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Sociodemographic Factors 
Associated with Bottle Feeding 
Practices in Infants Under Two 
Years of Age: A hospital-based 
study in Woldia, Ethiopia 
 
 
Yalew Mihret1, Fentanesh 
Endalew1, Hunegnaw Almaw2, 
Melese Linger3* 
 
1Department of Midwifery, College of 
Health Science, Woldia University, 
Woldia, Ethiopia;  
2Department of Public Health Nutrition, 
College of Medicine and Health Science, 
Bahir Dar University, Bahir Dar, Ethiopia; 
3Department of Public Health, College of 
Health Science, Woldia University, 
Woldia, Ethiopia  
 
*Corresponding Author email: 
melselinger@gmail.com 

 
Vol. 9, No. 1 (2020)   |   ISSN 2166-7403 (online)  
DOI 10.5195/cajgh.2020.440   |   http://cajgh.pitt.edu 



 
 
MIHRET 

 
This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 
This journal is published by the University Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

Central Asian Journal of Global Health 
Volume 9, No. 1 (2020) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.440 | http://cajgh.pitt.edu 

 
 

Abstract 

Introduction: Bottle feeding should be avoided when possible in infants under the age of two to improve health outcomes. The 
magnitude of bottle feeding practice is currently increasing in Ethiopia, however factors associated with bottle feeding usage are 
rarely addressed in research. We aimed to fill this gap and assess the magnitude of bottle feeding and its association with 
sociodemographic factors among infants in Woldia, Ethiopia in 2019. 
Methods: A hospital-based cross-sectional study was conducted in Woldia General Hospital at the Immunization Clinic. A total 
of 255 mothers who had infants were selected by systematic random sampling method. Data was collected through face-to-face 
interview using a structured standardized questionnaire. The data was entered to EpiData version 3.1 and analyzed using SPSS 
version 20. Binary logistic regression analysis models were used to assess the association between dependent and independent 
variables. Variables with p-value < 0.2 in bivariable logistic regression analysis were entered to multivariable logistic regression 
analysis. Finally, variables with p-value < 0.05 with 95% CI in multivariable logistic regression were taken as independent 
predictors. COR and AOR were used to show the strength of association between the dependent and independent variables. 
Results: The rate of bottle feeding practice in this study was 42.7% (95%CI: 35.8,48.2). Being an infant age 0-5 months old 
[AOR=0.16; 95%CI: 0.06,0.4], being a mother age 35-50 years old [AOR=0.43; 95%CI: 0.22, 0.85], having 2-5 children 
[AOR=6.37; 95%CI: 1.33, 30.44], and being a farmer as reported mother’s occupation [AOR=2.72; 95%CI: 1.30, 5.67] showed 
significant association with bottle feeding practice. 
Conclusion: The magnitude of bottle feeding practice was significantly higher in the current study as compared to national 
prevalence. Several sociodemographic factors showed significant association with bottle feeding practice which need to be explored 
further in the future research. 

Keywords: Bottle feeding; Children; Sociodemographic factors  

Sociodemographic Factors Associated 
with Bottle Feeding Practices in Infants 
Under Two Years of Age: A hospital-
based study in Woldia, Ethiopia 
 
Yalew Mihret1, Fentanesh Endalew1, 
Hunegnaw Almaw2, Melese Linger3* 
 
1Department of Midwifery, College of Health 
Science, Woldia University, Woldia, Ethiopia;  
2Department of Public Health Nutrition, 
College of Medicine and Health Science, 
Bahir Dar University, Bahir Dar, Ethiopia; 
3Department of Public Health, College of 
Health Science, Woldia University, Woldia, 
Ethiopia  
 
