MOTHERS’ KNOWLEDGE, PRACTICE OF EXCLUSIVE BREAST FEEDING AND ANTHROPOMETRIC INDICES OF THEIR INFANTS IN ABA SOUTH LOCAL GOVERNMENT AREA, ABIA STATE, NIGERIA.

MOTHERS’ KNOWLEDGE, PRACTICE OF EXCLUSIVE BREAST FEEDING AND ANTHROPOMETRIC INDICES OF THEIR INFANTS IN ABA SOUTH LOCAL GOVERNMENT AREA, ABIA STATE, NIGERIA.

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ABSTRACT

This study assessed mothers’ knowledge, practice of exclusive breastfeeding and the anthropometric indices of their infants in Aba south local government area, Abia state, Nigeria. Five hundred (500) lactating mother-child pair randomly selected during their postnatal care visit in six out of seventeen health centers in the LGA participated in the study. Ethical clearance was obtained from the chief medical officer in the LGA 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 anthropometric measurements of the children were taken using standard techniques and indices such as weight-for-age, weight-for length and length-for-age derived. The data obtained from the questionnaire were analysed using Statistical Package for Social Sciences, version16. The anthropometric indices of the children were compared with reference standards and the children subsequently classified as normal, underweight, stunted, wasted, and overweight. The results obtained showed that 68% of the urban and 53.6% of the rural respondents had adequate knowledge of EBF. About 24.7% of the urban and 20.1% of the rural respondents who had adequate knowledge of EBF practiced it.  Adequate knowledge was significant to EBF practice (p<0.05). The rate of EBF varied from 20% to 28% from birth to three months in rural and urban areas to 10.8% and16.8% from birth to six months, respectively. Only 16.4 % in the urban and 8% in the rural areas initiated breastfeeding within 30minutes of delivery. Over 90% of the respondents in both areas fed their children colostrum. A total of 34.8% of the urban and 55.6% of the rural respondents practiced prelacteal feeding. The main reason given by 35.6% of the urban and 35.3% of the rural respondents for prelacteal feeding practices was to stop stomach ache.  Only 8.8% and 6% in urban and rural areas respectively expressed breast milk (EBM) and 45.5% in urban and 33.3% in the rural area preserved the EBM by refrigeration. The major problems encountered during lactation were job commitment (16%) in the urban area and insufficient breast milk (20.8%) in the rural area. Socio-economic factors  that influenced compliance to EBF were mother’s age between 30-39 years (12.8 and7.6)%, higher maternal education (15.6 and10.4)%, places of delivery (16.4 and 10.8)% and mode of delivery (16.8and10.8)% in urban and rural areas, respectively. More than half of the urban (50.8%) and rural (72%) respondents introduced complementary foods within the 3rd month of the child’s birth. The major reason for early introduction of complementary food was that breast milk alone was not adequate for the baby (38.5% and 39.5 % in urban and rural areas, respectively). Exclusively breastfed males and females aged 0-6 months in the urban area had mean weight of 9.40kg ±0.1 and 8.56kg±0.1 respectively relative to 8.01kg ±1.3 and 7.84 kg ±1.5 kg, respectively weighed by the non-exclusively breastfed(Non-EBF) counterparts. Similarly, the exclusively breastfed males and female children from  0-6 months in the rural area had mean weight of 9.21 kg ±0.9 and 8.35 kg ±0.6, respectively relative  to 7.74 kg ±1.1 and 7.36 kg ±1.4 respectively  weighed by  the non-EBF breastfed counterparts.  Based on the new WHO child growth standards, none of the EBF was malnourished. A few (11.1%) of non-EBF females aged 19-24 months in urban area and 16.7% of non-EBF male children aged  of the same age in the rural area had low length-for-age. Low weight-for-age (underweight) was highest (26.7%) among non-EBF males aged 7-12 months in the rural area. The prevalence of wasting was 18.8% among non-EBF female children aged 7-12 months in the rural area. Based  on the finding of the study, integrated effort on protection, promotion and support for EBF is recommended among others to enhance the full benefit of EBF in Abia state in particular and Nigeria in general. 


