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

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.

1.0      Background of the Study

CHAPTER ONE

INTRODUCTION

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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