ABSTRACT
Improved infant and young child feeding (IYCF) knowledge among adolescent girls have the potential to improve child health and development outcomes. This study was conducted to assess the knowledge of infant and young child feeding practices among adolescent girls in Umuahia North 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 250 respondents which are all adolescent girls. Data on socio-demographic/economic characteristics, knowledge of exclusive breastfeeding and knowledge on complementary feeding of the respondents were collected using structured and validated questionnaire. The IBM SPSS version 21.0 computer programme was used to analyze the data. Significant relationship was judged at p ≤ 0.05. Data obtained were described using frequency, percentage, mean and standard deviation. Pearson correlation analysis was used to analyse the socio economic influences on adolescent girls’ knowledge on infant and young child feeding practices. Result revealed that more than half (55.2%) of the adolescent were between the age of 14-16 years. Majority (82.8%) of the girls are still in secondary school whole most (99.2%) of them are single. Majority (76.8%) of the respondents are aware of exclusive breastfeeding while some of them got the information from the hospital (24.4%) and family member (21.2%). However, more than half (54.4%) of the respondents had an average knowledge on exclusive breastfeeding while 26.4% had a good knowledge about exclusive breastfeeding. Additionally, (52.4%) of the respondents had a poor knowledge on continued breastfeeding and complementary feeding. Meanwhile, there exist a significant association (p=0.001) between the educational status of the adolescents and their knowledge on exclusive breastfeeding. There was also a significant positive relationship (p=0.023) between the respondents marital status and their knowledge on exclusive breastfeeding. Female adolescence is a window of opportunity for improving health outcomes among future children, and increased investment in early education of adolescent girls regarding safe IYCF may be an effective strategy to promote and support improved infant feeding practices.
TABLE OF CONTENTS
Title page i
Certification ii
Dedication iii
Acknowledgement iv
Table of contents v
List of tables viii
Abstract ix
CHAPTER 1 : INTRODUCTION
1.1 Background of the Study 1
1.2 Statement of Problem 4
1.3 Objective of the Study 5
1.3.1 General objective of the study 5
1.3.2 Specific objective of the study 5
1.4 Significance of the Study 5
CHAPTER 2: LITERATURE REVIEW
2.1 Adolescence 7
2.1.1 Characteristics of Adolescence 8
2.2 Trends in Infant Feeding Practices 8
2.3 Conceptual Framework on Attitude of Adolescents to Infant Feeding 11
2.4 Impact of Wrong Choice of Feeding on Infants 12
2.5 Infant Feeding 14
2.5.1 Determinant Factors to Infant Feeding 14
2.5.1.1 Health care practices 14
2.5.1.2 Maternal age 15
2.5.1.3 Neonatal Practices 15
2.5.1.4 Infant food industry and marketing 15
2.5.1.5 Family Influence 15
2.6 Meaning of Breastfeeding 16
2.6.1 Types of Breastfeeding 20
2.6.1.1 Exclusive Breastfeeding (EBF) 21
2.6.1.2 Predominant or Mixed Breastfeeding 21
2.6.1.3 Expressed Breast Milk (EBM) 22
2.6.1.4 Exclusively Pumping (EP) 23
2.6.1.5 Wet Nursing 23
2.6.1.6 Tandem Nursing 24
2.6.1.7 Induced Lactation 24
2.6.1.8 Re-lactation 24
2.7 Importance of Breastfeeding 25
2.7.1 Importance of Breastfeeding for the Infant/Young Child 26
2.7.2 Importance of Breastfeeding for the Mother 26
2.7.3 Campaign on Breastfeeding 28
2.8 Feeding in Exceptionally Difficult Circumstances 28
2.9 Formula Feeding Practices 30
2.9.1 Problems with Infant Formula 31
2.10 Complementary Feeding 32
2.10.1 Early and Late Introduction of Complementary Foods 32
2.10.1.1 Early weaning 33
2.10.1.2 Late Weaning 33
2.10.2 Complementary Foods 33
2.10.3 Common Feeding Difficulties in Infants 34
2.11 Improving Feeding Practices 34
CHAPTER 3: MATERIALS AND METHODS
3.1 Study Design 36
3.2 Area of Study 36
3.3 Population of the Study 37
3.4 Sampling and Sampling Technique 37
3.4.1 Sample size determination 37
3.4.2 Sample procedure 38
3.5 Preliminary Activities 39
3.5.1 Preliminary visits 39
3.5.2 Training of research assistants 39
3.5.3 Informed Consent 40
3.6 Data Collection 40
