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Journal of Nutrition & Food Sciences DOI: 10.4172/2155-9600.1000314

ciences
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ISSN: 2155-9600

Research Article Open Access

Early Initiation of Complementary Feeding and Associated Factors among

6 Months to 2 Years Young Children, in Kamba Woreda, South West
Ethiopia: A Community –Based Cross - Sectional Study
Eskezyiaw Agedew1*, Meaza Demissie2, Direslgne Misker1 and Desta Haftu1
Arba Minch University, Department of Public Health, Arba Minch Ethiopia
1

Professor, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia

2

Abstract
Background: Inadequate and inappropriate complementary feeding are major factors contributing to excess
morbidity and mortality in young children in low resource settings. The early introduction of complementary feeds
before the age of six months can lead to displacement of breast milk and increased risk of infections such as
diarrhea, which further contributes to weight loss and malnutrition. Therefore the objective of this study is to assess
early initiation of Complementary feeding and associated factors, in Kamba Woreda, South West Ethiopia.
Methods: a community based cross sectional study was conducted in Kamba woreda, Gamo Gofa Zone, South
West Ethiopia. The study was conducted on 562 mothers who have young child from 6 months to 2 years from
December 2013 to January 2014 by using pre tested structured questioners. Univariate, bivariate and multivariate
analysis was conducted by SPSS version 20.
Results: From all respondents 59.6% started complementary feeding before six months. Age of mothers those
who are in age group ≥30, AOR 2.60(1.07 - 6.35) years, Education level those who have no formal education AOR
2.76(1.63 - 4.69), occupational of mothers those who work as daily worker AOR 3.06(1.03 - 9.12)and Private work
activity(merchant, farmers) AOR 2.39(1.61-3.53), Mothers who have no post natal follow up for their child in Health
service AOR( 1.64(1.05 - 2.55) were significantly associated factors for early initiation of complementary feeding in
the study area.
Conclusion and Recommendation: - A relatively high proportion of mothers start early complementary feeding,
despite what is recommended in the national and global infant and young child feeding guidelines. Maternal age,
educational statues ,occupational statues, mothers who has no PNC, and mothers who encountered medical illness
at post natal period were significant predictors for early initiation of complementary feeding.

Keywords: Early initiation; Complementary feeding; Kamba woreda revealed that the prevalence of early initiation of complementary
feeding was 37.2%, 42.9% and 28.7% respectively [8-10]. Due to the high
Background prevalence of inappropriate child feeding practices and the importance
of exclusive breastfeeding, the Ethiopian government developed the
The period of complementary feeding refers to the stage of life
Infant and Young Child Feeding (IYCF) guideline in 2004 [11,12].
when foods and/or liquid milks are feed to infants and young children
Varying levels of interventions, giving due emphasis to key messages
in addition to breast milk; non-breast-milk food items consumed at this
on complementary feeding, were being given both at health institution
time are defined as complementary foods [1]. Complementary foods
and community level to meet the Millennium Development Goals’
may be either prepared specially for the young child, both to meet age-
(MDGs). These efforts were not based on organized evidence on the
related nutritional needs and to mitigate immaturity in chewing and
level of existing practices, which might be due to lack of studies which
swallowing, or they may be selected from the same foods consumed by
explored the factors predicting the high prevalence of early initiation
the remainder of the family. The complementary feeding should not be
of complementary feeding [7]. There are conflicting findings with
hyper-caloric, in order to prevent obesity in adulthood [2]. The target
regards to the consistency of the associations and the magnitude of the
age range for complementary feeding is generally taken to be 6 to 2 effects, suggesting that the context may be important when trying to
Years of age, even though breastfeeding may continue beyond two years isolate factors and practices that may be amenable to interventions [13].
[3-5].
Poor breastfeeding and complementary feeding practices have
been widely documented in the developing countries. Only about 39% *Corresponding author: Eskezyiaw Agedew, Arba Minch University,
of infants in the developing countries, 25% in Africa are exclusively Department of Public Health, Arba Minch Ethiopia, Tel: +251-46881-4986;
E-mail: [email protected]
breastfed for the first six months. Additionally, 6% of infants in
developing countries are never breastfed [6]. Received August 15, 2014; Accepted September 28, 2014; Published September
30, 2014
The early introduction of complementary feeds before the age of Citation: Agedew E, Demissie M, Misker D, Haftu D (2014) Early Initiation of
six months can lead to displacement of breast milk and increased risk Complementary Feeding and Associated Factors among 6 Months to 2 Years
of infections such as diarrhea, which further contributes to weight loss Young Children, in Kamba Woreda, South West Ethiopia: A Community –Based
Cross - Sectional Study. J Nutr Food Sci 4: 314. doi: 10.4172/2155-9600.1000314
and malnutrition [5,6]. According to Ethiopian Demographic Health
survey (EDHS) 2011, early initiation of complementary feeding in Copyright: © 2014 Agedew E, et al. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits
Ethiopia at the 6th month was only 49% [7]; recent study in Northern
unrestricted use, distribution, and reproduction in any medium, provided the
Ethiopia, Oromia Regional state Jima Arejo area and Goba district original author and source are credited.

