Table of contents
Concept of Breastfeeding
Discussion of findings
The present study was undertaken to assess the knowledge and practice of breast feeding among nursing these nursing mothers in Esan central local government area of Edo State. The sample was one hundred thirty nursing mothers attending immunization in all the Primary Health Care Centres in Esan Central Local Government in Edo State of Nigeria that were selected from the population through multistage method of sampling. The female nursing mothers were provided with yes or no for rating of the knowledge and practice of breast feeding among nursing these nursing mothers. The data were analyzed using frequent count and simple percentage for research question while Pearson Product Moment Correlation Coefficient were used to test the hypnoses to determine the relationship between knowledge and practice of breast feeding among nursing mothers. The finding revealed that there is a relationship between the knowledge and practice of breast feeding among nursing mothers in Esan central local government area. The findings also revealed that the knowledge of breast feeding among nursing mothers in Esan central local government area is high. The findings concluded there is a significant relationship between the knowledge and practice of breast feeding among nursing mothers. The study also concluded that the practice of breast feeding among nursing mothers in Esan central local government area is low .
Breastmilk is a natural food that is being secreted from the mother’s breast. It contains all the essential nutrients in their correct proportion. Such nutrients as protein, fats, carbohydrates, vitamins, leukocytes which helps in fighting infection, it also contains enzymes, hormones that cannot be added to infant formula. Breastmilk is ultimately the best source of nutrition for a new bornbaby. Many components in breastmilk help protect the baby against infectious diseases. The proteins in breastmilk are easily digested than in infant formula or cow’s milk(e.g. NAN). Human milk contains two types of proteins: whey and casein. Approximately 60% is whey while 40% is casein. This balance of the proteins allows for quick and easy digestion. Artificial milk, also called infant formula, has a greater percentage of casein, which makes it more difficult for the baby to digest. Approximately 60-80% of all protein in human milk is whey protein (World Health Organisation (WHO),2008). These proteins have great infection-protection properties.Examples of proteins found in Breast milk are: Lactoferrin, Secretory IgA, Lysozyme and Bifidus factor, fats, carbohydrates and vitamins(WHO, 2008).
Some women ultimately are not able to breastfeed, lactation consultants are able to provide support to women learning to breastfeed. For those who are not able to breastfeed, milk banks or donor milk may be an alternative (World Health Organization (WHO), United Nations International Children's Emergency Fund (UNICEF), 2014).
The World Health Organization (WHO) and United Nations Children Emergency Fund (2003) emphasizes that the nutrients are quickly and easily digested and absorbed in the body system of infants. Breastfeeding practice is carried out worldwide in order to fulfill the World Health Organization(WHO) and United Nations Children Emergency Fund (UNICEF) recommendation that infants be breastfed exclusively for six months and thereafter until 24 months (WHO, 2009).
Breastfeedingis recognized as the preferred form of infant nutrition by the American Academy of Pediatricians (AAP). The American Academy of Family Physicians (AAFP) and the American College of Obstetricians and Gynecologists (ACOG), Infants who are breastfed experience nutritional and developmental advantages that enhance their health throughout their lives. The choice to breastfeed conveys health benefits to the mother as well. Breastfeeding also has beneficial impact on the family as well as savings for our society. Several studies have established that education and support for pregnant women can dramatically increase breastfeeding rates (Arora, McJunkin, Weher, & Kuhn, 2000).
Mothers who breastfeed their children are rewarded with a lengthy list of benefits. Breastfed children exhibit greater resistance to infectious disease and stronger immune systems than their infant formula fed peers. They also experience lower rates of chronic diseases. There is a lower rate of infectious diseases among breastfed babies. The explanation for this enhanced resistance to diseases can be found in the biology of human milk. When a lactating mother is exposed to an infectious agent, her mature immune system begins to produce secretory immunoglobulin A [S-IgA], a compound that is the primary disease fighter in the human immune system (Cunningham, 1995). This substance is secreted into the mother’s breastmilk and consumed by her nursing baby. The child’s own immune system may also be producing S-IgA. The consumption of the mother’s S-IgA not only provides active resistance to diseases, it also stimulates the production of additional S-IgA in the infant, resulting in stronger immune responses among breastfed infants than in their formula fed peers (Cunningham, 1995).
Exclusive breastfeeding (EBF) in the first six months of life is recognized as an indispensable component of survival, physical and mental development of children (Lancet, 2008). The period from birth to two years of age is a “critical window” for the promotion of optimal growth, health, and behavioral development. Some of the consequences of poor nutrition during the first two years of life include significant illnesses, delayed mental and physical development or even death. Numerous factors have been identified as impediments to proper nutrition and infant feeding habits. Important among them is poverty and lack of adequate information and support on good feeding practices, especially exclusive breast feeding(EBF) which is for the first six months of life (Lancet, 2008).
