ABSTRACT
 The importance of exclusive breastfeeding on the health of infants is a topic of considerable interest in the field of public health. The purpose of this study was to explore the benefits of exclusive breastfeeding and its impact on infant health outcomes. The study reviewed literature from various sources, including academic journals, reports from international organizations, and government publications. The literature review indicated that exclusive breastfeeding for the first six months of life provides numerous benefits to infants, including reduced risk of infections, improved cognitive development, and better growth and development. In addition, exclusive breastfeeding has also been found to be associated with a reduced risk of chronic diseases later in life, such as obesity, diabetes, and cardiovascular disease. The study also highlighted the role of exclusive breastfeeding in promoting maternal health, including a reduced risk of breast and ovarian cancer. The study concluded that exclusive breastfeeding for the first six months of life is crucial for optimal infant health and development. It is a low-cost, low-tech intervention that has the potential to significantly improve the health outcomes of infants and mothers worldwide. Therefore, efforts should be made to promote and support exclusive breastfeeding as a standard of care for infant feeding.
CHAPTER ONE INTRODUCTION
- Background
Breast milk is the natural first food for infants (Davis, Darko & Mukuria, 2003). It renders all the nutrients an infant needs for the first six months of life. Breastfeeding together with complementary feeding continues to meet a child’s nutritional needs during the second half of the first year until the second year of life when a child could be weaned. It is an essential part of the reproductive process and contributes to the health and wellbeing of both mother and baby (WHO, 2011).
Breastfeeding is accepted globally as the preferred method of feeding infants. According to World Health Organization exclusive breastfeeding, is defined as giving only breast milk from a mother or wet nurse or expressed without any additional food or liquid for six months (WHO, 2002). This gives multiple benefits to the infant and mother. Exclusive breastfeeding is adequate in quality as well as quantity in terms of energy, protein, nutrients, water etc. (WHO, 2002). Research indicates that the quantity and quality of milk produced by undernourished mothers is remarkably good, with the amount of milk and energy concentration being only a little less than that of well-nourished mothers (Salwa, Soliman & Bakr, 2014). However the level of milk production could be increased by improving maternal nutrition (Allen, 1994).
Based on congregated evidence-based research by the WHO, the initial recommendation of EBF for four months was changed to 6 months. This was done after a study observed there was no deficits in growth of infants breastfed exclusively for six months and their mothers were more likely to remain amenorrheic for 6 months postpartum (WHO, 2001; WHO, 2002). WHO and UNICEF recommend that all mothers should breastfeed their children exclusively for the first 6 months and thereafter they should continue to breastfeed for as long as the mother and child desire, and both appropriate and sufficient weaning food should be included after six months of life (Peters, Wehkamp, Felberbaum, ger DK & Linder, 2005; Foo, Quek, Ng, Lim & Deurenberg- yap, 2005; WHO, 2005).
Also Seidu and Stade (2013) stated that efforts to promote exclusive breastfeeding have either achieved limited successes or run into severe problems due in part to poor understanding of the several influences on the practice. Out of the 6.9 million under five children who were reported dead globally in 2011 an estimated 1 million lives could have been saved just by adopting these simple and accessible practices such as EBF (WHO, 2012).
In Nigeria according to the Nigeria demographic and health survey, an estimated 53.1% of children 2-3 months are being exclusively breastfed. By age 4 to 5 months only 36.2% continue to receive EBF and this situation appears to be deteriorating as available information shows that EBF has declined from 54% in 2006 to 52% in 2014 (GSS, GHS & ICF Macro, 2014).
Therefore, for mothers to be able to exclusively breastfeed for the proposed 6 months, it is important to understand the factors that influence EBF. Diverse factors have been found to be associated with BF initiation and duration, and EBF practices (Aidam, Pérez-Escamilla, Lartey & Aidam, 2005). These include: demographic factors, biosocial factors, cultural factors, socioeconomic status; and employment policies affecting how long an infant can be in close proximity to the mother. Although the entire benefits are greater in settings of poverty (poor nutrition and hygiene), where baseline disease rates are higher, the relative risk of these diseases is significantly decreased by breastfeeding in high-income settings as well (Ip, Chung, Raman, Chew, Magula, DeVine et al., 2007; Wright, Holberg, Martinez,
Morgan & Taussig, 1989; Aniansson, Alm, Andersson, Håkansson, Larsson, Nylén et al 1994). It is against this background that this study seeks to investigate the EBF practices of first-time mothers in Nigeria in the Upper East Region which is one of the most impoverished municipalities in Nigeria.
