ARBA MINCH UNIVERISTY

COLLEGE OF MEDICINE AND HEALTH

SCIENCES
SCHOOL OF PUBLIC HEALTH

KNOWLEDGE AND ATTITUDE TOWARDS BREAST FEEDING AND ITS

ASSOCIATED FACTORS AMONG FATHER WHO HAVE UNDER TWO
YEAR AGE CHILD IN ARBA MINCH DEMOGRAPHIC AND HEALTH
SURVEILLANCE SITE, SOUTHERN ETHIOPIA, 2022

BY: FASIKA MEWZER (BSc)

AUGUST , 2022

ARBA MINCH, ETHIOPIA

ARBA MINCH UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES
 SCHOOL OF PUBLIC HEALTH

KNOWLEDGE AND ATTITUDE TOWARDS BREAST FEEDING AND ITS

ASSOCIATED FACTORS AMONG FATHER WHO HAVE UNDER TWO
YEAR AGE CHILD IN ARBA MINCH DEMOGRAPHIC AND HEALTH
SURVEILLANCE SITE, SOUTHERN ETHIOPIA, 2022

BY: FASIKA MEWZER (BSc in MIDWIFERY)

ADVISORS:

PRNCIPAL ADVISOR:SINTAYEHU ABEBE (MPH/RH, Ass. Professor)

CO-ADVISOR:ESHETU ANDARGE (MPH/RH, Ass. Professor, PhD

candidate)

A THESIS PROPOSAL TO BE SUBMITTED TO THE SCHOOL OF

PUBLIC HEALTH COLLEGE OF MEDICINE AND HEALTH SCIENCES,
ARBA MINCH UNIVERSITY IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE DEGREE OF MASTER OF PUBLIC
HEALTH IN REPRODUCTIVE HEALTH

AUGUST , 2022

ARBAMINCH, ETHIOPIA
APPROVAL SHEET

As thesis advisors, I hereby certify that I have read and evaluated this thesis entitled “knowledge
and attitude towards breast feeding and its associated factors among father who have under two-
year age child in Arba Minch demographic and health surveillance site, southern Ethiopia,
2022’’ Which is prepared by FASIKA MEWZER under my guidance. I recommend that it be
submitted as fulfilling thesis requirements.

SINTAYEHU ABEBE (MPH/RH, ASS.PROF) (main advisor)

Signature: ___________________ Date: _______________

ESHETU ANDARGE (MPH/RH, Ass. Professor, PhD candidate) (co-advisor)

Signature: ____________________ Date: _____________

i
APPROVAL SHEET

As thesis reviewer, I hereby certify that I have read and evaluated this thesis entitled “knowledge
and attitude towards breast feeding and its associated factors among father who have under two-
year age child in Arba Minch demographic and health surveillance site, southern Ethiopia,
2022’’ Which is prepared by FASIKA MEWZER under my guidance. I recommend that it be
submitted as fulfilling thesis requirements.

RIVEWER 1 Signature: ____________ Date: ____________

RIVIEWER 2 Signature: ___________ Date: _____________

ii
 ACKNOWLEDGMENT

First of all, I would like to acknowledge Arba Minch university college of medicine and health
sciences school of public health for giving me a chance to attend my postgraduate degree.

Secondly, I would like to express my warm appreciation and gratitude to my advisor Miss
Sintayehu Abebe (MPH/RH, Ass, Professor) and Mr. Eshetu Andarge (MPH/RH, Ass. Professor,
PhD candidate) for their invaluable comments, suggestions and encouragement in the
development of my thesis. I have special thanks to the study participants, data collectors and
supervisors for their invaluable input to the thesis work.

I would like to thank Gamo zuria Health department, head of zuria health offices and kebele
administrate for their cooperation and assistance in the study.

Finally, I extend my special thanks to my family, intimate friends and staff for their committed
assistance by giving supportive ideas and unreserved encouragement in carrying out this research
work.

iii
 ABBREVIATIONS

AOR Adjusted Odd Ratio

ANC Antenatal care
BF Breast feeding
CI Confidence Interval
COR Crude Odd Ratio
EBF Exclusive breast feeding
EDHS Ethiopian demographic and health survey
HDSS Demographic and health survey
KM Kilometer
LIFAS Iowa Infant Feeding Attitude Scale
LMIC Low- and middle-income countries
PCA Principal Component Analysis
SDGs Sustainable Development Goal
SNNPR Southern Nations Nationalities and Peoples Regional States
SPSS Statistical Package for Social Science
VIF Variable Inflation Factor
WHO World Health Organization

iv
Abstract

Background: Breastfeeding is a process that needs to be learned by mothers and fathers. Fathers
can support their partners by providing exclusive breastfeeding information to motivate and
assist them to breast feed, as well as providing practical support with care of additional children
and housework. Higher levels of paternal support and encouragement are associated with greater
maternal confidence to breast feeding. A fathers un favorable attitude and poor knowledge may
cause the father to be incapable of motivating or encouraging the mother to exclusively
breastfeed.

Objective: To assess the knowledge and attitude towards breastfeeding and its associated factors
among father who have under one year age child in Arba Minch Demographic and Health
Surveillance Site, southern Ethiopia

Methods: A quantitative community based cross-sectional survey was conducted among 422
randomly selected father who have under two year age child in Arba Minch Demographic and
Health Surveillance Site, southern Ethiopia. Data were entered into open data kit and exported
into SPSS version 25.0 for analysis. Bivariable and multivariable logistic regression were used to
identify factors associated with knowledge and attitude towards breast feeding. Adjusted odds
ratios with 95% confidence interval was computed and interpreted accordingly. A p-value <0.05
was considered to declare a result as statistically significant in this study.

Result:fathers who have good knowledge found to be 53.6% [95% CI:(48.84,58.358]

Antenatal care follow up1.809[AOR 95% CI:(1.063,3.079), child morbidity 1.862[AOR 95% CI:
(1.162,2.983)] and delivery 2.253%[AOR 95% CI:(1.437,3.533) were significantily associated
with fathers knowledge towards breast feeding.Fathers who have favorable attitude on breast
feeding found to be 51.2% [95% CI:(46.43,55.969) while 48.8% of participants had unfavorable
attitude.father age 1.815[AOR 95% CI:(1.065,3.093), sex of child 2.444[AOR 95% CI:
(1.518,3.936),household chore 5.663[AOR 95% CI:(3.295,9.733)] and knowledge4.816[95%
CI:(2.914,7.961)]were significantily associated with fathers attitude towards breast feeding.

Conclusion: The level of father’s knowledge and attitude towards breast feeding to be low
compared to the study conducted in Ethiopia. fathers knowledge towards breast feeding is

v
significantily associated with escorted during ANC follow up, escorted during delivery, child
morbidity and attitude and father’s favorable attitude towards breast feeding is associated with
knowledge, father age ,involvement in house hold chore and sex of child. This implied that the
level of knowledge and attitude of the fathers no adequate enough.

TABLE OF CONTENT

Contents Page Number

vi
ACKNOWLEDGMENT................................................................................................................iii

ABBREVIATIONS........................................................................................................................iv

Abstract............................................................................................................................................v

TABLE OF CONTENT................................................................................................................vii

LIST OF TABLES...........................................................................................................................x

LIST OF FIGURES........................................................................................................................xi

1-Introdction....................................................................................................................................1

1.1 Background............................................................................................................................1

1.2 STATEMENT OF THE PROBLEM.....................................................................................3

1.3 Significance of the study........................................................................................................5

2-Litreatures rivew...........................................................................................................................6

2.1 Knowledge of breast feeding among fathers who have under two-year age.........................6

2.2 Attitude of breast feeding among fathers who have under two-year age...............................6

2.3 Factors associated with knowledge and attitude of breast feeding among fathers who have
under two-year age.......................................................................................................................7

2.3.1 Socio demographics characteristics.................................................................................7

2.3.2 Health service-related factors..........................................................................................8

2.3.3 Obstetric and child related factors...................................................................................8

2.3.4 source of information......................................................................................................8

2.4 Conceptual frame work..........................................................................................................9

3. OBJECTIVES............................................................................................................................10

3.1 General objective.................................................................................................................10

3.2 Specific objectives...............................................................................................................10

4. Methodology..............................................................................................................................11

4.1 Study area and period...........................................................................................................11

vii
 4.2 Study design.........................................................................................................................12

4.3 Population............................................................................................................................12

4.3.1 Source population.............................................................................................................12

4.3.2 Study population............................................................................................................12

4.3.3 Study unit......................................................................................................................12

4.4 Eligibility criteria.................................................................................................................12

4.4.1 Inclusion criteria............................................................................................................12

4.4.2 Exclusion criteria...........................................................................................................12

4.5 Sample size determination...................................................................................................13

4.6 Sampling techniques and procedure....................................................................................15

4.7 study variables......................................................................................................................17

4.7.1 Dependent variables......................................................................................................17

4.7.2 Independent variables....................................................................................................17

4.8 Operational definitions.........................................................................................................17

4.9 Data collection tool and procedure......................................................................................18

4.10 Data quality assurance.......................................................................................................19

4.11 Data processing and analysis.............................................................................................19

4.12 Ethical considerations........................................................................................................21

4.13 Dissemination of result......................................................................................................21

5.Results.........................................................................................................................................22

5.1 socio-demographic and economic characteristics of fathers................................................22

5.1.1 distribution of socio demographic , economic characteristics and fathers knowledge

and attitude towards breast feeding........................................................................................22

5.2 distribution of health service-related characteristics and fathers knowledge of breast

feeding who have under two year age child in Arba Minch Demographic and healthservilance
site, southern Ethiopia, 2022......................................................................................................24

viii
 5.3 distribution of obstetric and child health related characteristics and fathers knowledge of
breast feeding who have under two year age child in Arba Minch Demographic and
healthservilance site, southern Ethiopia, 2022...........................................................................25

5.4 distribution of source of information related characterstics and fathers knowledge and
attitude towards breast feeding..................................................................................................27

5.5 prevalance of father’s knowledge and attitude towards breast feeding..............................28

5.6 Factors associated with fathers’ knowledge of breast feeding.............................................29

5.6 Factors associated with fathers’ attitude of breast feeding..................................................31

6. Discussion..................................................................................................................................33

Chapter 7: conclusion and recommendation..................................................................................36

7.1 conclusion............................................................................................................................36

7.2 Recommendation.................................................................................................................36

8- REFERENCES..........................................................................................................................37

9. ANNEX.....................................................................................................................................40

Annex I: Information sheet........................................................................................................40

Annex II: Consent form English version...................................................................................41

Annex III: Questionnaire English version.................................................................................42

Annex IV: Information sheet and consent form of Amharic version........................................48

Annex V: Amharic version questionnaire (በአማርኛ የቀረበ መጠይቅ)..............................................48

LIST OF TABLES

Table 1: Sample size determination for factors associated with knowledge and attitude of breast
feeding among father who have under one two age child in Arba Minch Demographic and Health
Surveillance Site, southern Ethiopia, 2022....................................................................................14

ix
Table 2 : distribution of socio demographic and socio economic characteristics of fathers
knowledge towards breast feeding who have under two year age child in Arba Minch
Demographic and Health Surveillance Site, southern Ethiopia, 2022...........................................23

Table 3:distribution of health service realated characterstics and fathers knowledge and attitude
of breast feeding who have under two year child in Arba Minch Demographic and Health
Surveillance Site, southern Ethiopia, 2022....................................................................................24

Table 4:distribution of obstetrics and child health related characterstics and fathers knowledge
of breast feeding who have under two year child in Arba Minch Demographic and Health
Surveillance Site, southern Ethiopia, 2022....................................................................................26

Table 5: Factors associated with knowledge of breast feeding among fathers who have under
two year child in Arba Minch Demographic and Health Surveillance Site, southern Ethiopia,
2022...............................................................................................................................................30

Table 6: Factors associated with attitude of breast feeding among fathers who have under two
year child in Arba Minch Demographic and Health Surveillance Site, southern Ethiopia, 2022. 32

LIST OF FIGURES

Figure 1: Conceptual frame work knowledge and attitude of breast feeding and the associated
factors among father who have under two-year age child in Arba Minch Demographic and
Health Surveillance Site, southern Ethiopia, 2022..........................................................................9

x
Figure 2: Schematic representation of sampling procedure on breast feeding and the associated
factors among father who have under two-year age child in Arba Minch Demographic and
Health Surveillance Site, southern Ethiopia, 2022........................................................................16

Figure 3: distribution of source of information related characterstics and fathers knowledge and
attitude towards breast feeding......................................................................................................27

Figure 4: Knowledge towards breast feeding among father who have under two year age child
in Arba Minch demographic and health surveillance site, southern Ethiopia, 2022.....................28

Figure 5:Attitude towards breast feeding among father who have under two year age child in
Arba Minch demographic and health surveillance site, southern Ethiopia, 2022.........................28

xi
1-Introdction

1.1 Background

Breastfeeding is the biological norm and the optimal mode for feeding infants to reduce
morbidity and mortality (1).Breast milk is a natural, renewable food that serves as a complete
source of infant nutrition until six month of age (2). Breast feeding had lots of benefits; the child
gets the optimal balance of nutrients and antibodies from his mother. Simultaneously, a breast-
feeding mother has increased hormonal products which facilitate uterine contraction. This
prevents morbidity and mortality because of hemorrhage. Breast feeding also reduces breast and
ovarian cancer with weight loss (3).

