KNOWLEDGE AND UTILIZATION OF EXCLUSIVE BREASTFEEDING AMONG

LACTATING MOTHERS ATTENDING POST NATAL CLINIC IN

GWAGWARWA HOSPITAL, KANO.

BY

ABDULMALIK, HADIZA
NOU060042146

Being a research project submitted to School of Science and Technology, National

Open University of Nigeria, Lagos, in partial fulfillment of the requirement for the

award of Bachelor of Nursing Science (BNSc.)

July, 2013

i
 DECLARATION

I HADIZA ABDULMALIK humbly declared that this research work on

“Knowledge and utilization of exclusive breastfeeding among lactating mothers attending

Post Natal clinic in Gwagwarwa Hospital, Kano” is a result of my research effort. Carried

out in the School of Science and Technology, National Open University of Nigeria

(NOUN) under the supervision of DR. MUSA SA’AD MUHAMMAD. I further wish to

declare that to the best of my knowledge and belief, it contains no material previously

published, nor written by another person, nor material which to a substantial extent has

been accepted for the award of any other degree or diploma of any University or other

institute of higher learning except where due acknowledgement has been made in the

text.

_____________________

HADIZA ABDULMALIK

Date……………………

ii
 CERTIFICATION

This is to certify that this research work entitled “Knowledge and Utilization of

Exclusive Breastfeeding among Lactating Mothers Attending Post Natal Clinic in

Gwagwarwa Hospital, Kano” was carried out by HADIZA ABDULMALIK, in the

School of Science and Technology, National Open University of Nigeria Sauna Kano for

the award of Bachelor of Nursing Science degree (BNSc.)

………………………………………. ……………………………

Project Supervisor Programme Leader

Date………………………….. Date….…………………

iii
 ACKNOWLEDGEMENT

In the name of Allah the most gracious the most merciful, peace and blessing of

Allah be upon His Messenger Muhammad (SAW).

The researcher’s profound gratitude goes to the Almighty Allah whose grace gave

me the life, strength and wisdom to undertake and complete this work.

The researcher’s supervisor Dr. Musa Sa’ad Muhammad for his support, guidance

and encouragement and for been patient with me all through. I pray that Allah (SWT)

reward him with Al-Jannah.

The researcher thanks the Director, and the entire staff of Kano Study Centre of

National Open University of Nigeria (NOUN) for their unrelenting support and

encouragement throughout the entire study. May Almighty Allah reward you abundantly.

The management of Aminu Kano Teaching Hospital, Kano had been very

supportive in the course of the researcher’s study. For this she wishes to express her

gratitude. Also to her numerous professional colleagues especially Matron Bunmi, she

extends her profound gratitude and appreciation.

iv
 DEDICATION

To my better part Alhaji Said Aliyu, my curious children- Bilkisu, Fatima and

Yusif for their unending love, understanding and copious encouragement. May Allah

(SWT) make our final destination AL-JANNAT FIRDAUS-Ameen

v
 ABSTRACT

This research work was carried out to investigate the knowledge and utilization of

exclusive breastfeeding among lactating mothers with a view finding out whether there is

awareness and corresponding utilization of exclusive breastfeeding.

Descriptive research method, structured questionnaire was used to generate responses

from the respondents. Simple frequency and percentage statistics were used to analyze

the data.

It was found that majority of the respondents are not practicing exclusive breastfeeding.

Probably due to their job, discouragement from the breastfeeding influencers and lack of

much information on exclusive breastfeeding.

In conclusion there is inadequate knowledge on exclusive breastfeeding and the practice

is not adequately enforced, thus there is need for more supports. The researcher suggests

further studies on Knowledge, Attitude and Practice (KAP) of health workers towards

exclusive breastfeeding.

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 TABLE OF CONTENT

Title Page i
Declaration ii
Certification iii
Acknowledgement iv
Dedication v
Abstract vi
Table of content vii

CHAPTER ONE (Introduction)

1.0 Introduction 1
1.1 Background of the Study 1
1.2 Statement of the Problem 3
1.3 Purpose of Study 3
1.4 Significance of the Study 3
1.5 Scope of the Study 4
1.6 Research Questions 4
1.7 Definition of Terms 5

CHAPTER TWO (Review of Related Literature)

