ABSTRACT
Appropriate and adequate infant feeding practices are an important factor in achieving optimal health in infants. This study was conducted to examine the use of breast milk substitutes by lactating mothers in selected rural locations in Enugu State. The study was a cross-sectional study .A multi-stage sampling technique was used to select a total of 340 respondents. Data on socio-demographic/economic characteristics, characteristic of the index child, attitude and utilization of breast milk substitutes of the infants were collected using structured and validated questionnaire. The IBM SPSS version 22.0 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. Regression analysis was used to analyze the factors associated with the use of breast milk substitutes.. From the result, most (67.4%) of the respondents are married and live with their husbands and among the working mothers, majority (91.5%) of them receive maternity leave. Some (40.6%) of the mothers fed their infants with infant formula/milk at delivery which was an advice given to more than half (50.3%) of them by the doctor/nurse/midwife. Meanwhile, majority (92.4%) of the respondents were aware of breast milk substitutes, some of them currently feed their infants with both breast milk and infant formula. Some (47.1%) of the women preferred using a specific brand of instant formula because it is good for their baby (24.1%), their doctor recommended it for them (20%) and their friends use it (17.4%). However, majority (73.4%) of the respondents have a positive attitude towards breast milk substitutes. From the anthropometric indices of the infants, majority of them had normal weight-for-height (57.4%), weight-for-age (76.8%), height-for-age (85.4%) and BMI-for-age (74.1%). Meanwhile, there was a significant relationship (p=0.001) between maternity leave and respondent’s attitude towards breast milk substitutes. There was also a significant relationship between being young (p=0.003), low income (p=0.042) and the use of breast milk substitutes by the respondents. Realizing that maternal employment is among the factors that influence the use of breast milk substitutes, there is need to increase awareness on maternity protection for working mothers in favor of improved maternal conditions that are related to optimal infant feeding.
TABLE OF CONTENTS
TITLE PAGE i
CERTIFICATION ii
DEDICATION iii
ACKNOWLEDGEMENT iv
TABLE OF CONTENTS v
LIST OF TABLES vi
ABSTRACT vii
CHAPTER 1
INTRODUCTION
1.1 Statement of Problem 3
1.2 Objectives of the Study 5
1.2.1 General objective 5
1.2.2 Specific objectives 5
1.3 Significance of the Study 5
CHAPTER 2
LITERATURE REVIEW
2.1 Breastfeeding 7
2.1.1 Exclusive Breastfeeding 7
2.2 Definitions 8
2.3 International Code of Marketing of Breast-Milk Substitutes (BMS) 9
2.4 Factors Necessitating Breast milk Substitutes 11
2.4.1 Low Birth Weight (LBW) 11
2.4.2 Emergency situations 12
2.4.3 Infant health conditions 13
2.5.4 Maternal health conditions 14
2.5 Reasons for use of Breast milk Substitutes by Lactating Mothers 15
2.5.1 Paternal factors 15
2.5.2 Mother’s employment status 16
2.5.3 Mothers’ decision 17
2.5.4 Superficial knowledge on infant formula 18
2.5.5 Hospital staff’s attitudes 19
CHAPTER 3
MATERIALS AND METHODS
3.1 Study Design 21
3.2 Area of Study 21
3.3 Population of the Study 22
3.4 Sampling and Sampling Techniques 22
3.4.1 Sampling size 22
3.4.2 Sampling procedure 23
3.5 Preliminary Activities 23
3.5.2 Preliminary visits 23
3.5.3 Training of research assistants 23
3.6 Data Collection 24
3.6.1 Questionnaire Design 24
3.6.2 Questionnaire administration 24
3.7 Data Analysis 25
3.8 Statistical Analysis 25
CHAPTER 4
RESULTS AND DISCUSSION
4.1a Socio Demographic Characteristics of the Lactating Mother 27
4.1b Socio-Economic characteristics of the Husband 32
4.2a Socio demographic characteristics of the lactating mother 34
4.2b Characteristics of the Index of the child currently being breastfed 36
4.2c Health problems child have suffered since he/she was born 33
4.3 Awareness and exposure to Breast Milk Substitutes 42
4.4 Utilization of Breast Milk Substitutes 45
4.5 Attitude of the Respondents towards Breast Milk Substitutes 51
4.6 Anthropometric indices of the children 54
4.7 Factors Influencing the Use of Breast Milk Substitutes by the
Respondents. 56
CHAPTER 5
CONCLUSION
5.1 Conclusion 57
5.2 Recommendations 57
REFERENCE 59
Appendix I 66
Appendix II 67
Appendix III 76
LIST OF TABLES
Table 4.1a: Socio-demographic characteristics of the Lactating Mothers 23
Table 4.1b Socio-Economic characteristics of the Husband 27
Table 4.2a: Socio demographic characteristics of the lactating mother 29
Table 4.2b Characteristics of the Index of the child currently being breastfed 30
Table 4.2c: Health problems child have suffered since he/she was born 34
Table 4.3: Awareness and Exposure to Breast milk substitutes 35
Table 4.4: Utilization of Breast milk Substitutes 39
Table 4.5: Attitude of the Respondents Towards Breast milk substitutes 44
Table 4.6: Anthropometric Indices of the Children 47
CHAPTER 1
INTRODUCTION
The best quality food for infants, in emergencies or non-emergencies, is breast-milk. Breastfeeding is perhaps the oldest practice in human history. It is the healthiest, simplest and least expensive means of meeting the nutritional needs of newborns and infants (Ballard and Morrow, 2013). Breast milk is nutritionally perfect, providing all the energy, nutrients and fluid that the baby needs for the first (six) months. It is still an important food through the second year, clean, safe, at the right temperature and easily digestible and helps to protect against infections, particularly diarrhoea, chest and ear infections International Baby Food Action Network (IBFAN, 2001).
