EFFECT OF NURSING BASED INTERVENTION ON EXCLUSIVE BREASTFEEDING PRACTICE AMONG PREGNANT WOMEN ATTENDING TWO PRIMARY HEALTH CARE CENTERS

1.1 Introduction

Exclusive breastfeeding is the process whereby an infant receives only breast milk. The significance of the provision of a nurse-based intervention such as breastfeeding readiness education for mothers during the antenatal visits is crucial to achieving exclusivity among them. All lactating mothers should exclusively breastfeed their children for the initial six months and go on with breastfeeding up to two years. Despite the nutritional, economic, immunological and psychological advantages of breastfeeding, its knowledge and practice appear to remain below recommended level (Adugne, 2014). Breastfeeding served and continues to serve as an appropriate method through which newborns are offered essential nutrients necessary for optimal growth and intellectual development. Breast milk is regarded as perfect, natural and protective food for newborns (Brulde, 2011).

As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitation of the study and Definition of terms.

1.2 Background of Study

Infant feeding methods are a major determinant of infant nutritional status, which in turn, affects infant morbidity and mortality. Among feeding methods, breastfeeding is of particular importance because this practice is fundamental for growth, development, health and survival of infants. Diallo et al., (2005) stated that about 5.6 million infants die annually because they do not receive adequate nutrition. Breastfeeding therefore has been classified by scientists and health workers as the best natural food for babies and breast milk contains all the necessary nutrients for the healthy growth of the child.

The benefits of breastfeeding are numerous ranging from providing the infant with antibodies, to helping ward off risks of illnesses and providing the baby with all his/her nutritional needs (Mundi, 2008). According to the World Health Organization (WHO) (2004), breast milk provides all the energy and nutrients that the infant needs for the first six months of life, and it provides about half or more of a child's nutritional needs during the second half of the first year, up to one third during the second year of life. Furthermore, breast milk not only protects the infant against infectious and chronic diseases, but also promotes sensory and cognitive development in addition to contributing to the health and well-being of mothers, helping in birth spacing, reducing the risks of ovarian and breast cancers as well as increasing family and national resources (WHO, 2004).

Generally, breastfeeding is practiced all over the world, though with variation in duration. Considering that the introduction of other food supplements at an early age often increase the risks of infections to the infant which may at times lead to life-threatening conditions such as diarrhoea, the WHO and United Nations Children's Emergency Fund (UNICEF)(2004), recommended that infants be exclusively breastfed for six months and, thereafter, up to 24 months, introducing other supplements to support the infants growth and development.

In view of the many benefits afforded by mothers and infants in breastfeeding, governments have also set goals and rates for breastfeeding practices. The Nigerian government has earmarked six University Teaching Hospitals as Baby Friendly Hospital Initiative (BFHI) centres, in Benin, Enugu, Maiduguri, Lagos, Jos, and Port-Harcourt, with the objective of reducing infant malnutrition, morbidity and mortality, as well as promoting the health of mothers. Since the inception of BFHI in 1991, a series of programmes, seminars, workshops and conferences aimed at promoting breastfeeding practices have been organized.

The BFHI itself has proved to be an effective method of improving breastfeeding practices worldwide (Salami, 2006). To further strengthen the practice of exclusive breastfeeding, government also approved a breastfeeding policy in 1998. The code on the marketing of substitutes of breast milk was reviewed and amended in May, 1999, to further introduce stiffer fines and a clearer definition of breast milk substitutes. These measures are aimed at increasing the rate of exclusive breastfeeding as well as the early initiation of breastfeeding so as to achieve the World Summit on Children 1990 goal of universal exclusive breastfeeding for infants up to six months of age (Mundi, 2008).

These measures notwithstanding, evidence showed that the practice of exclusive breastfeeding (though fast improving) is still low in many parts of the world. In Nigeria, the rate increased from 2% to 20% in infants 0-3 months and from 1% to 8% in infants 4-6 months between 1990 and 1999 (National Planning Commission (NPC)/UNICEF, 2001). The Nigeria Demographic and Health Survey (NDHS) (2008), however, revealed that 97% of Nigerian children under age five were breastfed at some point in their life. A small proportion of infant (13%) were exclusively breastfed throughout the first six months of life.

