ----የት ነው የወለዱት ?
ሕ
206
ሕጻኑን ማን ነው ያወለደው?
2
ህ
207 ሕጻኑ ስንተኛ ልጆዎ ነው ?
2
208
2
209
1.ቤትውስጥ
2.ሆስፒታል
3. ጤናጣቢያ
4.ጤናኬላ
5.የግልክልኒክ
6 6.ሌላ ካለ ይጠቀስ--1. ዶክተር
2. ነርስ
3. የጤናኤክስተሸን ሰራተኛ
4. 4.የሰለጠነ የልምድ ዋላጅ
5.ያልስለጠነ የልምድ አዋላጅ
6. ዘመድ፣ጓደኛናጎረቤት
7. 4.ሌላ-----------( (--------------)በቁጥር
በሕጻኑና በትልቁ መካከል ያለው(- (---------------)በቁጥር
የእድሜ ልዩነት ስንት ነው?
ከድህረ ወለድ በኃላ ተጎብኝተው1.
ያውቃሉ?
2.
1.አዎ
2. የለም
210 ከጥያቀዬ 209 መልስዎ አዎ ከሆነ፡1. 1.አዎ
ደህረ ወለድ ክትትል በሚያደርጉበት
2. 2.የለም
ወቅት ስለህጻናት አመጋገብ
ትምህርት ተሰጥቶዎት ያውቃል?
42
2
211
1. ጤናድርጅት
ከጥያቀዬ 210 መልስዎ አዎ ከሆነ 2.የህብረተሰብውስጥ
:የት ነበር ያገኙት?
3. ከዘመድ
4. 4. ከሬድዮወይምተለቭዥን
2
ከ
212
1.የጤናኤክስቴንሽሠራተኛ
2.ፈቃደኛየህብረተሰብጤና
ሰራተኞች
3.የሰለጠነችልምድአዋላጅ
4. ከዘመድ
ከጥያቀዬ 210 መልስዎ አዎ
ከ ማንነበር ያገኙት?
ክፍል፡-3 የህጸናት አመጋገብ ልምድ የሚዳስስ ጥያቄዎች
ተ.ቁ ጥ ጥያቄ
ምላሽ
3
ል ልጁን ጡት አጥብተው ያውቃሉ?
301
1. 1.አዎ 2. የለም
3
አ አሁንም ታጠቢያለሽ?
302
1. 1.አዎ 2. የለም
303ል ልጁ ለስንት ወር ነው የእናት
የጡት ወተት ብቻ ያጠቡት ?
(------------) በወር
ለ ለልጁ ተጨማሪ ምግብ
ጀምረዋል?
304
3
1.አዎ
2.የለም
305 መልስዎ አዎ ከሆነ ተጨማሬ ምግብ
ወይም መጠጥ መስጠት
(---------------) በወር
በ ጀመሩበት ጊዜ ዕድሜው ስንት
ነበር በወራት ይገለጽ?
ለምን ተጨማሪ ምግብ ጀመሩ ? 1. ትክክለኛዕድሜ ስለሆነ
306
2. ወደ ስራ ስለምመለስ
ብጫ
3.ሌላ ይጠቀስ
307
እእለፍስ
ስያሜ
ለመጀመሪያ ጊዜ የሰጡት
1.አጥሜት
ተጨማሪ ምግብ ምንድ ነው? 2. ገንፎ
3. የላምወተት
4. የዱቄትወተት
5. 5. ሌላይገለጽ
43
3
309
3 308
3 309
ብዙውን ጊዜ ልጇን
ለመመግብ ምን ትጠቀሚያለሽ?
ለልጅዎ ባለፈው 24 ስአት ውስጥ
ስንት አይነትተ ጨማሪ ምግብ
ተመገበ?
1.
2.
3.
4.
