Challenges of Exclusive Breast Feeding Among Working Class Mother's of Birnin Kudu General Hospital

Challenges of Exclusive Breast Feeding Among Working Class Mother’s of Birnin Kudu General Hospital

CHAPTER ONE

Objectives of the Study

To investigate factors that hinder exclusive breastfeeding and establish the nutritional status of non – exclusively breastfed infants in Birnin kudu

Specific Objectives

To identify factors that hinder exclusive breastfeeding
To establish the mothers‟ level of knowledge of exclusive
To assess the nutritional status of non – exclusively breastfed
To determine the relationship between mothers socio-demographic characteristics and exclusive breastfeeding

CHAPTER TWO

LITERATURE REVIEW

The historical background of breastfeeding

Breastfeeding has been practiced since mammals existed on earth. Breastfeeding was rarely described even by those few ancient writers interested in infant health. The ancient Greek and Roman medical writings from Hippocrates, Soranus and Galen included infant health and feeding to some extent in their broader treatises on health (Ted, 1998).

As far as the duration of breastfeeding accepted in ancient civilizations was concerned, it was said that “Plotinus at the age of eight used to run from his tutor to his nurse and clamour for the breast” (Wickes, 1953). Ploss et al. (1935), estimated an average breastfeeding duration of 3 – 4 years among “primitive” peoples. Hawaiians were said to breastfeed for five years and Eskimos for about 7 years reaching a maximum in King William Land of upto 15 years. Ford, (1945), noted that breastfeeding continued for 3 years or longer in 15 of 45 “primitive” cultures, for 2 years in 16 of them, for 18 months in 13 of them and for 6 months in one culture.

Wickes, (1953) located one source from the late 1400s suggesting that it was by then normal to breastfeed for only about one year in Germany. In Italy, it was noted that women gave up breastfeeding by the third month and stopped breastfeeding by the 13^th month.

Before the last few hundred years, alternatives to breastfeeding were rare. Attempts in the 15th Century in Europe to use cow or goat milk were not very positive. In the18^th century, flour or cereal mixed with broth were introduced as substitutes for breastfeeding but this did not have a favorable outcome either. True commercial infant formulas appeared on the market in the mid 19^th Century but their use did not become widespread until after World War II (Ted, 1998).

Before the 1900s, if a mother did not breastfeed, a substitute “wet nurse” was hired to do it (Gordon et al., 1994). Traditional patterns of both breastfeeding and other care for nutrition have been subjected to erosion. Wet nursing by grandmothers, a very valuable custom, rarely received reinforcement from breastfeeding programmes and hence has been lost (Ebrahim,1991). During the early 1900s, the technology of formulas and feeding improved. From the 1920s, and especially in the 1940s when women worked in armament factories during WW II, more and more babies were fed formula. Throughout the 1950s and early 1960s, interest in breastfeeding further waned. In the 1970s, breastfeeding enjoyed a resurgence, which has since leveled off (Gordon et al., 1994).

In 1981 and 1987, the La Leche League International (LLLI) board of directors voted to support the WHO / UNICEF International Code of Marketing of Breast milk Substitutes. In February 1988, the board directed LLLI to cooperate and network with other key breastfeeding organizations around the world and to lend strong US support to struggling countries. In October 1988, the board voted to support the efforts of the American Academy of Paediatrics for their policy opposing direct advertising of infant formula to the public. This was recognized as a positive step towards increasing the incidence and duration of breastfeeding in the US. The move was to lend support to breastfeeding worldwide.

On July 21, 1991 a historic meeting was held in the USA to discuss the marketing of artificial infant feeding in the US. At this meeting a consortium drafted the “Declaration for the Protection, Promotion and Support of Breastfeeding” (Janet et al, 2008). Breastfeeding was the normal way of feeding infants in all traditional societies. In a world – wide study of 45 different cultural and ethnic groups in the 1940s, it was found that on average the infant breastfed for 1.5 – 2 years. In some communities it continued for as long as 6 years (Ebrahim, 1991).

A multi – nation study sponsored by WHO, in 1981 found three main patterns of breastfeeding; in the first pattern, breastfeeding was rarely continued beyond 6 months and there was a tendency to terminate breastfeeding even sooner than that. On the other extreme, breastfeeding was prolonged and almost universal with about 50% of the mothers continuing to breastfeed at the age of 18 months. A third group of mothers exhibited a pattern which fell midway between the two extremes (Ebrahim, 1991).

CHAPTER THREE

RESEARCH METHODOLOGY

Research Design

Descriptive survey method was used to observe, describe and document aspects of exclusive breastfeeding practice and nutritional status of infants. This design was chosen because the study was concerned with specific prediction and describing characteristics of a particular group (mothers and infants). The design was preferred as the topic was a social survey under social and behavioral sciences (Role, 2007).

Target population

The target population was working class mothers’ of Birnin Kudu general hospital in Jigawa state, Nigeria

Study population

Mothers of infants aged 0-6 months drawn from the target population.

Inclusion criteria

Mothers of infants aged 0-6 months who were willing to participate in the study.

Exclusion criteria

Mothers of children aged 0-6 months not willing to participate. Mothers of children aged 0-6 months who were unwell.

Sampling techniques

Simple random sampling was used. Papers with two written choices yes and no were placed in a container. On each visit, mothers of children aged 0-6 months attending Birnin kudu general hospital willing to participate, picked the papers at random. The subjects who picked the yes response were included in the sample. On each day, the total number of mothers and infants was recorded. Once the sample size of 296 mothers and infants was achieved, the visits ended.

