ABSTRACT
This
study assessed mothers’ knowledge and practice of exclusive breastfeeding in
Gashua, Bade local government area, Yobe state, Nigeria. Seventy (70) lactating
mothers were selected during their postnatal care visit at the Specialist
Hospital Gashua in Bade LGA who participated in the study. Ethical clearance
was obtained from the Chief Medical Officer in the Hospital and mothers’
consent was sought through the clinic head. Interviewer administered
questionnaire was used to obtain information on the mothers’ socio-economic
characteristics, knowledge and practices of exclusive breastfeeding (EBF). The
results obtained showed that 71.6% of the respondents had adequate knowledge of
EBF. About 46.6% of the respondents who had adequate knowledge of EBF practiced
it. The rate of EBF varied from 20% to 28% from birth to three months in the
Gashua areas to 10.8% and16.8% from birth to six months, respectively. Only
16.4 % initiated breastfeeding within 30minutes of delivery. Over 90% of the
respondents in both health center fed
their children colostrum. A total of 8914% of
of the respondents practiced
prelacteal feeding.
TABLE OF CONTENTS
TITLE
PAGE...................................................................................................................................1
DECLARATION.............................................................................................................................2
CERTIFICATION............................................................................................................................3
DEDICATION.................................................................................................................................4
ACKNOWLEDGEMENTS.............................................................................................................5
TABLE OF CONTENT...................................................................................................................6
LIST OF
TABLES...........................................................................................................................8
LIST OF FIGURES.........................................................................................................................9
ABSTRACT..................................................................................................................................10
CHAPTER ONE............................................................................................................................12
INTRODUCTION.........................................................................................................................12
1.0 Background
of the
Study.....................................................12
1.2.
Global prevalence of Exclusive Breast
Feeding....................................................................13
1.3. Statement of the
Problem........................................................................................................14
1.4 Objective
of the
Study........................................................................................................15
1.5 Specific objectives were
to:.....................................................................................................16
1.6 Significance
of the
study....................................................................................................16
1.7 Definition of Key
Terms..........................................................................................................17
CHAPTER
TWO...........................................................................................................................19
LITERATURE
REVIEW...............................................................................................................19
2.1 Concept
of
breastfeeding....................................................................................................19
2.2 Physiology
of breast
feeding..............................................................................................22
2.3 Science
of
breastfeeding.....................................................................................................23
2.4 Composition of breast
milk.....................................................................................................25
2.5
Maternal
Nutrition................................................................................................................28
2.6 Complementary
foods.........................................................................................................29
2.7 Baby friendly hospital
initiatives (BFHI) and exclusive breast
feeding (EBF) in Nigeria...30
2.8. Ten
steps to successful breastfeeding advocated in the baby friendly hospital
initiatives. 32
2.9. Breastfeeding
techniques (How to breastfeed
successfully)..............................................32
2.10. Expressed breast milk
(EBM)...............................................................................................35
2.11. Exclusive Breastfeeding and HIV/AIDS
Infection...............................................................36
2.12. Factors affecting exclusive
breastfeeding in Nigeria............................................................37
2.12.
Infant anthropometry and
breastfeeding..............................................................................38
2.14 The new WHO growth
reference...........................................................................................41
CHAPTER
THREE.......................................................................................................................45
RESEARCH
METHODOLOGY.................................................................................................45
3.1. Area of the
study.....................................................................................................................45
3.2 Design of the
Study.................................................................................................................45
3.4.
Sample size and sampling
technique.....................................................................................45
3.5. Ethical
clearance.....................................................................................................................46
3.7.
