ABSTRACT
This study was carried out in order to access the use of breast milk substitute among lactating mothers in Okigwe Local Government Area of Imo State. The specific objectives are to assess the socio-demographic and economic characteristics of the lactating mothers, determine the utilization of breast milk substitute among lactating mothers. The populations of the study were all lactating mothers of 0-14 month’s old children in Okigwe Local government Area of Imo State. A multi-stage sampling technique was used to select the study sample (n=240). The questionnaire was structured into six sections, (Section A: Socio demographic/ economic characteristics of the respondents; Section B: Family structure of the respondents; Section C: Mother’s breastfeeding practices: Section D: Use of breast Milk Substitute; Section E: Exposure to Promotion of Breast Milk Substitute; Section F: Exclusive Breast Feeding Self Efficacy. The result of the study revealed that most (88.5%) of the lactating mothers attend antenatal clinic during pregnancy while few (11.5%) of them does not attend antenatal clinic during pregnancy, which indicates that the level of antenatal service utilization in the study area is significantly higher compared to other major ethnic groups in Nigeria which could be as a result of religion and cultural influences. This study also revealed that majority (78.6%) of the mothers had tertiary education which resulted in higher rate of utilization of antenatal care, some (14.8%) had secondary education, and 2.9% had junior secondary education, 1.6 had primary education and 0.8 of them had no formal education. The result showed that the most effective source of breast milk substitute awareness was internet/social media (11.1%). This study observed that (84.3%) of the mothers initiated breastfeeding immediately after birth while few (5% and 1.9%) introduced breast milk to their babies after 2-3 weeks and 1 month respectively. Some (26.7% and 21.7%) were advised by the doctor and mother-in-law respectively to feed their babies with infant formula, while 22.9% did not get the advice from anybody. From the study, less than half (22.6%) of the mothers use My Boy Eldorin Infant Formula, some (15.3%, 14.6% and 14.2%) prefers NAN Pro 1 milk powder, Lactogen Starter Infant Formula and Aptamil Infant Formula respectively. The study revealed that majority (71.5%) of the children were not so much thin, some (22.6%) are a little fat, few (2.9%, 2.5% and 0.4%) are not so much thin, very thin/skinny and very fat/plump respectively.- This study recommends more research on the use of breast milk substitutes among lactating mothers to enable proactive actions in other to forestall it. This study also recommends the following: Given the significant and widespread nutrition challenges Nigeria faces and the important role that breastfeeding can play in preventing illness in childhood and later life, more resources should be dedicated to educating communities, consumers, healthcare workers and baby food companies, as well as distributors and retailers, about the value of breastfeeding, emphasis should be placed on improving the technical skills of antenatal care clinic staff in hospitals/health centers to enhance the knowledge of mothers on infant breastfeeding, Immunization should be improved in most communities to reduce the effects of poor infant breastfeeding in affected areas. More awareness is needed on the use of breast milk substitutes especially after the first 6 months of exclusive breastfeeding.
TABLE OF CONTENTS
TITLE PAGE i
CERTIFICATION ii
DEDICATION iii
ACKNOWLEDMENT iv
TABLE OF CONTENTS v
LIST OF TABLES viii
ABSTRACT ix
CHAPTER 1
1.0 INTRODUCTION 1
1.1 Statement of Problem 5
1.2 Objective of the study 5
1.3 Significance of Study 5
CHAPTER 2
2.0 LITERATURE REVIEW 8
2.1 Breast milk substitutes (BMS) and suboptimal breastfeeding 8
2.1.1 What are Break Milk Substitutes (BMS) 8
2.1.2 Types of BMS used in Developed and Developing Countries 8
2.1.3 Contribution of Use of BMS to suboptimal Breastfeeding 9
2.2 The International Code of Marketing of BMS and the Breastfeeding
Promotion Regulation 11
2.3 Prevalence and timing of use of BMS 12
2.3.1 Worldwide prevalence and Timing of use BMS 12
2.3.2 Prevalence and timing of use of BMS 12
2.2.3 The Effect of Scores on the Breastfeeding Self Efficacy Scale on the
use of BMS 13
2.2.4 The effect of Mother’s Exposure to the Promotion of BMS on their use 15
2.3.5 The effect of Mother’s Employment Characteristics on the use of BMS 16
2.3.6 Mother’s Feeding Intention Prior to Delivery 16
2.4 Human Breast Milk 17
2.4.1 Composition of Human Breast Milk 17
2.4.2 Protein in Human Breast milk 19
2.4.3 Fats in Human Breast Milk 20
2.4.4 Vitamins, Minerals and other Bioactive Compose in Breast Milk 21
2.4.5 Human Milk Options-Milk Donors and Milk Banks 22
2.4.6 Infant Formulas 22
2.4.7 Cow Milk-Based Formula 23
2.5 Stages of Lactation 24
CHAPTER 3
3.0 MATERIALS AND METHOD 26
3.1 Study design 26
3.2 Area of study 26
3.3 Population of the study 27
3.4 Sampling and sampling techniques 27
3.4.1 Sampling size Determination 27
3.4.2 Sampling procedure 28
3.5 Preliminary activities 29
3.5.1 Preliminary visits 29
3.5.2 Training of research assistants 29
