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Exclusive breastfeeding lowers the odds of childhood diarrhea and other medical conditions: evidence from the 2016 Ethiopian demographic and health survey

Abstract

Background

Lack of exclusive breastfeeding during the first 6 months of infant life contributes to childhood morbidity and mortality. This study aimed to investigate the association of exclusive breastfeeding and childhood illnesses in Ethiopia.

Methods

A secondary data analysis was conducted using data from the 2016 Ethiopian Demographic and Health Survey (EDHS). Descriptive and multivariable logistic regression analyses were carried out.

Results

A total of 1034 mother-infant pairs were included in the analysis. The overall magnitude of exclusive breastfeeding among infants aged under 6 months was 87.6% (95% CI: 84.3–90.3%). Compared to infants who were non-exclusively breastfed, the odds of having an illness with fever in the last 2 weeks among infants who were exclusively breastfed decreased by 66% (AOR: 0.34; 95% CI: 0.16, 0.75). Similarly, exclusively breastfed infants had lower odds of having an illness with a cough (AOR: 0.38; CI: 0.20, 0.72) and having diarrhea (AOR: 0.33; CI: 0.13, 0.83) compared to non-exclusively breastfed infants.

Conclusion

Exclusive breastfeeding lowers the odds of an illness with fever, illness with cough and diarrhea. The findings of this study implicate the need for promotion of exclusive breastfeeding in the country.

Background

Breast milk provides ideal nutrition to meet the infant’s needs for growth and development. It protects against many infections, and may prevent some infant deaths. Hence, breastfeeding has well established short and long-term benefits in childhood. It reduces morbidity, mortality and the risk of hospitalization from diarrhea and respiratory tract infections [1].

Exclusive breastfeeding is an infant’s consumption of only breast milk in the first 6 months of life. The World Health Organization (WHO) recommend that 95% of children younger than 1 month and 90% of those younger than 6 months should be exclusively breastfed, and 90% of those aged 6–23 months should be partly breastfed. However, in low and middle-income countries, only 37% of children younger than 6 months of age are exclusively breastfed [2]. In Ethiopia, about 77% of infants scored low and medium breastfeeding performance index during the first 5 months of life [3], and only 58% of infants under age 6 months are exclusively breastfed [4].

Breastfeeding provides all the nutrients and water that a baby needs to grow and develop in the first 6 months [5, 6]. Exclusive breastfeeding has well-established short-term and long term benefits, particularly in the reduction of childhood morbidity and mortality due to diarrhea and respiratory infection [7]. Lower breastfeeding index has been associated with increased risks of diarrhea and fever [3]. Furthermore, an estimated 1.3 million lives would be saved worldwide by promoting exclusive breastfeeding [1].

The government of Ethiopia has adapted infant and young child feeding guidelines since 2004 [8] and the national nutrition program in 2013 [9] to unlock the lifesaving potential of optimal breastfeeding practices. The guideline is based on WHO recommendations that give emphasis on exclusive breastfeeding. Furthermore, the health extension program in Ethiopia aims at improving proper infant and young child nutrition, for instance, promotion of exclusive breastfeeding [8].

Nongovernmental organizations are also addressing the issue of exclusive breastfeeding in different regions of the country through advocacy, community mobilization, and mass communication [9]. However, little is known about the impact of different breastfeeding practices on childhood illnesses in Ethiopia. Therefore, this study aimed to investigate the association of exclusive breastfeeding and childhood illnesses in Ethiopia.

Methods

Study setting and design

The 2016 EDHS was designed to provide up-to-date estimates of key demographic and health indicators in Ethiopia. A detailed description of the study design and methodology of the 2016 is found elsewhere [8]. In brief, a stratified two-stage random sampling design was used to collect data from a nationally representative sample. In the first stage, a total of 645 Enumeration Areas (EA) (202 in urban areas and 443 in rural areas) were selected with probability proportional to EA size and with independent selection in each sampling stratum. In the second stage, a fixed number of 28 households per cluster were selected with an equal probability systematic selection from the newly created household listing. A total of 18,008 households were selected, of which 17,067 were occupied and 16,650 were successfully interviewed, thus yielding a household response rate of 98%. In the selected households, the response rate among women age 15–49 was 94.6%. The sampling frame for the current study consisted of 1036 infants last-born infants aged less than 6 months, currently living with their mothers. We excluded women with missing data on the question related to the outcomes of interest, exclusive breastfeeding practices and other covariates adjusted in the multivariable model. The final analytic sample consisted of 1034 participants.

