ABSTRACT
Despite ample evidence of the benefits of exclusive and continued breastfeeding for children, women and society, far too few children are breastfed as recommended. This represents a threat to the preservation of the high breastfeeding rate in Nigeria and will hamper any improvement in exclusive breastfeeding rates. This study examined the use of breast milk substitutes by lactating mothers in selected rural areas in Obowo Local Government Area of Imo State. It was a cross-sectional study and. A multi-stage sampling technique was used to select a total of 350 respondents. Data on socio-demographic/economic characteristics, attitude, utilization of breast milk substitutes and anthropometric status of the infants were collected using structured and validated questionnaire. The IBM SPSS version 21.0 was used to analyse the data. Significant relationship was judged at p ≤ 0.05. Data obtained were described using frequency, percentage and mean. Pearson’s correlation was be used to determine the relationship between the influence of the mother’s socio demographic and economic characteristics and their knowledge and attitude towards infant feeding on their use of breast milk substitutes. Results from the study showed that in the study majority (21%) of the respondents were literates with a few (25%) being illiterate. Most (79.7%) of them were aware of breast milk substitute with a few (20.3%) not aware. Their major source of awareness was from the hospital (health professionals). On the exposure to breast milk substitutes (BMS), different suggestions were made to promote the use of BMS; some of the mothers were given leaflets, take home samples of the infant formula from the hospital and suggestions on how to prepare the infant formulas. Majority (63.4%) received breast milk in addition with infant formula during the first six months of life. The results of this study has shown that most lactating mothers in the study area prefer the use of infant formula because they think it is the best option when a mother wants to go back to work. It is therefore recommended that health professionals should be trained on how to encourage exclusive breast feeding among lactating mothers because they are their source of information during antenatal and after delivery. Actions should be taken to decrease the impact of misleading advertisement, which influences mothers to switch from traditional breast feeding to BMS.
TABLE OF CONTENTS
Title page i
Certification ii
Dedication iii
Acknowledgements iv
Table of contents v
List of Tables viii
Abstract ix
CHAPTER 1
INTRODUCTION
1.1 Background to the Study 1
1.2 Statement of Problems 4
1.3 Objective of the Study 5
1.3.1 General Objective of the Study 5
1.3.2 Specific Objective of the Study 5
1.4 Significance of the Study 6
CHAPTER 2
LITERATURE REVIEW
2.0 Introduction 7
2.1 Breast milk Substitutes: A New Old-Threat for Breastfeeding Policy 7
2.2 Commercial Infant Formula Feeding 9
2.2.1 Infant Formula 9
2.2.2 Home-Modified Animal Milk 10
2.2.3 Generic Infant Formula 10
2.3 Replacement Feeding 10
2.4 Factors That Influence the Use of Breast Milk Substitutes by Lactating Mothers 11
2.4.1 Return to Work 11
2.4.2 Maternal Perception of Insufficient Milk Supply 13
2.4.3 Beliefs of Family and Society 14
2.4.4 Infant Formula Viewed As More Nutritious Than Breast Milk 15
2.4.5 Formula Feeding Perceived As Convenient In Public and Less Tiring 16
2.4.6 Infant Formula Viewed As More Nutritious Than Breast Milk 17
2.4.7 Lack of Knowledge about Safe Infant Feeding Practices 18
2.4.8 Advice by Health Professionals to Mothers 19
2.5 The Impact of Marketing of Breast-Milk Substitutes On
Who-Recommended Breastfeeding Practices 20
2.5.1 Free BMS, Discharge Gift Packs, and Other Promotional Materials 21
2.5.2 Marketing of BMS Directly To Consumers 22
2.5.3 Impact of Marketing on Maternal Self-Confidence 23
CHAPTER 3
MATERIALS AND METHODS
3.1 Study Design 25
3.2 Study Area 25
3.3 Population of the Study 26
3.4 Sampling and Sampling Technique 27
3.4.1 Sample Size Determination 28
3.4.2 Sample Procedure 28
3.5.1 Preliminary Activities 28
3.5.1 Preliminary Visits 28
3.5.2 Training of Research Assistants 29
3.5.3 Informed Consent 29
3.6 Data Collection 29
3.6.1 Questionnaire Design 29
3.6.2 Questionnaire Administration 30
3.7 Data Analysis 30
3.8.1 Statistical Analysis 31
CHAPTER 4
RESULT AND DISCUSSION
4.1 Socio-demographic Characteristics of the Lactating Mother 32
