KNOWLEDGE, ATTITUDE AND ADOPTION OF APPROPRIATE FEEDING PRACTICES BY MOTHERS AND ANTHROPOMETRIC INDICES OF THEIR CHILDREN IN AGUATA LOCAL GOVERNMENT AREA OF ANAMBRA STATE, NIGERIA

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ABSTRACT

This study was designed to assess the knowledge, attitude and adoption of appropriate infant feeding practices of mothers and the anthropometric indices of their children. Three hundred and seventy three mothers who attended infant welfare clinics at the three health settings (General hospital Ekwulobia, Primary health care Ekwulobia, and Primary health care Akpo) all in Aguata L.G.A were involved in the study. The study evaluated the nutritional status of the infants in relation to their anthropometric indices. Also infant feeding practices of mothers in the locality was assessed. A validated semi-structured questionnaire by experts at the Department of Home Science, Nutrition and Dietetics, University of Nigeria, Nsukka was used to elicit information on socio-economic characteristics of the mothers and their children. Results showed that age of the mothers involved in the study ranged from less than 20 years to 41 years and above. The mothers were mostly civil servants (29.50%), traders (29.30%), skilled workers (16.90%), housewives (16.60%) and unskilled workers (9.40%). Household size of 3-4 members dominated (38.90%) of population studied. On the average, 67.74% of the mothers had correct knowledge of infant feeding guidelines which means that mothers were knowledgeable on the infant feeding guidelines. Most mothers (67.60%) received information on breastfeeding through the midwives and nurses where they attended antenatal clinic. A total of (47.70%) of the mothers ever adopted exclusive breastfeeding for different periods of time. A total of (43.40%) stopped breastfeeding their babies after 12 months of age followed by (21.70%) who stopped breastfeeding after 15 months of age of the child. Only 19.30% and 13.90% stopped breastfeeding their babies after 9 months and 6 months of age respectively. Anthropometric indices (length and weight) were used to assess the nutritional status of the children. The boys were taller and heavier than the girls in all age groups except age 19-24 months. A total of 22.62% of males and 21.26% of the females were stunted. About 7.54% of the males and 14.37% of the females were wasted. A total of 12.06% males and 7.4% females were undernourished. There was positive and significant (r = 0.7714: P<0 .0001="" age="" among="" and="" as="" between="" breastfeeding="" children="" correlation="" feeding="" infant="" length="" method="" mothers.="" no="" of="" p="" predominant="" r="0.7937:" significant="" the="" their="" there="" was="" weight="" well="">0.05) difference between the weight and length of children fed breast milk only and those fed breast milk plus formula; breast milk and other foods. There was a significant (P<0 .05="" 0-6="" age="" and="" difference="" females="" in="" length="" males="" months="" no="" of="" significant="" the="" there="" was="" weight="" while="" within="">0.05) difference in their weight and body mass index (BMI). For those within 7-12 months of age there was no significant (P>0.05) difference in their length, while there was significant (P<0 .05="" and="" bmi.="" difference="" in="" span="" their="" weight="">

TABLE OF CONTENTS

Title page
Abstract

CHAPTER ONE
1.0 INTRODUCTION
1.1       Statement of the problem
1.2       Objective of the study
1.3       Significance of the study
1.4       Hypothesis

CHAPTER TWO
2.0 LITERATURE REVIEW
2.1       Global prevalence
2.2       Composition of breast milk
2.3       Advantages of breast feeding
            2.3.1    Benefits of breastfeeding
            2.3.2    Contribution to maternal health
            2.3.3    Factors that militate against breastfeeding
2.4       Complementary feeding
            2.4.1    Quality of complementary feeding
            2.4.2    Disadvantages of formula feeding
2.5       Practices of infant feeding
            2.5.1    Infant feeding practices in developing countries
            2.5.2    Infant feeding practices in developed countries
2.6       Attitude to infant feeding
            2.6.1    Maternal attitude and beliefs in developing countries
            2.6.2    Maternal attitude and beliefs in developed countries
2.7       Anthropometry

CHAPTER THREE
3.0 MATERIALS AND METHOD
3.1       Study area
3.2       Subjects
3.3       Study designs
3.4       Population
3.5       Sample selection
3.6       Preliminary visit
3.7       Sampling technique
3.8       Instrument for data collection
            3.8.1    Questionnaire
            3.8.2    Anthropometric measurements
            3.8.3    Statistical analysis

CHAPTER FOUR
4.0 RESULTS
4.1       Age and marital distribution of mothers
4.2       Knowledge of infant feeding guideline
4.3       Attitude of mothers towards infant feeding
4.4       Infant feeding practices by mothers

CHAPTER FIVE
5.0 DISCUSSION, CONCLUSION AND RECOMMENDATIONS
5.1       Knowledge of infant feeding
5.2       Infant feeding practices adopted by mothers
5.3       Reasons for stopping breastfeeding and complementary feed given to babies
5.4       Age of introduction and complementary feed
5.5       Nutritional status and (z-scores) of the children
5.6       Conclusion
5.7       Recommendation
References

Appendix

CHAPTER ONE

1.0                                                                        INTRODUCTION

Infant feeding comprises breastfeeding and complementary feeding (Ashworth and King, 1994). Appropriate infant feeding is the cornerstone for child’s development. The first two years outside the womb is crucial. It is a period of intensive growth and brain development of an individual. The nutrient requirement of the child is high per unit body weight because of the rapid growth rate (Ene-obong, 2001). The adverse effect of poor feeding will lead to impairment of cognitive development.

Breastmilk is natural and meets the nutritional needs of the infant in the first six months of life if exclusively given. This was why WHO/UNICEF (1990) advocated that breastfeeding should exclusively be given for six months of life. Human milk is the right food for the young infant and provides all the energy and nutrients that the infant needs for the first six months of life and upto one-third during the second year of life (de Andraca, ET AL., 1998).