More than seven in ten (76%) children of ages 6-9 months received complementary foods. 16% ofinfants less than six months of age were fed with a bottle with nipple, and the proportion bottle fed peaked at 17% among infant in the age ranges of 2-3 and 4-5 months. However, less than half of infants (38%) were put to the breast within one hour of birth and only 68% started breastfeeding within the first day. Relatively, among children born in the five year preceding the survey in Benue State, showed that 97.8% of children ever breastfed. 64.1% started breastfeeding within one hour of birth. 90.2% began breastfeeding within 1 day and 38.7% introduce pre-lacteal feed. Only 0.5% children were exclusively breastfed. These proportions indicate a marginal level of decline from the 1990, 1991, 1999, 2003 and the 2008 surveys (NDHS, 2008).

These dwindling attitudes regarding the practice of exclusive and non-exclusive breastfeeding have been attributed to several socio-economic, cultural and socio-demographic factors as it affects the development of children. Thus, this research project purposed to investigate the Effect of Nursing-Based Intervention on Exclusive Breastfeeding Practice Among Pregnant Women Attending Two Primary Health Care Centers in Taraba State.

1.3 Statement of Problem

Breastfeeding practices have undergone tremendous medical, cultural and sometimes religious challenges and debate. In an attempt to achieve successful breastfeeding globally by the year 2000, the World Health Organization and United Nations Children's Fund (1993), launched the Baby Friendly Hospital Initiative (BFHI) in 1991. The BFHI is a global effort involving 160 countries, of which 95 of them are in the developing world where Nigeria is inclusive (Salami, 2006). This project is to support, protect, and promote the practice of exclusive breastfeeding for six months and thereafter until 24 months of age. Several medical literatures have also established the superiority of breast milk over the other types of milk for the nourishment of the human infants, offering better health benefits.

Although breastfeeding is universal in the country, the trend is towards giving other feeds in addition to breast milk. Generally, the practices are more diversified and are characterized by late initiation of breastfeeding, the administration of substances other than maternal milk, and the introduction of weaning foods within one month following the infant's birth. The Nigerian Integrated Child Health Cluster Survey (ICHCS, 2003), indicated that a major area of need in infant breastfeeding was early initiation. The survey indicated a decline from 56% in 2000 to 34% in 2002. The Nigeria Demographic and Health Survey (NDHS, 2008) reports also revealed a 13% exclusive breastfeeding rate which is a decline from 17% indicated in 2003 report. The 2008 report further revealed that 34% of infants aged 0-5 months were given plain water in addition to breast milk, while 10% were given milk other than breast milk. Only 32% of infants' under-24 months of age were still on breast milk.

Considering the percentage of mothers practicing breastfeeding, it should not be surprising that Nigeria is still saddled with high incidence of malnutrition and its associated infant mortality. Many factors have been adduced to influence these practices. The decisions are very often influenced more by other factors than by health considerations alone. According to Sika-Bright (2010), the factors which influence the decision to exclusively or non-exclusively breastfeed include; mother's marital status, employment status, friends method of feeding their babies, social support and baby's age. Several other demographic studies conducted over the years (i.e National Demographic Sample Survey (NDSS), 1966; Nigeria Fertility Survey (NFS), 1982; National Population Policy (NPP), 1988; Integrated Child Health Cluster Survey (ICHCS) 2003; Nigeria Demographic and Health Survey (NDHS), 1990, 1999, 2003, & 2008; have also identified similar factors to include; mother's level of education, occupation, and income level to influence mother's choice of exclusive breastfeeding.

While significantly expanded in content, the primary objective of the previous surveys has been on emerging issues such as awareness and behaviour regarding HIV/AIDS and other sexually transmitted infection, poverty, gender inequality, fertility, mortality, nuptiality, awareness and use of family planning methods, sexual activity, nutritional status of mothers and infants, early childhood mortality and maternal mortality, maternal and child health and of course breastfeeding practices. However, these factors are apparent in the studies conducted over the years. The existence of a large scale of mothers practicing exclusive and non-exclusive breastfeeding, and its associated causes remained elusive in the studies.

