COMPARISON OF KNOWLEDGE, ATTITUDES AND PRACTICES OF EXCLUSIVE BREASTFEEDING BETWEEN PRIMIPAROUS AND MULTIPAROUS MOTHERS IN ONDO WEST LOCAL GOVERNMENT

CHAPTER ONE

INTRODUCTION

1.1BACKGROUND OF THE STUDY

Infant feeding methods are a major determinant of infant nutritional status, which in turn, affects infant morbidity and mortality. Among feeding methods, breastfeeding is of particular importance because this practice is fundamental for growth, development, health and survival of infants. Buchanan, (2015), stated that about 5.6 million infants die annually because they do not receive adequate nutrition. Breastfeeding therefore has been classified by scientists and health workers as the best natural food for babies and breast milk contains all the necessary nutrients for the healthy growth of the child. The benefits of breastfeeding are numerous ranging from providing the infant with antibodies, to helping ward off risks of illnesses and providing the baby with all his/her nutritional needs (Vennemann, et al., 2019). 

According to the World Health Organization (WHO) (2018), breast milk provides all the energy and nutrients that the infant needs for the first six months of life, and it provides about half or more of a child’s nutritional needs during the second half of the first year, up to one third during the second year of life. Furthermore, breast milk not only protects the infant against infectious and chronic diseases, but also promotes sensory and cognitive development in addition to contributing to the health and well-being of mothers, helping in birth spacing, reducing the risks of ovarian and breast cancers as well as increasing family and national resources (WHO, 2018).

Generally, breastfeeding is practiced all over the world, though with variation in duration. Considering that the introduction of other food supplements at an early age often increase the risks of infections to the infant which may at times lead to life-threatening conditions such as diarrhoea, the WHO and United Nations Children’s Emergency Fund (UNICEF), recommended that infants be exclusively breastfed for six months and, thereafter, up to 24 months, introducing other supplements to support the infants growth and development (Perez-Escamillia, et al., 2015).

In view of the many benefits afforded by mothers and infants in breastfeeding, governments have also set goals and rates for breastfeeding practices. The Nigerian government has earmarked six University Teaching Hospitals as Baby Friendly Hospital Initiative (BFHI) centres, in Benin, Enugu, Maiduguri, Lagos, Jos, and Port-Harcourt, with the objective of reducing infant malnutrition, morbidity and mortality, as well as promoting the health of mothers. Since the inception of BFHI in 1991, a series of programmes, seminars, workshops and conferences aimed at promoting breastfeeding practices have been organized. The BFHI itself has proved to be an effective method of improving breastfeeding practices worldwide (Perez-Escamillia, et al., 2015). To further strengthen the practice of exclusive breastfeeding, government also approved a breastfeeding policy in 1998. The code on the marketing of substitutes of breast milk was reviewed and amended in May, 1999, to further introduce stiffer fines and a clearer definition of breast milk substitutes. These measures are aimed at increasing the rate of exclusive breastfeeding as well as the early initiation of breastfeeding so as to achieve the World Summit on Children 1990 goal of universal exclusive breastfeeding for infants up to six months of age (Labbok, et al., 2016).

These measures notwithstanding, evidence showed that the practice of exclusive breastfeeding (though fast improving) is still low in many parts of the world. In Nigeria, the rate increased from 2% to 20% in infants 0-3 months and from 1% to 8% in infants 4-6 months between 1990 and 1999. The Nigeria Demographic and Health Survey (NDHS), however, revealed that 97% of Nigerian children under age five were breastfed at some point in their life. A small proportion of infant (13%) were exclusively breastfed throughout the first six months of life. More than seven in ten (76%) children of ages 6-9 months received complementary foods. 16% of infants less than six months of age were fed with a bottle with nipple, and the proportion bottle fed peaked at 17% among infant in the age ranges of 2-3 and 4-5 months. However, less than half of infants (38%) were put to the breast within one hour of birth and only 68% started breastfeeding within the first day. Relatively, among children born in the five year preceding the survey in most States, showed that 97.8% of children ever breastfed. 64.1% started breastfeeding within one hour of birth. 90.2% began breastfeeding within 1 day and 38.7% introduce pre-lacteal feed. Only 0.5% children were exclusively breastfed. These proportions indicate a marginal level of decline from the 1990, 1991, 1999, 2003 and the 2008 surveys (Palmer, 2019).

