Abstract

Adequate nutrition at early childhood is essential to ensure healthy growth and development of children, Breast feeding offer health benefits to mother and child when exclusively breast fed. Many children aged less than 5 years are dying due to inadequate exclusive breast feeding practices. Exclusive breastfeeding (EBF) is the best nutrition for children during the first six months of life. However, EBF remains a challenge. The objective of this study was to determined knowledge, attitudes, and practices of Exclusive Breastfeeding among Lactating Mothers in Laquintinie Regional Hospital Douala. In order to achieve the study objective, a sample of 234 participants (nursing mothers) was selected randomly through an interview guided structure questionnaire and cross sectional descriptive hospital base study as study design was used. Data was analyzed using SPSS 21.0 (Statistical Package for Social Science) where descriptive statistics of variables was obtained. Results revealed that, majority (43.64%) of the respondents were in the age group 21-30years, 51.36% were married and had average 1-2 kids. The majority of mothers (87.3%) knew about EBF and had a positive attitude towards EBF but did not know the recommended duration or that EBF is sufficient for six months. The study recommended that, mother’s breastfeeding counseling and health education on nutrition to the mother by health workers should be promoted.

Keywords: Lactating, Breastfeeding, Knowledge; Attitude; Practice

 

CHAPTER ONE

INTRODUCTION

Exclusive breastfeeding (EBF) is the best nutrition for children during the first six months of life.  Early initiation of breastfeeding and exclusive breastfeeding help in child survival, it accounts for healthy brain development, promotes cognitive and sensory performance (Isaacs et al. 2010, AAP 2012, UNICEF, 2015). Among the numerous benefits of breastfeeding, UNICEF in a breastfeeding Campaign (2013) termed the essence of breast-feeding as a “first immunization and an inexpensive life saver”. Mortality among newborns accounts for almost half of child deaths in the world. However, previous studies have shown that placing a new born to the mother’s breast shortly after delivery help reduce mortality to a very large extent (UNICEF 2015, WHO, 2016). In low income and developing countries, due to poor sanitation conditions, high disease burden and limitedness in the availability of clean drinking water, it is more necessary to practice exclusive breastfeeding in the initial stages in life (first six months of the child’s life). In spite of these recommendations, it has been documented over the years that the practice of exclusive breastfeeding has not been adopted universally; most mothers embrace the idea but fail to breastfeed exclusively few weeks after giving birth to their baby. As a result, leading to a let in statement; many infants 0- 6months are malnourished due to inadequate knowledge and poor practices of exclusive breastfeeding (UNICEF, 2005). This leads to the research question; what is the state of knowledge, attitudes and exclusive breastfeeding practices among lactating mothers in laquintinie hospital Douala? Hence the topic; knowledge, attitudes and practices of exclusive breastfeeding among lactating mothers in laquintinie hospital Douala with the general objective to assess the state of knowledge, attitudes and breastfeeding practices among lactating mothers in laquintinie hospital Douala.  The purpose or goal for carrying out this research is to gather a detail about knowledge, attitudes and exclusive breastfeeding practices among breastfeeding mothers which will help me understand more about this topic. The scientific significance of this research is to help in the improvement of knowledge, attitudes and practices of exclusive breastfeeding among lactating mothers in the hospital Douala laquintinie a. This research work will run from chapter one to chapter five. Whereby chapter one is introduction, chapter two is literature review, chapter three, methodology, chapter four, results and chapter five conclusions and recommendation.

 

1.1 Context Of The Study

1.1.1 The World Context Of Exclusive Breastfeeding

The study conducted by Labbok and Taylor (2008) to determine the achievement of exclu-sive breastfeeding in the United States: Findings and Recommendations, reported that, among children born in 2004 whose caregivers were interviewed in 2006, nearly 74% were breastfed, however, only 30.5% were exclusively breastfed through three months and 11.3% were exclusively breastfed through six months of age. Only ten states met one or both of the Healthy People 2010 objectives for exclusive breastfeeding. Rates vary by marital status and age, with married women exclusively breastfeeding to six months twice as frequently as un-married women (13% v. 6%). Rates of exclusive breastfeeding to six months’ increase as maternal age increases: from about 6% of mothers under 20 years of age to nearly 14% among mothers older than 30. Rates also vary by geographical location, suggesting social influences on exclusive breastfeeding practices. Rates are lowest in the South eastern region of the country and in rural areas in general. While in another study conducted in the same country among three categories of women; women who were employed full time, who work part time and who were not employed outside home. The study found out that in the hospital, women who work part time had a significantly higher rate of breastfeeding (68%) than those were employed full time (65%) or who were not employed (64.8%). The study also showed that working full time had a negative effect on breastfeeding duration. By six months after delivery, 26.1% of mothers employed full time, 36.6% of mothers working part time and 35.0% of non-working mothers breastfed their infants (Ryan et al., 2006). A 2003 study conducted by Dykes, Morm, Burt and Edward in the North West England, evaluated the experiences and support needs of adolescent mothers who had commenced breastfeeding. The study conduct-ed in-depth focus groups as well as interview to elicit the support needs identified with re-gard to breastfeeding. The study identified five themes of experiences and five themes of support needs were found. The five themes of breastfeeding experiences included feeling watched and judged, lacking confidence, tiredness, discomfort, and sharing accountability. The support needs themes included emotional support; esteem support, instrumental support, informational support and network support. Of these, esteem support was crucial to the adolescent in enhancing their feeling of self-worth, ability and being valued as both a mother and in relation to breastfeeding. The adolescents also valued instrumental support and the nurses’ pro-practical support with breastfeeding, particularly with attaching their baby effectively to their breast, but they wanted to be shown how to do it. The desire for praise and encouragement from significant others, and health professionals was particularly strong in this study and was a key element in self-efficacy building, and concluded that when encouragement was combined with provision of realistic, useful and accurate information, the adolescent perceived that encounters were supportive of breastfeeding.