*Corresponding Author email: 
melselinger@gmail.com 

Research 

Bottle feeding is the practice of feeding an 
infant any substitute for breast milk with a bottle. Based 
on World Health Organization (WHO) classification, a 
prevalence of exclusive breastfeeding below 50% is 
considered poor.1 The WHO recommends that 95% of 
infants younger than one month and 90% of those 
younger than six months should be exclusively breastfed, 
while 90% of those aged 6–23 months should be partly 
breastfed. However, in low and middle-income countries, 
only 37% of infants younger than six months of age are 
exclusively breastfed.2 In Ethiopia, about 77% of infants 
scored low or medium on the breastfeeding performance 
index during the first six months of life,3 and only 58% 
of infants under age six months are exclusively 
breastfed.4 



 
 
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 The period between birth up to two years of the 
child’s life is a “critical window period” because during 
this period, infants are vulnerable to malnutrition or any 
other illness.5 Feeding exclusively breast milk within the 
first six months is considered a first vaccine for the 
infant.6 Despite breastfeeding recommendations, the 
prevalence and duration of breastfeeding is declining 
rapidly and is being replaced by bottle feeding, 
particularly among urban residents in developing 
countries.7 Bottle feeding is generally not recommended 
as it can lead to an increased incidence of excessive 
weight gain, diarrhea, infection, malnutrition, increased 
mortality, iron depletion, and decreased birth spacing.8-15 
Even the expressed breast milk could increase infant 
weight gain if it is fed by the bottle.16 

Globally, 45%, or 3.1 million, of child deaths 
are attributable to undernutrition annually; this problem 
is severe in low income countries.14 Increasing 
appropriate complementary feeding has the potential to 
prevent 6% of all under-5 deaths, particularly in the 
developing countries.5 

Numerous studies in various countries have 
shown that being an urban resident,17,18 not being 
counseled on bottle feeding education,18,19 the infant 
being hospitalized,18 low infant age,19 being a 
homemaker, not obtaining postnatal care, lower mother’s 
age,19 being an employed mother, hospital delivery, high 
infant age,9,17 higher maternal education level, high 
wealth index,17,20,21 as well as workload and short 
maternity leave20,21 were contributing factors for bottle 
feeding. Previous research inconsistently reported factors 
associated with bottle feeding practice, especially 
sociodemographic variables, infant age, and mothers’ 
educational and occupational status. 

The government of Ethiopia adopted infant and 
young child feeding guidelines in 200422 and the national 
nutrition program in 201323 to unlock the lifesaving 
potential of optimal breastfeeding practices. The 
guideline is based on WHO recommendations that 
emphasizes exclusive breastfeeding. Furthermore, the 

health extension program in Ethiopia aims at improving 
proper infant and young child nutrition, including 
promotion of exclusive breastfeeding. 22 

Although the government put forth the efforts 
mentioned above, the  prevalence  of bottle feeding 
practice among infants under two years was 11.9 %24 in 
2011 and increased to 14% in 2016,25 according to 
Ethiopia Demographic and Health Survey Report. 
Therefore, this study was aimed to assess factors 
associated with bottle feeding practices among mothers 
with infants in Woldia General Hospital, Ethiopia, 2019. 

 

Methods 

Study setting and population 

This hospital-based cross-sectional study was 
conducted among mothers with infants (children less 
than 24 months of age) who attended the immunization 
clinic in Woldia General Hospital, Woldia, Ethiopia. The 
town is located 521 kilometers away from Addis Ababa, 
the capital city of Ethiopia, and 360 kilometers away 
from Bahir Dar, the regional city of Amhara. According 
to the national census of 2008, the town of Woldia had a 
total population of 75,496, of whom 38,167 were men, 
and 37,279 were women. Woldia has one general hospital 
and two health centers. This study was conducted from 
February to April 2019 at Woldia General Hospital.  

Sample size and sampling technique 

The sample size was calculated using a single 
population proportion formula: n=(Za/2)2P(1-P)/w2 with 
the assumptions Za/2=1.96 (95% confidence level), 
P=0.196 (19.6% as the prevalence of bottle feeding 
practice in Holeta town19) and w=0.05 (5% margin of 
error). The estimated sample size was 243. We accounted 
for a non-response rate of 10%, so our final sample size 
estimate increased to 267.  