Outcome of interest

The outcome of interest was childhood illnesses. Three childhood illnesses namely: illness with fever, diarrhea and illness with cough were assessed by asking the mother to recall if the infant had any of these illnesses in the last 2 weeks preceding the survey. Each of these variables was dummy coded to reflect the presence or absence of these illnesses. Women who responded “Don’t know” were excluded.

Exposure assessment

Exclusive breastfeeding was defined based on mother’s recall on feeds given to the infant on the previous day. Specifically, mothers were asked whether or not infants received any solid, semi-solid or soft foods 24 h preceding the survey.

Covariates

Based on existing literature, the following covariates were selected: age of mother at infant’s birth, household wealth index, educational level, place of delivery, place of residence, region of residence, antenatal care (ANC checkup), mode of delivery, age of infant, sex of infant, birth order, vaccination status, source of drinking water, wealth index and toilet facility.

Statistical analysis

Data were analyzed using SPSS version 23 (IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp.). Descriptive statistics and cross-tabulation were performed to describe the study variables. Bivariate associations between each covariate and exclusive breastfeeding were first examined using Rao-Scott chi-square test. Univariable and multivariable logistic regression models were employed to determine the association between exclusive breastfeeding and childhood illness. Variance inflation factor (VIF) was used to assess the presence of collinearity. Using a conservative threshold VIF value of 4, no co-linearity was detected. Crude odds ratios (COR) and adjusted odds ratios (AOR) were presented with 95% confidence intervals. Each covariate were included in the multivariable model regardless of their statistical significance in the univariable analysis. In the final multivariable logistic regression model, the association of EBF with childhood illness was declared statistically significant at p value < 0.05. As recommended by the DHS Program, sample weights that account for complex survey design and unequal probabilities of selection were incorporated in all analyses [10].

Ethical issues

The data were downloaded once approval was obtained from Measure DHS. The original DHS data were collected in confirmation with international and national ethical guidelines. The 2016 EDHS protocol was reviewed and approved by the Federal Democratic Republic of Ethiopia Ministry of Science and Technology and the Institutional Review Board of ICF International.

Results

Table 1 displays characteristics of the study sample. Overall, the prevalence of exclusive breastfeeding among infants aged under 6 months was 87.6% (95% CI: 84.3–90.3%). The prevalence of illness with cough in under-6 month infants was 17.9% (95% CI: 14.7–21.7%). About 12% of infants (11.8%; 95% CI: 9.4–14.8%) had illness with fever and 7.4% (95% CI: 5.4–10.1%) had diarrhea in the last 2 weeks. The mean (±SE) age of the mothers and their under six infants were 27.57 (0.31) years and 2.50 (0.08) months respectively. Majority (71.5%) of the mothers were in the age group of 20 to 34 years. About 8 out of 9 mothers (88.7%) were rural residents, and majority of them (59.4%) had no formal education. Women who were in the poorest and poor wealth index were more likely to exclusively breastfeed (Table 1).

Table 1 Characteristics of the study sample by exclusive breastfeeding status in Ethiopia, EDHS 2016 (n = 1034)

Only 8.8% of the households included in this analysis had improved toilet facility and nearly half of the households (54.1%) had improved drinking water source. From those who were non- exclusively breastfed about 87% of them had unimproved toilet facility or had no toilet facility (open defecation) at all. One third of the mothers (31.3%) had attended 4 or more ANC visits. Half of the mothers with non-exclusively breastfed neonates had no ANC visit and three forth of them had delivered at home which was significantly different (p value 0.037) from those mothers with exclusively breastfed neonates. Nearly all of the mothers had vaginal delivery (97%). Majority (73.0%) of the mothers initiated breastfeeding within 1 h of birth and about 7 out of 10 mothers had given anything other than breast milk. About 9 out of 10 (91.4%) under six infants were bottle-fed and there was significant difference (p value < 0.001) in bottle feeding status between exclusively and non-exclusively breastfed neonates (Table 2).