3.5.3 Informed consent 29
3.6 Date collection 30
3.6.1 Questionnaire design 30
3.6.2 Questionnaire Administration 30
3.7 Date analysis 30
3.8 Statistical analysis 31
CHAPTER 4
4.0 RESULTS AND DISCUSSION 32
4.1 Socio-demographic characteristics of the lactating mother 32
4.2 Socioeconomic characteristics of the lactating mother 36
4.3 Level of awareness and exposure to breast milk substitutes by the Mothers 39
4.4 Utilization of breast milk substitutes by mothers 41
4.5 The attitude of the respondents towards breast milk substitutes 46
4.6 The characteristics of the index of the child currently being breastfed 54
4.7 Characteristics of the Index of the Child Currently being Breastfed 56
CHAPTER 5
5.0 CONCLSION 59
5.1 Conclusion 59
5.2 Recommendation 60
References 62
Appendix 1 70
Appendix 2 80
Appendix 3 82
LIST OF TABLES
Table 4.la Socio-demographic characteristics of the lactating mothers 34
Table 4.1b Socio-demographic characteristics of the lactating mothers Continued 36
Table 4.2 Socio-Economic characteristics of the lactating mothers 38
Table 4.3 Socio-Economic characteristics of the Husband 40
Table 4.4a Level of Awareness and Exposure to Breast milk substitutes 43
Table 4.4b Level of Awareness and Exposure to Breast milk substitutes continued 45
Table 4.5a Utilization of Breast milk Substitutes 48
Table 4.5b Utilization of Breast milk Substitutes 49
Table 4.5c Utilization of Breast milk Substitutes 51
Table 4.5d Utilization of Breast milk Substitutes 52
Table 4.5e Utilization of Breast milk Substitutes 53
Table 4.6 Attitude of the Respondents Towards Breast milk substitutes 55
Table 4.7a Characteristics of the index of the child currently being Breastfeed 57
Table 4.7b Characteristics of the index of the child currently being Breastfed continued 58
CHAPTER 1
INTRODUCTION
Breastfeeding is one of the foundation of a child’s health development and survival especially in area where diarrhea, pneumonia and undernourishment are common causes of mortality among children younger than five years (Victoria et al., 2016). Increasing breastfeeding duration has been associated with reduced childhood infection better mental health (Oddy et al., 2010) and probably reduced risk of non-communicable disease, including overweight and diabetes (Kelishadi and Farajian, 2014). Nevertheless, the World Health Organization recommends exclusive breastfeeding for the first six months of life, followed by continued breastfeeding with appropriate complementary food for up to 2 years and beyond. Most women (although not all) are physically able to breastfeed, but a wide range of historical, cultural and socio-economic factors affects the choice to initiate and continue breastfeeding. One factor with a strong influence on intake and continuation of breastfeeding is the marketing and availability of infant formula or breast milk substitute (BMS) (Piwoz and Huffman, 2015) which are products intended to supplement or replace breast milk in infant feeding. Infant who are not exclusively breast fed during the first six months of their life are given a wild variety of other food or drinks during the period to complement or replace breast milk, this food items are termed breast milk substitute (BMS) (WHO, Huffman et al., 2018) while BMS are necessary for infant not breast milk substitute to a breast milk diet is associated with a higher risk of diarrhea and other disease among infant less than six months old.
Breast milk substitute can be divided into four main categories based on intended use;
i. Standard infant milk formula, for the use from birth until 6 months
ii. Follow –on milk formula, for babies aged 6-12 months
iii. Toddlers milk formula or growing up milk, for children older than 12 months and
iv. Special baby milk formula, which includes several types of specialized formula intended for babies with the special nutritional needs or allergies, e.g. soy-based formula, and represents only a small proportion of BMS sales (Euro monitor International, 2015). Most BMS are based on bovine milk, which is further processed to resemble human milk (Martin et al., 2016). Breast- milk is the global standard for optimal infant nutrition and health and breastfeeding promotion is a key newborn and child survival intervention. Optimal breastfeeding practices consist of initiation of breastfeeding within the first hour of birth, feeding the child only breast milk for the first 6 months(exclusive breastfeeding), and continuing to breastfeed for up to 24 months or beyond (World Health Organisation,2003).
According to Mason, Rawe and Wright (2013) multiple factors influence infant feeding decisions, in addition to BMS marketing, these include hospital or delivery center policies and practices that separate mother and baby; inadequate counseling and support and maternal lack of confidence; family or community pressures to introduce other foods or liquid, due to beliefs about thirst, health requirements, or cultural traditions; infant attributes; and lack of maternity protection and work which separates mother and young infants. It is difficult to parse out the contribution of each of these factors because they coexist and vary by setting, infant age, and specific breastfeeding behavior.
