Influence Of Information Sources On Knowledge, Attitude And Practice Of Exclusive Breastfeeding Among Nursing Mothers
This study was conducted to assess the influence of information sources on knowledge and attitude of nursing mothers toward the practice of exclusive breast feeding in Minna, Niger state. The background of the study gave a general and comprehensive introduction of the study, statement of the problem were identified. The significance of the study was outlined and operational definition of terms was included for proper understanding, scope of study was also drawn out current related literature were reviewed and theoretical framework that, is relevant lo the study that is discussed. Questionnaires with open and closed ended questions were administered to 210 respondents and all were retrieved and a total of 208 that were properly filled were analysed. Date was analyzed using frequency table, percentages pie chart and bar charts. The discussion of result and interpretation of findings were made.
The results from the findings shows that 95 (95%) of the respondents have good knowledge about exclusive breastfeeding while 15(15%) practices exclusive Breastfeeding. From the above, it was observed that the respondents have good knowledge about exclusive breastfeeding had no influence on their poor attitude towards the practice of Exclusive Breastfeeding. Other factors such as early resumption to duty and late closing hour 98 (98%) and also lack of support from colleagues (96%) are other hindrances to the effective practice of Exclusive Breastfeeding.
The findings result revealed that nursing mothers have good knowledge about Exclusive Breastfeeding while their attitude towards the practice of Exclusive Breastfeeding is very poor. Recommendations and suggestion for further study were made.
1.1 Background to the Study
New born children in many African households, especially in Nigeria receive less commitment of being exclusively breastfed by their mothers. A news report stated mothers have many reasons why they do not exclusively breastfeed; one of such is twin births, myths such as fear for loss of sexual appeal, sagged breasts and fear of infecting their new born children with Human Immunodeficiency Virus (HIV).(Business Hallmark Newspaper, 2015; Sina, 2016).Other reasons that may stop mothers from exclusively breastfeeding include, that nursing mothers did not likely continue with exclusive breastfeeding for six months, influence of loved ones like aged grandmothers affect the mother’s practice of exclusive breastfeeding. This is because they usually insist on traditional practices which include, discarding of colostrums, giving infants water, animal milk, pap, infant formula, honey, herbal preparations and also washings from quoranic inscriptions believed to be medicinal (Agunbaide & Ogunleye, 2012; Moisse, 2011; Umar & Oche, 2013). These practices can lead to an infant’s malnourished state, and may even lead to death if they are not properly managed.
The World Health Organisation (WHO) (2003), made it known that inappropriate breastfeeding practices contribute strongly to high mortality rate among children under the age of five. In the same vein, Veneman (2008) collaborated this, during the celebration of world breastfeeding week at Abuja, when she defined breastfeeding as a key tool in improving child survival in this world. She further stated that exclusive breastfeeding for the first six months of life can avert up to 13% 0f children under the age of five deaths in developing countries, This implies that exclusive breastfeeding to a large extent determines the health of an infant.
Nigeria demographic health survey (2008) in the view of evaluating the state of health stated Nigeria to have the highest number of stunted children in the continent and ranks third globally with more than ten million stunted children. Alexandra (2016) said the main indicator for malnutrition is stunting. Stunting is very much prevalent in Niger state. He also stated that Niger state accounts for the prevalence of stunting as 34%, underweight at 11% and wasting at 18% in children less than five years. This means that a large percentage of children under five years have symptoms of malnourishment in Niger state. This could be as a result of not been exclusively breastfed by their mothers, since breast milk offers all the nutrients needed, malnutrition sets in when the baby is not exclusively breastfed.
An article by Summary of child survival partnership (2008), stated Nigeria as one of the six countries that account for half of all children’s death worldwide with one million children under-five dying every year. Also, an article by Federal ministry of health saving newborn lives in Nigeria, 2011, stated that malnutrition contributes to over one third (35%) of those deaths. This implies that infants who are malnourished due to improper breastfeeding are likely to die. This could be the reason why Niger state has under-five mortality rate at 123 per 1000 live births (Alexandra, 2016). Malnutrition is a cause of child mortality; this is in agreement with the account given by Isaiah (2015) that malnutrition is responsible for over 50% of less than five mortality rate in children and women in northern Nigeria. United Nations Children’s Fund stated that 13% of 10 million deaths of children in the 42 countries that account for 90% of child’s deaths throughout the world can be prevented by exclusively breastfeeding children for the first six months of their lives (UNICEF, 2005). In order to reduce child mortality, deliberate efforts must be put together by government to ensure mothers exclusively breastfeed their infants.
