ABSTRACT
Malnutrition is common among children aged 6-24 months in developing countries.it increases the risk of mortality. Interventions to improve infant-feeding holds the promise of reducing malnutrition among these children.This study assessed the feeding pattern and anthropometric indices of infants (6-24 months)in umuahia north LGA, Abia state. The study was a cross-sectional study. A multi-stage sampling technique was used to select a total of 250 mothers with child aged 6-24months. Data on the socio-demographic characteristics of the parents, continuous and complementary feeding practices, food frequency and anthropometric status were collected using structured, pretested and validated questionnaire. The IBM SPSS version 20.0 computer programme ,WHO Anthro plus, T-test, Chi- square and Pearson Correlation was used to analyze the data.Result from the study showed that (72.0%) of mothers and fathers attained higher institution, some (33.2% and 30.4%) of mothers and fathers were civil servants respectively. Majority (64.0%) of child was aged 7-12 months.(48.4% and 51.6%) are male and female respectively. Majority (97.6%) continued breastfeeding after 6 months,(17.2%) continued breastfeeding until 1year of age.(41.2%) introduced complementary food at 6months,while (40.4%) introduced complementary food at 7 months.Prevalence of wasting, stunting and underweight in the study was 11.6%, 38%, 9.6% respectively.This study showed that despite the increase in the rate of compliance of continuous breastfeeding and complementary feeding ,malnutrition was still high among infants in the study area.
TABLE OF CONTENTS
TITLE PAGE
ii
CERTIFICATION
iii
DEDICATION iv
ACKNOWLEDGEMENT v
TABLE OF CONTENT vi
LISTS OF TABLES xi
ABSTRACT xii
CHAPTER 1
INTRODUCTION
1.1
Statement of problem 4
1.2 Objectives
of the study 9
1.3 Significance of the study 9
CHAPTER 2
LITERATURE REVIEW
2.1 Breastfeeding Practices 11
2.2 Infant Feeding 12
2.3 Breastfeeding 13
2.3.1 The advantages of breastfeeding and its
duration 13
2.3.2 Exclusive Breastfeeding 15
2.4 Benefits of Breastfeeding 16
2.4.1 Benefits of breastfeeding in infants 16
2.4.2 Benefits of breastfeeding for mothers 17
2.4.2.1 Breastfeeding promotes bonding between mother
and baby 17
2.4.2.2 Breastfeeding and risk of breast cancer 18
2.4.2.3 Breastfeeding and post partum hemorrhage 18
2.4.2.4 Breastfeeding and risk of ovarian cancer 18
2.4.2.5 Breastfeeding and endometrial cancer 18
2.4.2.6 Breastfeeding and osteoporosis 19
2.4.2.7 Breasfeeding and birth spacing 19
2.4.2.8 Sudden infant death syndrome(SIDS) 19
2.5 Composition of breast milk 19
2.6 Infants first milk 20
2.7 Complementary feeding practices 21
2.7.1 Early and late introduction of
complementary foods 21
2.7.1.1 Early weaning 22
2.7.1.2 Late weaning 22
2.7.2 Complementary foods 22
2.7.3 Requirements from complementary feeding
in early childhood 23
2.7.4 Food items used to prepare complementary
foods 25
2.8 Homemade complementary foods 26
2.8.1 Consistency of complementary foods 28
2.9 Weaning foods 28
2.9.1.1 Timing of weaning and pitfalls for health
outcomes 30
2.9.1.2 Excess weight and obesity 30
2.9.2 Blood pressure 32
2.10 Food preferences and eating behaviours
33
2.10.1 Developmental milestone 34
2.10.2 Food allergy 34
2.11 Mode of feeding and health outcomes 35
2.11.1 Diet diversity and health outcomes 35
2.11.2 Responsive feeding and health outcomes:
weight gain and obesity 36
CHAPTER 3
MATERIALS AND METHODS
3.1 Study
design 38
3.2 Area of
study 38
3.3 Population
of the study 39
3.4 Sampling
and sampling techniques 39
3.4.1
Sample size determination 39
3.4.2
Sampling Procedure 40
3.5 Preliminary
activities 41
3.5.1
Preliminary visits 41
3.5.2
Training of research assistants 41
3.5.3
Informed Consent 41
3.5.4
Ethical approval
42
3.6 Data
collection 42
3.6.1
Questionnaire administration 42
3.6.2
Anthropometric Measurement 42
3.6.2.1 Length 42
3.6.2.2
Weight 43
3.6.2.3
Mid-upper-arm circumference 43
3.6.2.3
Head circumference
43
3.7 Statistical
analysis 43
CHAPTER 4
RESULTS AND DISCUSSION
4.1a Socio- demographic characteristics of
respondents 45
4.1b Socio-demographic characteristics of respondents 47
4.2a Continous breastfeeding practices of mothers
48
4.2b Continous breastfeeding practices of mothers
50
4.3a Complementary feeding pattern of respondents
51
4.3b Complementary feeding pattern of respondents 53
4.4 Frequency of foods consumed by respondents 55
4.5
Anthropometric characteristics of respondents 57
4.6
Relationship between continuous breastfeeding patterns
and complementary Feeding pattern 59
CHAPTER 5
CONCLUSION AND
RECOMMENDATION
5.1 Conclusion
61