Table 2 Characteristics of mother-infant pairs in Ethiopia, EDHS 2016 (n = 1034)

Table 3 presents results from the univariable and multivariable logistic regression analyses. Exclusive breastfeeding was significantly associated with illness with fever, illness with cough and diarrhea. The odds of developing illness with fever in those infants exclusively breastfed were by 66% (AOR: 0.34 (CI: 0.16, 0.75)) lower than those who did not fed exclusively. Those infants who were exclusively breastfeeding had lower odds of developing cough and diarrhea by 62% (AOR: 0.38 (CI: 0.20, 0.72)) and 67% (AOR: 0.33 (CI: 0.13, 0.83)) respectively as compared to those who did not fed exclusively (Table 3).

Table 3 Association between exclusive breastfeeding and diarrhea, illness with fever and illness with cough among infants aged less than 6 months in Ethiopia, EDHS 2016

Discussion

In the current study, the overall magnitude of exclusive breastfeeding among infants aged less than 6 months was 87.6% and exclusive breastfeeding (EBF) was significantly associated with decreased odds of childhood illnesses. EBF lowered the odds of illness with fever, illness with cough and diarrhea in the last 2 weeks. These associations were independent of potential confounders. Our findings adds to the extant literature by being the first to examine the association between exclusive breastfeeding and childhood illnesses in Ethiopia.

The present study showed that exclusive breastfeeding decreased the odds of illness with fever by 66%. Exclusive breastfeeding is a strong predictor for infant survival in Ethiopia [11]. Evidence from a Scottish birth cohort reported formula-fed infants had increased rate of hospitalization for gastrointestinal and respiratory tract infections and fevers [12]. A randomized controlled trial revealed that not breastfeeding was associated with increased risks for childhood morbidities including fever, and gastroenteritis [13]. Additionally, longer duration of breastfeeding complemented with antimalarial drugs was linked with decreased childhood mortality [14]. Moreover, longer breastfeeding duration decreased the odds of recurrent cough [15]. Discontinuation of breastfeeding when the baby had fever/cold has been reported elsewhere [16]. Inadequate nutritionals requirement in early life can result in reduced protection against infections [17]. Because of the greater total immunoglobulin concentrations [18], longer duration and frequent breastfeeding might have important protective effect for infections.

The current study revealed there was a 62% lower odds of developing cough among exclusively breastfed infants. This finding is consistent with findings from other studies. A longitudinal study conducted in Assam, India revealed low birth weight babies without exclusive breastfeeding were at higher risk for morbidities like acute respiratory tract infections [19]. Similarly, a case-control study in Italy revealed that upper and lower respiratory tract infections were strongly associated with lack of breastfeeding [20]. Indeed, lack of breastfeeding was associated with lower respiratory tract infections in a randomized controlled trial [13]. Exclusive breastfeeding decreased the odds of rhinitis in Amazon islands, Brazil [21]. An ordinal increase in breastfeeding duration was associated with decreased risk of recurrent cough in adult life [22]. Moreover, a cohort study in Vietnam revealed exclusive breastfeeding was associated with decreased odds of admission for pneumonia [23]. Similarly, an eight-country cohort finding showed the protective effect of exclusive breastfeeding against respiratory tract infections [24]. In Indonesia, delayed initiation of breastfeeding was associated with increased risks of cough and difficulty in breathing during the first 6 months of life [25]. On the other hand, breastfeeding was not a protective factor for pertussis among unvaccinated infants in Italy [26]. This might be due to the baseline immune capacity of the infants or the nature of the disease against immunologic content of the breast milk. Stakeholders need to design appropriate interventions to help mothers breastfeed their babies in case of childhood illnesses.

In this study, exclusive breastfeeding decreased the odds of diarrhea by 67%. This finding is in line with a study conducted in rural Nepal, where suboptimal breastfeeding practices were associated with higher odds of childhood diarrhea [27]. Early life diarrheal disease among non-breastfed infants was associated with shorten telomere length in adult immune cells [28]. A cross-sectional study conducted in north Gondar zone and Afar region of Ethiopia reported children without breastfeeding/not-exclusive breastfeeding practices were at higher risk for diarrheal diseases [29, 30]. A Demographic and Health Survey (DHS) analysis in nine Sub-Saharan African countries revealed exclusive breastfeeding was significantly associated with lower risk of diarrhea [31]. A similar study using the DHS of Tanzania reported the protective effect of exclusive breastfeeding against diarrheal diseases [32]. Additionally, a cohort study in eight countries revealed the protective effect of exclusive breastfeeding on episodes of diarrhea [24]. Prenatal anxiety which might be related to less exclusive breastfeeding [33] and myths about discontinuation of breastfeeding during diarrheal episodes in some communities [34] should be discouraged [20]. As mothers are more receptive for skill-based interactive demonstrations targeted to exclusive breastfeeding [35], designing novel strategies tailored to exclusive breastfeeding is needed.

