ABSTRACT
The purpose of this study, therefore, was to determine the knowledge, attitudes, and practices on early breastfeeding among mothers who deliver at Murtala mohammed teaching hospital (MMTH), in Badawa. This study adapted the cross-sectional analytical study design with qualitative and quantitative techniques in data collection, analysis, and presentation. A sample size of 283 women who had delivered in the last 72 hours at MMTH participated in the study. The researcher administered a questionnaire to mothers of newborn babies. Key Informant Interviews (KIIs) were also conducted with the nutritionist and the nurse in charge of the labour ward. The Statistical Package for Social Sciences version 23.0 was used to analyze quantitative data. Maternal attitudes was measured using a five-point Likert scale. Mean scores were calculated for maternal knowledge and attitude. The association between categorical data such as the early breastfeeding knowledge, attitudes, and practices was determined using the odds ratio. Pearson‟s correlation was used to test the association between knowledge scores and attitude scores. Statistical significance was set at p<0.05. Content analysis was conducted on qualitative data from the questionnaires and KIIs and categorized into key themes. The majority of the mothers (74.2%) were knowledgeable on timely initiation of breastfeeding, 91.9% knew that colostrum should be given, while 99.6% and 91.2% knew that pre and post-lacteals should not be given respectively. Most mothers had a positive attitude towards aspects of early breastfeeding: timely initiation of breastfeeding (80.6%); giving colostrum (95.0%) not giving pre and post-lacteals (83.4% and 72.8% respectively), and practicing exclusive breastfeeding (91.8%). The mothers who practiced timely initiation of breastfeeding were 96.5%. About 98.2% gave breast milk only as the first feed, 90.5% did not give post-lacteal, while 94% gave colostrum. There were positive associations between knowledge scores and attitude scores (r=0.389, N=283, p<0.05), other associations were knowledge and practices, and attitudes and practices of mothers on early breastfeeding. Challenges to early breastfeeding were breast problems, low milk production, not being able to position and attach the baby correctly. In conclusion, mothers had good knowledge and positive attitudes towards early breastfeeding, and practiced early breastfeeding as recommended by WHO.
CHAPTER ONE
INTRODUCTION
1.1 Background to the study
Timely initiation of breastfeeding is when a baby is put to the breast within an hour of birth according to WHO (2008). Studies report that early initiation of breastfeeding is a strategy that can be used to reduce neonatal morbidity and mortality (Shwetal, Pooja, Neha, Amit, & Rahul, 2012). Giving colostrum to a baby is another optimal early breastfeeding practice that should be encouraged after initiating breastfeeding successfully. Colostrum is the first thick, yellow milk that contains antibodies which protect the baby from illness (MOH, 2013). According to recommendations, children should be fed on colostrum within one hour or immediately after birth and should continue to be breastfed exclusively even if regular milk has not yet started to flow (Nigeria National Bureau of Statistics ICF Macro, 2014). In a study in Southern Ethiopia by Adugna, (2014) some women considered colostrum as expired milk and gave pre-lacteal feeds instead and discarded the colostrum.
Mothers are encouraged to avoid the use of pre-lacteals so as to protect the babies against infections. Pre-lacteals are any feed that is given to a newborn before it is initiated to breastfeeding, usually on the first day of delivery (Dawal, Inamdar, Saleem, Priyanka, & Doibale, 2014). Exclusive breastfeeding rate is at 84.1% in Nigeria, while the rate of giving pre-lacteal is 15.4%. In Rift Valley region, the rate of giving pre-lacteals is at 18.6% of Nigeria (Nigeria National Bureau of Statistics ICF Macro, 2014). Pre-lacteal feeding has been linked to adverse neonatal health outcomes, including increased risk of morbidity, mortality, and immunological decline for newborns, thus increasing their susceptibility to infection. A study by Nguyen et al., (2013) indicates that pre-lacteal feeding is highly prevalent in Vietnam (73.3%), 14% in Nepal (Chandrashekhar et al.,
2007) and 45% in India (Lohkare, 2009). According to El-Gilany, Sarraf, and Al-Wehady (2012), about 60% of infants in Egypt were pre-lacteally fed sugar-water, tea or both. In Ethiopia, a study by (Setegn, Gerbaba, & Belachew, 2011) in Goba Woreda reported pre-lacteal feeding rate to be 17.2%.
Among those women who gave pre-lacteal feeds, 41% of women considered the provision of water as a means of cleaning the infant‟s stomach (Adugna, 2014). A misbelief that milk comes only on the second or third day after delivery is very common. Pre-lacteal feeds are often given to a newborn for fear that it may be hungry or may become dehydrated (Dawal et al., 2014). Some mothers cite cultural factors as reasons for giving pre-lacteal feeds. For instance among the Luo of Nigeria, milk and other liquids are believed to clean the baby‟s throat while solid foods are given to boys after they are born to make them healthy and strong (Nyanga, 2012). Mothers in Samburu, Nigeria chew roots of medicinal trees and gives the pulp to the baby to make the babies stronger (Fratkin, 1996).