4.2 Socioeconomic Characteristics of the Mother and Father 36
4.3 Awareness and Exposure to Breast Milk Substitute 39
4.4 Utilization of Breast Milk Substitute 43
4.5 Attitude of Mothers towards the Use of Breast Milk Substitute 51
4.6 Relationship between Socioeconomic Characteristics and Attitude Score 51
Towards The Use of Breast Milk Substitute 51
CHAPTER 5
CONCLUSION
5.1 Conclusion 53
5.2 Recommendations 53
REFERENCES 55
LIST OF TABLES
Table 4.1 Socio Demographic Characteristics of the Lactating Mothers 34
Table 4.1b Socio Demographic Characteristics of the Lactating Mother 35
Table 4.2 Socio Economic Characteristics of the Lactating Mothers and Husband 37
Table 4.2b Socioeconomic Characteristics of the Husband 38
Table 4.3a Awareness of Breast Milk Substitutes 40
Table 4.3b Exposure to Breast Milk Substitute 42
Table 4.4a Utilization of Breast Milk Substitute 44
Table 4.4b Utilization of Breast Milk Substitute 45
Table 4.4c Utilization of Breast Milk Substitute 47
Table 4.4d Utilization of Breast Milk Substitute 48
Table 4.4e Utilization of Breast Milk Substitute 50
Table 4.5 Attitude of Mothers towards Use of Breast Milk Substitute 52
Table 4.6 Relationship between Socio-economic Characteristics Score and The Use Of Breast Milk Substitute 52
CHAPTER 1
INTRODUCTION
1.1 BACKGROUND TO THE STUDY
Despite ample evidence of the benefits of exclusive and continued breastfeeding for children, women and society, far too few children are breastfed as recommended (Victora et al., 2015). Globally, three out of five children under 6 months of age are not exclusively breastfed and only 45% of children continue breastfeeding for 2 years (World Health Organization (WHO), 2011). Breast milk is widely acknowledged as the most complete form of nutrition for infants due to the fact that it provides the necessary elements for optimal growth and development (Lawrence et al., 2013). Breast milk has nutritional, immunological, biochemical, anti-allergic, anti-infective, intellectual, developmental, psychological, psychosocial, economic and environmental benefits for the mother and/or her infant (Earle, 2010).
Breast-feeding provides in all the infant’s nutritional needs and is therefore the preferred feeding option for all infants. Breastfed infants are at reduced risk of many health conditions, including gastrointestinal and respiratory tract infections, obits media, allergies, and sudden infant death syndrome (Gartner et al., 2012). Lactation is also associated with many positive long-term health outcomes, such as decreased risks of obesity and diabetes, and increased performance in intelligence tests during childhood and adolescence (Victora et al., 2015). For mothers, the advantages of breastfeeding include reduced postpartum bleeding, faster return to pre-pregnancy weight, a lower risk of breast and ovarian cancer, as well as decreased risks of hip fractures and osteoporosis in later life (Su et al., 2013; Vinter et al., 2014). The many health benefits of breastfeeding have led the World Health Organization to recommend mothers to exclusively breastfeed for the first six months of life and continue while complementary feeds are introduced.
Breast milk substitutes is referred to any food (solid or liquid) being marketed, otherwise represented or used as a partial or total replacement for breast milk, whether or not suitable for that purpose. In terms of milk products, recent WHO guidance has clarified that a BMS includes any milks that are specifically marketed for feeding infants and young children up to the age of 3 years (Gartner et al., 2012).
Milk substitutes include whole cow milk, evaporated or powdered milk (provided that it is full-fat and properly diluted with water). If you choose whole goat's milk, it must be pasteurized and have vitamin D and folic acid added.
The disadvantages of the use of breast milk substitutes are substantial, particularly for women in developing countries. These disadvantages include increased infant mortality and morbidity, hastened resumption of fertility, and loss of money for other necessities (Laukaran et al., 2011). Lactating mother’s decision to breast-feed or formula feed her infant results from a complex interaction of various factors (Sarah and Diana, 2008; Anderson et al., 2012). The mother’s current circumstances may therefore result in her opting to rather formula feed her infant, despite the known benefits of breast-feeding.