 

1.1.2 African context of Exclusive Breastfeeding

In recognition of the essential role of exclusive breastfeeding, a lot of effort has gone into scaling up the rates in developing countries where incidence of child malnutrition and mortality is still high. Yet, successes in increasing the levels of EBF have rather been modest. Breast-feeding practices and attitudes have been shown to be influenced by demographic, biophysical, social, cultural and psychological factors (Dennis, 2002; Thulier& Mercer, 2009). The study conducted by Khamnian et al., (2013) on exclusive breastfeeding and factors affecting knowledge, attitude and practice of mothers in rural and urban regions of East Azerbaijan, Iran, 750 breastfeeding mothers participated in the study with mean age of 23.5 and 27.8 years in rural and urban health area, respectively. The study showed that, 74% of the participant mothers were aware that breastfeeding did not produce weaknesses; while 26% thought that it did. While 63% of the mothers thought bottle feeding was acceptable during the first six months of life, 54% of the mothers were aware of the advantages of breastfeeding and disadvantages of bottle feeding. There were higher levels of awareness of the concept of positive feedback of lactation amongst mothers in the urban region as compared to the rural area. Also it was obtained that EBF was lower in employed mothers and it demonstrated the need to educate mothers to continue exclusive breastfeeding despite being employed with external duties at workplace. Similarly, in a study conducted by Ekambaram et al., (2009) in India, total of 100 postnatal mothers were included in the study with age ranges from18 to 35 (aver-age age of 26years) and 70% of the women between age group of 31-35 years were graduates. The study showed that, although, 92% of the mothers knew the recommendation of initiating breastfeeding within one hour, only 36% had actually done it. While 38% of the mothers knew that exclusive breastfeeding should be given for six months, only 56% of the mothers knew that colostrum needs to be given and about 38% of the mothers said that they would not breastfeed their child if the child has diarrhea. The study also showed positive association between breastfeeding and higher maternal age and educational status. It was also found that women who had antenatal care from tertiary care centres and from private practitioners had better breastfeeding scores than those who had availed care form primary health centre or health care worker with only 48% of the women who had received any advice on breastfeeding during antenatal period and only 17% from a healthcare worker and concluded that the knowledge and attitude of postnatal mothers towards breastfeeding is far from satisfactory.

Furthermore, the study conducted by Ally (2012) on exclusive breastfeeding: mothers’ awareness and health care providers practice during antenatal visits in Mvomero, Tanzania, found out that, out of the 80 pregnant women and the 6 nurses recruited in the study, 94% of pregnant women intended to breastfed, 68% were aware that colostrum was important and 52.8% were aware of the need to initiate breastfeeding within one hour after delivery. It was also found that 94% of women had never received breastfeeding counselling from Antenatal clinics, 68% of the women received breastfeeding information from their female relatives and only 23.8% intended to breastfeed inclusively for six months. On the nurses’ side, the study found out that they had satisfactory knowledge on how to solve breastfeeding problems and breastfeeding in special situation, most of this knowledge appeared to be based on personal and clinical experience, only one nurse received training on breastfeeding. It was revealed that, breastfeeding and formula feeding were practiced exclusively by 12% and 28% of mothers respectively, while 59.4% of the mothers practiced mixed feeding at the time of the study. 45% of the mothers reported to have introduced their babies to other foods aside breast-milk within the ages of three to four months. 37.7% mothers introduced other foods within the fifth and sixth months of their infants’ life. Also, seventeen mothers have not yet introduced their babies to any food apart from breast milk. The percentage of mothers exclusively breastfeeding and formula feeding tend to increase as the age of mother’s increase. However, that of mixed feeding decreases as mothers’ age increases. Exclusive breastfeeding was high among mothers aged between 28-32 years, among mothers living together with their partners, unemployed, less educated mothers and Christian mothers (Solomon, 2010). Adeyinkaet al (2008) conducted a study on Breastfeeding Behaviour and Practices among Nursing Mothers in Nigeria and Ghana, the study demonstrates that no difference was observed in the breastfeeding behaviour of nursing mothers in Africa irrespective of their country of origin. But high level of illiteracy in Africa is basically the factor slowing down the rate at which nursing mothers engages in EBF behaviour and practices. However, another study reported that knowledge and positive attitude alone is insufficient in promoting EBF and recommended that prompt actions must be taken by policy makers and institution in promoting exclusive and complementary breastfeeding for up to 2 years (Jalil et al., 2013). Humans and apes (all hominoids) have had similar defining features of their reproductive physiology including lactation and breastfeeding throughout history (Kennedy, 2005); yet detailed an-thropologic work on ancient breastfeeding practices and patterns has rather been scanty (Sel-len, 2009). The practice has been a method of feeding to which infants have not only adapted but lived on for most of human existence on earth (ibid). It was also in the course of several centuries, significantly practiced, respected, and the primary attractor of many artistic works such as paintings, drawing, and sculptures (Sellen, 2009). In many ancient societies, breast-feeding practices were often guided by traditions, ancient medical literatures etc.

