EXCLUSIVE BREAST FEEDING KNOWLEDGE, ATTITUDE AND PRACTICE AMONG WOMEN AND THEIR UNDER-TWO ANTHROPOMETRY IN NAVY TOWN HOSPITAL, OJO-LAGOS

ABSTRACT

The knowledge, attitude and practice of exclusive breast feeding among women of child bearing age in Navy Town, Ojo, Lagos state and the anthropometric assessment of their under-two children was assessed. The study showed that the mothers had a high knowledge of exclusive breast feeding, roughly same attitude and low practice. Of the 200 mothers with their babies studied, 76.5% correctly defined exclusive breast feeding, 91.3% and 82.0% were the mean scores for favourable and unfavourable attitude respectively and 38% practiced exclusive breastfeeding. For anthropometry, the anthropometric measures of length, weight and head circumference of their under two children was within range with the WHO reference standard. The EBF infants showed a higher increase in length at 6 months of age compared to their NEBF counterparts; The NEBF infants showed a higher increase in weight at 12 months of age unlike their EBF counterparts and there was no significant difference in head circumference between the two groups. Emphasis on benefits of exclusive breast feeding not just on information and duration of breastfeeding; evaluation of content of health talks regarding exclusive breast feeding so that messages are effectively communicated, re-training of health workers; encouraging breast feeding on demand are some recommendations to strengthen knowledge and enhance attitude and practice of exclusive breastfeeding

Key Words: Exclusive Breast Feeding, Knowledge, Attitude, Practice and Anthropometry

CHAPTER ONE

INTRODUCTION

According to the World Health Organization (WHO), “Exclusive breastfeeding means that an 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 medicines.” ¹

It is recommended that for the first six months of life, infants should be exclusively breastfed to achieve optimal growth, development and health. Thereafter, infants should receive nutritionally adequate and safe complementary foods while continuing to breastfeed for up to two years or more. Over the last decade, overwhelming scientific evidence supporting the integral role of breastfeeding in the survival, growth and development of a child, as well as in the health and well-being of the mother, has come to light.

Breast milk has the complete nutritional requirements that a baby needs for healthy development. Moreover, it is safe and contains antibodies that help protect infants and boost immunity. Consequently, breastfeeding contributes to reduced infant morbidity and mortality due to diarrhoea, respiratory infections, ear infections and other infectious diseases. For the mother, breastfeeding is economical; breast milk is always available, clean and at the right temperature. Breastfeeding also delays the return of fertility and reduces the risk of developing breast and ovarian cancers. ² Variables that may influence breastfeeding include race, maternal age, maternal employment, level of education of parents, socio-economic status, insufficient milk supply, infant health problems, maternal obesity, smoking, parity, method of delivery, maternal interest and other related factors.³

To enable mothers to establish and sustain exclusive breastfeeding for six months, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) recommend:

(1) Initiation of breastfeeding within the first hour of life; (2) Exclusive breastfeeding;

• Breastfeeding on demand that is – as often as the child wants; (4) No use of bottles, teats or pacifiers. ⁴

Anthropometric measures are used to assess the nutritional status of individuals and population groups, and as eligibility criteria for nutrition support programmes. Common anthropometric measures for under-two children include head circumference, height, weight and mid-upper arm circumference (MUAC). Some measurements are presented as indices, including height-for-age (HFA), weight-for-age (WFA), weight-for-height (WFH) and body mass index (BMI)-for-age. Each index is recorded as a Z-score that describes how far and in what direction a child’s anthropometric measurement deviates from the median. Based on the measurements, the nutritional status of under-2 children can be categorised as: Normal; Stunting (inadequate length or height relative to age); Underweight (inadequate weight relative to age); Wasting (inadequate weight relative to length or height); or Over nutrition (excessive fat accumulation that presents a risk to health).¹

1.2 PROBLEM STATEMENT

On a global scale, WHO, UNICEF, USAID and SIDA co-hosted and supported the Innocenti Declaration in the 1990s – a global action to reverse declining breastfeeding rate. In spite of the concerted efforts, available data shows that globally, less than 40% of infants under six months of age are exclusively breastfed, despite the documented benefits of breastfeeding. In addition, only 38% of infants aged less than six months in the developing world, Africa included, are exclusively breastfed⁴