5.2 Recommendation
61
References
62
Appendix i
Appendix ii
Appendix iii
LIST OF TABLES
Table Page
4.1a
Socio- demographic characteristics of respondents 45
4.1b Socio- demographic characteristics of
respondents 47
4.2a Continous breastfeeding practices of
mothers
48
4.2b Continous breastfeeding practices of mothers 50
4.3a Complementary feeding pattern of
respondents
51
4.3b Complementary feeding pattern of respondents 53
4.4 Frequency of foods consumed by respondents
55
4.5
Anthropometric characteristics of respondents
57
4.6
Relationship between continuous breastfeeding patterns
and complementary Feeding pattern
59
CHAPTER 1
INTRODUCTION
Early
initiation of breastfeeding increases chances of breastfeeding success besides,
it generally lengthens the duration of breastfeeding and immediately after
birth assists in uterus involution thus preventing postpartum haemorrhage (WHO/UNICEF, 2013). It is
recommended that infants should be exclusively breastfed for the first six
months of life. Thereafter, nutritionally adequate and safe complementary foods
should be introduced while breastfeeding continues for at least two years (King, 2012). Malgorzata et al. (2021) recommended the initiation of breast-feeding within the
first hour of birth for all new borns, 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
(WHO, 2003; Malgorzata et al., 2021).
Breastfeeding
is an important way of providing ideal food for nutrition, healthy growth and
development of infants and children (WHO, 2013).Breastfeeding plays a
fundamental role in the immune tolerance since the antigens in the maternal
diet are processed by herself, releasing immunological components (IgA, IL-10,
growth factors and antigens) in breast milk (Center for Disease Control and
Prevention (CDC), 2013). According to WHO, (2014) breastfeeding is acknowledged
as the continuous way to feed infants for the first six months by national and
many other health organizations. Breastfeeding is an
unequalled way of providing ideal food for the healthy growth and development
of infants; it is also an integral part of the reproductive process with
important implications for the health of mother”(Silfverdal, 2011).
Koletzko et al. (2012) reported that breastfeeding is the natural means of infant
nutrition. The composition of mother’s milk is optimally suited to the needs of
the infant. As long as the mother is taking a balanced diet, her milk gives her
child all the important nutrients for growth and normal development. Mother’s
milk is, generally speaking, hygienically unproblematic, at the right
temperature, and practically always available. It contains not only nutrients,
but also many immunologically active components with anti-infectious and
anti-inflammatory properties. Breastfeeding lowers the risk of infectious
disease (Bührer and Genzel-Boroviczény, 2014).
According to Dudenhausen,
(2014) the
current recommendations of WHO and UNICEF on breastfeeding are as, initiation of breastfeeding within the first hour after the birth, exclusive breastfeeding for the first six months and continued breastfeeding for two years or more and proper
introduction of solid foods starting in the sixth month which are nutritionally
safe and adequate. Breastfeeding has been shown to protect
infants from several morbidities in infancy and early childhood including acute
respiratory infections, diarrhea and other gastrointestinal conditions.
According to Daly et al. (2016) and
Kent, (2007) breastfeeding is a complex physiological process, and full milk
production is reliant upon adequate milk synthesis, secretion, ejection, and
removal from the breast. During established breastfeeding, milk synthesis rates
are largely under autocrine control, in that synthesis slows as breast fullness
increases (King, 2012). WHO,
(2018) revealed that breastfeeding of infants from birth through the first 6
months of life using breast milk (the ideal food for this period) is important
for optimal health, growth, and development.
Despite
its countless benefits to children and mothers, the continuation rates of EBF
are low (WHO, 2014).As infants grow and become more active following the first
6 months of life, however, breast milk alone falls short of providing the full
nutritional requirements where the gap keeps expanding with the increasing age
of the infants and young children (Dewey, 2001; King, 2012). Complementary feeding plays critical role in bridging
these gap.
Exclusive breastfeeding as defined by WHO and UNICEF is the
practice whereby an infant receives only breast milk from the mother or a wet
nurse or expressed breast milk (WHO/UNICEF, 2016).
