ABSTRACT
This cross sectional study was conducted among 243 mothers attending antenatal and post natal care at Primary health care center situated at Umuahia metropolis. The aim was to assess the knowledge, attitude and practices of exclusive breastfeeding among nursing mothers. Majority of respondents (80.1%) were between the ages of 21-40 years. 90.5% were married, the total population surveyed are all Christians. Majority (49.3%) of the respondents attained tertiary level of education, while very few (1.2%) stopped at primary school. Almost all the mothers (95.1%) knew the definition of exclusive breastfeeding which may be attributed to health talks being given by health facilitators at antenatal clinics. High percentage of respondents (89.3%) had a good knowledge about the introduction of colostrums to the baby immediately after birth. 81.5% knew that the duration of exclusive breast feeding should be six months. Lesser percentage of the respondents (37%) had sufficient knowledge that exclusive breastfeeding prevents postpartum fertility. Majority (75.7%) of respondents had an average knowledge, while few (18.9%) respondents had good knowledge. 8.2% of mothers agreed that exclusive breast feeding are for poor mothers, 9.1% of the respondents had a positive attitude that babies should not be given water when the weather is too hot. Majority of the respondents (54.3%) agreed that only milk can support child’s growth for six months. Thus the attitude score of the respondents showed that very few (1.24%) had a negative attitude, 51.87% of the mothers had an undecided attitude, and 46.89% of the mothers had a positive attitude towards exclusive breast feeding. 62.1% mothers introduced breast milk immediately after birth, 26.3% introduced breast milk the next day the reason being that there was no flow down of milk from the breast as at that point. And because of that, 38.7% respondents introduced water and glucose first before breast milk. 50.4% of the mothers practiced exclusive breast feeding for six months, while 62.1% did not practice EBF. Among the respondents, 3.3% of the respondents give other food in addition to breast milk to their babies during the first six months of life this is because many of them are civil servant and traders and they spend most of their times in their work place.
TABLE OF CONTENTS
Title
page i
Certification ii
Dedication
iii
Acknowledgement iv
Table
of contents v
List
of Tables vii
List
of figure viii
Abstract ix
CHAPTER 1:
INTRODUCTION
1.1
Statement of problem 8
1.2
Objectives of the study 9
1.3
Significance of the study 10
CHAPTER
2: LITERATURE REVIEW
2.1
Composition of human milk 12
2.2
Knowledge and attitude to breast feeding
17
2.3
Factors affecting breast feeding 19
2.3.1
Opposition to other source of breast milk 20
2.3.2
Benefit for exclusive breast feeding for the infants 22
2.3.3 Importance of exclusive breast
feeding to mothers 23
2.3.4
Types of infant feeding practices 25
2.3.5
The effect of early weaning 26
2.3.6
Strategies in promoting exclusive breasting 27
CHAPTER 3:
MATERIALS AND METHODS
3.1
Study design 30
3.2
Area of study 30
3.3
Sampling and sampling size 31
3.3.1
Sample size 31
3.4
Sampling technique 32
3.5
Instrument for data collection 32
3.6
Statistical analysis 33
CHAPTER
4: RESULT AND DISCUSSION
4.1 Personal data of the respondents 34
4.2 socio economic characteristic of the
respondents 35
4.3 knowledge of exclusive breast feeding
among nursing mothers 37
4.4 Mothers attitude towards breast
feeding 44
4.5 practice of
exclusive breast feeding among nursing mothers 49
CHAPTER 5:
CONCLUSION AND RECOMMENDATIONS
5.1 Conclusion 54
5.2 Recommendations 54
REFERENCES 56
LIST OF TABLES
Table 4.1:
personal data of the respondents 34
Table 4.2: socio
economic characteristic of respondents 36
Table 4.3a:
knowledge of exclusive breast feeding 39
Table 4.3b:
categorized knowledge score of exclusive breast feeding 41
Table 4.4a:
attitudes of mothers towards exclusive breast feeding 46
Table 4.4b:
attitude score of mothers towards exclusive breast feeding 48
Table 4.5a:
practice of exclusive breast feeding among nursing mothers 52
Table 4.5b:
practice of exclusive breast feeding among nursing mothers 53
LIST OF FIGURE
Figure 1:
knowledge of score graded 42
CHAPTER ONE
INTRODUCTION
Recent
studies have shown that one of the means of making the entire essential
nutrient available for the growing infants during the first six months of life
is through exclusive breastfeeding. The quantity of nutrients presents in the
volume of milk produced by healthy lactating mothers has been found to be
adequate in meeting the babies’ nutrient and energy requirement up to the age
of six months, World Health Organization (WHO) (2004). Ekpunobi (2007) reported
that mother’s milk provides the infants with immunity that is resistant to many
infectious diseases breast milk and its precursor’scolostrum’s ensure the
neonates adaption and successful transition to independent postnatal life. Thus,
placing a baby on breast milk which originally contains antibodies, helps to
prevent the baby from falling ill often. It is economical and nutritionally
adequate; it is safe and saves time, otherwise money spent in shopping for or
preparing formula. Dewey and Nommsen (2005)
emphasized that breast milk is sterile free from microorganism, easy to digest,
and usually does not cause allergic reactions
and the baby grows rapidly during the first few months of life than
formula fed babies.
