Abstract
World Health Organization (WHO) recommends that infants should be exclusively breastfed (EBF) for the first six months of life. Breast milk is considered an ideal food for the healthy growth and development of the infant. Exclusive breastfeeding is also important in ensuring the health of the mother. Lack of exclusive breastfeeding in the first six months of a child’s life is considered a risk for infant and childhood morbidity and mortality. The objective of this study was to determine what factors contribute to the inadequate exclusives breastfeeding of children at the Laquintine District Hospital Douala. In order to achieve the study objective, a convenience simple random sampling technique was employed to sample a population of 235 nursing mothers at the Laquintine Districts Hospital Doula using a structured questionnaire. Collected data was checked, coded, inputted and analysed using SPSS (Statistical Package for Social Science, 21.0). the findings revealed that the mean age of the mothers was 25±21years, (40.43%) were had attended the secondary school, (47.23%) were employed with (48.09%) having 3-4 kids. Findings further revealed that (86.4%) of the mothers were aware of EBF with major source information been the health care provider (64.3%). (68.5%) of the mothers had proper knowledge of what EBF was, however, only (49.8%) have actually practised EBF with only (8.5%) doing so for up to a period of 6months. The following factors were found to be associated with exclusive breastfeeding; maternal socioeconomic, demographic, socio-cultural factors. Socio-economic characteristics revealed that the educational status, occupation and marital status had a significant relationship with the practised of EBF among nursing mothers. It was recommended that health care providers should continue to be empowered with skills and knowledge to help to educate nursing mothers who come for ANC on the importance of EBF.
Keywords: Exclusive breastfeeding, Socio-demographic, Socio-cultural
CHAPTER ONE
INTRODUCTION
1.1 Background of the study
(WHO,2003 Lqbalsm et al,2010). Previous study data reveal that most mothers started to exclusively breastfeed their infants at birth and the rate decreased significantly about two or more months later (Qasem et al,2015& UNICEF,2007). Approximately half of the 10 million deaths of infants under 5 years old yearly are due to direct or indirect consequences of malnutrition and a greater proportion of these deaths are linked to inadequate exclusive breastfeeding practices (WHO,2003 & UNICEF, 2007).
Breast milk is the most important and safe food for infants (Kramer et al,2004, Mananga et al., 2014). Breastfeeding provides babies with superior nutritional content that is capable of improving their immunity and possibly reduce future health care spending (WHO,2001, Jones et al, 2003). Avoiding colostrum which reinforces the immune system and giving some pre-lacteal feed and bottle feeding are contributory factors for preventable diseases which ultimately lead to high infant mortality (lqbalsm et al., 2010)
Over 85% of mothers globally do not implement World Health Organization (WHO) breastfeeding recommendation with only 42 % (57 million) initiating breastfeeding within the first hour after birth, about 35-36 % of babies less than four months are exclusively breastfed.
Given the above irregularities, the researcher could not help but ask the question “What factors contributed to the inadequate exclusive breastfeeding of children”. Reflecting on this question led to the birth of the research topic “Factors contributing to inadequate exclusive breastfeeding of children 0-6months at the Laquinttine Hospital Douala.
The aim of this study was to determine the factors contributing to inadequate exclusive breastfeeding of children among breastfeeding mothers. Hence, this study will provide baseline information for future researchers in a relevant topic, and also recommendations from this study if implemented will improve the level of practice and compliance to exclusives breastfeeding thus reduces infant mortality and morbidity For the purpose organization and ease, the work has been organized into five chapters where chapter one is introduction and background, chapter two is literature review etc.
1.2 Context of the study
Inadequate exclusive breastfeeding is considered a normal phenomenon that most women normally neglected without knowing the benefits behind it. In these chapters, an overview is provided on inadequate exclusive breastfeeding practice worldwide.
