Feeding patterns and practices during the first year of life are very important because they will influence growth, development, and morbidity. About three quarters (76%) of the studied mothers have initiated BF within the first hour after birth. This result agrees with Egypt Demographic and Health Survey 2014 (EDHS) and Batal in Lebanon who revealed that 79% and 70% of the children subsequently were initiated BF within the first day after delivery [11, 12]. Lower percentages 55.4% and 46.3% were observed in other two studies [13, 14]. This might be due to sociodemographic differences including the relatively high level of parental education in our settings. It might also be explained by the low coverage and utilization of maternal health services; particularly poor postnatal care utilization in the Ethiopian study together with missed opportunities during antenatal care visits.
Our study showed that 81.8% of mothers practiced BF which is consistent with results of two studies; 96% in the EDHS study 2014 [12], and 99.6% in a study done in Ethiopia [13]. EBF practice was present in only 24.1% of our studied mothers, in accordance, Saleh in Bangladesh and Roy in India found nearly similar percentages (23% and 28.3% respectively) [15, 16] indicating the cultural and traditional nature of the phenomenon. But a much lower percentage was observed by EDHS 2014 which revealed that only 12.5% of studied children were being exclusively breastfed [12] this finding may be due to higher percentage of non-working mothers in our study which allows for EBF. Higher percentages (49.7%) were observed by Caetano in Brazil [17]. On other hand, 63.5% of Indian mothers exclusively breastfed their infants till 6 months of age [18]. These differences of results could be due to differences in socio-demographic factors which affecting feeding practice and level of health education and counseling provided to mothers in various countries.
The most common reasons reported by the mothers for the interruption of EBF in our study were as follows: advice from relative, friend, or even a health care provider (50%), deficient knowledge about proper time of CF starting (24%), perceived insufficient milk production (19%), and child’s refusal (3%). Nearly similar results were found by Caetano in Brazil, who stated that the most common causes were insufficient milk production in 17.7% and child’s refusal to be breastfed in 8.4% [17]. Batal and Memon explained that by mothers who did not have enough knowledge about EBF benefits, insufficient breast milk, or sickness of some mothers [11, 19]. About three-quarter (74%) of the reported reasons could be controlled by better health education and counseling to mothers and other family members/friends who would influence the decision of introduction of CF.
Our study showed that the average age of CF introduction was 3.4 months, while the WHO Multicenter Growth Reference revealed the mean age was 5.4 months [20]. In our study, only about 7.1% of the mothers started CF at 6 months of age. Higher results were found in other studies in different countries as Batal et al. in Lebanon (13.4%) [11], Abba et al. in Delhi (16.6%) [21], Khan et al. in a tertiary hospital in India (17.5%) [22], Yohannes et al. in Ethiopia (20.8%) [13], and Saleh et al. in Bangladesh (23%) [15]. In our study, only 13.4% of mothers started CF to their babies at age of 4-6 months, 80.2% before 4 months and 6.4% after 6 months, compared to results of a study in Lebanon revealed that 66% of mothers started CF at age of 4-6 months, 21.9% before 4 months and about 12% after 6 months [11].
In the present study, male infants were 2.4 folds more likely to be exclusively breastfed more than females which is mainly due to gender preference in our community and could be due to physician recommendation as male infants are more susceptible for infectious diseases than females [23]. So, mothers become more careful and do not hasten to introduce CF early to avoid the complications commonly occurring within starting of CF.
The first baby in the family was more likely to be given CF early and about 80% of mothers who introduced CF to their babies early were from rural areas. This may be due to deficient knowledge about timing of complementary feeding starting, low milk production because of poor maternal nutrition and the thoughts and cultural habits of the rural areas. These findings show that illiterate mothers were more likely to early initiate CF compared to highly educated mothers. It agrees with result found in a study in Ethiopia, illiterate mothers were above twofolds more likely to early initiate CF compared to highly educated mothers [13]. On other hand, in Malaysia, educated mothers were 3.5 folds more likely to early initiate CF compared to illiterate mothers [24]. Our results can be explained by the fact that the better educated mothers have good knowledge about the importance of CF practice, might also better understand the message and can use nutrition information resources.
In our study, 94.9% of mothers who gave their infants CF early before the recommended age were not working. Unlikely, in a study applied in Malaysia, working mothers were 3.5 folds more likely to early start CF compared to house wives [24]. A study in Lebanon revealed that employed mothers initiated CF earlier than house wives [11]. It may be explained that most of housewife mothers received lower levels of education and belong to low socioeconomic families, so they started CF early to their babies.
About 56% of mothers started CF with cereals followed by dairy products in 51%, vegetables in 42% then desserts in 38%, and the frequency was the same whatever the time of introduction. Similarly, in a study done in Lebanon, the most common weaning food was cereals in 83.7% [11]. About 80% of studied mothers gave fluids such as water, herbals, and juices to their infants before the 4 months of age, in comparison to Lebanon study, where only 13% of mothers gave liquids before the 4 month of age which reflects the effect of counseling and health education [11].
In our study, about 45.0% of exclusively breastfed infants were physically delayed, while about 33% of non-exclusively breastfed infants were physically delayed. This could be explained by the low vitamin D content in the breast milk unlike milk formula and other specific food types [25, 26]. We found that 25.7% of EBF infants were wasted and 33.6% were stunted, while 30.0% of non-EBF infants were wasted and 17.0% were stunted. This large portion of physically delayed, wasted, and stunted infants may be due to the low socioeconomic level, poor maternal nutrition, and early and faulty introduction of complementary foods.
Regression analysis of our study revealed some of the significant determinants of EBF; early breastfed infants after delivery, male infants, infants that came from urban areas, infants of older mothers group, infants whose mothers were not educated, and infants whose fathers were not working were more likely to be exclusively breastfed than infants of other corresponding groups, respectively.