This study is not without limitations. First, the cross-sectional nature of the study precludes drawing conclusions about the influence of exclusive breastfeeding on childhood illnesses. Second, exclusive breastfeeding and childhood illnesses may be prone to self-reported, recall and social desirability biases. Third, although 24-h recall has been widely used to measure infant feeding practices, a recent study in Ethiopia have shown that a single 24-h recall overestimates exclusive breastfeeding practices [36]. Additionally, this study is prone to selection bias, misclassification and residual confounding. The relatively large sample size, availability of detailed data on confounders, and standardized instruments, high-quality data collection are some of the strengths of the current study.

Conclusion

Exclusive breastfeeding was significantly associated with decreased the odds of illness with fever, illness with cough and diarrhea in a representative, sample of Ethiopian infants. This association remained independent of age of mother at infant’s birth, household wealth index, educational level, place of delivery, place of residence, region of residence, antenatal care (ANC checkup), mode of delivery, age of infant, sex of infant, birth order, vaccination status, source of drinking water, wealth index and type of toilet facility. Promoting exclusive breastfeeding throughout the country would have a greater contribution for infant health and development. Hence, in developing countries including Ethiopia, interventions targeting women who had no history of antenatal checkup and home delivery are the most cost effective intervention to strengthen exclusive breastfeeding.

Availability of data and materials

The datasets used for this manuscript are available from the corresponding author upon reasonable request.

Abbreviations

ANC:

Antenatal Care

AOR:

Adjusted Odds ratio

COR:

Crude Odds Ratio

DHS:

Demographic and Health Survey

EA:

Enumeration areas

EBF:

Exclusive Breastfeeding

SE:

Standard error

VIF:

Variance inflation factor

WHO:

World Health Organization

References

  1. Saadeh R, Casanovas C. Implementing and revitalizing the baby-friendly hospital initiative. Food Nutr Bull. 2009;30(2_suppl2):S225–S9.

    Article  PubMed  Google Scholar 

  2. Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475–90. https://doi.org/10.1016/S0140-6736(15)01024-7.

    Article  PubMed  Google Scholar 

  3. Haile D, Biadgilign S. Higher breastfeeding performance index is associated with lower risk of illness in infants under six months in Ethiopia. Int Breastfeed J. 2015;10(1):32. https://doi.org/10.1186/s13006-015-0057-2.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Central Statistical Agency. The DHS Program ICF. Ethiopian Demographic and Health Survey 2016. Addis Ababa and Rockville: CSA and ICF; 2017.

    Google Scholar 

  5. Organization WH, Unicef. Baby-Friendly Hospital Initiative: Revised, updated and expanded for integrated care. 2009.

    Google Scholar 

  6. Aborigo RA, Moyer CA, Rominski S, Adongo P, Williams J, Logonia G, et al. Infant nutrition in the first seven days of life in rural northern Ghana. BMC Pregnancy Childbirth. 2012;12(1):76. https://doi.org/10.1186/1471-2393-12-76.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Horta B, Victora C, Organization WH. Short-term effects of breastfeeding: a systematic review on the benefits of breastfeeding on diarrhoea and pneumonia mortality. Geneva: WHO, apps who int/iris/bitstream/10665/95585/1/9789241506120_eng pdf. 2013; 2013.

    Google Scholar 

  8. Fetene N, Linnander E, Fekadu B, Alemu H, Omer H, Canavan M, et al. The Ethiopian health extension program and variation in health systems performance: what matters? PLoS One. 2016;11(5):e0156438. https://doi.org/10.1371/journal.pone.0156438.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Kim SS, Rawat R, Mwangi EM, Tesfaye R, Abebe Y, Baker J, et al. Exposure to large-scale social and behavior change communication interventions is associated with improvements in infant and young child feeding practices in Ethiopia. PLoS One. 2016;11(10):e0164800. https://doi.org/10.1371/journal.pone.0164800.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Croft NT, AMJ M, Allen CK, et al. Guide to DHS statistics. Rockville: ICF; 2018. p. 2018.