Initiation of Breast feeding(BF) within the first hour of life is important for both the mother and
the child. The first breast milk contains colostrum, which is highly nutritious and has antibodies
that protect the newborn from diseases. Early initiation of breastfeeding also encourages bonding
between the mother and her newborn and facilitates the production of regular breast milk (4).

A father’s knowledge of breastfeeding is an important factor that contributes to the success of

breastfeeding (5, 6). The decision to breastfeed is important both for the child and the mother.
Therefore, mother and father should be engaged in the decisions related to their child, namely the
decision to breastfeed. Breastfeeding is a process that needs to be learned by mothers and fathers
(7-10).

Fathers can support their partners by providing breast feeding information to motivate and assist
them to breast feeding, as well as providing practical support with care of additional children and
house work (11). Encouraging fathers’ involvement in breast feeding, as well as the provision of
breast-feeding information during antenatal care, would assist them to be more supportive during
breast feeding (7). Higher levels of paternal support and encouragement are associated with
greater maternal confidence to breast feeding (12).and mothers whose partner is supportive,
report feeling more capable and competent in breast feeding decisions and challenge (13).

The study done by Cerniglia and colleagues (2014) showed that paternal involvement during
breastfeeding predicts a good quality of father–infant interactions and the children score higher
on

1
Social Orientation. This interaction was originated from a good family psychological profile and
the degree of involvement (14)

A recent study by Erris and colleagues (2020) showed that in the family’s life cycle the
relationships between parents and children have a significant influence on various aspects of
everyday life (15). The father's knowledge plays an important role in encouraging, assisting and
rewarding mothers in the process of breastfeeding, sharing household chores, and raising
children (16). Fathers negative attitude and poor knowledge may cause the father to be incapable
of motivating or encouraging the mother to exclusively breastfeed (17).

2
1.2 STATEMENT OF THE PROBLEM

Globally magnitude of fathers knowledge and attitude towards breast feeding in most of
developing countries are poor which ranges from 38.9 % to 76.5 % (Puskesmas Pucang Sewu
Surabaya and Nigeria) and 25.9% -70.9% (Puskesmas Pucang Sewu Surabaya and Malaysia),
respectively (18-20). In our country Ethiopian the magnitude of attitude among fathers toward
breast feeding extents between 52%-72.4(Addis Abeba and Misha woreda) and knowledge
among fathers toward breast feeding ranges between 35%-58.3% (Addis Abeba and Gurage
zone) (21-23).

The success or failure of breastfeeding is primarily determined by father support, especially in

the early weeks of breastfeeding (24). Inadequate support from fathers or close relatives of
nursing mothers also affects breast milk production. Therefore, the father’s participation
significantly increases breast milk production. Hence, sufficient milk is made available for
babies (25). Fathers unfavorable attitude and poor knowledge may cause the father to be
incapable of motivating or encouraging the mother to exclusively breastfeed (17). A father’s
knowledge of breastfeeding is an important factor that contributes to the success of breastfeeding
(5, 6, 26). Fathers support can influence initiation, continuation, and exclusivity of feeding. and
important in managing difficulties of feeding, and helping with household and child care duties
(15)

Fathers un favorable attitude towards BF causes suboptimal BF which contributes to 45% of

neonatal infectious deaths, 30% of diarrheal deaths, and 18% of acute respiratory deaths among
under five years of age children in developing countries (27). Also, suboptimal breastfeeding
opens doors to several risks like infectious morbidity, otitis media, lower respiratory tract
infection, gastrointestinal infection, obesity and metabolic disease, neurodevelopment, leukemia,
and also infant mortality (28). The long term consequence will make infants vulnerable for a
significant problems like poor school performance, reduced productivity and impaired
intellectual and social development (29).

3
Different Studies conducted in Africa and Ethiopia shows that accompany during ANC, health
provider support, taking cares of house hold chores, seeing mass media, mono gamy
matrimania, place of residence, educational status were significantly associated with fathers’
knowledge and attitudes among breast feeding(18, 19, 23, 30).

Breast feeding is considered as core practice to achieve 2030 sustainable development agendas,
specifically sustainable development goal two (SDG 2)-which focuses in ending hunger and
improving nutrition worldwide; SDG3-which focuses in reducing child, and maternal mortality,
and improving health for all people globally (31). Even though the Ethiopian Health Sector
Transformation Plan had planned to increase the proportion of breastfeeding to 70% by the end
of 2020, only 58% mothers breastfed exclusively (32). This may be because of poor knowledge
and unfavorable attitude of fathers towards BF. Therefore, assessing the prevalance and
associated factors of father’s knowledge and attitude towards BF is needed to improve women’s
breast-feeding practice. Moreover, there is limited evidence showing the knowledge and attitude
of father’s status. in Ethiopia and no study done in my study area.

4
1.3 Significance of the study

For study participant study will benefit: For father to improve their attitude and knowledge to let
them to be part of the promotion of breast feeding by supporting their partners throughout breast
feeding process.

For child: it helps to improve child nutritional status and prevent from disease.

For Health-care providers: this study will add new knowledge for health workers to incorporate
fathers in health education sessions of maternity and child health services and to come up with
evidence-based practices.

For stake holders to design appropriate intervention and evidence-based decision making.

For program planner the result of this study will be useful to guide program planning about men
knowledge and attitude towards breast feeding.

little is known about fathers’ knowledge and attitude towards breast feeding in our country so,
understanding the knowledge and attitude of fathers on exclusive breast feeding may
contribute for increasing initiation and continuation rate of breast feeding and becomes
benchmark for further studies.

5
 2-Litreatures rivew

2.1 Knowledge of breast feeding among fathers who have under two-year age

The research done in Malaysia revealed that 70.9% of fathers had good knowledge about breast
feeding (20). The study conducted in India showed that 75.3% had babies breast feed between 4-
6 months of age, while 58.1% fathers had knowledge about breastfeeding before baby’s birth and
73.1% were keen to get more information after baby’s birth (33).The study done in Padang in
Indonesia attested that father level of knowledge on breast feeding were 30.4 %(34). Also study
done in the area Puskesmas Pucang Sewu Surabaya 25.9% fathers had good knowledge about
breast feeding (19).

Study done in Addis Abeba Ethiopia indicated that 35% fathers had poor breast-feeding
knowledge (21). While the study done in Gurage zone southern Ethiopia showed that fathers
knowledge towards breast feeding practice was 58.3% (23).

2.2 Attitude of breast feeding among fathers who have under two-year age

The research done in Malaysia revealed that 52.6% respondents had favorable attitude toward
breastfeeding(20). And a study done in the area Puskesmas Pucang Sewu Surabaya 38.9 % of
father had favorable attitude about breast feeding (19).

A study conducted in Nigerian showed that 76.5% of males had un favorable attitude towards
infant feeding while only two out of ten father had favorable attitude (18). In this study three-
quarters (75.7%) of father with poor infant feeding knowledge had unfavorable attitude towards
infant feeding while only 2 out of every 10 fathers with adequate infant feeding knowledge had
favorable attitude towards infant feeding (18).

A study done in Addis Abeba Ethiopia indicated that 52% of participants fathers had un
favorable attitude towards breast feeding (21). A study conducted in Misha woreda; Southern
Ethiopia indicated that fathers involvement in breastfeeding practices was 72.4% (22).

6
2.3 Factors associated with knowledge and attitude of breast feeding among fathers who
have under two-year age

2.3.1 Socio demographics characteristics

Study conducted in Puskesmas Pucang Sewu Surabaya showed that fathers age was significantly
associated with knowledge and attitude of breast feeding among fathers (19). In opposite to this
study conducted in India and Ethiopia showed that there was no association between fathers age
with knowledge and attitude of breast feeding among fathers (21, 33).

The study conducted in Gurage zone southern Ethiopia showed that place of residence was
significantly associated with knowledge and attitude of breast feeding among fathers (23).

The study done in Turkey, Puskesmas Pucang Sewu Surabaya, Malaysia, Gurage zone southern
Ethiopia, and Misha district southern Ethiopia indicates that educational status was significantly
associated with Knowledge and attitude of breast feeding among fathers (19, 20, 22, 23, 35).
Contrasting to this the study conducted in India and Aldiss Abeba indicated that educational
status was not significantly associated with Knowledge and attitude of breast feeding among
fathers(21, 33).

Occupational status of fathers has significant association with knowledge and attitude of breast
feeding among fathers according to study done in Puskesmas Pucang Sewu Surabaya (19).
Contrasting to these studies done in India and Addis Abeba indicated that there were no
significant association between occupational status and knowledge and attitude of breast feeding
among fathers (21, 33).

Most of studies conducted at global and local level reveals that monthly income was not
significant association with knowledge and attitude of breast feeding among fathers (20, 23).
According to the Study conducted in Misha district showed that being monogamy matrimania
status were significantly associated with knowledge and attitude of breast feeding among
fathers(22).

7
2.3.2 Health service-related factors

According to a study done in Addis Ababa health care provider support has association with
knowledge and attitude towards breast feeding among fathers than who haven’t health care
provider support (21). While a study conducted in Turkey indicated that health education on
lactating and breast feeding was significantly associated with knowledge and attitude towards
breast feeding among fathers (35). Another study conducted in Misha district southern Ethiopia
showed that men’s who visited health facility with their wives were 5.5 times more likely to have
good involvement in breast feeding practices than those fathers who did not visit health facility
with their wives (22).

2.3.3 Obstetric and child related factors

A cross sectional study conducted in Gurage zone Ethiopia among 597 fathers knowledge and
associated factors towards breast feeding showed that accompany during ANC was 3.31 times
more knowledgeable than those fathers who did not accompany during ANC (23).Studies done
in Turkey, Malaysia and Gurage zone southern Ethiopia showed that number of children was
significantly associated with Knowledge and attitude of breast feeding among fathers (20, 23,
35).

Study conducted in India showed that men’s whose child was born by cesarian section and had
co morbidities in neonatal period was significantly associated with knowledge and attitude
towards breast feeding among fathers (33).