2.0 Introduction 6
2.1 The Practice of Real exclusive Breast Feeding 6
2.2 Composition of Breast Milk 10
2.3 Benefit of Breast Feeding 13
2.4 Breast Feeding Difficulties 14
2.5 Comparison of Breast Milk, Formula and Cow’s Milk 16
2.6 Exclusive Breast Feeding and HIV/Abrupt Weaning 17
2.7 Risks and Danger of Formula Feeding 18
2.8 Promotion and Supporting Exclusive Breastfeeding 21
2.9 Exclusive Breastfeeding Practice Among Communities in Nigeria 21
2.10 Exclusive Breastfeeding and Weaning 25
2.11 Cultural Issues Surrounding Breastfeeding 27

vii
CHAPTER THREE (Materials and Method/Methodology)
3.0 Introduction 28
3.1 Research Design 28
3.2 Area of the Study 29
3.3 Target Population 29
3.4 Sampling Technique 29
3.5 Instrument for Data Collection 30
3.6 Validity/Reliability of Instruments 30
3.7 Method of Data Collection 30
3.8 Method of Data Analysis 30

CHAPTER FOUR (Results, Analysis and Findings)

4.0 Result/Analysis of Data 31

CHAPTER FIVE (Summary, Conclusions and Recommendations)

5.0 Summary 52
5.1 Conclusion Including Contribution to Knowledge 53
5.2 Recommendation/Suggestion for Further Studies 54
References 56

viii
 CHAPTER ONE

1.0 INTRODUCTION

1.1 BACKGROUND OF THE STUDY

Breast feeding is the fundamental right of the child; it greatly improves quality of life by

providing unique, nutritional, immunological, economical, and psychological and child

spacing benefit. It also enhances maternal health (Gupta, 2007). He further asserts that

exclusive breast feeding for the first six month of life is the effective child survival

intervention in the developing countries.

Gupta (2007) and Ruth (1993) Explained that scientific evidence has proved beyond any

doubt that breast feeding is the ideal form of feeding the newborn baby. They further

state that it is estimated that exclusive breast feeding can reduce about 13% of childhood

death and is seen as the largest contribution to child survival intervention. Furthermore

they are of the opinion that in developing countries where the knowledge and skills of

breast feeding have been retained within the society, women consider it normal thing to

do. In these countries breastfeeding tend to have an excellent chance of been successful

as midwives may have no problem in encouraging mothers to breast-feed bearing in mind

the inherent norms of the society and its economic advantage.

On the other hand, in the so called developed world, the majority of women who choose

to breastfeed do so because they regard it as the fulfillment of motherhood and are less

conscious of the benefit of human milk for their babies (Ruth 1993).

1
It is interesting to note that from time immemorial, mothers do breast feed their babies

though not exclusively but intensively the first six (6) months of life, and thereafter infant

receive complementary food and continue breast feeding up to 2 years of life (Ruth

1993).

WHO, (2009) recommends exclusive breastfeeding for the first six months of life and

continued breast feeding up to 2 years or beyond. Promotion of exclusive breast feeding

is the single most cost effective intervention to reduce infant mortality in developing

countries (Dewey1995). It is estimated that sub-optimal breast feeding especially non-

exclusive breast feeding in the first six months of life, results in 1.4 million death and

10% of diseases in under-fives(Venneman2009). Non-exclusive breast feeding also has

long term impact, including poor school performance, reduced productivity, and impaired

intellectual and social development(KRAMER2008). It can also increase the risk of

dying due to diarrhea and pneumonia among 0 – 5 month old infants by more than two-

fold (INFACT CANADA2013) .

WHO, (2009) Explained that evidence shows that of the sixty percent of under-five

mortality caused by malnutrition (directly or indirectly), more than two-thirds of these are

associated with inappropriate breast feeding practices during infancy. Similarly the

evidences also indicate that not more than 35% of infants worldwide are exclusively

breastfed during their first four (4) months of life.

1.2 STATEMENT OF THE PROBLEM

2
Child birth is supposed to be a happy moment for both parents. A healthy neonate thrives

well, is active and agile which is attributable to feeding practices employed. However, the

current trend is that hospitals keep receiving babies with diarrhea, vomiting and

abdominal distension which are attributable to ingestion of contaminated food, most

likely arising from faulty feeding practice.

1.3 PURPOSE OF STUDY

i. The purpose of this study is to investigate the knowledge and utilization of

exclusive breast feeding among lactating mothers.

