ABSTRACT
This study was carried out to assess the factors affecting the practice of exclusive breastfeeding in Aba North Local Government Area of Abia State. All the health centers and hospitals with post-natal clinics in Aba North L.G.A were purposively selected to bring their numbers to eight while a simple random sampling technique was used to select the nursing mothers for the study. Data collection was carried out using a closed ended questionnaire. It was used to collect information on their socio-demographic/economic characteristics, knowledge and practice of mother’s exclusive breastfeeding and challenges of exclusive breastfeeding. Most (60.8%) of the mothers were married, some (24.7%) of them were single while few (6.3%) of the mothers were widows. More than half (53.8%) of the mothers had secondary education, some (24%) of them had tertiary education while few (4.9%) of the mothers had no formal education. More than half (53.8%) of the mothers were privately employed, some (23.3%) of them were publicly employed while few (5.9%) of the mothers were unemployed. Many (65.6%) of the mothers had correct knowledge on the definition of exclusive breastfeeding while some (34.4%) of them had wrong knowledge on the definition of exclusive breastfeeding. Majority (97.2%) of the mothers had wrong knowledge of the first food for new born while few (2.8%) of them had correct knowledge on the first for new born. More than half (53.8%) of the mothers did not exclusive breastfeed while some (46.2%) of the mothers breastfed exclusively. Less than half (46.2%) of the mothers introduced water and other foods at six months, some (28.1%) of them introduced other food and water immediately after birth. Half (50.7%) of the mothers with poor knowledge on exclusive breastfeeding practiced exclusive breastfeeding, more than half (54.3%) of the mothers who had fair knowledge on exclusive breastfeeding did not practice exclusive breastfeeding while many (63.6%) of the mothers who had good knowledge did not practice exclusive breastfeeding. From the result of this study, there is increased need for enlightenment campaign about benefits of exclusive breastfeeding for mother and child using various languages in order to accommodate women who do not understand English and those with low educational level. Also, breastfeeding counseling during antenatal care should be centered on solving problems associated with breastfeeding.
TABLE OF CONTENTS
TITLE
PAGE i
CERTIFICATION ii
DEDICATION
iii
ACKNOWLEDGMENT iv
TABLE
OF CONTENTS xi
LIST
OF TABLE x
ABSTRACT
CHAPTER 1
INTRODUCTION 1
1.1
Background of the Study 1
1.2
Statement of the Problem 4
1.3 General Objective
of the Study 5
1.4 Significance of
the Study 5
CHAPTER 2
LITERATURE REVIEW
2.1 Breastfeading 7
2.2 Exclusive
Breastfeeding 7
2.3 Benefits of Exclusive Breastfeeding to the
Mother 8
2.4 Benefits of Exclusive Breastfeeding to Infants 8
2.5 Composition of Breast Milk 9
2.5.1 Carbohydrates 9
2.5.2 Vitamins 10
2.5.3 Proteins 10
2.5.4 Fats 11
2.5.5 Immunoglobulins (Antibodies) 12
2.5.6 Hormones 12
2.5.7 Vitamins 12
2.5.8 Minerals 13
2.6 Ten Steps to Successful Breastfeeding 13
2.7 Factors
Influencing the Practice Of Exclusive Breastfeeding Among Mothers 14
2.7.1
Mothers’ educational status 15
2.7.2
Occupation/Employment 15
2.7.3 Antenatal
Care 16
2.7.4 Economic
Status 17
2.7.5 Marital
Status 17
2.7.6 Previous
Experiences with Breastfeeding 18
2.7.7 Multiple
Births 18
2.7.8 Support from
Family and Friends 18
2.7.9 Cultural
Practices 19
CHAPTER
3
MATERIALS
AND METHODS
3.1 Study
design 21
3.2 Study
area 21
3.3 Population of the study 22
3.4 Sampling and sampling techniques 22
3.4.1 Sample size 22
3.4.2 Sampling
procedure 23
3.5 Preliminary
activities 23
3.5.1 Preliminary
visits 23
3.5.2 Ethical approval 23
3.5.2 Training
of the research assistants 24
3.5.3
Informed consent 24
3.6 Data
collection 24
3.6.1 Questionnaire
25
3.7
Data analysis 25
3.8 Statistical analysis 25
CHAPTER 4
RESULTS AND DISCUSSION
4.1 Socio-demographic information of the mothers 26
4.2 Socio-economic characteristics of the mothers from Aba North Local
Government Area of Abia State 28
4.3 Knowledge and practice of exclusive breastfeeding among mothers 30
4.4 Challenges of exclusive breastfeeding among mothers 37
4.5 Relationship between
knowledge and practice of exclusive breastfeeding
among mothers 40
CHAPTER
5
CONCLUSION
AND RECOMMENDATIONS
5.1
Conclusion 41
5.2 Recommendation 41
REFERENCES
LIST OF TABLES
Table 4.1 Socio-demographic data of the mothers
from Aba North Local Government Area of Abia State 27
Table 4.2 Socio-economic characteristics of the
mothers from Aba North Local
Government Area of Abia State 29
Table
4.3a: Knowledge score 32
Table 4.3b Knowledge of exclusive breastfeeding among
mothers 33
Table 4.4 Practice of exclusive breastfeeding among
mothers 36
Table 4.5 Challenges of exclusive breastfeeding among mothers 39
Table 4.6 Relationship
between knowledge and practice of exclusive breastfeeding among mothers in Aba North Local Government Area of Abia
State 40
CHAPTER
1
INTRODUCTION
1.1
BACKGROUND OF THE STUDY
The practice of
breastfeeding is a very old method of feeding infants with breast milk of their
mothers. According to Essen et al.