3.6.1 Questionnaire Design 40
3.6.2 Questionnaire administration 41
3.7 Data Analysis 41
3.8 Statistical Analysis 42
CHAPTER 4: RESULTS AND DISCUSSION
4.1 Socio-Economic Characteristics of the Respondents 43
4.2 Socio-Demographic Characteristics of the Respondents 45
4.3 Level of Awareness of Exclusive Breastfeeding 47
4.4 Knowledge of Exclusive Breastfeeding 49
4.5 Knowledge on Continued Breastfeeding and Complementary Feeding 54
4.6 Socio Economic Influences on Adolescent Girls’ Knowledge on Infant and Young Child Feeding Practices 60
CHAPTER 5: CONCLUSION AND RECOMMENDATION
5.1 Conclusion 63
5.2 Recommendation 63
References
Appendix
LIST OF TABLES
Table 4.1 Socio-Economic Characteristics of the Respondents 44
Table 4.2 Socio-demographic characteristics of the respondents 46
Table 4.3 Level of awareness of exclusive breastfeeding 49
Table 4.4 Knowledge of Exclusive breastfeeding 50
Table 4.5 Knowledge on Continued Breastfeeding and Complementary Feeding 55
Table 4.6 Socio Economic Influences on Adolescent Girls’ Knowledge on Infant and Young Child Feeding Practices 62
CHAPTER 1
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
Despite what are often reported as clear, unambiguous benefits to exclusive breastfeeding in the first 6 months of life, the timely introduction of high-quality complementary foods, and continued breastfeeding until at least 2 years (World Health Organization (WHO), 2011), very few of the world‟s infants are actually fed according to these guidelines. Globally, less than half of infants are exclusively breastfed up to 4 months, and many do not receive appropriate complementary foods starting at 6 months (Gibson et al., 2008; Lauer et al., 2014). A majority of mothers self-express the first milk (colostrum) and provide prelacteal liquids such as water, milk, and butter (Lozoff, 2006). The early introduction of liquids and semisolids is of concern because of the potential for these foods to displace breast milk, lower the overall quality of an infant‟s diet (Dewey and Brown, 2013) and act as vehicles for transmission of contaminates, which are a significant source of diarrheal morbidity among infants (Motarjemi et al., 2013).
Optimal infant and young child feeding practices rank among the most effective interventions to improve child health. In 2006 an estimated 9.5 million children died before their fifth birthday, and two thirds of these deaths occurred in the first year of life. Under-nutrition is associated with at least 35% of child deaths (World Health Organisation, WHO, 2008). It is also a major disabler preventing children who survive from reaching their full developmental potential. Malnutrition has been responsible, directly or indirectly for 60% of the 10.9 million deaths annually among children under five (WHO, 2003). Around 32% of children less than 5 years of age in developing countries are stunted and 10% are wasted. It is estimated that sub-optimal breastfeeding, especially non-exclusive breastfeeding in the first 6 months of life, results in 1.4 million deaths and 10% of the disease burden in children younger than 5 years (Black et al., 2008). To improve this situation, mothers and families need support to initiate and sustain appropriate infant and young child feeding practices.
Non-recommended child feeding behaviors such as nonexclusive breastfeeding and suboptimal complementary feeding practices are responsible for a tremendous burden of disease. Improvements in infant and young child feeding could lower the number of under 5year child deaths by nearly 18% (Jones et al., 2013). To improve this situation, mothers and families need support to initiate and sustain appropriate infant and young child feeding practices. Health care professionals can play a critical role in providing that support, through influencing decisions about feeding practices among mothers and families (United Nation Children Emergency Fund and United States Agency for International Development, WHO/UNICEF/USAID, 2008). Therefore, it is critical for health professionals to have basic knowledge and skills to give appropriate advice, counsel and help solve feeding difficulties, and know when and where to refer a mother who experiences more complex feeding problems (WHO/UNICEF/USAID, 2008).
