Fathers involvement in child feeding and its associated factors among fathers having children aged 6 to 24 months in Antsokia Gemza Woreda, Ethiopia: Cross-sectional study

Solomon Ketema Bogale; Niguss Cherie; Eyob Ketema Bogale

doi:10.1371/journal.pone.0276565

. 2022 Nov 28;17(11):e0276565. doi: 10.1371/journal.pone.0276565

Fathers involvement in child feeding and its associated factors among fathers having children aged 6 to 24 months in Antsokia Gemza Woreda, Ethiopia: Cross-sectional study

Solomon Ketema Bogale ^1,^#, Niguss Cherie ^2,^#, Eyob Ketema Bogale ^3,^*,^#

Editor: Khatijah Lim Abdullah⁴

PMCID: PMC9704664 PMID: 36441739

Abstract

Background

Father Involvement is exercising positive influences on child feeding. Mothers are usually the primary caregivers for young children. The role of fathers in the proper child feeding of young children has not been a frequent topic of study. Past research has found low rates and little is known about fathers’ involvement in child feeding for children 6–23 months in Ethiopia. The aim of this study is to assess fathers’ involvement in child feeding children aged 6–24 Months.

Objectives

To assess fathers’ involvement in child feeding and associated factors among fathers having children aged 6 to 24 months.

Methodology

A community-based cross-sectional study design was conducted from Jan 23/2022 to April 07/2022. A systematic random sampling technique was applied to select study participants. A total of 408 respondents participated in the study. Data was entered into EPI data version 3.1 and then exported to SPSS version 25 for analysis. Bivariable and multivariable logistic regression was used for analysis.

Result

Father’s involvement in child feeding was 43.1%. Factors that were significantly associated with good fathers involvement in child feeding include urban residence(AOR = 3.878, 95% CI = (1.408–10.678), male sex of the youngest child(AOR = 3.681, 95% CI = (1.678–8.075)), first birth order of the youngest child(AOR = 3.970, 95% CI = (1.212–13.005)), Better(secondary and higher) educational status (AOR = 4.945,95% CI = (1.043–23.454)) and AOR = 5.151, 95% CI = (1.122–23.651)), having ever heard information(AOR = 8.593, 95% CI = (3.044–24.261)), good knowledge (AOR = 3.843,95% CI = (1.318–11.210)), positive attitude (AOR = 8.565, 95% CI = (3.521–20.837)) and good culture (AOR = 10.582,95% CI = (2.818–39.734)).

Conclusions

Father involvement in child feeding was poor in Antsokia Gemza Woreda. Urban residences, male sex of the youngest child, first birth order of the youngest child, better (secondary and higher) educational status, having ever heard information, good knowledge, positive attitude, and good culture were significantly associated with fathers’ involvement in child feeding. Health information dissemination on father involvement in child feeding should be strengthened.

Introduction

Father involvement is exercising positive influences on child feeding practices and can be involved in financial and resource support; social support and physical support such as shared responsibility for the nutritional well-being and health of the child. Positive nutritional outcomes in children can be brought by father involvement as seen by a study in Ethiopia which found that for children aged between 6–23 months, dietary diversity in the household increased by 13.7%. To promote optimal feeding practices in children, there is a need to increase the direct involvement of fathers [1].

Father Involvement has been shown to significantly improve appropriate infant and young child feeding practices [2]. Father involvement has been associated with positive social, emotional, psychological, developmental, and health outcomes in a child [3]. Proper child feeding is crucial for optimal growth, health, and development of children, especially in the age of 0‐2 years. However, this period is often marked by micronutrient deficiencies that result in frequent childhood illnesses [4].

A study in Vietnamese, Peruvian, sub-Saharan Africa, and South Africa showed that children whose fathers were not involved in child feeding were found to be at higher risk of malnutrition, which indicates the need for paternal involvement in child feeding and child health care system in general and nutritional outcome in particular [5].

Globally Over 33% of all infant deaths globally can be indirectly linked to malnutrition. [6]. And an estimated 5.4 million under 5 children died in 2017 and roughly half of these deaths occurred in sub-Saharan Africa [7]. In Ethiopia, 38% of children are stunted, 10% are wasted, and 24% are underweight which informed the occurrence of both acute and chronic undernutrition [8]. Child feeding practice is a significant topic in developing countries where undernutrition is the underlying cause of more than 50% of child deaths [9].

Studies reveal a strong correlation between dads’ substantial involvement in infant feeding activities and nutritional diversification [10]. and families with involved fathers had significantly better breastfeeding practices than those with less involved fathers, such as attending breastfeeding sessions with moms, participating in decision-making, and supporting the mother around the house [11, 12]. Another community-based participatory intervention study revealed that involving both parents equally and actively in child-feeding is a promising strategy for preventing childhood obesity [13]

Most of the studies and interventions on the parents’ role in Infant Young Child Feeding (IYCF) have focused on mothers, not fathers [14]. The role of fathers in child health including child feeding has recently begun to appear on the agenda of the developed world. However, in developing countries, despite fathers overruling roles in the incoming generation and decision-making for the family, they have been largely neglected in agendas for improvements to child health [15–17].

In Ethiopia, there are gender-specific roles. Fathers are responsible for raising money and ensuring there is food from the garden for the family, but looking after the children and performing domestic activities are mothers’ responsibilities. Mothers are usually considered to be subordinate to their husbands [18].

Interventions have been implemented through mothers as the primary caregivers to combat child malnutrition, but the father’s role is usually considered insignificant even though a child’s full development probably depends on the complex care that they receive from both the mother and father [19].

Determining the extent of Father Involvement in child feeding is important because early childhood represents a key developmental window to shape healthy behaviors into late childhood and adulthood [20]. A study in Ethiopia shows that fathers who had good participation in child feeding activities have a positive influence on better dietary diversity [21].

Alive &Thrive’s activities in Ethiopia are designed to engage fathers in child feeding by identifying the strategies that seem to make these programs work to ensure that fathers can play an active role in improving child feeding practice by applying 6 strategies such as grabbing their attention with emotion, ease the way by busting stereotypes, find fathers where they already are, “provide crystal-clear direction” for actions fathers can take, give fathers practice and show fathers a benefit that they care about [22].

To date studies most often address fathers’ socioeconomic status in relation to children’s lives, but they are superficial and insufficient evidence for understanding fathers’ involvement in child feeding practice. [23, 24]. To the best of our knowledge, there is minimal scientific literature on fathers’ involvement in child feeding. However, their role in their family other than income generation, farming, and dealing with family contacts outside the home is very limited.

The finding of this study will be helpful for policymakers (whether governmental or Non-Governmental Organizations working on child feeding practices) to design evidence-based alternative strategies. It is also used by researchers as a baseline for future related studies. It is also key for health professionals for providing evidence-based counseling on the study area. The purpose of this study will be to assess fathers’ involvement in child feeding practice and associated factors among fathers having children aged 6 to 24 months to address the aforementioned gap in the area.

Materials and methods

Study design and settings

A community-based cross-sectional study design was conducted from Jan 23 to April 07, 2022, among fathers who had children aged between 6 -and 24 months and residing in Antsokiya Gemza Woreda (Fig 1). it is found in the North Shoa zone, Amhara region around 400 km far away from Addis Ababa, 505 km from the city of Amhara regional state, which is Bahir Dar city, and 270 km from zonal capital Debre Berhan. The estimated total population of the woreda is estimated to be 66673 in 2021: among those 20% live in urban and 80% of them in rural areas. The majority of the inhabitants are orthodox which is 85%, 10% are Muslim and the rest 5% are protestant by religion. The woreda has 11% cold, 44% moderate, and 54% hot weather conditions. According to the 2021 report of the Antsokia health sector office, there were 5 health centers and 12 health posts. There are also around 2927 fathers who have children from 6 to 24 months living in the woreda [25].

Participants and sampling

Fathers who had children aged 6 to 24 months and household members, who resided in Antsokiya Gemza Woreda for at least six months during data collection were included in the study whereas fathers who were critically ill and unable to communicate during the data collection period were excluded from the study.

The sample size was calculated by considering the two specific objectives; using the formula for estimation of single population proportion and using Epi info version 7 to identify the factors. Based on the single population proportion assumptions were: A 95% confidence level (Z), 5% margin of error (E), and the proportion of fathers involved in child feeding was 59.1% (from the study in Dakshina Kannada, a coastal district in Karnataka State) in the previous study [26]. The final sample size was 408 after adding 10% non-respondent. We took the largest estimated sample.

Systematic random sampling was applied to select study participants. All 12 kebeles were incorporated into the study. The data were collected within a one-month duration. Proportional allocation of the study (PAS) participants was considered among all kebeles. A list of households with the study subjects was identified using the community health management information system (CHMIS) folder in the health post for rural kebeles and through census for urban kebele. The sampling interval (kth unit) was obtained by dividing the entire fathers (the total number of fathers who had children from 6 to 24 months) (2927) by the desired sample size (total number of sample size (408) and it was approximately 7. The first father was randomly chosen for the survey by the lottery method from the first seven fathers, and then every seventh was recruited for the study to identify a total of 408 samples. The name and address of fathers having children aged 6–24 months were specified and their location was identified in collaboration with the kebele’s health extension workers and health development army leaders, identified fathers were then interviewed in their homes.

Data collection

Literature is reviewed to develop a questionnaire [27]. The data were collected using pretested, structured, interviewer-administered questionnaire. Interviews were conducted at the father’s home in the Amharic language. Ethical approval for this study was obtained from the Institution Review Board (IRB) of Zemen Post Graduate College. A permission letter from the Antsokia Gemza Woreda Health office and selected kebeles administrations were informed about the study. Data were collected after explaining the study, the benefit of the study, the research purpose orally, and getting verbal informed consent from each participant. Data were collected by four clinical nurses. Data collectors were trained for one day prior to the data collection. Two Health officers supervised the data collection. Each day questionnaires were checked for completeness and consistency by the principal investigator and supervisors.

Measurements

Fathers’ involvement in child feeding practice was assessed using 22 items with five major domains such as shared decision making in child feeding practice (6 items), providing physical support to the mother (5 items), providing psychosocial support (3 items), providing financial and resource support (5 items) and workload sharing (3 items). From these 22 questions directed to the fathers, variable scores of 12 and above were considered as good fathers’ involvement while variable scores of below 12 were considered as poor fathers’ involvement in child feeding practices [28].