CHAPTER ONE

INTRODUCTION

1.0       Background of the Study                                                                                             

Over the years, experts have found that breast milk provides the best possible start to life in all areas of infant’s development. Evidences have confirmed that early initiation of infants to breast feeding and optimal breastfeeding of children for two years and beyond have the potential to prevent 6 million deaths in the developing countries (UNICEF, 2008 & 2009). In addition, breast milk carries anti-bodies from the mother that help combat diseases, protects babies from diarrhoea and acute respiratory tract infections. Breastfeeding stimulate infants’ immune system and response to vaccination and according to some studies confers cognitive benefits as well. Feeding at breast is emotionally satisfying, reduces the risk of post partum bleeding in mothers and thus a healthy practice for both the mother and the child. Continued breast feeding after six months accompanied by sufficient quantities of nutritionally adequate, safe and appropriate complementary foods also helps to ensure good nutritional status and protects the infants against illnesses (UNICEF, 2009).

Exclusive breastfeeding (EBF) means giving breast milk in response to all the child’s need for food, drink, suckling and perhaps comfort or soothing. It is usually practice on demand with no other food or drink given to the infant other than breast milk and medication for the first six months of life, after which continued breastfeeding is accompanied with appropriate complementary foods for two years and beyond (WHO & UNICEF, 1990). Due to the ample benefits of breast milk, the World Health Organization (WHO) and United Nation International Children’s Emergency Fund (UNICEF) adopted the Innocenti Declaration (ID) in 1990. It declared that every infant should receive breast milk exclusively from 0-6 month then continued breastfeeding accompanied by adequate complementary feeding for two years and beyond (WHO/UNICEF, 1990).

Breastfeeding was one of the main themes highlighted by the International Conference on Nutrition (ICN) which is also approved in the Nutrition goals of the World Summit for Children (WHO, 1996). World Health Organization recommended that in developing countries such as Nigeria, with high rates of infant morbidity and mortality, EBF from 0-6months of life is an appropriate, affordable and natural health practices that mothers and the general public should pay attention to. According to (UNICEF, 2009), breast milk alone is the ideal nourishment for infant for the first six months of life providing all the nutrients including vitamins and minerals an infant needs. This implies that no other food or drink is need at that period. The report continued that breastfeeding is a key tool in improving child’s survival and EBF from 0-6 months of life can avert up to 13 percent of under-five deaths in developing countries.

The world breastfeeding week (WBW) is celebrated annually from 1-7th August during which organizations and governments work to create awareness about the importance of EBF and the proper practices. The celebration commemorates the Innocenti Declaration of 1990. During the world breastfeeding week 2009, report from UNICEF explained that since Innocenti Declaration of 1990 a movement has been created to save millions of children annually and get closer to the Millennium Development Goals (MDG) particularly Goal No.4. “To reduce infant mortality rate by 1/5 by the year 2015” (UNICEF, 2009). Report indicated that there has been progress in EBF practice over 15 years but recently only 38 percent of infant under six months of age were exclusive breastfed in developing countries.

In order to improve successful breastfeeding globally, World Health Orgaisation and UNICEF launched Baby Friendly Hospital Initiatives in 1991. The BFHI aims to protect, promote and support EBF in its member countries. It works with comprehensive guidelines to update hospital practices to accelerate the rate of EBF (UNICEF, 1996). Trend data indicated that EBF rates has improved between 1990 to 2004 the figure rose from 34 percent to 41 percent in developing countries (DHS, 2003). African countries that have made major stride in EBF since 1990 include Burkina Faso, Cameroon, Ghana, Madagascar, Mali, Nigeria, Senegal, the United Republic of Tanzanian, Zambia and Zimbabwe (DHS, 2003).

Researches reviewed that breastfeeding initiation is prevalent in developing countries; the rate exceeds 95% in more than half of the countries (WHO, 2002). In Nigeria the rate was as high as 97 percent, however, the practice is far below WHO recommendation (Funmilola & Taiwo, 2006).    Recent researches reported tendency to early shift to bottle feeding particularly among relatively rich mothers in urban areas and cities. This practice is now considered as safe and effective as breastfeeding and thus adopted as modern-urban-life-style. This assumption is fast extending to rural communities although expose to economic and other barriers (Kumar, Nath & Reddaiah 1989). This token and short breastfeeding duration pattern is associated with ignorance, female participation in labour force, intensive advertisement and promotion of breast milk substitutes and cultural attitudes and perceptions. Recent scientific studies have found that nutrition education, counseling, and support for mothers and in health facilities will significantly   promote the practice of exclusive breastfeeding in developing countries (UNICEF, 2008).

1.1      Statement of  the Problem

Globally, less than 40% of infants under 6 months of age were exclusively breastfed despite of the documented benefits of EBF. In addition, 38% of infants less than six months in the developing world including Africa were exclusively breastfed (WHO, 2010). Also recent report from UNICEF (2008) indicated that EBF is declining in Nigeria while infant morbidity and mortality rate are rising.  Statistics showed that in 1999, 22% of infants were exclusively breastfed. Unfortunately, this came down to 17 % in 2003 and in 2008 only 11.7% of infants were exclusively breastfed for 0-6 months of life in Nigeria.

