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BREASTFEEDING PATTERN AMONG MOTHERS NURSING INFANTS AGED 3-6 MONTHS IN

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BREASTFEEDING PATTERN AMONG MOTHERS NURSING INFANTS AGED 3-6 MONTHS IN Powered By Docstoc
					              Continental J. Medical Research 5 (2): 19 - 23, 2011                            ISSN: 2141 – 4211
              © Wilolud Journals, 2011                                              http://www.wiloludjournal.com
                                                 ` Printed in Nigeria


      BREASTFEEDING PATTERN AMONG MOTHERS NURSING INFANTS AGED 3-6 MONTHS IN
                           ABRAKA, DELTA STATE, NIGERIA

                                   Oyibo PG, 1 Okperi BO, 2 Oyibo IA, 2
 1
     Department of Community Medicine, 2Department of Paediatrics, Delta State University Teaching Hospital,
                                           Oghara, Delta State.

      ABSTRACT
      Background:
      For over two decades, the Baby Friendly Hospital Initiative (BFHI) has promoted breastfeeding
      practices supported by adequate government legislation in Nigeria through decree 41 of 1990. The
      objective of this study was therefore to assess the breastfeeding pattern among mothers nursing infants
      aged 3-6 months in Abraka, Delta State, Nigeria.
      Method:
      This is a health facility based cross-sectional descriptive study was conducted from June 2010 to March
      2011 among two hundred and twenty mothers nursing infants aged 3-6 months who presented at the
      immunization clinic in government hospital, Abraka. The nursing mothers were selected by a
      systematic sampling technique (1 in 3). The study instrument was a pre-tested semi-structured
      interviewer administered questionnaire.
      Result:
      Two hundred and twenty nursing mothers with mean age of 27.9±5.6 years were studied. Over a third
      of the nursing mothers had acquired secondary (41.8 %) and tertiary (36.8 %) education respectively;
      while 6.4 % and 15.0 % had nil formal education and primary education respectively. Over half (60.5
      %) of the nursing mothers practiced mixing feeding (breastfeeding with concurrent complementary
      feeding), while 20.9 % and 18.6 % of them practiced predominant breastfeeding (breastfeeding with
      concurrent water) and exclusive breastfeeding respectively.
      Conclusion: This study has shown that the concept of exclusive breastfeeding has continued to meet
      shift resistance from all social class of nursing mothers in Abraka.

      KEYWORDS: Breastfeeding, pattern, nursing mothers, infants.

INTRODUCTION
Exclusive breastfeeding as defined by the World Health Organisation is the exclusive intake of breast milk by an
infant from its’ mother or wet nurse or expressed milk with the addition of no other liquid or solids with the
exception of drops or syrups consisting of vitamins, mineral supplements or medicine and nothing else (WHO,
1991). Breastfeeding is an unequalled way of providing ideal food for the health, growth and development of
infants. It is also an integral part of the reproductive process with important implication for the health of mothers
(http://www.who.inE/child-adolescent health/Nutrition/infant_exclusive.htmp1). Exclusive breastfeeding has
been recommended world over by the World Health Organisation and United Nations Children Fund as the
optimal feeding mode for young infants especially in environments where sanitation is poor (Feachem and
Kobinsky, 1984). Breastfeeding has several benefits for the infant, mother and community. These include
reductions in infant morbidity and mortality from infectious diseases, diarrhoeal incidence and allergies
(Uchendu et al, 2009; Ogbonna and Daboer, 2007). Longer duration of breastfeeding is associated with better
cognitive development, improvement of intelligence Horwood and Ferguson, 1998; Ferguson and Woodward,
1997), protection against development of asthma and wheeze in children and reduction in adolescent obesity
(Scariati et al, 1997). Maternal benefits of breastfeeding include lactational amenorrhoea which enhances child
spacing and early mother-infant bonding and reduction in infant abandonment and child abuse (Vekemas, 1997;
Lvoff et al, 2000). There is also reduction in the overall financial burden to government and families. A review
of evidence has shown that on a population basis, exclusive breastfeeding for 6 months is the optimal way of
feeding infants. Thereafter, infants should receive complementary foods with continued breastfeeding up to 2
years of age or beyond.5 Faced with the rising infant and early childhood morbidity and mortality rates and
following the Innocenti Declaration in 1990 at Florence in Italy, the World Health Organisation launched the
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                     Oyibo PG et al.,: Continental J. Medical Research 5 (2): 19 - 23, 2011


Baby Friendly Hospital Initiative (BFHI) in June 1991 (WHO, 1991;http://www.who.inE/child-adolescent
health/Nutrition/infant_exclusive.htmp1). It was noted then that over one million children died annually
worldwide due to cases arising from improper infant and early childhood feeding practices, notably diarrhoea,
malnutrition and respiratory infections. For over two decades, the Baby Friendly Hospital Initiative (BFHI) has
promoted breastfeeding practices supported by adequate government legislation in Nigeria through decree 41 of
1990. More than 20 years down, it is important to evaluate what impact the breastfeeding campaign has made
especially on breastfeeding practice among nursing mothers. This study was therefore conducted to assess the
breastfeeding pattern among mothers nursing infants aged 3-6 months in Abraka, Delta State, Nigeria.