A major factor undermining efforts to improve breastfeeding rates is continued and aggressive marketing of breast-milk substitutes, as well as the promotion of feeding bottles and teats. Inappropriate marketing of food products that compete with breastfeeding often negatively affects the mother’s choice to breastfeed her child optimally given the special vulnerability of infants and the risks involved in inappropriate feeding practices (Rollins et al., 2016). In addition, there is increasing promotion of breast-milk substitutes for older infants and young children (those between 6 and 36 months of age) including follow-up formula and “growing-up” milks. These products undermine sustained breastfeeding up to 2 years or beyond (WHO , 2006).
Inappropriate promotion of commercial complementary foods can mislead and confuse caregivers about their nutrition- and health-related qualities, and their age-appropriate and safe use. Promotion can be used to convince caregivers that family foods are inadequate, and create a dependency on expensive commercial products (WHO, 2016). In addition, caregivers often do not understand the distinctions between milk products promoted for children of different ages. Cross-promotion of such foods, through use of colours, mascots and wording on the labelling is frequently used to promote a company’s breast-milk substitute products (Smith et al., 2015). Because the packaging and marketing of these products often resemble those of infant formula, mothers may also decide to use them in the first 6 months of life.
The need for appropriate breast milk substitutes for women especially those who must work away from their infants cannot be disputed. Thus, this research work is aimed to assess the factors that influence the use of breast milk substitutes by lactating mothers.
1.2 STATEMENT OF PROBLEMS
Malnutrition is one of the biggest health problems that the world currently faces and is associated with more than 41% of the deaths that occur annually in children from 6 to 24 months of age in developing countries which total approximately 2.3 million (Phimmasone et al., 2006) reported that 54% of all childhood mortality was attributable, directly or indirectly, to malnutrition. Each year about 1 million Nigerian children die before their 5th birthday (United Nations, 2013). Malnutrition contributes to nearly half of these deaths. According to Children’s Investment Fund Foundation (CIFF) (2014), Up to 1 million Nigerian children under age 5 are affected by severe acute malnutrition (SAM) each year. The Nigeria Demograhic and Health Survey (NDHS)2018 Says that only 29 per cent of infants are exclusively breastfed in Nigeria.
Inadequate breastfeeding and weaning practices contribute to high rates of malnutrition and infant and child mortality. For many years, it has been recognized that in unhygienic conditions breast-milk substitutes carry a higher risk of infection than breastfeeding and can be fatal for infants (Coutsoudis et al., 2009). The situation now is slightly worse, and not only due to poor hygiene.
The attractiveness of breast milk substitutes (BMS) is of concern as these products become increasingly available. Mothers feeding their children are attracted by the new products on display. They may not be able to tell the difference between appropriate and inappropriate products. This is an old but well-known problem that has not been resolved. The advertising and use of BMS has a strong negative impact on child survival (WHO, 2016).
1.3 OBJECTIVE OF THE STUDY
1.3.1 GENERAL OBJECTIVE OF THE STUDY
The general objective of this study is to determine the factors that influence the use of breast milk substitutes by lactating mothers in selected rural areas in obowo local government Imo State.
1.3.2 Specific Objective of the Study
i. Assess the socio-demographic and economic characteristics of the mothers.
ii. Determine the utilization of breast milk substitutes among lactating mothers in selected rural locations in Imo State.
iii. Assess the attitude of the respondents towards the recommended infant feeding practices.
iv. Determine the factors associated with use of Breast milk substitute
1.4 SIGNIFICANCE OF THE STUDY
The findings of this study will contribute to the knowledge generated in future studies. Findings from this study will also help to identify the factors that influence the use of breast milk substitutes. This will benefit stakeholders such as the health policy makers, nutrition educators, health professionals, Ministries of Health (Division of Nutrition) at national and state levels and other health facilities providing a reference, which may inform policies.
The findings of the study will also bring to limelight the challenges of using breast milk substitutes among lactating mothers which include breast milk substitute being less digestible than breast milk which makes the baby eat less often than breastfed babies, Lack of antibodies because none of the antibodies found in breast milk are in breast milk substitute. Also, due to the complexity of breast milk it cannot be matched with breast milk substitutes, the manufacturers have yet to duplicate the complexity of breast milk, which changes as the baby's needs change. Unlike breast milk which is always available, unlimited, and served at the right temperature, breast milk substitutes requires planning and organization to make sure that you have what you need when you need it.
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