ABSTRACT
Infant nutrition is an integral part of infant health. Infant feeding practices are feeding options and activities undertaken by mothers/caregivers to meet the infant’s nutritional needs. Optimal Infant Feeding Practices recommended by World Health Organization (WHO) and United Nations International Children’s Emergency Fund (UNICEF) involves early initiation of breastfeeding, exclusive breastfeeding for the first 6months of life, followed by adequate complementary feeding and continued breastfeeding until the child is at least two years old. This study assessed the knowledge, attitude and practice of infant feeding in association with their anthropometric indices in Awka, Awka south local government area of Anambra State. A cross sectional descriptive survey design was adopted. The population of the study were all the mothers with 0-12 Months old infants. Data collection was done using a closed ended questionnaire. Recumbent length was measured using an infantometer and reading was taken to the nearest 0.1cm. Weight was taken using bathroom weighing scale and measurement was taken to the nearest 0.1kg. WHO-Anthro was used to assess the anthropometric status (Z-score) of the infant. In the classification of the knowledge questions correct response was assigned the value of one while zero was given to the wrong responses. In the classification of the knowledge questions correct response was assigned the value of one while zero was given to the wrong responses. The knowledge and attitude score was derived from the summation of the individual question scores while the percentage knowledge score was obtained by dividing the knowledge score by the number of knowledge items. Knowledge was graded thus: poor knowledge (≤ 39.9), fair knowledge (40.0-69.9) while good knowledge (≥ 70.0). Descriptive statistics (frequency and percentage, mean and standard deviation) were used to analyze the personal and socio-economic characteristics of the respondents, infants feeding practices among mothers, knowledge of mothers on breastfeeding and continued breastfeeding. Significant difference was judged at p<0.05. The result revealed that many of the nursing mothers (65.5%) who participated in the study had good knowledge on practice of breastfeeding and continued breastfeeding at one year. Few infants (30%) received adequately diversified foods during their weaning period, stunting and underweight were found to be prevalent among few infants (10.3% and 1.8%) involved in this study. Thus it concludes that although the knowledge of many of the mothers were good, some of the mothers practice early ceasation of breastmilk, early as well as late introduction of complementary foods which are most times nutritionally inadequate. The study recommends that sensitization and awareness creation during antenatal and post natal periods should be sustained through multi-sectoral efforts.
TABLE OF
CONTENTS
Title page i
Certification ii
Dedication iii
Acknowledgements iv
Table of Contents v
List of Tables x
Abstract xi
CHAPTER ONE:
INTRODUCTION 1
1.1 Statement
of Problem 4
1.2 Objectives
of the Study 5
1.2.1 General
Objectives of the Study 5
1.2.2 Specific
Objectives of the Study 6
1.3 Significance
of the Study 6
CHAPTER TWO: REVIEW
OF RELATED LITERATURE
2.1 Infant
and Young Child Feeding 8
2.2 Anthropometry 9
2.2.1 Height/Length
Measurement 11
2.2.2 Head/Chest
Circumference 11
2.2.3 Mid-upper Arm
Circumference 12
2.2.4 Skinfold Thickness 12
2.2.5 Weight-for-age 13
2.2.6 Weight-for-height 13
2.2.7 Length for age or
height for age 13
2.3 Breastfeeding 14
2.3.1 Early Initiation of
Breastfeeding 14
2.3.2. Exclusive
Breastfeeding 15
2.3.3 Health Benefits of
Breastfeeding 16
2.4 Complementary
Feeding 18
2.4.1 Early and Late
Introduction of Complementary Foods 19
2.4.2 Developmental and
Nutritional Reasons for Introducing Complementary Foods 20
2.5 Nutritional
Composition and Characteristics of Human Breastmilk. 22
2.6 Formula Feeding
Practices 24
2.6.1 Formula feeding
problems 25
2.7 Methods of
Evaluating Dietary Intake 26
2.7.1 24-hour dietary
recall 27
2.7.2 Food Record/Diary 27
2.7.3 Food Frequency
Questionnaire 28
CHAPTER THREE: MATERIALS AND METHODS
3.1 Study Design 30
3.2 Study Area 30
3.3 Population of the
Study 31
3.4 Sampling and
Sampling Technique 31
3.4.1 Sample Size Determination 31
3.4.2 Sampling Procedure 32
3.5 Preliminary
Activities 33
3.5.1 Preliminary visit 33
3.5.2 Training of research
assistants 33
3.5.3 Informed
Consent 34
3.6 Data Collection 34
3.6.1 Questionnaire Design 34
3.6.2 Questionnaire
Administration 34
3.6.3 Anthropometry