J Nutr Food Sci, an open access journal

ISSN: 2155-9600 Volume 4 • Issue 6 • 1000314
Citation: Agedew E, Demissie M, Misker D, Haftu D (2014) Early Initiation of Complementary Feeding and Associated Factors among 6 Months to 2
Years Young Children, in Kamba Woreda, South West Ethiopia: A Community –Based Cross - Sectional Study. J Nutr Food Sci 4: 314. doi:
10.4172/2155-9600.1000314

Page 2 of 6

Therefore this study will be undertaken to determine prevalence and one child in age 6 months-2 years from each household by direct
identify key determinant of early initiation of complementary feeding interviewing. Those who have more than one child in age range of 6
in young children from 6 months up 2 years old. months to 2 years one child was selected randomly by lottery methods.
A pre-tested structured questionnaire adapted from different literature
Methods and Materials was used to collect data. First the questioners was prepared in English
Study area, period and design and translated to Amharic which is the local language and pre tested
on 24 mothers before actual data collection outside the selected Keble;
This study was conducted in Kamba Woreda, one of the correction and modification was done based on the gap identified
administrative Woreda in Gamo Gofa Zone; South West Ethiopia. It is during interview. Sixteen Grade 12 completed female students were
located at 605 km away from Addis Ababa the capital city of Ethiopia and recruited as data collectors and supervised by 4 Clinical Nurse. Two
100 kms away from Zonal town Arba Minch. From the total population days intensive training was given on the aim of the research, content
around 44,000 are women in reproductive age group. The study was of the questionnaire, and how to conduct interview for data collectors
conducted from December 2013 to January 2014. A community based and supervisor to increase their performance in field activities. The
cross sectional study was conducted on mothers who have Child in age Collected data was checked every day by supervisors and principal
group from 6 month up to 2 years old who lives in Kamba Woreda. investigator for its completeness and consistency.
Source and study population Data analysis and handling
All Children in age group from 6 month up to 2 years old who Data was coded and entered in to Epi info version 3.5.1 and
lives in Kamba Woreda were source population and those who live in exported to SPSS Version 20 for analysis. Descriptive Frequencies
randomly selected Kebles for at least 6 months were included in the was conducted to describe the study population in relation to relevant
study. variables. Bivariate logistic regression analysis was calculated to assess
the crude association between dependent and independent variables.
Sampling and sample size determination Finally Variables which shows association in Bivariat logistic regression
The sample size was calculated using single population proportion and P-value less than 0.2 entered in to Multivariate logistic regression
formula by considering the following assumption the proportion of model, to identify key significant factors associated with outcome
mothers who initiate complementary feeding early to their child to variables. The collected data keep in the form of file in secure place
be 42.9% [9], 95% Confidence level, 5% marginal error, and 5% none where no one don’t access it except the investigator, confidentiality was
response rate and 1.5 design effect, the sample size became 467 mothers insured by avoiding recording names or any personal identifiers.
with their child.
Study variables
Sampling techniques Dependent variables:
From 39 Keble in the woreda eight Keble was selected by using
 Early initiation complementary feeding.
lottery method. Then the number of study participant was allocated
for each Keble based on proportional to population size allocation Independent variables:
methods by using community based demographic and Health related
ociodemographic (age,sex,residence,occupationalstatuse,educa-

