Journal of Childhood Obesity Open Access

Keywords

Mother; Breast feeding; Attitude; Knowledge

Introduction

The practice of lactation on the earth dates back to more than 100 million years ago and continued to the time of Homo sapiens which existed for about 40,000 years ago. Also wet nursing to lactate the child of the kings was appeared at about 200 years B.C as human being is the only in whom the natural and the most practical method of breast feeding is practiced [1-3]. The effective breast feeding is considered as the crucial part in strategy to improve the child health. This is because malnutrition contributes to 54% of underlying cause of less than 5 years old children mortality [4-6]. Thus, breast feeding has been found as vital nourishment in strategies to improve child health. But the practice of breast feeding nowadays is getting down. This is because the use of artificial substitutes of breast milk or bottlefeeding has become wide spread to the world recently [2].

Breast feeding is nearly universal practice in Ethiopia. Studies show that about 96% of children born breast fed at some time and the proportion of children ever breastfed ranges from 93% in Addis Ababa to 99% in Harari irrespective of other back ground. Type of assistant during delivery and place of delivery have found to influence early breast feeding practices. Early initiation of breast feeding is more common among children whose mothers where assisted at delivery by a trained traditional birth attendant and among children delivered at home [3]. Also it was found that the socio demographic features of population such as being dwellers of city or rural area and educational status of mothers are other variables found to affect the effective breast feeding practice. It was found that rural or illiterate mothers begin breast feeding within few hours from delivery compared to literate mothers [5].

Statement of the problem

Studies show that about 10 million children under age of five years die per a year and majorities from developing countries. In sub Saharan Africa, where almost half of all deaths in children aged less than five occurs, the decrease in mortality rates currently sluggish and in some countries the mortality rates has even increased. As this was devastating problem, the issue has got attention so that Millennium developmental goal number four is to reduce child mortality by 2/3 in 2015 [5]. The causes for the change in child survival are many and include rising poverty, fragile health systems, HIV/AIDS, and malnutrition. Malnutrition is estimated to be the underlying causes of 54% of under age of 5 years children mortality [4-6].

Appropriate feeding practice is one of the fundamental uses for the survival, growth, development, health, and nutrition of infants and young children. It is argued that promotion of EBF is the most effective child health intervention currently feasible for implementation at population level in low income countries. It is also found that EBF could lower infant mortality by 13% [7]. Although the role of EBF in reducing infant mortality is invaluable most women don’t practice EBF for recommended 6 months [8- 10]. In Ethiopia, despite of the universal practice, breast feeding is not effective.

In Ethiopia, the increase use of formula feeding by mothers, particularly in urban and semi urban areas is considered one of the leading causes of its flexibility and ease to use, freeing them to work. Others are convinced by the aggressive marketing campaign of commercial formula companies and by the appeal or modernity that bottle feeding has come too represented. Most poor mothers have no safe water to mix with formula and how problems to properly maintain bottle sterility, and often dilute the formula to make it last longer. These actions increase the likelihood of bacterial contamination and reduce nutritional benefits of the products [11-13].

The aim of this study is to collect baseline information about current knowledge, attitude and practice related to feeding of infants with a special focus on effective breast feeding. This information is intended to assist in designing intervention strategies to improve the practices that will be included in the result [14-16].

Objectives of the study

General Objective

To assess the knowledge, attitude, practice of exclusive breast feeding among inhabitants of Ginjo Guduru Kebele.

Specific Objectives

• To determine the mothers’ knowledge towards effective breast feeding.

• To identify influencing factors of the mother on breast feed of their child.

• To identify mothers’ attitude towards effective breast feeding.

Materials and Methods

Description of Study Area

The study was conducted in Ginjo Guduru kebele, Jimma town. It is located 2km from Jimma University, 335 km away from Addis Ababa, the capital city of Ethiopia. It is bordered by Mandara Kochi to North, Bacho Bore to South, Awetu mandara to west & Ginjo to East. The climate of the kebele is Weyina Dega. The kebele's total populations are 8062 of which 4164 are males and 3898 are females. Under one year children are 315. It has 2533 total households [17].

Study design

A cross sectional community based survey was conducted to assess mothers KAP towards exclusive breast feeding among inhabitants of Ginjo Guduru kebele, June 29- August 1, 2017.