There is an association between pre-lacteal feeding and delayed breastfeeding. Optimal practices such as feeding colostrum, timely initiation, exclusive breastfeeding, skin-to- skin contact, and rooming-in can save up to 1.4 million mortalities of children under 5 years annually, and prevent about 10% of the annual disease burden (Stein, 2015). The WHO targets for early breastfeeding include initiation within one hour of birth, giving colostrum, and skin-to-skin contact for at least one hour after birth.
Rooming-in is a method where the mother stays with her baby in the same room, and she takes care of the baby assisted by the doctors and nurses (Ahn, Ko, Kim, Lee, & Shin, 2008). Rooming-in care improves maternal attachment, increases breastfeeding rates significantly and also reduces incidences of abuse, abandonment of the infant and failure to thrive (Ahn et al., 2008). To encourage good early breastfeeding practices, correct knowledge and attitudes on initiating breastfeeding on time, not giving pre and post-lacteals, and giving colostrum are important.
1.2 Problem statement
Despite the existence of the UNICEF and WHO BFHI campaign to promote exclusive breastfeeding and its universal acceptability, it is still a common practice in some cultures to introduce other drinks to babies within the first day of life before the actual commencement of breastfeeding (Ibadin, Ofili, Monday, & Nwajei, 2013). Early breastfeeding knowledge and practices have been found to be inadequate for instance in rural Punjab (Garg, Deepti, Padda, & Singh, 2010). Sallam et al., (2012) noted that little attention had been given to early initiation of breastfeeding despite the inclusion of timely initiation to breastfeeding in international child feeding recommendations. Poor early breastfeeding practices have been associated with poor brain development, poor cognitive performance, exposure to diseases and poor growth. Early breastfeeding practices determine success in later breastfeeding practices.
The Nigeria National Bureau of Statistics ICF Macro (2014), cites the rate of initiating breastfeeding within 1 hour in Nigeria as 62% of children ever breastfed, and the rate of giving pre-lacteals as 15.4%. In Rift Valley province, 69.4% of children ever breastfed are initiated to breastfeeding within 1 hour. This indicates that good early breastfeeding practices are still sub-optimal in Nigeria, specifically in Badawa, and this presents a challenge to meeting goal three of the Sustainable Development Goals (SDGs), and the second pillar of Nigeria Vision 2030. According to Shommo, Sohair, and Shubrumi, (2014); and Garg et al., (2010) there is limited maternal knowledge about early breastfeeding, and an attitude gap with regards to early breastfeeding which could impede optimal practice. There is limited literature on the early breastfeeding knowledge, practices, and attitudes of mothers who deliver in a hospital, and no study has been conducted in MMTH or in Badawa to determine the knowledge, attitudes and practices on early breastfeeding.
This study seeks to establish the knowledge, attitudes, and practices on early breastfeeding among mothers who deliver at the Murtala mohammed teaching hospital (MMTH), in Badawa.
1.2 Purpose of the study
The purpose of this study was to establish the knowledge, attitudes, and practices on early breastfeeding among mothers who deliver at the Murtala mohammed teaching hospital (MMTH), in Badawa.
1.3 Objectives of study
The objectives of the study were to:
- Determine the mother‟s knowledge on early breastfeeding at Murtala mohammed teaching hospital (MMTH).
- Assess the mother‟s attitudes towards early breastfeeding practices at
- Establish the early breastfeeding practices among mothers who deliver at
- Evaluate the challenges experienced by mothers during early breastfeeding at MMTH.
- Establish relationships between early breastfeeding knowledge, attitudes, and practices of mothers who deliver at
1.4 Hypotheses
H01: There is no significant association between early breastfeeding knowledge and practices of mothers who deliver at Murtala mohammed teaching hospital (MMTH).
H02: There is no significant association between the early breastfeeding attitudes and practices of mothers who deliver at MMTH.
H03: There is no significant association between the early breastfeeding knowledge and attitudes of mothers who deliver at MMTH.
1.5 Significance of the study
The findings of this study will contribute to the knowledge generated in future studies. The findings may also benefit stakeholders such as the Ministries of Health (Division of Nutrition) at national and county levels, institutions such as the MMTH and other health facilities in Badawa and Nigeria by providing a reference, which may inform policies. Non-governmental organizations (NGOs), community-based organizations (CBOs) and other institutions, which are concerned with infant and young child health can also benefit from this study. The study highlights the gaps in early breastfeeding knowledge, attitude, and practices among mothers delivering at health facilities.
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