Knowledge of fathers towards fathers’ involvement in child feeding was also assessed using 9 items that were directed to the fathers. The questions asked had the following components asked in such a way that do you know about; baby start complementary feeding at 6 months, recommended duration of breastfeeds 24 months or more, have a role in providing advice on diet, have a role in farming/gardening nutritious food, have a role in financial support to buy nutritious food, have a role in cooking a meal for a child, have a role in accompaniment to medical appointments/growth monitoring, have a role in social and emotional support and have a role to help child feeding mothers with household chores. Fathers who scored five and above among the listed nine items were considered as having good knowledge of fathers’ involvement in child feeding practices while those who scored below five were considered as having poor knowledge of fathers’ involvement in child feeding practices [29].

The responses of fathers about the attitude towards father involvement in child feeding were in the form of a 5-point Likert scale, wherein a score of +2 meant they strongly agreed with the statement, +1 meant agreed, 0 neutral feeling to the statement, -1 meant disagreed to the statement and -2 was the score for strongly disagree. The total score was calculated and transformed into the mean ‘percent score’ by dividing the score by the possible maximum score and multiplying it by 100. Scores for attitude were categorized as negative [0-< = 60%] and positive [>60%] [29].

Data quality assurance

A pre-test was done on 5% (20) of the sample size before the actual data collection. Amendments were made on questions after pre-testing. The questionnaire was prepared first in English and then translated to the local language of Amharic and back-translated to English by a third person who was native to Amharic and had experience in translation. The reliability tests were checked using Cronbach’s alpha of 0.7 as the cut-off point to assess the internal consistency of the research instrument. The overall Cronbach’s alpha coefficient value for the data collecting instrument was found to be 0.827 indicating the acceptability of the scale for further analysis. Hosmer and Lemeshow’s test value was checked for its model fitness and its result is 0.833 indicating the model was fit.

The training was given to data collectors about the data collection tool and how to collect data before data collection, to have a common understanding. Data were cleaned and checked for outliers before analysis. Negatively worded statements of the items were reverse coded before analysis.

Literature is reviewed to develop a questionnaire [27] and it was modified in our context. Furthermore, we have done a pretest since pre-tests also provide the most direct evidence for the validity of the questionnaire. Moreover, to determine the content validity of the questionnaire, the collected views, as well as comments from experts in the fields of nutrition, biostatics, and epidemiology, were taken.

Data management and analysis

The data were collected, checked for completeness and consistency, and then entered into epi data version 4.7. The data was coded and cleaned; finally, it was exported to Statistical Package for Social Science (SPSS) version 25 software. The data were checked for outliers and missing values and were analyzed using SPSS version 25 software. Descriptive statistics were used to describe the percentage and number of distribution of respondents by each variable. Descriptive summary measures such as mean and median were computed and the results were presented using texts, figures, and tables.

Before logistic regression analysis, the assumption was checked and the data qualified for logistic regression. Bivariable and multivariable logistic regression analysis was used to identify predictors of behavioral responses. Independent variables with a P-value < of 0.25 in the bivariate analysis were entered into the multivariable logistic regression in order to control the possible effect of confounders using the backward likelihood regression variable selection method.

In the final model, a p-value < 0.05 was considered statistically significant. Significant independent variables were declared at a 95% Confidence Interval/CI/ and a P-value of less than 0.05. The odds ratio is used to observe the strength of the association between a dependent variable and each significant independent variable. In the multivariable model, the independent variables with a P-value < of 0.05 and AOR with a 95% confidence interval were used to set the statistically significant level and to identify predictors of fathers’ involvement in child feeding.

Results

Socio-demographic characteristics

A total of 408 fathers who had children between 6 to 23 months were enrolled in the study with a response rate of 100%. This 100% response rate was achieved by multiple contacts; a person was deemed non-responsive if absent after three consecutive visits. The mean age of the study participants was 36.8 with a standard deviation (SD) of 8.892 years and the majority of them, 334 (81.9%) lived in rural areas (Table 1).

Table 1. Socio-demographic characteristics of father involvement in child feeding among fathers who had children aged from 6–24 months in Antsokia Gemza Woreda,2022 (n = 408).

Sociodemography
Characterstics	Frequency	Percent
Age of fathers(In years)
Mean age	36.8
15–20	20	4.9
21–30	94	23.0
31–40	166	40.7
41–50	104	25.5
50+	24	5.9
Residence
Urban	74	18.1
Ruralg	334	81.9
Religion
Orthodox	236	57.8
Muslim	127	31.1
Protestant	45	11.0
Number of children
< = 4	329	80.6
>4	79	19.4
Sex of the youngest child
Male	233	57.1
Female	175	42.9
Age of the youngest child in month
6–12	150	36.8
12–18	91	22.3
18–24	167	40.9
Birth order of the youngest child
First child	71	17.4
Not first child	337	82.6
Marital status of Father
Married	345	84.6
Divorced	45	11.0
Widowed	18	4.4
Educational status of Father
Not formal education	169	41.4
Primary education	170	41.7
Secondary education	44	10.8
Higher education(12+)	25	6.1
Occupational status of Father
Farmer	314	77.0
Merchant	33	8.1
Government	48	11.8
Daily laborer	13	3.2
Household monthly income In Ethiopian birr
LESSTHAN 500	31	7.6
500–1000	45	11.0
1000–1500	38	9.3
1500–2000	29	7.1
2000–2500	38	9.3
2500–3000	84	20.6
3000–4000	97	23.8
4000+	46	11.3

Open in a new tab

Note: 52.811 Ethiopian birr is equivalent to 1 USD dollars, minimum wage for a family to classify as poor is less than 500 birrs.

Source of information of respondents about father involvement in child feeding

The majority 309(75.7%) of the respondents heard about father involvement in CF, from those about 177(43.4%) of them heard from health extension workers and health professionals, 94(23%) from television, 60(14.7%) from radio, and 38(9.3%) from relative/friend/family.

Knowledge of fathers about father involvement in child feeding

The majority, 323 (79.2%) of participants realized that babies should start eating foods in addition to breastmilk at 6 months of age. About 294(72.1%) of respondents identify fathers’ involvement in child feeding by providing diet advice followed by attending medical appointments/growth monitoring 271(66.4%). Overall, about 209 (51.2%) of fathers had poor knowledge and 199(48.8%) had good knowledge about father involvement in child feeding (Table 2).

Table 2. Knowledge of fathers about father involvement in child feeding in Antsokia Gemza Woreda, 2022.

Father Knowledge	Frequency	Percent
An infant should start complementary food at 6 months
Yes	323	79.2
No	85	20.8
A woman should breastfeed her child for 24 months and more
Yes	282	69.1
No	126	30.9
Do you know fathers have role in providing advice for mothers on child diet
Yes	294	72.1
No	114	27.9
Do you know fathers have role in farming/gardening nutritious food
Yes	243	59.6
No	165	40.4
Do you know fathers have role in financial support to buy nutritious food
Yes	253	62.0
No	155	38.0
Do you know fathers have role in cooking a meal for a child
Yes	242	59.3
No	166	40.7
Do you know fathers have role in accompaniment to medical appointments/growth monitoring
Yes	271	66.4
No	137	33.6
Do you know fathers have role in in social and emotional support
Yes	256	62.7
No	152	37.3
Do you know fathers have role to help child feeding mothers with house hold chores
Yes	265	65.0
No	143	35.0
Knowledge of Father
Good knowledge	199	48.8
Poor knowledge	209	51.2

Open in a new tab

The attitude of fathers about father involvement in child feeding

Nearly half of the respondents 202(49.5%) agreed and 43(10.5%) strongly agreed that confident in preparing food for their child. About 185(45.3%) of respondents agreed and 89(21.8%) strongly agreed that feel confident that supporting their wife with child feeding and care. Overall, 228 (55.9%) fathers had a negative attitude, or 180(44.1%) had a positive attitude toward father involvement in child feeding (Table 3).

Table 3. Attitude of fathers about father involvement in child feeding in Antsokia Gemza Woreda, 2022.

	Strongly disagree		Disagree		Neutral		Agree		Strongly agree
	Frequency	%	Frequency	%	Frequency	%	Frequency	%	Frequency	%
I am confident in preparing food for my child.	24	5.9	108	26.5	31	7.6	202	49.5	43	10.5
I feel difficult in giving the right kind of food for my child.	69	16.9	173	42.4	17	4.2	131	32.1	18	4.4
I feel less important for a father to spend much time with my children.	102	25.0	174	42.6	8	2.0	107	26.2	17	4.2
I feel difficult that support my wife for child feeding and care.	78	19.1	156	38.2	26	6.4	121	29.7	27	6.6
I feel confident that support my wife for child feeding and care.	4	1.0	97	23.8	33	8.1	185	45.3	89	21.8
I feel right that Mother should be as heavily involved in the child feeding than fathers.	9	2.2	30	7.4	7	1.7	234	57.4	128	31.4
I feel happy, if my wife asked me to help her by feeding the child.	11	2.7	87	21.3	24	5.9	185	45.3	101	24.8
I feel correct that child feeding practice is a shared responsibility of father and Mother	10	2.5	55	13.5	12	2.9	168	41.2	163	40.0
Attitude of Father			Frequency				Percent
Positive attitude			180				44.1
Negative attitude			228				55.9

Open in a new tab

Culture of fathers about father involvement in child feeding

About 226(55.4%) of respondents replied that the community didn’t discourage fathers to take an active role in child feeding, and also wives want fathers’ involvement in child feeding 285(69.6%), the community didn’t laugh, sanctioned in father involvement in child feeding 255(62.5%), there was no traditionally gender-specific role in the community 212(52%), and community didn’t think, child feeding is the only responsibility of mother 214(52.5%). Overall, 266 (65.2%) of respondents had good culture toward father involvement in child feeding (Table 4).

Table 4. Culture of fathers about father involvement in child feeding in Antsokia Gemza Woreda, 2022.

Culture items	Frequency	Percent
Community discourage father to take an active role in CF
Yes	182	44.6
No	226	55.4
Your wife did not want father involvement in CF
Yes	123	30.1
No	285	69.9
community laughed, sanctioned in your involvement in CHF
Yes	153	37.5
No	255	62.5
traditionally gender specific role in Your community
Yes	195	47.8
No	213	52.2
community think, CF is the only responsibility of mother
Yes	194	47.5
No	214	52.5
Culture of Father
Good culture	266	65.2
Bad culture	142	34.8

Open in a new tab

The magnitude of father involvement in child feeding

The magnitude of the father’s involvement in child feeding was found to be 43.1% good with 95% CI (38.7, 48.3) and56.9% poor with 95% CI (51.7, 61.3) (Table 5).

