Prevalence of harmful traditional practices among mothers of under five children in Dire Dawa Administration, Eastern Ethiopia, and associated risk factors

Abstract

Introduction

Harmful traditional practices remain a major global public health concern. These practices violate human rights and negatively impact the health and well-being of community members, especially women and children. However, in the current study area, there is a lack of comprehensive research and up-to-date data specifically focusing on harmful traditional practices affecting children.

Objective

To assess the Prevalence of harmful traditional practices among mothers of under five children in Dire Dawa Administration, Eastern Ethiopia, and associated risk factors.

Methods

A community-based cross-sectional study was conducted in Dire Dawa from October 2nd to November 10th, 2023, involving 845 mothers with children under five years of age. A multi-stage sampling technique was employed, followed by a systematic random sampling method to select the study participants. Data were collected using KoboCollect, then exported, cleaned, and analyzed using the Statistical Package for the Social Sciences (SPSS) version 27. Both bivariate and multivariable logistic regression analyses were conducted to examine associations between dependent and independent variables. A p-value of less than 0.05 was considered statistically significant.

Result

Approximately one-third of mothers, 246 (29.5%; 95% CI: 26.3–32.7%), reported practicing at least one harmful traditional practice (HTP) on their children. The most commonly reported HTPs included uvula cutting, anal perforation, and traditional male circumcision. Significant factors associated with the practice of HTPs included maternal age, occupation, history of undergoing HTPs themselves, utilization of postnatal care services, and receiving counseling on HTPs during the antenatal period.

Conclusion

Despite ongoing efforts, nearly one-third of mothers continued to practice at least one harmful traditional practice on their children. To address this issue, healthcare providers should consistently deliver targeted information on the adverse effects of harmful traditional practices during both antenatal and postnatal care visits. Additionally, raising community awareness about the negative consequences of these practices on children’s health may help reduce their prevalence.

Supplementary information

The online version contains supplementary material available at 10.1186/s12887-025-06111-8.

Introduction

Traditional and customary practices reflect values and beliefs held by members of a community, spanning generations. These practices may be positive and at times negative [1]. Harmful traditional practices (HTPs) have no clear and universally agreed definition. Perhaps, the following definitions of HTPs seem inclusive and summative towards various definitions about HTPs. Harmful traditional practices are those customs that are known to have negative effects on the lives of people and hamper their equality and realization of their rights [2].

National Strategy and Action Plan (NSAP) on HTPs against women and children in Ethiopia defined harmful traditional practices as “traditional practices which violate and negatively affect the physical, sexual or psychological well-being, human rights and socio-economic participation of women and children [3]. Despite their harmful nature and their violation of international human rights laws, such practices persist because they are not questioned and take on an aura of morality in the eyes of those practicing them [4].

Globally, harmful traditional practices are a major public health problem. HTPs interfere with human rights and have adverse effects on the health and welfare of community members particularly, women and children [4]. The Practices have impacts on Women’s and children’s overall living situation which can be illustrated in social, economic, and political activities and services [5]. HTPs are deep-rooted beliefs performed based on tradition, culture, and religion. Moreover, irrational attitudes, lack of knowledge, and being unaware of the effects of the practices help maintain these problems [6].

Even though the prevalence and degree may vary, HTPs which have numerous short and long-term devastating effects are also performed in all continents of the world [7]. As in most African countries, Ethiopian children are vulnerable to several HTPs which are widely practiced with no or little attention to hygiene [6]. In Ethiopia, surveys at the national level identified five top priority HTPs, such as female genital mutilation, Uvulectomy, Milk teeth extraction, early marriage, and marriage by abduction [8].

Globally, female genital mutilation (FGM) affects about 130 million women and girls. About 84% of parents still have the intention to circumcise their daughters [9]. FGM remains highly prevalent in East and West Africa varying from 97% in Egypt to 80% in Ethiopia [10]. FGM is an abnormal practice that results in a substantial physical, obstetrical, and psychological effect on women and newborns during childbirth [11]. The most severe form of FGM is infibulation in which the clitoris is removed along with the labia minora and at least two-thirds of the labia majora [12].