Like in many of the sub-Saharan African countries, the practice of breastfeeding in Nigeria has been a major aspect of infant feeding but exclusive breastfeeding practice is poor. Presently in Nigeria it has been shown by the Multiple Indicator Cluster Survey (MICS 2007) data and National Demographic Health Survey (NDHS, 2008) that only 13% of nursing mothers practiced exclusive Breastfeeding, this is a decline from 17% reported in NDHS (2004).⁵ This is far below the 90% level recommended by the WHO⁴ Malnutrition has been implicated in about 40% of the annual under two mortality rates of 11 million and lack of immediate and exclusive breastfeeding in infancy is said to cause another 1.5 million of these deaths². Available data indicates that a third of children in developing countries are malnourished, 150 million are underweight and 175 million are stunted due to chronic illness and poor diet.

National Demographic and Health Survey (NDHS) 2003 indicates that 40% of under-two children in Nigeria are stunted, almost 10% are wasted and 29% are underweight. Malnutrition is increasingly recognized as a prevalent and important health problem especially in the developing countries³. This problem has serious long-term consequences for the child and adversely influences their development. In Nigeria, the poor practice of exclusive breastfeeding is influenced by various socio-economic, beliefs and cultural factors such as unhealthy hospital practices, unemployment, lack of support for breastfeeding mothers, perceived lactational insufficiency, illiteracy and ignorance of the benefits of EBF. Others are adverse cultural practices, resistance to change, fear of maternal depletion syndrome, urbanization, working mothers, poor attitude of health workers, beliefs relating to the use of colostrum and sexual practices during breast feeding as well as aggressive advertising and marketing of breast milk substitutes. In view of the above statistics and the aforementioned restraints, this project work attempts to ascertain the knowledge, attitude and practice regarding exclusive breast feeding of infants by mothers in Navy Town Barracks, Ojo in order to sensitize them on the usefulness of exclusive breast feeding; the anthropometric assessment of their under-2 children and association between practice of exclusive breast feeding and infant anthropometry.

1.3 JUSTIFICATION

The study embarked upon is significant in that:

1. The study will go a long way to determine the knowledge, attitude and practice rate of exclusive breast feeding in Navy town Ojo and Lagos state at large. This could be achieved by helping health workers to knowing how and where to channel her education programmes in Ojo Town and Lagos state at large.
2. Reduce the mortality rate of infants/children due to diarrhoea and other infectious disease, if appropriate intervention strategies are embarked upon.
3. The study will also help the Government implement her policies towards achieving the 2015 Millennium Development Goals (MDGs) 4 and 5 of reducing under-five mortality and maternal mortality in the state
4. It will also serve as a guide for further research either for improvement on the work already carried out or otherwise.

1.4   RESEARCH QUESTIONS

1. What is the extent of knowledge of exclusive breastfeeding in Navy Town, hospital, Ojo, Lagos State?
2. What is the attitude of mothers to exclusive breastfeeding in Navy Town, hospital, Ojo, Lagos State?
3. What is the extent of practice of exclusive breastfeeding in Navy Town, hospital, Ojo, Lagos State?
4. What is the anthropometric measure of children by duration of exclusive breastfeeding in, Navy Town, hospital, Ojo, Lagos State?
5. Is there any significant difference in anthropometric measure and practice of exclusive breastfeeding in, Navy Town, hospital ,Ojo, Lagos State?

1.5 GENERAL AND SPECIFIC OBJECTIVES

1.5.1 GENERAL OBJECTIVE

The aim of this study is to assess the knowledge, attitude and practice of exclusive breastfeeding by women of child bearing age in Military Barracks, Navy Town, Ojo and anthropometric indices of their Under- two children.

1.5.2 SPECIFIC OBJECTIVES

1. To assess the knowledge of the women of child bearing age on exclusive breastfeeding in Navy Town, hospital, Ojo, Lagos State.
2. To assess the attitude of the women of child bearing age on exclusive breastfeeding in Navy Town, hospital, Ojo, Lagos State
3. To assess the practice of exclusive breastfeeding among under-two children in Navy Town, hospital, Ojo, Lagos State .
4. To assess the anthropometric measure of children in Navy Town, hospital, Ojo, Lagos State with the WHO reference standard.
5. To assess relationship between practice of exclusive breast feeding and anthropometric status of children in Navy Town, hospital, Ojo, Lagos State

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