Abstract
Breastfeeding practices, including initiation and duration, are influenced by multiple interwoven factors. Among these factors, decisions regarding initiation and duration of breastfeeding are influenced by maternal age, education, employment, parity, place of delivery, family pressure, and cultural values. This study examined the exclusive breastfeeding duration and perception of insufficient milk supply among mothers in Ikwuno Local Government Area of Abia State. The study was cross sectional and multi stage random sampling was used to select Five (5) health centers in Ikwuan Local Government Area of Abia State. Data were collected with the use of a well-structured and validated questionnaire to obtain information on socio-demographic characteristics, sufficient breast milk supply, the reason for perceived breast milk insufficiency, mothers’ knowledge of exclusive breastfeeding (EBF), mothers knowledge of breastfeeding, duration of exclusive breastfeeding practice in the study area. Data obtain was analyzed using WHO anthropometric software and statistical package for social science (SPSS) version 20.0. The result obtained was presented in frequency and percentage. The result showed that about 29.7% of the participants were aged between 31-35 years and mean age of the mother were 20 and were married (87.0%). About 40.3% were 6 to 10 months old, the mean age were 25. About 58% of mothers had good knowledge of exclusive breastfeeding, 17% of mothers had poor knowledge of exclusive breastfeeding. Majority 64% of mothers perceived breast milk insufficiency, 36% perceived breast milk sufficiency. About 45.5% of mother had reasons for early introduction of water and food. Therefore, there is need for large scale health enlightenment of members of the public on EBF and its benefits to the infant, mother and society at large. Therefore, we recommend, Efforts to promote exclusive breastfeeding duration should, in addition to improving maternal knowledge and attitudes, focus on the identification of factors that influence the practice and how they can be addressed in a participatory manner by all stakeholders in the community.
TABLE OF
CONTENTS
Title Page
Certification i
Dedication ii
Acknowledgement iii
Table of Content iv
List of Tables
Abstract vii
CHAPTER
1: INTRODUCTION
1.1 Statement of the Problem 5
1.2 Objectives of the Study 7
1.3 Significance of the study 8
CHAPTER 2: LITERATURE REVIEW
2.1 Concept of breastfeeding 10
2.2 Physiology
of breast feeding 11
2.3 Science
of breastfeeding 12
2.4 Breastfeeding
Practices 13
2.5 Factors
Associated With Breastfeeding Practice 14
2.6 Barriers to Exclusive Breastfeeding 16
2.7 Global prevalence of EBF 17
2.8 Composition
of breast milk 20
2.9 Maternal Nutrition 22
2.10 Complementary foods 24
2.11 Baby
friendly hospital initiatives (BFHI) and exclusive breast
feeding (EBF) in Nigeria. 26
2.12 Ten steps to successful breastfeeding advocated in the baby
friendly
hospital initiatives 27
2.13 Breastfeeding techniques (How to breastfeed successfully) 28
2.14 Expressed
breast milk (EBM) 32
2.15 Exclusive
breastfeeding and HIV/AIDS infection 34
2.16
Factors affecting exclusive breastfeeding in Nigeria 35
2.17 Infant
anthropometry and breastfeeding 36
2.18 Anthropometric
indicators of nutritional status in infant and children 38
2.19 The
new WHO growth reference 39
2.20 Ten
features of the new WHO child growth reference 42
2.21 Attitude
and Mothers Exclusive Breastfeeding Practice 43
2.22 Attitude Solutions with Exclusive
Breastfeeding Practice 43
CHAPTER 3: METHODOLOGY
3.1 Study Design 45
3.2 Area
of Study 45
3.3
Population of the Study 46
3.4 Sampling
and Sampling Technique 46
3.4.1 Sample size determination 46
3.4.2 Sampling
Procedure 47
3.5 Preliminary Activities 48
3.5.1 Preliminary Visits 48
3.5.2 Training of research assistants 48
3.5.3 Informed consent 48
3.5.3 Ethical
Approval 49
3.6 Data Collection 49
3.6.1 Questionnaire administration 49
3.7 Statistical Analysis 50
CHAPTER 4: RESULTS AMD DISCUSSION
4.1 Socio-demographic Characteristics of the Mothers 52
4.2
Mothers knowledge of exclusive breastfeeding 56
4.3
Mothers Perception of Insufficient Breast Milk Supply 61
4.4
Excusive Breastfeeding Practiced in the Study Area 63
4.5
