This research intended to assess the mother's knowledge, practice of exclusive breastfeeding and anthropometrics indices of their infant who were exclusively breast feed and not, at Obada Oko, Ogun state, Nigeria. This research employed a mixed cross sectional study design of both quantitative and more of qualitative methods. Totally, 250 lactating mothers who are users of nutrition program services, with infants’ 0-6months were selected through simple random sampling, assisted by systematic random sampling selecting mothers at an equal interval of kth term. The data collection tools were semi-structured interview questionnaires, focus group discussions guides, and direct observation, documentary analysis, interview guides whereas data analysis done using SPSS IBM 20 version software, ENA software, different statistical tools tests like chi square test, percentage, frequency, Odd ratio (OR), linear and logistic regressions, were used to assess its significance at P<=0.05. It was found that the factors influencing EBF were maternal age, intension to breast feed, the income status and type of income source, lack of previous experience in EBF, level of knowledge in EBF, and key message, type of household, and family size, family support, institutional at facility& community level support group, cultural belief by mothers, easy availability of animal milk, and infant morbidity and maternal breast complication. It was found that the rate infant under nutrition: acute malnutrition 24.4%, underweight 17.2%, stunting 12.8%. The mother’s knowledge of EBF was 93.9%, attitude 89%, practice 77.6% respectively. The recommendation was that the mothers had good awareness on EBF, positive attitude but low practice of EBF due to many factors and high undernuttion rate that require a coordinated intervention among stakeholders.

Key words: Exclusive breast-feeding, Breast feeding initiation, complementary feeding, breast feeding substitute, optimal infant and young child feeding, artificial feeding.

Chapter One Introduction
1.1.Background of the Study
Breastfeeding becomes an optimal way to feed infants for the first six months of life by many international organizations like WHO and UNICEF. They have developed various guidelines and strategies to promote infant and young child feeding practices. They have also established a clear indicator to measure the prevalence of infant feeding practices, and some of these indicators include breast feeding initiation just a few hours after a birth, rate of exclusive breastfeeding up to the first 6months, introduction of complementary feeding at 6months with continuous breast feeding up to two years, etc.

A study conducted at the Palestinian refugees indicated that feeding appropriate and adequate nutrition during infancy and early childhood called “critical window period” is very essential for the development of each child’s full potential and for promoting optimal growth. This was due the fact that this age is the peak for growth faltering, deficiencies of some essential micronutrients, and early childhood illness like diarrhea(Qanadelo, 2010).

His study indicated that many factors affected mother's choice to breastfeed. Some of these factors include: socioeconomic status, cultural beliefs, level of social support, level of education, maternal work demands, range of cares provided during pregnancy, childbirth and the early postpartum period (medical advice), family pressures and advertising for infant formula as well as biological factors such as: infant size, sex, development, interest/desire, growth rate, appetite, physical activity, and maternal locational capacity, etc. may also influence the decision about the type of feeding for infant, supplementation, and also determine the need and timing of complementary feeding.

The other studyshowed that breast-feeding is a natural gift that infant receives from the maternal breast. It also indicated that Exclusive breastfeeding has been defined as feeding of an infant with breast milk only without giving any other foods, not even water. This definition allows the inclusion of prescribed medicines, immunizations, vitamins, and mineral supplements in addition to breast milk (WANYONYI, 2010).

The study further (Debra J Hector, March 2005)showed that breastfeeding as a practice was identified by optimal feeding (i.e. exclusive breast-feeding for the first six months and continued breastfeeding for up to two years, with the introduction of other foods).

This research mainly focused on the breast feeding practices for the first 6months of life as breast feeding initiation, frequency of feeding, and exclusive breast feeding and other major determinants of EBF and how that could hampered the effectiveness of the feeding practices and how this could critically influence or contribute to the nutritional status of infants.

Though many researches have been done on the prevalence of malnutrition especially for children 6- 59 months, there is almost no significant research done on causal factors which can determine the rate of exclusive breastfeeding, as well as the possible effect of these determinants on the rate of child under nutrition and which intervention mechanism can best address the critical challenges affecting children, in particular infants under 6 months of age in refugee camp setting.

(Debra J Hector, March 2005)indicated that the barriers to exclusive breastfeeding (EBF) can be illustrated in to different categories by using conceptual framework. The framework is designed in to three levels namely individual, group and society. From this framework, one can generate premises about the determinants of breastfeeding, especially EBF and the types of interventions that may be used to address them.

Accordingly, the individual level factors connote directly to the mother, infant, and the ‘mother-infant dyad’. These factors include the mother’s intention to breastfeed, her knowledge, skills and parenting experience, the birth experience, health and risk status of mothers and infants, and the nature of early interaction between mother and infant. Each of these factors can directly influence the initiation and duration of breastfeeding, and frequently correlated with social and demographic variables.

Group level factors are environmental factors in which the mothers and infants, and infants find themselves, or something that can enable mother to breastfeed. Environments with a direct influence on mothers and infants include: the hospital and health facilities environment, or the facilities where services are given and infant friendly environment like baby friendly center in which practices and procedures such as infants routinely rooming-in with mothers to allow demand feeding, postpartum skin-to-skin contact and providing professional support with breastfeeding technique difficulties influence the early feeding experience and the follow-up care and support, the home and peer environment, where physical and social factors such as size of household, parity, family circumstances, partner attitudes and support, and peer support affect the time, energy and resolve that mothers have for breastfeeding and also the work environment, in which policies, practices and facilities such as work hours and flexibility, facilities and policies that enable on-site expressing and storing of breastmilk influence mother’s ability to combine work and breastfeeding and the community environment, which signals the extent to which breastfeeding is recognized as a norm, and reinforced by facilities and policies in public places, for example parenting rooms in shopping centers and entertainment venues, ‘breastfeeding friendly’ public transport, restaurants, etc. are among others.

