Knowledge And Attitude Of Nursing Mothers On Exclusive Breastfeeding

Project and Seminar Material for Nursing (Science)

Knowledge And Attitude Of Nursing Mothers On Exclusive Breastfeeding


Abstract


This project aimed at ascertaining the knowledge, practice, attitudes, feelings and some beliefs of exclusive breastfeeding among nursing mothers at Legon Hospital. The study was that of a descriptive one that relied on data collection using questionnaires administered to 50 nursing mothers who are breastfeeding babies aged between 1-12 months. From the study ,majority of the children,17{34%} brought to the post natal clinic were between 3-4 months, with also majority of the participants from East Leonean area apparently with high infrastructural development high residential status, suggesting upper income level earners. Also, majority of nursing mothers, 45{90%}, believe in EBF as beneficial to children. This indicates a positive relation among the as far as EBF promotion is concerned. Again, for the fact that majority of them,36{75%}said that they would breastfeed exclusively for 5-6 months suggest that most of the children in the age range 3-4 months are most likely to be exclusively breastfed for 6 months. Most of the mothers are traders and artisans which implies they the bulk of the supporters and believers of EBF.They therefore need a back-up support and motivation to propagate the education on EBF. Almost an equal number of either side of the mothers know or did not know of breast milk expression and storage. An effective way is to embark on an extensive education on EBF, expression, storage and management of breast milk on television, radio programmes, antenatal and postnatal clinics as well as individual counseling.


Chapter One


Introduction

1.1 Background of Study

Nurses play a major role in the promotion and implementation of Primary Health care (www.paho.org / English / DD / DIN / alma-ata declaration.htm). Since nurses are the bedrock in the delivery of healthcare, they frequently need to be updated with adequate knowledge so that they, in turn, spread adequate information and skills to mothers and the community as a whole. However, the health and nutritional status of children and mothers are intimately linked. This means that mothers and their children form a biological and social unit; the health and nutrition of one cannot be divorced from another.

Therefore, children have the right to access safe and nutritious food. These factors are important for achieving full potential growth and development. Women also have the right to adequate food and the right to decide how to feed their children and to have correct information and conditions that will enable them carry their decisions. They also have the right to maternity protection and nutrition (NIYCF, 2006-2010). Breastfeeding provides the healthiest beginning for the infant. With the risk of Mother to Child Transmission of HIV through breast feeding, health workers need guidance on how to address issues of optimal infant feeding on one hand whilst minimizing the risk of MTCT and the risk of infants dying from improper feeding practices on the other hand (NIYCF, 2006-2010).

In the recent past with the unfolding detail about HIV/AIDS and MTCT, the need for consistent and clear messages in relation to optimal infant and young child feeding practices has become more apparent. The National Infant Young Child Feeding (NIYCF) operational Strategy builds on the past and continuing achievements in promoting optimal infant and young child feeding. These include exclusive breast feeding for six months and continued breastfeeding up to 2 years with introduction of appropriate timely complementary feeding, the implementation and monitoring of the International Code of Marketing of breast milk substitutes and the rights of working women to maternity protection. In the past decade, the government has implemented programmes aimed at improving the welfare of infants and young children.

The government has 1 also enacted a legislation to reduce the marketing of breast-milk substitutes. Currently, various community-based initiatives (HIV positive living support groups, Home based Care support groups, etc), do not adequately include infant feeding issues in their agenda. However, recognition of these structures is cardinal for the implementation of various chosen successful breastfeeding initiatives in the Baby Friendly Hospital Initiative (BFHI). These include breast feeding and child survival and Baby Friendly Hospital Initiatives. Additionally, the effective referral system between health facilities and community needs to be strengthened where they do not exist.


1.2 Statement of the Problem:

There has not been a mechanism put in place to keep proper or concrete records on the activities as well as indicators of Exclusive Breastfeeding and mothers support groups in hospitals, polyclinics and health centres in Nigeria. There has however been occasional figures produced from special exercises or survey carried out. For instance, (World Linkages, Nigeria, July 2000; Country Profile), in a study in the upper East region in Nigeria, revealed that among children less than two months old, 43 percent are exclusively breastfed. By the fourth to the fifth month, the figure drops to 22 percent. Moreover, on the average, globally, only 39 per cent of babies breastfeed exclusively, even in the first four months of life (UNICEF; WABA, 2003).


1.3 The Purpose of the Study:

The purpose of the study is to ascertain the current feelings and views of a cross-section of the Breastfeeding mothers on a MCH clinic day at University of Benin Teaching Hospital (UBTH), about exclusive Breastfeeding in order to develop appropriate strategies.


