Factors Influencing The Choice Of Infant Feeding Practice Among Women Of Childbearing Age In Irrua Specialist Teaching Hospital
ABSTRACT
This study is aimed at describing the breastfeeding practices and their determinants among women of childbearing age attending the child welfare clinics of Irrua specialist teaching hospital (ISTH), Edo State, and the growth pattern of their infants aged 0-6 months.
The study was longitudinal. A total of 240 mother-neonate pairs were selected from the immunization registers using a systematic random sampling method. Of these mothers, 228 (95%) were completely followed up for six months. Data was collected using a semi-structured, interviewer-administered questionnaire, and analysed using SPSS version 11.0 and EPI Info version 3.2.2. This was complemented with four sessions of focus group discussions (FGDs), each involving 8-10 women of childbearing age selected purposively. Data was analysed both thematically and by cut-and-paste method.
The findings showed that majority of the mothers 190 (83.3%) were aged between 20 and 34 years. About 152 (66.6%) had attended or completed secondary education and were mainly traders 86 (37.7%) and full time housewives 66 (29.0%). Most of them 208 (91.2%) had at least good knowledge of breastfeeding.
Government health facilities served as their main source of breastfeeding education (80.5%), usually given during antenatal and postnatal visits (55.2% and 36.2%, respectively). Only 110 (48.2%) initiated breastfeeding immediately (<1hour) after delivery. Breastfeeding baby on-demand was popular than timed feeding (92.5% vs. 7.5%). About 188 (82.5%) of the mothers gave their babies colostrum milk, while 59 (25.9%) gave prelacteal feeds. Exclusive breastfeeding rate declined from 64.5% at birth to 37.3% at the age of six months. Maternal older age, multiparity, delivery at a government health facility, positive family attitude towards exclusive breastfeeding and government health facility as the main source of breastfeeding education were significantly associated with higher rates of exclusive breastfeeding (p<0.05). FGDs showed that mothers believed that adequate nutrition, physical, financial and emotional supports to them during pregnancy and lactation would increase exclusive breastfeeding practice.
CHAPTER ONE
INTRODUCTION
Adequate nutrition in the early years of life is a necessity for children to grow and develop to their full potential1. Breast-feeding is an important resource. It is one simple practice that provides food, health and care simultaneously for the child2. It is a natural way of feeding the infant in all tradition and has contributed to the healthy survival of children through the ages3. Breast milk is the ideal specie specific food for infants. Exclusive breastfeeding is recommended by the World Health Organization (WHO) as an optimal feeding method for infants of HIV positive women who may choose to breastfeed, as it is associated with less risk of postnatal HIV transmission than mixed feeding4-6, for optimal survival, growth and development. Exclusive breastfeeding is exclusive intake of breast milk by an infant from its mother or wet nurse or expressed breast milk with the addition of no other liquid or solids, with the exception of drops or syrups consisting of vitamins, minerals supplements or medicine and nothing else7. Mixed feeding is non
exclusive breastfeeding i.e. breast milk in addition to other liquids and solids8.
Exclusive breastfeeding provides valuable benefits to the infants, mothers and the nation as a whole6, 9. Breast milk is easily digested and absorbed, and contains all the nutrient and antimicrobial factors an infant needs to thrive10. The colostrum which is the initial milk produced in the first few days after delivery provides infants with their first immunization against many bacterial and viral infections. In addition to the antimicrobial factors, a number of other substances contained in breast milk also play an important role in the protection of the infant against diarrhoea and respiratory track infections11. The risk of some health problems such as atopic diseases, crohns disease, type I diabetes mellitus and necrotising enterocolitis is lower in breastfed infants12-15. Increased skin to skin contact and physical warmth between mother and child, which further strengthens the emotional bond between them and an overall decrease in the infant morbidity and hospitalization rates have also been reported16.
To the mother, breastfeeding enables her to return faster to her prepregnancy states17. Breastfeeding has a vital contraceptive effect18, 19. This is especially important in developing countries where the awareness and acceptability of modern family planning methods are very low.