It is not definite or clear whether demographic factors significantly or insignificantly influence the practice of exclusive and non-exclusive breastfeeding. It is worthy of note that up till recently, the principal foci of attention has been demographic factors and the practice of exclusive breastfeeding. None of the studies conducted over the years concern itself much with demographic factors and the effectiveness of exclusive breastfeeding in the development of under-fives in Benue State. Therefore, the study purposed to examine effectiveness of exclusive breastfeeding in the development of under-fives in Benue State.

1.4 Aim and Objectives of the Study

The aim of this study is to investigate the Effect of Nursing-Based Intervention on Exclusive Breastfeeding Practice among Pregnant Women Attending Two Primary Health Care Centers. In achieving this aim, the following specific objectives were laid out as follows:

1. To assess whether mothers have knowledge of the benefits and role that exclusive breastfeeding plays in child development (under-fives);
2. To assess whether mother's age, level of education and occupation has influence on the practice of exclusive breastfeeding;
3. To assess how effective exclusive breastfeeding is for children under-five; and
4. To determine the intervention of Nurses regarding breastfeeding influence on mother’s decision to exclusively breastfeeding.

1.5 Research Questions

This study sought to provide answers to the following specific research questions:

• Does mother's age, level of education and occupation influence the practice of exclusive breastfeeding?
• How effective is exclusive breastfeeding for children under-five?
• Do mothers have knowledge of the benefits and role that exclusive breastfeeding plays in child development (under-fives)?
• Does the intervention of Nurses regarding breastfeeding influence mother’s decision to exclusively breastfeeding?

1.6 Significance of Study

The findings of this study would give an insight into areas where health education campaigns are required to influence and promote the adoption of exclusive breastfeeding. Specifically:

It would also make progress towards obtaining demographic data on exclusive breastfeeding among nursing mothers attending antenatal clinics in Benue State. This, in addition, will benefit nutritionists, health planners in Benue State to formulate policies and strategies that are geared towards the promotion of exclusive breastfeeding on specific group of women and locations in which it is poorly practiced.

The findings of the study would benefit health workers to develop special intervention measures on specific age ranges of mothers who poorly practice exclusive breastfeeding.

The findings of this study would help health educators, nurses, nutritionists and curriculum planners to develop informed programmes for nursing mothers on the benefits of breastfeeding. This in addition, would update the curriculum to educate students in higher institutions of learning in preparing for future parenthood to adopt an effective method of breastfeeding the baby.

1.7 Scope of Study

The scope of this research is focused on the Effect of Nursing-Based Intervention on Exclusive Breastfeeding Practice among Pregnant Women Attending Two Primary Health Care Centers in Taraba State.

1.8 Limitations of the Study

The researcher experienced the following limitations. First, the relationship between types of breastfeeding and the infant mortality and morbidity were probably underestimated by some mothers as they did not attend post-natal care for further assessment and possible advice by the health care providers. Such nursing mothers were not included in the sample of the study. The study considered only nursing mothers that attended postnatal clinics.

The study did not take into account the differences between the infants who were raised by their biological mothers and those raised by significant others and this could involve some bias in the decision to exclusively or non-exclusively breastfeed the infant. Based on this, the researcher convinced the nursing mothers to provide accurate information on the method they feed their babies, as this was not to “witch hunt” them but was merely for academic purpose. Time and finances were limiting constraints to the work, notwithstanding the researcher was able to successfully complete the work.

1.9 Operational Definition of Terms

Exclusive Breastfeeding:

Exclusive breastfeeding means that the infant receives only breast milk. No other liquids or solids are given – not even water – with the exception of oral rehydration solution or drops/syrups of vitamins, minerals or medicines.

Under-fives:

Children who are less than five years old, especially those who are not in full-time education.

Perception:

Knowledge, Practice, Attitudes and beliefs about exclusive breastfeeding.