ABSTRACT
Poor feeding practices during the first two years of life have both immediate and long-term consequences. It is estimated that improper feeding of infant leads to about one-third of the cases of malnutrition worldwide. This study was conducted to assess infant feeding practices among mothers in selected communities in Ikwuano Local Government Area of Abia state. The study was a cross sectional study. A multi-stage sampling technique was used to select a total of 350 mothers with children 0-12 months from 7 communities in Ikwuano Local Government Area of Abia State. Data on the sociodemographic characteristics of the children and mother, breast feeding practices, complementary feeding practices and factors influencing infant feeding practices were collected using a structured and validated questionnaire. IBM SPSS Statistics version 21 was used to analyze the data. Data obtained were described using frequency, percentage, mean and standard deviation. The results from the study revealed that most (50%) of the women were 26-35 years old and married. A majority (25.7%) of the women were farmers and did not go past secondary education. Majority (98.6%) of the women breastfeed their baby. Early initiation of breastfeeding was practiced by 86.9% of the mothers however exclusive breastfeeding for six months was practiced by few (18.6%) mothers. Some bad feeding practices were observed such as late initiation of breastfeeding, discarding of colostrum and giving an infant water immediately after birth. Barriers to exclusive breastfeeding include lack of information, difficulty breastfeeding, lack of support from family members and breast abscess among others. The mothers practiced complementary feeding. Most (96.6%) initiated early complementary feeding while a few (3.4%) initiated complementary feeding late. Factor influencing complementary feeding include lack of information, family income, sore nipples, sickness, difficulty coping with work and inadequate milk secretion. Infants in the study were fed rice, bread, water, fluted pumpkin, pawpaw, fish and yam more frequently. This study has demonstrated a sub optimal infant feeding practices in our environment, through poor breastfeeding practices in terms of early initiation of breastfeeding, six months of exclusive breastfeeding, prelacteal feeding and inadequate complementary feeding and has a significant effect on infant and young child survival, growth and development, nutritional status, morbidity and mortality and impend economic development. Hence, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional needs, infants should receive safe and nutritionally adequate complementary foods while breastfeeding continues for up to two years of age or beyond.
TABLE
OF CONTENTS
Cover Page i
Certification ii
Dedication iii
Acknowledgment iv
Table of Contents v
List of Tables vii
Abstract viii
CHAPTER 1
INTRODUCTION
1.0 BACKGROUND
OF THE STUDY 1
1.1 STATEMENT
OF PROBLEM 3
1.2
GENERAL OBJECTIVE 5
1.3
SIGNIFICANCE OF THE STUDY 5
CHAPTER 2
LITERATURE REVIEW
2.1
INFANT FEEDING PRACTICES 7
2.2
EXCLUSIVE BREASTFEEDING PRACTICE 9
2.2.1
Breastfeeding from a public health
viewpoint 12
2.2.2
Barriers of exclusive breastfeeding and
significances of not
breastfeeding infants 13
2.2.3
The national breastfeeding policy in
Nigeria 15
2.3
COMPLEMENTARY FEEDING PRACTICE 16
2.3.1
Benefits of timely introduction of
complementary feeding 17
2.4
FACTORS AFFECTING FEEDING PRACTICE 19
2.5 FREQUENCY AND PATTERNS OF FEEDING 20
2.6
FACTORS THAT INFLUENCE CHILD GROWTH 20
2.7
DIVERSITY OF INFANT FEEDING METHODS 22
2.8
RECOMMENDED NUTRIENT INTAKE BY
INFANTS 23
2.9 THE
INFLUENCE OF SOCIOECONOMIC AND
`DEMOGRAPHIC
FACTORS 28
CHAPTER 3
MATERIALS AND METHODS
3.1
STUDY DESIGN 30
3.2 STUDY
AREA 30
3.4 POPULATION OF THE STUDY 31
3.4 SAMPLING AND
SAMPLING TECHNIQUE 31
3.4.1 Sample size
determination 31
3.4.2 Sample procedure 32
3.5 PRELIMINARY
ACTIVITIES 32
3.5.1 Preliminary visits 32
3.5.2 Training
of research assistants 33
3.5.3 Informed
Consent 33
3.5.4 Ethical
approval 33
3.5.5 3.6 DATA COLLECTION
3.6.1 Questionnaire
Design 33
3.6.2 Questionnaire
administration 36
3.7 DATA ANALYSIS 36
CHAPTER 4
RESULTS AND DISCUSSION
4.1 SOCIO-DEMOGRAPHIC
CHARACTERISTICS OF THE MOTHER
AND THEIR CHILD 37
4.2 BREAST FEEDING PRACTICES 40
4.3 BARRIERS TO
BREASTFEEDING 44
4.4 COMPLEMENTARY FEEDING 46
4.5 FACTORS
INFLUENCING COMPLEMENTARY FEEDING
PRACTICES 50
4.6 FEEDING FREQUENCY 52
CHAPTER
5
CONCLUSION AND RECOMMENDATIONS
5.1 CONCLUSION 55
5.2 RECOMMENDATION 56
REFERENCES
LIST
OF TABLES
Table 2.1 Summary of Differences Between Milk:
Comparing Breast 25
Milk vs.