Despite documented evidence of the benefits of breastfeeding, statistics indicate that most mothers do not practice optimal breastfeeding16, and exclusive breastfeeding for the first six months of life is a rare practice in a number of countries20. Early cessation of breastfeeding in favour of commercial breast milk substitutes, and needless supplementation on the premise that breast milk is not sufficient for the baby are still very common. Estimates from the WHO Global Data Bank21 indicate that only 35% of infants have been exclusively breastfed for some duration during the first four months of life, worldwide. In the African region it is 19%, while South East Asian region recorded the highest of 49%. The adverse effect of this decline in exclusive breastfeeding on the survival of the child in the developing countries is disturbing because of the combined factors of poverty, ignorance and unwholesome environment.
As a result of the observed global decline in the optimal practice of breastfeeding, many strategies and programmes were initiated to reinforce optimal breastfeeding culture among women globally. The Innocenti declaration on the protection, promotion and support of breastfeeding was developed and adopted by the world summit for children in 199020. It declared that “all women should be enabled to practice exclusive breastfeeding and all infants should be exclusively breastfed from birth to six months of age”. The Baby Friendly Hospital Initiative
(BFHI) programme was launched in 1991 by WHO/UNICEF following the
Innocenti declaration to ensure that all maternities support breastfeeding. With this initiative, a hospital is designated as “Baby Friendly” if it meets the 10 steps to successful breastfeeding set by WHO/UNICEF. Nigeria has adopted this programme and in the country 1,147 health facilities had been designated as “Baby
Friendly” by 2002, including all the centers of Irrua specialist teaching hospital (ISTH).
1.2 Statement of the Problem
Nutrition education has been supported as one suitable way to create awareness on proper nutrition practices. Literature on nutrition education, both as a stand-alone intervention and a complement to other interventions, is vast (e.g. (Bhutta et al., 2013; Ruel, 2013; Liu et al., 2009). Most of this evidence suggests that provision of appropriate nutrition information could lead to improved nutrition status and knowledge.
Nonetheless, limited attention has been given to behaviour change factors (Darnton-hill, 2014; Masset et al., 2011). Information is scanty about the relationship between psychosocial constructs known to influence behaviour and the behaviour intention towards using recommended infant and young child feeding (IYCF) practices among mothers in developing countries. Indeed, the few existing studies on this area have all been conducted in developed countries (Thomas et al., 2015; Marshall, 2013; Hamilton et al., 2010). Outcomes of nutrition interventions, constructive or modest, are entrenched on social and cognitive influences.
Hence, lack of understanding of how these elements/influences affect child feeding in a developing country context is an important gap in the literature that this study sought to fill.
Determinants of the use of recommended child feeding practices and mother‟s consumption of varied diets vital elements of food security and consumption behaviour have also been overlooked (Thompson, 2014). In addition, nutrition education strategies used in interventions are often mixed, thus calling for the understanding of the effect of different nutrition information dissemination channels and psychosocial factors on the use of MIYCF. This study therefore also contributes to the literature by identifying the psychosocial and socio-economic drivers of child feeding behavior among mothers.
1.3 OBJECTIVES
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.
1.4 Significance of the Study
This study is in line with global agenda of promoting nutrition-sensitive agricultural interventions targeting poor developing country households. It particularly aligns with sustainable development goal (SDG) number two and three which advocate for zero hunger and good health and well-being respectively.
This study will contribute to literature by identifying behavioral factors influencing infant and young child feeding behaviour. Such information can be used to develop more effective nutrition education campaigns. Therefore, support the targeting and integrating of information channels in promotional campaigns aimed at encouraging the adoption of the recommended breast feeding practices. Knowledge of mother‟s demand for food diversity as well as identifying the factors that affect demand for dietary diversity gives a better understanding of the consumption patterns that can assist in advocacy for healthy diets. Further, stakeholders advocating for healthy consumption behaviours will use the findings of this study in planning, implementing, improving and strengthening nutrition-sensitive agricultural interventions aimed at realizing the sustainable development goals that target the reduction of maternal and infant mortality rates from all preventable courses.
1.5 Scope of study
This study is focused on the feeding practice of child beraing mothers in Irrua LGA in Edo state.
1.6 Limitations of study
This study was carried out in a “baby friendly” health facility and this may have affected the reliability of the answers given by the mothers with a possibility of exclusive breastfeeding practice being over estimated.
There was also the possibility that infant had received something from some one else without the mothers knowledge. Likewise, some infants may have shifted from one feeding pattern to another and then returned to a previous one.
The women of childbearing age who participated in the FGDs were selected by convenience sampling method and their responses may not be representative of all the women of childbearing age attending the child welfare clinics of ISTH.
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