1.4 Objectives of the Study

Main objective

The main objective of the study is to find out the perception on exclusive breastfeeding among postnatal mothers.

Specific Objectives

Assess the level of Breastfeeding mothers’ views about the benefits of exclusive breastfeeding;

  1. Determine the level of breastfeeding mother’s views about barriers to exclusive breastfeeding;
  2. Find the feelings towards exclusive breastfeeding
  3. Identify the behaviour of participants;
  4. Investigate any kind of support for breastfeeding mothers on exclusive breastfeeding.

1.5 Research Questions

The question therefore is what the contemporary views of mothers and helpers about exclusive Breastfeeding at University of Benin Teaching Hospital (UBTH) are, though without previous concrete reports or record in place

  1. Do the breastfeeding mothers know how important the exclusive breastfeeding is and how to do it?
  2. Do they have confidence and where do they turn to when they face difficulty?
  3. Are people around them such as fathers and grandmothers supportive especially when mothers have to resume employment soon after delivery?

1.6 Significance

It is hoped that the findings of the study will provide a current perceptual database that will inform all of us and more importantly the policy makers on the feelings and views of the mothers about exclusive breastfeeding so that appropriate alternatives to motivate the indulgence of exclusive breastfeeding and its support, would be developed by Breastfeeding mothers, helpers and the populace of Nigeria.


1.7 Scope of the Study

The study is focused on examining the knowledge and attitude of nursing mothers on exclusive breastfeeding. The study will further arrow to; assessing the level of Breastfeeding mothers’ views about the benefits of exclusive breastfeeding, determining the level of breastfeeding mother’s views about barriers to exclusive breastfeeding, finding the feelings towards exclusive breastfeeding, identifying the behaviour of participants, and investigating the kind of support for breastfeeding mothers on exclusive breastfeeding. The study will be carried out in Legon Hospital, Ghana.


1.8 Limitation of the Study

Like in every human endeavour, the researcher encountered slight constraints while carrying out the study. Insufficient funds tend to impede the efficiency of the researcher in sourcing for the relevant materials, literature, or information and in the process of data collection, which is why the researcher resorted to a limited choice of sample size. More so, the researcher simultaneously engaged in this study with other academic work. As a result, the amount of time spent on research will be reduced.


1.9 Operational Definitions

These are precise descriptions of how to derive a value for characteristics the researcher is measuring. It also entails how specific these characteristics are ;

Exclusive breastfeeding

This means giving a baby only breast milk, and no other liquids or solids, not even water unless medically indicated. This should be for the first 6 months (NIYCF, 2007).

Exclusive replacement feeding

This is the process of feeding a child who is not breastfeeding with a diet that provides all the nutrients the child needs until the child is fully fed on family foods. Infant formula is recommended for exclusive replacement feeding when AFASS (Acceptable, feasible, affordable, sustainable and safe) is met (NIYCF, 2007).

Heat Treated Expressed Breast milk

This means that a mother expresses breast milk and heats it so that the HIV present in breast milk is destroyed making it safe to feed the infant (NIYCF, 2007),

Wet Nursing

This refers to breastfeeding by another woman, who is HIV-negative.

This may only be considered in special situations such as in case of an orphaned infant and the family can not meet AFASS. The wet nurse should be tested every three months (NIYCF, 2007).

Infant

A baby under one year of age or from birth to 12 months of age (NIYCF, 2007),

Knowledge

To have information in one’s mind as a result of experience or because you have learned or been told (Oxford Advanced Learner’s Dictionary, 2005).

Attitude

The way one thinks, feels or behaves about somebody or something (Oxford Advanced Learner’s Dictionary, 2005).

Bottle feeding

Feeding an infant from a bottle, whatever is in the bottle including expressed milk (NIYCF, 2007).

Breast milk substitute

Any food being marketed or otherwise represented as a partial or total replacement for breast milk, whether or not suitable for that purpose (NIYCF, 2007).

Complementary feeding

Child receives both breast milk or a breast substitute and solid (or semi-solid) food, recommended from the time the baby is 6 months old (NIYCF, 2007).

Complementary food

Any food, whether manufactured or locally prepared; suitable as a complement to breast milk or to infant formula when either becomes insufficient to satisfy the nutritional requirements of the infant (NIYCF, 2007).

Mixed feeding

Partial breast feeding and giving some other milk (NIYCF, 2007).


Chapter Five


Discussion, Conclusion and Recommendation

5.1 Discussion

Fifty respondents were sampled for the quantitative study aimed at exploring the perceptions of postnatal mothers on exclusive breast feeding. The study centred on the knowledge, practice, attitude and beliefs of a cross-section of mothers on exclusive breastfeeding.