(2009), breastfeeding means an unequalled way of providing ideal food for the
growth and development of infants; it is also an integral part of the
reproductive process with important implications for the health of mothers. Ojo
and Opeyemi (2012) opined that breastfeeding provides infants with super
nutritional content that is capable of improving infants’ immunity and possible reduction in future health care
spending. World Health Organisation (2015), stated that breastfeeding is the
normal way of providing young infants with the nutrients they need for health,
growth and development.
Exclusive breastfeeding
(EBF) as an extract and improvement on breastfeeding implies method of feeding
infants with only breastmilk of their mothers (either directly from the breast
or expressed) and no other liquids or solids with the exception of drops or
syrups consisting of vitamins, mineral supplements or medicines (Kook, 2011).
In congruent with this definition, World Health Organization/Nutrition for
Health and Development (WHO/NHD) (2015), excluded every food type including
water from breast milk of the mother of the baby.
Critical analysis of Kook
(2011), definition above can assist in bringing out hiding points for proper
understanding of the concept EBF. Thus, it is much healthier and preferable to
breastfeed infants with their mothers’ breast milk in absence of any health or
maternal health problems so as to avoid health problems which can erupt from
non-biological mothers’ breast. This type of breast milk can be dreadful to
infants; using wet nursing was actually discouraged during the middle Ages and
the Renaissance (Emily et al., 2009). They further asserted that
breastfeeding was not always possible, however, due to lactation failure of the
mother or to mother dying from childbirth.
Issues on EBF cannot be
concluded without emphases on Baby-Friendly Hospital Initiative (BFHI). This
was launched by WHO and UNICEF in 1991 following the Innocenti Declaration of
1990 in Italy (WHO/NHD, 2015). It further stated that the initiative is a
global effort to implement practices that protect, promote and support
breastfeeding. Furthermore, it posited that since its launching, BFHI had
grown, with more than 152 countries around the world implementing the
initiative. In summary, it is the introduction of BFHI in 1991 that gave birth
to EBF in the world today.
Exclusive breastfeeding as
an extreme breastfeeding (rooming) is preventive and most economical feeding
method one can experience. In this
regard, Chung, Raman, Chew, Magula, De Vine, Trikalinos and Lau (2007),
affirmed it that a history of breastfeeding was associated with reduction in
the risk of acute otitis media, non-specific gastroenteritis, severe lower
respiratory tract infections, atopic dermatitis, asthma (in young children),
obesity, type 1 and diabetes, childhood leukemia, sudden infant death syndrome
(SIDS), and necrotizenterocolitis. In the same vein, breastfeeding creates a
special bond between mother and baby and the interaction between the mother and
child during breastfeeding (UNICEF, 2015).
Significantly, EBF for six
months is the optimal way of feeding infants if the encouragement is there. It
is on this note that it is imperative to note that EBF is an exercise of first
4-6 months of child’s life (Ezenkiri and Hamisu, 2015). WHO recommendation for
the optimal practice of EBF is 90% (Agho et al., 2011; Ojo and Opeyemi,
2012). These indices (duration and required rate) are to assist the society to
practice the EBF initiative effectively so as to attain the maximum rate for
quantity and quality health. Therefore, the attainment of the recommended rate
of EBF is highly dependent on residential location, occupation, health,
maternal age and host of others (Ojo and Opeyemi, 2012).