Measurements 35
3.6.4. Dietary
Assessment methods 36
3.7 Data Analysis 37
3.8
Statistical Analysis 38
CHAPTER
4: RESULTS AND DISCUSSION
4.1 Personal and
Socio-Economic Characteristics of Mothers 40
4.2 Personal Characteristics
of the Infants 43
4.3 Knowledge
of Breastfeeding among Nursing Mothers 45
4.4 Information on
breastfeeding practice 47
4.5 Practice
of Breastfeeding and Continued Breastfeeding at one Year 52
4.6 Food
Groups Consumed by 30% of Infants by Dietary Diversity Tertile 56
4.7 Anthropometric Indices of
the Infants 58
CHAPTER
5: CONCLUSION AND
RECOMMENDATIONS
5.1 Conclusion 61
5.2 Recommendations 61
REFERENCES 63
LIST OF TABLES
Table 1: Physiological
and neurological maturation to determine the optimal
introduction of complementary feeding. 21
Table 4.1 Personal and Socio-Economics Characteristics
of Mothers 42
Table 4.2 Personal Characteristics of the Infant 44
Table 4.3 Knowledge of breastfeeding among Nursing Mothers 46
Table 4.4 Knowledge of breastfeeding Practice 49
Table 4.5: Practice of Breastfeeding and Continued Breastfeeding at one
Year 54
Table 4.6 Food groups consumed by 30% of Infants
by dietary diversity tertile 57
Table 4.7 Anthropometric Indices of the Infants 60
CHAPTER ONE
INTRODUCTION
Infant feeding practices have been responsible, directly or
indirectly for 60 percent of the 10.9 million deaths annually among under five
children (Kramer and Kakuma, 2004). Over two thirds of these deaths, which are
often associated with inappropriate feeding practices, occur during the first
year of life (Piwoz and Prebe, 2004). According to the World Health
Organization, 30 percent of children under five years worldwide have growth
problems as a consequence of poor feeding (World Health Organization, 2005).
Infant nutrition is an integral part of infant health. The infant is more
sensitive to abnormal nutritional situations and less adaptable than in later
life to different types, form, proportions and quantities of food. Nutrition is
the act and science of food consumption to help maintain a healthy and active
life. Infant feeding practices are feeding options and activities undertaken by
mothers/caregivers to meet the infant’s nutritional needs (Oly-Alawuba and
Ihedioha, 2018). An infant is a young child between zero to twelve (0-12)
months after birth (Anoshirike and Asinobi, 2008). A mother is someone who
loves unconditionally and places the needs of her children above her own, on a
personal level, and not only with words, but actions. Optimal Infant Feeding
Practices recommended by World Health Organization (WHO) and United Nations
International Children’s Emergency Fund (UNICEF) involves exclusive
breastfeeding for the first 6months of life, followed by adequate complementary
feeding and continued breastfeeding until the child is at least two years old.
Benefits to infants when breastfeed appropriately includes reduced risk of
diarrheal and gastro intestinal illness, allergies, acute respiratory
infections, bacterial meningitis, childhood asthma and childhood leukemia
(Anoshirike et al., 2014). Promoting adequate infant feeding practices
such as early initiation of breastfeeding and exclusive breastfeeding for up to
six months is an effective strategy for improving child survival.
Safety and sanitation of food, beverages and utensils used to feed
infants are of utmost importance given that microbial pathogens are the leading
causes of infant morbidity and mortality from gastro-intestinal and diarrheal
diseases in children. To emphasize the importance of child feeding, WHO and
UNICEF. (2002) jointly developed the strategy for infant and young child
feeding (IYCF). The recommendation in
this strategy states that children should be exclusively be breastfed for 6 months
after birth and provided with safe and adequate complementary foods with
continued breastfeeding up to 2 years. No more than 35 percent of infants
worldwide are exclusively breastfed during the first months of life, with only
12% of infants in Nigeria been exclusively breastfed in the first six months of
life in 2012. Complementary feeding frequently begins too early or too late and
foods are often nutritionally inadequate and unsafe (Awogbenja, 2010). Breastfeeding remains a pivotal factor
between life and death for the vast majority of children in developing
countries such as Nigeria, but the current data reveals that 55% of Nigerian
mothers are ignorant of the importance of exclusive breastfeeding. Artificial
feeding increases the risk of diarrhea and malnutrition and in turn substantially
increases the risk of infant’s death.