Table 5. Father involvement in child feeding in Antsokia Gemza Woreda, 2022.

Father involvement activities in CF	Frequency	Percent
discussing with your wife in CF before you become a decision
Yes	265	65.0
No	143	35.0
father have equal decision making as mothers at home
Yes	239	58.6
No	169	41.4
final decision on childfeeding
Yes	218	53.4
No	190	46.6
final decision on time to start complementary feeding
Yes	224	54.9
No	184	45.1
final decision on what food for start of complementary feeding
Yes	229	56.1
No	179	43.9
final decision on order of serving food during meal times
Yes	188	46.1
No	220	53.9
participate in child feeding during meal times
Yes	239	58.6
No	169	41.4
assist mother with household chores
Yes	227	55.6
No	181	44.4
assist mother with farming activities to get nutritious food for your child
Yes	269	65.9
No	139	34.1
accompanying mother for child health clinics
Yes	249	61.0
No	159	39.0
allowing other family members/relatives to support the mother after delivery
Yes	280	68.6
No	128	31.4
the community encourage you to take an active role in CF
Yes	209	51.2
No	199	48.8
encourage your children to take food while the mothers were in CF
Yes	275	67.4
No	133	32.6
motivate your spouse to get involved in the CF
Yes	226	55.4
No	182	44.6
buying food for the child
Yes	259	63.5
No	149	36.5
buy clothing, child care items like diapers and d/t child food for your child
Yes	239	58.6
No	169	41.4
buying food for the lactating mother
Yes	276	67.6
No	132	32.4
transporting to the child to health clinics
Yes	260	63.7
No	148	36.3
gave money to the mothers to purchase the necessary food for the children
Yes	286	70.1
No	122	29.9
you usually feed the child at home
Yes	104	25.5
No	304	74.5
cook a meal for a child food at home, when a mother is in breast feeding
Yes	194	47.5
No	214	52.5
looked after Your child when the mothers were not around
Yes	244	59.8
No	164	40.2
Father involvement
Good	176	43.1
Poor	232	56.9

Open in a new tab

Factors associated with father involvement in child feeding

In the bivariate analysis, age of the father, residence, number of children, sex of the youngest child, age of the youngest child, birth order of the youngest child, marital status, educational status, occupational status, monthly income, heard about father involvement, knowledge, attitude and culture were significantly associated with father involvement in child feeding. And hence, entered into the multivariable regression model.

After adjusting the effect of other variables (confounders), using multivariable logistic regression, residence, sex of the youngest child, birth order of the youngest child, educational status, heard about father involvement, knowledge, attitude, culture was significantly associated with fathers’ involvement in child feeding.

Fathers who lived in urban areas were 3.878 times more likely to have good involvement in child feeding than those fathers who lived in rural areas (AOR = 3.878, 95% CI = (1.408–10.678). Those fathers who had a male youngest child were 3.681 times more likely to have good involvement in child feeding than those who had a female youngest child (AOR = 3.681, 95% CI = (1.678–8.075)). Those fathers whose childbirth order is first were 3.970 times more likely to have good involvement in child feeding than those whose child was not first child (AOR = 3.970, 95% CI = (1.212–13.005)).

Fathers who attended secondary education were 4.945 times more likely to have good involvement in child feeding than those fathers who were not in normal education (AOR = 4.945, 95% CI = (1.043–23.454)). Fathers who attended higher education were 5.151 times more likely to have good involvement in child feeding than those fathers who were not in normal education (AOR = 5.151, 95% CI = (1.122–23.651)).

Those fathers who had ever heard information were 8.593 times more likely to have good involvement in child feeding than had not ever heard information about father involvement in child feeding (AOR = 8.593, 95% CI = (3.044–24.261)).

Those fathers who had good knowledge were 3.843 times more likely to have good involvement in child feeding than those who had poor knowledge (AOR = 3.843, 95% CI = (1.318–11.210)). Those fathers who had positive attitudes were 8.565 times more likely to have good involvement in child feeding than those who had negative attitudes (AOR = 8.565, 95% CI = (3.521–20.837)). Those fathers who had good culture were 10.582 times more likely to have good involvement in child feeding than those who had bad culture (AOR = 10.582, 95% CI = (2.818–39.734)) (Table 6).

Table 6. Multivariable logistic regression model for fathers’ involvement in child feeding practice in Antsokia Gemza Wereda, North East Ethiopia, 2022.

Variables	Father involvement in child feeding		COR (95%)	AOR (95%)
Characterstics	Poor	Good	COR (95%)	AOR (95%)
age of fathers in years
15–20	5	15	3.545(.974–12.905)	.122(.012–1.250)
21–30	52	45	1.023(.417–2.507)	.150(.022–1.031)
31–40	93	73	.928(.393–2.191)	.176(.028–1.118)
41–50	69	32	.548(.222–1.356)	.178(.028–1.141)
50+	13	11	1	1
Residence
Urban	13	61	8.936(4.712–16.944)	3.878(1.408–10.678)^**
Rural	219	115	1	1
number of children
< = 4	178	151	1.832(1.088–3.086)	.885(.301–2.602)
>4	54	25	1	1
Sex of the youngest child
Male	114	119	2.161(1.438–3.248)	3.681(1.678–8.075)^**
Female	118	57	1	1
Age of the youngest child in month
6–12	74	76	1.423(.913–2.218)	1.013(.451–2.274)
12–18	61	30	.681(.399–1.163)	.713(.224–2.277)
18–24	97	70	1	1
Birth order of the youngest child
First child	25	46	2.930(1.717–4.998)	3.97(1.212–13.005) ^**
Not first child	207	130	1	1
Marital status of Father
Married	188	157	4.176(1.187–14.69)	.326(.041–2.576)
Divorced	29	16	2.759(.693–10.984)	.145(.013–1.559)
Widowed	15	3	1	1
Educational status of Father
Not formal education	132	37	1	1
Primary education	81	89	3.920(2.443–6.289)	1.368(.581–3.222)
Secondary education	12	32	9.514(4.462–20.282)	4.945(1.043–3.454)^**
Higher education(12+)	7	18	9.174(3.562–23.628)	5.151(1.122–3.651)^**
Occupational status of Father
Farmer	188	126	3.686(.803–16.912)	.720(.067–7.772)
Merchant	24	9	2.062(.380–11.180)	.358(.022–5.799)
Government	9	39	23.83(4.478–26.85)	1.238(.097–15.801)
Daily laborer	11	2	1	1
House hold monthly income In Ethiopian birr
LESSTHAN 500	28	3	1	1
500–1000	31	14	4.215(1.095–16.22)*	1.752(.200–15.38)
1000–1500	27	11	3.802(.955–15.141)	.784(.078–7.921)
1500–2000	21	8	3.556(.840–15.044)	1.004(.089–11.38)
2000–2500	20	18	8.400(2.177–32.41)	.976(.100–9.503)
2500–3000	39	45	10.77(3.038–38.18)	1.052(.149–7.445)
3000–4000	48	49	9.528(2.715–33.44)	1.624(.236–11.17)
4000+	18	28	14.519(3.84–54.88)	1.892(.233–15.36)
Heared about father involvement
Yes	145	164	8.200(4.308–15.607)	8.593(3.044–24.26) ^**
No	87	12	1	1
Knowledge of Father
Good	53	146	16.436(9.986–27.053)	3.843(1.318–11.21) ^**
Poor	179	30	1	1
Attitude of Father
Positive	33	147	30.567(17.769–2.585)	8.565(3.521–20.84) ^**
Negative	199	29	1	1
Culture of Father
Good	95	171	49.32(19.519–24.621)	10.582(2.82–39.73) ^**
Bad	137	5	1	1

Open in a new tab

Note:

* significant variables at P value <0.25 in the bivariate analysis

** statistically significant variables at P value <0.05 in the multivariable analysis, COR: crude odds ratio; AOR, adjusted odds ratio; 1.00 _ reference category, 52.811 Ethiopian birr is equivalent to 1 USD dollars, minimum wage for a family to classify as poor is less than 500 birrs.

Discussion

The result of this study revealed that 43.1% of fathers had good involvement in child feeding which is lower than compared the studies conducted in a rural Southwestern District of Uganda, in which 65.5% of fathers had good involvement [30] and in Dakshina Kannada District in South India, in which 59.1% fathers had good involvement in child feeding [26]. This discrepancy might be due to the fact that mothers have primary responsibility for child feeding and the fathers’ role often comes after, and children spend most of the time with their mothers. Additionally, fathers frequently work away from their homes making them less accessible to participate in child feeding activities in the study area.

Activities by Alive &Thrive in Ethiopia are intended to get fathers involved in child feeding by identifying and using 6 strategies such as getting their attention with emotion, making the process easier by shattering stereotypes, finding fathers where they already are, “providing crystal-clear direction” for actions fathers can take, give fathers practice and show fathers a benefit that they care about [22].

In this study, fathers who lived in the urban area showed a significant association with good father involvement in child feeding. This finding is contrary to the finding from a district in coastal South India, in which fathers residing in urban locations had higher levels of poor involvement in IYCF than their counterparts [26]. This discrepancy might be due to fathers who lived in the urban area having a good opportunity for media to get full information about father involvement in child feeding than lived in rural areas.

In this study, fathers who had male index children were more likely to get involved in child feeding. This finding is contrary to the finding from South India, in which fathers with male children showed a significantly higher level of poor involvement than those with female children [26]. This discrepancy might be due to fathers being happier when their children’s sex would be male than female in the study area.

In this study, being first-child birth order was significantly associated with good father involvement in child feeding. This finding is in agreement with the study conducted in South India, in which fathers who had a first-time child had better involvement than fathers with more than one child [26]. This might be due to fathers having got children for the first time since they would be happy and try to fulfill all that the child needs.

The educational status of fathers was another independent predictor of fathers’ involvement in child feeding practices in that fathers who attended secondary education and higher were more likely to be involved in child feeding practices. This finding is in line with the studies conducted in Nepal and Equatorial Guinea where fathers who had higher levels of education showed greater involvement in encouraging their spouses to breastfeed their children [31, 32]. This might be explained by the fact that fathers who had better education could have better information and a better understanding of the importance of father involvement in child feeding.