 There was no documented rate of EBF in Aba South LGA but it was obvious that the rate was minimal. Aba south is a commercial area with inhabitant of different socio-cultural background. 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. However, formula milk was the option for majority of mother in Aba south LGA. This is because majority was into business thus can afford them and also the facilities to prepare and feed them to the baby. However, the use of these commercial formulas can contribute to under and\or malnutrition on the long run because in attempt to economize each tin the mother can offer dilute milk to the infant. Generally prelacteal foods were known to interfere with optimal breastfeeding and can lead to infant morbidity and mortality yet it was a common practice for over 50% of lactating mothers in Aba south LG A to feed plain warm water, glucose water, coconut/ bitter-kola-water and other herb concoctions to their babies immediately after birth due to cultural affiliation attached to these substances. Discontinuation of   breastfeeding before the age of 24 months is a risk factors to malnutrition, morbidity and mortality rate among children less than twenty four months of age, current researches revealed 9-12 months as breastfeeding duration in Aba south local government Area of Abia State.(Ukaegbu, 2011). Studies have shown that inadequate EBF information and lack of support to lactating mothers by healthcare personnel tends to lower the rate of EBF.   Some Health care personnel were reported to have insufficient knowledge and credibility on EBF and thus tend to mislead lactating mothers towards EBF practices.  Also some cultures and traditions are barriers to the promotion and practice of EBF by its adherents in Aba south Local Government Area.                                                                                                                               

1.2    Objective of the study

The general objective of this study was to assess the mothers’ knowledge, practice of exclusive breastfeeding and the anthropometric indices of their children in Aba South Local Government Area, Abia State.

1.3   Specific objectives were to:

1. determine the mothers’ knowledge,  and practice of exclusive breastfeeding (EBF) in  urban and rural communities in Aba south local government area of Abia state;

2. determine the factors affecting compliance to EBF in the study area;

3. determine the anthropometric indices of exclusively and non-exclusively breastfed infants; and

4. compare the anthropometric indices of exclusively and non-exclusively breastfed infants        in the study area.

1.4       Significance of the study

The findings of the study will show-case the rates of EBF in the different communities of the study area. This will aid the health workers and the government on how and where to plan   community based breastfeeding intervention programmes for promoting, protecting and supporting EBF. This will aid to enhance full benefit of EBF in the study area. The results will also be a guide for them when organizing nutrition and health education in the area so as to get target or vulnerable groups. This will make breastfeeding programmes and other government breastfeeding polices in the area well organized and cost effective.

The findings will also sensitize mothers and health workers the need and the benefits of initiating breastfeeding within 30minutes of delivery. This will help to enhance the rate of timely initiation of infants to breast milk immediately after delivery.  This will 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 findings of the study will provide nutrition education to trim down the rate of prelacteal feeding practices substantially; this will curtail the rate of infection and under nutrition and enhance child survival in the area. It will also cut down the socio cultural practices against the promotion of EBF practices in the study area.

The result of this research will provide 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 in a large scale reduce infant under nutrition emanating from over diluted formula. Mothers will understand and be aware of the locally available food items defined by World Health Organisation as complementary foods and how to combine, prepare and feed them to provide adequate nutrient for the child.  This in general will result in improved family resources and sanitized environment, thus improved general standard of living in the area.  The findings can inspire government of Abia state government to consider the extension of the maternity leave of employed breastfeeding mothers so as to be able to  breastfeed their babies up to six months as recommended by Baby Friendly Hospital Initiative.  

Both health workers mothers and the general public will in this study in collaboration with other  EBF campaign group understand the benefits of continued breastfeeding for two years or beyond in the health of both mother and her child. This will enhance child spacing and mothers productivity, improve the nutritional status of children, thus improving general standard of living in the study area. In general, the finding of this study aimed in reduction of infant and maternal morbidity and mortality rate, thus collaborating the findings with other appropriate breastfeeding interventions and government policies can help Aba South L G A in particular and Abia State government in general toward achieving the Millennium Development Goals  (MDGs)  in 2015 particularly goal ‘4 and 5 of reducing under-five mortality and  maternal mortality’  in the state. The research is necessary as a guide for other researchers embarking research in the related area for further research. It was also relevant to keep the practice of exclusive breastfeeding in continuous surveillance in the study area so that timely action could be taken at earliest indication of decline.




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