Factors Influencing the Choice of Infant Feeding Practice Among Women of Childbearing Age in Irrua Specialist Teaching Hospital
CHAPTER ONE
Objective Of Study
General
To describe the breastfeeding practices and their determinants among women of childbearing age, and assess growth pattern of their infants aged 0-6 months.
Specific Objectives
- To assess the knowledge of, attitude towards, and practice of breastfeeding among women of childbearing age.
- To determine the proportion of babies aged 0-6months who are
- exclusively breastfed.
- To identify the factors which influence breastfeeding practices.
- To find out the main source of information for the mothers regarding their infant feeding practices.
- To determine the growth pattern of exclusively breastfed and non exclusively breastfed infants aged 0-6months using weight & length, and compare them with the NCHS (WHO/CDC) reference standards.
CHAPTER TWO
LITERATURE REVIEW
Breastfeeding which has been a universal practice in the past is fast declining in this age of modernization; although everyone seems to accept the statement “Breastfeeding is the best”. Studies have shown that a high percentage of mothers consider breast milk the best food for infants.28, 30, 35 Other studies 3,36,37 have also noted that mothers feel breastfeeding is natural and favourable to the healthy growth of the infant. Despite this positive feeling, poor knowledge on proper breastfeeding was found by an intervention study among mothers in Enugu urban.38 Before the intervention only 54% knew that breastfeeding should commence within one hour after delivery, while 36.7% knew the meaning of exclusive breastfeeding. Similarly, 36% knowledge about exclusive breastfeeding was noted among mothers in Nsukka urban.39 In a prospective study among infants attending the under five clinic of a “baby friendly” hospital in India, it was reported that only 21.1% of the mothers could enumerate two specific advantages of breastfeeding.40 In contrast, a cross sectional study of 502 Bolivian mothers with infants between 0-1year reported that 92.6% of them mentioned at least one advantage of breastfeeding.41 The most frequently mentioned were nutrition (63.9%), defense against infectious diseases (62.0%) and as a means of enhancing bonding between mother and child (3.6%). Only 3.1% mentioned disease transmission as a disadvantage of breastfeeding.
A study in Nsukka urban showed that 82% of mothers agreed that exclusive breastfeeding was very good for their baby’s growth, while 75% said the practice prevented their babies from being sick always.39 In another study of 146 recently delivered mothers in a teaching hospital35, about 53.9% of the mothers who intended to exclusively breastfeed their babies chose this method because they felt that breast milk was better for the health of the baby, while 37.0% believed that breastfeeding was the natural thing to do. In Bolivia41 54.2% of mothers interviewed thought that breastfeeding was good to their child; and in Botswana, a cross sectional study42 conducted among 400 households with children under three years old reported that 94.4% of the mothers believed that breastfeeding was better than bottle feeding. However, a survey of 152 long term breastfeeding American and Canadian mothers43 noted that 29.1% complained that nursing interfered with their personal activities such as work and social life, although 50% believed that it resulted in emotional good health and wellbeing of the child, while 14% believed that breastfeeding created a pleasurable mother-child bond which enhanced the emotional wellbeing of both child and mother.
Data from 86 countries revealed that there are very large differences in breastfeeding practice between countries, between population groups within countries, and within different groups over a period of time.44 Studies carried out with large population settings in Asia, North Africa and Sub-Saharan Africa showed that large populations of infants were not put to the breast immediately after birth, thus depriving them of colostrum and exposing them to the potentially harmful and contaminated foods and liquids.45 A UNICEF report showed that 38% of women initiated breastfeeding one hour postpartum and that 66% did so within 24 hours.46 In the assessment of impact of BFHI in Ile-Ife47, it was reported that 61% of mothers in the BFHI facility started breastfeeding within 30 minutes after birth. Similarly, 53% of mothers in Nsukka urban initiated breastfeeding within 30 minutes of delivery.
CHAPTER THREE
RESEARCH METHODOLOGY
Study population
The study population consisted of all mother- neonate pairs who attended the child welfare clinics of ISTH at Nnewi, Neni, Ukpo and Umunya within seven days of delivery for routine immunizations. From the immunization registers, an average of 40-50 infants routinely received immunization every week in each of the three centers at Neni, Ukpo and Umunya; while 100-150 infants routinely received immunization every week at Nnewi center (at least twice that obtained in each of the other centers). The number of new born aged seven days and below were on the average 17 in each of Neni, Ukpo and Umunnya health centers, and 38 at ISTH Nnewi, giving a total of 89 eligible neonates per week from all the centers.