These dwindling attitudes regarding the practice of exclusive and non-exclusive breastfeeding have been attributed to several socio-economic, cultural and socio-demographic factors as it affects the development of children, hence the need for this study.

1.2 STATEMENT OF THE PROBLEM

Breastfeeding practices have undergone tremendous medical, cultural and sometimes religious challenges and debate. In an attempt to achieve successful breastfeeding globally by the year 2000, the World Health Organization and United Nations Children’s Fund (1993) as cited in Perez-Escamillia, R. et al., (2015), launched the Baby Friendly Hospital Initiative (BFHI) in 1991. The BFHI is a global effort involving 160 countries, of which 95 of them are in the developing world where Nigeria is inclusive (Perez-Escamillia, R. et al., 2015). This project is to support, protect, and promote the practice of exclusive breastfeeding for six months and thereafter until 24 months of age. Several medical literature have also established the superiority of breast milk over the other types of milk for the nourishment of the human infants, offering better health benefits.

Although breastfeeding is universal in the country, the trend is towards giving other feeds in addition to breast milk. Generally, the practices are more diversified and are characterized by late initiation of breastfeeding, the administration of substances other than maternal milk, and the introduction of weaning foods within one month following the infant’s birth. The Nigerian Integrated Child Health Cluster Survey (ICHCS, 2003) in Davis, (2015), indicated that a major area of need in infant breastfeeding was early initiation. The survey indicated a decline from 56% in 2000 to 34% in 2002. The Nigeria Demographic and Health Survey (Palmer, 2019) reports also revealed a 13% exclusive breastfeeding rate which is a decline from 17% indicated in 2003 report. The 2008 report further revealed that 34% of infants aged 0-5 months were given plain water in addition to breast milk, while 10% were given milk other than breast milk. Only 32% of infants’ under-24 months of age were still on breast milk.

Considering the percentage of mothers practicing breastfeeding, it should not be surprising that Nigeria is still saddled with high incidence of malnutrition and its associated infant mortality. Many factors have been adduced to influence these practices. The decisions are very often influenced more by other factors than by health considerations alone. According to Sika-Bright (2010), the factors which influence the decision to exclusively or non-exclusively breastfeed include; mother’s marital status, employment status, friends method of feeding their babies, social support and baby’s age. Several other demographic studies conducted over the years (i.e National Bartick, M., and Reinhold, (2017) and Baby-Friendly Hospital Initiative. (2018) have also identified similar factors to include; mother’s level of education, occupation, and income level to influence mother’s choice of exclusive breastfeeding.

While significantly expanded in content, the primary objective of the previous surveys has been on emerging issues such as awareness and behaviour regarding HIV/AIDS and other sexually transmitted infection, poverty, gender inequality, fertility, mortality, nuptiality, awareness and use of family planning methods, sexual activity, nutritional status of mothers and infants, early childhood mortality and maternal mortality, maternal and child health and of course breastfeeding practices. However, these factors are apparent in the studies conducted over the years. The existence of a large scale of mothers practicing exclusive and non-exclusive breastfeeding, and its associated causes remained elusive in the studies (Davis, 2015). It is not definite or clear whether demographic factors significantly or insignificantly influence the practice of exclusive and non-exclusive breastfeeding and whether it is from experience or lack of it. It is worthy of note that up till recently, the principal foci of attention has been demographic factors and the practice of exclusive breastfeeding. None of the studies conducted over the years concerned itself much with the knowledge of primiparous and multiparous mothers in breastfeeding. Therefore, the study purposed to compare the knowledge, attitudes and practices of exclusive breastfeeding between primiparous and multiparous mothers in Ondo West Local Government.