1.4 SIGNIFICANCE OF THE STUDY

Every mother has the capacity to produce sufficient milk for her baby, the mother’s lack

of confidence and pressures from the family may lead her to give artificial feeds

unnecessarily. This leads to failure of exclusive breast feeding and exposes the baby to

infections and other dangers of artificial feeds or contaminated water. The study will help

in proper understanding and utilization of exclusive breast feeding thereby leading to

reduction of infant mortality rate and enhancing maternal health.

3
1.5 SCOPE OF THE STUDY

This work is limited to lactating mothers attending post natal clinic Gwagwarwa, Kano.

It is specifically limited to knowledge and utilization of exclusive breastfeeding by the

respondents.

1.6 RESEARCH QUESTIONS

The research attempts to provide answers to the following questions:

i. Are mothers attending Gwagwarwa clinic in Nassarawa Local Government area

of Kano State adequately informed about exclusive breastfeeding?

ii. What is the major source of information on exclusive breastfeeding for lactating

mothers attending Gwagwarwa clinic in Nassarawa Local Government area of

Kano State?

iii. How frequently do mothers attending Gwagwarwa clinic in Nassarawa Local

Government area of Kano State breastfeed their babies?

iv. What feeding practice is most preferable to mothers attending Gwagwarwa clinic

in Nassarawa Local Government area of Kano State?

v. What are the major challenges that mothers attending Gwagwarwa clinic in

Nassarawa Local Government area of Kano State face in practicing exclusive

breastfeeding?

vi. Who are the major influencers of exclusive breastfeeding amongst mothers

attending Gwagwarwa clinic in Nassarawa Local Government area of Kano State?

4
1.7 DEFINITION OF TERMS/OPERATIONAL DEFINITION OF TERMS

 Breast Abscess: An area of breast that have become infected and filled with pus.

 Colostrums: The first breast milk after given birth, rich in antibodies.

 Cholesterol: a lipid produced by the liver.

 Lactoglubolin: Major whey protein of cows and sheep milk.

 Latch on: To attached on.

 Macro Nutrient: Nutrient needed in large quantity.

 Micro Nutrient: Nutrient needed in small quantity.

 Obesity: Overweight with a high degree of body far.

 UNICEF: United Nation International Children’s Fund

 WHO: World Health Organization.

5
 CHAPTER TWO

2.0 INTRODUCTION

The related literature has been reviewed under the following sub-headings,

i. The practice of real exclusive breastfeeding

ii. Exclusive breast feeding/HIV

iii. Component of breast feeding

iv. Benefit of breast feeding

v. Comparison of breast milk, cow’s milk

2.1 THE PRACTICE OF REAL EXCLUSIVE BREAST FEEDING

According to Gupta (2007), exclusive breast feeding means giving a baby no other food

or drink, not even water other than breast milk. Medicines and vitamins are permitted if

indicated; expressed breast milk is also permitted.

According to Galson, Steven K. (2008), breast feeding is an unequalled way of providing

ideal food for the healthy growth and development of infants; it is also an integral part of

the reproductive process with important implications for the health of mothers. Review of

evidence has shown that, on a population basis, exclusive breast feeding for 6 months is

the optimal way of feeding infants. Thereafter, infants should receive complementary

foods with continued breast feed up to 2 years of age or beyond. He further explains that

to enable mothers to establish and sustain exclusive breast feeding for 6 months, World

Health Organization (WHO) and UNICEF recommended as follows:

6
  Initiation of breast feeding within the first hour of life.

 Exclusive breast feeding-that is the infant only receives breast milk without any

additional food or drink not even water.

 Breast feeding on demand.

 No use of bottles, teats or pacifiers while breast feeding is a natural act and also a

learned behavior.

An extensive body of researches Falco, (2010); Horton, Sanghui, Phillips et al (1996)

have demonstrated that mothers and other care givers require active support for

establishing and sustaining appropriate breast feeding practices.

WHO and UNICEF launched the baby Friendly Hospital Initiative in 1992, to strengthen

maternity practices to support breast feeding,

The WHO / UNICEF recommended 10 steps to be observed by every facility providing

maternity service and care for newborn infants should include the following:

1. Have a written breast feeding policy that is routinely communicated to all health

care staff.

2. Train all health care staff in skills necessary to implement this policy.

3. Inform all pregnant women about the benefits and management of breast feeding.

4. Help mothers initiate breast feeding within one half hour of birth or within six

hours of delivery for baby born by caesarian section.

5. Show mothers how to breast feed and maintain lactation, even if they should be

separated from their infants.

7
 6. Give newborn infants no food or drink other than breast milk, unless medically

indicated.