The public policy environment, which modifies how each of these environments influence mother’s feeding decisions, have a significant impact on the hospital, home, and work environments that in turn, influence infant feeding decisions directly.

Societal level factors are broad level factor as a basic factor which influence the acceptability and ex- petitions about breastfeeding and provide the background or the context in which mothers’ feeding practices occur. Some of these factors include: cultural norms on breastfeeding, child feeding, and parenting; the role of women in society including how working outside the home is valued; the degree to which men’s social role includes support for breastfeeding mothers, the extent to which exposing breasts for feeding is complicated by cultural norms regarding sexuality, and the economic importance of products as breastmilk substitutes and complementary foods in the food system.

Generally, group level and societal level influences may interact in either positive or negative ways with maternal knowledge and skills. For example, a mother may be predisposed to breastfeed, but a non-supportive environment in the hospital or other facility level may lead to her deciding to stop breastfeeding early. Similarly, lack of support at home or in the community, etc. may also lead to her stopping early. Again, broader societal attitudes about sexuality, and especially breasts, can influence the manner and degree of community support (detail information in chapter two).

Globally, new estimates for the year 2004 found that stunting, severe wasting, and fetal growth restriction together were responsible for 2.2 million deaths of children under five years. Deficiencies of vitamin A and Zinc were estimated to be responsible for 0.6 million and 0.4 million deaths, respectively; and sub-optimum breastfeeding for 1.4 million deaths, (B. e. al, 2008)

(Robert E Black, 2013) on the Maternal and Child undernutrition, indicated a conceptual framework analysis that illustrate how child undernutrition is caused by multiple interrelated causal factors. Accordingly, child undernutrition has three interrelated causal factors: the immediate factors, the underlying factors, and the root causes or basic factors. For first instance, child undernutrition is an outcome of the balance between food intake and food requirements, which is influenced by disease and care. Inadequate energy and nutrient intake, infectious disease and inadequate care are thus the proximal risk factors for child undernutrition. Specifically, chronic energy and/or nutrient depletion in young children leads to slowed skeletal growth and a loss of, or failure to accumulate, muscle mass and fat and deficiencies of specific nutrients.

Because of the dependent status of infants and young children (under 2 years of age), food intake and disease are strongly influenced by the feeding, care-giving, and health care–seeking practices of the caregiver. As a result, it is not conceptually meaningful to separate, for example, food intake from feeding practices. Inappropriate infant and young child feeding practices have a negative impact on child nutrition status. The World Health Organization recommends breastfeeding initiation within 1 hour of birth, exclusive breastfeeding for the first 6 months, and appropriate complementary feeding beginning at 6 months, with breastfeeding continued for 2 years and beyond. Where these practices are not been followed, negative impacts on child nutrition and health can result.

Similarly, (Debra J Hector, March 2005) indicated that Breastfeeding could save 820,000 lives annually, which means, preventing 13% of all deaths of children under five years. Breastfeeding reduces one-third of respiratory infections and about half of all diarrhea episodes in low- and middle- income countries.

The other factors contributed to the high level of child undernutrition were: the lack of food diversity and access to food and lower position of women in income level and education which was attributed to the root cause of poverty, and socio-cultural factors at the community and society level such as family support, but our main focus here is to the relationship between factors affecting exclusive breastfeeding and how this could in turn affect child undernutrition and survival.

In Nigeria, several studies have also shown that exclusive breastfeeding for the first six months plays a great role in preventing morbidity and mortality. However, a study by (T. S. e. al, 2012)in Bale Goba District, southeast Nigeria, has shown that large portions of infants are not exclusively breastfed and according to the infant feeding recommendations, the prevalence rate on EBF was 71.3%.

In addition, did similar study in Nigeria to assess the determinants three--hundred and fourteen breastfeeding mothers with their index child less than 2 years were enrolled. Even though 93.6 % of study participants had heard about EBF, only 34.7 % were knowledgeable about the recommended duration. About 89.5 % had a positive attitude, but only 59.3 % believed that only EBF is enough for child up to six months and 26.4 % of children were exclusively breastfed for six months, this shows that though mothers have good knowledge, the practice was very law (Niguse Tadele*, 2015)

In the same manner, a study by the nutrition survey 2016 at Obada Oko indicated that timely initiation of breast-feeding was 82% and the rate of EBF was 84.8% while introduction of solid semi solid food at 6months was 78% respectively. From the survey result, even though the result of breast-feeding seemed to be good, there is still a gap of more than 5% and there is no research done about the major determinants that can affect EBF and the likely relationship between rate of EBF and child undernutrition.

There also need a research on the detail status of breast-feeding in terms of people’s knowledge, attitude and other related issues. In addition, the rate of child undernutrition for infants less than 6 months was overlooked also same to rate of EBF. Therefore, the output of this research partially intended to fill the gaps of existing breastfeeding challenges in the study area.

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Item Type: Project Material  |  Size: 82 pages  |  Chapters: 1-5
Format: MS Word  |  Delivery: Within 30Mins.


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