FGM is performed using a blade or sharp materials by a religious leader, town elder, or a medical professional with limited training and its consequences can even include death as a result of shock, hemorrhage or septicemia, and infectious disease transmission [13]. This practice is performed to prevent fear of being rejected by the community, to prepare the girl for marriage, to ensure premarital virginity, & to prevent marital fidelity [14].

The magnitude of uvula cutting in the Dire Dawa Administration was found to be high on both baseline and follow-up surveys conducted in Ethiopia [15, 16]. The practice of uvulectomy increases with the mother’s age rising from age 15–19 to age 45–49, indicating an increasing trend in the practice. The practice is most prevalent among rural, with no education, and women with the lowest wealth [17]. About 83.5% of uvulectomy were performed under 6 months of age and about 3 out of 30 children are dying as a result of complications of uvulectomy, such as hemorrhage, obstruction of the airway due to aspirations, tetanus hepatitis, HIV, anemia, and septicemia [18]. The major reasons for uvulectomy were: swelling, pus which erupts leading to death, no better cure in modern medicine, and preventing repeated sore throat [19].

Milk teeth extraction is another HTP that is performed to prevent diarrhea or vomiting, fever, and problems of growth and development, root of milk teeth can have things such as worms or hair. Eye borrow incision is also believed to prevent eye diseases or infections [15, 16]. However, MTE remains a public health issue for children under the age of five around the world, primarily in East African countries. It has the most common complications including damage to lips and cheeks, pain, swelling, infection and bleeding, dry socket, and temporary numbness [20, 21].

Stakeholders such as human rights bodies, and United Nations agencies started addressing HTPs early in the 1990 s but there was little progress. Currently, Ethiopia launched a national strategy and plans to end every HTP by 2025. Ethiopia made great efforts to achieve the national plans; such as health education about the negative consequences, community mobilization, and awareness creation to social help like “Idir” leaders, religious leaders, and traditional healers to draw clients enhancing the capacity of service provision [22].

Moreover, the national constitution, criminal and family laws, education, health, population, and cultural policies of Ethiopia included articles that directly or indirectly combat HTPs [23].

Despite the above efforts to reduce the problem over the years, findings from studies in different regions of Ethiopia showed that the practice continues and the victims are vulnerable to various health conditions. Therefore, it will be difficult to accomplish the national plan or expectation of ending every HTP from Ethiopia by 2025. To combat HTPs and achieve national expectations, a localized and contextualized understanding of commonly existing HTPs is very important.

However, a comprehensive study and up-to-date data on harmful traditional practices (HTPs) among children were lacking in the study area. After an extensive literature review, we identified the need to explore obstetric-related factors—such as antenatal care (ANC) follow-up, postnatal care (PNC) follow-up, place of delivery, and counseling by health professionals on HTPs during ANC and PNC—and their association with overall HTPs, beyond their known links to specific practices. Therefore, the objective of this study is to assess the prevalence of HTPs and their associated factors in the Dire Dawa Administration, Eastern Ethiopia.

Methods and materials

Study area and period

This study was conducted in the Dire Dawa administration from October 2nd to November 10th, 2023. Dire Dawa administrative is located 515 km east of Addis Ababa. The population of the administration is composed of heterogeneous ethnic groups with diversified cultures. These ethnic groups include Oromo (48%), Amhara (27.7%), Somali (13.9%), Guragie (4.5%), Sebat Bet (2.3%), Sodo (0.8%), Silte (1.4%), and 5.9% others. Regarding the religious composition, the most believers in Dire Dawa are Islam at 70.9%, 25.6% are Ethiopian Orthodox, 2.8% are Protestant, and 0.4% are Catholic. Dire Dawa is organized under 38 rural and 9 urban kebeles.

Study design and population

A community-based cross-sectional study design was employed. All mothers with children under the age of five in the Dire Dawa Administration were included in the study, while mothers who were seriously ill or unable to respond were excluded.

Sampling and sampling procedures

The sample size was obtained by a single population proportion formula using the following assumption: the estimated proportion of at least one harmful traditional practice among children in the Fentale Woreda was 48.4% [24], yielding a sample size of 384. Considering the use of a multi-stage sampling technique, a design effect of 2 was applied, resulting in 384 × 2 = 768. After adding a 10% non-response rate, the final sample size was calculated to be 845.

