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Background of the Study
Breastfeeding is the ideal method suited for the physiological and psychological needs of an infant. Under modern health care, human breast milk is considered the healthiest form of milk for babies (Subbiah, 2013). Breastfeeding has been accepted as the most vital intervention for reducing infant mortality and ensuring optimal growth and development of children. The beneficial effects of breastfeeding in the prevention of morbidity and mortality from diarrhoea in infants have been documented. Scientific researches, such as 2007 review for the World Health Organization (WHO), have found numerous benefits of breastfeeding for the infant (Horta, 2010, Amosu, 2011, Essein, 2009, Ekanem, 2011, Bolanle, 2012 and Perside, 2013).
According to the Centre for Disease Control and Prevention (CDC), one of the most highly effective preventive measures a mother can take to protect the health of her infant is to breastfeed. The success rate among mothers who want to breastfeed can be greatly improved through active support from their families, friends, communities, clinicians, health care leaders, employers, and policymakers. Given the importance of breastfeeding for the health and well-being of mothers and children, it is critical that we take action across the country to support breastfeeding. Though nationwide efforts to promote Exclusive breastfeeding started in Nigeria since 1992, data on this type of infant feeding are however, generally scarce (Lawoyin, 2011).
Exclusive breastfeeding (EBF) means giving infants only breast milk with no addition of other foods or drinks, including water (WHO/UNICEF, 2013). Exclusive breastfeeding has dramatically reduced infant deaths in developing countries by reducing diarrhea and infectious diseases. It has also been shown to reduce HIV transmission from mother to child, compared to mix feeding (Coutsoudis, 2011). National and international guidelines recommend that all infants be breastfed exclusively for the first six months of life. Breastfeeding may continue with the addition of appropriate foods, for two years or more.
Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts (i.e. via lactation) rather than using infant formula from a baby bottle or other container (Await, 2009). American Academy of Paediatrics (AAP), reported that breast feeding provides advantages with regard to general health, growth and development. It documents diverse and compelling advantages for infants, mothers, families, and society from breastfeeding and use of human milk for infant feeding. These advantages include health, nutritional, immunologic, developmental, psychological, social, economic, and environmental benefits (Gartner, 2013). During breastfeeding, approximately 0.25-0.5 grams per day of secretory immuno-globulin (IgA) antibodies pass to the baby via the milk (Hanson & Soderstrom, 2011). Breastfeeding may decrease the risk of cardiovascular disease in later life, as indicated by lower cholesterol and C-reactive protein levels in adult women who had been breastfed as infants (Williams, 2012).
Breastfeeding promotes health for both mother and infant and helps to prevent disease. Longer breastfeeding has also been associated with better mental health through childhood and into adolescence. Breastfeeding appears to reduce the risk of extreme obesity in children (Armstrong, 2012). Due to many health benefits of breastfeeding to mothers and children, governments of many nations have set goals for breastfeeding practices and rates.
WHO (2013) recommends exclusive breastfeeding for the first six months of life, after which infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues up to two years of age or beyond. AAP states that breast feeding also has economic health benefits because breastfeeding results in reduced health care costs. The significantly lower incidence of illness in the breastfed infant also allows the parents more time for attention to siblings and other family duties and reduces parental absence from work and lost income.
The WHO recommends that national authorities in each country decide which infant feeding practice should be promoted and supported by their maternal and child health services to best avoid HIV infection transmission from mother to child. Breastfeeding with HIV guidelines established by the WHO suggest that HIV-infected mothers (particularly those in resource-poor countries) practice EBF only, rather than mixed breastfeeding practices that involve other dietary supplements or fluids (Moland, 2010). However, a recent study conducted by researchers from the University Of North Carolina School Of Medicine suggests that women infected with HIV can, in fact, breastfeed without transmitting the virus to their children, because components in breast milk are understood as able to kill the virus (Wah, 2012).
In Africa, majority of the mothers fail to practice Exclusive breastfeeding as recommended (WHO, 2009). This is caused by factors such as lack of self-security, breast soreness, poor infant positioning, mothers’ perception of inadequate milk supply and lack of necessary support and information from health care provider (WHO, 2009). There are cultural, social and economic barriers to EBF including pre-lacteal feeding, giving drinking water and herbal teas (Shirima, Gebre-Madhin and Greiner, 2001). In Nigeria, it has been shown by the Multiple Indicator Cluster Survey (MICS) data and National Demographic Health Survey (NDHS, 2008), that only 13.0% of nursing mothers practiced Exclusive breastfeeding, (MICS in Amosu, 2010), this is a decline from 17% reported in NDHS (2004).
Experts agree that breastfeeding is beneficial and have concerns about the effects of artificial formulas. Artificial feeding is associated with more deaths from diarrhea in infants in both developing and developed countries (Horton, 2014). Breastfeeding declined significantly from 1900 to 1960, due to improved sanitation, nutritional technologies, and increasingly negative social attitudes towards the practice. However, from the 1960s onwards, breastfeeding experienced a revival which continues to the 2000s, though some negative attitudes towards the practice still remain (Riordan, 2015). Exclusive breastfeeding for the first six months of life is estimated to lower infant death by 13% (Jones, 2010). Other dangers associated with not breastfeeding as recommended include high infant death rates caused by lowered protection against harmful bacteria and other gastrointestinal infections and slow recovery from illnesses (WHO, 20011). Infant feeding practices account, to a large extent, for the high rates of malnutrition among children in developing countries (WHO, 2011). 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 of age (WHO, 2011).