The WHO and UNICEF, both recommend that mothers should breastfeed their child
exclusively for the first 6 months and continue breastfeeding up to 2 years or
longer rather than stop EBF practice as from 4-6 months (WHO/UNICEF, 2016).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. 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
(WHO/UNICEF, 2003). According to WHO/UNICEF, (2015) 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.
While
continuous 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 (Kramer and Kakuma, 2004). Continuous
breastfeeding as reported by (Ip et al.,
2009; Ladomenou et al., 2010) for the
first six months and continued breastfeeding to 24 months and complementary
feeding tops the list of preventive interventions that would most reduce the
number of childhood mortality . Breast-feeding is crucial for the healthy
growth and development of the child (WHO/UNICEF (2003).
Continuous
breastfeeding during the early childhood has protective effect on infections
including diarrhoea and respiratory infections (Horta and Victora, 2013).
1.1 STATEMENT OF TH PROBLEM
Currently,
the global prevalence of EBF for infants aged 0-6months is only 37% (Louisa
Adda et al., 2020) which is far
behind to make exclusive breastfeeding during the first 6 months of life the
norm for infant feeding and Researchers indicate that 11.6% of mortality in
children under 2 years of age was contributed by non-exclusive breastfeeding.
In 2012, the World Health Assembly endorsed a Comprehensive implementation plan
on maternal, infant, and young child nutrition with six specified global
nutrition targets for 2025 and the fifth target states increment of the rate of
breastfeeding in the first 6 months up to 50% and only 31 of 194 countries were
on the line with this endorsement in 2018 (WHO, 2012). According to (UNICEF,
2015) reported the rate of breastfeeding is low compared to the 2012 world
health assembly endorsement, Accordingly, breastfeeding is (25, 30, 47, 32, 51,
46, 38) % in western and central Africa, East Asia and Pacific, South Asia,
Central America and the Caribbean, eastern and southern Asia, least developed
countries and worldwide respectively. Between 1985 and 1995, global rates of
exclusive breastfeeding raised by 2.4% and Twenty-five countries raised their
rates of exclusive breastfeeding by 20% or more after 1995. Similarly, Cambodia
and Malawi showed an increment of exclusive breastfeeding (EBF) from (11 to 74)
% and (3 to 71) % respectively between (1992- 2010) (WHO/ UNICEF, 2015).
World
Health Organization and UNICEF emphasized breastfeeding as the superior method
for the infant. About 75 percent of the women start feeding from the breast in
postpartum period and 50% continue to six months and 25% continue to one year
(WHO, 2019). Latest obtained statistics from Isfahan Province in 2006 also
indicated the same finding; it indicated that only 17.4% of the infants aged
6-month old exclusively fed by breast milk (WHO, 2019). There has been an
increase in exclusive breastfeeding rates from 13% in 2003 (Kenyan National Bureau of Statistics (KNBS) and ICF Macro, 2010) to 32%
of children below 6 months exclusively breastfeeding and at six to eight months
the prevalence is 3.6% (KNBS and ICF Macro, 2010) from 3.2% in 2003. In China,
the rates of any breastfeeding since mid-1990s in the majority of the cities
and provinces are above 80% at four months but very few reached the national
target of exclusive breastfeeding of 80% (Xu et al., 2009). Findings of an infant feeding survey in the UK
showed that breastfeeding initiation rates were high at 76%, and at one week
45% were still exclusively breastfeeding but at six months this dropped to less
than 1% (Scientific Advisory Committee on Nutrition, 2008).
In
2007, the Kenyan government established a comprehensive infant and young child
feeding (IYCF) programme (UNICEF, 2009a), and this together with efforts by
other agencies may have contributed to the increase. The prevalence has yet to
reach the WHO goal of 90% and is below the global prevalence currently at 37%.
Exclusive breastfeeding rate in Kenya is among the lowest in East Africa region
where prevalence is 47% (UNICEF, 2011). Breastfeeding for infants less than six
months old has increased in all but one developing region (UNICEF, 2009d). In
the developing world as a whole, progress has been modest, from 33% around 1995
to 37% around 2008 a relative increase of about 16% (UNICEF, 2011c and UNICEF,
2009a) and currently stands at 36% (UNICEF, 2011a). South Asia, East Asia /
Pacific and Eastern / Southern Africa are regions with the highest levels of
exclusive breast feeding (44%, 43% and 39%) (UNICEF, 2009e and UNICEF, 2011a).