7. Practice rooming-in, that is, allow mothers and infant to remain together 24 hours

a day.

8. Encourage breast feeding on demand.

9. Give no artificial teats or pacifiers (also called dummies or soothers) to breast

feeding infants.

10. Foster the establishment of breast feeding support groups and refer mothers to

them on discharge from the hospital or clinic.

The hospitals fulfilling the above are assed and designated baby friendly.

Azubuike (2007) further suggests the following;

1. Feed on demand, a baby should be fed as soon as he or she cries.

2. Get comfortable. To avoid back pain, bending over or down to bring breast should

be discouraged.

3. Wear practical clothes for easy access to the breast.

4. Positioning the mother should breast feed in a positions she feels most

comfortable with skin contact with her infant. The baby’s mouth should open and

the breast introduced so that the baby’s lips are on the areolar accessing the milk

through the lactiferous ducts.

5. Attachment and “Latch-on” the nipple and areolar should be inserted into the

baby’s mouth. After feeding the breast should be removed from the breast by

8
 placing a finger into the infant’s mouth between the gums. Improper latch-on with

the baby sucking at the nipples only, may lead to cracked, sore or bleeding

nipples.

6. Let the baby set the pace, the mother should remember that for infants, breast

feeding is both nutrition and comforting. The baby may pause during feeding to

rest, gaze at mother or look around the room. This often amounts to a short break

not a problem with feeding.

7. Avoid rushing through a feed. Mother should view breast feeding as a time to

slow down and enjoy intimate moment with the baby.

Azubuike further explained that to encourage effective sucking and to prevent the

introduction of contaminants, use of bottles or pacifiers (dummies or artificial teats) is

discouraged. If the mother has to miss a breast feed, she can maintain her supply by

expressing milk when she would have breast fed. Expressed breast milk can be fed by

cup at a later time.

9
2.2 COMPOSITION OF BREAST MILK

Azubuike (2007) breast milk is dynamic and varies even during feeds and as the infants

mature. Mothers feeding babies of the same age seem to have about that same

composition provided the mother is not undernourished. Colostrum is the milk produced

in the first few days after delivery; it is thick and yellowish or clear in color. It contains

more protein, more antibodies, more white blood cells and anti-infective proteins than

mature milk. These anti infective proteins and white cells provide the first immunization

against diseases; protecting the baby after delivery. He further explained that “colostrum

has a mild laxative effect which helps the baby evacuate meconium. This clears bilirubin

from the gut and helps to prevent jaundice. Colostrum contains growth factors which

helps the baby’s immature intestine to develop after birth. This helps to prevent the baby

from developing allergies and intolerance to other foods. Colostrum is richer than

mother’s milk in some vitamins, especially vitamin A which helps to reduce the severity

of any infections that the baby might have.

WHO/UNICEF (2000), explain that the protein in breast milk contains all the essential

amino acids and is adequate for the size of the baby. The iron in breast milk is in ferrous

state and therefore easily digested and unavailable for bacterial utilization. Babies should

not be given prolactin feeds before they start breast feeding. Artificial feeds given before

a baby has colostrum are especially dangerous as they reduce the desire of the baby to

feed while exposing the child to great morbidity. It is interesting to note that colostrum is

gradually replaced by the mature milk by the 2 nd week (Transitional milk) (Azubuike

10
2007).. Mature milk comprises of both fore milk and hind milk. The fore milk is grayish

and contains more water while the hind milk contains more fat for satiety.

Alive and Thrive (2013) explain that breast milk is 88% water. They explain that studies

have shown that healthy exclusively breast fed infants under 6 months old do not need

additional fluids, even in countries with extremely high temperatures and low humidity,

offering water before 6 months of age reduces breast milk intake, interferes with full

absorption of breast milk nutrient and increases the risk of illness from contaminated

water and feeding bottles.