A systematic random sampling technique was 
conducted to select a representative population in the 
immunization clinic. The sampling interval (K) was 



 
 
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This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 
This journal is published by the University Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

Central Asian Journal of Global Health 
Volume 9, No. 1 (2020) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.440|http://cajgh.pitt.edu 

 
 

established by dividing the average number of women 
who visited the immunization clinic in the previous three 
months before data collection (average n=900) by the 
sample size, which produced K=900/267=3. Women 
were recruited daily by simple random sampling 
technique using the lottery method, and the next 
respondent was selected by adding a sampling interval to 
the number of the selected women. The same procedure 
was done on subsequent days until the required sample 
size was reached. 

Exposure and outcome variables 

The exposure variables were sociodemographic 
factors and obstetric factors. The definition and 
measurements standards of the variables were adopted 
from the Ethiopian Demographic and Health Survey 
2016.25 

The outcome variable was bottle feeding 
practice, which was categorized as yes/no. Bottle feeding 
practice was measured based on WHO definition of this 
indicator: "proportion of children 0–23 months of age 
that were fed any liquid (including breastmilk) or 
semisolid from a bottle with nipple/teat in previous 24 
hours prior to data collection period".25 

Data collection tools and procedures 

Data were collected by using a structured 
standard questionnaire through face-to-face interview. 
The questionnaire was adopted from the Ethiopian 
Demographic and Health Survey 2016.25 It has two parts: 
sociodemographic information and obstetric information. 
First, the English version of the questionnaire was 
prepared. It was translated to the local language of 
Amharic and then translated back to English. The data 
collectors were five graduate class midwifery students 
who had received one day of training before starting the 
data collection. The quality of the data collection process 
was monitored, and clear uniform instructions were given 
to all data collectors. All data collected as a part of this 
research were checked by the principal investigator. 

Data processing and analysis 

Data were entered and cleaned in EpiData 
version 3.1, and SPSS version 20.0 was used for data 
analysis. Descriptive statistical analyses were employed. 
Binary logistic regression analysis models were used to 
assess the association between dependent and 
independent variables. Variables with p-value of < 0.2 in 
bivariable logistic regression analysis were entered to 
multivariable logistic regression analysis. Finally, 
variables with p-value < 0.05 with 95% CI in 
multivariable logistic regression were taken as 
independent predictors for bottle feeding practice. COR 
and AOR were used to show the strength of association 
between the dependent and independent variables 

Ethical consideration 

Ethical clearance was obtained from the ethical 
review committee from the College of Health Science, 
Woldia University. The purpose of the study was 
explained, and confidentiality was secured by omitting 
any identifiers. Verbal consent was obtained from each 
study participant over 18 years of age. For mothers under 
18 years of age, verbal consent was obtained from both, 
the participant and her guardian.  

 

Results 

Sociodemographic characteristics 

From the estimated sample size, 255 
participants responded to survey, (95.5% response rate). 
Among the study participants, 222 (87.1%) were married, 
155 (60.8%) were 15-24 years of age, 138 (54.1%) were 
orthodox by religion, and 165 (64.7%) of mothers were 
urban residents (Table 1). 

Obstetric related factors 

In this study, 241 (94.5%) mothers had antenatal 
care in their previous pregnancy. During their antenatal 
care follow up, 209 (87.1%) of women did not receive 
counseling about bottle feeding practice. From the total 



 
 
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of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 
Central Asian Journal of Global Health 

Volume 9, No. 1 (2020) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.440 | http://cajgh.pitt.edu 

 
 

study participants, 218 (85.5%) received postnatal health 
care services for the current child (Table 2). 