Sampling techniques

A multistage sampling technique was employed to select the study participants. First, the kebeles were stratified into urban and rural categories. Then, 6 urban kebeles were selected from a total of 9, and 8 rural kebeles were selected from a total of 38, using a simple random sampling method. The number of mothers to be included in the study from each selected kebele was determined proportionally, based on the total number of children under five in each kebele. Within the selected kebeles, participants were chosen using systematic random sampling. The first participant was selected by the lottery method from the first three households, and thereafter, every 4th household was included in the study.

Finally, mothers in the selected kebeles were interviewed for the quantitative study. If a household had more than one child under the age of five, one child was selected using the lottery method.

Operational definitions

• Harmful traditional practices: Having practiced one of the malpractices is considered a harmful cultural practice; i.e. (FGM, uvulectomy, milk teeth extraction, and anal perforation) [25].

• Female Genital Mutilation: a traditional operation that involves cutting away parts of the female external genitalia or other injuries to the female genitalia for cultural reasons [26].

• Uvulectomy: this is a procedure involving the cutting of the uvula and sometimes the nearby structures such as the tonsils [8].

• Milk teeth extraction: is the procedure of pulling out the early teeth of children [8].

Data collection instruments and measurements

Data were collected through face-to-face interviews using a structured questionnaire adapted from several relevant studies [27, 30, 31], covered socio-demographic characteristics, the prevalence of harmful traditional practices, and maternal obstetric health-related factors. The questionnaire was initially prepared in English, then translated into the local languages (Amharic, Afan Oromo and Somali) subsequently back-translated to English to ensure consistency. Fourteen BSc midwives who were fluent in the local languages (Afan Oromo and Somali) were recruited as data collectors, and three supervisors oversaw the entire data collection process. The questionnaire is provided as a supplementary file.

Data quality assurance

The quality was ensured through a pretest of the data collection tools, conducted on 5% (43 mothers) of the target population who had children under five years old but were from kebeles not included in the main study. Based on the results of the pretest, necessary modifications were made to the questionnaire. Prior to data collection, a two-day training session was provided to the data collectors and supervisors. The training emphasized the objectives of the study, the significance and correct interpretation of each question, ethical considerations, and the handling of sensitive content.

Investigators and supervisors closely monitored the entire data collection process, reviewing each step for completeness and logical consistency. Completed questionnaires were checked daily, and feedback was provided to data collectors each morning. Supervisors were responsible for collecting the completed questionnaires, coordinating the fieldwork, and conducting spot checks to ensure the overall quality and integrity of the data collection process.

Data processing and analysis

The data were checked for completeness and consistency before analysis. The collected data were exported from KoboCollect to SPSS version 27.0 for analysis. Frequencies and percentages were used to present the findings in tables and text. The association between the outcome variable and independent variables was assessed using a binary logistic regression model. A backward stepwise approach was employed for variable selection in the regression analysis.

Hosmer and Lemeshow’s goodness-of-fit test was used to evaluate whether the model assumptions were met. The direction and strength of statistical associations were determined using odds ratios (ORs) with 95% confidence intervals (CIs). An adjusted odd ratio (AOR) with a 95% CI and a p-value of less than 0.05 was considered statistically significant for the association with practicing at least one harmful traditional practice (HTP).

Result

Sociodemographic characteristics

Out of the total calculated sample size, 833 mothers were interviewed, yielding a response rate of 98.57%. The mean age of the mothers was 29.27 years (SD ± 4.74), and the mean age of the children was 2.36 years (SD ± 1.32). Regarding the sex of the children, slightly more than half, 425 (51%), were male. More than half of the participants, 534 (64.1%) was Muslim followers, and 237 (28.5%) of the mothers had completed high school education (grades 9–12). Nearly 60% of the participants were housewives by occupation [Table 1].

Table 1.