It also involved the feelings of their supporters and of participants in programmes regarding breast feeding, as well as the problems they have with exclusive breastfeeding{EBF}.The age structure of the subjects showed a higher majority of the mothers in the ages of 25 – 35. The highest,15{30%}, fell within the 25 – 29 age groups showing a feature of a high fertility population in developing countries such as Nigeria. According to Nigeria Demographic & Health Service (1998), the total fertility rate for women aged 15 – 49 is 4.6 births per women and the fertility rate for women aged 20 – 29 is higher than other age groups’. The fertility rate of those aged 45 and above is the least. The study reveals that 30.0% of the mothers are within the age range of 25 – 29 years, giving the impression that more young mothers are in the study than older ones. It also implies that age has no bearing on the practice of exclusive breastfeeding. The pattern suggested that the 25-29 years age group were the most active sexual as well as marriage peak group and hence ,could be responsible for the high fertility rate.

Significantly enough, this is contradictory to the notion of Scarlet et al (1996) that older mothers are more likely to exclusively breastfeed than younger ones. Talking about the ages of the children, the study unearthed that the respondents had children aged between 1 – 12months. Out of these, 17(34.0%) were within 3 – 4 months,16( 32.0%) were within 7-12 months,10(20.0%) within 5-6 months, and the least was 7(14.0%) within 1-2 months. This is a demonstration that a greater percentage of children are exclusively breastfed and have a greater likelihood of being given complementary breastfeeding after 6 months. This was in line with WHO’s expectation of complementary feeding as feeding on breast milk complemented by formula food or solid food. The least numbers of 7(14%)was due most probably to the common traditional beliefs that it is too early to go out especially before the third month after delivery .there is the need to intensify education The participants of the EBF study came from various communities, mainly East Legon, West Legon, and North Legon with inhabitants ranging from upper through to lower income levels. Majority of the Respondents, 21[42.86%}, reside in East Legon alone and North legon alone with 10{20.41%}.East Legon apparently portrays the picture of upper income level of inhabitants, considering its infrastructure development and high residential status. There seem to be a correlation between the places of residence and the practice of exclusive breastfeeding. East Legon apparently shows inhabitants of high income earners who may have no much problem of attendance and the practice of EBF.

This fact is buttressed by the work of Batal et al (2006) at a national study in Lebanon.They complained that exclusivity of breastfeeding was associated with place of residence of (rural/urban) and negatively associated with educational level of the mother. They contended that rural mothers and those who practiced exclusive breastfeeding maintained it for a longer duration. It was discovered that 90.0% (45) of the respondents were married and had initiated breastfeeding. This positive outlook on breastfeeding is suggestive of the tremendous support the family, basically the partners, were giving to these mothers. This is opposed to Scarlet et al (1996) assertion that marriage status had no impact on rates of exclusive breastfeeding. The study supports work of Scott et al{1997} which indicated that the paternal preference for breastfeeding was a principal factor influencing the mothers to breastfeed.{Journal of Pediatrics in child health,1997}This could be due to the fact in Nigerian society, husbands are considered the decision makers of the family. The result from the study revealed that married women are more likely to practice EBF than the unmarried women. In the area of education, only three (3) that is 6.0% were illiterates, but quite a substantial number of the mothers,15{30.0%} interviewed were SSS graduates,28.0% had tertiary education and 26.0% (13) had JSS qualification. The assessment of their knowledge on exclusive breastfeeding portrayed a higher understanding of the practice among the mothers. This could be attributed to their high level of educational attainment. From the study, majority, 47{94.0%} out of the 50 respondents have heard of EBF and in addition majority,45(90%) respondents, heard it from the antenatal clinic. This goes to support a study done by Muhammad student of University of Nigeria, Nursing school in 2001 on knowledge and practices of EBF among nursing mothers in Zabzugu/Tatale district in the northern region of Nigeria, which showed that most of the mothers had heard of EBF mostly from nurses. This does not mean the other ways or methods be left dormant as revealed in this study. A finding by the Nigeria Health Service/Linkages{GHS/LINKAGES} at a training project showed that, at the national level, EBF rate increased from 31% in 1998 to 53% in 2003 and said this was achieved through the use of several different methods of communication, workshops song administration, story-telling and dramas and festivals to reach out to the wider communities in Nigeria.