2.3.4 source of information

According to a cross sectional Study conducted in Misha district and Gurage zone southern
Ethiopia showed that having mass media in their home had significantly associated with
knowledge and attitude than those fathers who didn’t have mas media in their home (22, 23).

According to a study conducted in Addis Ababa Ethiopia fathers who taking care of house hold
chores were significantly associated than those who didn’t taking care of house hold chores (21).

8
 2.4 Conceptual frame work

Obstetric and child related

Socio demographic
characters factors

 Father Age  Accompany during ANC

 Occupation status
of parents  Mothers Mode of delivery
 Educational status  number of children
of parents
 sex of child
 Place of Residence
Knowledge of fathers  age of child
 monogamy
toward breast feeding
matrimania  illness of the index child
 house wealth
index  Mothers place of delivery
 fathers support in

Attitude of father toward

Health service factor
breast feeding
 health provider
support
Source of information  health education
 visited health
 Mass medi facilities

Source: developed from different literatures (20,21,33,35,)

Figure 1: Conceptual frame work knowledge and attitude of breast feeding and the associated
factors among father who have under two-year age child in Arba Minch Demographic and
Health Surveillance Site, southern Ethiopia, 2022.

9
 3. OBJECTIVES

3.1 General objective

To assess the knowledge and attitude towards breastfeeding and its associated factors among
father who have under two-year age child in Arba Minch Demographic and Health Surveillance
Site, southern Ethiopia, 2022.

3.2 Specific objectives

 To determine knowledge of father towards breast feeding

 To determine attitude of father towards breast feeding

 To identify factors associated with fathers’ knowledge towards breast feeding
 To identify factors associated with fathers’ attitude towards breast feeding

10
 4. Methodology

4.1 Study area and period

This study was conducted in Arba Minch Demographic and Health Surveillance Site from
April1 to April 30,2022. The surveillance site is located in Arba Minch zuria district with the
administrative center of Arba Minch town, which is located 505 kilometers southwest from
Addis Ababa, the capital city of Ethiopia and 275 km southwest of Hawassa, capital city of
SNNPR.

The surveillance site was established in 2009 with the aim of tracking demographic changes as
death, birth, migration and marital status change. The surveillance activities further extended by
adding surveys in nutrition, reproductive health, morbidity/health seeking behavior and health
care utilization. Surveillance activity is instituted in 9 Kebeles (the smallest administrative unit in
Ethiopia) based on the population proportion to size, altitude (climatic zone) accessibility service
and urban, and rural composition. Eight of the Kebeles are rural and the remaining one is semi-
urban Kebele (AM-HDSS, 2009). Based on agro ecologic zone (climatic zone), three kebeles of
them are highlands (Zigit Merche, Gatse and Laka), four of them are lowlands (Chano Chalba,
Kolla Shara, Shelle Mella and Kolla Shelle) and the rest two are midlands (Genta Myche and
Zeyse Dembile).

The population profile of the site is in Gatse 9990 (16.7%), Kolla Shelle 8787 (14.7%), Zigity
Mechie 8292, Laka 6625 (11.1%), Shelle Mella 6408 (10.7%), Kolla Shara 5775 (9.6%), Zeyesie
Dembile 5632 (9.4%), Chano Chalba 5497 (9.2%), and Ganta Meyechie 2869 (4.8%), with
summarized total of 59,875 populations and 12,537 households.

11
4.2 Study design

A community based cross-sectional study design was employed to assess the knowledge and
attitude towards Breastfeeding and its associated factors among father who have under two-year
age child in Arba Minch Demographic and Health Surveillance Site, Southern Ethiopia.

4.3 Population

4.3.1 Source population

All father who has under two-year age child in Arba Minch Demographic and Health
Surveillance Site, Southern Ethiopia

4.3.2 Study population

Randomly selected father who have under two-year age child in Arba Minch Demographic and
Health Surveillance Site, Southern Ethiopia and who are fulfilling eligibility criteria.

4.3.3 Study unit

An individual father will be the study unit

4.4 Eligibility criteria

4.4.1 Inclusion criteria

All father who has under two-year age child and who lives at list six months in Arba Minch
Demographic and Health Surveillance Site, Southern Ethiopia

4.4.2 Exclusion criteria

Those father who were seriously ill during data collection period excluded.

12
4.5 Sample size determination

The sample size for the first objective was calculated by using single population proportion
formula to assess fathers’ knowledge towards breast feeding from previous study done in Gurage
zone knowledge magnitude of 58.3% (23), 5% marginal error and 95% confidence interval and
adding a non-response rate of 10%.

n = (Zα/2)2 P (1-P)/ d2

n= Sample size
P= fathers’ knowledge towards breast feeding (58.3%)
95% level of confidence, Zα/2 at 95% level of confidence = 1.96
d= margin of error (5%)

n = [(1.96)2 *0.583* (1-0.583)]

(0.05)2

n=374
After adding 10% for non-response rate, total sample size for first objective is 411.

The sample size for the second objective was determind by using the formula single population
proportion to assess fathers’ attitude towards breast feeding from previous study done in Addis
Ababa unfavorable attitude prevalence of 52%(21) ,5% marginal error and 95% confidence
interval and adding a non-response rate of 10%.

n = (Zα/2)2 P (1-P)/ d2

n= Sample size
P= 52% fathers with unfavorable attitude.
(Zα/2)2= level of confidence at 95% certainty (1.96)
d= 5% marginal error
Non-response rate, 10%

13
 n = [(1.96)2 0.52 (1-0.52)]

(0.05)2

n=384
The sample size will be = 384

After adding 10% for non-response rate, total sample size for second objective is =422

Sample for third and fourth objective is determined using double population formula by using
Epi-Info 7.1 by assuming 95% level of confidence, 80% power, percent of outcome among
exposed and non-exposed, 1:1 ratio, and adjusted odds ratio from different studies (Table 1)

Table 1: Sample size determination for factors associated with knowledge and attitude of breast
feeding among father who have under one two age child in Arba Minch Demographic and Health
Surveillance Site, southern Ethiopia, 2022

Variables CI Power % of % of AOR 10% Total Reference

outcome outcome NRR sample
in in un size
exposed exposed
Knowledge
Accompany 95 80 40.8 59.2 3.31 145 (23)
during ANC
Attitude
Fathers 95 80 53.7 28.5 0.3 194 (21)
support in
house hold
chores

After comparing calculated sample for all objectives, the largest sample size 422 is taken for
conducting this study.

14
4.6 Sampling techniques and procedure

There are nine kebeles found in Arba Minch Zuria wereda HDS site. Those kebeles are Chano
Chalba, kolla shara, Genta Meychie, Zeyese Dimbile, kola shelle, laka, Gastse, shelle mella and
Zigiti merchie. All nine kebeles were included in study. Then the calculated sample size was
proportionally allocated to each kebeles. The study participant were selected from each kebeles
by computer generated simple random sampling using the SPSS software ‘select’ command from
the list of fathers obtained from HDSS data base.

15
 Arba Minch HDS site

Chano kolla Genta Zigiti Shelle

Gastes Laka kola Zeyese
Chalba shara Meychie merche Mella Shelle Dembile
457 255
99 124 6 200 69 156 211

Proportionally allocate

26 33 2 54 122 68 19 42 56

Computer generated simple random sampling

422

Figure 2: Schematic representation of sampling procedure on breast feeding and the associated
factors among father who have under two-year age child in Arba Minch Demographic and
Health Surveillance Site, southern Ethiopia, 2022

16
4.7 study variables

4.7.1 Dependent variables

 Fathers’ knowledge towards breast feeding (good/poor)
 Fathers’ attitude towards breast feeding (fvorable/unfavorable)

4.7.2 Independent variables

Socio demographic characters (fatherage, occupation, religion, maritalstatus,

educational status, place of residence, taking care of house hold chore and monogamy).
Health service factors (health provider support, health education, and member of local
leader ship )
Obstetric and child related factors (accompany during ANC, number of children,sex of
child, mothers’ mode of delivery, mothers place of delivery and illness of the index child)

Source of information (mass media )

4.8 Operational definitions

Knowledge: The questions to assess knowledge was adopted from the previous study conducted
in Gurage Zone (23). which comprises 12 yes or no questions and the score given from 0
(minimum) to 12 (maximum).

Good knowledge: Participants who scored the median and above were considered having good
knowledge. While participants who scored below the median score were considered having poor
knowledge.

Attitude: Attitude measurement scale contained the Lowa infant feeding attitude scale (LIFAS)
was used to assess attitudes towards breast feeding. The LIFAS contains 17 items (21).

Favorable Attitude: Participants who scored median and above were considered having favorable
attitude towards breastfeeding. While participants who scored below the median score were
considered having unfavorable attitude towards breastfeeding.

17
4.9 Data collection tool and procedure

An interview questionnaire was adapted after reviewing different works of peer reviewed
literatures(21, 23) The questionary contain socio demographic characters, obstetric and child
related factors, Health service and source of information factors. Data was collected by face-to-
face interview technique using a pretested structured interviewer-administered questionnaire
with open data kit (software) which is mobile data collection platform by 9 diploma health
workers. The data was collected at community level under close supervision of the assigned 2
supervisors and principal investigator during the data collection period

Measurment

Household’s wealth index of study participants: The respondents were asked to answer 25
items, which are closed-ended questions, to assess the study participant’s household’s wealth
index level. The correct answer will give a score of 1, and the incorrect answer will give a score
of 0. Then it was analyzed by using principal component analysis (PCA) to reduce the data
obtained from 25 items to a single factor or component called the household wealth index level.
The wealth index of study participants was ranked into five wealth quintiles (poorest, poorest,
middle, richest, and richest) (36). Finally, it was used for further investigation to determine
whether or not it was related to fathers knowledge and attitude towards breast feeding.

18
4.10 Data quality assurance

One day training was given for all data collectors and supervisors about the study and its
objectives, tools used and procudures. Close follow up was also be made to them during data
collection by supervisors and principal investigator. Moreover, a pre-test was done in Chencha
Southern Ethiopia on 5% of the sample (21) to ensure clarity, wordings, logical sequence, and
skip patterns of the questions and the pretested sample was not included in the study and
modification(like questions who need skip patern ) was done accordingly before starting the
actual data collection. In addition, the supervisors and principal investigator were supervise the
data collection process and check the filled questionnaires every day for completeness,
correctness and necessary corrections was made timely. Reliable tool was used to assess
households wealth index ,attitude and knowledge questions with cronbach’s Alpha of 0.842,0.85
and 0.81 (35, 36 ).

4.11 Data processing and analysis

Collected data were checked and entered to Epi -Data version 3.1 and then it exported to
statistical packages for Social Sciences, (SPSS) version 20.0 for data cleaning and analysis.
Descriptive statistics were computed for all variables according to type of variables. For
continuous variables, mean /median and standard deviation /inter-quartile range was produced,
while categorical variables were assessed by computing frequency and proportions. The
household wealth index was determined using Principal Component Analysis (PCA). Variables
coded between 0 and 1 were entered and analyzed using PCA and the PCA assumptions were
fulfilled ( i.e. the variable was dichotomous, sample size was 422 which is greater than 50, ratio
sample to variables was ≈17 to 1 which is greater than 5 to 1,there are 32 correlations in the
matrix greater than 0.30, KMO of sampling adequacy was 0.715 this is greater than 0.5 and
significant Bartlett’s Test of Sphericity) and those variables with greater than 0.5 communality
values were used to produce factor scores which were summed and ranked into five quintiles as
“poorest”, “poorer”, “medium”, “richer and “richest”.