The result of our study revealed that fathers who had ever heard information about child feeding were significantly associated with good father involvement in child feeding. This finding is supported by Ethiopian National Strategy on Infant and Young Child Feeding shows that Health professionals, and educational and media authorities provide information about appropriate child feeding practices for fathers, mothers, and other caregivers [33].

In this study, fathers who had good knowledge were significantly associated with good father involvement in child feeding. This finding is in line with the studies conducted in Brazil, Australia, Malaysia, and the United States of America were fathers who had better knowledge of breastfeeding and complementary feeding increased participation in child feeding [34–37]. This might be the fact that fathers had good knowledge affects fathers’ attitude, which leads to a change of behavior in good fathers’ involvement in child feeding [38]. In addition, the behavior changes communication (BCC) strategies program in Ethiopia that targets fathers’ engagement in child feeding in both father and mother has a greater impact on the father’s knowledge [39].

The result of our study revealed that fathers who had a positive attitude about father involvement in child feeding were significantly associated with good father involvement in child feeding. This finding is in line with the studies conducted in England and Northern Jordan where fathers who had positive attitudes about child feeding increased fathers’ involvement in child feeding [40, 41]. This might be due to a result of a change in behavior in good fathers’ involvement in child feeding brought on by a positive attitude [38]. This finding is also supported by the Alive & Thrive strategy in Ethiopia showing that successfully used positive emotions/feelings/attitudes to draw fathers into child feeding [22].

In this study, fathers who had good culture were significantly associated with good father involvement in child feeding. This finding is in line with the studies conducted in Taiwan and Malawi where fathers who had good cultural practices can positively influence parental involvement in child feeding [37,42] These similarities might be due to the community encouraging fathers to participate in child feeding in the study area. This finding is supported by the Alive & Thrive strategy/initiatives in Ethiopia to involve fathers in child feeding shows that the strategy eases the way by busting stereotypes in which gender roles are deeply embedded in culture [22].

Limitations and strengths of the study

Since the study is cross-sectional it may not demonstrate direct cause and effect between dependent and independent variables. Another limitation is possible social desirability bias despite caution being used in order to reduce it. However, our study has some strengths. As the Ethiopian national nutrition program is targeting children and mothers to overcome malnutrition, this study tried to address father involvement in child feeding practices which if promoted could improve the overall health of children.

Conclusions

The finding of this study showed that good father involvement in child feeding was low (43.1%), since the world’s Father’s Day 2019 report, which aims to facilitate an enabling environment where men take on 50% of involvement. Better (secondary and higher) educational status, having ever heard (information), urban residence, male sex of the youngest child, first birth order of the youngest child, good knowledge, positive attitude, and good culture were predictors of good fathers’ involvement in child feeding. The purpose of this study was to assess fathers’ involvement in child feeding practice and associated factors among fathers having children aged 6 to 24 months Hence, it is important to promote fathers’ involvement in child feeding practices through promoting their education, availing information sources, improving their knowledge, attitude and culture of fathers about child feeding practices. Future researchers should better conduct studies by using a mixed methodology and including females as potential participants to ensure fathers’ involvement from women’s perspectives.

Supporting information

S1 File

(DOCX)

Click here for additional data file.^{(16.9KB, docx)}

Acknowledgments

We would like to thank the Antsokia Gemza Health office and each kebele administration for giving valuable information and permission. We want to give our special thanks to the study participants for their willingness to participate, data collectors, and supervisors. Finally, it is our pleasure to give our deepest thanks to our family for their contributions and patience throughout this study.

Acronym and abbreviation

CF: Child Feeding
CHMIS: Community Health Management Information System
CI: Confidence Interval
IYCF: Infant and Young Child Feeding
PAS: Proportional Allocation of the study
SRS: Simple Random Sampling
SPSS: Statistical Package for Social science
WHO: World health organization
IRB: Institution Review Board
ZPGC: Zemen Post Graduate College and
AOR: Adjusted odd ratio

Data Availability

All relevant data are within the article and its Supporting Information files.

Funding Statement

The authors received no specific funding for this work.

References

1.Gebremedhin S, Baye K, Bekele T, Tharaney M, Asrat Y, Abebe Y, et al. Predictors of dietary diversity in children ages 6 to 23 months in largely food-insecure area of South Wollo, Ethiopia. Nutrition. 2017; 33:163–8. Available from: 10.1016/j.nut.2016.06.002 [DOI] [PubMed] [Google Scholar]
2.Pisacane A, Continisio GI, Aldinucci M, D’Amora S, Continisio P. A controlled trial of the father’s role in breastfeeding promotion. Pediatrics. 2005;116(4). doi: 10.1542/peds.2005-0479 [DOI] [PubMed] [Google Scholar]
3.Garfield CF, Fisher SD, Barretto D, Rutsohn J, Isacco A. Development and validation of a father involvement in health measure. Psychol Men Masculinity. 2019;20(1):148–60. doi: 10.1037/men0000144 [DOI] [PMC free article] [PubMed] [Google Scholar]
4.Stevens GA, Finucane MM, Paciorek CJ, Flaxman SR, White RA, Donner AJ, et al. Trends in mild, moderate, and severe stunting and underweight, and progress towards MDG 1 in 141 developing countries: A systematic analysis of population representative data. Lancet. 2012;380(9844):824–34: doi: 10.1016/S0140-6736(12)60647-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
5.LA D, BM K, FM K. Effect of Father Involvement in Infant Feeding on Nutritional Status and Morbidity in Kisumu, Kenya. J Nutr Heal Sci. 2018;5(1). [Google Scholar]
6.Bain LE, Awah PK, Geraldine N, Kindong NP, Sigal Y, Bernard N, et al. Malnutrition in Sub—Saharan Africa: Burden, causes and prospects. Pan Afr Med J. 2013; 15:1–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
7.Developed E, Group UNI, Estimation CM. Global levels and trends in mortality. 2017;5–28. [Google Scholar]
8.Macro. 2001. Ethiopia Demographic and Health Survey 2000. Addis Ababa, Ethiopia: Central Statistical Authority/Ethiopia and ORC Macro. [Google Scholar]
9.Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008;371(9608):243–60. doi: 10.1016/S0140-6736(07)61690-0 [DOI] [PubMed] [Google Scholar]
10.Bilal, S. The fathers’ role in child nutrition in Ethiopia. [Doctoral Thesis, Maastricht University]. Datawyse / Universitaire Pers Maastricht, 2015. 10.26481/dis.20151014sb [DOI]
11.Pontes CM, Osorio MM, Alexandrino AC. Building a place for the father as an ally for breast feeding. Midwifery 2009;25(2):195‐202. doi: 10.1016/j.midw.2006.09.004 [DOI] [PubMed] [Google Scholar]
12.Sasaki Y, Ali M, Kakimoto K, Saroeun O, Kanal K, Kuroiwa C. Predictors of exclusive breast‐feeding in early infancy: a survey report from Phnom Penh, Cambodia. J Pediatr Nurs 2010;25(6):463‐9. doi: 10.1016/j.pedn.2009.04.010 [DOI] [PubMed] [Google Scholar]
13.Davison KK, Jurkowski JM, Li K, Kranz S, Lawson HA. A childhood obesity intervention developed by families for families: results from a pilot study. Int J Behav Nutr Phys Act 2013; 10:3. doi: 10.1186/1479-5868-10-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
14.Pryer JA, Rogers S, Rahman A. The epidemiology of good nutritional status among children from a population with a high prevalence of malnutrition. Public Health Nutr. 2004;7(2):311–7. doi: 10.1079/PHN2003530 [DOI] [PubMed] [Google Scholar]
15.Moore T, Kotelchuck M. Predictors of Urban Fathers’ Involvement in Their Child’s Health Care. Pediatrics. 2004;113(3 I):574–80. doi: 10.1542/peds.113.3.574 [DOI] [PubMed] [Google Scholar]
16.Garfield CF, Isacco A. Fathers and the well-child visit. Pediatrics. 2006;117(4). doi: 10.1542/peds.2005-1612 [DOI] [PubMed] [Google Scholar]
17.Sarkadi A, Kristiansson R, Oberklaid F, Bremberg S. Fathers’ involvement and children’s developmental outcomes: A systematic review of longitudinal studies. Acta Paediatr Int J Paediatr. 2008;97(2):153–8. doi: 10.1111/j.1651-2227.2007.00572.x [DOI] [PubMed] [Google Scholar]
18.Kansiime N, Atwine D, Nuwamanya S, Bagenda F, Mengesha Bilal S. The fathers’ role in child nutrition in Ethiopia. J Nutr Metab. 2015:1–9. Available from: https://cris.maastrichtuniversity.nl/portal/files/2888655/guid-b585ea1c-2c75-4714-a279-b8b08f9af935-ASSET1.0 [Google Scholar]
19.Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, et al. What works? Interventions for maternal and child undernutrition and survival. Lancet. 2008;371(9610):417–40. doi: 10.1016/S0140-6736(07)61693-6 [DOI] [PubMed] [Google Scholar]
20.Dietz WH, Gortmaker SL. Preventing obesity in children and adolescents. Annu Rev Public Health. 2001; 22:337–53. doi: 10.1146/annurev.publhealth.22.1.337 . [DOI] [PubMed] [Google Scholar]
21.Bilal SM, Dinant GJ, Blanco R, Crutzen R, Mulugeta A, Spigt M. The influence of father’s child feeding knowledge and practices on children’s dietary diversity: a study in urban and rural districts of Northern Ethiopia, 2013. Matern Child Nutr. 2016;12(3):473–83. doi: 10.1111/mcn.12157 [DOI] [PMC free article] [PubMed] [Google Scholar]
22.Fhi T, Avenue C, Washington NW. Dads can do that! Strategies to involve fathers in child feeding. 2012;(1):1–8. [Google Scholar]
23.Tessema M, Belachew T, Ersino G. Feeding patterns and stunting during early childhood in rural communities of Sidama, South Ethiopia. Pan African Medical Journal. 2013. May 4;14(1). doi: 10.11604/pamj.2013.14.75.1630 [DOI] [PMC free article] [PubMed] [Google Scholar]
24.Owoaje E, Onifade O, Desmennu A. Family and socioeconomic risk factors for undernutrition among children aged 6 to 23 months in Ibadan, Nigeria. Pan Afr Med J. 2014; 17:1–7. doi: 10.11604/pamj.2014.17.161.2389 [DOI] [PMC free article] [PubMed] [Google Scholar]
25.Woreda A. budget year woreda based health sector EFY annual plan and report, 2020
26.Mithra P, Unnikrishnan B, Rekha T, Kumar N, Holla R, Rathi P. Paternal Involvement and Sociodemographic Correlates of Infant and Young Child Feeding in a District in Coastal South India: A Cross-Sectional Study. Front. Public Health, 04 June 2021, 10.3389/fpubh.2021.661058 [DOI] [PMC free article] [PubMed] [Google Scholar]
27.Save the children, Father to Father Support Group KAP Survey in North East Nigeria Final Report, 2019.
28.CRS, Father Engagement in Nutrition: A Qualitative Analysis in Muhanga and Karongi Districts in Rwanda, 2016
29.Yonas F, Asnakew M, Wondafrash M, Abdulahi M. Infant and Young Child Feeding Practice Status and Associated Factors among Mothers of under 24-Month-Old Children in Shashemene Woreda, Oromia Region, Ethiopia. OALib. 2015;02(07):1–15. [Google Scholar]
30.Kansiime N, Atwine D, Nuwamanya S, Bagenda F. Effect of Male Involvement on the Nutritional Status of Children Less Than 5 Years: A Cross Sectional Study in a Rural Southwestern District of Uganda. 2017;2017. [DOI] [PMC free article] [PubMed] [Google Scholar]
31.Bhatta DN, Involvement of males in antenatal care, birth preparedness, exclusive breast feeding and immunizations for children in Kathmandu, Nepal. BMC Pregnancy Childbirth; 2013, 13: 14. doi: 10.1186/1471-2393-13-14 [DOI] [PMC free article] [PubMed] [Google Scholar]
32.Jimoh LF, Eshiemokhai E. Bibliometric Analysis of International Journal of Research in Education, 2004–2012. 2014;4(12):42–9. [Google Scholar]
33.Ministry of Health F, Health Department F. National Strategy for Infant and Young Child Feeding—Ethiopia—Federal Ministry of Health, Family Health Department. 2004;(April). [Google Scholar]
34.Februhartanty J, Bardosono S, Septiari AM. Problems During Lactation are Associated with Exclusive Breastfeeding in DKI Jakarta Province: Father’s Potential Roles in Helping to Manage These Problems. Mal J Nutr. 2006;12(2):167–80. Available from: http://nutriweb.org.my/publications/mjn0012_2/mjn12n2_art4. [Google Scholar]
35.Tohotoa J, Maycock B, Hauck YL, Howat P, Burns’ S, Binns CW. Dads make a difference: An exploratory study of paternal support for breastfeeding in Perth, Western Australia. Int Breastfeed J. 2009; 4:1–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
36.Al Furaikh SS, Ganapathy T. First Time Expectant Fathers’ Perspectives on Breastfeeding. Malaysian J Med Res. 2018;2(2):80–7. [Google Scholar]
37.Chen YC, Chie WC, Chang PJ, Chuang CH, Lin YH, Lin SJ, et al. Is infant feeding pattern associated with father’s quality of life? Am J Mens Health. 2010;4(4):315–22. doi: 10.1177/1557988309350491 [DOI] [PubMed] [Google Scholar]
38.Vaarno J. Parental influences and mothers’ experiences on infant and young child feeding practices, Vol. 1233. 2016. Available from: https://www.utupub.fi/bitstream/handle/10024/124124/AnnalesD1233Vaarno. [Google Scholar]
39.Han YE, Park S, Kim JE, Kim H, Hoddinott J. Father Engagement in Improving Infant and Young Child Feeding (IYCF) Practices: Evidence from a Clustered Randomized Controlled Trial in Ethiopia (P11-112-19). Curr Dev Nutr. 2019;3(Supplement_1):1085–7. [Google Scholar]
40.Sherriff N, Hall V, Panton C. Engaging and supporting fathers to promote breast feeding: A concept analysis. Midwifery.2014;30(6):667–77. Available from: doi: 10.1016/j.midw.2013.07.014 [DOI] [PubMed] [Google Scholar]
41.Abu-Abbas MW, Kassab MI, Shelash KI. Fathers And Breastfeeding Process: Determining Their Role and Attitudes. Eur Sci Journal, ESJ. 2016;12(18):327. [Google Scholar]
42.FAO. Food and Agriculture Organization of the United Nations. International Fund for Agricultural Development. World Food Programme. The State of Food Insecurity in the World. Strengthening the enabling environment for food security and nutrition. 2014. 52 p.