Cow Milk and Infant Formula Composition
Table
2.2 Age-Specific Estimates of Energy in MJ
(kcal) Day Required 26
from Complementary Foods in Industrialized and
Developing
Countries, Assuming an Average Breast-Milk Intake
Table
2.3 Minimum Energy Density in KJ (kcal)/g
of Complementary 26
Foods by Number of Meals per Day, Breast Milk
Intake, and
Age Group
Table
4.1 Socio-demographic
characteristics of the mother and their child 38
Table
4.2 Breastfeeding practices 42
Table
4.3 Barriers to breastfeeding 45
Table
4.4 Complementary feeding
practices 47
Table
4.5 Factors influencing
complementary feeding practices 51
Table
4.6 Food consumption 53
CHAPTER 1
INTRODUCTION
1.0
BACKGROUND OF THE STUDY
Infant refers to a human child from birth to the end of the
first year of life. Up until 2 years of age, a child is in a
critical phase of growth and development, during which appropriate nutrition
should be given to guarantee the attainment of all of the child’s developmental
milestones. Globally, approximately 50-70% of the burden of diarrhoea, malaria,
upper respiratory tract infections and measles in infant can be attributed to
under-nutrition, and over 60% of the 10.9 million deaths among infant under 5
years result from improper feeding practice (WHO, 2010). More than 65% of these
deaths are usually associated with inappropriate feeding practices that occur
in infancy (Black et al., 2013). Empirical evidence based on
observational studies (such as cohort and case control studies), intervention
studies and systematic reviews has shown that optimal feeding behaviours reduce
the risk of diarrheal diseases, upper respiratory tract infections, obesity,
and improve childhood innate immunity as well as reduce childhood mortality (De
Leoz, et al., 2014; Lamberti et al., 2011 and Kramer and Kakuma,
2012).
Poor feeding
practices during the first two years of life have both immediate and long-term
consequences. It is estimated that improper feeding of infant leads to about
one-third of the cases of malnutrition worldwide (Anoshirike et al.,
2014). Ensuring health, growth and development of infant requires adequate
nutrition during infancy and early childhood (Demilew et al., 2017).
Therefore, optimal feeding during the first two years of life provides
opportunity for prevention of growth faltering and under-nutrition. Hence,
Improvement of infant feeding practices for infant less than two years should
be a high priority globally. A global strategy for optimal infant feeding was
set up by World Health Organization (WHO) and United Nations Children’s Fund
(UNICEF) in order to reduce poor feeding practice among the infant. The
strategy recommends early initiation of breastfeeding within one hour of birth,
exclusive breastfeeding for the first six months, and introduction of
appropriate, adequate, and safe complementary foods along with continuing
breastfeeding up to two years and beyond. Improving infant practices is
important to reduce under-nutrition and its consequences (WHO, 2010).
It has been recognized that inappropriate feeding
practices include absence of exclusive breastfeeding in children below 6 months
old, premature ablactation after 6 months, and giving complementary foods too
late (Zhou et al., 2012). Zhou et al., 2012 states that some
intervention studies aimed at improving feeding practices were conducted in
some areas with a high prevalence of poor infant feeding practice and found
that infant growth improved significantly after nutritionally adequate and
hygienic complementary foods were added to the infants’ diet. These researches
showed that exclusive breastfeeding in children below 6 months, continued
breastfeeding up to 2 years of age, and timely introduction of complementary
food were essential for infant development.
Breastfeeding and complementary feeding practices can
prevent up to 19% of all childhood deaths in low-income countries if adequately
promoted and practiced. However, questions arise about the level at which
current recommendations are implemented (Wamani et al., 2015).
In Nigeria and some other countries in Africa, high use of pre-lacteals (fluids
given before initiating breastfeeding at birth) and poor exclusive
breastfeeding practices has been reported. It is estimated that fewer than 50%
of infant under 6 months of age are exclusively breastfed in low-income
countries, where the relative benefits of optimal feeding are greatest (Ogbo,
2016). In Nigeria, an estimated 2,300 infant less than five years lose their
lives daily, in which sub-optimal infant feeding practices play a major role,
despite a range of policy initiatives to improve infant feeding practices. It
has been reported that Inappropriate infant feeding practices account for more
than 40,000 disability-adjusted life years in Nigeria by contributing to lost
productivity among infant under 5 years. The national study in Nigeria revealed
that early initiation of breastfeeding significantly decreased by 4.3% between
1999 and 2013 while exclusive breastfeeding remained unchanged. It also showed
that predominant breastfeeding significantly increased by 13.1%, and infant
ever breastfed declined by 16.4% over time (WHO, 2010).
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 (Mattew et al., 2010). Progress in improving infant feeding in
the developing world has been reported to be remarkably slow due to several
factors. 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 (WHO,
2010). There is the need to focus attention on the promotion of feeding
practices at the household level that are beneficial to the survival of infant
and mothers in Nigeria. The above studies indicate the need for a comprehensive
strategic plan that is achievable to improve infant feeding practices in
Nigeria, and to build on previous policy initiatives of past years. Therefore,
this study was conducted to assess current status of infant practices among
mothers in selected communities in Ikwuano Local Government Area of Abia State.
1.1 STATEMENT OF PROBLEM
Poor
infant feeding practice is a public health concern in developing nations such
as Nigeria. Over 33% of all infant deaths globally can be indirectly linked to
poor infant feeding practices, even though it is hardly registered as a direct
cause (Bain et al., 2013). In 2011 it was observed that poor infant
feeding practices in developing countries accounted for 54% of all infant
mortalities; in addition, impoverishment of households remains the primary
contributing factor to this public health problem (Bain et al., 2013).
UNICEF (2016b) maintained that infant are the most nutritionally susceptible segment
of the population. Poor feeding practices among infants is generally higher in
the rural and sub-urban areas in Nigeria, (UNICEF, 2016b). In 2016, it was
estimated that a little over 475,000 infants suffered from severe acute
undernutrition in this region of the country (UNICEF, 2016b).
Poor
feeding practices have been widely documented in Nigeria despite the government
and other stakeholders implementing a number of strategies aimed at improving infant
feeding practices (Kimani-Murage et al., 2011). In line with this, a
significant proportion of infants and young infant in Nigeria are exposed to
the hard consequences of poor feeding practices (APHRC, 2012). While mortality
due to sub-optimal feeding practices is significant, interventions promoting optimal
feeding can prevent 6% of deaths for infant under the age of 5 years (Jones et
al., 2013). Inappropriate feeding practices such as; untimely introduction
of complementary foods, improper feeding frequency and low dietary diversity of
complementary foods have been widely shown to increase the risk of underweight
and stunting especially among the urban poor (Muchina, 2010).
Much
more needs to be done by policymakers and stakeholders to increase the numbers
of mothers who adopt these appropriate feeding practices, particularly in
developing nations, to enhance their infant’s wellbeing and attainment of their
developmental milestones.
There
was limited scientific data on infant feeding practices among mothers in
Nigerian communities. To improve complementary feeding in low-resource settings
during this critical period of growth and development, assessment of infant
feeding practices is essential. This study therefore obtained information that
could be used to facilitate targeting of appropriate interventions geared
towards reducing child malnutrition in rural and sub-urban communities.
1.2 GENERAL OBJECTIVE
The
general objective of this study is to assess infant feeding practices among mothers
in selected communities in Ikwuano Local Government Area of Abia state.
Specifically,
the study will;
i.
Assess the sociodemographic
characteristics of the children and mother
ii.
Determine breast feeding
practices
iii.
Determine complementary feeding
practices
iv.
Examine factors influencing
infant feeding practices
1.3 SIGNIFICANCE OF THE STUDY
This study will generate information that will be useful
to the Federal Ministry of Health (FMoH) and other agencies working on
improving child health through feeding practices. Promotion of appropriate
infant feeding practices including exclusive breastfeeding is an effective
strategy in improving the nutritional status of children as well as timely
introduction of appropriate complementary food to infants. The information
generated could be useful in designing appropriate interventions to improve infant
feeding practices among lactating mothers thus mitigating child malnutrition in
the target area and other similar
areas. The findings may also benefit health facilities
in Ikwuano Local Government Area of Abia State by providing a reference, which
may inform specific knowledge gaps among mothers. This knowledge gaps could be
addressed during antenatal visits. Health care providers would also be keen to
follow through to ensure compliance. Non-governmental organizations (NGOs),
community-based organizations (CBOs) and other institutions, which are
concerned with infant and young child health can also benefit from this study.
The findings of this study will contribute to the knowledge generated in future
studies.
With persistent double burden of malnutrition in many
countries (including Nigeria), the World Health Assembly Resolution 65.6
endorsed a Comprehensive implementation plan on maternal, infant and young
child nutrition, which specified six global nutrition targets for the year 2025
(for example, Global Nutrition 5 and 6 – increase the rate of exclusive
breastfeeding in the first six months up to at least 50%, and reduce and
maintain childhood wasting to less than 5% by the year 2025, respectively) 60,
61. Similarly, Sustainable Development Goals 2 and 3, advocate for improved
nutrition, and healthy lives for all 62. To achieve these goals and other
global targets on infant feeding in Nigeria, findings from this study will
provide objective and comparable assessments of key health-related indicators
for measuring progress towards achieving these developmental agendas in
Nigeria.
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