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AN ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE OF EXCLUSIVE BREASTFEEDING AMONG WOMEN IN KADUNA METROPOLIS
1.1 Backgroundto the Study
Over the years, breastfeeding has been a universal means of feeding infants and a common feature of all cultures since the survival of mankind. It is a phenomenon that is deeply rooted in the tradition of human culture. Although, breastfeeding practices have fluctuated over the years, it is widely regarded as an unequalled way of providing ideal nutrition for the healthy growth and development of infants (World Health Organization, 2002a). Breast milk is mostly referred to as nature‘s most precious gift to the newborn and the ideal food for the human infant of which an equivalent is yet to be developed by the scientific community despite tremendous advances in science and technology (Nanthini and Jeganathan, 2012).
There are several methods of infant feeding, prior to the discovery and recommendation of exclusive breastfeeding. Mixed feeding has been a common practice, where infants received breast milk and other food or liquids and predominant feeding, where infants receive breastmilk as a predominant source of nourishment and also receive water and water-based drinks or liquids (WHO, 2008).
Exclusive breastfeeding means only breast milk is allowed with the exception of medicine, vitamin syrup and oral rehydration solutionfor the first six months of life to achieve optimal growth, development and health. Thereafter, infants should receive nutritionally adequate and safe complementary foods (WHO, 2002b). Complementary feeding means infants can receivebreast milk, expressed milk or milk from a wet nurse, as well as solid or semi-solid foods, liquids, formula milk,while continuing to breastfeed for up to two years or more (United nations children‘s funds, 2009). This has been one of the primary aims of nutrition and public health
programmes across the world with the aim of improving infant and child morbidity and mortality and also to improve maternal health. Exclusive breastfeeding is internationally the most preferred way of feeding infants during the first six months of their lives, and it is recognized as being one of the most natural and best formsof preventive medicine (WHO, 2002b).
During the first few days after delivery, colostrum, known asthe first fluid that comes from the breast immediately after birth, is produced and should be fed to the new-born, while awaiting the production of regular breast milk (Makena, 2014). It is yellowish in colour, contains high proteinand anti-bodies and often described as the first form of immunization because it is an important source of nutrition and antibody protection for a newborn child. Therefore, it is recommended that infants should be put on the breast immediately or within one hour after birth, which enables the stimulation of breast milk production (WHO, 2002b).
Although, the composition of breast milk varies according to factors such as maternal nutritional status, genetic makeup, maternal dietary habits, and so on, it contains nutrients, anti-bodies, and properties important for growth and development, which makes it a uniquely perfect food for babies with nutrient in the right proportion and ready in the right temperature (Riordan, 2005). Breast milk is the most complete form of nutrition because it has the right amount of fat, sugar, water, and protein which most babies find easier to digest than formula (United nations international children‘s Emergency Fund, 2009).The water content of breast milk consumed by an exclusively breastfed baby meets the water requirements for infants and provides a considerable margin of safety because breast milk contains 10% solids and 90% water (Lawrence and Lawrence, 2005).
The period from birth to two years of age is a critical window for the promotion of optimal growth, health and behavioural development. Poor nutrition during the first two years of life results to illnesses, delayed mental and physical development or even death (Ajibuah, 2013). Breast milk provides passive immunity against infection, as it protects the infant against infectious and chronic diseases, which reduce morbidity and infant mortality due to common childhood illnesses, such as diarrhoea, pneumonia, and so on.It also provides a quick recovery during illness and improves maternal-infant bonding (Kramer and Kaulma,2001).
The mother also benefits from exclusive breastfeeding by experiencing increased production of hormones that are responsible for uterine contraction, prevention of postpartum haemorrhageand maternal mortality (Labbok, 2001). Other benefits also include:lactational amenorrhea, which is a natural contraceptive, fast return of the uterus to its normal size, reduction in the risk of breast and ovarian cancer and emotional satisfaction (Kumar, 2011). It is also healthy for the mothers as it can help in child spacing among women who do not use contraceptives,it may also reduce the risk of osteoporosis and anaemia as well as allows the mother to recuperate before she conceives again (Leon-Cava, Lutter, and Martin, 2002).
