1.1 Introduction
Nurses play a major role in the promotion and implementation of Primary Health care (Paho, 2021). Since nurses are the bedrock in the delivery of healthcare, they frequently need to be updated with adequate knowledge so that they, in turn, spread adequate information and skills to mothers and the community as a whole. However, the health and nutritional status of children and mothers are intimately linked. Breastfeeding provides the healthiest beginning for the infant. With the risk of Mother to Child Transmission of HIV through breast feeding, health workers need guidance on how to address issues of optimal infant feeding on one hand whilst minimizing the risk of MTCT and the risk of infants dying from improper feeding practices on the other hand (NIYCF, 2006-2010).
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 technical 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, Bell, Moutquine, & Garrant (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 examine the Knowledge and Attitude of Nursing Mothers on Exclusive Breastfeeding in Benue State, Nigeria.
1.3 Statement of Problem
Breastfeeding practices have undergone tremendous medical, cultural and sometimes religious challenges and debate. There has not been a mechanism put in place to keep proper or concrete records on the activities as well as indicators of Exclusive Breastfeeding and mothers support groups in hospitals, polyclinics and health centres in Nigeria. There has however been occasional figures produced from special exercises or survey carried out. For instance, (World Linkages, Nigeria, July 2000; Country Profile), in a study in the upper East region in Nigeria, revealed that among children less than two months old, 43 percent are exclusively breastfed. By the fourth to the fifth month, the figure drops to 22 percent. Moreover, on the average, globally, only 39 per cent of babies breastfeed exclusively, even in the first four months of life (UNICEF; WABA, 2003).
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 the study is to ascertain the current feelings and views of a cross-section of the Breastfeeding mothers on a MCH clinic day at University of Benin Teaching Hospital (UBTH), about exclusive Breastfeeding in order to develop appropriate strategies. In achieving this aim, the following specific objectives were laid out as follows to:
- Find out the perception on exclusive breastfeeding among postnatal mothers.
- Assess the level of Breastfeeding mothers' views about the benefits of exclusive breastfeeding;
- Determine the level of breastfeeding mother's views about barriers to exclusive breastfeeding;
- Identify the behaviour and feelings of participants towards exclusive breastfeeding of participants;
- Investigate any kind of support for breastfeeding mothers on exclusive breastfeeding.
1.5 Research Questions
This study sought to provide answers to the following specific research questions:
- Do the breastfeeding mothers know how important the exclusive breastfeeding is and how to do it?
- Do they have confidence and where do they turn to when they face difficulty?
- Are people around them such as fathers and grandmothers supportive especially when mothers have to resume employment soon after delivery?
1.6 Significance of Study
The findings of this study will provide a current perceptual database that will inform all of us and more importantly the policy makers on the feelings and views of the mothers about exclusive breastfeeding so that appropriate alternatives to motivate the indulgence of exclusive breastfeeding and its support, would be developed by Breastfeeding mothers, helpers and the populace of Nigeria.
The findings will also 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
This research project is focused on examining the Knowledge and Attitude of Nursing Mothers on Exclusive Breastfeeding in MCH clinic day at University of Benin Teaching Hospital (UBTH), Benue State, Nigeria.
1.8 Limitations of the Study
During the course of this study, many things militated against its completion, some of which are:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Research material: availability of research material is a major setback to the scope of the study.
- Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
- Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
1.9 Operational Definition of Terms
These are precise descriptions of how to derive a value for characteristics the researcher is measuring. It also entails how specific these characteristics are;
Exclusive breastfeeding: This means giving a baby only breast milk, and no other liquids or solids, not even water unless medically indicated. This should be for the first 6 months (NIYCF, 2007).
Exclusive Replacement Feeding: This is the process of feeding a child who is not breastfeeding with a diet that provides all the nutrients the child needs until the child is fully fed on family foods. Infant formula is recommended for exclusive replacement feeding when AFASS (Acceptable, feasible, affordable, sustainable and safe) is met (NIYCF, 2007).
Heat Treated Expressed Breast milk: This means that a mother expresses breast milk and heats it so that the HIV present in breast milk is destroyed making it safe to feed the infant (NIYCF, 2007),
Wet Nursing: This refers to breastfeeding by another woman, who is HIV-negative. This may only be considered in special situations such as in case of an orphaned infant and the family cannot meet AFASS. The wet nurse should be tested every three months (NIYCF, 2007).