A binary logistic regression model was used to determine the significant association between
dependent and independent variables. First, bivariable logistic regression analysis was conducted

19
between each independent variables and dependent variables. Crude odds ratio (COR) along with
95% confident interval (CI) was used to present the results of the bivariable analysis. All
variables with association in bivariable analysis at p-value ≤ 0.25 were entered in to a
multivariable logistic regression model to assess the adjusted association between dependent and
independent variables. An enter method was used to fit a multivariable logistic regression model
to identify factors remaining in the model. The adjusted odds ratio (AOR) along with a 95% CI
and p-value <0.05 was used to determine the strength of the association and to declare statistical
significance in the final model.

Multi-collinearity between independent variables were checked for all candidate variables, and
the highest observed variable inflation factor (VIF) score was 1.157 (tolerance=0.865) and (VIF)
score was 1.189 (tolerance=0.841) indicating that no threat of multi-collinearity. The Hosmer-
Lemeshow goodness of fit test was used to check model fitness,(0.266 and 0.412) for knowledge
and attitude respectively and was satisfied . Finally, the finding was presented using texts, tables
and figures

20
4.12 Ethical considerations

Ethical clearance was obtained from Institutional Review Board of Arba Minch University,
College of Medicine and Health Sciences with reference number of IRB/1237/2022. Following
ethical approval, an official letter was written by Arba Minch University College of Medicine
and Health and Sciences school of Public Health to Arba Minch zuria woreda health department.
Supportive letters were obtained from Arba Minch zuria health department and submitted to each
kebele.Then, informed written consent was obtained from each respondent aged greater than or
equal to 18 years of age after explaining the purpose and procedure of the study, the importance
of their participation, the benefits, and risks associated with the study, and the right to
withdrawal at any time if they feel discomfort.

For participant whose age is less than 18 years old assent with the waiver of consent was
required or applicable to enroll in the study. To maintain the confidentiality of information
gathered from the study participant, code numbers was used throughout the study. During data
collection period the standard covid 19 protocol was fulfilled.

4.13 Dissemination of result

The final report of the study will be presented and submitted to Arba Minch University College
of Medicine and Health Sciences.

It is also planned to communicate the result with Arba Minch zuria health office, and respective
health offices with documentation and possibly with presentation.

Effort will be applied to present this study in different symposiums and the paper will be sent for
pear reviewed publication.

21
 5.Results

5.1 socio-demographic and economic characteristics of fathers

5.1.1 distribution of socio demographic , economic characteristics and fathers knowledge

and attitude towards breast feeding

A total of 422 participants were involved in the study and making response rate of 100%. One
handred seventy five (41.5%) of study participant of fathers were in the age ranging from 18-24.
The mean (±SD) age of the study participants was 30.44% (±9.326) and with the age ranging
from 18 to 65 years. All the respondents were married. Majority of the respondents 379(89.8%)
were Gamo and 252(59.7%) protestants in ethnicity and religion respectively. All the study
participants were rural residents. Concerning educational status of the study participants
155(36.7%) were secondary and higher education level. Regarding house hold wealth index
around 83(19.7%) of study participants were poorest. the remaining
85(20.1%),67(15.9%),96(22.7%),91(21.6%) was poorer, middle, richer and richest respectively.

22
 Table 2 : distribution of socio demographic and socio economic characteristics of fathers
knowledge and attitude towards breast feeding who have under two year age child in Arba
Minch Demographic and Health Surveillance Site, southern Ethiopia, 2022

Variables Categories knowledge attitude

Good Poor Favourabl Unfavorab
e le Frequency (%)
N (%) N (%) N (%) N (%)
Father 18-24 100 (44.2) 75 (38.3) 77 (35.6) 98( 47.6) 175 (41.5)
age
25-35 89 (39.4) 83 (42.3) 100 (46.3) 72 (35.0) 172 (40.8)

≥35 37 (16.4) 38 (19.4) 39 (18.1) 36 (17.5) 75 (17.8)

Non formal education 66 (29.2) 71 (36.2) 76 (35.2) 61 (29.6) 137 (32.5)
father’s Primary education 68 (30.1) 62 (31.6) 64 (29.6) 66 (32.0) 130 (30.8)
education Secondary and 92 (40.7) 63 (32.1) 76 (35.2) 79 (38.3) 155 (36.7)
Higher education
father’s Unemployed 143 (63.3) 127 (64.8) 143 (66.2) 127 (61.7) 270 (64.0)
occupatio Employed 83 (36.7) 69 (35.2) 73 (33.8) 79 (38.3) 152 (36.0 )
n
Househol Poorest 35 (42.2) 48 (57.8) 39 (18.1) 44 (21.4) 83 (19.7)
d wealth Poorer 29 (34.1) 56 (65.9) 53 (24.5) 32 (15.5) 85 (20.1)
index 39 (58.2) 28 (41.8) 38 (17.6) 29 (14.1) 67 (15.9)
Middle
Richer 33 (34.4) 63 (25.3) 50 (23.1) 46 (22.3) 96 (22.7)

Richest 37 (40.7) 54 (59.3) 36 (16.7) 55 (26.7) 91 (21.6)

23
 5.2 distribution of health service-related characteristics and fathers knowledge of breast

feeding who have under two year age child in Arba Minch Demographic and

healthservilance site, southern Ethiopia, 2022.

Nearly half 205(48.6%) of study participants were escorted their wife to health facility while
their child was ill and only 178(42.2%) were get health education from health providers. And
also, from the participants who escorted their wife to health facility and get health education.
(Table 3)

Table 3:distribution of health service realated characterstics and fathers knowledge and attitude
of breast feeding who have under two year child in Arba Minch Demographic and Health
Surveillance Site, southern Ethiopia, 2022

Variables Categories Knowledge Attitude Frequency(%)

Good Poor Favorable Unfavorable

N (%) N (%) N (%) N (%)
Escorted Yes 113 (50.0) 92 (46.9) 108 (50.0) 97 (47.1) 205 (48.6)
their wife to
No 113 (50.0) 104 (53.1) 108 (50.0) 109 (52.9) 217 (51.4)
health
facility
Recived Yes 94 (41.6) 84 (42.9) 82 (38.0) 96 (46.6) 178 (42.2)
Health
education No 132 (58.4) 112 (57.1 ) 134 (62.0) 110 (53.4) 244 (57.8)
from health
provider
Perceive Yes 90 (39.8) 84 (42.9) 94 (43.5) 80 (38.8)
support from 174 (41.2)
health care No 136 (60.2) 112 (55.8) 122 (56.5) 126 (61.2) 248 ( 58.8)
provider is
helpful
Father Yes 158 (69.9) 130 (66.3) 185 (85.6) 103 (50.0) 288 (68.2)
support in
House hold No 68 (30.1) 66 (33.7) 31 (14.4) 103 (50.0) 134 (31.8)
chore

24
5.3 distribution of obstetric and child health related characteristics and fathers knowledge

of breast feeding who have under two year age child in Arba Minch Demographic and

healthservilance site, southern Ethiopia, 2022.

Most,335(79.4%) of the study participants escorted their wive during ANC visits and also
237(56.2%) participants escorted their wife during delivery time. From the study participants
wives, 373(88.4%) gave birth by SVD and 181(42.9%) gave birth at home. About 174(41.2%)
of participants had two child,103(24.4%),145(34.5%) had one child and more than two children
respectively. Two handred threeten(50.5%) participants who participated in this study thinks
having more than one child can help to know about breast feeding than others.

25
 Table 4:distribution of obstetrics and child health related characterstics and fathers knowledge
and attitude of breast feeding who have under two year child in Arba Minch Demographic and
ealth Surveillance Site, southern Ethiopia, 2022

Variables Categories knowledge Attitude Frequency(%)

Good Poor Favorable Un

favorable
N (%) N (%) N (%) N (%)
Father Yes 193 (85.4) 142 (72.4) 182 (84.3) 153(74.3) 335 (79.4)
escorted their
wife during
No 33 (14.6) 54 (27.6) 34 (15.7) 53 (25.7) 87 (20.6)
ANC Follow
up
Father Yes 124 (71.7) 113 (45.4) 137 (63.4) 100 (48.5) 237 (56.2)
escorted their
wife during No 49 (28.3) 136 (54.6) 79 (36.6) 106 (51.5) 185 (43.8)
delivery
Mode of SVD 191 (84.5) 182 (92.9) 185 (85.6) 188 (91.3) 373 (88.4)
deliveryof
C/S 35 (15.5) 14 (7.1) 31 (14.4) 18 (8.7) 49 (11.6)
index child of
a mother
Index child Health 133 (58.8) 108 (55.1) 120 (55.6) 121 (58.7) 241 (57.1)
mother Place facilities
of delivery Home 93 (41.2) 88 (44.9) 96 (44.4) 85 (41.3) 181 (42.9)
Sex of child Female 92 (40.7) 107 (54.6) 73 (33.8) 126 (61.2) 199 (47.2)
Male 134 (59.3) 89 (45.4) 143 (66.2) 80 (38.8) 223 (52.8)
<6month 71(31.4) 70 (35.7) 59 (27.3) 82 (39.8) 141 (33.4)
Child age 6-12month 43 (19.0) 42 (21.4) 55 (25.5) 30 (14.6) 85 (20.1)
>12month 112 (49.6) 84 (42.9) 102 (47.2) 94 (45.6) 196 (46.4)
Number of One child 101 (44.7) 73 (37.2) 97 (44.9) 77 (37.4) 174 (41.2)
children Two 62 (27.4) 41 (20.9) 59 (27.3) 44 (21.4) 103 (24.4)
children
More than 63 (27.9) 82 (41.8) 60 (27.8) 85 (41.3) 145 (34.4)
two children
Yes 172 (76.1) 124 (63.3) 147 (68.1) 149 (72.3) 296 (70.1)
Child
morbidity No 54 (23.9) 72 (36.7) 69 (31.9) 57(27.7) 126 (29.9)

26
5.4 distribution of source of information related characterstics and fathers

knowledge and attitude towards breast feeding

All of the respondents had an access to media in different way and also heard about importance
of breast feeding. Of all participants 87(20.6%), 134(31.8%),201(47.6%) Tv and Radio, health
care provider and from friends respectively. From the study participant’s 220(52.1%) had
community participation in their living area. while 202(47.9%) did not participate.

Chart Title

250

200

150

100

50

0
Tv and Radio Health care provider Friend

Figure 3: distribution of source of information related characterstics and fathers knowledge and
attitude towards breast feeding

5.5 prevalance of father’s knowledge and attitude towards breast feeding

The overall prevalance of good knowledge was found to be 53.6% [95% CI:(48.84,58.358)]
while 46.6% of participants had poor knowledge about breast feeding and favorable attitude on

27
breast feeding was found to be 51.2% [95% CI:(46.43,55.969)] while 48.8% of participants had
unfavorable attitude.(Figure 4 and Figure5 respectively)

Father knowledge

poor
knowl-
edage
46%
good
knowledage
54%

good knowledage poor knowledage

Figure 4: Knowledge towards breast feeding among father who have under two year age child
in Arba Minch demographic and health surveillance site, southern Ethiopia, 2022

Father Attituied

49%
51%

Favorable Attituied Unfavorable Attituied

Figure 5:Attitude towards breast feeding among father who have under two year age child in
Arba Minch demographic and health surveillance site, southern Ethiopia, 2022

5.6 Factors associated with fathers’ knowledge of breast feeding

Bivariable logistic regression analysis was carried out to assess the association of each
independent variable with knowledge of breast feeding. six variables were identified as factors.
Those variables whose bivariable test had a p-value less than 0.25 were candidate for multi

28
 variable analysis model. This candidate variables include sex of child, father escorted their wives
during ANC follow up, father escorted their wife during delivery, wives mode of delivery, child
morbidity and father attitude were associated with knowledge at a p-value of <0.25 and were
candidate for multi variable logistic regression analysis.

Multivariable logistic regression analysis was used to control the confounding variable and
identify the independent predictors of father’s knowledge on breast feeding. In multivariable
analysis father escorted their wife during ANC follow up, father escorted their wife during
delivery, child morbidity and father attitude were significantly associated with fathers
knowledge towards breast feeding at p-value <0.05. (Table 5).