Child feeding practices 

The overall rate of bottle feeding was 42.7% 
(95%CI: 35.8, 48.2) and the magnitude was 12.7%, 
46.6% and 55.7% respectively when disaggregated into 
age categories of 0-5 months, 6-11 months and 12-24 
months, respectively. Among the respondents who were 
asked about the reason why they practiced bottle feeding, 
around 42 (38.5%) respondents reported that they 
practiced bottle feeding due to work. Seventy (44.9%) 
anticipated practicing bottle feeding up to two years, and 
176 (69.0%) previously obtained information on the 
benefits of breastfeeding from health professional (Table 
3). 

Health status of an infant 

Among respondents who used bottles for 
feeding, 103 (58.9%) used formula, 18 (10.3%) of the 
mothers cleaned the bottle once daily, 39 (15.3%) of the 
infants had history of recurrent diarrhea in the past one 
month, and only 90 (51.4%) of the mothers cleaned the 
bottle through boiling (Table 4). 

Factors associated with bottle feeding practice 

In multivariable logistic regression analysis, 
infants aged 0-5 months old, mothers aged 35-50 years 
old, having 2-5 children and being a farmer as mother’s 
occupation showed significant association with bottle 
feeding practice. Other factors like father’s occupation, 
father’s education, antenatal care follow up, postnatal 
follow up, place of delivery, mother’s education level, 
sex of the child, parity and gravidity had no association 
with infant bottle feeding practices.  

Infants 0-5 months old were 84% less likely to 
be bottle fed than infants 12-23 months old [AOR=0.16; 
95%CI: 0.06, 0.4]. Furthermore, mothers who were 
between 35-50 years old were 57% less likely to practice 
bottle feeding than those who were in between ages 15-
24 [AOR=0.43; 95%CI: 0.22, 0.85]. Mothers who had 2-

5 children were six times as likely to practice bottle 
feeding as compared to mothers who have 6-10 children 
[AOR=6.37; 95%CI: 1.33, 30.44]. Being a farmer as 
mother’s occupation increased the odds of bottle feeding 
by 2.7 times as compared to a mother who were 
homemakers [AOR=2.7; 95%CI: 1.30, 5.67] (Table 5).  
 

Variables Frequency Percentage 
Age of mother    
   15-24 40 15.7% 
   25-34 155 60.8% 
   35+ 60 23.5% 
Residence    
   Urban 165 64.7% 
   Rural 90 35.3% 
Marital status    
   Married 222 87.1% 
   Divorced 18 7.1% 
   Single 8 3.1% 
   Widowed 7 2.7% 
Mother’s occupation    
   Homemaker 128 50.2% 
   Farmer 32 12.5% 
   Daily laborer 15 5.9 % 
   Merchant 39 15.3 % 
   Government employee 41 16.1% 
Educational status of 
mother   
   Unable to read and write 64 25.1 % 
   Primary 76 29.8% 
   Secondary 68 26.7% 
   Higher education 47 18.4% 
Religion of mother   
   Orthodox 138 54% 
   Muslim 91 36.2 
   Protestant 20 7.8% 
   Others 6 2% 
Occupation of husband   
   Farmer 72 28.2% 
   Daily laborer 21 8.2% 
   Merchant 86 33.7% 
   Government employee 76 29.8% 
Educational status of 
husband    
   Illiterate 38 14.9% 
   Primary 73 28.6% 
   Secondary 60 23.5% 
   Higher education 84 32.9% 

Note: Other religions=Adventist 
Table 1. Sociodemographic characteristics of mothers with 
infants less than 24 months of age in Woldia General Hospital, 
Ethiopia, 2019 (N=255) 

 



 
 