The reason for perceived breast milk insufficiency 68
4.6 Mothers Knowledge of Breastfeeding 70
CHAPTER
5: CONCLUSION AND RECOMMENDATION
5.1 Conclusion 74
5.2 Recommendation
74
Reference 75
Appendix
List of Table
Table 4.1 Socio-demographic
Characteristics of the Mothers
Table 4.2 Mothers knowledge of
exclusive breastfeeding
Table
4.3 Mothers Perception of Insufficient Breast Milk Supply
Table
4.4 Exclusive breastfeeding practiced in
the study Area
Table
4.5 The reason for perceived breast milk
insufficiency
Table 4.6
Mothers Knowledge of Breastfeeding
CHAPTER 1
INTRODUCTION
Breastfeeding
practices, including initiation and duration, are influenced by multiple
interwoven factors (Ogbonna and Daboer, 2007). Among these factors, decisions
regarding initiation and duration of breastfeeding are influenced by maternal
age, education, employment, parity, place of delivery, family pressure, and
cultural values (Ogbonna and Daboer, 2007). According to Aborigo, Moyer and
Rominski, (2012) mother’s prenatal intention to breastfeed is a consistently
strong predictor of decisions to initiate and sustain exclusive breastfeeding.
Besides normative expectations, personal experiences and networks of support have
influence on the forms and quality of breastfeeding practices. These factors
exert pressure on breastfeeding mothers, thereby making their experience
pleasurable or painful within time and space. In order to achieve the benefits
of optimal breastfeeding, transmitting the knowledge to women on the practice
of optimal breastfeeding should be utmost. This is important because the
behavior adopted by an individual on EBF is moulded partly by that individual’s
knowledge of EBF (Qureshi, et al.
2012). Often times, these practices are as a result of traditional and modern
perceptions of breastfeeding and its benefits, some of which are not based on
scientific evidence (Aniebue, Aniebue and Adimora, 2010). Poor breastfeeding
practices are a major cause of neonatal and infant mortality. In Nigeria, 52%
of childhood deaths are attributed to the effect of malnutrition on disease
(Omolulu, 2015). Adequate nutrition in the early years of life is necessary for
children to grow and develop to their full potential (Thapa, Short and Potts,
2018). The World Health Organization (WHO) recommends exclusive breastfeeding
(EBF) as the optimal feeding method for the first 6 months. This provides
valuable benefits to the infants as well as to mothers and the nation as a
whole (Cutting, 2014). According to WHO, (2014) providing encouragement and
continued support are keys to breastfeeding success. Breastfeeding women and
families need adequate breastfeeding counseling to initiate and maintain
optimal breastfeeding practice. Globally, no more than 40% of infants below six
months of age are exclusively breastfed. Gradual increase in the EBF rate is
associated with an inconsistent definition of EBF and a lack of addressing the
importance of increasing the duration of EBF (Bai, Middlestadt, Joanne Peng,
and Fly, 2009; WHO, 2003). According to Cross-Barnet, Augustyn, Gross, Resnik,
and Paige, (2012) women who failed to receive adequate support from healthcare
professionals when faced with breastfeeding challenges were less likely to
continue breastfeeding.
Breastfeeding
is acknowledged as the optimal way to feed infants for the first six months by
national and many other health organizations (AAP, 1997; United Nations
Children’s Fund, 2006; WHO, 2003). Despite its countless benefits to children
and mothers, the continuation rates of EBF are low (Centers for Disease Control
and Prevention [CDC], 2013c; Dudenhausen, 2014; Silfverdal, 2011). It is
essential to understand how multiple factors affect breastfeeding practices in
order to improve the duration of exclusive breastfeeding. Thulier and Mercer,
(2009) have consistently shown positive associations between increased duration
of breastfeeding and demographic, biological, and social factors associated
with mothers.
Exclusive
breastfeeding (EBF), refers to the exclusive intake of breast milk or expressed
breast milk by an infant without the addition of any other liquids or solids,
with the exception of oral drops, or syrups containing vitamins, mineral
supplements or medicines (Otaigbe, et al.
