THE KNOWLEDGE, ATTITUDE AND PRACTICE TOWARDS EXCLUSIVE BREASTFEEDING BY MOTHERS IN AROCHUKWU LOCAL GOVERNMENT AREA OF ABIA STATE.

4.3    Knowledge of the mothers towards exclusive breastfeeding              52

4.4  Attitude of mothers towards exclusive breastfeeding        56

                               

 

 

 

Breastfeeding is the act of giving a baby breast milk (Abasiattai et al., 2014). It is an unequalled way of providing ideal food for the health, growth and development of infants and the most natural way of feeding them in all traditions (Otaigbe et al., 2005; Abasiattai et al., 2014). Breast milk is a natural resource that has a major impact on a child’s health, growth and development and it is recommended for at least the first two years of a child’s life (Ajibuah, 2013). Breast milk contains virtually all the nutrients, antibodies and anti-oxidants an infant needs to thrive for the first six months of life (Okechukwu and Otokpa, 2008; Abasiattai et al., 2014).

Exclusive breastfeeding (EBF) is 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 (WHO and UNICEF, 1990; Abasiattai et al., 2014).

Breastfeeding addresses all four facets of health, which are physical, spiritual, mental and social for mothers, children, fathers/partners and the immediate family (National Breastfeeding Committee, 2009; Tyndall et al., 2016). EBF during the first year of a child’s life ensures the provision of certain biological and psychological needs and therefore increases the probability of survival during this critical stage of development (National Resources Defense Council, 2005; Tyndall et al., 2016).

World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) (2003) emphasizes that the nutrients are quickly and easily digested in the body system of infants. Breastfeeding activities are carried out worldwide in order to fulfill the WHO/UNICEF recommendations that infants be breastfed exclusively for six months and thereafter until 24 months (Ajibuah, 2013). Efforts are being made both in private and public sector on improving maternal health. These efforts are also directed at reducing infant morbidity and mortality related to mix feeding as breast milk is very vital for the newly born babies (Udoudo and Ajayi, 2015).

Consequently, mothers are encouraged to breastfeed exclusively in the first six months of a child’s life in ante-natal and post-natal clinical sessions and through a range of mass media (Quinn et al., 2005; Esquivel et al., 2014; Tyndall et al., 2016). Studies have shown that breastfeeding during the early stages of a child’s development stimulates the immune system and improves the child’s responses to inoculation (Subbiah et al., 2003; Young et al., 2011; Tyndall et al., 2016). Reduction in the incidence of gastro-intestinal diseases, respiratory infections, ear infections and improvements in dentition have been observed in children who have been breastfed exclusively for six months or more (Tyndall et al., 2016).

Sub-optimal exclusive breastfeeding has been linked to an increased risk for Autism Spectrum Disorders (ASD), Attention Deficit Hyperactivity Disorder, Schizophrenia, depression, pervasive developmental disorders and epilepsy (Brown and Austin, 2009; Al-farsi et al., 2012; Tyndall et al., 2016). Furthermore, there has been evidence of an increase in the cognitive abilities and educational achievement of children associated with DHA in breast milk (Lauritzen et al., 2004; Tyndall et al., 2016). With respect to the psychological effects of exclusive breastfeeding, it has been proposed that the process of breastfeeding increases the bonding between mother and child and therefore increases the chances of academic success (Krugman and Law, 1999; Tyndall et al., 2016).

Breastfeeding in the first hour of birth facilitates the expulsion of placenta, reduces post-partum hemorrhaging and also expedites the recovery from the trauma of childbirth and labor (Awi and Alikor, 2007; Tyndall et al., 2016). Endocrinological studies by Tay et al.,(1993) has demonstrated that exclusive breastfeeding has been associated with a reduction in gonadotropin levels and the cessation of the menstrual cycle, thus reserving the stores of iron while serving as a natural form of birth control (Eiger and Wendkos, 1999; Tyndall et al., 2016). Furthermore, women who breastfed return to their pre-birth weight more easily (Tyndall et al., 2016).

Consequently this necessitated the Innocenti Declaration commendation of 1990 by WHO/UNICEF policy makers that all infants should be fed exclusively on breast milk from birth to six months of age (Galtry, 2003; Udoudo and Ajayi, 2015). However, this clarion call is to be answered by all mothers, in our contemporary society, women are actively involved in paid job which has strict laws and codes of conduct which may not enable them have adequate time to practice exclusive breastfeeding (Udoudo and Ajayi, 2015).

Like in many of the sub-saharan African countries, the practice of breastfeeding in Nigeria has been a major aspect of infant feeding but exclusive breastfeeding practice is poor (Ajibuah, 2013). In addition to breast milk, 34% of infants aged 0-5 months are given plain water only, while 10% are given non-milk liquids and juice and 6% are given milk other than breast milk (Ajibuah, 2013). The afore mentioned explains the high incidence of infant malnutrition and mortality experienced in developing countries which is mainly due to poor infant feeding practices (Ajibuah, 2013). According to the 2008 Bulletin of WHO, the distribution of deaths due to diarrhea in low and middle-income countries was highest in Africa and Nigeria was ranked second amongst countries with the highest mortality rate due to diarrhea (WHO, 2008; 2014; Obilade, 2015). WHO Global data on Infant and young child feeding in Nigeria indicated that 22.3% of children were exclusively breastfed for less than 4 months, while 17.2% were exclusively breastfed for less than 6 months in the year 2003 (Agunbiade and Ogunleye, 2012; Dudu et al.,2016). The figure of 17.2% dropped slightly to 17% according to the 2013 Nigerian Demographic Health Survey (NDHS, 2013). Exclusive breastfeeding is necessary for successful curbing of infant malnutrition and the reduction of child mortality rate across Nigeria (WHO, 2010; Dudu et al., 2016). Two aspects of exclusive breastfeeding are crucial “initiation and duration” which are affected by factors such as; level of education, nature of job, place of delivery, culture, family pressure (Ogunlesi, 2010; Henry et al., 2010; Dudu et al., 2016). The rate of exclusive breastfeeding initiation has been on the increase compared to the duration in Nigeria (Ogunlesi, 2010; Dudu et al., 2016).