Some researchers have proposed that lack of suitable facilities outside of the home, inconvenience; conflicts at work, family pressure and ignorance adversely affect the willingness of women to practice Exclusive breastfeeding (Ogbonna, 2009). Another research have shown that various factors such as education, social class, culture, locale, nature of work, and health status of both the mothers and their infants, influence nursing mothers’ decision to breastfeed their children (Newton & Newton, in Adeyinka, 2012). The Nigerian government established the Baby-Friendly Hospital Initiative (BFHI) in some states within the country 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 continue 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. Exclusive breastfeeding rates in Nigeria continue to fall well below the WHO/UNICEF recommendation of 90% exclusive breastfeeding in children less than 6 months (WHO, 2009). The key to successful breastfeeding is Information, Education and Communication (IEC) strategies aimed at behaviour change (Ekambaram, 2010). Part of the efforts to promote improved breastfeeding practices focused on hospital norms and services, legislation institutional policies, health workers training, mass media campaigns, peer counselling and educating mother - to - mother support, and a combination of these strategies (Green, in Adeyinka, 2009). Meanwhile, lots of these efforts have been of limited size and scope (Quinn, 2010).
Unluckily, this has not yielded an encouraging result. This is because in Nigeria, the national rates for early initiation of breastfeeding were low. As it has been said that optimum breastfeeding ensures the safety, optimum growth, survival of the human infants; that, duration of the breastfeeding may also determine the strength of mother - child bond and attachment, yet EBF is not being in full practice by Nigerian nursing mothers. Therefore, there is need for improving infant breastfeeding practices among nursing mothers. A more detailed understanding of the knowledge, attitude and practice of mothers toward EBF in Nigeria is needed to develop effective interventions to improve the rates of EBF and thus reduce infant mortality.
Several factors are cited as reasons of sub-optimal feeding practices in Nigeria in general and in Kajuru Local Government Area of Kaduna State. Many of these are related with universally known barriers that mothers or caregivers have to comply with optimal exclusive breastfeeding and initiation of adequate complementary feeding practices (Alive, 2013). These barriers are predominantly related to one’s culture, social norms, beliefs, behaviours and regulations of specific area. This means that barriers known in one geographical area might not necessarily be taken as barriers in other areas because cultural and social norms are extremely different from one state against the other with a region, especially in the context of Nigeria (USAID, 2011).
Statement of the Problem
Poor Exclusive breastfeeding rates might have resulted from the absence of knowledge of breastfeeding during antenatal nutrition education and infants that are subjected to poor breastfeeding practices may easily become malnourished with the tendency of contributing to the increasing rate of infant mortality (Amosu, 2010). Diarrhoea is one of the problems associated with the use of feeding bottles while growth retardation in babies has been found to coincide with the introduction of milk substitutes (Sumati, 2011).
According to the Ministry of Health (MOH, 2010), Maternal Mortality Rate (MMR) is estimated at 449 per 100 000 live births. Infant and Child Mortality rates stand as follows: Neo-natal mortality at 34.5 per 1000 live births; Post-neonatal mortality rate at 51 per 1000 live births; Infant Mortality Rate at 70 per 1000 and Under-five at 119 per 1 000 live births respectively.
According to the Health Management Information Systems (HMIS) data, (MOH, 2010) the incidence per 1000 population of key diseases affecting children under five years of age includes malaria (203.6), respiratory infections (non- pneumonia) (85) diarrhoea (30.8) and pneumonia (21.3).
A relationship exists between feeding practices, infection and nutritional status. Inadequate nutrient intake leads to poor nutritional status which leads to immune impairment that worsens the effect of infection. Infection increases the need for nutrients but at the same time compromises food intake.
WHO and UNICEF (2012) recommends that infants and young children be exclusively breastfed for the first six months of life and that complementary feeding be started at 6 months with continued breastfeeding up to at least two years.
In view of the above, the researcher has decided to carry out an appraisal on the knowledge, attitude and practice of Exclusive Breastfeeding by Mothers in Kajuru Local Government Area of Kaduna State.
Purpose of the Study
The main purpose of the study is to appraise the knowledge, attitude and practice of exclusive breastfeeding by mothers in Kajuru Local Government Area of Kaduna State. Specifically, it seeks to:
i. Assess the level of compliance of Nursing mothers towards exclusive
ii. Assess the attitudes of mothers toward exclusive breastfeeding.
iii. Identify the factors that influence exclusive breastfeeding by mothers.
Significance of the Study
The research work is expected to be of great benefits to variety of people in the family, offices especially the area of the study, society and the nation at large, as it aims of exposing them to advantages of exclusive breastfeeding and disadvantages of not breastfeeding their babies for the first six months.
It is hoped that at the end of the study, the result will:
The study is designed to improve the nutritional status of the infant and children in the study area. The findings will also assist the government to use it as emphericla research. This study also enables the parents, especially the nursing mothers to know the necessary measures to take in order to get rid of the situation.
Health workers in the field may also use the findings as a tool to evaluate the success, the effectiveness, failures and constrains of the breast feeding practices. Student can also use it as a further research.
The findings of this study will provide the government with necessary information on how to improve exclusive breastfeeding practices that will help improve maternal and child health services in the area, reduce maternal and child mortality or morbidity, reduce poverty and improve general wellbeing of the people.
Finally, if the government adopts and implement strong exclusive breastfeeding practices, it will help reduce the health problems of the children and improve resources for other sectors in the country.
i. What is the level of compliance of Nursing mothers towards exclusive
breastfeeding in Kajuru Local Government Area?
ii. What is the attitude of mothers toward exclusive breastfeeding in Kajuru Local Government Area?
iii. What are the factors that influence exclusive breastfeeding among mothers in Kajuru Local Government Area?
Scope of the Study
This research work is limited to the appraisal of the knowledge, attitude and practice of exclusive breastfeeding by mothers in Kajuru Local Government Area of Kaduna State.
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