11
 COMPOSITION OF COLOSTRUM, BREASTMILK AND COW’S MILK PER 100ML
CONSTITUENTS COLOSTRUM BREAST MILK COW’S MILK
Water 87.6 8.2
Solids 12.8 12.4 12.8
Ph 7.1 6.8
Total protein (g) 10 1.1 3.6
Casein when ratio 20:80 40:60 80:20
Lactalbumin (mg) 0.4 0.1
Lactoglobulin (mg) 0.2 0.2
Lactoforin 1.4 0.15 -
Immunoglubin A 5.4 0.15 -
Fat-ratio of saturated and unsaturated 11.59 50:50 63:37
Carbohydrate lactose 5.3 7.0 1.8
Calories variables 71 67
Electrolyte sodium 48 15 52
chloride (mg) 59 13 98
calcium (mg) 31 35 120
Phosphurus (mg) 11 15 95
Iron (mg) ? 76 50
Vitamin A 126 60 10
Vitamin B 4.4 3.8 1.5
Vitamin D 1.8 0.6 0.02
Adapted from Essential pediatrics by Azubuike 2007

12
2.3 BENEFIT OF BREAST FEEDING

Huggins (1999),Alive and Thrive (2013) assert that exclusive breast feeding saves life

and is the most effective intervention for preventing child’s death, yet less than 40% of

infants under 6 months old receive the benefit of exclusive breast feeding. Diarrhea and

pneumonia are the leading causes of death among infants in developing countries. Infants

less than 2 months old who are not breastfeed are six times more likely to die from

diarrhea or acute respiratory infections than those who are breast fed. Approximately 1.3

million deaths could be prevented each year if exclusive breast feeding rates increased to

90%.

Huggins further explained that some of the benefits of exclusive breast feeding are

protection against illness and promotion of recovery of the sick child.

Azubuike (2007); Falco (2010) ; Galson (2009) are of the opinion that breast milk

contains just the right balance of nutrients for the baby and it is readily available; it

provides exactly as much energy, proteins, vitamins, minerals and fat as the baby needs

to grow and mature. They also maintain that breast milk provides antibodies to help boost

immunity against infection, reduces the baby’s risk of developing allergies and asthma,

tooth decay, high blood pressure and many other ailments.

A benefit of exclusive breast feeding to the mother according to Gupta (2007) is that it

reduces anemia due to reduction in post-partum bleeding and reduced blood loss because

of delayed menstruation. Other benefits he contends include:

 Helping the mother to regain her figure and promote uterine involution.

13
  Protective effect against breast and ovarian cancers.

 Helps in delaying another pregnancy.

According to Weiss (2010), breast feeding the baby is one of the most special times in the

mother’s life wherein a special bondage develops between the mother and the baby. The

breast milk provides complete nutrition received by the baby to develop immunity against

various infections. Another reason by the team why breast feeding is good for the baby is

that the colostrum secreted from the breast for the first few days after delivery helps the

baby’s digestive system to function efficiently.

2.4 BREAST FEEDING DIFFICULTIES

According to Hausman B (2003) most mothers are able to breast feed their babies. These

are however some important anatomical or physiological conditions or improper

techniques that poses some challenges to successful breast feeding for the mother:

a. Nipple soreness and fissures: This is caused by the baby sucking on the nipple

due to poor attachment, forcing baby to nipple suck, washing the nipple with soap

and pulling baby off breast. This is corrected by proper latchinging on.

b. Breast Engorgement sometimes accompanied by fever, it is due to incomplete

breast emptying with resultant congestion.

c. Breast Abscess: This is due to unresolved mastitis. Mother’s should continue

breast feeding on the unaffected side while breast feeding can be established on

14
 the affected side within 1-2 days no form of breast infection will necessitate

taking the baby off the breast permanently.

d. Not Enough Breast Milk: This is one of the commonest complaints by breast

feeding mothers. It is associated with poor positioning and attachment. Prevention

includes establishment of good breast feeding practices to ensure adequate milk

production and let down reflex for intake of milk by the infant.

e. The working mother: These groups of mothers should be taught how to maintain

lactation by expressing breast milk to be fed to the babies while they are away at

work. They should be supported by having adequate maternity leave. It is well

recognized that having crèches at places of work boosts mothers commitment to

work and increases productivity.