Despite
WHO’s recommendations on breastfeeding, the global picture falls short of the
world standards, as only 35% of infants worldwide are exclusively breastfed
(WHO 2002). The Nigeria demographic and Health Survey (NDHS) (2013) reported
that only 38% of mothers initiate breastfeeding early and low socioeconomic
status was found to be associated with a decrease in the exclusive
breastfeeding rates. The Health for all initiative (HFAI) sought to increase
the percentage of all infants being exclusively breastfed to 80% by 2015. The
United Nations Children’s Fund (UNICEF) (2003) recommended that 90% infants
less than 6 months of age in developing countries should be exclusively
breastfed. For Nigeria to meet these recommendations, an understanding of the
factors associated with reduced exclusive breastfeeding rates is important for
solutions addressing these factors to be proffered.
Brown
(2011) stressed that the benefits of breastfeeding to mothers and infants are
well established. Federal breastfeeding promotion efforts and greater
understanding of the advantages of breastfeeding have contributed to the
resurgence of breastfeeding in the united states since 1970s., Nevertheless
racial and ethnic disparities in breastfeeding initiation rates remains, and
despite the knowledge that the benefits increase with longer duration, there
has been little increase in the duration of lactation among all women .She further emphasized that the health care
system, the workplace, and the community can either hinder or facilitate the initiation
and continuation of breastfeeding. Health programs can play a significant role
in increasing breastfeeding rates to optimize maternal and infant nutrition.
Health care professionals who wish to manage and promote breastfeeding should
understand the physiology of lactation, the composition of human milk, and the
benefits to mothers and infants. Helping women achieve appropriate nutritional
status to optimize breastfeeding requires consideration of energy and nutrients
needs, weight goals, and effects of exercise during breastfeeding, and vitamin
and minerals supplement needs. Multilevel (health care system, community,
workplace, and family) support is critical for women who suffer from common
breastfeeding challenges and medical conditions. She continued to report that
human milk is the preferred food for premature and sick newborns. It is rarely
necessary to discontinue breastfeeding to manage medical problems or medication
use. However, adequately experienced and informed health care professionals are
needed to provide support for successful breastfeeding.
According to Brown (2011) the
importance of breastfeeding to mothers and infants, thus that breastfeeding
women experience hormonal, physical, and psychosocial benefits. Health and
human Service (HHS) (2000) stressed that breastfeeding immediately increases
level of oxytocin, a hormone that stimulates uterine contractions, minimizes
maternal postpartum blood loss and help the uterus to return to non-pregnant
size. Heininget al,(2001) reported
that there is delay in ovulation which
results in longer interval between pregnancies. They also emphasized
that breastfeeding alone however, is not as effective as other available birth
control methods. Consequently, many health care professionals in the Nigeria do
not offer breastfeeding as an option for birth control. Kuzela et al,.(2002), ascertained that many
women experience psychological benefits, including increased self- confidence
and facilitated bonding with their infants. Many still consider faster return
to pregnancy weight a benefit of breastfeeding; however, women may lose or gain
weight while nursing. Narod (2006) stressed that in addition to these short
term benefits, women who nurse at a younger age and for longer duration have
lower risk of breast, ovarian cancer and rheumatoid arthritis. Karlson and
Lubbock (2004) reported that breastfeeding is the main source of active and
passive immunity in the vulnerable early months and years of life and is
considered to be the most effective preventive means of reducing the death rate
of children under five. (Gartner, 2005) ascertained that human milk is
recommended as the exclusive nutrient source for feeding infants for the first
six months of life. Breastfeeding should be continued with the addition of
solid foods for six months of age (Gordon 2009 and Emeaso2012).
1. Nutritional Benefits:
The value of the composition of human milk is widely recognized. Companies that
make human milk substitute often use human milk as standard, recognizing the
many unique properties of human milk
a. With
its dynamic composition and the appropriate balance of nutrients, human milk
provides optimal nutrition to the infants.(Lawrence, 2005; and Cox, 2006)
b. The
balance of nutrients in human milk matches human infant requirement for growth
and development closely; no other milk or human milk substitute (HMS) meets infant’s
needs as well.
c. Human
milk is isosmotic (of similar ion concentration; in this case human milk and
plasma are of similar ion concentration) and therefore meets the requirements
for infants without other forms food and water.
d. The
relatively low protein content of breast milk compared to cow’s milk meets the
infant’s needs without overloading the immature kidneys with nitrogen.
e. Whey
protein in human milk forms a soft, easily digestible curd.
f. Human
milk provides generous amounts of lipids in the form of essential fatty acids,
saturated fatty acids, medium-chain triglycerides, and cholesterol.
g. Long
chain polyunsaturated fatty acids, especially docosahexaenoic acid (DHA), which
promotes optimal development of the central nervous system, are present in
human milk.
h. Minerals
in breast milk are largely protein bound and balanced to enhance their
availability and meets infant needs with minimal demand on maternal reserves
(Brown 2011).