Attempts have been made by the government and WHO to ensure that infant malnutrition is limited. In relation to this is the world breastfeeding week. The week is an annual celebration which is held every year within August 1-7 in more than 120 countries. It was first celebrated in 1992 by the World Alliance for Breastfeeding Action (WABA). It was formed on the 14th February 1991(World Breastfeeding Week, 2010). According to an article by Nursing World (2016) Nigeria is one of the countries that celebrate the world breastfeeding week; the week is spent campaigning, encouraging exclusive breastfeeding and also warning against risk of formula feeding. Many mothers are informed about exclusive breastfeeding through such campaigns. According to Brikins (2016), the materials distributed during this breastfeeding campaign are flyers, stickers and handbills on breastfeeding. This shows that information has been passed across to mothers concerning exclusive breastfeeding.
According to Nigeria’s Federal Ministry of Health (2011), exclusive breastfeeding refers to feeding babies with breast milk only, without giving them water, mixtures from local herbs or other forms of liquid and food. Drops such as vitamins, minerals supplements or medicines can however be given when they are prescribed. Furthermore exclusive breastfeeding means that the infant or newborn receives only breast milk. WHO (2016) stated that exclusive breastfeeding should therefore not be combined with any other food while it is being practiced. Exclusive breastfeeding emphasizes feeding solely with breast milk. Veneman (2008) emphasized that exclusive breastfeeding means that no other liquid or solid is fed to the infant, with the exception of medicines.
The importance of exclusive breastfeeding is propagated on occasions such as world breastfeeding week. UNICEF (2015) affirmed that exclusive breastfeeding is a good influence on child nutrition. The United Nations Children Fund in Nigeria, invited journalists to Kano as part of its activities to mark “breastfeeding week”. It solicited for media assistance on ways of sensitizing authorities and other stakeholders on the crisis of child malnutrition in Nigeria. UNICEF Chief of Communication, Porter (2015) in her remark called for intensified media advocacy on child nutrition in Nigeria. Porter noted that past efforts by the media have been effective.
This was said based on many media campaigns ranging from topics such as breastfeeding and childcare, women breastfeeding, the essence of exclusive of exclusive breastfeeding to new born health in Nigeria. The media and other information sources have, in electronic, print and vocal forms being used to convey the importance of exclusive breastfeeding to mothers.
Nursing mothers are continuously remembered of the importance of exclusive breastfeeding through information sources around them, one of which is the media. Since there have been few systematic, large scale media campaigns, full potential of mass media to promote breastfeeding is as yet unrealized and therefore unknown. What has been learnt is that breastfeeding promotion programs are designed to address three types of factors affecting breastfeeding practices: 1) negative public attitudes toward breastfeeding; 2) lack of knowledge of specific breastfeeding skills such as correct positioning of the baby on the breast and increasing milk production; and 3) social norms that define breastfeeding as unusual behaviour (Cynthia, 1989).
This shows that for information sources campaigns to be effective they have to largely cover every breastfeeding issue and not be limited in their coverage. Cynthia (1989) stated that one of the lessons learnt about breastfeeding campaigns is that general messages proclaiming the benefits of breastfeeding are not effective since they do not address the major impediments to optimal breastfeeding practice. Successful breastfeeding programs use mass media as part of a long range promotion strategy rather than as sporadic, short lived campaigns. A change in group norms favouring breastfeeding which some experts believe is the key factor determining breastfeeding practices cannot be achieved by a brief media campaign.