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Variables  Frequency Percent 
Gravidity of mother    
   Primigravida  70 27.5% 
   Multigravida  185 72.5% 
Number of children    
   1 75 29.4% 
   2-5 160 62.7% 
   6-10 20 7.8% 
Age of youngest child in months    
   0-5 55 21.6% 
   6-11 103 40.4% 
   12-23 97 38% 
Sex of infant    
   Male  163 63.9% 
   Female  92 36.1% 
Attended PNC for the current child   
   Yes 218 85.5% 
   No  37 14.5% 
Attended ANC for the last pregnancy    
   Yes  241 94.5% 
   No  14 5.5% 
Counseling about bottle feeding obtained   
   No  209 87.1% 
   Yes  31 12.9% 
Place of delivery    
   Health institution  179 70.2% 
   Home  76 29.8% 

Note: PNC=Postnatal care, ANC=Antenatal care 
Table 2. Obstetric related factors of mothers with infants less than 24 months of age in Woldia General Hospital, 
Ethiopia, 2019 (N=255) 
 

 

 

 

 

 

 



 
 
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This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 
This journal is published by the University Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

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Variables  Frequency Percent 
Source of information on the advantage of 
breast feeding 

  

   Mass media  28 11% 
   Health professional  176 69% 
   Family  51 20% 
Type of feeding for the youngest children now   
   Only breast milk  100 39.2 
   Only bottle feeding  32 12.5 
   Breast and other foods with cup and spoon 116 45.5% 
   Other food with cup and spoon  7 2.7% 
Duration of bottle feeding practice    
   Up to 6 months 30 19.2% 
   Up to 1 year 37 23.7% 
   Up to 2 year  70 44.9% 
   Until the baby discontinues  19 12.2% 
Child bottle fed presently    
   Yes  109 42.7% 
   No  146 57.3% 
Reasons to start bottle feeding   
   Mothers return to work  42 38.5% 
   Inadequate breast milk  30 27.5% 
   Availability of formula milk  14 12.8% 
   Pregnancy  3 2.8% 
   Mother is ill  20 18.3% 
Time of initiation of breast feeding    
   Immediately after birth  218 85.5% 
   After 1 year  23 9% 
   When the mother feels comfortable  10 3.9% 
   I don’t know  4 1.6% 
Breast feedings per day   
   1-7 107 42% 
   ≥ 8 148 58% 

 
Table 3. Child feeding practices among mothers with infants less than 24 months of age in Woldia General 
Hospital, Ethiopia, 2019 (N=255) 
 

 

 

 



 
 
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This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 
This journal is published by the University Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

Central Asian Journal of Global Health 
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Variables  Frequency Percent 
Source of water for drinking    
   Pipe  205 80.4% 
   River  13 5.1% 
   Spring (protected) 35 13.7% 
   Other  2 0.8% 
History of recurrent diarrhea in the past one month    
   Yes  39 15.3% 
   No  216 84.7% 
History of illness in the past one month    
   Yes  20 7.9% 
   No  235 92.1% 
Type of illness    
   Diarrhea  5 25% 
   Weight loss 4 20% 
   Vomiting  3 15% 
   Abdominal pain  5 25% 
   Respiratory infection  3 15% 
Number of bottles    
   One  60 34.3% 
   Two  73 41.7% 
   More than two  42 24% 
Frequency of bottle cleaning   
   Every feeding pattern  91 52% 
   Only when spoiled  34 19.4% 
   Once daily  18 10.3% 
   Every 6 hours  32 18.3% 
Techniques of cleaning the bottle   
   Boiling  90 51.4% 
   Rinsing with water and soap  64 36.6% 
   Only rinsing with water   21 12% 
Additional food with bottle feeding    
   Yes  105 60% 
   No  70 40% 
Kind of fluid offering to the baby with bottle feeding   
   Cow’s milk  63 36% 
   Formula milk 103 58.9% 
   Tea  2 1.1% 
   Expressed breast milk  7 4% 

Note: Other water source=unprotected spring  
 
Table 4. Health status of infants less than 24 months of age in Woldia General Hospital, Ethiopia, 2019 (N=255) 
   



 
 
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Central Asian Journal of Global Health 