Distribution of sociodemographic profiles among mothers who have a child less than 5 years old in dire dawa, Eastern ethiopia, 2023 (n = 833)

Variable	Frequency	Percentage
Resident
Urban	726	87.2
Rural	107	12.8
Age of child in months
0–12	107	12.8
12–24	101	12.1
25–36	217	26.1
37–48	199	23.9
49–59	209	25.1
Sex of child
Male	425	51
Female	408	49
Age of Mothers (Years)
<20	8	1.0
20–24	99	11.9
25–29	349	41.9
30–34	225	27
35–39	135	16.2
40+	17	2.0
Religion
Orthodox	274	32.9
Muslim	534	64.1
Protestant	25	3
Mothers education status
Unable to read and write	89	10.7
Able to read and write	87	10.4
Elementary 1-8th grade	188	22.6
High school 9-12th grade	237	28.5
Diploma and above	232	27.9
Occupation of mothers
Housewife	491	58.9
Government employed	142	17
Merchant	175	21
Farmer	6	0.7
Others**	19	2.3
Husband education status
Unable to read and write	38	4.6
Able to read and write	63	7.6
Elementary 1-8th grade	149	17.9
High school 9-12th grade	197	23.6
Diploma and above	386	46.3
Fathers Occupation
Farmer	88	10.6
Merchant	191	22.9
Government Employed	264	31.7
Daily Laborer	159	19.1
Self-employed	90	10.8
Jobless	14	1.7
Others**	27	3.2

** Daily laborer, barber; **Military, Driver

Awareness & experience of mothers on harmful traditional practice

Almost all mothers, 826 (99.2%), reported awareness of at least one harmful traditional practice (HTP) that affects children. The most commonly mentioned HTPs were female genital mutilation (787, 94.5%), followed by uvula cutting (uvulectomy) (699, 83.9%) and child or early marriage (580, 69.6%).

Regarding sources of information, the most frequently mentioned were family members (435, 52.2%), followed by mass media (421, 50.5%) and schools or reading materials (376, 45.1%).

Nearly 60% (59.3%) of the mothers reported having experienced at least one HTP themselves. Among these, the majority had undergone uvula cutting (377, 76.3%) and female genital mutilation (327, 66.2%) during early childhood. Additionally, 99 mothers (11.9%) believed that harmful traditional practices have some benefit. Of these, 83 (84.7%) cited cultural value as the reason. Still, 60 mothers (7.2%) stated that they intend to perform HTPs on their children in the future, with uvula cutting being the most commonly mentioned [Table 2].

Table 2.

Distribution of mentioned HTPs and their source of information among mothers who have a child aged less than 5 years in dire dawa, Eastern ethiopia, 2023 (n = 833)

Variable	Frequency	Percentage
Information about HTPs
Yes	826	99.2
No	7	0.8
Types of HTPs mentioned
Female genital mutilation	787	94.5
uvula cutting (uvulectomy)	699	83.9
child marriage or early marriage	580	69.6
Tonsillectomy	488	58.6
Milk Teeth Extraction	432	51.9
Son preference	322	38.7
Traditional male circumcision	423	50.8
Anal perforation	461	55.3
Feeding fresh butter to newborn babies	409	49.1
Forbidding food and fluids during diarrhea	375	45.0
Keeping babies out of the sun	367	44.1
Source of information for HTP
Mass media	421	50.5
Health professional	312	37.5
Family members	435	52.2
Meeting/conferences	240	28.8
Community leader	242	29.1
Religious leader	179	21.5
School/reading	376	45.1
Any HTPs performed on the mother
Yes	494	59.3
No	332	39.9
Type of HTPs performed on mothers (n = 494)
Female genital mutilation	327	66.2
Uvula cutting	377	76.3
Milk Teeth Extraction	84	17
Tonsillectomy	78	15.8
Anal Perforation	157	31.8
Feeding fresh butter to newborn babies	87	17.6
Others*	3	0.4
Thinking if HTPs are harmful (n = 826)
Yes	727	87.3
No	99	11.9
Reasons of mothers considering HTPs are beneficial (N = 99)
Due to our culture	83	84.7
The child will be harmed	22	22.4
Previous experiences of children died b/c of HTPs	17	17.3
Others*	13	13.3
Perform HTPs in the future
Yes	60	7.2
No	705	84.6
I do not know	61	7.3
Types of HTPs will be performed
Uvula cutting	50	83.3
FGM	13	21.7
Tonsillectomy	8	11.7
MTE	6	10
Anal perforation	9	15
Should HTPs be eradicated? (n = 826)
Yes	717	86.1
No	109	13.1
Reasons for Shoudn.t eradicated HTPs
Beneficial Against culture	95	11.4
Eradication is against culture	33	4.0
It is used for treatment purposes	19	2.3
Others*	3	0.3