Similarly, specific breastfeeding skills and advice need to be provided on a continuous basis; there are always new mothers giving birth .As the world evolves lots of issues arise concerning the practice of exclusive breastfeeding and media campaigns on exclusive breastfeeding should be able to address these issues. Joan (2016) in agreement with Cynthia noted that factors influencing exclusive breastfeeding are evolving. Years past, the public encouraged breastfeeding mothers to breastfeed their infants where ever the need arises but presently it seems uncultured to breastfeed in public places like markets, offices.
1.2 Statement of the Problem
Over time information concerning exclusive breastfeeding and its importance have been passed across to mothers through several information sources such as mass media, internet, interpersonal sources and information education materials. Exclusive breastfeeding has been noted to solve the problem of malnutrition which is at factor influencing infant mortality as agreed by (Mde 2011; Lloyd, 2011, Save the children 2012). Some much effort has been put in by stakeholders to see that nursing mothers adopt exclusive breastfeeding for their infants. This study found out the influence of information sources on knowledge, attitude and practice of exclusive breastfeeding amongst nursing mothers in Minna, Niger state.
1.3 Objective of the Study
The main objective of this study was to investigate influence of information sources on knowledge, attitude and practice of exclusive breastfeeding amongst nursing mothers, in Minna, Niger State. The specific objectives are to:
- Indentify the sources from which nursing mothers get information about exclusive breastfeeding;
- Ascertain respondents knowledge on exclusive breastfeeding in Minna, Niger State;
- Determine the attitude of respondents towards exclusive breastfeeding in Minna, Niger State;
- Ascertain the practice of exclusive breastfeeding by respondents in Minna, Niger State;
- Examine the influence of intervening demographic variables such as age, religion, academic qualification, employment status, marital status on the practice of exclusive breastfeeding by respondents in Minna, Niger State;
- Determine if information sources of exclusive breastfeeding significantly influence knowledge of exclusive breastfeeding;
- Find out if information sources of exclusive breastfeeding significantly influence attitude to exclusive breastfeeding and
- Find out if information sources of exclusive breastfeeding significantly influence practice of exclusive breastfeeding.
1.4 Research Questions
- What are the sources from which nursing mothers get information on exclusive breastfeeding in Minna, Niger State?
- What is knowledge of respondents on exclusive breastfeeding in Minna, Niger State?
- What is the attitude of respondents towards exclusive breastfeeding in Minna, Niger State?
- What is the practice of respondents towards exclusive breastfeeding in Minna, Niger State?
- How do intervening demographic variables such as age, religion, academic qualification, employment status, marital status influence the practice of exclusive breastfeeding by respondents in Minna, Niger State?
- Do information sources of exclusive breastfeeding significantly influence knowledge of exclusive breastfeeding?
- Do information sources of exclusive breastfeeding significantly influence attitude to exclusive breastfeeding?
- Do information sources of exclusive breastfeeding significantly influence practice of exclusive breastfeeding?
H01; Respondents’ attitude to exclusive breastfeeding will not be significantly influenced by their knowledge of exclusive breastfeeding got from the information sources.
H02; Respondents practice of exclusive breastfeeding will not be significantly influenced by their knowledge of exclusive breastfeeding got from these information sources.
H03; Information sources of exclusive breastfeeding do not significantly influence knowledge of exclusive breastfeeding.
H04; Information sources of exclusive breastfeeding do not significantly influence attitude to exclusive breastfeeding.
H05; Information sources of exclusive breastfeeding do not significantly influence practice of exclusive breastfeeding.
1.6 Scope of the Study
This study was delimited to influence of information source on knowledge, attitude and practice of exclusive breastfeeding among nursing mothers in Minna, Niger State. The study was not concerned with only the reasons why mothers do not practice exclusive breastfeeding rather it covered the influence all kinds of information source on knowledge, attitude and practice of exclusive breastfeeding amongst nursing mothers in Minna, Niger State.
The study was conducted in the capital of Niger State, from January 31, 2017 to March 31 2017. It was delimited to the capital, Minna, because it was where we could find diverse nursing mothers with different attributes such as educational status, employment status and marital status which helped the population of the study to be unbiased. There were only two local governments in the capital, which are Bosso and Chanchaga, thirty three healthcare centres in the two local governments have were selected, this was to limit the time scope of the study.