SUBJECTS AND METHODS
This health facility based cross-sectional descriptive study conducted from June 2010 to March 2011 among
mothers nursing infants aged 3-6 months in Abraka, a semi-urban town in Ethiope East Local Government Area
of Delta State. Abraka is situated in the tropical rain forest area of Nigeria and accommodates the Delta State
University. The official language of the people is urhobo and their major occupation is farming.

A minimum sample size of 219 was obtained using the Fischer’s formula for population above ten thousand
(Araoye, 2003) with an exclusive breastfeeding prevalence of 17.2 % from a national survey (National
population Commission, 2003).

A systematic sampling technique (1 in 3) was used to select a total of 220 nursing mothers who presented in the
immunization clinic at the government hospital Abraka and gave informed consent for the study. The target
population of interest was mothers nursing infants aged 3-6 months residing in Abraka. Nursing mothers not
residing in Abraka but who presented at the clinic were not selected for the study.

The study instrument was a pre-tested semi-structured interviewer administered questionnaire. The
questionnaire schedule elicited information with respect to maternal characteristics (age, educational status,
occupation, marital status) and pattern of breastfeeding (exclusive breastfeeding, predominant breastfeeding and
mixed feeding).

Ethical approval for this study was obtained from the Ethics and Research Committee of the Delta State
University Teaching Hospital.

Data generated were analysed using SPSS version 15 statistical soft ware package. Proportions and tables were
used in data analysis. This was followed by a chi-square analysis. The level of significance was set at P< 0.05.

RESULTS
The socio-demographic characteristics of the nursing mothers interviewed for the study are shown in Table 1.
Two hundred and twenty nursing mothers with mean age of 27.9±5.6 years were studied. Over a third (43.6 %)
of the nursing mothers were in the age group 26-30 years, while 9.1 %, 20.5 %, 19.1 %, 5.4 % and 2.3 % were
in the age groups 16-20, 21-25, 31-35, 36-40 and 41-45 years respectively. Over a third of the nursing mothers
had acquired secondary (41.8 %) and tertiary (36.8 %) education respectively; while 6.4 % and 15.0 % had nil
formal education and primary education respectively. Over three-quarter (97.7 %) of the nursing mothers were
married, while 12.3 % of them were single nursing mothers. Most of the nursing mothers (37.3 %) were petty
traders, followed by 30.5 % of them who were civil servants.

The socio-demographic characteristics of the nursing mothers in relation to the breastfeeding are shown in Table
2. Over half (60.5 %) of the nursing mothers practiced mixing feeding (breastfeeding concurrently with
complementary feeding), while 20.9 % and 18.6 % of them practiced predominant breastfeeding (breastfeeding
concurrently with water) and exclusive breastfeeding respectively. While the associations between the age,
educational status and occupational status of the nursing mothers and the pattern of breastfeeding were found
statistically insignificant (P>0.05), the associations between the marital status of the nursing mothers and the
pattern of breastfeeding was statistically (P<0.05).

DISCUSSION
The World Health Organisation following the Innocenti Declaration in 1990 at Florence in Italy launched the
Baby Friendly Hospital Initiative (BFHI) which has the ten cardinal steps to successful breastfeeding in June
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                     Oyibo PG et al.,: Continental J. Medical Research 5 (2): 19 - 23, 2011


1991 (WHO, 1991; http://www.who.inE/child-adolescent health/Nutrition/infant_exclusive.htmp1) Since then,
it had been part and parcel of antenatal care to health educate pregnant women on the benefits of exclusive
breastfeeding of infants from birth to six months of age and thereafter the gradual introduction of
complementary or weaning foods with continued breastfeeding up to 2 years of age or beyond (Ogbonna and
Daboer, 2007). Despite these efforts, exclusive breastfeeding appears not to be widely and strictly practiced as
expected (Salami, 2006; Vaahtera et al, 2001; Kulsoom and Saeed, 1997; Samuel and Gideon, 2004).