A nationwide survey conducted in Pakistan on breastfeeding practice revealed that fewer mothers breastfed their children and these mothers often supplemented breast milk unnecessarily and/or stopped breastfeeding early (Morisky et al., 1991). Study findings from a UK based research indicated that reasons for low breastfeeding rates included cultural attitudes, limited knowledge of the benefits of breastfeeding and heavy media promotion of bottle-feeding (Mitch et al., 2006). According to Kong et al. (2004), undesirable breastfeeding practices were found to be associated with urban residence, younger mother’s age and higher educational attainment. In Denmark, 4 % of babies were exclusively breastfed to 4 months (Vester et al., 1991).
Only 25% of Dutch mothers feed their children mainly on breast milk during the first 6 months (Lanting et al., 2005). The percentage of exclusive breastfeeding on other countries goes as follows Sweden53%, Norway 50%, Polan10%, Canada 24%, Netherland 25%, Britain 21%and the United States 20%. (WBFR,2018, WHO/UNICEF, 2018)
The rates of exclusive breastfeeding have improved over the recent past, with the global rate at 37% (UNICEF, 2009 and UNICEF, 2011). However, in all regions, the percentage of infants under six months receiving the benefits of exclusive breastfeeding is less than 50% (UNICEF, 2011b). In the developing world, less than 40 % of infants under 6 months old receive the benefits of exclusive breastfeeding. The rate is particularly low in Africa, where less than one-third of infants under 6 months old are exclusively breastfed (UNICEF, 2009a). There has been a major increase in exclusive breastfeeding in 19 African countries including Rwanda (88%), Tanzania (41%) and Malawi (57%) among others (UNICEF, 2011c and UNICEF, 2009b). In Kenya however, rates of exclusive breastfeeding remain low with only 32% of infants below six months being exclusively breastfed (KNBS and ICF Macro, 2010). In many Sub-Saharan Africa societies, exclusive breastfeeding is considered by far the best feeding option for women of unknown HIV status and for most HIV positive mothers, although it is challenged by low acceptability and feasibility (Cames et al., 2009).
Data on the prevalence of exclusive breastfeeding vary widely in African countries and rates for exclusive breastfeeding under 4 months of age are very low. For example, Zimbabwe, 17%, Zambia, 23%, (WHO, 2003), South Africa, 29%, (Bland et al., 2002), Tanzania 19%, Uganda 48% (Coutsoudis et al., 2001), According to UNICEF (2006), one out of every three children is exclusively breastfed for the first six months of life in the developing world. East Asia / Pacific and Eastern / Southern Africa are the regions with the highest levels of EBF in the first six months of life (43 %), while the west and central Africa have the lowest levels (20 %). Globally, available figures show few babies are exclusively breastfed to 3 months (UNICEF, 1994)
Breastfeeding rates vary both between and within countries. In Cameroon, preceding studies have shown that between 18-20 per cent of infants are exclusively breastfed for the first six months after birth (WHO,2013). Paucity of published data exists regarding exclusive breastfeeding determinants in Cameroon. The study conducted to identify determinants of exclusive breastfeeding in a group of mother-infant pairs attending postnatal consultation at Efoulan Health District in Yaounde, Centre region of Cameroon.
1.3 Statement of Problem
Cameroon is among the countries with a high rate of infant mortality, inadequate exclusive breastfeeding being one of the main factors, (CIA world Factbook 2011). Efforts have been made by the Government, NGO and another stakeholder to protect, support and promote exclusive breastfeeding but still, there is an inadequate practise of exclusive breastfeeding. In Cameroon and according to the 2004 Demographic Health Survey (DHS) although 99%of the babies are breastfed at birth, the main duration of breastfeeding is less than 6 months and only 24% are exclusive breastfed up to 6months, thus as a result let to the Inadequate exclusive breastfeeding practices, in Cameroon (UNICEF Cameroon/Brecher,2015). Nutritional Status and other partners have been implementing a National program on infant and young child nutrition initiatives in collaboration with the Ministry of Public Health (UNICEF /brecher, 2015), the goal was to empower the lactating mother to breastfeed their infant exclusively breastfed and introduce complementary food after six months. Apart from the effort made by The World Breastfeeding Trend Initiative (WBTi, 2015) still there is a challenge of inadequate exclusive breastfeeding practice in Cameroon. Observation during clinical support. supervision indicated the majority of nursing mother admitted with their children less than six months of age have already started complimentary food.