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Variable 
Bottle feeding 

COR (95% CI) AOR (95% CI) 
Yes No 

Mother’s age in years     
   15-24  18 22 1 1 
   25-34 74 81 0.89(0.446,1.800) 0.46(0.19,1.10) 
   35-50 17 43 2.07(0.896,4.787) 0.43(0.22,0.85) 
Child’s age in months     
   0-5 7 48 0.17(0.07,0.4) 0.16(0.06,0.4) 
   6-11 48 55 0.89(0.51,1.55) 0.96 (0.51,1.8) 
   12-24 54 43 1 1 
Number of children     
   1 30 42 7.07 (1.53,32.66) 4.12(0.8,21.19) 
   2-5 70 86 7.7(1.73,34.48) 6.37(1.33,30.44) 
   6-10  9 18 1 1 
Mother’s occupation     
   Homemaker  48 80 1 1 
   Farmer 12 20 11(0.45,2.23) 2.72(1.3,5.67) 
   Daily laborer  6 9 0.9(0.3,2.69) 2.29(0.87,6.04) 
   Merchant  18 21 0.7(0.34,1.44) 2.75(0.79,9.24) 
   Government employee  25 16 0.38(0.19,0.79) 1.79(0.72,4.42) 
Mother’s educational status     
   Unable to read and write 20 44 0.36(0.19,0.69) 4.12(0.8,21.19) 
   Primary  25 51 0.39(0.21,0.71) 0.27(0.64,1.01) 
   Secondary and above  64 51 1 1 

Note: P-value significant at level of P<0.05, Backward LR method, Hosmer Lemeshow P-value=0.98 
 
Table 5. Multivariable logistic regression analyses among mothers with infants less than 24 months of age in Woldia 
General Hospital, Ethiopia, 2019 

Discussion 

The aim of this study was to assess the magnitude 
of bottle feeding practice and associated factors among 
infants less than two years old in Woldia General 
Hospital. In the current study, the prevalence of bottle 
feeding practice was 42.7% (95%CI: 35.8, 48.2). Age of 
the child, age of the mother, mother's occupation, and 
number of children in the family were found to be 
associated with bottle feeding practice. 

The magnitude of bottle feeding in the current 
study was consistent with the studies conducted in Sudan 
and Namibia.17,18 The magnitude of bottle feeding in this 
study was higher compared to the national prevalence 
reported in the 2016 EDHS,25 Holeta town,19 Bahir Dar26 
and Nigeria.27 The possible reason for this difference 
might be attributed to study period variation, as there has 
been increasing advocacy for using formula in this region 
recently.  



 
 
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The practice of bottle feeding from the current 
findings was lower than in the study conducted in 
Ethiopia.21 There might also be differences due to 
variations in socio-cultural aspects among study 
participants regarding feeding practices. 

Mothers in the age group of 35-50 were less likely 
to practice bottle feeding as compared to mothers in the 
age range of 15-24 years old. This finding is also 
supported by another study conducted in Southern Nation 
Nationality of People Regional State, Ethiopia, 2016.28 
The possible explanation could that as mothers age 
increases, her experiences in childcare increase as well, 
and more appropriate care and feeding patterns are 
adopted.  

Infants in the age group of 0-5 months old were less 
likely to be bottle fed than infants 12-23 months old; this 
finding has also been reported elsewhere19 and 
inconsistent in studies conducted in Namibia17 and 
Kenya.9 Infants, especially those less than 6 months of 
age, have gastrointestinal systems that are not well 
matured. Bottle feeding at this age may be associated 
with problems in digestion and absorption, which in turn 
may lead to diarrhea, vomiting, and infections. If mothers 
had experienced this previously, they may not start bottle 
feeding their child within the first year.  

Being a farmer as the mother’s occupation 
increased the likelihood of bottle feeding as compared to 
mothers who were homemakers. This result is consistent 
with a study conducted in Brazil, in which women who 
worked outside of home practiced bottle feeding more 
often.29 This pattern may be attributed to challenging 
workload among mothers who are working in farming.  