As regards occupation, most of the respondents, 21{42.86%}, were traders, followed by civil servants with 13{26.53%} and artisans representing 12(24.49%). The nature of the occupation had a toll on some of the mothers and this would impact negatively on their daily commitment to the practice of exclusive breastfeeding.
Therefore, Williams Worthington (1992) is right to the point in stating that employment is associated with cessation of breastfeeding as early as two or three months post partum. However, our assessment of the duration for their practice of exclusive breastfeeding showed different feelings and attitudes. 3{75.0}% of the rspondents said they would breastfeed exclusively for 5 – 6 months and a few mentioned between 1 – 2 months, 3-4 months and 7-12 months. 36(75.0%) of the mothers adhered strictly to the current breastfeeding recommendations by UNICEF/WHO (1993): That no drinks, foods, pacifier/dummies or artificial teats be given to a baby. This study did not support estimates from WHO global Data Bank{1996} which indicated that only 35% of infants had been exclusively breastfed for some duration during the first 4 months of life, with Africa having only 19% of children below 4 months of age exclusively breastfeeding. The short durations mentioned by the other small numbers of mothers could probably be due to lack of enough knowledge on EBF and absence of breastfeeding facilities. Navaro et al{1999};identified the material, work and health services factors associated with a short duration of breastfeeding among a cross section of working mothers in Mexico.

The study suggested that the comparison between mothers working in the formal sector to those working in the non-formal sector (traders and artisans) show that, the latter breastfed exclusively as compared with those who work in the formal sector. A nursing mother working in the formal sector `s breastfeeding behavior may be influenced by her working schedule. Nigerian women working in the formal sector of the economy are entitled to three months maternity leave. This probably contributed to the increased rate in the practice of EBF. Only 14(28.0%) give pacifiers to their children especially when they are in public. Majority of 18(36%) nursing mothers from the study believed that the breast milk was too small which accounts for the early introduction of complementary feeding to the child. Attention should rather be paid to educating mothers on nutritious diet that contains a high level of proteins and calories. Babies should also be put to the breast regularly for 5-10 minutes on each side every 3-4 hours. This finding seems relative because other factors like work and occupation by nursing mothers.Mil Med, 2003, indicated that work makes it impossible for some mothers to exclusively breastfeed their infants. 8(16%) mothers introduced their children to complementary feeds to enable them to resume work, also, 8(16%) saw it as traditional practice and advice from significant others. 4(8%) mothers held that it is modern and 5(10%) said pain at the nipple made them do so. The nursing mother should be taught how to hold her body correctly, lean well back in the chair and relax the arm around the baby so aiding his comfort. Mothers should also talk and smile to the baby so establishing eye and facial contact. In the study, 45{90.0%} of the mothers believed in exclusive breastfeeding as beneficial to their children and to themselves as well. The study confirms Scarlet et al (1996) views that among normal birth weight babies, those exclusively breastfed have higher weight gain than the partially fed ones. It is also an indication that the mothers have unflinching desire and support for the healthy growth and development of their children. Accordingly, these proponents are stressing the importance of exclusive breastfeeding to their peers in their communities and eschewing all negative beliefs, attitudes, practices, knowledge with regard to feeding infants with exclusive breast milk for the first 6 months of life. It is therefore, their hope that healthcare givers would give exclusive breastfeeding education at both antenatal and postnatal clinics to sustain the interest and confidence of mothers in exclusive breastfeeding. These suggestions would materialize if only nurses and other health workers are motivated to continue education relentlessly. In the study majority of the respondents, 30{60.0%}, suggested that education be continued to encourage EBF. This may only materialize if health professionals or nurses are given refresher courses on breastfeeding management. This suggestion supports a survey conducted by the American Academy of pediatrics in 1999 on the educational needs of EBF which showed that majority of the pediatricians had not attended a presentation on breastfeeding management in the past three years and most said they wanted more education on breastfeeding management.


5.2 Implication of Findings to Nursing

The results of the study generally inform us that nursing mothers are aware and have the knowledge about the EBF. From their various suggestions, nurses are called upon to strengthen the campaign for EBF by continuous relentless health education and support to nursing mothers. It is also imperative of nurse educators to be advocative and collaborative in search for support from NGOs, District assembly, other public sectors, etc to promote EBF. Nurses and nurse educators should educate on nutritious diet to nursing mothers and their supporters. Nurses should teach nursing mothers the practical ways to know if the infant is taking enough mother’s milk or not, viz-a-viz feeding, satisfaction, wetness, and weight indicatives. Health workers should use demonstration to educate mothers on the proper fixing of the baby to the breast and encouraged to be relaxed and happy about breastfeeding and eat balanced diet to enhance lactation.