1.7 Significance of the Study
The contributions and outcome of this study would be of great benefits to stakeholders such as media organizations, government, healthcare systems, World Health Organizations and United Nations child’s fund. It was an evaluation of how much effort that has been put in to ensure mother adopt exclusive breastfeeding by these stakeholders. To mass media scholars, it would likely act as a guide for further studies towards influence of mass media on knowledge, attitude and practice of exclusive breastfeeding. It also enlightened media professionals on the approach most suitable for influencing mother’s knowledge, attitude and practice towards exclusive breastfeeding.
1.8 Operational Definition of Terms
These are some operational definition of terms in relation to this study.
In this study, the term influence is used to mean power to change something in some way. The power of information sources to change exclusive breastfeeding knowledge, attitude and practice among mothers in Minna, Niger State.
2. Information Source:
In this study, the term information source is used to mean all forms of communication sources of exclusive breastfeeding. This refers to mass media, interpersonal sources, new media, pamphlets, fliers and all kinds of tools used in communicating information about exclusive breastfeeding.
In this study the term knowledge is used to explain awareness, understanding of information concerning something. Knowledge refers to information gotten from information source about exclusive breastfeeding by nursing mothers in Minna. Knowledge here means definition of exclusive breastfeeding, the importance of exclusive breastfeeding, how to practice exclusive breastfeeding, when to practice exclusive breastfeeding (exclusive breastfeeding is to be practiced for the first six months of the infants life), and also challenges of exclusive breastfeeding.
In this study the term refers to the behaviour towards something. That is the positive and negative feelings that mothers have towards exclusive breastfeeding among nursing mothers in Minna.
In this study the term, practice is used to mean continuous exercise of exclusive breastfeeding by mothers in Minna; this includes the committed or negligent practice of exclusive breastfeeding. Practice will be measured by the information sources messages that encouraged continuity of exclusive breastfeeding by nursing mothers.
6. Exclusive Breastfeeding:
In this study it means infant receiving only breast milk. No other liquids or solids are given, not even water, with the exception of oral rehydration solution or drops of syrups of vitamins, minerals or medicines. In exclusive breastfeeding, the mother feeds the child with only breast milk with the exception of drugs recommended by the doctor”.
7. Nursing mother:
In this study, the term refers to women of all ages who have the ability to breastfeed and are also within the time of this study breastfeeding their infants. Nursing mothers in this study also encompasses nursing mothers who are employed or unemployed, young or old. Mothers who have lost their babies after childbirth are not included in the term “nursing mothers” for this study.
Summary, Conclusion and Recommendations
5.1 Summary of Key Findings
The study discusses essentially, the knowledge attitude and practice of exclusive breastfeeding among women among nursing mothers in Niger state. The objectives of the study were to find out women‘s knowledge of exclusive breastfeeding, examine the attitude of women towards exclusive breastfeeding among nursing mothers in Niger state, identify the behaviour of women towards exclusive breastfeeding in the study area and analyse factors influencing the practice and non-practice of exclusive breastfeeding among women in the study area.
The findings showed that most (38%) of the respondents were within the age bracket of 21-30 years, findings also revealed that respondents who were between the ages of 21-30 practiced mixed feeding more than other age groups.
Furthermore, majority (52%) of the respondents are Christians, most of the respondents have (53%) have attained tertiary education and majority (31%) are public servants. Findings also reveal that majority (33%) of the respondents earn below 18,000 naira monthly, most (40%) of the respondents are from other tribes, majority (84%) are married women, and (40%) are experienced mothers.
Findings on knowledge of exclusive breastfeeding show that majority (95%) of respondents were aware of exclusive breast feeding, majority(85%) received their education in a hospital, majority (51%) believe that breastfeeding should be initiated within one hour of birth, most (81%) of the respondents believe it is recommended for 0- 6months and majority (61%) of the respondents believe it is beneficial to both the mother and child. Further findings revealed that respondent‘s knowledge of benefits of exclusive breastfeeding. Result shows that majority (93%) agreed that breastfeeding increases mother and infant bonding, 92% of the respondents agreed that exclusive breastfeeding increases stronger immune system. Also, majority (93%) agreed that exclusively breastfed infants have reduced risk of infectious diseases and majority (66%) agreed that exclusively breastfed infants have reduced rates of diseases.