 

1.1.3 Cameroon context on exclusive breastfeeding

Sub-optimal breastfeeding practices in-particular exclusive breastfeeding (EBF) still prevail in many developing countries including Cameroon, despite the documented evidence on the vital role of breastfeeding on the health and Health Survey. Multiple binary logistic regres-sions were used to identify and development of infants. Methods: from the 2004 Cameroon Demographic and predict exclusive breastfeeding practice while controlling for potential con-founders. Results: Only 18.1% of the mothers practiced EBF. EBF was highest (35.2%) in the 0-1 month old infants and lowest (2.4%) in 6 months old infants (p<0.001). The North region and the Northwest region had the lowest proportion (0%) and highest proportion (52.9%) of EBF practice, respectively (p<0.001). Ethnicity and religion were retained as important maternal predictors of EBF practice in the multivariate analysis (p<0.001). Decreased likelihood of EBF practice was found among mothers who were Kirdis (OR=0.23, 95%CI: 0.11-0.48), Pahouin-Betis (OR=0.56, 95%CI: 0.33-0.94) and Atheist (OR=0.30, 95%CI: 0.11-0.80). Cultural disparities and religion are the major maternal factors that influence EBF practice in Cameroon. However, further research to understand the influence of these cultural practices and beliefs, and religion on EBF practice is recommended in order to guide policy makers and public health organizations in planning appropriate and adequate interventions to improve EBF practice.

 

1.2 Statement Of Problem

Infants below 6 months of age have not yet fully developed to make use of other food be-sides breast milk, this has been well established among Public Health scientists; hence the recommendation for EBF for all children under six months old. Socio cultural and religious beliefs, taboos and ignorance hinder the practice of EBF (Ene-Obong, 2001). Inadequate knowledge, poor attitudes, negative beliefs and poor practices of EBF might be disastrous to infants (Ene-Obong, 2001). Global campaigns urge mothers to be baby friendly (UNICEF, 2005; WHO, 2007). Successful breastfeeding depends on many factors, such as willingness of the mother to breastfeed, a healthy infant and encouragement by healthcare personnel; and mothers’ knowledge, attitudes and practice about breastfeeding. Breastfeeding behaviour of mothers is an important predictor of infant and child nutrition, health and development. It is estimated that sub-optimal breastfeeding, especially non-exclusive breastfeeding in the first 6 months of life, results in 1.4 million deaths and 10% of the disease burden in children young-er than 5 years of age (WHO, 2009). Some researchers have proposed that lack of suitable facilities outside of the home, inconvenience; conflicts at work, family pressure and ignorance adversely affect the willingness of women to practise EBF (Ogbonnaet al., 2000; Forbes et al., 2003). And other research have shown that various factors such as education, social class, culture, nature of work, and health status of both the nursing mothers and their infants, influ-ence nursing mothers’ decision to breastfeed their children (Newton & Newton, in Adeyin-kaet al., 2008).  Even so, however, efforts to promote EBF have either in most cases achieved less than desired outcomes or run into severe problems, malnutrition is still high and life threatening, particularly affecting the poor. High mortality rates are still persisting among the babies who are not breastfed (Ene-Obong, 2001; Frazer & Cooper, 2003; UNICEF, 2005) hence the topic, knowledge, attitude and practice of exclusive breastfeeding among lactating mothers in laquintinie Hospital Douala. In view of getting concrete solutions to this problem a research question was set up.

 

1.3 Research Question

A research question is an answerable inquiry into a specific concern or issue. It is the initial step in a research project. In view of this some general and specific research questions were ask as given below.

1.3.1 General Research Question

What is the state of knowledge, attitudes and practice of EBF among lactating mothers in the laquintinie Hospital Douala?

1.3.2 Specific Research Questions                              

1. What is the state of knowledge of lactating mothers regarding exclusive?
2. Breast feeding in laquintinie Hospital Douala?
3. What is the attitude of breastfeeding mothers towards exclusive breastfeeding (EBF) in laquintinie hospital Douala?
4. What is the practice rate s among lactating mothers in laquintinie hospital Douala?