information registration prepared by Health Extension workers as
tional,income,religion)
a sampling frame. Rapid census was conducted first to identify the
target House hold. Finally infant-mother pairs were selected from  Mothers obstetric (reproductive) History (number live birth,
each Keble by using systematic sampling technique after giving code birth interval and family planning utilization )
for each House Hold Which has young child from six months to 24
 Mothers Health service utilization History (ANC, PNC, Place
months (Figure 1).
of delivery
Data collection instrument, procedure and quality control  Media exposure, influence of others, wrong perception about
Data was collected from Mothers/cares giver who has at least sufficiency of breast milk)

Kameba woreda
(39 kebeles)
SRS (Simple random sampling)

Kemba Lae Gata fudele Mero Shamla Dembedolo Dembedolo

Dembe 01 shalle
sero 301 247 323 223 178 203
225
267

PPs

77 11 87 71 93
64 51 65 59

Systematic sampling methods

.
567

Figure 1: Simple random sampling.

J Nutr Food Sci, an open access journal

ISSN: 2155-9600 Volume 4 • Issue 6 • 1000314
Citation: Agedew E, Demissie M, Misker D, Haftu D (2014) Early Initiation of Complementary Feeding and Associated Factors among 6 Months to 2
Years Young Children, in Kamba Woreda, South West Ethiopia: A Community –Based Cross - Sectional Study. J Nutr Food Sci 4: 314. doi:
10.4172/2155-9600.1000314

Page 3 of 6

Operational definition: Variables Frequency Percent (%)

 Complementary feeding: is the period (between 6-2 years) du- Age of child

ring which foods or liquids are provided along with continued 6-8 months 125 22.2
breastfeeding [1,6] 9-12 months 172 30.6
13-17 months 119 21.2
 Early initiation of complementary feeding-it is incitation of 18-24 months 146 26
complementary feeding before six months [1,8]. Sex of child    
 Timely initiation complementary feeding-it is time of inci- Male 273 48.6
tation of additional supplementary food for young child at six Female 289 51.4
months [1,8]. Residence of mother
   
Rural
Ethical considerations Urban 205 36.5

Ethical clearance was obtained from Addis continental institute of Age of mother    

Public Health Research ethics review committee. Permission letter was 15-19 88 15.7
obtained from Areba Minch University Post graduate Public Health 20-24 151 26.9
coordination office and kameba Woreda Health office. Verbal informed 25-29 271 48.2
consent was obtained from each study participant after proper >=30 52 9.3
explanation about the purpose of the study. All the study participants Religion statues    
were reassured that they would be anonymous. Names or any personal Orthodox 197 35.1
identifiers were not recorded. They were given the chance to ask Protestant 348 61.9
anything about the study and made free to refuse or stop the interview Muslim 17 3
at any moment they want. Education    
No education 173 30.8
Results Primary Education 202 35.9
Socio-demographic characteristics of the mothers and young Secondary & above 187 33.3
child Occupational statues    
Daily laborer 20 3.6
A total of 562 women having young child aged 6 months to 2 years
Private business 259 46.1
were interviewed in the study from 567 sampled mothers with 99.11%
Government 27 4.8
response rate. The overall mean age of young child 13.82 months ± 5.85
Housewife 256 45.6
(SD), 53% were in age range from 6 months to 1 years and 273(48.6%)
Monthly Income    
were male and 289(51.4%) were female half of them were farmers and
≤500 birr/month 475 84.5
daily workers in there occupational statues (Table 1)
≥501 birr/month 87 15.5
Prevalence of Early Initiation of Complementary feeding Table 1: Socio-demographic Characteristics of mothers, who had infant aged from
6 months to 2 year, who live in Kameba Woreda, from December 2013 to January
From 562 interviewed mothers 59.6% CL (59.56 - 59.64) start 2014.
complementary feeding early before sex months and 228(40.6%) CL
(40.36 - 40.44) started complementary feeding at six months. Reasons
of respondent who start early complementary feeding were perception
of mother’s towards breast milk is not sufficient to satisfy the Childs
water demand, working outside home and lack of information about
the real time of initiation of complementary feeding were the major
reasons(Figure 2 and Table 2).

Discussion
In this study, the prevalence of early initiation of complementary
Figure 2: Reasons of mother’s early initiation of complementary feeding before
feeding was 59.6% CL (59.56 - 59.64) which is higher than research six months, among mothers who have 6-2 year’s young child in Kameba
findings in Sri Lanka 15% [12], Ethiopia (National prevalence 49%) Woreda, from December 2013 to January 2014.
[7], North Ethiopia Mekelle town (37.2%), Oromia Region Jima Arejo
(42.9%), Goba District (28.7%) [8,10,14] and relatively similar to West
Bengal India (55.1%) [15]. This relatively higher prevalence of early
initiation of complementary feeding can be explained the present study
was conducted in area where one forth mothers (26.6%) involved in
outside work activity and stay long time away from home for work
purpose. These enforce mothers to give fluid based liquid including
water and others semi-solid locally prepared food before six months due
to fear of breast milk alone is not sufficient to satisfied water demand
of the child due to lack of time to feed breast frequently [10,16,17].
Figure 3: Time of initiation of complementary feeding mothers who have 6-2
Wide variations in the prevalence of early incitation of complementary year’s young child in Kameba Woreda, from December 2013 to January 2014.
feeding have been observed and direct comparisons is difficult because

J Nutr Food Sci, an open access journal

ISSN: 2155-9600 Volume 4 • Issue 6 • 1000314
Citation: Agedew E, Demissie M, Misker D, Haftu D (2014) Early Initiation of Complementary Feeding and Associated Factors among 6 Months to 2
Years Young Children, in Kamba Woreda, South West Ethiopia: A Community –Based Cross - Sectional Study. J Nutr Food Sci 4: 314. doi:
10.4172/2155-9600.1000314

Page 4 of 6

Complementary feeding Complementary feeding Crude OR Adjusted OR

Explanatory Variable P-value
initiation time initiation time (95% CI) (95% CI)
<6 mo(1) 6 mo(0)
Residence          
Rural 147(44) 58(25.4) 2.30(1.59-3.33) 1.34(0.82-2.19) 0.24
Urban 187(56) 170(74.6) 1 1  
Age
≤ 19 39(11.7) 49(21.5) 1 1
20-24 66(19.8) 85(37.3) 1.03(0.60-1.74) 1.15(0.647-2.08) 0.62
25-30 108(32.3) 163(71.5) 1.20(0.74-1.95) 0.97(0.54-1.75) 0.924
≥ 31 15(36.2) 37(130.3) 1.96(0.94-4.09) **2.60(1.07-6.35) 0.035
Education level
No formal Education 126(37.7) 47(20.6) 3.08(1.98-4.79 **2.76(1.63-4.69) 0.001
Primary education 121(36.2) 81(35.5) 1.72(1.15-2.57) 1.42(0.89-2.25)
Secondary & above 87(26.1) 100(43.9) 1 1  
Occupational statues
Daily laborer 15(4.5) 5(2.2) 3.55(1.40-9.09) 0.41(0.28-0.59) **3.06(1.03-9.12) 0.045
Private(merchant, farmers,) 184(55) 75(32.9) 0.34(0.12-0.96) **2.39(1.61-3.53) 0.001
Government worker 6(1.8) 129(38.7) 21(9.2) 1 0.44(0.16-1.18) 0.103
Housewife   127(55.7)   1  
Media Exposure
Yes 158(47.3) 144(63.2) 1
No 176(57.7) 84(67.8) 1.91(1.35-2.69) 0.86(0.53-1.39) 0.54
Place of delivery
1.41(0.89-2.24)
Home 125(37.4) 74(32..4) 1.25(0.87-1.78) 0.14
1
Health facility 209(62.6) 154(67.6) 1
ANC follow up
Yes 288(86.2) 208(91.2) 1 1
No 46(13.8) 20(8.8) 1.66(0.95-2.89) 0.82(0.44-1.57) 0.55
PNC follow up
Yes 70(20.9) 83(36.4) 1
No 264(79.1) 145(63.6) 2.16(1.48-3.2) **1.64(1.05-2.55) 0.029
maternal illness
Yes 167(55.9) 95(41.7) 1.40(0.99-1.96) **1.56(1.05-2.32) 0.027
No 167(44.1) 133(58.3) 1

**Significant factor
Table 2: Factors associated with early initiation of complementary feeding before six months, among mothers who have 6-2 year’s young child in Kameba Woreda, from
December 2013 to January 2014.

of differences in methodologies like sampling, data collection methods complementary feeding timely, and empowers them to involved in
and setting, nature of study population, timing of the study, and related better economic statues than there counterpart. In addition education
environmental and socioeconomic factors. empowers them to resist external interferences and pressures from
traditional belief and misconception.
Mothers in age group ≥30 years 2.6(1.07 - 6.35) times start early
inanition of complementary feeding as compared to others age groups Mothers who work as daily workers, farmers, merchant and
this is consistent with study conducted in oromia region Jimma Arejo Government employed were more likely early initiate complementary
[9]. This is due to the fact that this age group was influenced by different feeding as compared to House wife it is supported with others
traditional and cultural misconception. Like in many other developing research[8-10,18]. The possible explanation for this association is
countries; most mothers provided their children water because they majority (98.22%) respondent has no breast milk expression feeding
believe that the breast milk was insufficient; breast milk seen primarily practice to feed their child at home when they move away from home
as food and water is required to satisfy the needs of the child [7,10]. for work purpose, in addition they believe the child is exposed with
Mothers who have no formal education early initiate complementary hunger and water thrust due to lack of time to breast feed frequently. So
feeding 2.76 (1.63-4.69) times as compared to with mothers who have that they start to initiate early feeding of their child solid and semi-solid
higher education. This finding is supported by other finding [4,8,9,18], food; but House wife mothers are more likely start complementary
this is due the fact that improved maternal education enhances mothers feeding timely since they stay in home with their child and have
knowledge, attitudes and practice towards benefits of introducing sufficient time for frequent breast feeding.

J Nutr Food Sci, an open access journal

ISSN: 2155-9600 Volume 4 • Issue 6 • 1000314
Citation: Agedew E, Demissie M, Misker D, Haftu D (2014) Early Initiation of Complementary Feeding and Associated Factors among 6 Months to 2
Years Young Children, in Kamba Woreda, South West Ethiopia: A Community –Based Cross - Sectional Study. J Nutr Food Sci 4: 314. doi:
10.4172/2155-9600.1000314

Page 5 of 6

Mothers who have No post natal, child growth monitoring follow design to understand deeply socio-cultural and behavioral
up in Health institution were start early complementary feeding as related factors towards complementary feeding to develop and
compared to mothers who have follow up. These finding is supported implement better strategy to improve complementary feeding.
by others studies [19-21]. This is explained Mothers who get advice Acknowledgements
and Health education on complementary feeding during Post natal
and growth monitoring has favorable impact on the promotion of We would like to Arba Minch University for financial and material support to
conduct this research. We are also greatly indebted to thank all respondents for
timely initiation of complementary feeding. But Antenatal follow their willing to participate in the study and our colleagues Befekadu tariku and
up and place of delivery has no significant association with timely Shekur Mohemed for their relevant materials, valuable comments and thoughtful
initiation complementary feeding practice in these study these finding suggestions.
is inconsistent with others study [8,19-21]. These may be Health Authors’ Contributions
professional advice and counsel mothers mainly on danger sign of
EA: Initiated the research, wrote the research proposal, conducted the
pregnancy and birth preparedness rather than on timely initiation of research, did data entry and analysis and wrote the manuscript. MD: Involved in
complementary feed during ANC visit. the write up of the proposal, write up of the manuscript. DM contributed in the
designing of methods, write up, DH contributed in the designing of methods, write
Conclusions up and analysis.

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Citation: Agedew E, Demissie M, Misker D, Haftu D (2014) Early Initiation of Complementary Feeding and Associated Factors among 6 Months to 2
Years Young Children, in Kamba Woreda, South West Ethiopia: A Community –Based Cross - Sectional Study. J Nutr Food Sci 4: 314. doi:
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