Breast –milk alone is the ideal nourishment for infant, and contains all the nutrients required for optimal development for the first six months of life. It is safe, easily digested, efficiently used and contains antibodies, in sharp contrast to BMS (WHO, 2009). Mother’s own milk is considered to be the best source of infant nutrition (lessen, and Kavanagh, 2015). Extensive evidence has shown that breast milk contains a variety of bioactive agents that modify the function of gastrointestinal tract and immune system, as well as in brain development. Thus, breast milk is widely recognized as a biological fluid required for optimal infant growth and development. Savino, (2013) breast milk mitigates infant programming of late metabolic diseases, particularly protecting against obesity and type 2 diabetes. Infant formula is intended as an effective substitute to breast milk and is formulated to mimic the nutritional composition of breast milk.
Despite the high prevalence of breast-feeding to young infants (Huffman et al, 2018), the breast-feeding pattern is not ideal in some communities. Short duration of exclusive breast-feeding and inappropriate feeding are common in both urban and rural areas of these communities (Das et al, 2012).
Breast milk is an ideal food for healthy growth and development of infants as strengthens emotional bondage between mother and child and is the most economical way of feeding the child (Klaus and Kennell, 2013; Ball and Bennett, 2001). Breastfed infants have improved neuro-development (Rogers, 2018) and a lower incidence of infections compared to formula-fed infants (Howie et al., 2010). According to Decsi et al., (2012) human milk with different types of infant food in the nutrition of full term neonates showed higher levels of scrum calcium and protein in breast-fed infants compared to those receiving infant formula. Breastfed infants also have better feed-tolerance and less physiological gastro-oesophageal reflux than formula-fed infants (Heacock et al., 2016).
Breast milk substitute is any food being marked or otherwise present as a partial or total replacement for breast milk, whether or not suitable for that purpose. Infant formula a breast milk substitute formulated industrially in accordance with application Codex Alimentarius standards to satisfy the normal nutritional requirements of infants aged up to 4-6months, and adapted to their physiological characteristics. Regardless of evidence of die benefits of breast-feeding, many women still use breast milk substitutes (BMS) and often acquire milk powder, infant formula, and cow’s milk from the market. Zeitlyn and Rowshan, (2017) reported low levels of mothers on using BMS are not well-documented. A better understanding of the mother’s perceptions and practices of feeding BMS is needed to plan appropriate interventions to improve infant feeding (Das and Ahmed, 2015).
1.1 STATEMENT OF THE PROBLEM
Breast-milk alone is the nourishment for infants, and contains all the nutrients required for optimal development for the first six months of life. It is safe, easily digested, efficiently used and contains antibodies, in sharp contrast to BMS (WHO, 2009). The first two years of life is a critical period in regards to growth and development (WHO, 2009). Energy and nutrient requirements are high and children in this age group are at the greatest risk of nutrient deficiencies (Patel et al., 2012). According to Edmond et al., (2012) 16% of neonatal death can be prevented if infants were breastfed from day one, and as much as 22% if breastfeeding staged within the first hour after birth. UNICEF (Infant and Young Child Feeding, 2014) states that a non-breastfed child living under unhygienic conditions and in areas with unsafe water is between six to 25 times more likely to die as a result of diarrhea and four times more likely to die of pneumonia than a breastfed child. Breastfeeding is therefore of great importance when it comes to protecting children and decreasing morbidity and mortality rates.
The International Code clearly recognized that the category breast-milk substitutes is broader than just infant formula, describing the scope of the code as applying to “breast milk substitutes, including infant formula” (Article 2). The code provide no upper age limit on the definition of breast-milk substitutes. The code made a clear distinction between foods that “replace” breast-milk (and are thereby breast-milk substitutes) and those that “complement” breast-milk when it becomes insufficient to meet nutritional requirements. Thus, distinguishing between a breast-milk substitute and a complementary food hinges on whether the food directly reduces breast-milk consumption or adds to it. The STAG that developed the recommendations concluded that there was sufficient evidence that milks target specifically to children under the age of 3 years do replace the intake of breast milk. Breast-feeding mothers either reduce the number of breast-milk feedings a day or stop breast-feeding altogether when other milks are introduced (WHO, 2009).
1.2 OBJECTIVES OF THE STUDY
The main objective of the study is to assess the use of breast milk substitute among lactating mothers in Okigwe Local Government Area of Imo State.
1.2.1 SPECIFIC OBJECTIVES
The specific objectives are to;
1. Asses the socio-demographic and economic characteristics of the lactating mothers.
2. Determine the utilization of breast milk substitute among lactating mothers.
3. Determine the factors associated with the use of breast milk substitutes among the lactating mothers.
1.3 SIGNIFICANCE OF THE STUDY
Findings from this will help to identify the use of breast milk substitutes among lactating mothers in Okigwe LGA. This will help health policy makers, nutrition educators, health professionals, young adults who are in the verge of getting married to choose breastfeeding also the better way of breastfeeding their new born. It will also help human nutrition and dietetics students who are researching in the related topic and it will also add to the existing literature.
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