This study had some limitations. The cross-
sectional nature of the study may be subject to recall bias, 
and social desirability bias might influence the 
determinants of bottle feeding. For future researchers, 
conducting the studies with large sample size and 
incorporating factors such as media exposure and social 
media utilization will help to identify other important 

predictors of bottle feeding practices. The study’s 
strength is that it used primary data and included infants 
up to the age of two, which helps to estimate the 
magnitude of bottle feeding appropriately. 

Designing special nutrition intervention program 
for mothers who are working in farming, as well as 
developing a strategy to increase mothers' education in 
the area of nutrition and infant health, could contribute to 
lower bottle feeding use and improved infant outcomes. 

 

References  

1. Batista CLC, Ribeiro VS, Nascimento M, Rodrigues 
VP. Association between pacifier use and bottle-feeding 
and unfavorable behaviors during breastfeeding. J 
Pediatr (Rio J). 2018;94(6):596-601. 

2. Victora CG, Bahl R, Barros AJ, et al. Breastfeeding 
in the 21st century: epidemiology, mechanisms, and 
lifelong effect. The Lancet. 2016;387(10017):475-490. 

3. Haile D, Biadgilign S. Higher breastfeeding 
performance index is associated with lower risk of 
illness in infants under six months in Ethiopia. 
International breastfeeding journal. 2015;10(1):32. 

4. Central Statistical Agency., The DHS Program ICF. 
Ethiopian Demographic and Health Survey 2016 Addis 
Ababa, Ethiopia, and Rockville, Maryland, USA: CSA 
and ICF2017. 

5. Shukure R. Assessment of Knowledge, Attitude and 
Practice on Initiation of Complementary Feeding 
Among Under Two Years Children in Fiche Town, 
North Showa Zone, Ethiopia. International Journal of 
Biomedical Engineering and Clinical Science. 
2017;3(6):103-109. 

6. Jabbar NS, Bueno AB, Silva PE, Scavone-Junior H, 
Ines Ferreira R. Bottle feeding, increased overjet and 
Class 2 primary canine relationship: is there any 
association? Braz Oral Res. 2011;25(4):331-337. 

7. Lakshman R, Ogilvie D, Ong KK. Mothers' 
experiences of bottle-feeding: a systematic review of 
qualitative and quantitative studies. Archives of Disease 
in Childhood. 2009;94(8):596-601. 

8. Ventura AK, Mennella JA. An Experimental 
Approach to Study Individual Differences in Infants' 



 
 
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Intake and Satiation Behaviors during Bottle-Feeding. 
Child Obes. 2017;13(1):44-52. 

9. Matanda DJ, Mittelmark MB, Kigaru DM. Breast-, 
complementary and bottle-feeding practices in Kenya: 
stagnant trends were experienced from 1998 to 2009. 
Nutr Res. 2014;34(6):507-517. 

10. Sutcliffe TL, Khambalia A, Westergard S, Jacobson 
S, Peer M, Parkin PC. Iron depletion is associated with 
daytime bottle-feeding in the second and third years of 
life. Arch Pediatr Adolesc Med. 2006;160(11):1114-
1120. 

11. Olatosi OO, Sote EO. Association of Early 
Childhood Caries with Breastfeeding and Bottle 
Feeding in Southwestern Nigerian Children of 
Preschool Age. J West Afr Coll Surg. 2014;4(1):31-53. 

12. Avila WM, Pordeus IA, Paiva SM, Martins CC. 
Breast and Bottle Feeding as Risk Factors for Dental 
Caries: A Systematic Review and Meta-Analysis. PLoS 
One. 2015;10(11):e0142922. 

13. Krogh C, Biggar RJ, Fischer TK, Lindholm M, 
Wohlfahrt J, Melbye M. Bottle-feeding and the Risk of 
Pyloric Stenosis. Pediatrics. 2012;130(4):e943-949. 