PLoS One. doi: 10.1371/journal.pone.0276565.r001

Decision Letter 0

Khatijah Lim Abdullah

6 Jul 2022

PONE-D-22-14665Fathers Involvement in Child Feeding and Its Associated Factors Among Fathers Having Children Aged 6 to 24 Months in Antsokia Gemza Woreda, Ethiopia: Cross-Sectional StudyPLOS ONE

Dear Dr. Bogale,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Aug 20 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Khatijah Lim Abdullah, DClinP, MSc., BSc

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf.

2. You indicated that you had ethical approval for your study. In your Methods section, please ensure you have also stated whether you obtained consent from parents or guardians of the minors included in the study or whether the research ethics committee or IRB specifically waived the need for their consent.

3. Thank you for stating the following financial disclosure:

[No funders].

At this time, please address the following queries:

a) Please clarify the sources of funding (financial or material support) for your study. List the grants or organizations that supported your study, including funding received from your institution.

b) State what role the funders took in the study. If the funders had no role in your study, please state: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.”

c) If any authors received a salary from any of your funders, please state which authors and which funders.

d) If you did not receive any funding for this study, please state: “The authors received no specific funding for this work.”

Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

4. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript.

5. Please ensure that you refer to Figure 3 in your text as, if accepted, production will need this reference to link the reader to the figure.

6. Please include your tables as part of your main manuscript and remove the individual files. Please note that supplementary tables (should remain/ be uploaded) as separate "supporting information" files.

Additional Editor Comments:

Please ensure the manuscript has undergo proof reading before resubmission

**********

Review Comments to the Author

Reviewer #1: 1) Background - is there any studies as such has been identified in the world health report? The write up needs to be reword and revised such as too many dash in page 4. It needs to be written clearly

2) methods section, how did the author reach the community? Please explain. What is the response rate? What is kebeles in page 5.

- With the questionnaire that is used has it been validated especially the KAP or etc. Please cite it. If pre test done, is there any variables been removed? For data analysis, author highlighted double entry. Did you do that and what percentage is the discrepancy?

- Ethical approval?

3) the discussion is too long. What is the limitations and strengths of this study? What is alive and thrive strategies? Is it been supported by the government or NGO? Does the mothers for the child also working thus more fathers have to help their partners?

4) What is the anticipate plan after such findings?

Reviewer #2: Thank you for the opportunity to review this manuscript. This is an interesting topic for nursing research.

Background:

Please provide information to highlight the significance of the study. Explain the father’s role in child feeding and how the father can influence the nutritional outcomes among children. Provide the association or relationship between malnutrition with father involvement in child feeding with literature support.

Methods:

My main concern is the questionnaire used for the study. Detailed description is needed for the development and validation of the questionnaire. It is not sufficient with one sentence “Literature is reviewed to develop a questionnaire (23).”

The questionnaire is consisted of 4 parts: Father involvement, Knowledge, attitudes. Culture of Fathers about Father Involvement in Child Feeding.

Please provide information on the number of items, the scoring methods and interpretation of the scores for each part of the questionnaire.

Item 3 to 9 for knowledge questions are more related to practices towards father involvement in child feeding as we cannot expect a dichotomous response for these questions and it is not appropriate to assess knowledge, for instance: Item no. 3 – “fathers involvement in child feeding in providing advice or suggestions on diet” and item no.6 – “fathers involvement in child feeding in prepare and cooking a meal for a child.”

Apart from that, items for father involvement activities in child feeding (assist mother with household chores, accompanying mother for child health clinics, allowing other family members/relatives to support the mother after delivery, transporting the child to health clinics, looked after your child when the mothers were not around). These questions are more related to activities of looking after the child, shar burden of the wife, not measure father involvement in child feeding directly.

Is it possible multiple submissions as the father might have two children range 6 months to 24 months?

Please provide justification of pilot test with 5% of sample size.

Please provide explanation on types of bivariate analysis and multivariate logistic regression analysis.

Results:

Please provide justification for 100% response rate.

Suggest to remove figure 1, 2 and 3.

Discussion:

The authors have discussed the study results and have attempted to link it with previous studies. However, the result was not been analyzed and argued critically.

Please provide description on “Alive &Thrive's activities in Ethiopia” as background information.

Overall comments:

This paper requires proof-reading as there are grammatical and sentence structure errors. Citing and referencing skills can be further improved. There are some claims that are not having references. As a reader, I had difficulties to follow which of the sentences / ideas were from the references and which were authors own ideas. I hope the authors be more precise with the referencing.

Reviewer #3: General Comments

Language – grammatical and editorial issues all over the paper.

The manuscript needs careful revision by a proof-reader as there are numerous grammatical

errors, missing words, and errors in tense which make it sometimes difficult to read easily.

Background:

The background overall well written. Just wonder.,

Paragraph 4 - Can the stated information linked significantly with father involvement in child feeding?

Is the father involvement truly important in determining a child development especially in an underdeveloped country?

Ensuring a 'good food' for their family is a big task and timely responsible.

To me, a good socioeconomic status is an answer for all particularly in country like Ethiopia, Kenya etc.

Method and Design

Study Design and Settings

Paragraph 1 Line 3 - the information given a least related with the study and hard for reader to understand the geography of the study setting, It would be good if the author can provide i.e. the setting map.

Participants and Sampling

Paragraph 1 - is repetition (L1-4) and (L4-8)

A good and systematic random sampling method had been applied.

Measurement

A questionnaire developed - was validated.

Data Quality Assurance

Well mentioned

Suggestion: the writing is too long can be rewrite and merge the paragraph 1 and 3.

Data Management and Analysis

The descriptive result should be concise i.e., a repetitive information in text, figures and tables should be avoided.

Figure 1-3 can be deleted; the same information can be found in the bottom of Table 2-4 and in the text.

Results

Socio-Demographic characteristics

The text can be shortened, all information from Table 1 is self-explanatory.

Information of Respondents about Father Involvement in Child Feeding

Is this data only reported in text? The title Information of Respondents about Father Involvement in Child Feeding seem to be confused with Table 5 and its text.