The multivariable analysis indicated that the odds of having good knowledge were 1.8 times
higher for fathers who escorted their wife during ANC follow up than fathers who did not escorte
their wives (AOR= 1.809,95% CI :1.063,3.079).

The odds of having knowledge was 2.25 times higher for fathers who escorted their wive during
delivery time than who did not go with their wive’s (AOR= 2.253,95% CI :(1.437,3.533).
Likewise, the odds of having good knowledge was 1.86 times higher for fathers’ whose child had
been sick compared with those whose child had not been sick (AOR= 1.862,95% CI :
(1.162,2.983). Regarding fathers attitude those having favorable attitude had 3.97 times higher
knowledge of breast feeding than fathers’ who have un favorable attitude(AOR= 3.978,95% CI :
(2.546,6.216). (Table 5)

Table 5: Factors associated with knowledge of breast feeding among fathers who have under
two year child in Arba Minch Demographic and Health Surveillance Site, southern Ethiopia,
2022

Variables knowledge COR (95%CI) AOR (95%CI) P-value

Good Poor
N (%) N (%)

29
Sex of child
Male 134 (59.3) 89 (45.4) 1.751(1.190,2.578) 1.076(0.688,1.683) 0.747
Female 92 (40.7) 107 (54.6) 1 1
Escorted their wive during
ANC follow up
Yes 193 (85.4) 142 (72.4) 2.224(1.370,3.610) 1.809(1.063,3.079) 0.029*
No 33 (14.6) 54 (27.6) 1 1
Escorted their wive
duringDelivery
Yes 154 (68.1) 83 (42.3) 2.912(1.955,4.336) 2.253(1.437,3.533) 0.000*
No 72 (31.9) 113 (57.7) 1 1
Wives mode SVD 19 (84.5) 182 (92.9) 1 1
of delivery
Ceserial 35 (15.5) 124 (63.3) 2.382(1.241,4.573) 1.428(0.677,3.011) 0.349
section
Child Yes 54 (23.9) 72 (36.7) 1.849(1.213,2.820 1.862(1.162,2.983) 0.010*
morbidity )
No 72 (31.9) 113 (57.7) 1 1
Father Favorable 152 (67.3) 64 (32.7) 4.236(2.818,6.370) 3.978(2.546,6.216) 0.000*
Attitude Un favorable 74 (32.7) 132 (67.3) 1 1

*Significance at p-value <0.05

5.6 Factors associated with fathers’ attitude of breast feeding

Bivariable logistic regression analysis was carried out to assess the association of each
independent variable with fathers’ attitude of breast feeding. Nine variables were identified as
factors.Those variables whose bivariable test had a p-value less than 0.25 were candidate for
multi variable analysis model. This candidate variables include father age,child age, sex of child,

30
 escorted their wive during ANC follow up, escorted their wive during delivery, wives mode of
delivery, reciving health education from health care providers, involvement in house hold chore
and fathers knowledge about breast feeding were associated with fathers’attitude. Multivariable
logistic regression analysis was used to control the confounding variable and identify the
independent predictors of father’s attitude on breast feeding. In multivariable analysis father
age, sex of child, fathers’ involvement in house hold chore and fathers’ knowledge about breast
feeding were significantly associated with fathers’ attitude towards breast feeding.

The odds of father’s favorable attitude on breast feeding were 1.8 higher for fathers whose age
were25-35 year compared to >35 years and 18-24 fathersage[AOR= 1.815,95% CI: 1.065,3.093].
Father who had male child were 2.44 times higher odds of favorable attitude compared with
fathers’ who had female child [AOR= 2.444, 95% CI: 1.518,3.936].

The odds of father favorable attitude on breast feeding was 5.66 higher for fathers’ who have
been involved in house hold chores compared with those not involved in house hold chores while
their wives were breast feeding [AOR= 5.663, 95% CI: 3.295,9.733].

The odds of having a favourable attitude towards breast feeding was 4.8 time higher for fathers
who had good knowledge compared with fathers who had poor knowledge about breast feeding
[AOR= 4.816, 95% CI: 2.914 , 7.961 ].(table 6)

Table 6: Factors associated with attitude of breast feeding among fathers who have under two
year child in Arba Minch Demographic and Health Surveillance Site, southern Ethiopia, 2022

Variables Categories COR (95%CI) AOR (95%CI) P-value

Attitude
Favorable Unfavorable

N ( %) N ( %)
Child age
<6month 59 (27.3) 82 (39.8) 1 1
6-12 month 55 (25.5) 30 (14.6) 2.548(1.460,4.446) 0.779(0.451,1.345) 0.370

31
>12 month 102 (47.2) 94 (45.6) 1.508(0.975,2.333) 1.603(0.850,3.022) 0.145
Sex of child
Male 143 (66.2) 80 (38.8) 3.085(2.073,4.591) 2.444(1.518,3.936) 0.000*
Female 73 (33.8) 126 (61.2) 1 1
Father age
18-24 77 (35.6) 98 (47.6) 1 1
25-35 100 (46.3) 72 (35.0) 1.768(1.155,2.705) 1.815(1.065,3.093) 0.028
>35 39 (18.1) 36 (17.5) 1.379(0.801,2.372) 1.279(0.654,2.502) 0.472
Escorted their wive during
ANC follow up
Yes 182 (84.3) 153 (74.3) 1.854(1.146,3.001) 1.562(0.866,2.820) 0.139

No 34 (15.7) 53 (25.7) 1 1

escorted Yes 137 (63.4) 100 (48.5) 1.838(1.246,2.712) 1.144(0.682,1.918) 0.611

their wive
during No 79 (36.6) 106 (51.5) 1 1
delivery
Wives SVD 185 (85.6) 188 (91.3) 1 1
Mode of C/S 31 (14.4) 18 (8.7) 1.750(0.946,3.238 1.735(0.778,3.868) 0.178
delivery )
Reciving Yes 82 (38.0) 96 (46.6) 0.701(0.476,1.033) 0.633(0.390,1.025) 0.063
Health No 134 (62.0) 110 (53.4) 1 1
education
Involvement Yes 185 (85.6) 103 (50.0) 5.968(3.736,9.532) 5.663(3.295,9.733) 0.000*
in House No 31 (14.4) 103 (50.0) 1 1
hold chore
Father Good 152 (70.4) 74 (35.9) 4.236(2.818,6.370) 4.816(2.914,7.961) 0.000*
knowledge knowledge
Poor 64 (29.6) 132 (64.1) 1 1
knowledge

*Significance at p-value <0.05

6. Discussion

When I assed the knowledge and attitude towards breast feeding of fathers in this research, my
objectives were to probe there knowledge and attitudes and explaining the factors that are
associated with it. The study revealed that good knowledge about breast feeding among fathers
who have under two-year-age child was 226 (53.6%) [95% CI:(48.84,58.358]. The identified

32
factors significantly associated with fathers’ knowledge of breast feeding were escorted their
wives during ANC follow up, escorted their wives during delivery, child morbidity and fathers
attitude.

The result of this study slightily less than the study conducted in India (58.1%)% [95% CI:
(48.072,68.127]. of father’s had good knowledge towards breast feeding (37). That is because
the study area of this study completely lays in the rural and some demographic difference.

The finding of the study is lower than from result of studies conducted in Malaysia (70.9%),
Addis Ababa (61.0%), and Gurage (58.3%)(20, 21, 23).The difference might be due to this study
being conducted in rural areas while their study was conducted in both rural and urban
areas,which helped to access health facility easily and also to have high health-seeking behaviour
at comminity level .

However, the study of this finding is higher than the study conducted in Padang (30.4%) and
puskemas (25.9%)(19, 34). The discrepancy may be due to socio- economic, cultural variation in
the country where the community is found with in and geographical difference with large
infrastructure gaps across the study population.

The finding of this study discovered that escorted during ANC follow up was significantly
associated with father knowledge of breast feeding. the result of this study is in line with other
study conducted in gurage (23).This may be due to the fact that those fathers who escorted their
wives during ANC-follow up have access of health education and counseling that may change
their perspective of knowledge positively and also it benefit the family.

The finding of this study also showed that fathers who escorted their wives during labor time had
higher odds of being of good knowledge compared with their counterparts. The result of this
study is in line with studies done in gurage (23). This may be due to the fact that fathers who
accompany their wives during labor time have an opportunity to grasp different awareness about
neonatal and child health tips directly from healt professionals at spot level.

This study revealed that child morbidity was significantly associated with fathers’ knowledge of
breast feeding.This was consistent in studies conducted in India and gurage (23, 37). The
possible reason for this could be that as a child gets sick, the father will go to a health facility to

33
seek care. At that time, he may acquire information from health professionals and also, he may
ask his friends and relatives this can help to improve his knowledge about breast feeding.

This study revealed that almost half 51.2% of fathers have favourable attitude towards breast
feeding. The result of the current study was lower when compared to the study done in Nigeria
and misha woreda (76.5%) (72.4%) respectively(18, 22). this difference may be happened
because of this study done only in rural area which found with in small radius from the town but
the other study done both in rural and urban area.

The result of this study is in lined with study conducted in Malaysia and Addis Ababa 52.6% and
48% respectively(18, 20, 21). However higher as compared to comparative studies done in
puskesmas 38.9% (19). this difference may be due to the sample size difference and also
different culture.

The finding of this study showed that fathers age was significantly associated with fathers’
attitude towards breastfeeding. Fathers whose age 25-35 was 1.8 times higher than those whose
age were >35 and 18-24 years . This may be due to when the fathers age increases the father’s
attitude towards their child may also increase and in this age they may be seek to know about
their child needs and this may increase their attitude .

The study revealed that the sex of a child was significantly associated with fathers’ attitude
towards breast feeding. Having male child was 2.44% higher than having a female child. This
may be due to our culture that most of the fathers have special care for their male child more
often than female child.

The present study avowed that fathers who did housework were significantly associated with
their fathers’ attitude towards breast feeding. Fathers who help their wive’s by doing the house
hold chore were 5.663% more likely to have favorable attitude than those who don’t help. This is
supported by the study done in Addis Ababa (21). This may be due to the tradition pattern still
holds away fathers to help their wives and if they break this and support their partner their
attitude is favorable.

34
In addition, this study revealed that fathers who had good knowledge of breast feeding also had
favorable attitude. Fathers who had good knowledge about breast feeding were 3.978% more
likely to have favorable attitude towards breast feeding than those who had poor knowledge.
This finding is similar to the study done in India and Addis Ababa (21). This may be due to
having adequate knowledge can leads to favorable attitude.

This study also revaled that fathers who had favourable attitude also had good knowledge about
breast feeding.

In general, the finding of this study implies escorted during ANC follow up, escorted during
delivery and child morbidity were identified as predictor of father’s knowledge towards breast
feeding and also fathers age, father involvement in house hold chore, sex of child and knowledge
also identified as a predictor of father’s attitude towards breast feeding.

Limitation of this study

Despite the strength, this study has some limitation. The tools used to asses the fathers
knowledge and Attitude towards breast feeding designed to asses mothers knowledge and
attitude.

Chapter 7: conclusion and recommendation

7.1 conclusion

The level of father’s knowledge and attitude towards breast feeding to be low compared to the
study conducted in Ethiopia(21, 23). fathers knowledge towards breast feeding is significantily
associated with escorted during ANC follow up, escorted during delivery, child morbidity and
attitude and father’s favorable attitude towards breast feeding is associated with knowledge,
father age,involvement in house hold chore and sex of child. This implied that the level of
knowledge and attitude of the fathers no adequate enough.