2. Lower Infant
Mortality in Developing Countries: In the developing
world, 10 million children die each year, and 60% are believed to be
preventable deaths (WHO 2003).Improving breastfeeding practices could save
approximately 1.3 million lives annually and continuing breastfeeding with
complementary foods could save an additional 600,000. This protection of lives
is at the center of the World Health Organization (WHO) and UNICEF’s joint
efforts called the Global Strategy for Infant and Young Child Feeding to remind
the international community of the impact of feeding practices (including
breastfeeding) on children’s health outcomes. WHO (2003) emphasized that
breastfeeding may also play a role in reducing the risk of sudden infant death
syndrome(SIDS), but this is still under investigation. Researchers disagree
about whether breastfeeding has a primary effect in reducing risk of SIDS. An
analysis of available studies found that bottle-feeding increases the risk of
sudden Infant Death Syndromes SIDS, but other factors related to feeding choice
may be responsible for this finding (McVeaet
al.,2002).
3. Analgesic effect:
Breastfeeding seems to work as an analgesic in infants. Breastfeeding during
venipuncture seems to reduce infants pain as well as a 30% glucose solution
followed by pacifier use (Orsetal.,
2009). Shah et al., (2009)
reportedthat breastfeeding before a heel prick did not seem to reduce infants
pain response. Breastfeeding may be used to reduce infants discomfort during
minor invasive procedure (Splettet al.,
2008).
4. Fewer Acute Illness:
Reduced infants illness is evident in countries with high infant illness (morbidity)
and mortality rates, poor sanitations, and questionable water supplies. In
developed countries, where modern healthcare system, safe water, and proper
sanitation are commonplace there is a clear relationship between breastfeeding
and reduced rates of illness in infants. Dewey et al., (2005) reported that inU.Ssamples, the incidence of
diarrhea is estimated to be50% lower in exclusively breastfed infants
internationally. Gastrointestinal infection was lower among infants exclusively
breastfed for 6 months when compared to those exclusively breastfed for only 3
months (Brown, 2011). She continued to emphasize that ear infections are 19% lower,
and the number of prolonged episodes of ear infections was 80% lower among
breastfed infants than among infants fed with human milk substitute.
5. Cognitive Benefits:Hellandet al., (2003) stressed that several
reports have linked breastfeeding, especially duration of breastfeeding, with
cognitive benefits, assessed by intelligent quotients (IQ). The increases in
cognitive ability associated with breastfeeding, are significant even after
adjusting for family environment. Cognitive development gains increase with the
duration of breastfeeding (Even house 2005). Rogan et al.,(2007) reported that higher intelligence quotients(IQ), of
infants breastfed for 6months appear to be greater among infants born small for
gestational age than among infants born appropriate weight for age. Rao et al.,( 2002) also reported that the
differences in cognitive function are also greater in premature infants fed
human milk than those fed with human milk substitute (HMS).Recognition that the fatty acid composition of
milk plays an important role in neuropsychological development bolsters the
credibility of psychological or cognitive benefits from breastfeeding (Smith et al., 2003).
6. Reduction in chronic illness:
In addition to the lower rate of acute illness in breastfed children,
breastfeeding also seems to protect against chronic childhood diseases. It may reduce the risk of celiac diseases,
(Ivarssonet al 2008)inflammatory
bowel diseases and neuroblastoma (Olshanet
al 2002).Human milk substitute (HMS) and feeding result in an increased risk
of 30% allergy and asthmatic diseases 25% (Oddyet al.,2012). There is reduction in acute
and chronic infant illness, with greater use of human milk (Scariatiet
al, .2007).They continued to ascertain that infants who receives some human
milk and some human milk substitute (HMS) are at 60% greater risk of ear
infection than those fed exclusively human milk. The risks, particularly for
allergy and asthmatic diseases, are reduced for the duration of breast feeding
and for months to years after weaning (Scariatiet al, .2007).