Knowledge of Fathers about Father Involvement in Child Feeding

Is the item listed in the Table 2 portrayed knowledge of fathers about father involvement? i.e. fathers involvement in child feeding in social and emotional support; fathers involvement in child feeding in sharing workload and health etc. Wonder such items can its represented father’s knowledge on father involvement.

The Attitude of Father about Father Involvement in Child Feeding

Table 3, explained on the fathers’ attitude, Figure 2 is redundant.

Culture of Fathers about Father Involvement in Child Feeding

Table 4 can explain the Culture of Fathers.

The Magnitude of Father Involvement in Child Feeding

Please check

Factors Associated with Father Involvement in Child Feeding

Table’s title can be revise i.e. Table 6: Fathers involvement in child feeding and Its’ Association Factor. Please write only concise text.

Discussion

This part is monotonous and sounded in one unvarying tone, would be better to have a linkage between the sentences or points, discussion should be more in depth, not just reporting and compared deadly with other.

Conclusion

Well conclude by restating the purposes of the study with summarized results.

and conclusion that can early predict.

References

Please be consistent.

Check-up: Reference no 8, 9,17,19,21,22, 23, 24, 28

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachment

Submitted filename: PONE-D-22-14665_reviewer comments.docx

Click here for additional data file.^{(17.8KB, docx)}

PLoS One. 2022 Nov 28;17(11):e0276565. doi: 10.1371/journal.pone.0276565.r002

Author response to Decision Letter 0

31 Jul 2022

RESPONSE TO EDITOR AND REVIEWERS

RESPONSE TO EDITOR

RESPONSE: Thank you for coordinating the review process and fruitful comments. We have revised the manuscript and addressed Reviewer’s comments.

Journal Requirements:

COMMENT: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming.

RESPONSE: We have checked and attest that all formatting and style requirements have been met and revised based on the guideline

COMMENT: 2. You indicated that you had ethical approval for your study. In your Methods section, please ensure you have also stated whether you obtained consent from parents or guardians of the minors included in the study or whether the research ethics committee or IRB specifically waived the need for their consent.

RESPONSE: we have assured for you that our all-study participant were adults

COMMENT: 3. Thank you for stating the following financial disclosure:

[No funders]. At this time, please address the following queries:

a) Please clarify the sources of funding (financial or material support) for your study. List the grants or organizations that supported your study, including funding received from your institution.

c) If any authors received a salary from any of your funders, please state which authors and which funders.

d) If you did not receive any funding for this study, please state: “The authors received no specific funding for this work.”

Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

RESPONSE: We have added “The authors received no specific funding for this work.”

COMMENT: 4. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript.

RESPONSE: We have checked and ensured that ethical statement only appear in the methods section of our manuscript

COMMENT: 5. Please ensure that you refer to Figure 3 in your text as, if accepted, production will need this reference to link the reader to the figure.

RESPONSE: We have removed fig 3 because we accept suggestion from reviewer 2 to remove figure 1, 2 and 3.

COMMENT: 6. Please include your tables as part of your main manuscript and remove the individual files. Please note that supplementary tables (should remain/ be uploaded) as separate "supporting information" files.

RESPONSE: We have removed table as individual file and we include it in our main manuscript

Additional Editor Comments:

COMMENT: Please ensure the manuscript has undergo proof reading before resubmission

RESPONSE: We have done it before resubmission.

RESPONSE TO REVIEWER 1:

RESPONSE: We thank the reviewer for kind words. We have revised our manuscript based on the comments as described below.

REVIEWER COMMENT: 1) Background - is there any studies as such has been identified in the world health report? The write up needs to be reword and revised such as too many dashes in page 4. It needs to be written clearly

RESPONSE: There is no studies has been identified in the world health report. We paraphrase it and we removed those inappropriate dash in page 4

REVIEWER COMMENT: 2) methods section, how did the author reach the community? Please explain.

RESPONSE: We have reached to community as

Thee name and address of fathers having children aged 6 months to 2 years were specified and their location was identified in collaboration with the kebele’s health extension workers and health development army leaders, identified fathers were then interviewed in their home.

REVIEWER COMMENT: What is the response rate?

RESPONSE: response rate refers to the number of people who completed your survey divided by the number of people who make up the total sample group.

REVIEWER COMMENT: What is kebeles in page 5.

RESPONSE: thank you for kind question.

Ethiopia is administratively divided into four levels: regions, zones, woredas (districts) and kebele. Woredas are divided into kebele, municipalities. This is the smallest administrative division.

REVIEWER COMMENT: - With the questionnaire that is used has it been validated especially the KAP or etc. Please cite it.

RESPONSE: the questionnaire was validated (27) and further more we have done pretest since pre-tests also provide the most direct evidence for the validity of the questionnaire; More over to determine the content validity of the questionnaire, the collected views, as well as comments experts in the fields of nutrition, biostatics, and epidemiology, were taken.

REVIEWER COMMENT: If pretest done, is there any variables been removed?

RESPONSE: We have done pre test and we revised the questionnaire based on the finding of pretest. We didn’t encounter removal of variable but we revised it for understandability, the wording, logic, and skip pattern etc,

REVIEWER COMMENT: For data analysis, author highlighted double entry. Did you do that and what percentage is the discrepancy?

RESPONSE: We have done double data entry to ensure the integrity of the captured data. We ensured that Items in the double data entry are similar with the initial data entry.

REVIEWER COMMENT: - Ethical approval?

RESPONSE: We have revised Ethical approval in the methods section of our manuscript as

Ethical approval for this study was obtained from the Institution Review Board (IRB) of Zemen Post Graduate College. A permission letter from the Antsokia Gemza Woreda Health office and selected kebeles administrations were informed about the study. Data were collected after explaining the study, the benefit of the study, the research purpose orally, and getting verbal informed consent from each participant.

REVIEWER COMMENT: 3) the discussion is too long.

RESPONSE: We have revised it based on your comment

REVIEWER COMMENT: What are the limitations and strengths of this study?

RESPONSE: We have revised it as Limitation of the study

Since the study is cross-sectional it may not demonstrate direct cause and effect between dependent and independent variables. Another the limitation is possible to social desirability bias despite caution were used in order to reduce it. However, our study has some strength. As Ethiopian national nutrition program is targeting children and mothers to overcome malnutrition, this study tried to address father involvement in child feeding practices which if promoted could improve the overall health of children.

REVIEWER COMMENT: What is alive and thrive strategies?

RESPONSE: We have been revised it and provide description on “Alive &Thrive's activities in Ethiopia” as background information.

Alive &Thrive's activities in Ethiopia are designed to engage fathers in child feeding by identifying the strategies that seem to make these programs work to ensure that fathers can play an active role in improving child feeding practice by applying 6 strategies such as grabbing their attention with emotion, ease the way by busting stereotypes, find fathers where they already are, “provide crystal-clear direction” for actions fathers can take, give fathers practice and show fathers a benefit that they care about ( 22).

REVIEWER COMMENT: Is it been supported by the government or NGO?

RESPONSE: Alive & Thrive (A&T) funded by the Bill & Melinda Gates Foundation to improve infant and young child nutrition by increasing rates of exclusive breastfeeding and improving complementary feeding practices.

REVIEWER COMMENT: Does the mothers for the child also working thus more fathers have to help their partners?

RESPONSE: We didn’t ask from mothers’ perspective; we would like to recommend for future researchers to gather information from both fathers and mothers’ perspective by including mothers as study subjects.

REVIEWER COMMENT: 4) What is the anticipate plan after such findings?

RESPONSE: We are glad to inform you that we have plan to present in conference at regional level and we invited to present it on July 26-28/2022. Here we attach their invitation letter.

Congratulations!!!

Thank you, very much dear researchers, for submitting your abstract/s for consideration at APHI-BDU-CMHS joint international conference held from July 28-30/2014. All abstracts reviewed by several potential independent reviewers and status of your abstract/s is/are determined. Based on the reviews report, we are likely to accept your abstract/s for oral presentation in the conference, providing that you are kindly asked to prepare 15-20 slides following the template and present for 15 minutes.

Note: We sincerely request that all presenters collect and provide their travel receipts. Presenters who come by airline need only bring a passing board, a copy of their ticket, and bank receipts.

____//_____

*Tadesse Hailu Jember (PhD)

RESPONSE TO REVIEWER 2:

RESPONSE: We thank the reviewer for kind words. We have revised our manuscript based on the comments as described below.

REVIEWER COMMENT: Reviewer #2: Thank you for the opportunity to review this manuscript. This is an interesting topic for nursing research.

RESPONSE: We thank the reviewer for kind words. We have revised our manuscript based on the comments as described below.

Background:

REVIEWER COMMENT: Please provide information to highlight the significance of the study.

RESPONSE: The finding of this study will be helpful for policymakers (whether governmental or Non-Governmental Organizations working on child feeding practices) to design evidence-based alternative strategies. It is also used for researchers as a baseline for future related studies. It is also a key for health professionals for providing evidence-based counseling on the study area.

REVIEWER COMMENT: Explain the father’s role in child feeding and how the father can influence the nutritional outcomes among children. Provide the association or relationship between malnutrition with father involvement in child feeding with literature support.

RESPONSE: We have revised it as

Studies reveal a strong correlation between dads' substantial involvement in infant feeding activities and nutritional diversification (10). and families with involved fathers had significantly better breast-feeding practices than those with less involved fathers, such as by attending breast feeding sessions with moms, participating in decision-making, and supporting the mother around the house (11-12). Another community-based participatory intervention study revealed that involving both parents equally and actively in child-feeding is a promising strategy for preventing childhood obesity (13)

Methods:

REVIEWER COMMENT: My main concern is the questionnaire used for the study. Detailed description is needed for the development and validation of the questionnaire. It is not sufficient with one sentence “Literature is reviewed to develop a questionnaire (23).”

RESPONSE: We have revised it as

Literature is reviewed to develop a questionnaire and it was validated (27) and further more we have done pretest since pre-tests also provide the most direct evidence for the validity of the questionnaire. More over to determine the content validity of the questionnaire, the collected views, as well as comments experts in the fields of nutrition, biostatics, and epidemiology, were taken.

REVIEWER COMMENT: The questionnaire is consisted of 4 parts: Father involvement, Knowledge, attitudes. Culture of Fathers about Father Involvement in Child Feeding. Please provide information on the number of items, the scoring methods and interpretation of the scores for each part of the questionnaire.

