This study attempted to determine the prevalence of timely initiation of breast feeding including factors associated with timely initiation of breastfeeding. Majority 602(98.7%) of mothers practiced ever breastfeeding. This figure is similar to the ever breastfeeding rate of the country (96%) and Oromia region (94.1%) and other regional states in Ethiopia ranging from 93% in Addis Ababa to 99% in Harari [8, 17].
Although World Health Organization (WHO), global and national infant and young child feeding guidelines recommend that all newborns should start breastfeeding immediately (with in the first hour after delivery) and the feeding of colostrums be promoted, the current study showed that 35.0% of mothers squeezed and discarded the colostrums. This is due the cultural belief that colostrums can cause abdominal cramp in the child. The prevalence of pre-lacteal feeding in this study was 17.2% which is lower than the national pre-lacteal feeding reported by others (29%). The findings show that the reasons for giving pre-lacteal feeds are colostrums causes abdominal cramp, breast milk insufficiencies and to soften the stomach of the newborn. The prevalence of timely initiation of breastfeeding(52.4%) observed in the study area is better compared to the study report from Bangladesh where majority (88.8%) of the mothers initiated breastfeeding within three days after delivery and the prevalence of timely initiation of breastfeeding(41%) in Ghana .
The prevalence of timely initiation of breastfeeding in this study was relatively similar with studies done in Sudan (54.2%), Jordan (49.5%), Amhara region (60%) and Southern Nations Nationalities and Peoples (SNNP) region (50%). But, the figure we obtained is much lower than those observed in other studies from North Jordan (86.6%), Nepal (72.2%), Zambia; (70%), Bolivia (74%), Ethiopia (national) (69%), Oromia region (77%) [1, 8–11, 14, 16–18].
The near average rate of timely initiation of breastfeeding in this study could possibly be attributed to the fact that in this study large proportion of respondents came from rural kebeles where timely initiation was less practiced (47.3% for rural and 73.5% for urban) and educational status is much lower in rural area as compared to urban. This can also be evidenced from the qualitative finding from Nurse, working at Goba hospital "...as I told you ANC providers are very responsible for promoting breastfeeding. But I think health care professionals are not doing well especially in this regard".
Significant proportion of mothers practiced pre lacteal feeding that is something other than breast milk (17.2%) which is lower than the Ethiopia Demographic Health Survey (EDHS) (29%). Binary logistic regression analysis showed no difference in the timing of initiation of breast feeding by gender of the infants. Other characteristics, such as attendance of formal education, being urban mothers, institutional delivery, and receiving post-natal advise/counseling on breastfeeding were associated factors of timely initiation of breastfeeding practices. In this study those mothers who gave birth in health institutions were better in practicing timely initiation of breastfeeding (48.1%Vs 63.9%). This is contrary to the result obtained from Ethiopian Demographic Health Survey which indicated that home delivery has direct relationship with timely initiation of breastfeeding . However, in our analyses also, when the models is adjusted for other variables the effect of institutional delivery has disappeared which supports the findings of EDHS. The multivariable logistic regression analysis showed that, mothers from urban areas were 4 times more likely to initiate breastfeeding within one hour as compared to their rural counterparts. This result is consistent with the finding from Tanzania where timely initiation of breastfeeding was more common in urban areas (82%) than in the rural area (52%) . But this finding was in contrast to a finding from Dominican Republic where initiation of breastfeeding was found to be slightly higher in rural areas than in urban areas where 95% and 92% respectively and the Ethiopian Demographic Health Survey finding where rural infants were more likely to breastfeed timely after birth than urban infants [8, 20]. The difference in timely initiation of breastfeeding between urban and rural mothers or the difference within the same country might be explained by the fact that early initiation of breast feeding is more common among children whose mothers were assisted by trained traditional birth attendants and among children who are delivered at home. This was also indicated by the difference in the proportion of mothers who delivered at home and timely initiated BF in this study (48.1%) and in Ethiopian Demographic Health Survey (69.7%), . In this study, counseling on breast feeding issues at post natal care period was an independent predictor of timely initiation of breastfeeding. Those mothers who got post-natal counseling on breastfeeding were 2.7 times more likely to initiate breastfeeding timely compared to mothers who did not receive counseling on breastfeeding after they gave birth. This might be related to the fact that mothers are exposed to breastfeeding information during their visit during the post natal period which is the most appropriate time for delivering key infant and young child feeding messages [1, 15]
Ethiopia has developed National Infant and Young Child Feeding Guidelines with the objectives of achieving optimal breastfeeding. For the implementation, many health extension workers have been trained to provide community level breastfeeding promotion and in-service training has been given to promote breastfeeding at the health facility level. Despite all these interventions, the basic and easiest indicator of optimal breastfeeding (i.e. timely initiation of breastfeeding) remains at a near average. Furthermore, timely initiation is predicted by the nutrition behavior change communication delivered at during the post-natal period, implying the need for strengthening the delivery of key messages for optimal breast feeding through postnatal contacts both at the health institution and at health post levels.
The use of validated questionnaire and triangulating both quantitative and qualitative methods of data collection were the strengths of this study. However; a mother may have difficulty remembering when she initiated breastfeeding for her youngest infant; as a result, timely initiation of breastfeeding is subjected to potential recall bias. In addition, this study used a cross sectional study design; it is difficult to establish causal associations. Since the objective of this study is to assess the magnitude of the timely initiation and its determinants, we could not measure reason behind pre-lacteal feeding and colostrums removal quantitatively. Finally, this study is also limited to those missing data, thus interpretation of the finding shall take in to account the missing data.