1 INTRODUCTION

Infant and young child feeding (IYFP) is defined as early initiation of breastfeeding (EIBF) within  1 h of birth, exclusive breastfeeding for 6 months and nutritionally adequate and safe complementary feeding starting from the age of 6 months with continued breastfeeding up to 2 years of age or beyond as recommended by United Nation international emergency fund (UNICEF) and World Health Organization (WHO).¹ The first 2 years are the critical window for growth and development of children. If there is nutritionally deficit during this age period, it is difficult to redress later in life. The consequence of inappropriate IYCF during this critical time can lead children to falter physical growth, mental development, survival, and then reduce productivity and school performance too. Also it has negative implication on sustainable socioeconomic development and poverty reduction as a result of long term impact.^{2, 3} The overall, living standards in European or developed countries reflect a combination of economic prosperity, robust infrastructure, comprehensive social services, high-quality healthcare and education, safety and security, environmental consciousness, and a range of cultural and recreational opportunities that contribute to a high quality of life for their residents. So, this disparity on adequate education and rapid economic growth as well as the availability of more facilitated health and nutritional infrastructure may lead poor and insufficient feeding practices in developing country, Ethiopia.

Globally, about 10.9 million deaths occur among less than five children annually due to the cases of malnutrition which accounted around 60.0%. The scaling up of breastfeeding to near universal levels can estimated to prevent 823,000 child deaths, which is corresponds to 13.8% of the deaths of children under 2 years of age.^{4, 5} Different strategies and guidelines are developed to realize the recommended standards of IYCF practices, which focuses on international code of marketing breast-milk substitutes⁶ the innocent declaration,⁷ the millennium development goal, and global nutrition targets 2025, global strategy for IYCF³ guiding principles for complementary feeding of the breastfed child,⁸ are few of policies and strategies developed to strengthening IYCF practices.

Several studies have been conducted in several region of the country and the study revealed that, there is great challenges and problems which influencing infant feeding behaviors.^{9, 10} But practices of infant and young children feeding and associated factors has not been well studied in Ethiopia, particularly in the study area (Leka Dullecha). Most of the studies conducted in Ethiopia were not comprehensive and focused mainly on the breastfeeding aspects and not the dietary diversity and meal frequency. Hence there are significant gaps in our knowledge as to what amount of optimal IYCF and specific factors related to specific area with suboptimal child feeding at individual, house hold and community level. This study aimed to reveal the current practice of all IYCF components and associated factors which will be helpful for all sectors both government and NGO to have detail understand on magnitude of the child feeding problem and associated factors at all levels (from individuals to community level) in the area, this will enable stakeholders to clearly see the interventions need their effort to improve child nutrition practice and consider it during planning and play their role. So, this study was aimed to evaluate the infant and young child feeding practices and its associated factors among mothers of children 0–23 months in Leka Dellacha District, East Wollega Zone.

2 METHODS AND MATERIALS

2.1 The study area

The study was conducted in Leka Dulecha District, East Wollega Zone. It is 27 km far from Nekemte to the south and 358 km from Addis Ababa. The District is bordered by Diga, Jimma Arjo, Wayu Tuka and Chawaka Districts to the north, south, and east and to the west respectively (Figure 1). According to the District report, the total populations projected for 2022 fiscal year were 103,023 from this, 51,099 were men and 51,924 were women. This District has a total of 21,463 households and 2299 women in reproductive age group (15–49 years). Above 1 year's infants were 3314 and 0-23 months children are accounted 5882 in the district, according to the information obtained from Leka Dulecha District Health office, the district has three public Health center, one NGO Health center which is not for profit, nine primary private clinics, two rural drug venders, and two drug store, Likewise one preparatory, two high schools, and 35 elementary School. The main economic activities are food crop, and livestock production. No exaggerated cash crops are produced, but some parts of the communities are produce khat and coffee. The most important crops produced are cereals, potatoes, vegetables and partially fruits.

2.7 Sampling procedures

A stratified sampling technique was used. Initially the kebeles found in the District was stratified as urban and rural from total kebeles of Leka Dullecha District. Then one urban kebele and six rural kebele were selected by lottery method among total kebeles of the District. Lists of children age 0–23 months that is prepared by Health Extension Works from community health information system folder was used as a sampling frame (Figure 2). By taking all mothers of children 0–23 months age in Leka Dullecha District among seven selected kebeles, the proportional allocation of sample size was made for each selected kebeles by using the following statistical formula; -

$$$\text{ni}\,={Ni}\,\ast \,n/N$$$

Where ni = total sample size in kebele

Ni = total number of mothers of children 0–23 months aged in each selected kebele