• It is allowed by religious

The magnitude of harmful traditional practices

Out of the total participants, 246 mothers (29.5%; 95% CI: 26.3–32.7) reported practicing at least one harmful traditional practice (HTP) on their children—132 involving male children and 114 involving female children. The most commonly performed HTPs were uvula cutting (178, 72.4%), anal perforation (56, 22.8%), and traditional male circumcision (37, 28%). In contrast, practices such as withholding food and fluids during diarrhea, keeping babies out of the sun, son preference, and nasal perforation were the least reported, each accounting for less than 2%.

Regarding who performed the most recent HTPs (prior to the data collection date), traditional healers were responsible for 171 (20.4%) cases, followed by the mothers themselves (48, 5.8%), and grandparents (19, 2.3%). Other performers included fathers and neighbors (3 cases each, 0.4%) and siblings (2 cases, 0.2%). The majority of the children (209, 84.9%) were reportedly healthy at the time the HTP was performed, while 37 (4.4%) were sick. After the procedures, 34 children (4.1%) experienced complications, including difficulty swallowing (21, 2.5%), wound or infection (13, 1.6%), excessive bleeding (12, 1.4%), and swelling (3, 0.4%) (Fig. 1).

Fig. 1.

Types of harmful traditional practices carried out on children less than 5 years old in Dire Dawa, Eastern Ethiopia, 2023

Reasons to perform harmful traditional practices

The main reason mothers reported for performing female genital mutilation (FGM) was cultural tradition, cited by 29 respondents (74.4%). Additional reasons included preventing the destruction of household property (10, 25.6%) and avoiding early sexual activity before marriage (8, 20.5%). Among mothers who practiced uvula cutting, the primary reason was to prevent sleep apnea, as reported by 165 respondents (19.8%). For those who practiced milk teeth extraction, 26 mothers (3.1%) cited reasons such as preventing diarrhea and vomiting, avoiding dental problems, and curing or preventing illness [Table 3].

Table 3.

Reasons associated with harmful traditional practices among mothers of children less the 5 years old in dire Dawa administration, Eastern ethiopia, 2023

Variable	Frequency	Percentage
Reasons for performing FGM
For cultural purpose	29	3.5
To prevent the destruction of material in the home	10	1.2
To prevent early sexual intercourse pre-marriage	8	1
Reasons for performing uvula cutting
To prevent sleeping apnea	165	19.8
To prevent vomiting and headache	23	2.7
Other*	2	0.2
Reason to perform tonsillectomy
To prevent swelling, pus, or rupture of the tonsil	17	2
To prevent sore throat	25	3
No better medical cure	7	0.8
Reason to perform MTE*
To prevent diarrhea and vomiting	26	3.1
Prevention of teething problem	15	1.8
Reason to perform Anal perforation
To manage constipation	42	5
To open the anal canal	32	3.8
Others**	35	4.2

* To prevent the descent of uvula

Mother’s healthcare obstetric conditions

The majority of mothers, 812 (97.5%), had antenatal care (ANC) follow-up, and 789 (94.7%) delivered at a health institution. Additionally, more than 95% of the respondents had at least one postnatal care (PNC) follow-up for their selected child. Over 40% of the mothers received counseling on harmful traditional practices (HTPs) during ANC follow-up (365, 43.8%), while 380 (45.6%) received similar counseling during PNC follow-up.

Factors associated with the magnitude of harmful traditional practice

In the bivariate logistic regression analysis, ten variables were found to be eligible for further analysis. These included mother’s occupation, mother’s age, educational status, maternal history of HTPs, antenatal care (ANC), place of delivery, postnatal care (PNC) follow-up, and receiving counseling about harmful traditional practices (HTPs) during ANC and PNC.

In the multivariate analysis, the mother’s occupation, age, history of HTPs, PNC follow-up, and receiving counseling during ANC were significantly associated with the practice of at least one HTP.

There was a strong association between the mother’s occupation and the practice of HTPs. Housewives were more than three times more likely to practice HTPs on their children compared to mothers who were merchants or had other occupations (AOR = 3.326; 95% CI: 1.755–6.302). Mothers who had experienced HTPs themselves were four times more likely to practice it on their children (AOR = 4.210; 95% CI: 2.806–6.317) compared to those without such history.