This study have revealed that the practice of exclusive breastfeeding among the nursing mothers studied was
low compared to the practice of mixed feeding (breastfeeding concurrently with complementary feeding) and
predominant breastfeeding (breastfeeding concurrently with water). This observation suggests that most nursing
mothers are yet to embrace or believe in the benefits of the practice of exclusive breastfeeding. Most worrisome
is the fact that the educational status of the nursing mothers did not seem to have a bearing on them in accepting
the practice of exclusive breastfeeding. Although it was not within the scope of this study to assess the factors
militating against the practice of exclusive breastfeeding among nursing mothers in the studied area, the low
exclusive breastfeeding rate observed in this study may not be unconnected with resistance from superstitions
and die hard cultural beliefs that breastfeeding alone may not be able to sustain the baby. The belief that babies
who are exclusively breastfed do not accept water well after the practice of exclusive breastfeeding is an
erroneous belief held by a number of women in developing countries. It is thought that this belief adversely
affects a lot of women and breeds in them an unwillingness to carry on with exclusive breastfeeding (Uchendu
et al, 2009). A rather positive perception by those who disagree to this apparently erroneous belief may probably
have encouraged them to breastfeed exclusively. Evidence from previous studies has shown that nursing
mothers, who believe in the benefits of exclusive breastfeeding, see these benefits as a drive to practice
exclusive breastfeeding for their babies (Otaigbe et al, 2005; Dennis et al, 2002). This emphasises the need to
encourage women to appreciate the overall benefits of exclusive breastfeeding while redressing the false belief
that may have been acquired from ill-informed individuals in the community. What can be inferred from this
study is that there seem to be some level of failure or disconnect in the prosecution of the breastfeeding
campaign strategies. Stakeholders in the campaign need to go back to the drawing board to review the existing
breastfeeding campaign strategies.

This study has shown that more than 20 years after the Innocenti Declaration and prosecution of the
breastfeeding campaign the concept of exclusive breastfeeding has continued to meet shift resistance from all
social class of nursing mothers in Abraka. The need to re-investigate and modify the existing campaign
strategies is imperative. There is also need for continuous health education and reiteration of the benefits of
exclusive breastfeeding by physicians and other health workers at every point of contact with nursing mothers
so as to improve on their exclusive breastfeeding practice. Establishment of breastfeeding support groups in the
study area is also recommended.

REFERENCES
Araoye MO (2003). Subjects selection: In Research Methodology with Statistics for Health and Social Sciences.
Nathadex Publishers, Odun-Okun Sawmill, Ilorin; Pp 115-125

Dennis C, Hodnett E, Gallop R, Chalmers B (2002). The effect of peer support on breasting duration among
primiparous women: a randomized controlled trial. CMAJ; 166: 21-26

Feachem RG, Kobinsky MA (1984). Interventions for the control of diarrhoea diseases among young children.
Promotion of breastfeeding. Bull. WHO; 62: 271-291

Ferguson DM, Woodward LJ (1997). Breastfeeding and later psychosocial adjustment. Paediatr Perinatal
Epidemiol; 13: 144-157

Horwood LJ, Ferguson DM (1998). Breastfeeding and later cognitive and academic outcomes. Paediatrics; 101:
E9

Kulsoom U, Saeed A (1997). Breastfeeding practices and beliefs about weaning among mothers of infants aged
0-12 months. J Pak Med Assoc; 47 (2): 54-60

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                      Oyibo PG et al.,: Continental J. Medical Research 5 (2): 19 - 23, 2011


Lvoff NM, Lvoff V, Klaus MH (2000). Effect of the baby friendly initiative on infant abandonment in a Russian hospital.
Arch Paediatr Adolesc Med, 2000; 154: 474-477

National population Commission (NPC) and ORC Macro (2003). Nigeria Demography and Health Survey; Pp 151-154

Ogbonna C, Daboer JC (2007). Current knowledge and practice of exclusive breastfeeding among mothers in Jos, Nigeria.
Nigerian Journal of Medicine; 16 (3): 256-260

Otaigbe BE, Alikor EAD, Nkanginieme KEO (2005). Growth pattern of exclusively breastfed infants. Nig J Med; 14: 137-
145

Salami L (2006). A project work on factors influencing breastfeeding practices in Edo State, Nigeria. African Journal on
Food, Agriculture, Nutrition and Development; 6 (2): 13-15

Samuel NU, Gideon CI (2004). Complementary feeding pattern in a population of preschool children: Any relationship with
current feeding habit? Orient Journal of Medicine; 16 (3& 4): 26-30