1. ማንኪያ
2. ኩባያ
3. ስኒ
4. ማጉረስ
5. መጋት
6. ጡጦ
7.ሳህን
8. 8.ሌላይገለጽ----
ከትላንትና ንጋት እሰከ ዛሬ
ንጋት ድረስ ዕጻኑ የምግብ
አይነት ዝርዝሮችን በማንበብ
ቢያንስ
አንዱን
ከተመገበ
በሳጥኑ ዉስጥ 1 ን ያስቀምቱ
ካልተመገበ
ደግሞ
2ን
ያስቀምቱ
አዎ
ከጤፍየተዘጋጀ
ማንኛውም
ምግብ(እንጀራ፣ቂጣ,
ገንፎ)ማንኛውምአይነት ጥራጥሬ፣ ዳቦ, ፓስታ, ሩዝ,
ብስኩት, ኩኪስ ወይም ከአጃ የተሰራ ደረቅ ምግብ, በቆሎ,
ገብስ,
ስንዴ,
ማሽላ,
ዳጉሳ,
ሌሎች
ጥራጥሬዎች?ማንኛውም አይነት ድንች, ሌሎች ስራስሮች
አይብ፤ እርጎ፤ ወተትና ሌሎች የወተት ተዋፆዎች፣
ሴርፋም፣ ፋፋእና ሌሎች የህፃናት የታሸጉ ምግቦች
ካሮት,
ጭማቂ,
በውጩ
ቢጫ/ብርቱካናማ
ቀለም
ያለውስኳርድንች ደማቅ አረንጓዴ ተክሎች, ቅጠላማ
አትክልቶች, የበሰለማንጎ, የበሰለፓፓያ
ከባቄላ የተዘጋጀ ምግብ, አተር, ምስርወይምሉሎች
ከዘይትየተሰሩ ምግቦች, ስብ, ቅቤ?ኦቾሎኒ, ሰሊጥ/ሱፍ?
ሌሎች ፍራፍሬዎች ወይም አትክልቶች
ጉበት, ኩላሊት, ልብና ሌሎች የውስጥ አካሎች የበሬ
ሥጋ, የበግ, የፍየል ሥጋ, የዶሮ, ማንኛውም አይነት የአሳ
ሥጋ
ማንኛውምአይነትእንቁላል
44
የለም
3 310
311
ልጅዎ ባልፈው 24 ስአት
1.አንድጊዜ
ውስጥ ስንት ጊዜ ተጨማሪ ምግብ 2. 2.ሁለትጊዜ
ተመገበ?
3. 3.ሦስትጊዜ
4.አራትጊዜ
5.አምስትጊዜናበላይ
ለጥያቄ 302 መልስዎ የለም
ከሆነ ለልጅዎ ተጨማሬ
ምግብ ሳይጀምሩ የቆዩበት
ምክንያት አለዎት?
1.ለህፃናት ተጨማሪ ምግብ መቸ
መጀመር እንዳለበት አላውቅም
2.የጡት ወተት ብቻይበቃዋል
ብየ ስለማምን ነው
3. ሌሎች ሰወች በዚህ እድሜው
ተጨማር ምግብ እዳትሰጭው
ስላሉኝ ነው
4.ምግብ ብሰጠው አይፈጭለትም
ብየ ስላሰብኩት ነው
5.ሌላ ካለ ይገለፅ …………
ክፍል4፡- ስለሕጻናት አመጋገብ እውቀት የሚጠይቁ ጥያቄዎች
ተ.ቁ
ጥያቄ
ምላሺ
401
ህጻናት ከስንት ወር በኋላ ነው ተጨማሪ ምግብ
የሚያስፈልጋቸው?
እልፍ ስያሜ
(---------)በወር
402 ከስድስት ወር በኃላ ተጨማሪ ምግብ ከእናት ጡት 1. አዎ
ጋር ለህጻናት ጤንነትናእድገት ይጠቅማል?
2. የለም
3.አላዉቅም
403
ከስድስት ወር በኃላ አንድ ሕፃን በአንድ ቀን
ውስጥ ስንት ጊዜ ተጨማሪ ምግብ ይመገባል?
404
ከስድስት ወር በኃላ አንድ ሕፃን በአንድ ቀን
ውስጥ ቢያንስ ስንት ምግብ አይነቶችይመገባል?
(---------)በቁጥር
405
ሕፃን ለመመገብ ጡጦ መጠቀም አሰፈላግ ነው?
1.አዎ
2.የለም
3.አላዉቅም
ስላደረጉልን ትብብር እና መሰግናለን!!
45
(--------)በቁጥር