14. Li R, Magadia J, Fein SB, Grummer-Strawn LM. 
Risk of bottle-feeding for rapid weight gain during the 
first year of life. Arch Pediatr Adolesc Med. 
2012;166(5):431-436. 

15. McAteer JP, Ledbetter DJ, Goldin AB. Role of 
bottle feeding in the etiology of hypertrophic pyloric 
stenosis. JAMA Pediatr. 2013;167(12):1143-1149. 

16. Kim HY, Han Y, Pyun Y, Kim J, Ahn K, Lee SI. 
Prolonged bedtime bottle feeding and respiratory 
symptoms in infants. Asia Pac Allergy. 2011;1(1):30-
35. 

17. Berde AS. Factors Associated with Bottle Feeding 
in Namibia: Findings from Namibia 2013 Demographic 
and Health Survey. J Trop Pediatr. 2018;64(6):460-467. 

18. Hassan AA, Taha Z, Abdulla MA, Ali AA, Adam I. 
Assessment of Bottle-Feeding Practices in Kassala, 
Eastern Sudan: A Community-Based Study. Open 
Access Maced J Med Sci. 2019;7(4):651-656. 

19. Kebebe T, Assaye H. Intention, magnitude and 
factors associated with bottle feeding among mothers of 
0-23 months old children in Holeta town, Central 
Ethiopia: a cross sectional study. BMC Nutr. 2017;3:53. 

20. Yngve A, Sjöström M. Breastfeeding determinants 
and a suggested framework for action in Europe. Public 
health nutrition. 2001;4(2):729-739. 

21. Sheka Shemsi Seid, Elsa Muluneh, Ismael Ahmed 
Sinbirro, Tolasa Takele Moga, Tura Koshe Haso, 
Shamsedin Amme Ibro. Utilization of Bottle Feeding 
Practices and Associated Factors among Mothers Who 
Have Infant Less than 12 Months of Age in Agaro 
Town, Jimma Zone South West Ethiopia, 2018. Health 
Science Journal. 2019;13(1):630. 

22. Fetene N, Linnander E, Fekadu B, et al. The 
Ethiopian health extension program and variation in 
health systems performance: what matters? PloS one. 
2016;11(5):e0156438. 

23. Kim SS, Rawat R, Mwangi EM, et al. Exposure to 
large-scale social and behavior change communication 
interventions is associated with improvements in infant 
and young child feeding practices in Ethiopia. PloS one. 
2016;11(10):e0164800. 

24. Central Statistical Agency [Ethiopia], ICF 
International. Ethiopia Demographic and Health Survey 
2011. In: Central Statistical Agency , ICF International, 
eds. Addis Ababa, Ethiopia. Calverton, Maryland, USA, 
2012. 

25. Croft, N. T, Marshall AMJ, Allen CK, al. e. 2018. 
Guide to DHS Statistics. Rockville, Maryland, USA: 
ICF; 2018. 

26. Demilew YM, Tafere TE, Abitew DB. Infant and 
young child feeding practice among mothers with 0 – 24 
months old children in Slum areas of Bahir Dar City, 
Ethiopia. International breastfeeding journal. 
2017;12(26).  

27. Ogbo FA, Agho KE. Determinants of suboptimal 
breastfeeding practices in Nigeria: evidence from the 
2008 demographic and health survey BMC Public 
health. 2015;15(259). 

28. Kelaye T. Assessment of Prevalence of Exclusive 
Breast Feeding Practice and Associated Factors among 
Under Six-Month-Old Children Selected Woreda South 
Nation Nationality of People Regional State, Ethiopia, 
2016. Journal of Nutritional Health & Food Science. 
2016. 

29. Buccini Gdos S, Benicio MH, Venancio SI. 
Determinants of using pacifier and bottle feeding. Rev 
Saude Publica. 2014;48(4):571-582. 

 
 


