Bishoftu is located in Oromia National Regional State, East Shoa Zone at a distance of 47 Km from Addis Ab- aba, the Capital City of Ethiopia. It is one of the reform towns in the region and has a city administration, muni- cipality and nine kebeles, lowest administrative unit. The 2007 national census reported a total population of Bishoftu is 99,928 of whom 47,860 were men, 52,068 were women and 3177 were infants. Bishoftu has got one hospital and three health centers. The hospital logs roughly 154,000 visits a year with 4000 annual admissions.

Institutions based cross sectional study was conducted among mothers of infant aged less than six months who are selected in Bishoftu town at four public health facilities from January to February 2015 G.C.

Source of population comprised of mothers with infant aged less than six months who were attending four public health facilities for penta-valent three immunizations in Bishoftu town, of Oromia Region, Ethiopia.

Sample size for this study was calculated using single population proportion and assuming that the proportion of early initiation of complementary feeding for infants less than six months of age was 59.6% documented by Agedew et al. in Kamba district of South West Ethiopia [10] margin of error 5% and 95% confidence level. Therefore, n = 370, considering 14% for refusal and incomplete data (n= 370 + 52= 422).

The sampling unit was taken from each four public health facilities based on their predetermined client flow rate. To allocate the study subjects, first the average numbers of clients who visit for penta-valent three vaccinations were estimated by referring client registration book/record prior to data collection. Proportion to population size was made. Finally mothers’ infant pairs fulfilling the criteria were recruited based on their time of arrival at the survey site. The samples were collected from four public health facilities based on proportional allocations.

The questionnaire was adapted from the Ethiopian Demographic and Health Survey (EDHS) [8] and WHO recommended tools for the assessment Infant and Young child feeding practices for national surveys [13] . To proceed with data collection the questionnaire originally prepared in English language were translated in to local languages Afan Oromo and Amharic and then back to English for consistency. The interview guide was pretested using 12% of estimated sample size among mother infant pair visiting public health facilities for vaccination services in nearby town called Dukem, Oromia Region.

Data were collected on socio demographic characteristics, maternal health service uptake and infant feeding practice using “recall since birth” method. Face to face interview was conducted with mothers who visited health facility for penta-valent vaccination service for their child in four public health facilities. The data collectors were four female nurses, who have diploma or degree level of education and who were working in Modjo town were recruited and trained for one day on objectives, relevance of the study, confidentiality, informed consent, and techniques of interview.

According to WHO (2008) the term complementary feeding, reserved to describe appropriate feeding practices in breastfed children 6 - 23 months of age. Complementary foods are foods other than breast milk or infant formula liquids, semisolids, and solids introduced to infants to provide nutrients [14] [15] . In this study a baby received foods or fluids other than breast milk preceding the survey was considered as a child early exposed to complimentary food.

Delayed breastfeed initiation: If breast feeding were not initiated immediately after birth (within an hour) it is considered as late breast feeding initiation [14] [15] .

One day long training and pretesting was arranged for data collectors and supervisors. Moreover, the questionnaires were pre-tested at Dukem Health Center. The data collection tools were amended based on the finding of the pilot test. Supportive supervision was conducted during the beginning of the actual data collection by the investigator. Every questionnaire was checked for completeness and supervisors were providing feedback on the quality of the data on daily basis. In addition, filled questionnaires were cleaned and coded to enter into the computer by the data encoder.

Data were entered using EPI info statistical software 3.5.1 (CDC, Atlanta, Georgia, USA) and exported to Statistical Package for Social Science (SPSS) research (SPSS-IBM-version 20) for analysis. Cleaning was made using frequencies and univariate analysis. Percentages, frequency distributions and measures of central tendency and measures of dispersion were used for describing data. The investigator used “recall since birth” method to determine the prevalence of early initiation of complementary feeding among infants attending health facilities for penta-valent three vaccinations. Bivariate logistic regression was computed to identify the association of independent and dependent variables. Finally, independent variables found to have P-value ≤ 0.2 were entered to multivariate logistic regressions to control the effect of confounding.

Ethical approval was obtained from institutional review board of Adama Science and Technology University and Addis Continental Institute of Public Health (ACIPH). Permission to undertake the study was obtained from the Hospital, Health Centers, and Administrative Authorities. Informed consents were also obtained from the study participants after explaining the purpose of the study. Participation of all respondents in the survey was strictly voluntary. All information obtained from the respondent was anonymous and confidential.

In this study a total of 422 mothers with their index were enrolled, resulting a response rate of 100%. The mean (±SD) age of the mothers was 27 years (±4.66). Slightly higher than one third of mothers 155 (36.74%) were attended primary level of education. The most citied occupation of mothers 253 (60%) were house wife. And a little higher than half of respondents 244 (57.8%) were deliver their babies in hospital. The age of infants ranged from 3 to 4 months. Slightly lower than half of the children 196 (46.4%) were males. In terms of birth order around half 200 (47.4%) of them were first child for their family (Table 1).

Three hundred eighty four (91.0%) of mothers had received at least a single antenatal care services for the index infant. Slightly lower than half 47.4% of mothers were premipara, close to half 21 (51.2%) were multipara and the rest 6 (1.4%) were grand multipara mothers. The majority 96.4% of all mothers had institutional delivery and 15 (3.6%) of mothers reported home delivery.

Of all 416 (98.6%) mothers who had breastfed their child, at the time of the interview 32.9% (137/416; 95% CI: 28.0% - 37.0%) mothers had started complementary for their child. This finding revealed, in the study area, one third of infants were exposed to complementary food at three to four months of age. The foods/drinks given to breastfeeding child were milk other than breast milk 74.5%, infant formula 65.0%, plain water 5.1% and the others were constituted by fresh butter, glucose water and sugar salt solution (Figure 1).

A logistic regression model was used to examine factors associated with early initiation of complementary feeding as dependent variable. Multi-variable logistic regression analysis was computed and four predictor variables of early initiation of complementary feeding were identified. The odds of mothers with delayed initiation breastfeeding was 4.76 time higher to start early complementary feeding for their child than women who initiated breastfeeding within an hour with AOR 4.76 (95% CI; 2.48 - 9.13, P value < 0.001). The odds of mothers with employed mothers and mothers who gave birth in health facilities were 64% and 74% less likely exposed their infants for complementary feeding than their counterpart with AOR 0.34 (95% CI; 0.21, 0.55) and AOR 0.26 (95% CI; 0.08, 0.89), respectively. The odds of mother who lack knowledge on the recommended optimum duration of exclusive breastfeeding for a child was 3.91 times higher to start complementary feeding than mothers who knows it with AOR 3.91 (95%; 2.33, 6.54, P-value 0.001) (Table 2).