5.3 Recommendations

Further population based studies in a number of developing countries have shown that the greatest risk of nutritional deficiency growth retardation occurs in children between 3 and 15 months of age associated with poor breastfeeding practices{Shrimpton et al,2001}.Also,UNICEF,2001;Every family and community has the right to know about breastfeeding.

The following recommendations are therefore suggested;

  1. Baby friendly hospital initiative be reconsidered and extended to more hospitals to enhance EBF promotion in the countries.
  2. Continuous refresher presentations and workshops be revived nurses and other health workers as a way of motivating them to get the best out of them to support nursing mothers exclusively breastfeed.
  3. Nurses should teach mothers how to know if a baby is breastfed or not. Social support in general is the responsibility by all.
  4. The coordination of support services between clinics, hospitals and the community should be scrutinized in order to ensure the education component of the social support interventions for breastfeeding.
  5. Professionally mediated supports should be employed to influence the behavioural beliefs of women who are making decisions about their infant’s feeding behavbiour.
  6. The influential significant others like the grandmothers, grandfathers, etc be given recognition and role to play in the promotion of EBF within the family and the community.
  7. Government should adopt and maintain policies such as the extension of maternity leaves to 90 days as recently put in place in the health sector. Also, packages are developed for well doing nursing mothers in EBF as a way of motivation to others to emulate the example.
  8. Breastfeeding at night, early in the morning and any time they are with their babies to help keep milk supply high.
  9. Nursing mothers should be encouraged to put their babies to the breast immediately after delivery. They should be taught breast milk expression and storage at the clinics through group discussions and individual counseling with demonstrations.
  10. Outreach services should be embarked to visit pregnant and newly delivered mothers in order to reinforce the education given at the clinics.
  11. Workshops, seminars, radio jingles etc, should be organized more frequently to up-grate knowledge on EBF.

5.4 Conclusion

Throughout, most of global history the distinction between BF and EBF was not nearly as sharp as we have it today
One would argue that the knowledge, practice, attitudes and Beliefs about BF, EBF and complementary feeding as practices in early life took hold only in the past couple of decades.

It goes without saying that from childhood, we are surrounded by contradictory messages about food body size appearance and exeraise. These message teach us to view our meals and bodies warily.

Following that it is undeniable that the latter part of the twentieth century has been witness to the vise in perception of exclusive breastfeeding

In our research, it appeared that only a handful of mothers are very upset about the practice of EBF. Some made it clear to us that they waned nothing to do with the practice and the sooner they reverted formula feed the better. They summelup the prevailing attitude forward EBF as a cause for their frustration.

Secondly, a few mothers questioned as to why they always have to be part of a group such as mothers support group on EBF. This conviction is why can they not be just individuals and why should they have to follow the crowd? These mothers tend to see this strong need to identify with the support group as a moral failing

However it seems to us that these mothers are being a bit hard on themselves as well as their children and we suspect that their vacations were feeding to the kind of phrases. Some antagonists to EBF, such as grand mothers and TBA had thrown at them. But looking at the significance of mothers support Groups, it makes perfect sense for teen, young and adult mothers to form new bonds as new ways to belong and learn outside the family. The misconception is a cliché but also a reality and with this misconder.

Health care givers may be culpabable for this misunderstanding. Because a large part of the problem of perception on EBF lies less in the obeharious of postnatal mothers than in the attitude of Health care givers particularly at both antenatal and postnatal clinics.

The way Health worker perceive EBF will colour the way other people including mothers will respond to the current breast feeding recommendations propounded by UNICEF/WHO 1993.

Mothers would be strongly involved in the EBF practice when we as Health Professionals are confident, which would confirm our sense of healthy living. All and sundry, more specifically, health professionals, we have to keep reminding ourselves of one crucial fact. That EBF is precisely what is supposed to be happening at this stage of life for the preservation and protection of children’s health, prevention of maternal mortialtiy and the continuing growth and development of socity. The modern mothers should turn to this common culture of EBF for validation of the lives of their children and acknowledgement of what they are going through.

In earlier times, patterns of breastfeeding did not differ much among societies. And with the recent introduction of exclusive breastfeeding globally, patterns of breastfeeding are now fairly similar among young and adult mothers and among people form different ethnic, socio- economic and religious group but much more systematized. The programme of UNICEFF/ WHO 1993 has arrived in good time to make the future of Nigeriaian. It is the outmost hop and aspirations of the student nurses/Research team that the culture/practice of exclusive breast feeding would continue to become such a global phenomenon that this generation of young people would think of themselves as truly global healthy citizens.


Knowledge And Attitude Of Nursing Mothers On Exclusive Breastfeeding


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