RESPONSE:

Fathers’ involvement in child feeding practice was assessed using 22 items with five major domain such as shared decision making in child feeding practice (6 items), providing physical support to the mother (5 items), providing psychosocial support (3 items), providing financial and resource support (5 items) and workload sharing (3 items). From these 22 questions directed to the fathers, variable scores of 12 and above were considered as good fathers’ involvement while variable scores of below 12 were considered as poor fathers’ involvement in child feeding practices (28).

Knowledge of fathers towards fathers’ involvement in child feeding was also assessed using 9 items that were directed to the fathers. The questions asked had the following components asked in such a way that do you know about; baby start complementary feeding at 6 months, recommended duration of breastfeeds 24 months or more, have role in providing advice on diet, have role in farming/gardening nutritious food, have role in financial support to buy nutritious food, have role in cooking a meal for a child, have role in accompaniment to medical appointments/growth monitoring, have role in in social and emotional support and have role to help child feeding mothers with house hold chores. Fathers who scored five and above among the listed nine items were considered as having good knowledge towards fathers’ involvement in child feeding practices while those who scored below five were considered as having poor knowledge towards fathers’ involvement in child feeding practices (29).

The responses of fathers about attitude towards father involvement in child feeding were in the form of 5-point Likert scale, wherein a score of +2 meant they strongly agreed to the statement, +1 meant agreed, 0 neutral feeling to the statement, -1 meant disagreed to the statement and -2 was the score for strongly disagree. The total score was calculated and was transformed into mean ‘percent score’ by dividing the score with possible maximum score and multiplied by 100. Scores for attitude was categorized as negative [0-<=60%] and positive [>60%] (29).

REVIEWER COMMENT: Item 3 to 9 for knowledge questions are more related to practices towards father involvement in child feeding as we cannot expect a dichotomous response for these questions and it is not appropriate to assess knowledge, for instance: Item no. 3 – “fathers’ involvement in child feeding in providing advice or suggestions on diet” and item no.6 – “fathers involvement in child feeding in prepare and cooking a meal for a child.”

RESPONSE: To the best of our knowledge, framing of knowledge items possible in two section such as multiple choice and yes or no items. it seems practice because we didn’t write whole part of question to reduce space, but it misleads readers. So that we have revised all knowledge questions as it was.

REVIEWER COMMENT: Apart from that, items for father involvement activities in child feeding (assist mother with household chores, accompanying mother for child health clinics, allowing other family members/relatives to support the mother after delivery, transporting the child to health clinics, looked after your child when the mothers were not around). These questions are more related to activities of looking after the child, shar burden of the wife, not measure father involvement in child feeding directly.

RESPONSE: We have been assured for you that father involvement is broad and we have considered father involvement in five broad domains such as 1. shared decision making in child feeding practice, 2 Providing Physical support to the mother, 3. Providing psycho-social support, 4. Providing Financial and resource support, 5. Workload sharing and promoting optimal child feeding practices. Those listed activities are directly or indirectly linked with father involvement in child feeding.

REVIEWER COMMENT: Is it possible multiple submissions as the father might have two children range 6 months to 24 months?

RESPONSE: There is no possibility for multiple submissions even if father have two children range 6 months to 24 months, we already asked him about index child.

REVIEWER COMMENT: Please provide justification of pilot test with 5% of sample size.

RESPONSE: We have done pretest on 5% of sample size because due to low resource and time.

REVIEWER COMMENT: Please provide explanation on types of bivariate analysis and multivariate logistic regression analysis.

RESPONSE: We have revised it as

Independent variables with a P-value < of 0.25 in the bivariate analysis entered into the multivariable logistic regression in order to control the possible effect of confounders using the backward likelihood regression variable selection method.

Results:

REVIEWER COMMENT: Please provide justification for 100% response rate.

RESPONSE: This 100% response rate was achieved by multiple contacts; a person was deemed non-responsive if absent after three consecutive visits.

REVIEWER COMMENT: Suggest to remove figure 1, 2 and 3.

RESPONSE: We have removed figure 1, 2 and 3

Discussion:

REVIEWER COMMENT: The authors have discussed the study results and have attempted to link it with previous studies. However, the result was not been analyzed and argued critically.

RESPONSE: We have revised it based on your comment

REVIEWER COMMENT: Please provide description on “Alive &Thrive's activities in Ethiopia” as background information.

RESPONSE: We have been revised it and provide description on “Alive &Thrive's activities in Ethiopia” as background information.

Overall comments:

REVIEWER COMMENT: This paper requires proof-reading as there are grammatical and sentence structure errors.

RESPONSE: We have revised our manuscript based on the comments for grammatical and sentence structure errors.

REVIEWER COMMENT: Citing and referencing skills can be further improved. There are some claims that are not having references. As a reader, I had difficulties to follow which of the sentences / ideas were from the references and which were authors own ideas. I hope the authors be more precise with the referencing.

RESPONSE: We have revised our referencing to reduce any confusion.

RESPONSE TO REVIEWER 3:

RESPONSE: We thank the reviewer for kind words. We have revised our manuscript based on the comments as described below.

Reviewer #3: General Comments

REVIEWER COMMENT: Language – grammatical and editorial issues all over the paper.

The manuscript needs careful revision by a proof-reader as there are numerous grammatical errors, missing words, and errors in tense which make it sometimes difficult to read easily.

RESPONSE: We thank the reviewer for kind words. We have revised our manuscript based on the comments for grammatical and editorial issues.

Background:

REVIEWER COMMENT: The background overall well written. Just wonder.,

Paragraph 4 - Can the stated information linked significantly with father involvement in child feeding?

RESPONSE: We thank the reviewer for kind words. Stated information in paragraph 4 does not have linked with father involvement in child feeding. Even if it has no direct link with it, we just providing general information on malnutrition globally, sub-Saharan Africa and Ethiopia. If you suggest us to delete it, please let us know.

REVIEWER COMMENT: Is the father involvement truly important in determining a child development especially in an underdeveloped country? Ensuring a 'good food' for their family is a big task and timely responsible. To me, a good socioeconomic status is an answer for all particularly in country like Ethiopia, Kenya etc.

RESPONSE: we have considered father involvement in five broad domains such as 1. shared decision making in child feeding practice, 2 Providing Physical support to the mother, 3. Providing psycho-social support, 4. Providing Financial and resource support, 5. Workload sharing and promoting optimal child feeding practices

so that as you stated above good socioeconomic status is an answer for all particularly in developing country, father involvement also includes the above broad domains which include Providing Financial and resource support which has indirectly linkage with determining a child development.

Method and Design

REVIEWER COMMENT: Study Design and Settings

RESPONSE: We have revised it and provide map of study setting

REVIEWER COMMENT: Participants and Sampling

Paragraph 1 - is repetition (L1-4) and (L4-8)

RESPONSE: We have deleted (L1-4) to reduce repetition

REVIEWER COMMENT: A good and systematic random sampling method had been applied.

RESPONSE: Thank you for kind words.

REVIEWER COMMENT: Measurement A questionnaire developed - was validated.

RESPONSE: Yes, developed questionnaire was validated.

REVIEWER COMMENT: Data Quality Assurance

Well mentioned Suggestion: the writing is too long can be rewrite and merge the paragraph 1 and 3.

RESPONSE: Thank you for kind words. We have revised and merged the paragraph 1 and 3 as.

A pre-test was done on 5% (20) of the sample size before the actual data collection. Amendments were made on questions after pre-testing. The questionnaire was prepared first in English and then translated to the local language of Amharic and back-translated to English by a third person who was native to Amharic and had experience in translation. The reliability tests were checked using Cronbach's alpha of 0.7 as the cut-off point to assess the internal consistency of the research instrument. The overall Cronbach's Alpha Coefficient value for the data collecting instrument was found to be 0.827 indicating the acceptability of the scale for further analysis. Hosmer and Lemeshow's test value was checked for its model fitness and its result is 0.833 indicating the model was fit.

REVIEWER COMMENT: Data Management and Analysis

The descriptive result should be concise i.e., a repetitive information in text, figures and tables should be avoided. Figure 1-3 can be deleted; the same information can be found in the bottom of Table 2-4 and in the text.

RESPONSE: We have revised it and we removed Figure 1-3 to reduce redundancy

Results

REVIEWER COMMENT: Socio-Demographic characteristics

The text can be shortened, all information from Table 1 is self-explanatory.

RESPONSE: We revised it as

A total of 408 fathers who had children between 6 to 23 months were enrolled in the study with a response rate of100%. The mean age of the study participants was 36.8 with a standard deviation (SD) of 8.892 years and the majority of them, 334 (81.9%) lived in rural areas.

REVIEWER COMMENT: Information of Respondents about Father Involvement in Child Feeding Is this data only reported in text? The title Information of Respondents about Father Involvement in Child Feeding seem to be confused with Table 5 and its text.

RESPONSE: Yes, this part is only reported in text. We have revised it as Source of Information of Respondents about Father Involvement in Child Feeding. Table 5 has different idea and it is about items report to say good or poor father involvement.

REVIEWER COMMENT: Knowledge of Fathers about Father Involvement in Child Feeding Is the item listed in the Table 2 portrayed knowledge of fathers about father involvement? i.e., fathers’ involvement in child feeding in social and emotional support; fathers’ involvement in child feeding in sharing workload and health etc. Wonder such items can its represented father’s knowledge on father involvement.

RESPONSE: it seems practice because we didn’t write whole part of question to reduce space, but it misleads readers. So that we have revised all knowledge questions as it was. As we provide information about father involvement in five broad domains such as 1. shared decision making in child feeding practice, 2 Providing Physical support to the mother, 3. Providing psycho-social support, 4. Providing Financial and resource support, 5. Workload sharing and promoting optimal child feeding practices. So that we want to know fathers’ knowledge on whether they have role on those listed domains which are directly or indirectly linked with father involvement in child feeding.

REVIEWER COMMENT: The Attitude of Father about Father Involvement in Child Feeding Table 3, explained on the fathers’ attitude, Figure 2 is redundant.

Culture of Fathers about Father Involvement in Child Feeding Table 4 can explain the Culture of Fathers. The Magnitude of Father Involvement in Child Feeding Please check

RESPONSE: We have revised it and we removed Figure 1-3 to reduce redundancy

REVIEWER COMMENT: Factors Associated with Father Involvement in Child Feeding. Table’s title can be revise i.e., Table 6: Fathers involvement in child feeding and Its’ Association Factor. Please write only concise text.