Mothers who did not attend PNC follow-up were 6.28 times more likely to practice HTPs (AOR = 6.280; 95% CI: 1.685–23.406) than those who did. Additionally, mothers who did not receive counseling on HTPs during ANC were seven times more likely to practice HTPs on their children (AOR = 7.418; 95% CI: 3.251–16.926) compared to those who received such counseling [Table 4].

Table 4.

Factors associated with the prevalence of harmful traditional practices among mothers of under five children in dire Dawa administration, Eastern ethiopia, 2023

Factors	Perform at least one HTP		Crude Odd Ratio (95% CI)	AOR (95% CI)	P-value
	Yes	No
Address
Urban	192	534	1	1
Rural	54	53	2.834 (1.874, 4.284)	1.026 (0.574, 1.832)	0.931
Age of mothers (years)
<25	22	85	1	1
25–29	84	265	2.191 (1.234, 3.889)	2.405 (1.230, 4.701)	0.010*
30–34	85	140	1.789 (1.185, 2.701)	1.535 (0.927, 2.540)	0. 096
35+	55	97	0.934 (0.61, 1.431)	0.823 (0.490, 1.381)	0. 461
Educational status
No formal education	81	95	2.542 (1.801, 3.589)	1.289 (0.831, 2.001)	0.257
Educated	165	492	1	1
Mothers Occupation
Housewife	167	324	4.059 (2.336, 7.054)	3.326 (1.755, 6.302)	0.000**
Civil Servant	16	126	1.121 (0.788, 1.594)	0.980 (0.647, 1.486)	0.925
Merchant and Others	63	137	1	1
HTPs performed on the mother themselves
Yes	197	297	3.926 (2.76, 5.583)	4.210 (2.806, 6.317)	0.000**
No	49	290	1	1
ANC follow-up
Yes	233	579	1	1
No	13	8	4.038 (1.652, 9.870)	0.445 (0.133, 1.494)	0. 190
Place of Delivery
Home	25	19	3.382 (1.826, 6.264)	0.674 (0.238, 1.909)	0.457
Health facility	221	568	1	1
PNC follow-up
Yes	219	580	1	1
No	27	7	10.215 (4.385, 23.798)	6.280 (1.685, 23.406)	0.006*
Received Counseling on HTPs during ANC
Yes	50	315	1	1
No	196	272	4.540 (3.198, 6.444)	7.418 (3.251, 16.926)	0.000**
Received Counseling on HTPs during PNC
Yes	62	318	1	1
No	184	269	3.508 (2.521, 4.882)	0.745 (0.333, 1.666)	0.473

*Statistically significant at p-value < 0.05 in multivariate logistic regression analysis

Discussion

This study revealed that the magnitude of at least one Harmful Traditional Practice was 29.5%. This finding is lower than those reported in previous studies: 87.8% in Axum (2014), 74% in the Awi Zone, Amhara Region (2022), and 48.4% in Fentale Woreda [27, 30, 31]. The difference may be attributed to the time gap and improvements in the healthcare system in the current study area, which may now actively discourage harmful traditional practices. Additionally, in this study, a high proportion of mothers received both antenatal and postnatal care, during which they likely received counseling on the consequences of harmful traditional practices.

However, our study also found that the most commonly performed HTP on children was uvula cutting. This finding is consistent with those from Axum, the Awi Zone, and Fentale Woreda. This may be due to the persistent belief within the community that uvula cutting helps prevent snoring, along with the perception that there is no better medical treatment available for this condition.

In this study, the prevalence of female genital mutilation (FGM) among children was 34 (9.3%), which is lower than the findings from the 2016 Ethiopian Demographic and Health Survey (EDHS) in Dire Dawa (75%) and the study conducted in the Awi Zone (24.6%). This difference may be due to the fact that our study focused specifically on children under five years of age, whereas the EDHS includes all women of reproductive age. Another possible explanation is the time gap between the studies, during which increased awareness and education about the harmful consequences of FGM may have contributed to a decline in the practice within the community.