Breastfeeding
is a natural act, and also a learned behavior. An extensive body of research
has demonstrated that mothers and other care givers require active support for
establishing and sustaining appropriate breastfeeding practices. “WHO and
UNICEF launched the Baby Friendly Hospital Initiatives (BFHI) in 1992, to
strengthen maternity practices, to support breastfeeding. Nigerians government
earmarked six University Teaching Hospitals as BFHI centers with three
objectives of reducing infants’ malnutrition, morbidity, and mortality as well
as promoting the health of mothers. However a gamut of factors not limited to
race and cultural beliefs, maternal characteristics, infants health
problem,socio-economic status and some psychosocial factors may hamper the full
realization of the baby-friendly initiatives.
Factors Influencing
Breastfeeding Initiation and Duration
a. Obesity and
Breastfeeding: Overweight and obesity prior to
pregnancy and excess weight gain during pregnancy are associated with shorter
duration of breastfeeding (Oddy 2006).Brown(
2011) stated that this association is independent of socioeconomic status and
other factors also known to affect breastfeeding duration. She further stressed that this influence of
obesity may be related to lower prolactin responses early postpartum and
resulting difficulty in establishing adequate milk supply. Therefore
maintenance of ideal body weight is important for lactation success.
b. Socioeconomic: Brown
(2011) emphasized that all new mothers, both low-income and more affluent, need
support for breastfeeding. She continued to report that low-income women often
lack the education, support, and confidence to interpret the abundant and
pervasive mixed messages on infant feeding practices, consider the strikingly
different context for pregnancy, birth and parenting for low income and their
more affluent counterparts (Brown 2011).
c. Profile of an Affluent
Pregnant Woman: Brown (2011) ascertained that the
affluent expectant mother has a friend who have breastfed and have helped build
her confidence that she can breastfed successfully. That She might have been
able to choose her birth setting and select a hospital with knowledgeable staff
who allow mother and baby to stay together around the clock. Because she knows
there may be bumps in the road getting started, she seeks out supports from
friends or the doctors after discharge. She continued to explain that at home,
she has a supportive husband who is proud of her for offering the best for
their baby. If she returns to work, she knows she can still breastfeed to keep
that special closeness with her baby even after returning to work (Brown,
2011).
1.1
STATEMENTOF PROBLEM
Human
breast have been discovered to be an adequate food for infants 0-2 years (0-24
months). It is the best nutrition for infants with the introduction of
complementary foods at 6 months and continued breastfeeding beyond 2 years. In
Umuahia, majority of mothers fail to practice exclusive breastfeeding as
recommended. This is caused by factors such as lack of self-security, breast
soreness, poor infant positioning, mother’s perception of inadequate milk
supply and lack of necessary support and information from health care provider.
There are cultural, social and economic barriers to exclusive breastfeeding
including pre-lacteal feeding, giving drinking water and herbal tea. Poor
exclusive breastfeeding rates might have result from the absence of knowledge of
breastfeeding during antenatal, nutrition education. Infants that are subjected
to poor breastfeeding practices may easily become malnourished with the
tendency of contributing to increasing rate of infant mortality. Another
factors that affects the practice of exclusive breastfeeding among nursing
mothers in Umuahia metropolis are educational, social class, culture, locale,
nature of work and health status of both the nursing mothers and their infants.
The key to successful breastfeeding is information, education and communication
(IEC) aimed at behavior change. Therefore, there is need for improving infant
breastfeeding practices among nursing mothers. A more detailed understanding of
the knowledge, attitude and practices of mothers towards exclusive breastfeeding
in Umuahia metropolis is needed to develop effective interventions to improve
the rates of exclusive breastfeeding and thus reduce infant mortality.
1.2 OBJECTIVES OF THE STUDY
The
general object mothers towards exclusive bretives of this study are to assess
the knowledge, attitude and practice of exclusive breastfeeding among nursing
mothers attending Primary health centers in Umuahia Metropolis.
Specific
Objectives are to:
1.
assessthe knowledge of
exclusive breast feeding among nursing mothers attending health centers in
Umuahia Metropolis.
2.
determinethe attitude
among nursing mothers towards exclusive breast feeding.
3.
determine the
socio-economics factors which affect patterns of breast feeding
4.
determineextent to which
breast feeding is actively practiced.
5.
helpreduce public
misconception on women’s choices to exclusive breast feeding.
1.3 SIGNIFICANCE OF THE STUDY
At
the end of this research, the result obtain from this study will provide
information to the health workers such as medical doctors, dieticians, teachers
and commercial health workers in Abia state. This work will help to tackle some
nutrition related problems that is associated with poor breastfeeding practices
and also reduce death rate among children in the society. Throughthe result of
this research, it will help to motivate and encourage mothers’ interest in
exclusive breastfeeding. The information generated from this study, will be
used to note the need for further sensitization on breastfeeding in post-natal
and pre-natal out-patient clinic in all the Primary Health Centers in Abia
State where nutrition education goes on, in educating expectant mothers and the
nursing mothers on the need and importance of exclusive breastfeeding.
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