RESPONSE: We have revised it as Table 6: Multivariable logistic regression model for fathers’ involvement in child feeding practice in Antsokia Gemza Wereda, North East Ethiopia, 2022.

Discussion

REVIEWER COMMENT:

RESPONSE: We have revised it based on your comment

Conclusion

REVIEWER COMMENT: Well, conclude by restating the purposes of the study with summarized results and conclusion that can early predict.

RESPONSE: We have revised it as

References

REVIEWER COMMENT: Please be consistent. Check-up: Reference no 8, 9,17,19,21,22, 23, 24, 28

RESPONSE: We have revised our reference based on your comment and for further checkup reference no 8: deleted based on other reviewer suggestion, 9: changed to 8, 17: changed to 20, 19: changed to 23, 21: changed to 25, 22: changed to 26, 23: changed to 27, 24: changed to 28, 28: changed to 31

Attachment

Submitted filename: Response to Reviewers.docx

Click here for additional data file.^{(34KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0276565.r003

Decision Letter 1

Khatijah Lim Abdullah

8 Sep 2022

PONE-D-22-14665R1Fathers Involvement in Child Feeding and Its Associated Factors Among Fathers Having Children Aged 6 to 24 Months in Antsokia Gemza Woreda, Ethiopia: Cross-Sectional StudyPLOS ONE

Dear Dr. Bogale,

Please submit your revised manuscript by Oct 23 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

We look forward to receiving your revised manuscript.

Kind regards,

Khatijah Lim Abdullah, DClinP, MSc., BSc

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

Dear Authors

Thank you for the revised manuscript. However, there are minor issues that need to be addressed as per reviewer comments and the need for proof reading

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: It is not clear in Table 6, the income is less than 500 and etc. What is the minimum wage for a family should be? 500 is equivalent to how many dollars (USD)?

I don't understand in financial disclosure no funders but this work is supported by Bill and Melinda gates as well ?

Besides this study findings will be presented at conference, how is the data will be conveyed to the general public in Ethiopia?

Reviewer #2: Thank you for the opportunity to review the revision of the manuscript. This manuscript is very much improved and it is good to see that the authors have addressed the issues based on reviewers’ feedback. However, the validation of the questionnaire issue remains.

Methods:

Please provide clearer illustration of the map (Figure 1).

The key area of concern relates to the validation of the questionnaire. There is insufficient evidence provided to support the claims that the instruments used are reliable and valid.

Detailed description is needed for the development and validation of the questionnaire. “Literature is reviewed to develop a questionnaire and it was validated…”

Please provide psychometric properties of the instrument.

Overall comments:

It is strongly suggested to send the paper for proof-reading as there are grammatical and sentence structure errors.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

**********

Attachment

Submitted filename: PONE-D-22-14665_R1_reviewer comments.pdf

Click here for additional data file.^{(182.3KB, pdf)}

PLoS One. 2022 Nov 28;17(11):e0276565. doi: 10.1371/journal.pone.0276565.r004

Author response to Decision Letter 1

12 Sep 2022

RESPONSE TO EDITOR AND REVIEWERS

RESPONSE TO EDITOR

RESPONSE: Thank you for coordinating the review process and fruitful comments. We have revised the manuscript and addressed Reviewer’s comments.

Journal Requirements:

COMMENT: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

RESPONSE: We have reviewed our reference list and we have got it complete and correct

Additional Editor Comments:

COMMENT: Dear Authors, Thank you for the revised manuscript. However, there are minor issues that need to be addressed as per reviewer comments and the need for proof reading

RESPONSE: We thank the reviewer for kind words and for fruitful comments. We have revised our paper by correcting grammatical and sentence structure errors.

RESPONSE TO REVIEWER 1:

Reviewer #1: All comments have been addressed

RESPONSE: We thank the reviewer for kind words. We have revised our manuscript based on the comments as described below.

REVIEWER COMMENT: Reviewer #1: It is not clear in Table 6; the income is less than 500 and etc. What is the minimum wage for a family should be? 500 is equivalent to how many dollars (USD)?

RESPONSE: We thank the reviewer for kind words and comments. We would like to notify for you that we add the term Ethiopian birr to make clarity for the income. Now a days 52.811 Ethiopian birr is equivalent to 1 USD dollars. So that 500 Ethiopian birr is Equivalent to 9.467 USD dollars. In Ethiopia, the household is deemed as living in poverty if the per capita consumption is less than equal Birr 3781, so that minimum wage for a family to classify as poor is less than 500 birrs.

REVIEWER COMMENT: I don't understand in financial disclosure no funders but this work is supported by Bill and Melinda gates as well?

RESPONSE: We thank the reviewer for kind words and comments. We have not received specific funding starting from proposal development to report writing. We ensured for you that, we have not received specific fund from Bill and Melinda gates.

REVIEWER COMMENT: Besides this study findings will be presented at conference, how is the data will be conveyed to the general public in Ethiopia?

RESPONSE: We thank the reviewer for kind words and comments. We will have plan to contact Ethiopian Ministry of Health to use our data for policy development and to design intervention based on our finding.

RESPONSE TO REVIEWER 2:

PONE-D-22-14665_R1: Fathers Involvement in Child Feeding and Its Associated Factors Among Fathers Having Children Aged 6 to 24 Months in Antsokia Gemza Woreda, Ethiopia: Cross- Sectional Study 1 Thank you for the opportunity to review the revision of the manuscript. This manuscript is very much improved and it is good to see that the authors have addressed the issues based on reviewers’ feedback. However, the validation of the questionnaire issue remains.

RESPONSE: We thank the reviewer for kind words. We have revised our manuscript based on the comments as described below.

REVIEWER COMMENT: Please provide clearer illustration of the map (Figure 1).

RESPONSE: We thank the reviewer for kind words. We have been readjusted it based on your comment

REVIEWER COMMENT: -

Methods: The key area of concern relates to the validation of the questionnaire. There is insufficient evidence provided to support the claims that the instruments used are reliable and valid. Detailed description is needed for the development and validation of the questionnaire. “Literature is reviewed to develop a questionnaire and it was validated…” Please provide psychometric properties of the instrument.

RESPONSE: we adapt the questionnaire with necessary modification from the study conducted in North East Nigeria (27) which aimed to asses fathers’ knowledge, attitude and practices of fathers on their role to support recommended IYCF practices. In that study the questionnaire preliminary draft questionnaire developed by the consultant was reviewed by SC. It was then pre-tested in the field, revised and completed for the field survey, but psychometric analysis was not performed. Furthermore, as we informed you before, we have done pretest since pre-tests also provide the most direct evidence for the validity of the questionnaire; More over to determine the content validity of the questionnaire, the collected views, as well as comments experts in the fields of nutrition, biostatics, and epidemiology, were taken. We thank the reviewer for kind words and such an interesting comment and we will consider your comment as a title for future study which entitled with tool validation on fathers Involvement in Child Feeding and Its Associated Factors by using Confirmatory factor analysis.

REVIEWER COMMENT: Overall comments: It is strongly suggested to send the paper for proof-reading as there are grammatical and sentence structure errors.

RESPONSE: Thank You for fruitful comments. We have revised our paper by correcting grammatical and sentence structure errors.

Attachment

Submitted filename: Response to Reviewers.docx

Click here for additional data file.^{(1.3MB, docx)}

PLoS One. doi: 10.1371/journal.pone.0276565.r005

Decision Letter 2

Khatijah Lim Abdullah

27 Sep 2022

PONE-D-22-14665R2Fathers Involvement in Child Feeding and Its Associated Factors Among Fathers Having Children Aged 6 to 24 Months in Antsokia Gemza Woreda, Ethiopia: Cross-Sectional StudyPLOS ONE

Dear Dr. Bogale,

Please submit your revised manuscript by Nov 11 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

We look forward to receiving your revised manuscript.

Kind regards,

Khatijah Lim Abdullah, DClinP, MSc., BSc

Academic Editor

PLOS ONE

Journal Requirements:

Additional Editor Comments:

Dear Authors

Many thanks for the time and effort in revising the manuscript

Overall most of the comments have been addressed

However we noted that although Table 6 have been added the term Ethiopian birr to make clarity for the income, it was noted that

1) Table 1 should also have the added term Ethiopian birr to made clear on the household monthly income.

2) To include an NB that a) 52.811 Ethiopian birr is equivalent to 1 USD dollars. b) minimum wage for a family to classify as poor is less than 500 birrs.

There is also a need to proof read the manuscript before acceptance.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #2: Yes

**********

6. Review Comments to the Author

Reviewer #2: Thank you for the opportunity to review the second revision of the manuscript.

All the comments have been addressed. The paper will make an important contribution to the literature.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No

**********

Attachment

Submitted filename: Reviwer comment_PONE-D-22-14665_R2.pdf

Click here for additional data file.^{(105.9KB, pdf)}

PLoS One. 2022 Nov 28;17(11):e0276565. doi: 10.1371/journal.pone.0276565.r006

Author response to Decision Letter 2

28 Sep 2022

RESPONSE TO EDITOR AND REVIEWERS

RESPONSE TO EDITOR

RESPONSE: Thank you for coordinating the review process and fruitful comments. We have revised the manuscript and addressed both editor and Reviewer’s comments.

Journal Requirements:

RESPONSE: We have reviewed our reference list and we have got it complete and correct

Additional Editor Comments:

COMMENT:

Many thanks for the time and effort in revising the manuscript. Overall, most of the comments have been addressed. However, we noted that although Table 6 have been added the term Ethiopian birr to make clarity for the income, it was noted that

1) Table 1 should also have the added term Ethiopian birr to made clear on the household monthly income.

2) To include an NB that a) 52.811 Ethiopian birr is equivalent to 1 USD dollars. b) minimum wage for a family to classify as poor is less than 500 birrs.

RESPONSE: We thank the editor for kind words and for fruitful comments. We have revised it

1) by adding word In Ethiopian birr in table 1 in household monthly income part.

2) by adding remember note below table 1 and table 6 as: a) 52.811 Ethiopian birr is equivalent to 1 USD dollars. b) minimum wage for a family to classify as poor is less than 500 birrs.

COMMENT: There is also a need to proof read the manuscript before acceptance.

RESPONSE: We thank the reviewer for kind words and for fruitful comments. We have revised our paper by correcting grammatical and sentence structure errors.

RESPONSE TO REVIEWER 1:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict-of-interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed