ABSTRACT
Over the years, experts have found that breast milk provides the best possible start to life in all areas of infant’s development. Exclusive breastfeeding (EBF) is giving the child breast milk alone in the first six months of life World Health Organization (WHO) (2014). The inclusion of water along with the breast milk is not considered EBF but if water is given as part of an oral rehydration solution, it does not negate EBF (WHO, 2014). According to WHO (2007) exclusive breastfeeding rates in Nigeria continue to fall well below the WHO/UNICEF recommendation of 90% EBF in children less than 6 months. Infant feeding practices account, to a large extent, for the high rates of malnutrition among children in developing countries. In Africa, majority of the mothers fail to practice exclusive breastfeeding as recommended WHO. This is due to the fact that the knowledge, attitude and practice of exclusive breastfeeding have been prejudiced by lack of knowledge, cultural, demographic, social, biophysical, and psychosocial factors. The main objective of the study is to assess the knowledge, attitude and practice of exclusive breastfeeding among nursing mothers in Amasiri and the relationship with their socioeconomic characteristics. The study is descriptive cross-sectional in design and was carried out in Amasiri in Afikpo North Local Government Area of Ebonyi State. The study populations are nursing mothers of newborns and other infants up to twelve (12) months of age. Copies of structured questionnaire were administered to consenting mothers by trained female interviewers during post-natal clinic sessions, and house-hold visit. Data for 277 participants with their filled questionnaires as presented in this study. The socio-demographic characteristics of the mothers showed that majority are Christians within the age of 18 -31. The result of this study showed that majority (76.2%) of the mothers had good knowledge of breastfeeding, while (23.6%) had poor knowledge. Despite the good knowledge of breastfeeding majority had negative attitude and incorrect practice towards it. The result of this study also shows that income of these mothers has a negative effect on knowledge and practice of exclusive breastfeeding. This study recommends that breastfeeding mothers should be educated on the benefits of exclusive breastfeeding through periodic conferences. To optimally reap the potential benefits of proper infant feeding, effort needs to be shifted to strategies that not only sustains and promotes knowledge to those that confer behavioural change. Exclusive breastfeeding support groups may be able to serve this need.
TABLE OF CONTENTS
COVER PAGE
TITLE PAGE i
CERTIFICATION ii
DEDICATION iii
ACKNOWLEDGMENT iv
TABLE OF CONTENTS v
LIST OF TABLE ix
ABSTRACT x
CHAPTER 1: INTRODUCTION 1
1.1 Statement of problem 3
1.2 Objective of the study 5
1.3 Significance of study 6
CHAPTER 2: LITERATURE REVIEW
2.1 Breastfeeding 8
2.1.1 Breast milk 8
2.1.2 Exclusive breast feeding 9
2.1.3 Breast feeding recommendation 9
2.1.4 Physiology of breast feeding 11
2.1.5 Science of breastfeeding 12
2.2 Nutritional component of human milk 13
2.2.1 Macro-nutrients 15
2.2.2 Micro-nutrients 18
2.3 Benefits of exclusive breast feeding 20
2.3.1 Benefit of exclusive breastfeeding to babies 20
2.3.2 Benefit of exclusive breastfeeding to mothers 23
2.4 Bioactive components and their sources 24
2.5 Factors affecting breast feeding in Nigeria 25
2.5.1 Attitude 25
2.5.2 Cultural influence 26
2.5.3 Personal motivation and confidence 26
2.5.4 Maternal education 27
2.5.5 Maternal age 28
2.5.6 Employment status and durations of maternity leave 28
2.5.7 Place of giving birth 29
2.5.8 Support 30
2.6 Expressed Breast Milk 32
2.7 Knowledge, Attitude and Practice of exclusive breast feeding in Developing countries 34
2.7.1 KAP of EBF in Nigeria 34
2.8 Challenges of Exclusive Breastfeeding among Mother 41
2.9 Strategies for Promoting Exclusive Breastfeeding 43
CHAPTER 3: MATERIALS AND METHODS
3.1 study design 5
3.2 Area of study 45
3.3 Population of study 46
3.4 Sample and sampling technique 46
3.4.1 Sample size 46
3.4.2 Sampling procedural 47
3.4.3 Ethical clearance 47
3.4.5 Primary visit 48
3.4.6 Training of research assistant 48
3.4.7 Informed consent 48
3.5 Data Collection 49
3.6 Data Analysis 49
3.7 Statistical Analysis 50
CHAPTER 4: DISCUSSION
4.1 Socio-demographic characteristics of mothers 51
4.2 Knowledge of Exclusive Breastfeeding of mothers 54
4.3 Attitude of exclusive breastfeeding of mothers 59
4.4 Practice of exclusive breast feeding of mothers 63
4.5 challenges of exclusive breastfeeding by the nursing mothers 68
4.6 Relationship between Socio-Economic Characteristics with Knowledge
and Practice of Breastfeeding 70
4.7 Relationship between Socio-Economic Characteristics with Challenges of Exclusive Breast Feeding 73
CHAPTER 5: CONCLUSION AND RECOMMENDATION
5.1 Conclusion 7
5.2 Recommendation 76
REFERENCE 77
APPENDIX I 93
APPENDIX II 98
APPENDIX 11
APPENDIX 1V
LIST OF TABLES
Table 4.1 Socioeconomics characteristics of the nursing mothers 53
Table 4.2a Knowledge of exclusive breastfeeding among the mothers 55
Table 4.2b Knowledge score of exclusive breastfeeding among the mothers 60
Table 4.3a Attitude on exclusive breastfeeding among mothers 61
Table 4.3b Attitude grade of exclusive breastfeeding among the mothers 62
Table 4.4a practice of exclusive breastfeeding among nursing mother 64
Table 4.4b Practice of Exclusive Breastfeeding among Nursing Mothers 67
Table 4.5challenges of exclusive breastfeeding among the nursing mothers 69
Table 4.6 Relationship between Socio-Economic Characteristic Knowledge and Practice of Exclusive 71
Table4.7 Relationship between Socio-economic characteristics with Knowledge and Practice of Exclusive Breastfeeding in Amasiri, Afikpo North Local Government Area, Ebonyi State. 73
CHAPTER 1
INTRODUCTION
Over the years, experts have found that breast milk provides the best possible start to life in all areas of infant’s development. Exclusive breastfeeding (EBF) is giving the child breast milk alone in the first six months of life (World health organization WHO, 2014). The inclusion of water along with the breast milk is not considered EBF but if water is given as part of an oral rehydration solution, it does not negate EBF (WHO 2014).
According to a statement by the World Health Organization (WHO), “Breastfeeding is the cornerstone for an infant’s survival, nutrition and development, (WHO, 2013). Breast milk is the optimal food for infants and it benefits are numerous. Early initiation of breastfeeding and exclusive breastfeeding help in child’s survival, it accounts for healthy brain development, promotes cognitive and sensory performance and is noted for enhancing intelligence and academic performance in children (Isaacs et al., 2010). In addition, breast milk carries anti-bodies from the mother that help combat diseases, protects babies from diarrhoea and acute respiratory tract infections. Breastfeeding stimulate infants’ immune system and response to vaccination and according to some studies confers cognitive benefits as well. Feeding an infant with only breast milk is advocated by stakeholders in health, is one of the most important practices in an infant’s life and the best way a mother can invest into the wellbeing of her child.
It contains bacterial and viral antibodies, including relatively high concentrations of secretary immunoglobulin (IgA) that prevents microorganisms from adhering to the intestinal mucosa. It also contains substances that inhibit growth of many common viruses such as rotavirus, norovirus and adenovirus. Antibodies in human milk are thought to provide local gastrointestinal immunity against organisms entering the body via this route (Kliegman et al, 2011) Breastfeeding promotes health for both mother and infant and helps to prevent disease. Longer breastfeeding has also been associated with better mental health through childhood and into adolescence (Oddy et al., 2010).
The WHO recommends that national authorities in each country decide which infant feeding practice should be promoted and supported by their maternal and child health services to best avoid HIV infection transmission from mother to child. Breastfeeding with HIV guidelines established by the WHO suggest that HIV-infected mothers (particularly those in resource-poor countries) practice EBF only, rather than mixed breastfeeding practices that involve other dietary supplements or fluids (Moland et al., 2010).
Researches reviewed that breastfeeding initiation is prevalent in developing countries; the rate exceeds 95% in more than half of the countries (WHO 2002). In Nigeria the rate was as high as 97 percent, however, the practice is far below WHO recommendation (Funmilola and Taiwo 2006). According to United Nation Children’s Fund (UNICEF), breastfeeding has the potential to avert 13% of all under-five deaths in West and Central Africa. Exclusive breastfeeding rates have remained low in most parts of the world. Campaigns such as Baby Friendly Hospital Initiatives (BFHI) and a UNICEF - introduced world breastfeeding week were aimed at increasing breastfeeding rates. Sadly, despite these interventions, there hasn’t been any significant improvement in exclusive breastfeeding rates especially in developing countries. Reported rates in the literature range from 2% to 3% in Bulgaria and Chad to 50% and 54% in Guatemala and Afghanistan respectively in 2010.
The knowledge attitude and practice of exclusive breastfeeding has been prejudiced by cultural, demographic, social, biophysical, and psychosocial factors. EBF rates in Nigeria continue to fall well below the WHO/UNICEF recommendation of 90% EBF in children less than 6 months (WHO, 2009). Recent scientific studies have found that nutrition education, counselling, and support for mothers and in health facilities will significantly promote the practice of exclusive breastfeeding in developing countries (UNICEF, 2008).
1.1 Statement of problem
According to WHO (2007) exclusive breastfeeding rates in Nigeria continue to fall well below the WHO/UNICEF recommendation of 90% EBF in children less than 6 months. Infant feeding practices account, to a large extent, for the high rates of malnutrition among children in developing countries. In Africa, majority of the mothers fail to practice exclusive breastfeeding as recommended WHO. This is due to the fact that the knowledge, attitude and practice of exclusive breastfeeding have been prejudiced by lack of knowledge, cultural, demographic, social, biophysical, and psychosocial factors (WHO, 2009). Other factors include self-security, breast soreness, poor infant positioning, mothers’ perception of inadequate milk supply and lack of necessary support and information from health care provider. There are cultural, social and economic barriers to EBF including pre-lacteal feeding, giving drinking water and herbal teas. Thus, there is need for improving infant breastfeeding practices among nursing mothers. A more detailed understanding of the knowledge, attitude and practice of mothers toward Exclusive breastfeeding in Nigeria is needed to develop effective interventions to improve the rates of Exclusive breastfeeding and thus reduce infant malnutrition, poor mental development and mortality. In Nigeria, the rates of early initiation, exclusive breastfeeding are far from desirable and further knowledge attitude and practice studies about breastfeeding are limited among Nigerian mothers (Funmilola and Taiwo 2006). Further, there is a paucity of literature on knowledge attitude and practice studies regarding exclusive breastfeeding from Nigeria and till no such study has been done from Amasiri. Thus, we are conducting a study to assess knowledge, attitude, and practices of exclusive breastfeeding among nursing mothers in Amasiri, Afikpo North Local Government Ebonyi State, Nigeria.
1.2 Objectives of the study
General objective
The general objective of the study is to assess the knowledge, attitude and practice of exclusive breastfeeding among nursing mothers in Amasiri, Afikpo north, Ebonyi state
Specific objectives:
1. To evaluate the knowledge of exclusive breastfeeding among nursing mothers in Amasiri Afikpo North Ebonyi state.
2. To determine the attitudes of nursing mothers towards exclusive breastfeeding in Amasiri, Afikpo North, Ebonyi state.
3. To determine the level of practice of exclusive breastfeeding among nursing mothers in Amasiri, Afikpo North, Ebonyi state.
4. To examine the challenges of exclusive breastfeeding among nursing mothers in Amasiri Afikpo North, Ebonyi state.
5. To determine the relationship between socioeconomic variables with knowledge and practice of exclusive breastfeeding in Amasiri Afikpo North, Ebonyi state.
6. Relationship of challenges of exclusive breastfeeding with socioeconomic variables in Amasiri Afikpo North, Ebonyi state.
1.3 Significance of the study
Poor knowledge attitude and practice towards exclusive breastfeeding is a significant public health problem in Nigeria. It affects the cognitive growth and development of infants, increase the rate of malnutrition, morbidity and mortality and thus affecting economic growth. The findings of the study will show-case the rates of EBF in Amasiri also help 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. 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 30minutes of delivery. 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. It will also cut down the socio-cultural practices against the promotion of EBF practices in the study area. 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. This in general will result in improved family resources and sanitized environment, thus improved general standard of living in the area.
In general, the finding of this study aimed in reduction of infant and maternal morbidity and mortality rate, thus collaborating the findings with other appropriate breastfeeding interventions and government policies can help Amasiri, Afikpo North, Ebonyi State government in general toward achieving the Millennium Development Goals (MDGs) in 2015 particularly goal ‘4 and 5 of reducing under-five mortality and maternal mortality’ in the state. The research is necessary and can serve as a guide for other researchers embarking research in the related area for further research. It would also be 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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