35
7.2 Recommendation

Based on the result of the study, the following recommendation was forwarded:

For public and private health facilities

 At health facility level the health profesionals should appreciate fathers who accompany
their wife during ANC follow up, during labor and also while seeking health care and
should educate about breast feeding and increase their knowledge and attitude.
 Using the existing one-to-five health system to mobilizing the community to improve
fathers knowledge and attitude towards breast feeding.

For researchers

 Researchers should do further studies by using strong study design

8- REFERENCES

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Clinics of North America. 1994;41(5):925-41.
2. Mekuria G, Edris M. Exclusive breastfeeding and associated factors among mothers in Debre
Markos, Northwest Ethiopia: a cross-sectional study. International breastfeeding journal.
2015;10(1):1-7.
3. Jharna Elisabeth Neupane RKaSK. KNOWLEDGE ATTITUDE AND CALLENGES OF
EXCLUSIVE BREAST FEEDING AMONG PRIMI GRAVIDAS. March 2014.
4. Rockville M UEaI. Ethiopia Mini Demographic and Health. 2019.
5. Tsegaye M, Ajema D, Shiferaw S, Yirgu R. Level of exclusive breastfeeding practice in
remote and pastoralist community, Aysaita woreda, Afar, Ethiopia. International breastfeeding
journal. 2019;14(1):1-15.

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6. Bhatta DN. Involvement of males in antenatal care, birth preparedness, exclusive breast
feeding and immunizations for children in Kathmandu, Nepal. BMC pregnancy and childbirth.
2013;13(1):1-7.
7. Tohotoa J, Maycock B, Hauck YL, Howat P, Burns S, Binns CW. Dads make a difference: an
exploratory study of paternal support for breastfeeding in Perth, Western Australia. International
breastfeeding journal. 2009;4(1):1-9.
8. Gill SL, Reifsnider E, Lucke JF. Effects of support on the initiation and duration of
breastfeeding. Western journal of nursing research. 2007;29(6):708-23.
9. Hector D, King L, Webb K, Heywood P. Factors affecting breastfeeding practices. Applying a
conceptual framework. New South Wales public health bulletin. 2005;16(4):52-5.
10. Kramer MS, Kakuma R. The optimal duration of exclusive breastfeeding. Protecting infants
through human milk. 2004:63-77.
11. Rempel LA, Rempel JK. The breastfeeding team: the role of involved fathers in the
breastfeeding family. Journal of Human Lactation. 2011;27(2):115-21.
12. Helina S, Yanti Y, Susilawati E. Corelation Between Husband’s Support With Maternal Self-
Efficacy in Pekanbaru. Journal of Midwifery. 2020;4(2):50-9.
13. Al Furaikh SS, Ganapathy T. FIRST TIME EXPECTANT FATHERS’PERSPECTIVES ON
BREASTFEEDING. Malaysian Journal of Medical Research (MJMR). 2018;2(2):80-7.
14. Cerniglia L, Cimino S, Ballarotto G. Mother–child and father–child interaction with their 24‐
month‐old children during feeding, considering paternal involvement and the child's
temperament in a community sample. Infant Mental Health Journal. 2014;35(5):473-81.
15. Erriu M, Cimino S, Cerniglia L. The role of family relationships in eating disorders in
adolescents: A narrative review. Behavioral Sciences. 2020;10(4):71.
16. Rumaseuw R, Berliana SM, Nursalam N, Efendi F, Pradanie R, Rachmawati PD, et al.,
editors. Factors affecting husband participation in antenatal care attendance and delivery. IOP
Conference Series: Earth and Environmental Science; 2018: IOP Publishing.
17. Sopiyani L. Relationship between Social Support (Husband) and Motivation to Give
Exclusive Breastfeeding to Mothers in Klaten Regency. 2014.
18. Samuel FO, Adepoju OT, Leshi OO. Knowledge and attitude of male staff in a Nigerian
tertiary institution towards infant feeding. British journal of medicine and medical research.
2016;12(1):1.

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19. Pradanie R, Tristiana RD, Lestari RD. Husband Knowledge and Attitude Towards Mother's
Breastfeeding Self-Efficacy. 2018.
20. Ramzaa WIA, Sugumar M, Ahmad NB, Lim PY. Factors associated with knowledge and
attitude of breastfeeding among staff of Faculty of Medicine and Health Sciences, Universiti
Putra Malaysia. Malaysian Journal of Medicine and Health Sciences. 2019;15(203).
21. Birhanu E. Assesement of Fathers Attitude towards Breast Feeding and Associated Factors
among Fathers who Acompaing their Partner for Delivery in Selected Govemental Hospitals
Ofaddis Abeba, Ethopia, 2017: Addis Ababa University; 2017.
22. Abera M, Abdulahi M, Wakayo T. Fathers’ involvement in breast feeding practices and
associated factors among households having children less than six months in Southern Ethiopia:
a cross sectional study. Pediatr Ther. 2017;7(1):1000306.
23. Shitu S, Adane D, Abebe H, Mose A, Yeshaneh A, Beyene B, et al. Knowledge of
breastfeeding practice and associated factors among fathers whose wife delivered in last one year
in Gurage Zone, Ethiopia. PloS one. 2021;16(7):e0254824.
24. Aini N, Yusnitasari E, Armini A. Hubungan dukungan suami dengan produksi ASI pada ibu
post partum di wilayah kerja Puskesmas Senor Kabupaten Tuban. Fakultas Keperawatan
Universitas Airlangga, Surabaya. 2014.
25. Suriah S, Yunus Z, Yani A, Jafar N, Khoshab H. Husband's Participation in Breastfeeding in
Rural Areas: A Qualitative Case Study. LINGUISTICA ANTVERPIENSIA. 2021.
26. Mullany BC, Lakhey B, Shrestha D, Hindin MJ, Becker S. Impact of husbands' participation
in antenatal health education services on maternal health knowledge. JNMA; journal of the
Nepal Medical Association. 2009;48(173):28-34.
27. Nigatu D, Gebremariam A, Abera M, Setegn T, Deribe K. Factors associated with women’s
autonomy regarding maternal and child health care utilization in Bale Zone: a community based
cross-sectional study. BMC women's health. 2014;14(1):1-9.
28. Rallis A. Autonomous and Transparent Scientific Research in the Covid-19 Epoch.
29. Dallak AM, Al-Rabeei NA, Aljahmi YA. Breastfeeding knowledge, attitude, and practices
among mothers attending health centers in Sana'a City. ARC J Public Health Community Med.
2016;1(2):9-17.
30. Organization WH. World health statistics 2015: World Health Organization; 2015.

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31. Katsinde SM, Srinivas SC. Breastfeeding and the sustainable development agenda. Indian
Journal of Pharmacy Practice. 2016;9(3):144-6.
32. Ethiopia F. Health sector transformation plan I. Adis Ababa. 2015.
33. Abhinaya K, Arunprasath T, Padmasani L. Father’s knowledge and attitude towards breast
feeding. Profession. 2016;8:8.6.
34. Susilawati D. The Level of Knowledge and Support of Husband With Exclusive
Breastfeeding at Padang. Journal of Midwifery Vol. 2019;4(1).
35. Taşpınar A, Çoban A, Küçük M, Şirin A. Fathers' knowledge about and attitudes towards
breast feeding in Manisa, Turkey. Midwifery. 2013;29(6):653-60.
36. Csa I. Central Statistical Agency (CSA)[Ethiopia] and ICF. Ethiopia Demographic and
Health Survey, Addis Ababa. Central Statistical Agency. 2016.
37. Abhinaya K, Arunprasath T, Padmasani L. Father’s knowledge and attitude towards breast
feeding. International Journal of Medical Research and Review. 2016;4(10):1778-85.

9. ANNEX

Annex I: Information sheet

Arba Minch University, College of Medicine and Health Sciences, study on knowledge and
attitude towards Breastfeeding and its associated factors among fathers who have under two-year
age child in Arba Minch Demographic and Health Surveillance Site, southern Ethiopia, 2022

Greeting: Hello, my name is_____________________ I am here today to collect data on

knowledge and attitude towards Breastfeeding and its associated factors among father who have
under two-year age child in Arba Minch Demographic and Health Surveillance Site, southern
Ethiopia,2022

The study is being conducted by Fasika mewzer from Arba Minch University, College of
Medicine and Health Sciences. on Knowledge and attitude of breast feeding and the associated
factors among father who have under two-year age child in Arba Minch HDS site, Arba Minch
zuria woreda, southern Ethiopia, 2022.

39
I request you to take part in this study and to respond honestly. Your cooperation and willingness
are greatly helpful in identifying problems related to knowledge and attitude of breast feeding
among fathers. The study will be conducted through interviews and you are being asked for a
little of your time, about 25 min, to help us in this study. Your name will not be written in this
form and will never be used in connection with any information you tell us. There is no possible
risk associated with participating in this study except the time spent for responding to the
questionnaire. All information given by you will be kept strictly confidential. Your participation
is voluntary and you are not obligated to answer any question you do not wish to answer. If you
feel discomfort with the question, it is your right to drop it any time you want. If you have
questions regarding this study or would like to be informed of the results after its completion,
please feel free to contact the principal investigator.

Address of the principal investigator: Fasika mewzer Cell phone: +251 965 57 27 21 E-mail:
fmewzer@gmail.com

Annex II: Consent form English version

In signing this document, I am giving my consent to participate in the study titled knowledge and
attitude towards Breastfeeding and its associated factors among father who have under two year
age child in Arba Minch Demographic and Health Surveillance Site, southern Ethiopia,2022. I
have been informed that the purpose of this study is to assess knowledge and attitude toward
breast feeding and associated factors. I have understood that participation in this study is entirely
voluntarily. I have been told that my answers to the questions will not be given to anyone else
and no reports of this study ever identify me in any way. I have also been informed that my
participation or nonparticipation or my refusal to answer questions will have no effect on me. I
understood that participation in this study does not involve risks. I understood that Fasika
Mewzer is the contact person if I have questions about the study or about my rights as a study
participant.

Are you willing to participate in this study?

1. Yes - …………………………. Continue to the next page

2. No- …………………………… Skip to the next participant

40
Respondent’s signature_________________________________

If no, skip to the next participant

Date of interview: _______________ Time started: _______ Time finished: _________

Interviewer

Name_________________________Signature___________Date____________

Supervisor’s name ________________ signature ________

Results of interview questionnaire

1. Completed

2. Refused

3. Partially completed

Annex III: Questionnaire English version

Section 1: Socio-demographic and economic characteristics

S.NO Questions Answers Skip

101 Fathers Age in year ______________
102 Child Age in month _____________

103 What is your child sex 1.male

2.female

104 Which Ethnic group you are? 1.Gamo 2. Gofa

3. Wolaita 4. Amhara
5. Other (specify) _____________
105 What is your religion? 1.Orthodox 2. Protestant
3. Muslim 4. other(specify)____
106 What is your current marital 1. Married 2. Single If 2, 3, or 4,
status? 3. Divorced 4. widowed skip to
Q#106

41
107 If your answer is 1 for no 105 1. Polygamy 2. Monogamy
108 Where is your residence? 1. Rural 2. Urban
108 What is father educational 1.non formal education
status? 2. Primary education
3. secondary and higher education

109 What is your wife educational 1.non formal education

status? 2. Primary education
3. secondary and higher education

110 What is your current 1.Farmer 2. Daily laborer

Occupation? 3. Government employee
4. Merchant
5.Other(specify)________________
111 What is your wife current 1. House wife 2. Daily laborer
occupation 3. Government employee
4. Merchant
5Other(specify)________________
Households’ wealth index items
S.No questions response skip
W101 Owner ship of the house 1.private
2.rented from individual
3.kebele
4.other(specify)-------
W102 Number of rooms ____________in number
W103 Does your household have electricity? 1. Yes 2. No