Knowledge has been recognized as important factors in the World Health Organization‟s (WHO) model of the determinants of infant and child feeding behaviour (Lutter, 2010). Child health in general, and infant and young child feeding more specifically is often not well addressed because of lack of adequate knowledge and skills (WHO UNTCEF/USAID, 2008). In many non-Western societies especially Nigeria, children readily engage in childcare themselves and directly observe others doing so, especially in communities where breastfeeding is openly carried out in public (Weisner and Gallimore, 2007; LeVine, 2014). Because children learn through observation and participation (Fiske, 2007), this experience and observation is a major vehicle for transmission and internalization of specific knowledge. Knowledge regarding child feeding behaviours are likely to be internalized quite early in life, and adolescents are likely to have internalized knowledge of child feeding behaviors before they have had a child or perhaps even thought about having a child. WHO (2008), advocated the promotion and support of breastfeeding. However, before this will be done, it is important to find out the level of understanding and knowledge of mothers and potential mothers on breastfeeding and the factors that could militate against the practices of appropriate breastfeeding. Thus, this research work is designed to assess the adolescent girls knowledge on infant and young child feeding practices in Umuahia North Local Government Area of Abia State.
1.2 STATEMENT OF PROBLEM
Approximately 165 million children under the age of five are chronically undernourished (Black et al., 2008). Stunting, along with fetal growth restriction, suboptimum breastfeeding, wasting, and Vitamin A and zinc deficiencies are estimated to account for 3.1 million annual deaths of children under five (Black et al., 2013). Chronic under nutrition leads to poorer schooling outcomes, lower economic productivity, and a greater likelihood of being poor in adulthood (Hoddinott et al., 2013). Poor infant and young child nutrition (IYCN) practices contribute to poor pre-school nutrition outcomes and where these have been improved, gains in length and weight have been observed (Ahmed et al., 2012; Avula et al., 2013). For this reason, in a number of countries especially in Nigeria where the burden of under nutrition is high, efforts are being made to improve IYCN practices. Where these efforts exist, they are nearly always directed towards already married women (Nguyen et al., 2014).
In Nigeria, women marry at a relatively early age and soon afterwards become pregnant. For these women, the short duration between marriage, pregnancy, and birth allows little time to provide information on correct infant and young child nutrition (IYCN) practices. What they know about IYCN in adolescence, therefore, may well play an important part in their IYCN practices. Yet, little is known about the extent of IYCN knowledge in adolescent girls. Thus, this research work is designed to assess the adolescent girls knowledge on infant and young child feeding practices in Umuahia North Local Government Area of Abia State.
1.3 OBJECTIVE OF THE STUDY
1.3.1 General objective of the study
The general objective of the study was to assess the adolescent girls knowledge on infant and young child feeding practices in Umuahia North Local Government Area of Abia State.
1.3.2 Specific objective of the study
The specific Objectives of the study were to:
i. determine the socio-economic status of the adolescent girl.
ii. assess their exposure to sources of information on infant and young child feeding practices.
iii. assess the adolescent girl knowledge on infant and young child feeding practices.
iv. determine the relationship between socio economic characteristics and the adolescent girl’s knowledge on infant and young child feeding practices.
1.4 SIGNIFICANCE OF THE STUDY
Findings from this study will provide information on the adolescent girls‟ knowledge on infant and young child feeding practices. Findings from this study will also help to identify the sources of information on infant and young child feeding practices. It will also help to determine household influences on adolescent girls‟ knowledge on infant and young child feeding practices. This will inform policy makers and development partners on strategies that will help improve exclusive breastfeeding practices.
Again, this research's findings will add to the rising body of scientific understanding and knowledge on new born feeding practices and how to plan and position health interventions among young girls. Additionally, this research will certainly provide a basis for future research
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