Exclusive breast feeding (EBF) for the first 6 months of lifeand continued breastfeeding through the second year of life in addition to safe as well as adequate and age appropriate complementary feeding from 6 to 24 months were recommended(WHO, 2008). Worldwide, it is estimated that only 34.8% of infants are exclusively breastfed for the first 6 months of life, the majority receiving some other food or fluid in the early months, complementary foods are often introduced too early or too late andis often nutritionally inadequate and unsafe (WHO, 2009). It is no longer a doubt that breast feeding is essential component of children’s survival and healthy living, hence the knowledge and practice of breast feeding among nursing mother is very important.
Statement of the problem
In Nigeria, breast feeding practice is a major aspect of infant feeding but exclusive breastfeeding practice is poor (National Demographic Health Survey (NDHS), 2008). Despite the fact that 98% of under 5 children were ever breastfed at sometime, 13% of children below 6 months are breastfed exclusively and complimentary food are introduced early in life while only 10% of children are fed appropriately based on recommended infant and young child feeding practice (NDHS, 2008).
The researcher observed that in Esan Central Local Government Area of Edo State, breast feeding practice does not translate to the optimum, that is water, infant formula, pap are often mixed complemented with breast feeding before six months and that these infant are not also breast fed up to 24 months. This practice does not translate to the recommended practice by WHO (2008), which said that infant be breastfed exclusively for six months from birth and that the breast milk be complemented until the infant is 24 months.
This practice could be influenced by the knowledge of breastfeeding among the nursing mothers. Hence the need to explore these findings to test the knowledge and practice of breast feeding among nursing these nursing mothers in Esan central local government area of Edo State to enable the researcher close the gap of this practice.
1. What is the knowledge of breast feeding among nursing mothers in Esan central local government area?
2. What are the levels of breast feeding practice among nursing mothers in Esan central local government area?
3. What is the relationship between the knowledge and practice of breast feeding among nursing mothers in Esan central local government area?
The hypotheses was formulated and tested at 0.5 level of significance
There is no significant relationship between the knowledge and practice of breast feeding among nursing mothers in Esan central local government area.
Purpose of the Study
The purpose of this study is to investigate the knowledge and practice of breastfeeding among nursing mothers in Esan Central Local Government Area.
This study will be based on the theory of reasoned action (TRA). The theory of reasoned action was developed by Martin Fishbein and IcekAjzen in 1967 and was derived from previous research that began as the theory of attitude. The theory aims to explain the relationship between attitudes and behaviors within human action. TRA is used to predict how individuals will behave based on their pre-existing attitudes and behavioral intentions. An individual's decision to engage in a particular behavior is based on the outcomes the individual expects as a result of performing the behavior(Rogers Gillmore, Mary; Archibald, Matthew; Morrison, Diane; Wilsdon, Anthony; Wells, Elizabeth; Hoppe, Marilyn; Nahom, Deborah; Murowchick, Elise,2002). The ideas found within the theory of reasoned action have to do with an individual's basic motivation to perform an action. TRA says that a person's intention to perform a behavior is the main predictor of whether or not they actually will perform that behavior. According to the theory, intention to perform a certain behavior precedes the actual behaviour (IcekAjzen; Madden, Thomas, 1986). This intention is known as behavioral intention and comes as a result of a belief that performing the behavior will lead to a specific outcome. Behavioral intention is important to the theory because these intentions "are determined by attitudes to behaviors and subjective norms" (Colman, 2015). The theory of reasoned action suggests that stronger intentions lead to increased effort to perform the behaviour, which also increases the likelihood for the behaviour to be performed.
This theory as it relates to breast feeding, the act of breast feeding is an attitudinal display of the behavioral intention. Breast feeding is a social norm that is approved world wide. The breast feeding practice may be facilitated by some factors such as good family support, education, while it can be impeded by lack of education mothers returning to work, lack of family support (Chye, Zain& Lim, 1997).
Most mothers especiallyprimigravida are often faced with perceived behavioral control. This is because they have not engaged in such an activity before (Fairer Brother & Stranger Ross, 2009).Breast feeding behavior is planned right from the ante natal clinic when the nurse, lactation consultant, nutritionist hold incessant sessions with the women pre and after birth emphasizing on the mother’s confidence and verdict to breast feed. Harmonization of formal group which includes the nurse, lactation consultant, nutritionist and informal group which includes the husband, mother, relatives and community support providers should be in progress prenatally and postnatally for preferred results (Vari, 2000).
Concept of Breastfeeding
Breastfeeding is a natural process of infant feeding involving two main methods; exclusive and partial with the latter being most trendy. Nevertheless, exclusivity is the absolute and suitable scheme. However, a good mental, emotional and physical collaboration between the mother and her newborn is required desired outcome (Khresheh, 2011). Breast milk consists of basic nutrients containing proteins, vitamins, fats, minerals and carbohydrate.
