Table 1 shows the complementary food hygiene practices among mothers/ caregivers in Robe town, Southeast Ethiopia. Four hundred sixty-seven mothers, 91.9% cook food for their child separately from food of other family members, while the rest mothers reported they were given food for their children from domestic foods prepared for other family members. This study also revealed that 30.5% and 40.2% of mothers reported that prepared food is served immediately after preparation and within two hours, respectively. But, the study revealed that 29.3% mothers were storing prepared food for more than two hours, which they use to serve it two and more times. Four hundred sixty-six mothers, 87.8% store prepared food in a covered place. However, 9.6% of interviewed mothers store uncovered food in room temperature. Forty-one 8% of participated mothers store food in the refrigerator and 2% of them left it as hot in high temperature (most of them responded they left it on the stove which they used for cooking) until served (Table 1).

More than half, 58% of mothers participated in the study reported they always reheat food when they want to give their child ready to eat food (cooked food) that stayed more than two hours at room temperature. Whereas 28% of the study participants discard it and 13.8% of them feed without reheat.

Concerning hand washing at critical times, most mothers, 81.5% washed their hands after visiting the toilet and only 32.7% of them reported they wash their hands before feeding their child. But the proportion of mothers who have practiced hand washing with soap at a critical time was lower. For instance, 17.5%, 21.3% and 32.7% of them were reported, they wash their hands with soap before eating food, before feeding baby and before preparing food, respectively (Figure 1). Most of the mothers who did not report hand washing with soap at critical times reported that they use soap other times such as; after they eat or prepare foods containing fat and oil, after touching charcoal, after the meal, morning and evening, and before religious practices (i.e. Salat).

The mothers were asked type of utensils or methods they use to feed their child. According to the result of the study, 86.6% of mothers feed with a spoon/cup, and 40.7% of them use their bare hands. From which 28.5% of mothers use both spoon and bare hand simultaneously to feed depending on types of food. For foods like bread and ‘injera’ they use their bare hands, whereas for foods like milk and semi-solids they use spoon or cups. Bottle feeding was also practiced by 35% of mothers (Figure 2).

The majority of mothers, 79.7% and 55.5% use soap and hot water respectively to clean utensils used for child feeding, whereas some mothers, 20.5% used only cold water to clean utensils, while few numbers of mothers, 9% did not use soap and hot water at the same time to clean and sanitize spoons and plates used to feed their children.

Pertaining waste disposal practices, 15% of mothers dispose of the children’s feces to open field. Few mothers responded that they do not dispose child feces in the latrine; they throw out at other places; for example, near the fence where the adults’ feet could not reach. In addition, more than half of study participants, 57% practiced open field disposal of other liquid wastes generating from the household.

According to the result of the study the overall food hygiene practice of mothers was significantly associated with child age, growth monitoring follow-up, media exposure and knowledge of mothers on critical times of hand washing. Mothers of children aged 12-23 months practice 1.63 times good food hygiene than that of children aged 6-11 months of age (AOR, 1.82 95% CI (1.21, 2.73)). Mothers whose child attend growth monitoring session practice good food hygiene than their counterpart (AOR, 2.74 95% CI (1.49, 5.06)). The finding also identified that mothers who have media exposure practiced good food hygiene practices compared to mothers who have no media exposure (AOR, 0.73 95 CI (1.14, 2.62)). Mothers who have knowledge on critical times of hand washing have more likely to practice better food hygienic practices than mothers who does not have knowledge on critical times of hand washing (AOR, 1.94 95% CI (1.33, 2.82)). Educational status of mothers, occupation of fathers and marital status of mothers showed significant association in bivariable regression, but not in a multivariable regression model (Table 2).

