Acceptance of Exclusive Breast Feeding Among Nursing Mothers in Yala Local Government of Cross River State
Chapter One
Purpose of the Study
The Purpose of the study was to investigate acceptance of exclusive breastfeeding among nursing mothers in Yala LGA, Cross River.
Research Objectives
The study objectives were:
- To establish the demographic and socio-economic characteristics of nursing mothers in Yala LGA.
- To assess the level knowledge on EBF among nursing mothers in Yala LGA.
- To determine exclusive breastfeeding acceptance among nursing mothers in Yala LGA
- To determine the relationship between knowledge levels and breastfeeding acceptance among nursing mothers in Yala LGA.
CHAPTER TWO
LITERATURE REVIEW
Exclusive Breastfeeding
Exclusive breastfeeding means giving a child no other food, including no water, in addition to breastfeeding with the exception of medicines, vitamin drops or syrups and mineral supplements (WHO, 2010; WHO/UNICEF, 2013) until the age of six months. The World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) jointly recommend that women exclusively breastfeed infants for the first six months and continue to breastfeed into second year of life or longer (Abba et al., 2010; NBS & ICF macro, 2010).
Benefits of Exclusive Breastfeeding
Benefits of Exclusive Breastfeeding to the Infant
The first two years of life are essential for a child healthy growth and development. Any damages emanating from the nutritional deficiencies during this period might lead to low economic productivity, impaired cognitive development and compromised educational achievement (Grantham-McGregor et al., 2017; Victora et al., 2018). Breastfeeding is an unequalled way of providing ideal food for the growth and development of infants. Breastfeeding contributes to infant nutrition and health through a number of important mechanisms (Utoo et al., 2012). It provides a complete source of nutrition for the first six months of life, half of all the requirements in the second six months of life and one-third of the requirements in the second year of life.
Breast milk promotes sensory and cognitive development and protects the infant against infectious and chronic diseases. Colostrum is the baby’s first immunization as it contains high levels of antibodies, vitamin A and other protective factors. It is the most potent natural immune system booster known to science (Masson et al., 2013;
Riordan, 2015). Some of the benefits of breastfeeding are most likely to occur when the infants are exclusively breastfed. Lower rates of diabetes and cancers have been reported to infants who were exclusively breastfed (Ortega-Garcia et al., 2018; Owen et al., 2016). However, infants who receive complementary feeding when they are below six months are reported to have a higher rates of gastrointestinal infections compared to infants who were exclusively breastfed (Khadivzadeh & Parsal, 2014).
Breastfeeding presents both short-term and long-term benefits to the infants. In a study conducted in Dar es salaam, Tanzania it was found that in children born to HIV infected women, every additional month of exclusive breastfeeding was associated with a 49% reduction in mortality from birth to six months of age (Natchu et al., 2012). Breastfed children exhibit greater resistance to infectious diseases and stronger immune system and therefore experience lower rates of chronic diseases. Further research has demonstrated the lower rates of infectious diseases among the breastfed infants; this is because of breast milk which is attributed to the secretory immunoglobulin A secreted in the mother’s milk (Clark, 2013). Moreover, in a study conducted in Ghana, it was reported that early initiation can reduce neonatal deaths by 16% (Edmond et al., 2016)
It is well documented that exclusive breastfeeding leads to a remarkable reduction in morbidity and mortality from childhood infectious diseases such as diarrhoea and respiratory illnesses. These infections still account for the highest proportions of mortality in infants and children under five years of age in Africa, Asia and other less developed and developing regions of the world (Clark, 2013; Ochola, 2018). In developing countries, exclusive breastfeeding for the first six months was associated with approximately 13% reduction in childhood deaths (Jones et al., 2013).
If every infant was breastfed within the first hour of life, it is estimated that 830,000 deaths could be avoided (Masson, 2013). Twenty-two (22%) of newborn deaths could be prevented if breastfeeding started within the first hour after birth and 16% if breastfeeding started within the first 24 hours (Edmond et al., 2016). Exclusive breastfeeding has also been shown to reduce the likelihood of obesity later in life. The prevalence of childhood obesity in the developing countries has recently been on the rise. This has been associated with lack of breastfeeding by the mothers (Langley- Evans, 2019).
CHAPTER THREE
RESEARCH METHODOLOGY
Research Design
A cross-sectional analytical design was used in this study (Katzenellenbogen et al., 2012). This is because a cross-sectional research gives an overview of the variables of interest. The study is analytical because it is anticipated to show the association between maternal knowledge and exclusive breastfeeding practises among mothers receiving information from various sources.
Variables
Dependent Variables
The dependent variables for the study were: Knowledge levels and breastfeeding acceptance of nursing mothers in Yala LGA.
Independent Variables
The independent variables for the study were: Demographic and Socio-economic characteristics, Sources of information on exclusive breastfeeding; content on Exclusive breastfeeding and maternal knowledge on breastfeeding of nursing mothers in Yala LGA.
Target Population
The study targeted nursing mothers living in Yala Local government and attending the selected health facilities (AMREF, Yala DO, Undugu, Makina clinic, Chemichemi, Lindi clinic, St Mary Karanja, St. Mary container clinic, Langata Health centre and Ushirika clinic). The estimate of mothers obtained from the selected health facilities records was 2010.
CHAPTER FOUR
RESULTS
This study investigated sources, content and level of maternal knowledge on exclusive breastfeeding acceptance among nursing mothers. A total of 313 respondents were included but the final sample for the study was 293 reflecting a response rate of 93.6% due to inconsistent and incomplete questionnaire.
CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATIONS
Introduction
This was a cross-sectional analytical study whose purpose was to determine sources and content of maternal knowledge on exclusive breastfeeding acceptance among nursing mothers in Yala Local government.
Summary of the Findings
The most common source of information on breastfeeding was health facilities but mothers still relied on other sources of information such as radio, television, friends and relatives. Some of the information provided to the mothers was well understood. Most of the mothers knew that breast milk should be given immediately after birth, exclusive breastfeeding is beneficial, colostrums should be fed to the baby and infants need to be breastfed on demand. However, some of the content given was not adequate because although they understood, some of the mothers were unaware of some issues like advantages of exclusive breastfeeding to the mothers. Moreover, some of the information given from the relatives and friends was not correct. For instance a mother being advised by a friend to give water to the infant because they believe the infant had a stomachache.
Most of the mothers were knowledgeable about exclusive breastfeeding but due to a number of factors surrounding the urban slums like high level of unemployment and poverty, they are unable to maintain exclusive breastfeeding for six months. There is a great improvement among mothers regarding exclusive breastfeeding acceptance. Nevertheless, early initiation of breast feeding, giving colostrums as well as advantages of exclusive breastfeeding to mothers, no pre lacteal feeds, no post lacteal feeds and exclusive breast feeding are not practiced at a desired level.
Conclusions
The first objective of the study was to establish the demographic and socio-economic characteristics of the mothers. Results showed that the majority of the respondents were mostly young women. The Majority of the mothers were married only a few were separated. Mothers had low levels of education most of them mainly had completed primary school education. They were mainly of low socio-economic status with the main sources of income being from their husbands. Stove (kerosene) was the main source of cooking fuel for the households. Majority of the study participants lived in rented houses. However, only a few of the mothers were still living in their parent’s home and depended on their parents. The results from this objective showed that mothers in Yala Local government are subjected to poverty and other poor living conditions which affected the exclusive breastfeeding acceptance
The second objective of the study was to establish the sources and content of information received by mothers. Results showed that more than a half of the mothers first learnt or heard about exclusive breastfeeding from the health professional while a quarter obtained the information from relatives and friends. Almost half of the mothers learnt on exclusive breastfeeding. However, it is only a few of the mothers who had learnt on attachment and that breast milk helps the baby to grow respectively. The results from this objective showed that mothers in Yala Local government were knowledgeable on exclusive breastfeeding and the source of this information was mainly the health facilities.
The third objective of the study was to determine exclusive breastfeeding acceptance among mothers. The results demonstrated that the rate of exclusive breastfeeding in Yala LGA had improved. The rate of timely initiation of breastfeeding was almost three quarters while those who initiated after 1 hour were a quarter. various reasons were given by mothers for delaying the initiation of breastfeeding but the common reason was the mother being sick.
In this study it was found out that a few of the mothers gave pre-lacteal feed to their infants. The most commonly given pre-lacteal were; plain boiled water. About a half of the mothers gave post-lacteal feeds to their infants. The most common post-lacteal feed was; plain boiled water. Most of the mothers gave post-lacteal feeds to sooth stomach pain, while majority of the mothers said that the infant should be put to breast within 1 hour, about a half said that the baby should be breastfed for 2 years and more. Almost all of the mothers knew that infant should be breastfed on demand. However, it is only a few that knew the benefits of colostrum. The results from this objective showed that the rate of initiation of breastfeeding was relatively high, some mothers still gave pre-lacteal feeds and the most common given was plain boiled water.
The fourth objective of the study was to assess the level of maternal knowledge on breastfeeding acceptance among mothers. Results showed that almost two-thirds of the mothers had high knowledge on exclusive breastfeeding; about one third of the mothers had average knowledge whereas a few of the mothers had low knowledge on exclusive breastfeeding. The results from this objective showed that the mean knowledge score for all mothers on exclusive breastfeeding was relatively high.
The fifth objective of the study was to determine the relationship between knowledge levels and exclusive breastfeeding acceptance among mothers. There was a significant relationship between maternal knowledge and time for introducing food to the infants. However, there was no significant relationship between maternal knowledge and breastfeeding initiation, pre-lacteal feed given, post-lacteal feed given, ever breastfed the child and breastfeeding within the last 24 hours.
There was a significant association between sources and content received by the mothers. Majority of the mothers first obtained information from the health professional at the health facility.
There was a significant correlation between content and the knowledge levels among the mothers. The relationship was a very strong correlation. This suggests that as the content of mothers increases the knowledge of the mothers’ increases as well. There was no significant association between various breastfeeding acceptance such as; mothers who ever breastfed their infants, breastfeeding initiation, mothers who gave pre-lacteal, mothers who gave post-lacteal and breastfeeding within the last 24 hours . However, there was a significant association between maternal knowledge and introduction to food by the mothers.
Recommendations
Recommendations for Policy
Government of Nigeria should put into place strategies that should encourage more mother participations in EBF initiatives which may have a better effects to enhance better acceptance like the mother to mothers support groups
Recommendations for Practice
The community needs to be more sensitized on EBF information and acceptance. This will ensure that the friends/relatives or even the grandmothers are aware of the correct information on EBF therefore not misleading the nursing mothers.
Recommendations for Further Research
Similar studies should be conducted in others areas besides slum areas and other context to establish the quality of information given in terms of adequacy and correct information concerning exclusive breastfeeding.
More studies need to be conducted to understand the disconnect between the maternal knowledge and acceptance concerning exclusive breastfeeding.
More studies need to be conducted on the sources and content of exclusive breastfeeding especially in the rural slums areas
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