2005). EBF is being advocated the world over as the optimal mode of feeding for
young infants in the first six months of life, followed by breast milk and
complimentary feeds thereafter till two years of age or beyond (Otaigbe, et al. 2005). According to WHO/UNICEF,
(2005) exclusive breastfeeding (EBF) is an exclusive intake of breast milk by
an infant from its mother or wet nurse or expressed milk with addition of no
other liquid or solid with the exception of drops or syrups consisting of
vitamins, minerals supplements, or medicine and nothing else for the first six
months.
Exclusive
breastfeeding, which giving breast milk only and no other liquids, except drops
or syrups with vitamins, mineral supplements or medicines, is superior to
non-exclusive breastfeeding with a protective effect against both morbidity and
mortality (Kramer and Kakuma 2004). Exclusive breast-feeding provides low cost,
complete nutrition for the infant, protects him/ her against infections
including infant diarrhea, and prolongs lactation amenorrhea, thereby
increasing birth spacing (Thappa, Short and Potts, 2018).
Breastfeeding remains the best option for infants in
the first six months of life. It is a natural, cost-effective and
evidenced-based nutritional activity that promotes the optimal wellbeing and
survival of infants (Krammer and Kakuma, 2004). Breast milk contains antibodies
and essential nutrients, necessary for the promotion of health and adequate
development of infants and very young children. Breastfeeding has been shown to
protect infants from several morbidities in infancy and early childhood
including acute respiratory infections, diarrhea and other gastrointestinal
conditions Hajeeboy, et al. 2014;
Lakati, Binno and Stevenson, 2002). Identifying the barriers to exclusive
breastfeeding will help to develop appropriate practice guidelines to overcome
those hindrances associated with discontinuation of breastfeeding during the
early postpartum period.
Breast-feeding
is crucial for the healthy growth and development of the child (Ip, Chung and
Raman, 2007; Ladomenou, Moschandreas and Kafatos, 2010). Appropriate
breast-feeding improves childhood immunity and reduces the incidence of
gastroenteritis, malnutrition, otitis media, obesity and sudden infant death
syndrome, as well as childhood mortality (Goldman, Goldblum and Hanson, 2010;
Kramer and Kakuma, 2004). WHO/UNICEF has recommended the initiation of
breast-feeding within the first hour of birth for all newborns, exclusive
breast-feeding (EBF) until 6 months of age and continued breast-feeding until 2
years and beyond, including introduction of timely, adequate and safe
complementary food at 6 months of age (World Health Organization, 2003).
Breast
milk is considered as the most complete nutritional source for infants because
it contains the essential fats, carbohydrates, proteins, and immunological
factors needed for infants to thrive and resist infection in the formative
first year of life (Awano, and Shimada, 2010; Pound, and Unger, 2012). Human
milk is the most appropriate of all available types of milk that is uniquely
adapted for infant nutrition as its components consistently adapt to the
child’s need and environmental challenges (Labbok, 2006). Breast milk contains
virtually all the nutrients, antibodies and anti-oxidants an infant needs to
thrive for the first six months of life (Okechukwu and Otokpa, 2008).
1.1 STATEMENT OF THE PROBLEM
Globally, less than 40% of infants under 6
months of age were exclusively breastfed despite of the documented benefits of
EBF. In addition, 38% of infants less than six months in the developing world
including Africa were exclusively breastfed (WHO, 2010). Also recent report
from UNICEF (2008) indicated that EBF is declining in Nigeria while infant
morbidity and mortality rate are rising.
Statistics showed that in 1999, 22% of infants were exclusively
breastfed. Unfortunately, this came down to 17 % in 2003 and in 2008 only 11.7%
of infants were exclusively breastfed for 0-6 months of life in Nigeria.
There was no documented rate of EBF in Ikwuano
LGA but it was obvious that the rate was minimal. Ikwuano is a commercial area
with inhabitant of different socio-cultural background. Hence knowledge,
understanding and practices of EBF were also function of different cultures and
social groups. This made EBF practices unpopular to many lactating women in the
study area due to inadequate knowledge, lack of credibility and misconception
regarding EBF.
