Data collection methods and outcome measurements
Mothers who were enrolled in the study were surveyed at the beginning and end of the study using a structured questionnaire to gather information on child, maternal, and household characteristics. The mothers’ knowledge of breastfeeding was assessed based on 17 questions, with correct answers receiving a score of one and incorrect answers or unsure responses receiving a score of zero. The questionnaire used was adapted from a previous study among Chinese mothers, which was translated from English to Amharic (The mothers’ attitudes toward breastfeeding were evaluated using the Iowa Infant Feeding Attitude Scale, consisting of 17 items rated on a five-point Likert scale. Attitude toward breastfeeding was categorized as follows: (1) positive to breastfeeding (IIFAS score 70–85), (2) neutral (IIFAS score 49–69), and (3) positive to formula feeding (IIFAS score 17–48) (Mothers’ knowledge, attitude, and self-efficacy about complementary feeding were assessed using a pretested questionnaire. The knowledge questionnaire consists of 10 items and consists of both open-ended and multiple-choice questions. Each question was scored 1 for correct and 0 for incorrect answers. The scores were summed, and a mean score for knowledge questions was computed. Respondents who scored less than the mean were labeled as having “low” knowledge, and those who scored equal to or above the mean were considered to have “high” knowledge.Attitudes toward complementary feeding consisted of 8 items on a five-point Likert scale, rating maternal attitudes toward complementary feeding. A mean score for attitude questions was computed, and respondents who scored below the mean were considered to have an “unfavorable” attitude, and those who scored equal to or above the mean were considered to have a “favorable “attitude. Complementary feeding self-efficacy was measured by 9 items on a five-point Likert scale measuring maternal confidence. A mean score for self-efficacy questions was computed, and respondents who scored below the mean were considered to have “low” self-efficacy, while those who scored equal to or above the mean were considered to have “high “self-efficacy.Infants and children’s length and weight were measured twice by two different teams of data collectors. The measurements were recorded on separate forms to ensure that the first measurement did not influence the second. Before each measurement, the weighing scale was calibrated to zero. Standard measures were obtained for height and weight (