Instrument for Data
collection..............................................................................................46
3.8 Method of Data Collection.................................................................................................46
CHAPTER
FOUR.........................................................................................................................47
4.0. RESULTS...............................................................................................................................47
CHAPTER
FIVE...........................................................................................................................94
5.0 DISCUSSION..........................................................................................................................94
5.1 Mothers’
knowledge and practices of
EBF.........................................................................94
5.2 Socio-economic
factors that affected compliance of
EBF..................................................97
5.3 Complementary
feeding practices of the
mothers..............................................................99
5.4 Anthropometric
indices of the
children..............................................................................99
5.5
Stunting..................................................................................................................................100
5.6 Underweight..........................................................................................................................101
5.7 Wasting.............................................................................................................................102
6.1
Conclusion.............................................................................................................................104
6.2
Recommendations..................................................................................................................104
REFERENCES............................................................................................................................105
APPENDIX
I...............................................................................................................................114
APPENDIX
II..............................................................................................................................115
CHAPTER ONE
INTRODUCTION
1.0 Background of
the Study
Exclusive breastfeeding (EBF) for the first 6 months of
life improves the growth, health and survival status of newborns and is one of
the most natural and best forms of preventive medicine. EBF plays a pivotal
role in determining the optimal health and development of infants, and is
associated with a decreased risk for many early-life diseases and conditions,
including otitis media, respiratory tract infection, diarrhea and early
childhood obesity. It has been estimated that EBF reduces infant mortality
rates by up to 13% in low-income countries. The importance of breastfeeding as
a determinant of infant nutrition, child mortality and morbidity has long been
recognized and documented in the public health literature. In response to this,
the Nigerian government established the Baby-Friendly Hospital Initiative
(BFHI) in Benin, Enugu, Maiduguri, Lagos, Jos and Port Harcourt with the aim of
providing mothers and their infants a supportive environment for breastfeeding
and to promote appropriate breastfeeding practices, thus helping to reduce
infant morbidity and mortality rates. Despite these efforts, child and infant
mortality continues to be major health issues affecting Nigeria. The infant
mortality rate for the most recent five-year period (1999-2003) is about 100
deaths per 1,000 live births and EBF
rates in Nigeria continue to fall well below the WHO/UNICEF recommendation of
90% EBF in children less than 6 months in developing countries. The low rate of
EBF in Nigeria may, in part, be due to traditional beliefs, practices and
rites. For example, in Yoruba and Benin communities, EBF is considered
dangerous to the health of the infant who is thought to require water to quench
thirst or stop hiccoughs. A more detailed understanding of the factors
associated with EBF in Nigeria is needed to develop effective interventions to
improve the rates of EBF and thus reduce infant mortality. The purpose of the
present study is assess the knowledge and practice of exclusive breastfeeding
in North-East Nigeria using Gashua, Bade Local Government as a study area.
1.2. Global prevalence of
Exclusive Breast Feeding
The percentage of infants who are breastfed
varies considerably among regions and countries.
Demographic and Health Survey (DHS) data from surveys
carried out between 1984 and 1990 (Perez-Escamilla, 2010) indicate that in
Africa, the rate of breastfeeding in each country ranged from 92% to 99% where
as in Latin America and the Caribbean, the range was much wider from 77% to 940% compare to range
across the developing countries (Saadeh ,1993b)
cited by WHO,2012. In western pacific
region, the rate was 63-89% and 73-94% in South East Asia.
Region with indication of higher rates in rural areas than
urban (WHO, 2011). In many cultures, Colostrum is reportedly withheld up to 3
to 4 days, primarily because it is believed to be harmful to infants probably
due to its laxative influence. In Northern Pakistan, Colostrum is expressed and
discards in this situation; the new born may be fed for a few days by a
lactating relatives or wet nurse or given gruel which often lead to diarrhea
(WHO, 2011).
In some cultures, pre-lacteal foods are given until true
milk has come; in part of Malaysia, mashed ripped banana is fed to the baby the
first day of delivery. Often, this is undertaken in part to clean out the
meconium (WHO, 2011). The discarding of colostrum may be widespread; however,
there is considerable variability within culture with regards to actual practice.
In a recent study of 248 mothers in Bangladesh, no infant was totally deprived
of colostrum and almost 30% of infants were breastfed within the first 24 hours
of birth. The exclusive breastfeeding rates for infant less than four months of
age are generally lower than desired ranging from 19% in Africa to 49% in
South-East Asia. Only a few countries reported a prevalence of more than 45%.
In West Africa where water supplementation is prevalent, the rate of EBF is
less than 10%. These estimates are constant with most other reports (Saadeh, 2011). It was indicated that at
present, most breastfeeding mothers in developing countries particularly Nigeria uses fluid and other breast milk
substitutes within the first four months of infants’ life.