15
 2.5 COMPARISON OF BREAST MILK, FORMULA AND COW’S MILK (NELSON 7TH EDITION)
CONTENT BREAST MILK FORMULAR ANIMAL
MILK
Calories (Kcal/Ml) 0.67 0.67
Protein (%) 1-1.5 3.3 3-4
Correct amount, easy to Partly corrected Too much
digest. Whey 75% casein 75% difficult to digest
langelyAlpha-lactoalbumin langely beta- no anti-infective
anti-infective proteins. lactoglobulin no proteins.
anti-infective
proteins.
Lactose (%) 6.5 – 7.0 4.5
Fat (%) 3.5 3.25 – 4.0 Lack of
Qualitative Enough essential fatty acids, Lack essential essential fatty
mainly triglycerides, olein, fatty acids mainly acids no lipase
palmitin and sterarm but triglyceride olein,
twice more absorbable palmnutin and
olein. The volatile fatty stearin but less
acids (butyric, capric, absorbable olein.
caproic and capryllic) The volatile fatty
constitute only about 1.3% acids constitute
of fat more linoleic acid lonoleic acid. Does
contains lipase to help not contain lipase.
digest fat. Fat more Fat not completely
completely digested and digested and
efficiency used by a baby’s efficiently utilized.
body.
Vitamins Enough more vitamins A Vitamins added Not enough A
more C less B and K, Low less vitamin A, and C
D. less vitamin C
more B and K, low
D.
Minerals Total Enough 0.15 – 0.25% small Added 0.7 – Small amount
Content Iron amounts, well absorbed. 0.75% extra added, not well
not well absorbed. absorbed
Water Enough May need extra Extra needed

16
 Bacterial None Likely when Likely
Contaminants mixed
Growth Factors Present Not present Not present

2.6 EXCLUSIVE BREAST FEEDING AND HIV/ABRUPT WEANING

According to Glynn (2013), current rating for exclusive breast feeding for more than 4

months lowers mother to infant HIV risk. HIV infected mothers who exclusively breast

fed for more than the first four months of life have a lower risk of transmitting the virus

to their babies through their milk. Glynn further explained that “Women who stopped

breast feeding earlier than 4 months had the highest concentration of HIV in their breast

milk and those who continued to breast feed, but not exclusively had concentration levels

in-between the two practices”. Babies generally have a 10% to 15% risk of receiving the

virus through their HIV infected mothers breast milk. However, since infectious diseases

are wide spread and often potentially fatal in sub-Saharan Africa, breast feeding is crucial

for keeping infants healthy.

Several critical components that help developing immune system ward off infectious

diseases are found in breast milk. A previous report found that stopping breast feeding

before 18 months was linked to considerable increases in mortality among children born

to an HIV infected mother.

According to Kuhn (2013) and colleagues who set out to examine whether changes in

breast feeding routines have an impact on HIV levels in breast milk, in order to observe

the success of early weaning to decrease HIV transmission and infant mortality. The team

17
conducted a randomized clinical trial; more than 950 mothers infected with HIV in

Zambia were advised to breast feed their children at birth for at least 4 months, 50% of

the women were persuaded while the other 50% were encouraged to keep breast feeding.

At four and half 4/1 months the scientist collected breast milk from all of the mothers;

additionally the babies were analyzed on a regular basis for potential HIV transmission.

The highest HIV concentrations were found in the breast milk of women who stopped

breast feeding at 4 months according to the experts.

The findings indicate that even subtle alterations in the frequencies of breast feeding

during infancy can have HIV concentrations in breast milk.

Kuhn concluded that the result have profound implications for prevention of mother to

child HIV transmission program in settings where breast feeding is necessary to protect

infant and maternal health, the data demonstrated that early and abrupt weaning carries

significant risk for infants

2.7 DANGERS OF FOOD SUPPLEMENTED IN THE NEONATE

According to breastfeeding action group (2013), 14 risks of formula feeding are:

 HIGHER RISK OF LUNG INFECTION

Children who are formula fed are 16.7 times more likely to have pneumonia than

children who were given only breast milk as infants.

 HIGHER RISK OF EAR INFECTIONS

18
 Studies shows that infants who are formula fed are 50% more likely to have ear

infection than babies who receives only breast milk.

 HIGHER RISK OF INFECTION CONTAMINATED FORMULA

Babies have become very sick and some have died because of harmful germs in

formula. Some formulas cannot be sterilized.

 HIGHER RISK OF CHRONIC DISEASES

Formula feeding is linked to higher risk for type 1 diabetes and bowel diseases such

as celiac disease and inflammatory bowel disease.

 RISK OF LOWER INTELLIGENCE

Studies shows that children who are breastfed do better on intelligence tests than

children who were formula fed.

 HIGHER RISK OF EFFECTS OF ENVIRONMENTAL POISONS

Breastfeeding lowers the harmful effects on a children’s health from poisons in the

environment like PCBs and dawns children who are breastfed do better on tests for

brain development than formula fed children.

 HIGHER RISK OF ALLERGY

Formula feeding is linked to higher incidence of eczema, allergies and which affect

breathing such as they fever.

 HIGHER RISK OF ASTHMA

Medical studies show that babies who are fed formula are 40 to 50 percent more

likely to have asthma or wheezing.