The rates of exclusive breastfeeding are particularly low in West and Central
Africa (23%), East Asia and Pacific (28%), Central and Eastern Europe/Common
wealth of Independent States (CEE/CIS) with 29% (UNICEF, 2011b). A study in
Brazil by Parada et al. (2007)
assessing complementary feeding practices in children during their first year
of life found out that continued breastfeeding rates at 8, 10 and 12 months were 51.0%, 43.1%
and 37.8% respectively. A study aimed at assessing trends in breastfeeding and
complementary feeding practices in Pakistan from 1990 to 2007 by Hanif et al., (2011) established that the
percentage of infants 12 to 16 months who continued to breastfeed increased
slightly from 78.2% in 1990-91 to 79% in 2006-07.
Globally, less than 40% of infants under 6
months of age were exclusively breastfed despite of the documented benefits of
BF. 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 BF 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.
Breastfeeding
during the initial months of life and continued breastfeeding through at least
the first year of life is associated with substantial reduction in the burden
of infections (Fisk et al., 2010).
Breastfeeding reduces the mother's risk of fatal postpartum hemorrhage, the
risk of breast and ovarian cancer, and of anemia, and by spacing births,
breastfeeding allows the mother to recuperate before she conceives again (Fisk et al., 2010).
Another
study conducted in 13 western African countries and sub-Saharan countries
showed the prevalence of exclusive breastfeeding for infants under 6 months of
age ranges from 13.0% in Côte d'Ivoire to 58.0% in Togo and 45.2% in
sub-Saharan countries respectively. Besides this, according to the 2016
Ethiopian demographic health survey (EDHS), the prevalence of exclusive
breastfeeding for infants under 6 months was 58% (African et al., 2019). Worldwide around 600,000 children and 100,000 women
die each year because of complications such as diarrhea and pneumonia especially
for childhood death that could easily be prevented with exclusive breastfeeding
and Millions of dollars have been lost to treat children with the above
problems and others. According to a study conducted in Latin America and the
Caribbean countries, Bangladesh, and others, exclusive breastfeeding for the
first 3 months of life can prevent 55% of infant deaths related to diarrheal
disease and acute respiratory infection. Similarly, a study conducted in Ghana
and Ethiopia showed that the risk of neonatal death was higher for infants with
nonexclusive breastfeeding (The Federal Democratic Republic of Ethiopia,
Ministry of Health, 2015). A cohort study in Burkina Faso by Sawadogo et al., (2011) established that the
duration of breastfeeding was ideal with more than 98% and 61% of children
still breastfeeding at 18 and 24 months respectively.
In Nigeria 41% of children under-5 years of age
are stunted, with an increase from 27% at age 6 months to 50% at
23 months which is the period were complementary feeding intensifies.
About 23% of children under-5 years are underweight in Nigeria and the
prevalence among children aged 6–23 months is 24%; wasting among
under-five children is 13%, and 17% among children aged 6–23 months. On
the other hand obesity stands at 9% among under-five children (National
Population Commision (NPC) and ICF Macro 2018).
Continuous breastfeeding practice decreases child
death and contribute significantly to the long term health of children. In
2016, a Lancet series estimated that 823,000 deaths of children under two years
could be prevented every year through continuous breastfeeding practices.
Continuous breastfeeding practices reduce hospitalization among children from
diarrhoea, respiratory infections, and otitis media illnesses.
1.2 Objectives of the Study
The
general objective of the study is to assess the feeding pattern and anthropometric indices of infants (6-24
months)
The specific objectives are to;
i. determine
socioeconomic and demographic characteristics of the parents of the infants
ii. assess
the continuous breastfeeding practices of the mothers with infants within two
years
iii. evaluate
the complementary feeding pattern in the study area
iv. determine
the association between continuous breastfeeding and complementary feeding in
the study area
v. determine
the anthropometric status of the infants.
1.3 Significance of the Study
The
study feeding pattern
and anthropometric indices of infants (6-24 months) in Umuahia North Local government area of Abia State will provide
information on the feedings
patterns and anthropometric indices of
infants in the study area. The findings of this study will aid nutritional policy
makers in designing appropriate policies and interventions that can effectively
alleviate continuous breastfeeding and complementary feeding on
infant. The result obtained from this
study will extensively provide information on the extent of continuous
breastfeeding and complementary feeding in the study area. The information will indicate health and
nutritional related problems that are associated with breastfeeding and finding
possible solution to households that does not believe in continuous child
breastfeeding and complementary if found necessary.
This
will help educate health
policy makers, nutrition educators, health professionals, caregiver’s and parents on health danger of low
continuous breastfeeding and complementary feeding on the children and
households alike. It will also help human nutrition and dietetics students who
are researching in the related topic and it will also add to the existing
literature.
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