Previous reports have shown that non practice of exclusive
breastfeeding is a risk factor for a number of diseases, including diarrhea and
upper respiratory infections (Ogbo, 2016). Feeding practices during infancy are
critical for the growth and health of a child during the first two years of
life and of importance for the early prevention of chronic degenerative
diseases (Matthew et al., 2009). The risks of early childhood survival
in Nigeria are to be considered. A newborn Nigerian baby has a 30 times higher
chance of dying before the age of 5 years than a baby born in the developed,
industrialized countries (Ruel, 2003). The report of a research showed that the
regional prevalence of diarrhea, under-nutrition and under five mortality in
Nigeria are far more prevalent in the northern than in the southern part of
Nigeria (Hodges, 2001). There is the need to focus attention on the promotion
of feeding practices at the household level that are beneficial to the survival
of children and caregivers in Nigeria. The above studies indicate the need for
a comprehensive strategic plan that is achievable to improve IYCF practices in
Nigeria, and to build on previous policy initiatives of past years. Therefore,
this study was conducted to assess current status of infant (0 - 12months) and
young child feeding practices as reported by mothers and caregivers in Awka
metropolis, Anambra State, SouthEast Nigeria.
1.1 STATEMENT OF PROBLEM
Malnutrition is a universal public health problem in both children
and adults globally. In children under 5 years of age, 155 million are stunted,
52 million are wasted, 17 million are severely wasted and 41 million are
overweight and/or obese (World Health Organization, 2019).
Nigeria is Africa’s most populous country with an estimated
population of 177.5 million (The World Bank and Nutrition, 2017), with about 40
million children, of which about 11 million (under 5 children) are stunted and
approximately 1.7 million are acutely malnourished (UNICEF, 2015). Many
infants, due to diverse sociocultural factors, are not optimally breast fed and
this has consequences for child survival (Sika-Bright, 2011). Only about 29% of
infants aged 0–6 months in Nigeria are exclusively breastfed (Nigeria Demographic
Health Survey, 2018). Timely initiation of complementary foods remains a
challenge as 16% of Nigerian infants are introduced to solid and semi-solid
foods at 2–3 months while 40% are introduced at 4–5 months, contrary to the WHO
recommendation of six months (National Population Commission, 2013), and these
foods are often of poor nutritional value, mostly inadequate in terms of
energy, protein and micronutrients such as iron, zinc, iodine and vitamin A.
It was observed in Awka that most nursing mother's do not practice
exclusive breastfeeding due to their involvement in white-collar jobs when
breastmilk should be the primary source of an infant's nutrition. Majority
practice early cessation of breastfeeding particularly during the first 6
months of age giving rise to early introduction of complementary foods, the
quality most times is low and quantity of the food is under measured because
they use only pap, ceareals and formula milk which may increase the risk of
malnutrition and diarrheal diseases among infants. Thus, this study was
conducted to assess feeding practices and nutritional status of infants in Awka
and to profer healthy feeding solutions in order to improve child care.
1.2 OBJECTIVES OF THE STUDY
1.2.1 General Objectives of the Study
The
general objective of the study is to assess the anthropometric indices of
infants in association with their feeding practices among mothers in Awka,
Anambra State.
1.2.2
Specific Objectives of the Study
- To determine the
knowledge, attitude towards and practice of breastfeeding among nursing
mothers
- To determine the
proportion of babies who are exclusively breastfed.
- To
identify average duration of breastfeeding by mothers
- To assess
complementary foods for infants using Minimum dietary diversity score
table.
- To assess the
anthropometric indices of infants using weight, height or length, and
mid-upperarm circumference and to compare values using WHO reference
standards.
1.3 SIGNIFICANCE OF THE STUDY
v The study will sensitize mothers and caregivers on appropriate
nutrition and child care practices, from the findings, mothers will be educated
on the appropriate feeding practices and care of their infants and young
children for their healthy growth and survival.
v It will increase the gap in the availability of data for use by
community nutritionists, dietetians, and those in related professions with
respect to feeding practices of infants as this will help strengthen the
practice of nutrition education and enable them to plan programs to address the
poor breastfeeding and complementary feeding practices.
v The data provided will help the ministry of health in their
nutrition related health programmes planning and resource allocation for the
rural community.
v It will further sensitize the government and non-governmental
organizations on the necessity of developing important strategies and concepts
that center on elevating nutritional education in the society, since this is an
essential factor for providing nutritional intervention to children at risk of
malnutrition.
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