The result showed that 55% of interviewed mothers scored above the mean of overall food hygiene practices. Their practice of food hygiene is significantly associated with age of the child. Mothers of younger children had lower odds of practicing good complementary food hygiene than those of older children (12-23 months). This might be because most of the time mothers consider hygiene measures for their children when they become older, particularly hand washing for infants were not common. Mothers having media exposure and knowledge on critical times of hand washing practice relatively good food hygiene, compared to their counterparts. This confirms the reality that media exposure has a positive association with their knowledge, which in turn has a positive influence on their practice of good food hygiene. In addition, mothers whose child attended growth monitoring session practice good food hygiene than those who did not attend. This might be as a result of counseling given to mothers or caregivers during this session.

When we see handwashing practices of the study participants, the study showed that 33% of mothers reported they wash their hands with water and soap before food preparation. It was lower than study conducted in India, which was 74% 24. This difference might be due to the difference in the study area and period. Handwashing practice with water and soap after using latrine was 81%, which was better, however, only 21% of mothers reported they wash their hands with water and soap before feeding their children. This finding was low compared to that of India 79% and Bangladesh 55% 1524. Some of the mothers reported that they wash their hands with soap only during special occasions, which are not considered as critical times like after eating foods containing fat or oil, the morning when they wake up and when they touch like fumes and charcoal which have minimal public health importance. These mothers did not have a habit of washing their hands with soap at the critical times to prevent diseases, which could be risk for children s and other families health. Concerning cleaning and sanitizing of utensils, few mothers were not properly washed the plates and spoons used for serving food after previous use. This problem might be arises from different reasons, like the shortage of water, mothers workload and inadequate knowledge on the importance of cleaning and sanitizing utensils. They use only cold water to clean utensils, and this may contribute to post cooking contamination of the complimentary food. Ideally, all mothers should clean and sanitize utensils used for an infant or young child s food thoroughly to remove microorganisms found on it. In other way, a number of study participants use bottles with teats to feed their children, which is difficult to clean and sanitize regularly in the context of current study setting. The use of bottles is an obviously harmful practice which increases the risk of food contamination and diarrheal diseases and should not be practiced at all.

The study showed that 40% of mothers use their bare hand to feed the children. Of which only 19% of them wash their hands using soap and water, which also contributes to the contamination of complementary foods and in turn childhood illnesses 1718.

According to this finding, 29% of mothers store prepared child meal for more than two hours to serve it two times and more. The place where this food stored determines the level of contamination. If it refrigerated the bacterial multiplication becomes very slow. If it does not refrigerated it should be eaten soon, no more than 2 hours, before microorganisms have time to multiply. However, the study shown that only 8% of families store food in the refrigerator. Cooking small amounts of food which child can consume within a short period of time to avoid long periods of storage and spoilage is the first one choice and could solve the problems related to food storage practice especially in low-income families. Because there is the issue of lack of proper operation and maintenance of refrigerator, discontinuity in power supply or faulty of temperature control, it could be harmful for the food spoilage and contamination.

This study has shown that 30% of mothers feed always fresh food immediately after preparation and 29% of mothers store food for more than two hours to serve it for another time. This can increase the risk of contamination and diarrheal diseases among children due to the fact that microbial counts increased as food stored at room temperature and can reach its infective dose within two hours 2025. Most of the mother s store foods covered and few of them; however, stored in uncovered place and increase the level of food contamination 26. Ideally, it is important to never store complementary food to prevent contamination 27. But, especially in low socioeconomic households whose purchasing power is low, it is difficult to discard leftovers at every time the food is prepared for the children. Thus, it is better to educate mothers the principles of food hygiene practices.

The study also revealed that 58% of mothers always use the reheating method after serving left over. Reheating is easy to prescribe, but could be difficult, especially for poor and busy mothers to practice. The reason for reheating food among our mothers is another critical issue to be considered, because most of them practice reheating simply to make foods warm to make it palatable, rather than to destroy harmful microorganisms. As previous studies show, reheating foods before consumption can considerably reduce food contamination and the risk of illness 2528.

The mothers food hygiene practices were determined based on self-reported data which might introduce social desirability bias; and it could overestimate the appropriate practices. This limitation was considered in the study procedures while interviewing the mothers to minimize it as much as possible.