    Google Scholar 

  11. Biks GA, Berhane Y, Worku A, Gete YK. Exclusive breast feeding is the strongest predictor of infant survival in Northwest Ethiopia: a longitudinal study. Journal of health, population, and nutrition. 2015;34:9.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Ajetunmobi OM, Whyte B, Chalmers J, Tappin DM, Wolfson L, Fleming M, et al. Breastfeeding is associated with reduced childhood hospitalization: evidence from a Scottish Birth Cohort (1997–2009). J Pediatr. 2015;166(3):620–5.e4.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bork KA, Cournil A, Read JS, Newell ML, Cames C, Meda N, et al. Morbidity in relation to feeding mode in African HIV-exposed, uninfected infants during the first 6 mo of life: the Kesho bora study. Am J Clin Nutr. 2014;100(6):1559–68. https://doi.org/10.3945/ajcn.113.082149.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. K'Oyugi BO. Effects of bed nets and anti-malaria drugs use on childhood mortality in Kenya's malaria endemic and epidemic areas. BMC Public Health. 2015;15(1):34. https://doi.org/10.1186/s12889-015-1398-x.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Lodge CJ, Dharmage SC. Breastfeeding and perinatal exposure, and the risk of asthma and allergies. Curr Opin Allergy Clin Immunol. 2016;16(3):231–6. https://doi.org/10.1097/ACI.0000000000000266.

    Article  CAS  PubMed  Google Scholar 

  16. Kamath SP, Garg D, Khan MK, Jain A. Perceptions and Practices regarding Breastfeeding among Postnatal Women at a District Tertiary Referral Government Hospital in Southern India, vol. 2016; 2016. p. 5430164.

    Google Scholar 

  17. Karim T, Muhit M, Khandaker G. Interventions to prevent respiratory diseases - nutrition and the developing world. J Obstet Gynaecol India. 2017;22:31–7.

    Google Scholar 

  18. Pedersen SH, Wilkinson AL, Andreasen A, Kinung'hi SM, Urassa M, Michael D, et al. Longitudinal analysis of mature breastmilk and serum immune composition among mixed HIV-status mothers and their infants. Clin Nutr (Edinburgh, Scotland). 2016;35(4):871–9.

    Article  CAS  Google Scholar 

  19. Borah M, Baruah R. Morbidity status of low birth weight babies in rural areas of Assam: a prospective longitudinal study. J Fam Med Prim Care. 2015;4(3):380–3. https://doi.org/10.4103/2249-4863.161326.

    Article  Google Scholar 

  20. Martines F, Salvago P, Ferrara S, Messina G, Mucia M, Plescia F, et al. Factors influencing the development of otitis media among Sicilian children affected by upper respiratory tract infections. Brazil J Otorhinolaryngol. 2016;82(2):215–22. https://doi.org/10.1016/j.bjorl.2015.04.002.

    Article  Google Scholar 

  21. Freitas MS, de Cordoba LF, Monteiro JC, Sole D. Prevalence of rhinitis and associated factors in schoolchildren who live in the Amazon islands. Am J Rhinol Allergy. 2016;30(3):79–82. https://doi.org/10.2500/ajra.2016.30.4293.

    Article  PubMed  Google Scholar 

  22. Gerhart KD, Stern DA, Guerra S, Morgan WJ, Martinez FD, Wright AL. Protective effect of breastfeeding on recurrent cough in adulthood. Thorax. 2018;73(9):833–9. https://doi.org/10.1136/thoraxjnl-2017-210841.

    Article  PubMed  Google Scholar 

  23. Hanieh S, Ha TT, Simpson JA, Thuy TT, Khuong NC, Thoang DD, et al. Exclusive breast feeding in early infancy reduces the risk of inpatient admission for diarrhea and suspected pneumonia in rural Vietnam: a prospective cohort study. BMC Public Health. 2015;15(1):1166. https://doi.org/10.1186/s12889-015-2431-9.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Richard SA, McCormick BJJ, Seidman JC, Rasmussen Z, Kosek MN, Rogawski ET, et al. Relationships among common illness symptoms and the protective effect of breastfeeding in early childhood in MAL-ED: an eight-country cohort study. Am J Trop Med Hygiene. 2018;98(3):904–12. https://doi.org/10.4269/ajtmh.17-0457.

    Article  Google Scholar 

  25. Lee KJ, Bines JE, Watts E, Satria CD, Atthobari J, Nirwati H, et al. Delayed Breastfeeding Initiation Is Associated with Infant Morbidity. BMC Pediatr. 2017;191:57–62.e2.

    Google Scholar 

  26. Pandolfi E, Gesualdo F, Carloni E, Villani A, Midulla F, Carsetti R, et al. Does breastfeeding protect young infants from pertussis? Case-control study and immunologic evaluation. Pediatr Infect Dis J. 2017;36(3):e48–53. https://doi.org/10.1097/INF.0000000000001418.

    Article  PubMed  Google Scholar 

  27. Acharya D, Singh JK, Adhikari M, Gautam S, Pandey P, Dayal V. Association of water handling and child feeding practice with childhood diarrhoea in rural community of southern Nepal. J Infect Public Health. 2018;11(1):69–74. https://doi.org/10.1016/j.jiph.2017.04.007.

    Article  PubMed  Google Scholar 

  28. Eisenberg DTA, Borja JB, Hayes MG, Kuzawa CW. Early life infection, but not breastfeeding, predicts adult blood telomere lengths in the Philippines. Am J Hum Biol. 2017;29(4).

  29. Getachew A, Guadu T, Tadie A, Gizaw Z, Gebrehiwot M, Cherkos DH. Diarrhea prevalence and sociodemographic factors among under-five children in rural areas of North Gondar zone, Northwest Ethiopia, vol. 2018; 2018. p. 6031594.

    Google Scholar 

  30. Gizaw Z, Woldu W, Bitew BD. Child feeding practices and diarrheal disease among children less than two years of age of the nomadic people in Hadaleala District, Afar region, Northeast Ethiopia. Int Breastfeed J. 2017;12(1):24. https://doi.org/10.1186/s13006-017-0115-z.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Ogbo FA, Agho K, Ogeleka P, Woolfenden S, Page A, Eastwood J. Infant feeding practices and diarrhoea in sub-Saharan African countries with high diarrhoea mortality. PLoS One. 2017;12(2):e0171792. https://doi.org/10.1371/journal.pone.0171792.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Ogbo FA, Nguyen H, Naz S, Agho KE, Page A. The association between infant and young child feeding practices and diarrhoea in Tanzanian children. Trop Med Health. 2018;46(1):2. https://doi.org/10.1186/s41182-018-0084-y.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Field T. Prenatal anxiety effects: a review. Infant Behav Develop. 2017;49:120–8. https://doi.org/10.1016/j.infbeh.2017.08.008.

    Article  Google Scholar 

  34. Etokidem AJ, Johnson O. Child survival strategies: assessment of knowledge and practice of rural women of reproductive age in Cross River state, Nigeria. J Trop Med. 2016;2016:5098463.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Greenland K, Chipungu J, Chilekwa J, Chilengi R, Curtis V. Disentangling the effects of a multiple behaviour change intervention for diarrhoea control in Zambia: a theory-based process evaluation. Glob Health. 2017;13(1):78. https://doi.org/10.1186/s12992-017-0302-0.

    Article  Google Scholar 

  36. Fenta EH, Yirgu R, Shikur B, Gebreyesus SH. A single 24 h recall overestimates exclusive breastfeeding practices among infants aged less than six months in rural Ethiopia. Int Breastfeed J. 2017;12(1):36. https://doi.org/10.1186/s13006-017-0126-9.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

The authors are grateful for Woldia University. We also thank Ohio University staff (Haile ZT, Ice G, Johnson L and Lewis M) for the training on complex data analysis.

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Authors and Affiliations

Authors

Contributions

TM, NBY, BA, ML and MLL conceived and design the study. All authors extracted the data. TM, NBY and MLL analyze the data. BA and ML assisted in the data analysis. TM and NBY drafted the manuscript. All authors read and approve the final manuscript.

Corresponding author

Correspondence to Misgan Legesse Liben.

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Ethics approval and consent to participate

The data were downloaded once approval was obtained from Measure DHS. The original DHS data were collected in confirmation with international and national ethical guidelines. The 2016 EDHS protocol was reviewed and approved by the Federal Democratic Republic of Ethiopia Ministry of Science and Technology and the Institutional Review Board of ICF International.

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Not applicable.

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The authors declare that they have no competing interests.

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Mulatu, T., Yimer, N.B., Alemnew, B. et al. Exclusive breastfeeding lowers the odds of childhood diarrhea and other medical conditions: evidence from the 2016 Ethiopian demographic and health survey. Ital J Pediatr 47, 166 (2021). https://doi.org/10.1186/s13052-021-01115-3

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