The global rate of exclusive breastfeeding has remained stagnant since 1990 with only 38%of infants aged 0 to 6 months are exclusively breastfed (WHO, 2015). Worldwide, only two out of every five infants under 6 months of age are exclusively breastfed, with large disparities among regions (UNICEF, 2015). Reports from WHO and UNICEF on the current exclusive breastfeeding rates in 2017 revealed that the overall rate of exclusive breastfeeding for infants under six months of age is 40%. This implies that exclusive breastfeedingin most cases achieved less than desired outcomes or run into severe problems, as only 2% increase is recorded as at
2016/2017. Only 23 countries have achieved at least 60% of infants less than six months being exclusively breastfed (WHO and UNICEF, 2017).
The overall exclusive breastfeeding rate worldwide is not satisfactory considering the policy responses established for improving infant and young child feeding practices. One of such responses is the Baby Friendly Hospital Initiative (BFHI) launched in 1991 to encourage exclusive breastfeeding for the first six months of life and continued breastfeeding for at least one year of life. The initiative has been launched in at least 152 countries worldwide and in several parts of Nigeria(UNICEF and WHO, 2009). Although, considerable improvements have been made in some regions, the prevalence of exclusive breastfeeding remains far too low especially in many areas of the developing world which is far below the widely accepted 90% universal coverage target of the international recommendation (Cai, Wardlaw, and Brwon, 2012). This implies thatthere is a great deal of low or non-compliance worldwide. For this reason, the World Health Organization aims to increase the global rate to at least 50% by the year 2025 (WHO and UNICEF, 2014).
Malnutrition is a poor condition of health caused by a lack of food or a lack of the right type of food and it has been responsible directly or indirectly for 60% for the 10.9 million deaths annually among children under-five (WHO, 2012). High mortality/morbidity rates are caused mainly by pneumonia, diarrhoea and malaria with malnutrition as an underlying cause and over two-thirds of these deaths are associated with inappropriate feeding practices that occur during the first year of life. Such occurrence can be avoided by practicing exclusive breastfeeding as the practice of EBF is majorly associated with increased nutrition (WHO, 2012).
Exclusive breastfeeding for the first six months has the capability to prevent 13% of all under five deaths in developing countries (UNICEF, 2014). However, infant and child mortality remains disturbingly high in Africa and other developing countries, despite the significant decline in most parts of the developed world. Only about 39% of infants in the developing countries and 25% in Africa are exclusively breastfed for the first six months (Lauer, Betran, De-onis and Barros, 2004).
In Nigeria, malnutrition contributed to 452,620 under-five deaths in 2013 (NDHS, 2013), while the National Nutrition and Health Survey(NNHS)reported that 37% of under-fives were stunted, 29% underweight, and 18% wasted. Also, NNHS reports showed that 26.6% under-fives had moderate and severe underweight, 44.3% moderate and severe stunting, and 10.9% moderate and severe acute malnutrition.
Although, breastfeeding is a common practice in Nigeria with 97% infants receiving breastmilk, only 17-25% of children less than six months of age were exclusively breastfed(Nte and Njepuome, 2015).However, the Nigerian government has responded to the low prevalence of Exclusive breastfeeding by initiating several programmes and policies responses to promote and support infant and young child feeding practices, such as the Baby Friendly Hospital Initiative (BFHI) in 1992, the National Breastfeeding Policy in 1998, the National Policy on Food and Nutrition in 2001(Ogunlesi, Dedeke, Okeniyi and Oyedeji, 2004).
In2005, the National Policy on Infant and Young Child Feeding was also launched and the Baby friendly community initiative (BFCI) was developed by the United Nations and UNICEF to expand on the BFHI, with the aim of sustaining exclusive breastfeeding after mothers leave the hospital. The initiative emphasises community involvement, formation and training of mother
support groups at the village level, close link to the health facility and training messages (Ekanem and Fajola, 2016).All these are policies set up by the international bodies in collaboration with the Nigerian government to improve the practice of exclusive feeding and child feeding in general. Despite these initiatives, malnutrition, and early childhood feeding related diseases and mortality still remain apublic health problem in Nigeria (Ogbo, Page, Idoko,Claudio and Agho, 2017).
The use of colostrum, pre-lacteal feeding, nutritional supplementation and the duration of breastfeeding has varied and still varies between cultures, urban and rural areas, as well as the rich and the poor (WHO, 2002). Regional or societal differences in breastfeeding reflect the trend towards what is regarded as normal and acceptable in different social settings. There are rules that govern how one ought or should behave in a given context and one‘s decision and behaviour are interdependent with certain reference groups in that given society and, therefore, require compliance (Bicchieri, 2012).