Generally
prelacteal foods were known to interfere with optimal breastfeeding and can
lead to infant morbidity and mortality yet it was a common practice for over
50% of lactating mothers, to feed plain warm water, glucose water, coconut/
bitter-kola-water and other herb concoctions to their babies immediately after
birth due to cultural affiliation attached to these substances. Discontinuation
of breastfeeding before the age of 24
months is a risk factors to malnutrition, morbidity and mortality rate among
children less than twenty four months of age, current researches revealed 9-12
months as breastfeeding duration in Aba south local government Area of Abia
State.(Ukaegbu, 2011). Studies have shown that inadequate EBF
information and lack of support to lactating mothers by healthcare personnel
tends to lower the rate of EBF.
Even
if social-demographic predictors of both the initiation and the duration of BF
are widely described, very few studies consider at the same time (i) the
mothers’ desired BF duration, (ii) the dissatisfaction generated by not
achieving a certain BF duration, and (iii) the primary reason for weaning. It
seems yet obvious that breastfeeding is a personal choice and the mothers’
desired duration cannot be ignored (Ibanez, et
al. 2014). These elements could partially explain why the initiation rates
and also the BF duration remain too low according to the WHO recommendations on
which, however, the vast majority of scientists agree.
The
literature shows that the reasons for an “early” weaning, defined as not
achieving the mother’s desired breastfeeding duration, depend on various
factors including psychosocial (self-esteem, self-efficacy), cultural factors
Negayama, et al. (2012), but also the
duration of the maternity leave (Bonet, Marchand, and Kaminski, 2009). The perception of
insufficient milk (PIM), that is, the mother’s belief that the breast milk is
inadequate in amount or nutritional quality to meet her infant’s needs, is
another factor often highlighted (Gatti, 2008).
Intrinsic
BF problems were considered as direct causes linked with BF problem. A
difference was made between perceived insufficient milk (PIM) and no/no more
milk. The perception of insufficient milk (PIM) is defined as a mother’s belief
that her breast milk is inadequate in amount or nutritional quality to meet her
infant’s need (McCarter-Spaulding, and Kearney, 2001). No/no more milk is less
subjective than PIM. The mother observed she had no milk.
1.2 OBJECTIVE OF THE STUDY
The
general objective of this study was to determine exclusive breastfeeding
duration and perception of Insufficient milk supply among mothers in Ikwuno
Local Government Area of Abia State.
The
specific objectives are;
1.
Determine mothers and child socio-demographic characteristics.
2.
determine the mothers knowledge of exclusive breastfeeding in Ikwuano Local
Government Area of Abia State.
3.
determine the duration of exclusive breastfeeding Practice in the study Area.
4.
determine mothers perception of breast milk supply in the study area
5.
assess reasons for perceived breast milk insufficiency
1.3 Significance of the study
The findings of the study
will show-case the rates of EBF in the different communities of the study area.
This will aid the health workers and the government on how and where to
plan community based breastfeeding
intervention programmes for promoting, protecting and supporting EBF. This will
aid to enhance full benefit of EBF in the study area. The results will also be
a guide for them when organizing nutrition and health education in the area so
as to get target or vulnerable groups. This will make breastfeeding programmes
and other government breastfeeding polices in the area well organized and cost
effective.
The findings will also
sensitize mothers and health workers the need and the benefits of initiating
breastfeeding within 30 minutes of delivery and sustaining it for 6 months.
This will help to enhance the rate of timely initiation of infants to breast
milk immediately after delivery. This
will help to reduce infant morbidity and mortality rate due to neonatal
starvation.
The result of this
research will provide nutritional and health education for both the government,
health workers, lactating mothers and the general public on the benefits of EBF for the first six months of infant’ life .
This will reduce the rate of early introduction of complementary feeding, and
bottle feeding rate. It will also in a large scale reduce infant under
nutrition emanating from over diluted formula.
Both
health workers mothers and the general public will in this study in
collaboration with other EBF campaign
group understand the benefits of continued breastfeeding for two years or
beyond in the health of both mother and her child. This will enhance child
spacing and mothers productivity, improve the nutritional status of children,
thus improving general standard of living in the study area.
The
research is necessary as a guide for other researchers embarking research in
the related area for further research. It was also relevant to keep the
practice of exclusive breastfeeding in continuous surveillance in the study
area so that timely action could be taken at earliest indication of decline.
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