In this study, mothers under the age of 25 were less likely to perform at least one harmful traditional practice (HTP) on their children. This finding aligns with the study from the Awi Zone, which also reported that younger mothers (under 25) were less likely to engage in HTPs compared to older mothers (above 24 years). This may be because older mothers tend to be more supportive of traditional practices and may have less awareness about their negative health consequences.

In this study, mothers who had experienced harmful traditional practices (HTPs) themselves were four times more likely to practice HTPs on their children compared to those who had not. This finding is supported by a study conducted in Axum. A possible explanation is that these mothers may view HTPs as important cultural traditions passed down through generations. Additionally, they may believe that such practices have therapeutic benefits for their children’s health problems.

This study also examined maternal obstetric factors associated with the practice of HTPs. Notably, mothers who did not attend postnatal care (PNC) follow-up were 6.28 times more likely to perform HTPs compared to those who did. Similarly, mothers who did not receive counseling on HTPs during antenatal care (ANC) were seven times more likely to practice HTPs on their children than those who received such counseling. These associations may be explained by the role of ANC and PNC visits in providing mothers with crucial health education. Mothers who attend PNC are more likely to receive accurate information about the risks of HTPs and learn about appropriate medical care for common childhood health concerns. This awareness may discourage them from resorting to traditional practices. Conversely, mothers who do not receive counseling on HTPs during ANC may be more inclined to continue such practices due to cultural beliefs or the perception that they have therapeutic value.

A limitation of this study is that the study population was restricted to children under five years of age, which may have affected the observed prevalence of certain harmful traditional practices (HTPs), particularly female genital mutilation (FGM), as this practice can be performed at older ages, even up to the reproductive period. Additionally, the use of self-reported data to assess maternal obstetric health-related factors and the health status of children may have introduced reporting bias.

Conclusion

Based on the findings, the following conclusions were drawn:

• Nearly one-third (29.5%) of mothers reported practicing at least one harmful traditional practice on their children.

• The most commonly performed HTPs were uvula cutting, anal perforation, and traditional male circumcision, with uvula cutting being the most prevalent.

• The key factors associated with the practice of at least one HTP included the mother’s age and occupation, a history of HTPs performed on the mother, lack of postnatal care (PNC) follow-up, and not receiving counseling on HTPs during antenatal care (ANC).

Supplementary information

Below is the link to the electronic supplementary material.

Abbreviations

AOR

Adjusted odds ratio

CI

Confidence Interval

EDHS

Ethiopian Demographic Health Survey

FGM

Female Genital Mutilation

HTPs

Harmful Traditional Practices

IRB

Institutional Review Board

MTE

Milk Teeth Extraction

NSAP

National Strategy and Action Plan

SDG

Sustainable Development Goal

UC

Uvula Cutting

UNFPA

United Nations Population Fund

UNICEF

United Nations International Children’s Emergency Fund

WHO

World Health Organization

Author contributions

“AG: involved in originating the research concept, design of the study, data collection, data analysis, drafting, and critically reviewing the manuscript. LA and TA: Originating research concept, involved in designing the study, analysis of the data and critically reviewing the manuscript.All authors reviewed the manuscript.”

Funding

Not applicable.

Data availability

The datasets used and/or analyzed are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

Ethical clearance was obtained from the Institutional Review Board (IRB) of Dire Dawa University (protocol number DDU-IRB-2023-192). Following approval, an official letter of support was submitted to the Dire Dawa Regional Health Bureau. Subsequently, permission was obtained from the management bodies of each selected kebele. Participants were informed that their participation was voluntary and that they could withdraw at any time if they felt uncomfortable with the questionnaire. Written informed consent was obtained from all participants prior to the interviews, which were conducted privately in designated counseling rooms. To ensure anonymity, no names or personal identifiers were recorded on the questionnaires. Furthermore, all fundamental principles of human research ethics—including respect for persons, beneficence, voluntary participation, confidentiality, and justice—were strictly observed.

During data collection, if participants exhibited injuries related to recent harmful traditional practices or experienced psychological or mental health issues due to these practices, data collectors and supervisors provided appropriate counseling. Depending on the situation, first aid was administered, and referrals were made to relevant health facilities.

Consent for publication

This part is not applicable because the manuscript contains no person’s data in any form (including individual details, images, or videos).

Competing interests

The authors declare no competing interests.