Inclusion criteria: Only mothers residing in the LGAs where the centers were located, whose babies were full term and have a birth weight of at least 2500g. Exclusion criteria: Mothers who reside outside the LGAs, as they are usually on temporary visits, especially during festive periods, and may not be available throughout the study period, adopted infants, multiple deliveries, infants with congenital or oral anatomical abnormalities like Downs Syndrome, cleft lip/palate or micrognathia; infants with pathological jaundice or serious illness, and infants whose mothers defaulted at follow up for two or more consecutive visits and could not be traced to their homes.
CHAPTER FOUR
RESULTS
Two hundred and forty mother-neonate pairs were recruited for the study, but a total of 228 mother-neonate pairs were completely followed up for six months. Five families had changed location, four children died from convulsion and diarrhea, while three other subjects could not be traced with their addresses.
Table 1 above shows that majority of the mothers, 190 (83.3%) were aged between 20 years and 34 years. Two hundred and twenty two (97.4%) were married, five (2.2%) were single, while one (0.4%) was separated. About 63 (27.6%) were nursing their first baby, 130 (57.0%) had between 2-4 children, while 35 (15.4%) had five or more children. One hundred and fifty two (66.6%) mothers had attended or completed secondary education, only two (0.9%) had no formal education. The mothers were mainly traders, 86 (37.7%) and full time housewives, 66 (29.0%).
CHAPTER FIVE
CONCLUSIONS AND RECOMMENDATIONS
CONCLUSIONS
The study revealed that the mothers had high knowledge of, and positive attitude towards breast feeding; but optimal breast feeding practice was poor among them as reflected in their late initiation of breast feeding and low rate of exclusive breast feeding. Maternal older age, multiparity, delivery at a government health facility, positive family attitude towards exclusive breast feeding, and government health facility as the main source of breast feeding education were significantly associated with higher rates of exclusive breast feeding.
Furthermore, exclusively breast fed infants showed a better and more rapid growth than the non exclusive breast fed infants. They were also heavier and longer than the 50th centile NCHS infants at 24th week of age.
Therefore, any intervention aimed at promoting exclusive breast feeding should be intensified, and targeted among the group of mothers and location in which poor breast feeding practices occur.
RECOMMENDATIONS
Based on the findings, the following recommendations are being made to promote optimal breastfeeding:
- Continued training and re-training of those providing maternal and child health services to give simple and appropriate breastfeeding education to expectant and women of childbearing age so as to sustain the current level of knowledge.
- There should be active involvement of the media in dissemination of breastfeeding information through more collaboration between the health sector, the mass media and the communities.
- Breast feeding education should be targeted at young and nulliparous mothers, and other significant others such as husbands and mothers-in-law.
- The baby friendly hospital initiative concept should be expanded beyond government health facilities to privately owned hospitals, and the communities.
- Food demonstration classes during antenatal and postnatal clinics to help mothers acquire nutritional skills should be intensified.
REFERENCES
- Thapa S, Short RV, Potts M. Breast feeding, birth spacing and their effects on child survival. Nature. 1988; 358(20): 679 – 82.
- Armstrong HO. Breastfeeding as the foundation of care. Food and Nutr. Bull. 1995; 16: 299 – 312.
- Ibe BC, Nkanginieme KEO. Breastfeeding in a developing country: Influence of Maternal time spent away from child on duration of Breastfeeding. Orient J. Med. 1990; 2(2): 56 – 59.
- Piwoz E, lliff P, Tavengwa N, Zunguza C, Marinda E, Nathoo K, Moulton L, Ward B, Humphrey J. Early introduction of non-human milk and solid foods increases the risk of postnatal HIV-1 transmission in Zimbabwe. XV International AIDS Conference, July 11-16, 2004; Bangkok, Thailand.
- Leroy V, Becquet R, Rouet F, Ekouevi DK, Viho I, Bequet L, Sakaravitch C, Towne-Gold B, Timite-Konan M, Dabis F. Postnatal transmission risk according to feeding Modalities in children born to HIV-infected mothers in a PMTCT project in Abidjan, Cote D’ Ivoire. DITRAME PLUS project ANRS 1201/1202. XV International AIDS conference; July 11-16, 2004; Bangkok, Thailand.