W104 Does your household have a radio? 1. Yes 2. No

W105 Does your household have a television? 1. Yes 2. No

W106 Does your household have a refrigerator? 1. Yes 2. No

W107 Does your household have an electric 1. Yes 2. No
mitad?
W108 Does your household have a table? 1. Yes 2. No

W109 Does your household have a chair? 1. Yes 2. No

42
W110 Does your household have a bed with 1. Yes 2. No
cotton/sponge mattress?
W111 Does any member of your household 1. Yes 2. No
have a bank account?
W112 Does any member of your household own 1. Yes 2. No
have mobile phone?
W113 Does any member of your household own 1. Yes 2. No
have bicycle?
W114 Does any member of your household own 1. Yes 2. No
have Motor or Bajaj?
W115 Does any member of your household own 1. Yes 2. No
have Animal drawn cart?
W116 What is the main source of drinking water 1.Piped to yard/plot
for members of your household? 2. Other
W117 What kind of toilet facility do members 1. Pit latrine without
of your household usually use? slab/open fit
2.No facility/field
W118 What type of fuel does your household 1. Electricity
mainly use for cooking? 2.Wood
3.charcoal
4.Animal dung
5.others(specify)-------
W119 What is the main material of the floor in 1. Earth/soil 2. Dung
your household? 3.cement 4. ceramic
5. Others(specify)--------
W120 What is the main material of the exterior 1.stone with mud
walls in your household? 2.wood with mud
3.stone with cement
4.Others(specify)____
W121 What is the main material of the roof in 1.Metal / corrugated iron
your household? 2.thatch
3.Other(specify)_____
W122 Does any member of the house hold own 1.yes 2. No
any land that can be used for agriculture?
W123 Ownership of the farm land 1.own, in
hectares/gemed
2.rent, in hectares/gemed
W124 Annual total agricultural products ____________kuintal
(includes all)
Questions assessing associated factors of knowledge and attitude of fathers
Section 1: Obstetric and child related factors

S. Questions Response skip

No

43
401 Did you go to health 1. Yes 2. No
facility with your wife
during antenatal follow
up?
402 Did you go to health 1.yes
facility with your wife 2.no
during child birth?
403 Where did your wife 1. Health center
deliver 2. Hospital
3. Home
Other(specify)______________
404 How did your wife give 1. SVD
birth 2. C/S
3. Assisted vaginal delivery
405 How many children do 1. one child 2. Two children’s
you have?
3. More than two children
406 Do you think having 1.yes 2. No
more than one child is
helpful to know about
breastfeeding?
407 Did your child previously 1.yes 2. No If no skip
get ill? question406
408 If yes what were the 1.malaria 3. Diarrhea
disease 2.pneumonia
4. other(specify)_____

Section 5: Health service-related factors

SNO QUESTIONS YES (1) NO (2) skip

501 Did you go to health facilities with

your wife while your child getting
ill?
Did you get health education from
501 health professions while accompany
your wife?
502 Do you think health provider support
is helpful to know about breast
feeding?

44
Section7: other factors

SNO QUESTIONS YES (1) NO (2)

601 have you ever heard about the benefit of breast

feeding?
601 What is your source of information? 1.TV 2. Radio
3.health care
provider 4. friend
5.other-------
602 Do you support your breastfeeding partner by taking care
of house hold chores while she breast feed?
603 Do you have any community leader participation in your
area?
Section 2: Questions assessing fathers’ knowledge
S. No Questions True(1) False (2) Not sure (3)
201 Breast milk as the first given to infant after
birth.
202 Water or glucose water should not be
introduced to the infant to their first few days of
life.
203 Infant formula is more beneficial to the baby
than the breast milk.
204 It is common for mothers to have insufficient
milk in their breast.
205 A mother who feels she has insufficient milk
should feed with infant formula in addition to
Breastfeeding.
206 Mothers should stop breastfeeding if the
Baby is ill.
207 Breast milk alone is sufficient to provide all
nourishment for infants in the first six months
of life.
208 In breast feeding time mothers should ensure
that one breast is fully emptied before
introducing the second breast.
209 Exclusive breast feeding protects mothers from
pregnancy in the first few months’ afterbirth
210 A baby should be fed formula as soon as he/she
born.

45
211 Semi-solid or soft foods should not be
introduced to the infant before six months
212 Breast feeding should be stopped the moment
the baby is introduced to semi-solid or soft
foods.
Section 3: Questions assessing attitude of fathers
S.NO Questions Strongly Agree Neutral Disagree Strongly
agree (2) (3) (4) disagree
(1) (5)
301 The nutritional benefits of breast milk
last only until the baby is weaned from
breast milk
302 Formula feeding is more convenient than
breast feeding.
303 Breast feeding increases mother-infant
bonding.
304 Breast milk lacks iron.
305 Formula-fed babies are more likely to be
over feed than are breast-fed babies.
306 Formula feeding is the better choice if a
mother plans to work outside the home.
307 Mothers who formula-fed miss one of
the great joys of motherhood.
308 Women should not breast feed in public
places such as restaurants.
309 Fathers feel left out if a mother breast
feeds
310 Breast milk is the ideal food for babies.
311 Breast milk is more easily digested than
formula.
312 Formula is as healthy for an infant as
breast milk.
313 Breast milk is more convenient than
formula.
314 Breast milk is less expensive than
formula
315 Breast fed babies are more likely to be
over fed than formula fed babies.
316 Babies fed breast milk are healthier than
babies who are fed formula
317 A mother who occasionally drinks
alcohol should not breast feed her baby.

46
Thank you for allowing us to share your precious time and for your willingness to
participate in this study.

Annex IV: Information sheet and consent form of Amharic version

አርባ ምንጭ ዩንቨርስቲ ህክምና እና ጤና ሳይንስ ኮሌጅ

ጤና ይስጥልኝ ስሜ ይባላል እኔ ዛሬ እዚህ የተገኘሁት አባቶች ስለጡት ማጥባት ያላቸውን
እውቀት እና አመለካከት እንዲሁም ተያያዥነት ያላቸው ኩነቶች ላይ በሚሰራዉ ጥናት ላይ መረጃ ለመሰብሰብ ነዉ፡፡
ይሄ ጥናት የሚሰራዉ በ አ/ም/ዩ የሁለተኛ ዲግሪ ተማሪ በሆነችዉ ተማሪ ፋሲካ መዉዜር ነዉ፡፡የዚህ ጥናት ዋና አላማዉ
በአ/ምንጭ ዙሪያ የሚኖሩ አባቶች ስለጡት ማጥባት ያላቸውን እውቀት እና አመለካከት እንዲሁም ተያያዥነት
ያላቸው ኩነቶች ለመገምገም ነዉ፡፡ እርሶ በዚህ ጥናት ላይ ለመሳተፍ ስለተመረጡ እንዲሳተፉ በትህትና እጠይቃለሁ፡፡
የእርሶ ትብብር እና ፍቃደኝነት ስለጡት ማጥባት አባቶች ያላቸውን እውቀት እና አመለካከት እንዲሁም ተያያዥነት
ያላቸው ኩነቶች ለመለየት በጣም ይጠቅማል፡፡ የዚህ ጥናት መረጃ የሚሰበሰበዉ ፊት ለፊት በሚደረግ ቃለ መጠይቅ
ሲሆን ይህን መረጃ ለመሰብሰብ እስከ 25 ደቂቃ የሚሆን ጊዜ ሊወስድ ይችላል እና ተባበሩኝ፡፡

የሚሰጡኝ መረጃ ሁሉ ሚስጥራዊነቱ የተጠበቀ ነዉ ለዚህም የእርሶ ስም በዚህ መረጃ ዉስጥ በጭራሽ አይካተትማ፡፡
ለዚህ ጥናት የሚሰበሰበዉ እርሶን የሚመለከት መረጃ በማህደር የሚቀመጥ ሲሆን ማህደሮ በስም ሳይሆን በተለየ መለያ
የሚቀመጥ ይሆናል መለያውን ከዋናዉ ተመራማሪ ዉጪ ለማንም አይገለፅም፡፡

በዚህ ጥናት በመሳተፎ ምንም አይነት ችግር አያጋጥሞትም፤ ምናልባትም በቃለ መጠይቁ ሲሳተፉ ጊዜዎትን
ሊሻማቦት ይችላል፡፡
እርሶ በዚህ ጥናት ላይ ሙሉ ለሙሉ በፍቃደኝነት ነዉ የሚሳተፉት፡፡ በጥናቱ ለመሳተፍ ከወሰኑ በኀላ
በማንኛውም ሰአት ለማቋረጥ ከፈለጉ ማቋረጥ ይችላሉ እንዲሁም በቃለ መጠይቁ ጊዜ መመለስ
የማይፈልጉትን ጥያቄ አለመመለስ ይችላሉ፡፡
ይሄን ጥናት በተመለከተ ማንኛዉም አይነት ጥያቄ ካሎት ወይም ይሄ ጥንት ሲጠናቀቅ ስለተገኘዉ ዉጤት
ማወቅ ከፈለጉ ዋና ተመራማሪዋን መጠየቅ ይችላሉ፡፡

47
ለጥያቄዎ ይሄን አድራሻ መጠቀም ይችላሉ

 ስልክ: 0965572721
 E-mail: fmewzer@gmail.com

በዚህ ጥናት ላይ ለመሳተፍ ፍቃደኛ ኖት?

አወን ……………………………………

አይደለሁም …………………………………….

Annex V: Amharic version questionnaire (በአማርኛ የቀረበ መጠይቅ)

ክፍል 1. የማህበራዊ-ስነ-ሕዝብ ባህሪያት

ቁጥር ጥያቄ መልስ ዝለል

101 ዕድሜዎት በዓመት
102
የልጁ ዕድሜ በወር
103 ሀ/ ሴት
የልጅዎ ፆታ ምንድነው? ለ/ ወንድ

104 ሀ/ ጋሞ ለ/ ጎፋ
ብሔርዎ ምንድ ነው? ሐ/ ወላይታ መ/ አማራ
ሠ/ ሌሎች ብሔሮች-----------
105 ሀ/ ኦርቶዶክስ ለ/ ፕሮቴስታንት
ሃይማኖትዎ ምንድን ነው? ሐ/ ሙስሊም መ/ ካቶሊክ
106 የአሁኑ የጋብቻ ሁኔታዎ ምንድ ነው? ሀ/ ያገባ ለ/ ያላገባ መልስዎ
ሐ/ የተፋታ መ/ የትዳር አጋሩ የሞተችበት ለ፣ሐ ወይም
መ ከሆነ
ጥያቀ ቁጥር
104 ይሂዱ

107 ለቁጥር 102 ጥያቄ መልሶ ሀ ከሆነ ሀ/ ከአንድ በላይ የትዳር አጋር ነው ያሎት፡፡
ለ/ አንድ የትዳር አጋር ነው ያሎት፡፡

108 የልጆች ብዛት ሀ/ አንድ ልጅ ያለው

ለ/ ሁለት ልጆች ያለው
ሐ/ ከሁለት በላይ ልጆች ያለው
109 መኖሪያ ስፍራዎት የት ነዉ ሀ/ ገጠር ለ/ ከተማ

48
110 የትምህርት ደረጃዎ ምንድ ነው? ሀ/ ማንበብ እና መጻፍ የማይችሉ
ለ/ማንበብ እና መጻፍ የሚችሉ
ሐ/ 1 ኛ ደረጃ
መ/ ከ 2 ኛ ደረጃ በላይ
ሠ/ ሌሎች
111 ሀ/ ማንበብ እና መጻፍ የማይችሉ
የባለበትዎ የትምህርት ደረጃ ምንድ ለ/ማንበብ እና መጻፍ የሚችሉ
ሐ/ 1 ኛ ደረጃ
ነው? መ/ ከ 2 ኛ ደረጃ በላይ
ሠ/ ሌሎች
112 ስራዎ ምንድን ነዉ?
1. ገበሬ 2. የቀን ሰራተኛ

3. የመንግስት ሰራተኛ 4. ነጋዴ

5. ሌላ (ይግለጹ)
113
የባለበትዎ ሥራ ምንድ ነው? 1. የቤት እመቤት 2. የቀን ሰራተኛ

3. የመንግስት ሰራተኛ 4. ነጋዴ

5. ሌላ (ይግለጹ)
የቤተሰብ ሀብት ደረጃን የሚያሳዩ ጥያቀዎች
W101 የእርስዎ ቤተሰብ ኤሌክትሪክ
አለው? 1. አዎ 2. አይደለም
W102
የእርስዎ ቤተሰብ ሬዲዮ አለው? 1. አዎ 2. አይደለም
W103
የእርስዎ ቤተሰብ ቴሌቪዥን 1. አዎ 2. አይደለም

አለው?
W104
የእርስዎ ቤተሰብ ማቀዝቀዣ 1. አዎ

አለው? 2. አይደለም
W105
የእርስዎ ቤተሰብ የኤሌክትሪክ 1. አዎ
ምጣድ አለው?
2. አይደለም
W106
የእርስዎ ቤተሰብ ጠረጴዛ አለው? 1. አዎ 2. አይደለም
W107
የእርስዎ ቤተሰብ ወንበር አለው? 1. አዎ 2. አይደለም
W108 ቤተሰብዎ ከጥጥ / ስፖንጅ
ፍራሽ ጋር አልጋ አለው? 1. አዎ 2. አይደለም

49
W109
ማንኛውም የቤተሰብዎ አባል 1. አዎ 2. አይደለም

የባንክ ሂሳብ አለው?