Population

Study population was all of mothers who have children less than one year in Ginjo Guduru kebele. The representative samples of 190 mothers who have children less than one year.

Sample Size and Sampling Technique

The sample size was estimated using sample size determination formula for a single population proportion. Since there were no previous studies which estimate the prevalence of noneffective breast feeding in the area, prevalence level that estimate maximum sample size/50%/ marginal error(d) 0.05, non-response rates 10%, 95% confidence certainty and alpha 0.05 was considered, based on these assumptions, a total sample size of 190 was calculated using formula indicated below [18-20].

Since the total population is less than 10,000 the final sample size will be calculated by applying the population correction formula.

Nf = ni Nf = Sample size required

1+ ni ni = initial sample size

N N = No of mothers who have < 1years

173x10% =17.3(non- response rate of 10%) Total sample size = 173+17.3=190

Study Variables

Dependent Variables

• Knowledge about EBF

• Attitude in relation to EBF

• Practice towards EBF

Independent Variables

• Age

• Sex

• Language

• Religion

• Ethnicity

• Marital Status

• Educational status

• monthly income

Operational Definitions

Knowledge: The information of understanding and skills that you going through education or experience.

Good knowledge: Score>60% on the overall knowledge questions.

Poor level of knowledge: Score <60% on the overall knowledge questions.

Atitude: The way that you think and feel about something, the way that you behave towards something that shows how you think and feel.

Good (Positive): attitude towards attitude questions of EBF scores >60%

Poor level: of attitude score < 60%

Practice: The overt behavior habit or custom of a women.

Good practice score > 60%

Poor practice score < 60%

Key Terms

Complementary feeding: Provision of other foods or Liquids along with breast milk

Colostrum’s: special milk that secreted in the first 2-3 days after delivery

Early weaning: Supplementation of food in addition to breast feeding started before the age of 4 months.

Exclusive breast feeding: means optimal breastfeeding from birth to the first 6 moths

Extended Family: Families with additional members other than the mothers father, and children

Meconium: the first stools of a new born baby which are sticky and dark green.

Nuclear Family: Families made up of only parents and children.

Post-Partum: is the period of 6-12 weeks after delivery of new

Data collection procedure and Instrument

Data was collected by trained 6th year medical student through interviewing each participant from the households to be selected using structured questionnaire.

Data Processing and Analysis

The collected data was checked for completeness of information and consistency. The data was complied, analyzed and presented using tables and percentage. A scientific calculator was used for mathematical operation of numerical variables. Computer was used for writing and editing. Chi-Square test was used to determine the level of significance and association between dependent and independent variables [20-22].

The results were compared with regional, national and WHO results.

Quality Control Measure

The questionnaire was checked for its clarity, completeness, reliability, consistency, sensitivity, time and patterns of response were used. Training was given for data collectors on the instrument and data collection procedure. Were there be any difficulties during data collection, things were explained, discussed and briefed to respondents by their mother languages. Daily monitoring of the process & feedback on each day performance at the end of working hours was done. Then correction was made accordingly [23-24].

Result and Discussion

A total of 190 mothers were interviewed concerning the KAP towards EBF. The Socio demographic characteristic of these study shows 18 and 42 years respectively are the minimum age and the maximum ages of population. 68 (35.79%) of respondents fall in to 25-29 years age ranges. 64.21% are distributed into different age groups as presented in (Table 1) [25]. The result shows that 50.53% of mothers have children under age of six months, 5.26% have children above 12 months. 44.21% of children are in the age of 6-12 months. Most of the women about 80% are married the other 20% are divorced and widowed [26]. About 48.95% of respondents are Muslims, 26.84% were orthodox and the remaining 20% are protestant. Majority of the respondents (41.1%) are Oromo by ethnicity followed by 26.8% were Amhara by ethnicity. About 56.84% completed above grade ten schools. About 3.16% are illiterate and 24.21% completed secondary school. The rest are in primary school and preschool level. Regarding occupational status of mothers about 38.95% of them are sales and services followed by clerical and manual labors which accounts for about 24.21% and 16.84% respectively. Most of women’s (30.2%) monthly income is between 601- 1000 birr and only few (6.9%) of women earn 1000 birr and above. About 56.84% of mothers have at most two children and about 37.94% have 3-4 children in home. The remaining 0.12% of women has greater than 7 children number per home [27-29].