19
 HIGHER RISK OF HEART DISEASE

A study shows that breastfeeding may help to reduce the risk of heart disease by

keeping cholesterol levels low later in life. It also shows that 13-16 years old who

were formula fed have higher blood pressures than children who had receive breast

milk.

20
 HIGHER RISK OF DEATH FROM DISEASES

Babies who are formula fed have a higher risk of death due to illness such as diarrhea

and lung infections.

 HIGHER RISK OF OBESITY

Research is showing that children who are formula fed are nearly 40% more likely to

be obese than children who are breastfed-even after looking at other thinks that may

explain why a person may be overweight.

 HIGHER RISK OF CHILDHOOD CANCER.

Research shows that children who have not been to breast breastfed are more likely to

get leukemia and other cancers than children who were given only breast milk.

 HIGHER RISK OF DIARRHEA

Studies shows that babies who are formula fed are twice as likely to have diarrhea as

breastfed babies.

 HIGHER DIABETES

Research shows that formula feeding increases the risk of getting diabetes later in

later.

2.8 PROMOTION AND SUPPORTING EXCLUSIVE BREASTFEEDING

According to WHO (2003) obstacles to exclusive breastfeeding can be overcome in the

following ways:

21
 Prevent and treat problems; most breastfeeding problems occur in the first 2 weeks of

life. These problems include cracked nipples, engorgement and mastitis and all too

often lead to a very early infant supplementation and abandonment of exclusive

breastfeeding. Proper positioning and attachment of the baby to breast and frequent

breastfeeding can prevent these problems. Support to the mother for early initiation is

easy to provide via peer support networks and has been effective at prolonging

exclusive breastfeeding.

 Restrict commercial pressure; aggressive marketing of infant formula often gives new

mother and families the impressing that human milk is less modern and thus less

healthy for infant than infant formula enforced restrictions on marketing of infant

formula are part of efforts to support and prolong exclusive breastfeeding.

 Provide timely and accurate information; many women and family members are

unaware of the benefits of colostrums and exclusive breastfeeding. Women must sort

through myths, misinformation and mixed messages about breastfeeding, ensuring

that women receive complete, accurate time and consistent information is

fundamental for any programme promoting exclusive breastfeeding.

 Address social barriers; Attitudes that undervalue breastfeeding discourage women

from advice of relatives and friends. Successful efforts to promote good feeding

practices because not only on the mother but on those who influences her feeding

decision, such as her doctor, mother-in-law and husband.

22
 Create supportive work environment; few mothers are provided with paid maternity

leave or time and a private place to breastfeed or express their breast milk, legislation

around maternity leave and policies that provide time space, and support for

breastfeeding.

 Establishes good practices in health facility distribution of free samples of infant

formula, the use of glucose water and separation of mother from new born are

obstacles to the establishment of good feeding in health services. Adopting the baby

friendly hospital initiative’s “Ten Steps to Successful Exclusive Breastfeeding” and

enhancing skills of health care providers to support exclusive breastfeeding would

help to ensure the best start for infants.

2.9 EXCLUSIVE BREASTFEEDING PRACTICE AMONG COMMUNITIES IN

NIGERIA

The Enufuro (2013) stressed that it is an indisputable fact that the exclusive breastfeeding

of newborn for six (6) months has many positive implications but due to poverty and

work pressure, many nursing mothers in the country do not find the practice convenient.

He further writes that the 2013 commemoration of the world breastfeeding week has

provided stakeholders with the opportunity to underscore its importance. Nigeria is again

declining on the list of countries adhering to the six months exclusive breastfeeding

practice advocated by the World Health Organization. The WHO estimates that only 38%

of infants are exclusively exclusive breastfed globally for six (6) months, statistics from

23
UNICEF also indicate that Nigeria has made no improvement on this score over many

years.

The documents further suggest that Nigeria rated eight in Africa with the lowest

exclusive breastfeeding practice, a report from save the children initiative has shown. A

fact sheet from the WHO says; breast milk gives infants all the nutrients they need for

healthy development (Anufro, 2013).

Gupta (2013) states that “there is no other single health intervention that has such a high

impact for babies and mothers as breastfeeding and which cost so little for government.

Breastfeeding is baby’s first immunization and the most effective inexpensive life saver”.