1.3 OBJECTIVES OF THE STUDY

The primary purpose of this study is to compare the knowledge, attitudes and practices of exclusive breastfeeding between primiparous and multiparous mothers in Ondo West Local Government. Specific objectives of this study are to:

Determine the knowledge of exclusive breastfeeding between primiparous and multiparous mothers in Ondo West Local Government.

Find out the attitudes towards exclusive breastfeeding between primiparous and multiparous mothers in Ondo West Local Government.

Investigate the factors influencing the adoption of exclusive breastfeeding practices between primiparous and multiparous mothers in Ondo West Local Government.

Examine the factors that hinders exclusive breastfeeding between primiparous and multiparous mothers in Ondo West Local Government.

1.4 RESEARCH QUESTIONS

The following research questions will be answered in this study:

What are the knowledge of exclusive breastfeeding between primiparous and multiparous mothers in Ondo West Local Government?

What are the attitudes towards exclusive breastfeeding between primiparous and multiparous mothers in Ondo West Local Government?

What are the factors influencing the adoption of exclusive breastfeeding practices between primiparous and multiparous mothers in Ondo West Local Government?

What are the factors that hinders exclusive breastfeeding between primiparous and multiparous mothers in Ondo West Local Government?

1.5 RESEARCH HYPOTHESES

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho1: There is no significant difference in the knowledge of exclusive breastfeeding between primiparous and multiparous mothers in Ondo West Local Government.

Ho2: There is no significant difference in the attitude of exclusive breastfeeding between primiparous and multiparous mothers in Ondo West Local Government.

1.6 SIGNIFICANCE OF THE STUDY

The findings of this study would give an insight into areas where health education campaigns are required to influence and promote the adoption of exclusive breastfeeding. Specifically:

It would also make progress towards obtaining demographic data on exclusive breastfeeding among primiparous and multiparous mothers in Ondo West Local Government. This, in addition, will benefit nutritionists, health planners in Ondo West Local Government to formulate policies and strategies that are geared towards the promotion of exclusive breastfeeding on specific group of women and locations in which it is poorly practiced.

The findings of the study would benefit health workers to develop special intervention measures on specific age ranges of mothers who poorly practice exclusive breastfeeding.

The findings of this study would help health educators, nurses, nutritionists and curriculum planners to develop informed programmes for nursing mothers on the benefits of breastfeeding. This in addition, would update the curriculum to educate students in higher institutions of learning in preparing for future parenthood to adopt an effective method of breastfeeding the baby.

1.7 SCOPE OF THE STUDY

Broadly, this study focuses on the comparison of knowledge, attitudes and practices of exclusive breastfeeding between primiparous and multiparous mothers in Ondo West Local Government. Specifically, this study focuses on determining the knowledge and attitudes of exclusive breastfeeding between primiparous and multiparous mothers, gathering information about the knowledge and other factors that influence the practice of exclusive breastfeeding in Ondo West Local Government, examining the factors that hinders exclusive breastfeeding, determining mothers level of knowledge on exclusive breastfeeding and determining how educational status of nursing mothers relate to their extent of adoption of EBF.

Selected mothers in Ondo West Local Government will serve as the enrolled participants for the survey of this study.

1.8 LIMITATIONS OF THE STUDY

Like in every human endeavour, the researchers encountered slight constraints while carrying out the study. The significant constraint was the absence of  literature on brand switching behaviour of consumers. Thus much time and organization was required in sourcing for the relevant materials, literature, or information and in the process of data collection. Also the study is limited in sample size and geography covering only Ondo West Local Government. Therefore findings of this study cannot be used for generalization thus creating a gap for further studies. 

Also encountered was time constraint as the researcher had to carry out this research in addition to attending lectures and other educational activities required of him.

1.9 DEFINITION OF TERMS

Exclusive Breastfeeding: Exclusive breastfeeding means that the infant receives only breast milk. No other liquids or solids are given – not even water – with the exception of oral rehydration solution or drops/syrups of vitamins, minerals or medicines.