Breastfeeding is a unique process that provides ideal nutrition for infants and contributes to their healthy growth and development. It has a unique biological and emotional influence on both the mother and the child (WHO/UNICEF, 1990). Armstrong (1995) also stated that it is an unequalled way of providing food for the healthy growth and development of infant.

Breastfeeding has overwhelming advantage everywhere in the world, but especially in developing countries, where hygiene is poor and some cannot afford to buy sufficient formula. Most mothers have no basic education to be able to use formula properly if affordable (Jelliffe and Patrice, 1991). Breastfeeding is the most ancient method of child spacing provided the child is taking breastmilk as required for the day, it causes the menstrual period to stop (lactation amenorrhoea). Kennedy and Visiness (1992); Dada, Akesode, ET AL.,(2002) reported that breastmilk helps to space children and reduce the risk of ovarian and breast cancer (Lancet, 2002). Breastmilk also increases family and national resources (WHO, 2004). Breastfeeding stimulates bonding between the child and the mother and psychosocial development. It leads to improved nutritional and physical growth, reduced susceptibility to common childhood infections and better resistance to cope with them (Health Canada, 2004). Improve health outcome in infants have long lasting effects throughout lifespan including increased performance and productivity (WHO, 2004). Optimum breastfeeding prevents both under nutrition as well as over-nutrition and provides protection from obesity related diseases.


A review of evidences have shown that on a population basis, exclusive breastfeeding for the first six months of life is the optimal way of feeding infants (Health Canada,2004). Thereafter, infant should receive complementary foods with continued breastfeeding upto two years of age and beyond (Goldman, 1993; Dewey, ET AL., 1999).

Complementary feeding is the transitional period of gradual introduction of solid food or semi-solid food to the infant and this is usually as from six months of life (Malcolm, 1999). The transition from exclusive breastfeeding typically covers the age from 6-18-24 months of age (Pelto, Levitt ET AL., 2003). Between these period is a critical transition period when the exposure to environmental pathogens are most intense and the likelihood of inadequate nutrient intake most probable (Underwood, 1985). Complementary-feeding should be timely, adequate, and safe and appropriate (WHO,2002). The frequency and amount of food given to the infant should also depend on the age and the need of the infant. This is important to ensure that complementary foods which are often poor do not displace the more nutritive breastmilk in the child’s diet (Cohen et al., 1995).

Complementary feeding is an action that is largely under the control of the family, although support from the health care provider is essential (SCN,2006). Thus complementary feeding needs to be learned through

behavioural modeling, as well as through the acquisition of knowledge (Pelto et al., 2003).

Over the centuries, human infants have been fed with their mother’s breastmilk. The development of alternative, milk formula, infant formula, have given contemporary mothers a second choice (Nwachukwu, 1998). Owing to the poor knowledge of composition and production of breastmilk by some mothers, insufficient milk production or weight gain is reason for not exclusively breastfeeding their babies (Nwazor,1996). According to king (1998), mothers resort to early introduction of complementary feeding thereby exposing the infant to diarrhoea, under-nutrition and malnutrition. Lack of support from close female relatives, health workers and pressure of urban life prevent mothers from breastfeeding their babies adequately. Poverty and ignorant, however, may result in nutritionally inadequate complementary foods which could lead to malnutrition and associated increase risk of infection (Ashworth and king., 1994). The level of the mother’s nutritional status which is very low in most cases prevents her from meeting up with the demand made upon her by the suckling baby.

To this effect, such mothers put up non-challant attitude towards breastfeeding their babies (Azagiro, 2000). Some mothers have poor attitudes and ideas such as colostrum not being good for baby, breastfeeding may spoil a woman’s figure and interfere with her relationship with men and breastfeeding in public is embarrassing which may lead to poor breastfeeding practices and early introduction of complementary food. These have adverse effect on the children if not properly handled (King, 1998).

1.1        Statement of problem
In Nigeria, Malnutrition is one of the major causes of infant mortality and this usually peaks between 1 – 2 years of life when baby is taken off breastmilk and inappropriate complementary feeding instituted. The nutrient intakes of these babies deteriorate as a result of poor knowledge, attitude, practices and ignorance of most mothers towards adequate nutrient intake. Some believe that the baby can tolerate any food provided the baby is hungry. This results in failure to thrive with resultant high mortality rate. Mother’s poor attitude of complementary-feeding expose babies to so many hazards like malnutrition, infections, and stunted growth, (Filtea and Tomkins, 1994).

Infant feeding practices are influenced by numerous factors such as economic, socio-cultural and biomedical constraints in many areas (Butte, Lopez-Alarcon ET AL., 2002). As a result of these prevailing factors, the researcher deem it fit to study the knowledge, attitude and adoption of appropriate infant feeding practices among nursing mothers in Aguata.

1.2        Objectives of the study
1.2.1 General objective: The general objective of the study is to asses the knowledge, attitude and adoption of infant feeding practices of mothers and anthropometric indices of their children in Aguata local Government Area.

1.2.2    Specific objectives

The study has the following specific objectives:

i.                   to asses knowledge of infant feeding guidelines among mothers in Aguata Local Government Area.

ii.                 to ascertain infant feeding methods adopted and practiced by mothers in the study area.

iii.               to asses mothers attitude towards exclusive breastfeeding.

iv.               Compare feeding methods with anthropometric indices of children 0-2years.

1.3    Significance of study


The result generated from this study will help mothers improve on their knowledge, attitude and adoption of infant feeding practice. Some of the negative beliefs and attitude of mothers towards infant feeding will be corrected. Depending on the result generated, the health workers will learn good infant feeding practices and the effect of poor practices......

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