Table 1: Socio-demographic characteristics of mothers of child bearing age among in Ginjo Guduru kebele, Jimma town, August, 1 2017.

Influencing Factors of mothers of child bearing age

There were different influencing factors towards KAP of exclusive breast feeding. Among women of child bearing age about 92.63% had practiced breast feeding. The remaining women’s are not practiced. Regarding the health education about 74.74% of mothers had got health education. The remaining mothers had not got health education. The greatest of them had got from mass media which accounts for about 49.47%. The remaining ones got from books and health institution which accounts for about 12.63% and 11.58% respectively. Majority of mothers evaluated their general health status as good and very good this accounts for 44.21% and 33.16% respectively. About 3.36% of mothers evaluated themselves as very bad (Table 2 and 3) [30].

Table 2: Influencing Factors of mothers of child bearing age in Ginjo Guduru, Jimma town, August 2017

Table 3: Influencing factors of mother of child bearing age in Ginjo Guduru kebele, Jimma town, August 1, 2017.

Knowledge of mothers of child bearing age

Regarding the knowledge of mothers on KAP of exclusive breast feeding about 92.63% of them knew the importance of breast feeding, the remaining one did not know the importance. About 81.05% of mothers knew as breast milk alone is important for the new born. The other mothers said water and butter are important this accounts for about 10.53% and 6.32% respectively. Concerning the duration of exclusive breast feeding about 82.1% said up to four to six months, 10% said up to four months, the remaining said for more than six months. About 92.63% of the mothers had knowledge on breast feeding as it did not cause harm to the child [31-33].

The reaming said it harm the child. Concerning the knowledge of bottle feeding 46.84% of the mothers said it did not cause harm to the child, 53.16% knew bottle feeding cause harm to the child. Concerning to the time to start complementary feeding about 81.05% did not start before four months. About 18.95% started before four months. The reason they started before four months as they said was their breast feeding was not sufficient alone in about 8.95%, the others said breast feeding was not sufficient in about 4.74%. 3.68% of mothers said due to child refusal. Regarding to the duration of exclusive breast feeding 55.26% of the mothers exclusively breast feed for six months. About 15.79% exclusively breast feed for four months (Table 4 and 5) [34].

Table 4: knowledge of mothers of child bearing age among Ginjo Guduru kebele, Jimma town, August 1, 2017.

Table 5: Attitudes of mothers of child bearing age in Ginjo Guduru kebele, Jimma town, July 2017.

Concerning the attitude of mothers towards KAP of exclusively breast feeding as usual 190 of child bearing age women interviewed. Among these 55.79% preferred to feed their babies in the first four months with breast milk alone. About 32.63% prefer to feed with breast milk and cow milk together. The remaining 7.37% preferred to feed with breast milk and formula milk. 58.42% of mothers agreed as exclusively breast feeding for the first six months was advantageous for the baby’s. The others had ideas of neutral and disagree which accounts for 26.84% and 14.74% respectively. Concerning colostrum about 65.26% said colostrum should not discard and 9.47% agreed on the ideas, while the remaining ones were neutral. About 55.26% of mothers said that exclusively breast feeding is sufficient for the baby in the first four months. Other said it was not sufficient as cow milk and formula milk which accounts for about 16.84%. About 93.16% of the mothers said their babies’ breast fed as frequent as they need and the remaining said no(Table 6 and 7) [35-37].

Table 6: Practice of mothers of child bearing age in Ginjo Guduru kebele , Jimma town, August 1, 2017.

Table 7: Practice of exclusive breast feeding in mothers of child bearing age in Ginjo Guduru kebele, Jimma town. August 1,2017

Regarding attitude of bottle feeding about 64.74% of mothers said it was useful if breastfed was impossible, 22.11% of mother said it was useful we there breast fed or not and the remain told it was not important. Regarding opinion of mothers on breast feeding as mothers of today about 54.21% of mothers said it was natural and appropriate, about 23.68% said it was outmoded and about 13.16% told it disfigures the women's shape. About 6.84% said it looks her old (Table 8 and 9) [38].

Table 8: The practice of breast feeding in women of child bearing age in Ginjo Guduru kebele, Jimma town, August 2017.