1 .4 Research Questions
A research question is the fundamental core of a research project, study or review of the literature. (Syed, 2017)
1.4.1 General research question
What factors contribute to the inadequate exclusives breastfeeding of children at the Laquintine District Hospital Douala?
1.4.2 Specific Research Questions
What socio-demographic factors contribute to the inadequate exclusive breastfeeding of mothers at the Laquintine hospital Douala?What knowledge do nursing mothers have about exclusive breastfeeding.?What are the socio-cultural factors associated with exclusive breastfeeding practice?
1.5 Hypothesis
A hypothesis is a proposition in testable form and predicts a particular relationship between two or more variables. (Bailey,1978)
1.5 1 General Hypothesis
ALL breastfeeding mothers have multiple factors contributing to inadequate exclusive breastfeeding.
1.6 Research objectives
1.6.1 General Research Objective.
To determine the factors contributing to inadequate exclusive breastfeeding of children at the Laquintine Hospital Douala.
1.6.2 Specific research objectives.
To determine the sociodemographic factors contribute to the inadequate exclusive breastfeeding to mother at the Laquintine Hospital Douala.To identify the state of exclusive breastfeeding knowledge to nursing mothers.To determine the socio-cultural factors associated with inadequate exclusive breastfeeding.
1.7 Significance of The Study
1.7.1 Scientific Significance
Scientifically, the study will go a long way to add to the literature of other researchersThe results will go a long way to identify the gap of inadequate exclusive breastfeeding factors to other researchers could not fine Exclusive breastfeeding reduces infant mortality due to common childhood illness such as diarrhoea or pneumonia and helps for a quicker recovery during illnessProfessional significanceIt will identify the factors that contribute to inadequate exclusive breastfeeding which will go a long way to help nurses.Educationally, findings from this study will aid the increasing practice of exclusive breastfeeding.
1.8.3 Socio-economic significance
Recommendations from this study if implemented will improve the practice and compliance to exclusive breastfeeding thus reduces infant mortality and morbidity.
1.8.4 Personal significance
It will help the researcher to acquire skill knowledge about exclusive breastfeedingIt will help the researcher to put into practice the knowledge she had acquired to help other researcher and her family members.
1.9 Operational Definition of Key Concepts.
Breast
Breast of an adult consists of the mammary gland and between15-20 lobes, whereby the lobes give the breast size and shape (Widmaier, et al., 2004).
Breast Milk
Breast milk is the ideal nourishment for infants for the first six months of life, providing all the nutrients, including vitamins and all minerals, an infant need, which means no other liquid or food is required(UNICEF,2011)
Breast Feeding
This is the process of breastfeeding a baby at least up to the two years old regardless of the addition of other complementary foods (UNICEF, 2012).
Exclusive Breast Feeding (EBF)
This is a process of feeding breast milk for 6 months of life since birth, without feeding any type of food, drinks, even water, except medicine like vitamin and minerals (WHO, 2004). UNICEF and WHO recommended exclusively breastfeeding for 6 months of life.
Inadequate Breast Feeding
This is when the Newborn baby does not obtain any or enough breast milk resulting to lose more calories than it gaining which leading to serious complication like cerebral oedema, intracranial haemorrhage, disseminated intravascular coagulation (a life-threatening condition where there is excessive clotting or bleeding throughout the body, kidney failure, permanent brain injury and even death (Pelleboer, et al.,2009)
FACTORS CONTRIBUTE TO THE INADEQUATE EXCLUSIVES BREASTFEEDING OF CHILDREN AT THE LAQUINTINE DISTRICT HOSPITAL DOUALA, CAMEROON
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