CHAPTER FOUR

RESULTS AND DISCUSSION

Factors that hinder exclusive breast feeding practice

The important factors that hindered EBF were mother‟s insufficient breast milk production, mother‟s inability to express breast milk, to improve infant‟s health, mother‟s return to work, mother socially tied down, inadequate knowledge about EBF and lack of health messages on EBF from both antenatal and post- natal clinics.

Mothers’ insufficient breast milk production

Many mothers decided to feed their babies artificially – either partially or completely because they believed that they did not have enough breast milk. On responses given under personal factors, 20.6% strongly agreed, 39.9% agreed and 39.5% disagreed that they did not have enough milk; χ² = 11.290, df =2, P= 0.004. Most mothers reported that their breasts could not produce adequate milk because the baby cried a lot on breastfeeding alone. This could be attributed to mothers not feeding well. They opted to give other feeds to satisfy the baby. Breastfeeding women should eat a well balanced diet and drink enough liquids like juice, water, milk and soup to increase milk production. Breastfeeding at least every two to three hours helps to maintain milk production. For most women, eight breastfeeding or pumping sessions every 24 hours keeps their milk production high (UNICEF, 1999). Feeding a baby on demand (when a baby shows signs of hunger) helps to maintain milk production and ensures the baby‟s needs for milk and comfort are met (WHO, 2003).

CHAPTER FIVE

SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

Summary

The main objective of this study was to investigate factors that hinder exclusive breastfeeding and establish the nutritional status of non – exclusively breastfed infants in Birnin kudu. Descriptive research design was used in the study. The study population were mothers of infants aged below 6 months and the sample size was 296. A questionnaire was used in data collection. Anthropometric method that involved height and weight measurement was used to assess the nutritional status of infants. The Statistical Package for Social Sciences and EPI Info 2002 software package were used for data analysis. From the findings of the study, there were many factors that hindered the practice of exclusive breastfeeding. This included mothers‟ perception of insufficient breastmilk production, mothers‟ inability to express breastmilk, mothers‟ return to work, inadequate knowledge about EBF and lack of health messages from both antenatal and postnatal clinics.

Conclusions

The following were drawn as the main conclusions from the study:

All the socio – demographic characteristics of the mothers (age, marital status, education level, employment status and form of employment) had some influence on mothers‟ practice of exclusive breastfeeding. There were relationships between socio – demographic characteristics and EBF practice at significance level P < or= 0.05.
Among the factors that hindered EBF, mothers` insufficient breast milk production had the highest percentage (29%), followed by inability to express breast milk (24%) The least factors was breastfeeding being seen as socially limiting (11%).
Maternal understanding of EBF and its recommended period in Birnin kudu was low. The mean age of EBF was 1.8 months. The highest percentage (36%) of infants was introduced to other drinks and foods at the age of 2 months while the least percentages were, 2% at 6 months and 3% before 1 month. EBF upto 6 months was very low; only 15.5% of the infants were exclusively breastfed while 84.5 % were both breastfed and mixed By age 6 months no infant was EBF. This is an indicator that WHO recommendation on EBF upto 6 months is not being practiced. Barriers to EBF upto 6 months could be attributed to lack of adequate knowledge on EBF.
The prevalent form of malnutrition was wasting (low HAZ) 9.3%. Cases of underweight (low WAZ) were 2.7% and stunting (low HAZ) were 6.9%. Malnutrition in this study could be attributed to early introduction of complementary
From the findings of the data analysis, the null hypothesis that there were no factors that hindered EBF practice was rejected, P = 004.

Recommendations

All mothers, irrespective of their age, marital status, education level and employment status should be encouraged to exclusively breastfeed their infants. Public forums should be used as a channel to promote
There is a great need for health education to explain to mothers the importance of breastfeeding the child on demand to sustain the quantity of breast milk This should be done in both antenatal and postnatal clinics in health facilities. Mothers need counseling if they doubt their milk is inadequate or if going back to work.
Staff in the ministry of Public Health concerned with child health should be more aggressive in implementing the existing policy on EBF. It should be made clear to the mothers the meaning of exclusive breastfeeding, its recommended period and its health benefits both for the mother and
To reduce cases of malnutrition, early introduction of complementary foods to infants by mothers should be

Recommendation for further research

Research beyond this descriptive study (qualitative research) is needed; for instance a research on the adequacy of breast milk in meeting the nutritional needs of infants to 6
A similar study may be done in a different geographical and cultural setting incorporating factors like religion and income that were not captured in this research.

REFERENCES

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American Academy of Pediatrics. (2005). Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2005; 115: 495- 566.
Ari, K. (2006). An interesting take on Religion and Breastfeeding. Retrieved March 21, 2008, from http://blog.imperfectparent.com.
Ashwin, B. and Neeta, H. (2007). Maternal Knowledge and Perception about breastfeedin and Factors Influencing it – A Study in Urban Low Socioeconomic Class of Pune, India.
Barbara, G. IIse, M., Andre, J. K. and Constant, P. (2007). Factors associated with the duration of exclusive breastfeeding in asthmatic families. Health Education Research in Oxford Journal, Vol 27: 123 – 125.
Bland, R.M., and Rollins, N.C. (2002). Breastfeeding practices in an area of high prevalence in South Africa. Acta paediatrica, 91,704-711.
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