Table 9: Association between socio-demographic factors and knowledge of mothers towards EBF in Ginjo Guduru kebeles, Jimma town, August 1, 2017.

5.3 Practice of mothers of child bearing age

Concerning practice of KAP on exclusive breast feeding of mothers of childbearing age in the kebeles, as usual 190 were interviewed. Among them about 59.47% started to breast feeding within one hour of delivery, where as 35.79% started after one hour. About 47.79% of the woman breast fed their child 8-10 times per a day. Whereas 33.16% breastfed for greater than 10 times per a day. The remaining one breast fed their child less than 8 times per a day. Majority of the mothers is about 92.11% exclusively breastfed their babies. Among the 84.21% exclusively breastfed their babies for the first six months and about 5.79% of the mothers breast fed for greater than six months. Regarding colostrum about 76.84% of mothers gave colostrum to their baby, the remaining didn’t do that. The reason they didn’t gave is, because it seems like dirty and pus in about 13.68% of mothers, the elder child got sick and no opinion which accounts for about 7.37% and 1.05% respectively. The practice of giving first nutrient for the infant was in about 56.84% breast milk, 21.58% water, 11.05% sugar and 6.64% butter [39]. Regarding the time of cessation of breast feeding about 54.74% of the mothers said from 19- 24 months. About 24.74% of mothers said from 13- 18 months. The remaining said 7- 12 months and up to 6 months which accounts for 12.63% and 5.79% respectively. The reason they stopped breast feeding was in about 51.59% due to it was the time to stop breast feeding, in about 17.37% their baby didn’t eating well, 11.05% was due to decrease in flow of their milk. The others told because of they were sick and took drugs in about 7.9%, in about 5.79% due to they got pregnant (Table 10 and 11).

Table 10: Association between socio-demographic factors and Attitude of mothers towards EBF in Ginjo Guduru kebeles, Jimma town, August 1,2017.

Table 11: Association between socio-demographic factors and practice of mothers towards EBF in Ginjo Guduru kebeles, Jimma town, August 1, 2017.

Conclusion

This study showed that the prevalence of exclusive breast feeding for infant age less than six months is 92.11%. This gap might be related the majority of mother’s educated and uses mass media and this helped them to practice exclusive breast feeding. In addition the reason for this might be the current policy implementation on the use of health extension worker to promote breast feeding.

This study also showed that majority of mothers had EBF knowledge, attitude and practice. This difference might be high proportion of mothers got information from mass media, health worker and books which could help them to initiate breast feeding early. In this study mothers were asked about the frequency of breast feeding. It showed that appropriate frequency of breast feeding rate was found to be 47.9%. This difference could be explained that in the current study majority of the respondents work outside home by occupation, so they might have low chance of staying with their babies.

Regarding the time of cessation of breast feeding about 54.74% of the mothers said between 19- 24 months and most of them addressed the reason was they assume this time as adequate for weaning. Majority of mothers stop breast feeding when they became sick or pregnant or their child became sick. More than half of the women decide to discontinue breast feeding when become pregnant again. The reason majority of mothers stop adequacy of time secondary to information they got from health institutions, mass media and books might.

Like in many other developing countries, the practice of mother giving water to their children in addition to the breast milk was common. It is evident that early introduction of liquids and solid is unnecessary, reduces the duration and frequency of breastfeeding, and increases risk of infant morbidity and mortality and therefore such unhealthy behavior needs to be corrected. Knowledge is associated positively with age of the mothers, types of family, educational status and occupation of the mothers. About 24.06% of mothers had poor knowledge of EBF

Attitude of the mothers is related with type of family and occupation. About 36.11% of mothers had poor level of attitude on EBF. Practice is also related with age of the mother and education. About 31.31% of mothers had poor practice of EBF.

Recommendation

Health service delivery staffs, Policy makers, administrators and Non-governmental organization should collaborate to draw strategies to enhance the awareness of mothers about EBF. Mothers who deliver in the health institute should have prior knowledge about EBF so that they initiated to breast feed their child including the time of initiation immediately after birth. The harmful effect of failure in exclusive breast feeding and similar large scale study should be conducted in regional and country level so that best strategies to achieve EBF practical in Ethiopia.

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