It is on this note that
Mgomgo et al. (2013), asserted that the factors influencing EBF have
shown to vary from to country and within countries. Employment status,
urban/rural differences, marital status, knowledge on breastfeeding, education
status, place of delivery, HIV status, advice
on breastfeeding, ant-natal care clinic (ANC) attendance and type of
delivery have shown to have an influence on EBF (Lande et al., 2003;
Tanzania Demographic and Health Survey, 2010; National Bureau of Statistics
Tanzania and ICF Macro, 2011). Thus, Oche et al. (2011), agreed that
educational level of the mothers is a factor affecting EBF practices.
Constraints to EBF such as maternal health problems, pressures from mother
in-law and work are not exempted (Ojo and Opeyemi, 2012). Ogbonna et al.,
(2000), also opined that mothers’ literacy level, ante-natal services, home
locations and occupation are really
influencing EBF practices in Jos, Nigeria. Sika-Bright (2010), suggested that
the following are adduced to be influencing breastfeeding practices; mother’s
marital status, employment status, friends’ method of feeding their babies,
social support and babies’ age.
1.2
STATEMENT OF THE PROBLEM
According to the 2008 Nigerian Demographic
and Health Survey (NDHS), the rate of EBF in Nigeria is estimated at 13%, which
is a decline from the 2003 NDHS survey at 17%. However, the current rate is 25%
as reported in the National Nutrition and Health Surveys (NNHS), 2014. These
rates are lower than other low and middle-income countries. For instance, 37%
of all infants less than six months in Mozambique are exclusively breastfed.3
Furthermore, estimates from the WHO Global data on Infant and Young Child
Feeding in Nigeria shows that 22.3% of children were exclusively breastfed for
less than 4 months (WHO, 2010).
Several studies have shown that contributory
factors are responsible for the observed EBF rates; including power and gender
relations, shifting work patterns, cultural, religious and social norms, maternal educational level, small family size,
antenatal visits, sex of infants, and geographical area (Agho et al.,
2011). Traditionally, in Nigeria, as in most African countries, breastfeeding
is a cultural practice. However, the idea of EBF appears alien (Sokol et al.,
2007). More so, EBF conflicts with some long-standing traditional practices,
making a case for social and cultural feasibility relatively low (Brownlee,
2001). Therefore, this study adopted a mixed research methodology to identify
factors associated with the low EBF rates in the Aba North Local Government of
Abia State in Nigeria. Furthermore, the study seeks to describe the demographic
characteristics and breastfeeding practices of mothers in the study site.
1.4 GENERAL OBJECTIVE OF THE STUDY
The general objective of this study is to
assess the factors affecting the practice of exclusive breastfeeding in Aba
North Local Government Area of Abia State.
Specific
objectives of the study
The
specific objectives of this study include to;
1.
assess the knowledge and practice of exclusive breastfeeding in mothers
from Aba North Local Government Area of Abia State.
2.
determine the factors influencing exclusive breastfeeding in Aba North
Local Government Area of Abia State.
3.
determine the relationship
between knowledge and practice of exclusive breastfeeding in Aba North Local Government Area of Abia State.
1.4 SIGNIFICANCE OF THE STUDY
A study of this kind will be useful in many
ways. The finding will be useful to health educators and all those interested
in passing the information based on the principles of EBF. If the finding
proves negative, then suggestions will be to health educators especially those
working with mothers the need to increase their effort towards the teaching of
the principles and practice of EBF to mothers.
This finding will also be useful to such
government agencies as UNICEF and WHO, who are interested in promoting EBF.
Thus, they will use the finding to evaluate the EBF programme so far and also
plan strategies for improvement.
There will be research on parity, religious
affiliation, age and location to the effect of EBF adoption in the area of
study. Knowing this will help health workers, particularly health educators in
planning their health instruction and teachings of EBF. Attention should then
be given to all nursing mothers irrespective of parity, age, religious
affiliation to help and encourage them to adopt EBF.
Also, this study will be
useful in reducing the rate of infant malnutrition and its associated risks
such as gastrointestinal diseases and acute respiratory infections, and enhance
intellectual and social development.
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