Scariati PD, Grummer-Strawn LM, Fein SB (1997). A longitudinal analysis of infant morbidity and the extent of
breastfeeding in the United States. Paediatrics; 9: E5

Uchendu UO, Ikefuna AN, Emodi IJ (2009). Exclusive Breastfeeding- The relationship between maternal perception and
practice. Nigerian Journal of Clinical Practice; 12 (4): 403-406

Vaahtera M, Kulmala T, Hietanen A et al (2001). Breastfeeding and complementary feeding practices in rural Malawi. Acta
Paediatr; 90 (3): 328-332

Vekemas M (1997). Postpartum contraception: the lactational amenorrhoea method. Eur J Contracept Reprod Health Care;
2: 105-111

World Health Organisation (1991). Indicators for assessing breastfeeding practices. WHO/CDD/SER/91.1

World Health Organisation. Infant and young child. Child and Adolescent Health and    Development.
http://www.who.inE/child-adolescent health/Nutrition/infant_exclusive.htmp1. Accessed 28th October 2011

                   Table 1: Socio-demographic characteristics of the nursing mothers
           Age group (years)    Number Exam           Frequency              Percent (%)

           16-20                       220               20                        9.1
           21-25                       220               45                        20.5
           26-30                       220               96                        43.6
           31-35                       220               42                        19.1
           36-40                       220               12                         5.4
           41-45                       220                5                         2.3
                                                     Mean age=27.9± 5.6
           Marital status
           Single mother               220                 27                        12.3
           Married                     220                 193                       97.7
           Educational status
           Nil formal education         220                 14                      6.4
           Primary education            220                 33                      15.0
           Secondary education          220                 92                      41.8
           Post-secondary education     220                 81                      36.8
           Occupational status
           Civil servant                220                 67                       30.5
           Unemployed housewife         220                 20                       9.1
           Petty trader                 220                 82                       37.3
           Teacher                      220                 23                       10.5
           Farmer                       220                 28                       12.7




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                      Oyibo PG et al.,: Continental J. Medical Research 5 (2): 19 - 23, 2011


Table 2: Socio-demographic characteristics of the nursing mothers in relation to the
         Breast feeding pattern
Age group (years)       No. Ex          Exclusive          Predominant              Mixed feeding
                                         Breastfeeding      Breastfeeding                N (%)
                                            N (%)               N (%)


16-20                      20                 3 (15.0)              7 (35.0)               10 (50.0)
21-25                      45                 13 (28.9)             9 (20.0)               23 (51.1)
26-30                      96                 20 (20.8)             15 (15.6)              61 (63.5)
31-35                      42                 9 (21.4)              7 (16.7)               26 (61.9)
36-40                      12                 1 (8.3)               3 (25.0)               8 (6.7)
41-45                      5                  - (0)                 - (0)                  5 (100.0)
Total                      220                46 (20.9)             41 (18.6)              133 (60.5)

Chi-square:                                            X2=13.9; df=10; P=0.34

Educational status

Nil formal education         14                - (0)                   9 (64.3)            5 (35.7)
Primary education            33                8 (24.2)                7 (21.2)           18 (54.5)
Secondary education          92                20 (21.7)               12 (13.0)          60 (65.3)
Post-primary education       81                18 (22.2)               13 (16.0)          50 (61.7)
Total                        220               46 (20.9)               41 (18.6)         133 (60.5)

Chi-square:                                               X2=3.9; df=6; P=0.74

Marital status

Single mother               27                  4 (14.8)             12 (44.4)            11 (40.7)
Married                    193                  42 (21.8)            29 (15.0)           122 (63.2)
Total                      220                  46 (20.9)            41 (18.6)           133 (60.5)

Chi-square:                                                 X2=1.32; df=2; P=0.032

Occupational status

Civil servant                    67             17 (25.4)             8 (11.9)             42 (62.7)
Unemployed housewife             20             3 (15.0)              1 (5.0)             16 (80.0)
Petty trader                     82             22 (26.8)             14 (17.1)            46 (56.1)
Teacher                           23            4 (17.4)              3 (13.0)             16 (69.6)
Farmer                           21              - (0)                8 (38.1)             13 (61.9)
Total                            220            46 (20.9)             41 (18.6)           133 (60.5)

Chi-square:                                                 X2=12.7; df=8; P=0.64


Received for Publication: 24/10/2011
Accepted for Publication: 10/12/2011

Corresponding Author
Oyibo Patrick Gold
Department of Community Medicine, Delta State University Teaching Hospital, Oghara, Delta State.
P.M.B 007, Oghara, Delta State
E-mail: oyibopatrick@yahoo.com

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