W110
ማንኛውም የቤተሰብዎ አባል 1.አለ 2. የለም

የሞባይል ስልክ አለው?

W111
ማንኛውም የእርስዎ ቤተሰብ አባል 1.አለ 2. የለም

ብስክሌት አለው?

W112
ማንኛውም የእርስዎ ቤተሰብ አባል 1.አለ 2. የለም

ሞተር ወይም ባጃጅ አለው?

W113
የእርስዎ ቤተሰብ አባል የሆነ 1.አለ 2. የለም

የእንስሳት የተሳለ ጋሪ አለው?

W114
ለቤተሰብዎ አባላት የመጠጥ ውሃ 1. የቧንባ 2. ሌላ

ምንጭ ምንድን ነው?

W115
ብዙውን ጊዜ የቤተሰብዎ አባላት 1. መከለያ ያለዉ መፀዳጃ ቤት

ምንዓይነት መጸዳጃ ቤት 2. ሜዳ ላይ

ይጠቀማሉ?
W116 የእርስዎ ቤተሰብ በዋነኛነት
ለማብሰያ የሚጠቀሙበት ምን 1. ኤሌክትሪክ 2. እንጨት
ዓይነት ነዳጅ ነው?
W117 በቤትዎ ውስጥ ወለሉ ምንድ 1.አፈር / አሸዋ 2. ሌላ
ነው?
W118 የቤትዎ የውጭ ግድግዳ ምንድ 1. በጭቃ 2. ሌላ
ነው?
W119
የቤትዎ ጣሪያ ምንድ ነው? 1. ብረት / ቆርቆሮ ብረት
2. ሌላ

50
W120
ምግብ ማብሰያው ብዙውን 1. እንደ ኩሽና ውስጥ በተለየ ክፍል

ጊዜ በቤት ውስጥ, በተለየ ቤት ውስጥ

ውስጥ ወይም ከቤት ውጭ 2. በቤቱ ውስጥ ሌላ ቦታ

ይከናወናል? 3. በተለየ ቤት ውስጥ

4. ከቤት ውጭ

5. ሌላ(ይግለጹ)___
W121
ለግብርና የሚውል መሬት 1.አዎ 2. አይደለም

ያለው የቤተሰብ አባል አለ?

W122
የእርሻ መሬት ባለቤትነት 1. የራስ 2.ኪራይ

W123
በሄክታር በቁጥር ይጥቀሱ______________

W124
አመታዊ አጠቃላይ የግብርና ______________ ኩንታል

ምርቶች (ሁሉንም ምርቶች

ያካትታል)

ክፍል 2፡- የአባቶችን እውቀት መለኪያ ጥያቄዎች

ተ/ቁጥር ጥያቄ እውነት)(1) ሐሰት(2) እርግጠኛ

አይደለሁም(3)
201 የእናት ጡት ወተት ገና ለተወለደ
ልጅ እንደ መጀመሪያ ይሰጣል?

ውሃ ወይም ስኳርና ውሃ
202 ከተወለዱ የመጀመሪያ ቀናት ላይ
ላሉ ልጆች መሰጠት የለበትም?
203 ከእናት ጡት ወተት ይልቅ ሰው
ሰራሽ ወተት ለህፃናት ጠቃሚ
ነው?
204 በእናቶች ጡት በቁ ወተት
አለመገኘት የተለመደ ነው?

51
 205 በጡትዎ በቂ ወተት እንደሌላት
የምታስብ እናት ከእናት ጡት
ወተት በተጨማሪ ሰው ሰራሽ
ወተት መመገብ ትችላለች?

206 ህፃኗ/ዋ/ የታመመባት እናት ጡት

ማጥባትዎን ማቆም አለባት?

207 ልጅ ከተወለደ በኃላ ባሉት

የመጀመሪያ ስድስት ወራት
የእናት ጡት ወተት ላይ ንጥረ
ነገር ስላለው ብቻውን በቂ ነው?

208 እናቶች ጡት በማጥባት ወቅት

ማጥባት ማጥባት የጀመሩትን
ጡት በሚገባ ሳይጠባ ወደ
ሌላኛው እንደማይሄዱ እርግጠኛ
መሆን አለባቸው?

209 ጡት ማጥባት እናቶችን ከወለዱ

በኃላ ላሉት የመጀመሪያ ወራት
ከእርግዝና ይከላከላል?

210 አንድ ህፃን ከተወለደጊዜ አንስቶ

ሰው ሰራሽ ወተት መመገብ
አለበት?
211 ለስላሳ ምግቦችና በከፊል ጠጣር
የሆኑ ምግቦች ከስድስት ወር
በታች ከሆኑ ህፃናት መሰጠት
የለበትም?
212 ህፃናትለስላሳ ወይም በከፊል
ጠታር የሆኑ ምግቦችን መመገብ
ከጀመሩ ጡት ማጥባት ማቆም
አለባቸው?

ክፍል 3 የአባቶች አመለካከት መለኪያ ጥያቄዎች

ተ.ቁጥር ጥያቄ በጣም እስማማለሁ(2) እርግጠኛ አልስማማም(4) በጣም

እስማማለው(1) አይደለሁም(3) አልስማማም(5)
301 የእናት ጡት ለልጅ
ንጥረ-
ነገራዊ ጠቀሜታ
የሚኖረው ጡት
መጣል እስከቻሉበት
ጊዜ ድረስ ብቻ ነው
302 ሰው ሠራሽ የሆኑት
ተበጥብጠው ለልጅ
የሚሰጡ የዱቄት

52
 ወተቶች የተፈጥሮ
የእናት ጡትን ለልጅ
ከማጥባት የተሻሉ
አመቺ ናቸው
303 ጡት ማጥባት እናትና
ልጅ መሃል ያለውን
ግንኙነት የበለጠ
ያጠናክራል
304 የእናት ጡት ወተት
ብረት(Iron)
የተባለው ንጥረ ነገር
የለውም
305 ሰው ሰራሽ የዱቄት
ወተት የሚመገቡ
ህፃናት ከእናት ጡት
ከሚመገቡ የተሻለ
የመጥገብ ዕድል
አላቸው
306 ሰው ሰራሽ የዱቄት
ወተቶችን ለህፃናት
ምግብነት ማዋል
ከቤት ውጭ
ለመስራት ለምታስብ
እናት የተሻለ ምርጫ
ነው
307 ልጆቻቸውን ሰው
ሰራሽ ወተት
የሚመግቡ እናቶች
ጡት በማጥባት
የሚገኘው
የእናትነት አንድ
ታላቅ ደሰታ
ይቀርባቸዋል
308 ሴቶች ህዝባዊ በሆኑ
እንደ ምግብ ቤት ባሉ
ቦታዎች ጡት
ማጥባት የለባቸውም
309 እናቶች ሲያጠቡ
አባቶች የተገለሉ
ይመስላቸዋል
310 የእናት ጡት ወተት
ለህፃናት ከሁሉም
የላቀ ምግብ ነው
311 የእናት ጡት ወተት
ከሰው ሰራሽ ወተት
ይልቅ በቀላሉ
ይፈጫል
312 ሰው ሰራሽ ወተት

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 ከእናት ጡት ወተት
እኩል ለህፃኑ ጤና
ይሆናል፡፡
313 ጡት ማጥባት ሰው
ሰራሽ ወተት
ከመመገብ ይልቅ
አመቺ ነው
314 ጡት ማጥባት ሰው
ሰራሽ ወተት
ከመመገብ ይልቅ
ወጪ ቆጣቢ ነው
315 ሰው ሰራሽ ወተት
ከሚጠቡ ህፃናት
ይልቅ የእናት ጡት
የሚጠቡ ህፃናት
ይጠግባሉ
316 ጡት የሚጠቡ ህፃናት
ሰው ሠራሽ ወተት
ከሚጠቡ የበለጠ
ጤነኞች ናቸው
317 አልፎ አልፎ አልኮል
መጠጥ የምትጠጣ
እናት ልጇን ጡት
ማጥባት የለባትም

ክፍል 4፡- የአባቶች እውቀት እና አመለካከት ላይ ተያያዥነት ያላቸው ኩነቶችን የሚዳስስ ጥያቄ
የጽንስ እና ህጻናት ጤና የተመለከተ ጥያቄ

ተ/ቁጥር ጥያቄ አዎ(1) አይደለም(2)

401 በእርግዝና ክትትል ጊዜ ከባለቤትህ

ጋር ወደጤና ተቋም አብረህ መሄድ
ጥሩ ነው ብለህ ታስባለህ?
402 ከአንድ በላይ ልጅ መኖር በጡት
ማጥባት ላይ የተሻለ አመለካከት
ይፈጥራል ብለህ ታስባለህ?
403 ባንተ አስተሳሰብ ልጅ የወለደችበት
መንገድ ጡት ማጥባት ላይ ተጽኖ
አለው ብለህ ታስባለህ?

ክፍል 5፡- ከጤና ባለሞዎች ጋር የተያያዙ ኩነቶች

ተ/ቁጥር ጥያቄ አዎ (1) አይደለም (2)

501 ከቤተሰብ የሚሰጣት ድጋፍ ጡት
እንድታጠባ ያበረታታታል ብለህ
ታስባለህ?

54
502 ከጤና ባለሞያዎች የሚሰጣት ድጋፍ
ጠቃሚ ነው ብለህ ታስባለህ?
503 ጡት ማጥባት የእናቷ ሚና ብቻ ነው
ብለው ያምናሉ?

ክፍል 6፡- ሌሎች ኩነቶች

ተ/ቁጥር ጥያቄ አዎ (1) አይደለም (2)

601 የመገናኛ ዘዴዎችን መጠቀም ስለጡት

ማጥባት ጥቅም እውቀት ይሰጠኛል ብለህ
ታስባለህ?
602 የአቤት ውስጥ ስራዎችን በመስራት
የምታተባዋን ባለቤትህን ታግዛለህ?

ይህንን የመጠይቅ ፎርም ለመሙላት ላወጡት ጊዜ ከልብ አመሰግናለሁ፡፡

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