However, when breast milk is not available, iron-fortified infant formula is an appropriate alternative for the infant’s first year of life. Infant formula is “a food which purports to be or is represented for special dietary use solely as a food for infants by reason of its simulation of human milk or its suitability as a complete or partial substitute for human milk” (Section 201, USC 321). Because infant formulas are often the only source of nutrition for infants, the Food and Drug Administration (FDA) monitors infant formula manufacturers very closely to assure the product provides the appropriate nutrition for all infants. (FDA, 2008)
Literature indicates that a mother’s decision to breast-feed or formula feed her infant results from a complex interaction of various factors (Sarah and Diana, 2004; Shake ret al., 2004). The mother’s current circumstances may therefore result in her opting to rather formula feed her infant, despite the known benefits of breast-feeding (Sowden et al., 2009).
Certain health conditions of the infant or the mother may as well be able to justify recommending that a mother does not breastfeed temporarily or permanently. Some of these conditions together with some health conditions, may concern very few mothers and their infants, although serious, are not medical reasons for using breast-milk substitutes (WHO, 2009). According to WHO (2009) on acceptable medical reasons for use of breast-milk substitutes, infants with classic galactosemia and infants with phenylketonuria, should not receive breast milk or any other milk except specialized formula. For some other infants born weighing less than 1500g (very low birth weight); born at less than 32 weeks of gestational age (very pre-term); and new born infants who are at risk of hypoglycemia by virtue of impaired metabolic adaptation or increased glucose demand (such as those who are preterm, small for gestational age or who have experienced significant intrapartum hypoxic/ischaemic stress, those who are ill and those whose mothers are diabetic), if their blood sugar fails to respond to optimal breastfeeding or breast-milk feeding such infants, breast milk remains the best feeding option but may need other food in addition to breast milk for a limited period (WHO, 2009).
Maternal condition (for instance HIV infection) may justify permanent avoidance of breastfeeding (WHO, 2005; WHO, 2007; WHO, 2009). Also, certain maternal conditions may justify temporary avoidance of breastfeeding which may include: severe illness that prevents a mother from caring for her infant, for example sepsis; Herpes simplex virus type 1 (HSV-1); and certain maternal medications (WHO, 2009).
1.1 STATEMENT OF PROBLEM
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). Under-nutrition is associated with at least 35% of child deaths (World Health Organization, 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 (WHO, 2003).
Despite the recognized health (Quigley et al., 2007) and safety (Renfrew et al., 2003) benefits of breastfeeding, many babies worldwide are not breastfed (Organization for Economic Cooperation and Development, 2009). The 2018 National Nutrition and Health Survey (NNHS) report by National Bureau of Statistics (NBS) and United Nations Children's Fund (UNICEF) showed a widespread practice among the Nigerian population with nearly all the assessed children 0-23 months ever breastfed (97.1%), however, only 28 percent of infant under-six months were exclusively breastfed, a percentage consistent with the 2014 NNHS findings of 25 percent but far below the recommended WHO/UNICEF level of 50 percent (UNICEF, 2018).
The early introduction of breast milk substitutes, based on erroneous assumptions, affects breastfeeding initiation and sustainability. Poor complementary feeding practices, coupled with high rates of infectious diseases, are the principal causes of malnutrition during the first two years of life. Some researchers have proposed that lack of suitable facilities outside of the home, inconvenience, conflicts at work, family pressure and ignorance influence the use of breast milk substitutes by nursing mothers (Ogbonna et al. 2000; Forbes et al, 2003). Another research has shown that various factors such as education, social class, culture, nature of work, and health status of both the nursing mothers and their infants, influence nursing mothers’ decision to use breast milk substitutes (Adeyinka et al. 2008).
This study was therefore aimed to assess factors that influence the use of breast milk substitute among lactating mothers in Enugu rural.
1.2 OBJECTIVES OF THE STUDY
1.2.1 General objective
The general objective of this study is to assess the use of breast milk substitute among lactating mothers in selected rural areas in Enugu State.
1.2.2 Specific objectives
The specific objectives of the study include to:
1. assess the socio-economic and demographic characteristics of the mothers
2. determine the utilization of breast milk substitutes among lactating mothers in selected rural areas in Enugu state
3. assess the attitude of the respondents towards the recommended infant feeding practices
4. Determine the factors associated with the use of breast milk substitute.
1.3 SIGNIFICANCE OF THE STUDY
Findings from this study will portray the reasons influencing the use of breast milk substitute among lactating mothers in Enugu rural as a whole. This will help policy makers, nutrition educators, health professionals, government and non-governmental organization, young adults and the general public tailor out interventions, implement, monitor and evaluate its impacts. It may also convince the Federal Ministry of Health at large to restore and closely monitor implementation of WHO approved Infant and Young Child Feeding practices.
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