Findings also reveal that majority, agreed that mothers who breastfeed exclusively have reduced risk of breast and ovarian cancer with83% and 85% respectively. Analysis on higher cognitive development capacity of exclusively breastfed infant shows that majority 75% of the respondents agreed that exclusively breast-fed infants have higher cognitive development and intellectual capacity than their formula fed peers, 83% agreed that exclusive breastfeeding increases intellectual capacity and 81%believe that exclusive breastfeeding reduces health care cost.
Findings further revealed that majority (71%) agreed that mother‘s perception of insufficiency of breast milk discourages the practice of exclusive breastfeeding and most (66%) agreed that lack of maternal education predisposes mothers not breastfeed exclusively. Results also revealed that majority (85%) agreed that nutritional status of mother influences decision to breastfeed exclusively and majority (53%) agreed that mother/child medical condition can hinder the practice of EBF. Finally, majority (16%) of respondents suggested education for everyone as means of motivating the practice
Mixed feeding still seems to be more prevalent among nursing mothers in Niger state. Despite the increased knowledge of exclusive breastfeeding, and the favourable attitude towards it, it consequently reflects in the health of mothers and children. This implies that the knowledge of exclusive breastfeeding does not necessarily translate into practice. Other factors were identified as barriers to the practice. Such factors include: lack of support from spouse and relatives, employment, lack of support from co-workers and management at places of work. Also, findings of the study revealed that social cultural beliefs and practices, lack of maternal education, poor perception about insufficiency of breast milkand poor power supply for the storage of expressed breast milk, hinders the practice of exclusive breastfeeding. Maternal nutritional status, medical condition, and infant‘s medical condition were also identified as possible factors that hinder the practice of exclusive breastfeeding.
Based on the findings of the research, the following recommendations are made:
- Although, knowledge is no longer a challenge like it was before, the ministry of health and other health organization still need to intensify their efforts in educating women of child bearing age by organizing seminars and symposia specifically addressing the concerns of delayed milk production and breastfeeding difficulties. Mothers should be educated on breastfeeding techniques, how to care for the breast and ways to prevent breast feeding problems such as breast pain and engorgement. They also need to be educated on how to maintain good health and proper diet as they contribute to ensuring a successful practice.
- Current public health interventions on exclusive breastfeeding are tailored to the needs of breastfeeding women only. As a result, health organizations and NGO‘s should come up with strategies in educating grandmothers, fathers and traditional birth attendants with the aim at increasing the familiarity of family relations on exclusive breastfeeding, as they play a key role in influencing mothers in infant feeding practices. Husbands should be fully involved throughout the stages of pregnancy and delivery so they can understand what is needed to provide adequate support
- Breastfeeding education should be introduced in school curriculum. That way, young people of both sexes can be educated at an earlier stage as they are future parents.
- Based on the findings of the study, lack of support from management at the work place has been a barrier to the practice of exclusive breastfeeding. Therefore, the ministry of labour and productivity need to address women‘s right to breastfeed in the workplace by ensuring that employers provide breastfeeding and expressing facilities at the work place, such as crèche facilities to be used by employees who are nursing mothers. Also, employers should consider reduced working hours for breastfeeding employees or extension of maternity leave period. This will give nursing mothers time to breastfeed on demand and that will consequently motivate the practice of exclusive breastfeeding.
- Based on the findings of the study, lack of support was identified as one of the major factors that hinder the practice of exclusive breastfeeding. Therefore, government in collaboration with health organizations should come with intervention on behaviour change programmes to support the practice of exclusive breastfeeding.
- Government and health professionals need to especially target low-income women when creating and applying interventions. Women with very low income find it difficult to feed themselves let alone breastfeed exclusively. Early cessation was associated with impoverished living conditions, and the government need to tackle the issue of poverty and improve its citizen‘s standard of living.
- Government and electricity distribution companies should address the problems of power supply so as to ensure a proper storage of expressed milk.
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