1.3. Statement of the
Problem
Although a lot of efforts have been made
WHO which motivated the Nigeria government into taking steps towards decreasing
the child mortality rate. EBF rate remains low in Nigeria and fall short of the
expected levels needed to achieve a substantial reduction in child mortality.
Antenatal care was strongly associated with an increased rate of EBF.
Appropriate infant feeding practices are needed if Nigeria is to reach the
child survival Millennium Development Goal of reducing infant mortality from
about 100 deaths per 1000 live births to a target of 35 deaths per 1000.
Exclusive breast
feeding (EBF) has important protective effects on the survival of infants and
decreases risk for many early-life diseases. The purpose of this study was to
assess the factors associated with EBF in Nigeria and Bade Local Government
Area.
The levels are far below the program target of 90% of
women exclusively breastfeeding their infants in the first 6 months of life,
which is associated with a reduction of 10% of under-five deaths. The key
factors that were associated with higher rates of EBF included antenatal clinic
visits, household wealth and gender. Also of importance were the types of
addition liquids and foods given to young infants that resulted in the low EBF
rates. These could be due to so many
factors such as poverty, culture and may be climate. (W.H.O. 2015).
A substantial improvement of EBF can be achieved in Nigeria
by avoiding the practice of mothers giving water to their babies in addition to
breast milk. (W.H.O. 2015)
EBF promotion programs targeted at mothers, with
special focus on poor and illiterate families, mothers who delivered at home
and mothers who have had no antenatal clinic visits is not adhered to in the
study area. There was no documented rate of EBF in the study area Gashua, but
it was obvious that the women did not adhere to strict EBF. Hence knowledge,
understanding and practices of EBF were also function of different cultures and
social groups. This made EBF practices unpopular to many lactating women in the
study area due to inadequate knowledge, lack of credibility and misconception
regarding EBF. The World Health Organization recommends that complementary
foods for infants should be derived from locally available foods.
1.4 Objective of the
Study
The general objective of this study was to assess the
mothers’ knowledge and practice of exclusive breastfeeding in Gashua the study
area.
1.5 Specific objectives were to:
1. Determine the mothers’ knowledge of exclusive breastfeeding
(EBF) in the study area,
2. Determine the mothers’ practice of exclusive breastfeeding (EBF)
in the study area,
3. Determine the factors affecting compliance to EBF in the study
area.
1.6 Significance of
the study
The findings of the study will show-case the rates of
EBF in the study area. This will aid the health workers and the government on
how and where to plan community based breastfeeding intervention programs for
promoting, protecting and supporting EBF. This will enhance full benefit of EBF
in the study area, Bade Local Government, Gashua. The results will also be a
guide for them when organizing nutrition and health education to target
vulnerable groups. This will make breastfeeding programs in the area well
organized and effective. The findings will also sensitize mothers and health
workers on the need and the benefits of initiating breastfeeding which will
contribute to the long life span and thus reduce mortality rate. This will help
to enhance the rate of timely initiation of infants to breast milk immediately
after delivery. However, it will also help to reduce infant morbidity and
mortality rate due to neonatal starvation. Early breastfeeding initiation also
aids convolution of uterus and return of pre pregnancy shape in mothers, thus
it’s wide application or practice will boost both maternal and child survival
in the area.
The study will serve as a channel to create awareness to
the Government and other health providers on the delivery of nutritional and health education for both the
government, health workers, lactating mothers and the general public on the
benefits of EBF for the first six months of infant’ life . This will reduce the
rate of early introduction of complementary feeding, and bottle feeding rate.
It will also to a large extent reduce infant under nutrition emanating
from diluted formula.
1.7 Definition of Key
Terms
ü
Mother: A Woman in relation
to her child or children.
ü
Knowledge: Information, and
skills acquired through experience or education; the
theoretical or practical understanding of
a subject.
ü
Exclusive Breast Feeding:
Means that an infant receives only breast milk from his or her mother or a wet
nurse, or expressed breast milk, and no other liquids or solids, with the
exception of oral rehydration solution, drops or syrups consisting of vitamins,
minerals supplements or medicines.
ü
Infant: A very young child
or baby.
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