$$${\rm{n}}1=\frac{\text{Ni}\,\times \,{\rm{n}}}{{\rm{N}}}=\frac{408\times 590}{1458}={\bf{165}}$$$

$$${\rm{n}}2=\frac{{\rm{N}}2\times {\rm{n}}}{{\rm{N}}}=\frac{185\times 590}{1458}={\bf{75}}$$$

$$${\rm{n}}3=\frac{{\rm{N}}3\times {\rm{n}}}{{\rm{N}}}=\frac{125\times 590}{1458}={\bf{51}}$$$

$$${\rm{n}}4=\frac{{\rm{N}}4\times {\rm{n}}}{{\rm{N}}}=\frac{220\times 590}{1458}={\bf{89}}$$$

$$${\rm{n}}5=\frac{{\rm{N}}5\times {\rm{n}}}{{\rm{N}}}=\frac{207\times 590}{1458}={\bf{84}}$$$

$$${\rm{n}}6=\frac{{\rm{N}}6\times {\rm{n}}}{{\rm{N}}}=\frac{170\times 590}{1458}={\bf{69}}$$$

$$${\rm{n}}7=\frac{{\rm{N}}7\times {\rm{n}}}{{\rm{N}}}=\frac{142\times 590}{1458}={\bf{57}}$$$

3 RESULT

4 DISCUSSION

In this study, the prevalence of appropriate IYCF practice was 62.3% which was consistent with study conducted in Dangila district, North West of Ethiopia from which 62.5% was reported (83), also nearly similar with study conducted in Debrelibanos district 65.8%¹¹ and Kalu District 57.7%¹² in other hand it was higher than finding in Shashemene 32.1%¹³ in Affar, Assayita 9.2%.¹⁴ The deference might be due to the study setting that in current study consumption of iron-rich or iron-fortified foods was excluded while conducted in Affar asayita, and the finding from shashemene was emphasize only on seven indicators whereas eight in this study. In addition, time gap between study periods may be other reason for this difference.

In this study early initiation of breast feeding within 1 h of delivery was encountered 445(76.6%). This finding is similar finding in Kalu District, Northeast Ethiopia,¹² but higher than findings in India,¹⁴ Afar¹⁵ and shashemene,¹³ this disparity might be due to high prevalence of mothers had information about IYCF practices and better in giving birth at health facility at study area.

In Ethiopia breastfeeding is universal, as some studies indicated, the prevalence of every breastfed is 95.6% in Asella and 99.3% in Shashemene.^{9, 16} Similarly in this study all respondent 581(100%) had reported as ever breastfeed their child and generally, the variation might be due to socioeconomic difference and breast feeding is normally known in the study area.

As recent study indicated the exclusive breastfeeding for children 0–5 complete months was 156(78.8%), it was similar with result obtained in Dire¹⁷ but lower than study finding in Bahir Dar,¹⁸ however it was higher than MDHS 2019 of Ethiopia, and Somaliland,¹⁹ this higher result may be due to high percent 74.2% of mothers gave birth at health facility and 70.1% of them had received information about IYCF practices in this study area. The present study revealed bottle feeding as 152(26.2%), which is consistence with study result in Affar Asayit,¹⁵ Bahir Dar city¹⁸ and far higher than finding in Pakistan (12%) and Ethiopian MDHS (9%) for children less than 6 months,^{20, 21} this discrepancy might be due to different age categories of children in capturing for study.

In current study the prevalence of continued breast feeding at age of 12–23 months children was 176(88.4%). The result shows nearly similar with finding in Debre-libanos north showa oromia and in Bahir Dar. This was higher than study conducted in India²² for same age group, and the higher disparity was revealed which might be due to fact that continuing breast feeding till 2 years was becoming as a norm of this district societies.

In this study the prevalence of TICF among 6-8 months aged children was 52(46%). It was higher than findings from Bangladesh, Nigeria, and India,^23-25 this difference might be due to socioeconomic disparity. In other hand it was lower than study results in some parts of Ethiopia, like; in Kalu District northeast Ethiopia^{18, 19, 26} in Afar, North shoa and shashemenne respectively, this difference might be due to poor knowledge about IYCFP, as it was reported by less than half in current study and due to the study setup that 6-8 complet months age children were assessed for last 24 h before survey in this study while retrospective history asked in other studies.