Lactoferrin inhibits the growth of iron-dependent bacteria in the gastrointestinal tract. This inhibits certain organisms, such as coliforms and yeast that require iron.Secretory IgA also works to protect the infant from viruses and bacteria, specifically those that the baby, mother and family are exposed to. It also helps to protect against E. coli and possibly allergies. Other immunoglobulins, including IgG and IgM, in breast milk also help protect against bacterial and viral infections. Eating fish can help increase the amount of these proteins in your breast milk.Lysozomeis an enzyme that protects the infant against E. coli and Salmonella. It also promotes the growth of healthy intestinal flora and has anti-inflammatory functions.Bifidus factorsupports the growth of lactobacillus. Lactobacillus is a beneficial bacteria that protects the baby against harmful bacteria by creating an acidic environment where it cannot survive.
Fats inhuman milk also contain fats that are essential for the health of your baby. It is necessary for brain development, absorption of fat-soluble vitamins, and is a primary calorie source. Long chain fatty acids are needed for brain, retina, and nervous system development. They are deposited in the brain during the last trimester of pregnancy. The amount and types of vitamins in breast milk is directly related to the mother’s vitamin intake. This is why it is essential that she gets adequate nutrition. Fat-soluble vitamins including vitamins A, D, E and K, are all vital to infant’s health.
Water-soluble vitamins such as vitamin C, riboflavin, niacin, and pantothenic acid are also essential. Because of the need for these vitamins, many healthcare providers and lactation consultants will have nursing mothers continue on prenatal vitamins. While lactose is the primary carbohydrate found in human milk. It accounts for approximately 40% of the total calories provided by breast milk. Lactose helps to decrease a large number of unhealthy bacteria in the stomach, which improves the absorption of calcium, phosphorus, and magnesium. It helps to fight disease and promotes the growth of healthy bacteria in the stomach.
However, presence of minerals fulfills micronutrient needs and maternal antibodies improves the immune system inhibiting infantile infections like gastrointestinal, respiratory and skin infections and increases physical and neurological growth of the baby.
There is increased production of hormones that are responsible for uterine contraction e.g. oxytocin, preventing hemorrhage and maternal mortality. Lactation amenorrhea is mentioned as a natural contraceptive benefactor following exclusivity,on the other hand, breast cancer and ovarian cancer risk prospects are reduced with weight loss following exclusive breastfeeding; also prevention of early cardiac morbidity and mortality (Fairbrother& Stranger-Ross, 2009). During 1940s, exclusive breastfeeding was a communal tradition in all corners of the globe; subsequent to the World War II, there was a reduction and conversion to modern trend in the use of fabricated formula milk particularly in the western world. The use of infant formula became inevitable as it started to become widespread despite the advice from World Health Organization (WHO) and United Nations Children Fund (UNICEF) which recommends exclusive infant breastfeeding for the first six months of life and continuing up to two years of age and beyond (Coates, 2007).
Breastfeeding is the normal, natural way to feed infants and is part of laying the foundation for a healthy life from infancy and childhood. Breast milk is easily absorbed, has a low solute load and an increased availability of minerals, vitamins, and proteins. It has been estimated that exclusive breastfeeding (EBF) reduces infant mortality rates by up to 13% in low-income countries(Jones, Steketee, Black, Bhutta& Morris, 2003).Stuebe(2009) indicated that breastfed infants have fewer ear and respiratory tract infections, diarrhea illnessesand atopic skin disorders. Early introduction of breast milk substitution for cow’s milk has been shown to increase the risk of type 1 diabetes later in life (Sandanskaitte, Ludvigason, Padaiga, Jasinskiene& Samuelsson, 2004). The World Health Organization (WHO) recommends that infants be fed exclusively on breast milk from birth to six months of age. While exclusive breastfeeding rate is on the increase globally and in sub-Saharan Africa, it has continuously been on the decline in Nigeria. The Nigerian Demographic and Health Survey as it is reported by UNICEF (2008) estimated the level of exclusive breastfeeding in the country at 13% which is a drop from the 17% estimated in 2003. Nigeria has poor nutritional indices which indicate 14% low birth weight, 13% EBF, 14% stunting and 27% underweight (Ogbonaya&Aminu, 2013). Nigeria comes third after India and China in the world list of greatest number of undernourished children and is currently one of the two African countries listed among the twenty responsible for the 80% of global malnutrition. Malnutrition is particularly severe in the Northern region of the country (UNICEF, 2009). Complementary feeding is defined as the process of starting additional food to breast milk when breast milk alone is no longer sufficient to meet the nutritional requirements of infants, and therefore other foods and liquids are needed, along with breast milk. It is recommended that complementary foods (solid or semisolid foods fed to infants in addition to breast milk) should be introduced at age 6 months (WHO, 2003). This is necessary because breast milk alone is no longer sufficient to meet the nutritional requirement for the infant from 6 months hence affect their optimum growth and development. Inadequate knowledge about appropriate complementary foods and feeding practices is often a greater determinant of malnutrition than lack of food (WHO, 2003).