1.2Â Statement of the problem
Regardless the benefits EBF exhibits, the prevalence and duration rate of EBF among Chinese, Malay and Indian mothers was found to be (21.1%) lower than the international recommendation for the first six months of an infant’s life (Foo, Quek, Ng, Lim & Deurenberg- yap, 2005; Haider, Kloos, Haile & Demissie, 2006). Globally, Cai, Wardlaw, & Brown, 2012 discovered 39% of infants 0-5 months were breastfed exclusively. Also, the regions with high rates of infants exclusively breastfed for less than 6 months were Eastern/Southern Africa (52%), as well as South Asia (47%). Hence Sub-Saharan Africa recorded the lowest coverage of 37% (WHO, 2012).
In order to achieve the Millennium Development Goal of reducing child mortality and curbing of infant malnutrition, one of the major intervention areas that have been identified by the World Health Organization both globally and nationally is infant breastfeeding. Unfortunately, early cessation of breastfeeding in support of breast milk substitutes is far too common (Labbok, Wardlaw, Blanc, Clark and Terreri, 2006). These substitutes include introduction of liquids such as water and juices, needless supplementation and poorly timed introduction of solid, semi-solid and soft foods, often of poor quality, (Cai, Wardlaw, & Brown, 2012). From observation, women of first delivery often fall victim to these practices (using of breast milk substitutes). Also, this group of women are a vulnerable group and very dependent on the various supports around them. Therefore decision making is influenced highly by the knowledge, beliefs and attitudes of people around them.
In Nigeria, for example, the median BF duration is 22 months and 53.4% of women with children less than six months breastfeed exclusively (GSS & Macro, 2004; GSS, GHS & ICF Macro, 2003). Anecdotal evidence has it that in spite of high rates of breastfeeding practices among mothers in Nigeria, the practices of exclusive breastfeeding still remain low especially among first-time mothers. A study by Adokiya, (2010) in then Nigeria, concluded that early introduction of complementary foods may be a risk factor for increased morbidity and undernutrition of children.
Undernutrition is a health issue among children in most communities located in the Nigeria. A study revealed the prevalence of child undernutrition in then Nigeria as follows: stunting was 15.6%, underweight 15.3% and wasting 8.7% (Adokiya, 2010). It is therefore important to understand the factors that influence exclusive breastfeeding. Various studies have investigated the effect of breastfeeding education or support on initiation and duration; although most show positive results, a few have not (Aidam, Pérez-E camilla, Lartey, & Aidam, 2005).
1.3Â Justification of the study
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Exclusive breastfeeding is essential for optimal growth and intellectual development, and reduces the incidence of infant morbidity and mortality. Infants who are exclusively breastfed have a lower risk of acquiring childhood illnesses and infections. Poor feeding practices such as sub-optimal breastfeeding is still widespread and often leads to malnutrition which is a major cause of more than half of all child deaths (Sokol, Aguayo, and Clark, 2007). Therefore by studying and bringing to light the perceptions, influences and challenges of these first time mothers would add to knowledge and also help to better understand how best to promote a behaviour change when designing an intervention. It is also to explore whether the previously reported associations elsewhere exist in the study area.
1.4Â Research questions
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Answers to the following questions will help attain the objectives of the research. They are as follows;
- How do perceptions of first-time mothers on exclusive breastfeeding affect the breastfeeding practices they adopt?
- What factors influence the practice of exclusive breastfeeding among first-time mothers?
- What coping strategies do first-time mothers adopt in relation to exclusive breastfeeding?
1.5Â Objectives
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- General objective
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This study seeks to investigate the importance of exclusive breastfeeding on the health of infant
1.6.2Â Specific objectives
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- To assess the perception and practices of first-time mothers about exclusive
- To examine the factors that influences the practice of exclusive breastfeeding among first-time mothers.
- To explore the coping strategies adopted by first-time mothers in relation to exclusive
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