In present study 316(82.5%) of 6–23 months old children have been given the minimum meal frequency. This finding is line with finding in shashemene¹³ Debrelibanon district north shoa Oromia¹¹ and nearly consistent with Kolkata India²² and Kenya.²⁷ However it is higher than study result from Asella town,²⁸ in Slum areas of Bahir Dar City,¹⁸ and in Jimma Zone.²⁹

The prevalence of dietary diversity was only 73(19.1%) among 6–23 months aged children, who received five and above food categories out of 8 as recommended by WHO. Nearly all the children aged 6–23 months old consumed foods made from grains, roots and tubers beside breast milk mainly in form of porridge and ‟injera.” Women who gave flesh food to their child was almost nil, whereas eggs, Vitamin A rich fruits and vegetable, other fruits and vegetables were given by very few respondents. This is similar to studies in rural Damot sore district, Southern Ethiopia,³⁰ and in Dangila Town, Northwest Ethiopia.³¹ This disparity of dietary diversity result might be due to socio economic factors and low knowledge of mothers about IYCFP among the current study area. In other hand this finding was higher than study from rural population of northwest Ethiopia³⁰ and Bahir Dar Amhara.³² This high result might be due to awareness of mothers on the importance of diversifying diet in feeding children.

According to WHO definition, a child who met both the MDD and MMF are categorized as adequate minimum acceptable diet.²⁹ The proportion of children who received the mini- mum acceptable diet was 68(17.8%), from Sheno town Oromia.³³ In current study similar to study reported from Gorche district, Sidama Zone Southern Ethiopia,³⁴ the most children failed to satisfy the MAD requirement largely due to suboptimal dietary diversity. According to this study, as age of child increase practicing appropriate IYCF was decrease. Child age being between 6 and 11 months was 2.7 times more likely to have appropriate IYCF practice than those children age 12-23 months (AOR = 2.7; 95% CI: (1.645, 4.615)). This finding was coincide with national representative data of Ethiopian in 2021.³⁵

This finding revealed that mothers who gave birth at health facility were 2.6 times more likely to have appropriate IYCF practice than mothers who gave birth at home (AOR = 2.6; 95% CI: (1.694, 4.007)). It was line with study reported from Assayita Affar,³⁶ (AOR = 2.55, 95% CI (1.32, 4.93)), Kalu district¹² (AOR = 1.977; 95% Cl (1.101, 3.552)), and slum of Bahir Dar city (AOR 2.4; 95% CI 1.1, 7.3)³² also with study in Asella town (AOR = 1.77(1.02, 3.06)).¹⁶ In this study mothers who had sufficient knowledge about IYCFPs were 2.6 times more likely to practice appropriate IYCF when compared with those who had insufficient knowledge about IYCFPs (AOR = 2.6; 95%CI; (1.782, 3.895)). This is supported with study conducted in Dangila Districty (AOR = 5.061, 95% CI: 2.465, 10.389),³⁷ and study conducted in Debrelibanos(AOR = 2.82, 95% CI: (1.27, 26.26)) (Id et al. 2021). But in similar setup of study con- ducted in shashemenne and Kalu District,^{13, 38} it was found as nonsignificant.

The age of children being less than 12 months, children from mothers gave birth at health facilities, and mothers having knowledge to ward IYCFP were positively associated with appropriate infant and young child feeding practices. All concerned bodies should focus on health information communication on infant and young child feeding practices with giving due attention for indicators those recommended by WHO.

5 LIMITATION AND FURTHER STUDY

Collecting accurate data on feeding practices relies heavily on the respondents' ability to recall and report information, which can be influenced by factors like social desirability bias or memory lapses. In addition, the study focus on specific factors associated with feeding practices, potentially overlooking other important determinants such as cultural beliefs, access to healthcare, and maternal employment status. Conducting a longitudinal study could provide insights into how feeding practices evolve over time and their long-term impact on child health and development.

Complement quantitative data with qualitative research to understand the underlying reasons behind certain feeding practices and the cultural context influencing them. Implement and evaluate interventions aimed at improving feeding practices, such as educational programs for caregivers or community-based support systems. Nutritional Assessment: Include comprehensive nutritional assessments alongside feeding practices to understand the overall nutritional status of children in the region.

AUTHOR CONTRIBUTIONS

Fekadu Bulcha, Haile Bikila, Sidise Debelo participating on Data collection, field work and Data conceptualization, in addition, they are participating 1st, 2nd and 3rd author. Chimdesa Tolera, Desalegn Amenu and Temesgen Tafesse were participating on data analysis, edition and conceptualization; furthermore, Desalegn Amenu is the corresponding author. Copy editing, translation, paraphrasing and finally edition was supervised and processed by Desalegn Amenu.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

DECLARATION OF TRANSPARENT STATEMENT

We, the researchers involved in the assessment of Infant and Young Child Feeding Practices and Associated Factors among Children under 2 Years Old in Leka Dullecha District, East Wollega, Ethiopia, hereby declare our commitment to transparency in all aspects of our study. By upholding these principles of transparency, we aim to promote integrity, accountability, and trustworthiness in our research endeavors and contribute to the advancement of knowledge in the field of Infant and Young Child Feeding Practices.