As a complement to community based efforts to promulgate the code in 1991, UNICEF and WHO began an intensive effort to transform breastfeeding practices in maternity hospitals to support breastfeeding (Obilade, 2015). A UNICEF State of the World’s Children in 1998 reported that before Baby Friendly Hospital Initiative (BFHI), four percent of mothers practiced exclusive breastfeeding for the first six months (Obilade, 2015). After the launching of the Baby Friendly Hospital Initiative (BFHI), there was a gradual increase in the percentage of mothers that were breastfeeding exclusively (Obilade, 2015). The percentage of mothers that were breastfeeding exclusively rose from a modest 25% in 1991 to 40% in 1996 (UNICEF, 1998; Obilade, 2015). However, the 2014 State of the World’s Children has shown a decline in the momentum of exclusive breastfeeding (UNICEF, 2014). Despite the efforts of the BFHI, the practice of exclusive breastfeeding is still below expectations (Obilade, 2015). Globally, the rate of exclusive breastfeeding is below 40% (UNICEF, 2014; Obilade, 2015).

Malnutrition is still high and life threatening, particularly affecting the poor (Essien et al., 2009). The most affected are babies and children under 5 years of age (Essien et al., 2009). High mortality rates are still persisting among the babies who are not breastfed (Ene-Obong, 2001; Frazer and Cooper, 2003; UNICEF, 2005; Essien et al., 2009). Recently there has been an increase in the prevalence of malnutrition in Africa which means that the goal set to reduce the levels of malnutrition by 50% between 1990 and 2015 may not be met (Mwangome et al., 2010; Ngwu et al., 2014). Many studies have shown that poor nutrition prevents children and communities from reaching their social and economic life (Ngwu et al., 2014).

 

Malnutrition, largely preventable contributed to more than half of the deaths of one fifth of the 5 million babies born in Nigeria yearly (Onyezili, 2005; Ngwu et al., 2014). The major underlying causes of nutritional problems include; poor maternal and child care practices, lack of awareness and education, family food insecurity, poor intra-family food distribution, poor access to good quality health and sanitation services (World Bank, 2002; Ngwu et al., 2014). Poor nutrition is also caused by non-exclusive breast feeding, the early introduction of food other than breast milk and inadequate amounts of complementary foods, starting at about six months (Onyezili, 2005; Ngwu et al., 2014).

 Presently in Nigeria it has been shown by the United Nations Children’s Fund (UNICEF, 2007) data and National Demographic Health Survey NDHS (2008) that only 13% of nursing mothers practiced exclusive breastfeeding, this is a decline from 17% reported in NDHS (2004). According to Jones et al., (2003), malnutrition has been responsible directly or indirectly for 60% of the 10.9 million deaths among children under-five during their first year of life. The available Food Consumption and Nutrition survey (FCNs, 2001-2003) revealed that four out of every 10 children (40%) are stunted, one out of every 10 under-five (5) children in Nigeria are underweight while 14% are wasted. Socio-cultural and religious beliefs, taboos and ignorance hinder the practice of EBF (Ene-Obong, 2001; Essien et al., 2009). Global campaigns organized by UNICEF and WHO urge mothers to be baby-friendly (UNICEF, 2005; WHO, 2007; Essien et al., 2009).

Successful breastfeeding depends on many factors such as; willingness of the mother to breastfeed, a healthy infant and encouragement by healthcare personnel and mother’s knowledge, attitude and belief about breastfeeding (Essien et al., 2009). Breastfeeding behavior of mothers is an important predictor of infant and child nutrition, health and development.

The general objective of the study was to assess the knowledge, attitude and practice towards exclusive breastfeeding by mothers in Arochukwu LGA of Abia State.

The specific objectives were to:

1. assess the knowledge of the mothers about exclusive breastfeeding 

2. evaluate the practice of exclusive breastfeeding

3. examine the attitude of mothers towards exclusive breastfeeding

4. determine the socio-demographic factors affecting the practice of exclusive breastfeeding.

A survey of knowledge, attitude and practices on exclusive breastfeeding is necessary to know what obtains in rural communities in Arochukwu L.G.A where many low income and lower class people dwell. Findings will add to the existing database and will assist nurses and doctors in the Primary Health Centres (PHC) in the community to plan strategies to enhance and sustain exclusive breastfeeding among mothers. If it is found that the mothers practice EBF, they will be encouraged to continue this practice. However, if it is otherwise, they will equally be educated about the advantages of EBF and its positive practices to be maintained in order to enhance the healthy growth of the children.