Nigeria’s Minister of health Chukwu (2013) lamented that the declining rate at which

mothers obey the exclusive breastfeeding policy was dropping. According to a report by

save the children initiative working on maternal and childcare (2013) expressed that

Djibouti has the worst compliance (1%) regarding exclusive breastfeeding on the

continent; while Rwanda has the highest 85%. Nigeria ranked eigth coming after

Djibouti, Chad, Cote d’ivore, Gabon, South Africa which have 1%, 3%, 4%, 6% and 8%

compliance rates respectively.

The report further states that nutrition in Nigeria has over the years assumed a negative

dimension with malnutrition accounting for more than 50% of under-fives’ deaths. This,

the survey says, emanates from poor infant and young feeding practices (Enufuro, 2013).

Nigeria’s operational demographic and health survey (NHHS, 2008) shows that exclusive

breastfeeding in the country currently stands at 13%. The report states further that

24
nutrition in Nigeria has over the years assumes public health proportion with malnutrition

accounting for more than 50% of the under five death.

According to UNICEF (2013) breastfeeding for at least one year is preferred practice for

Nigerians (97%). However, many Nigerian mothers will not begin breastfeeding until at

least 24hours after birth in the belief that colostrum is not good for the baby. Furthermore

it is very common for the Nigerian mother to supplement breastfeeding with bottle

feeding and water after just 2 – 3 weeks

2.10 EXCLUSIVE BREASTFEEDING AND WEANING

According to Kramer M,Mattush,L,Vanilovich I,et al (2007) shows that breast milk is the

only food and drink your baby needs for at least six (6) months. It has all the essential

nutrient in just the right amount and is a better food than anything else you could give

them (because the baby needs more iron). Studies have shown that the baby’s iron

reserves from birth, along with the well absorbed iron in breast milk, usually keeps iron

levels normal well into the baby’s second six (6) months. The author further suggested

that babies are ready to start trying some solid foods around six (6) months, though some

may prefer to leave it until late.

Studies have also shown clear advantages of exclusive breastfeeding for the first six (6)

months of life and starting solid food earlier may compromise some of the protective

properties of breast milk (Pisacane et al 1996). He further suggest the following as signs

indicating that baby is ready to try solid diet.

25
  Baby is around six (6) months old.

 He can sit up unassisted.

 He has lost the tongue trust reflex which pushes things out of his mouth.

 He is able to pick up food and put in his mouth and shows interest in food.

 He is still hungry after a feed and demands more.

Gulick (1986) explains that weaning into solid food doesn’t mean the end of

breastfeeding. Breast milk should remain a large part of your baby’s diet until he is at

least twelve (12) months and breastfeeding can continue long after your baby’s first

birthday. Breastfed toddlers have fewer illnesses than toddler’s who no longer breast

feed. Child will continue to get immunities through the breast milk.

According to Ghanaian national survey, 58% of the children were below 80% of the

National Center for Health Statistic (NCHS) weight for age, while 8% suffered from

severe malnutrition, 40 were wasted and 52% were stunted. It was observed that 30% of

the infants who were fed with cereals, porridge and adult food as weaning food were

malnourished; they attributed this to inadequate complementation to breast milk.

2.11 CULTURAL ISSUES SURROUNDING BREAST FEEDING.

The most widely spoken languages are Hausa, Igbo, Yoruba and Fulani. Breastfeeding

for at least one year is the preferred practice. Emma(2012)cultural practices of breast

feeding fit into only 3 categories:beneficial,harmful or harmless.He further opined that

many muslims which to practice the sunnah of “tahneek”a softened date is sometimes

26
rubbed on the baby’s palate before first breast feeding,so the baby will enter a sweet

world’traditionally,if a date cannot be found,anything sweet will do.

One study of 120 cultures showed that 50 witheld the infant from the breast for 48hours

or more due to the belief that colostrums is dirty, old or not real milk(Emma

2012).Women in kenya are strongly instructed to avoid breast feeding after querrels to

prevent “bad blood”entering the milk and affecting the baby.This may mean that breast

feeding is paused or a mother’s right are infringed by family members(Pickett 2012).

27
 CHAPTER THREE

RESEARCH METHODOLOGY

3.0 INTRODUCTION

This chapter deals with the methodology adopted in execution of this study. The

procedures and methods were presented as follows:

1. Research design

2. Area of the study

3. Population of the study

4. Sampling technique

5. Instrument for data collection

6. Validity and reliability

7. Administration of instrument

8. Method of data analysis

9. Ethical consideration

3.1 RESEARCH DESIGN

Descriptive research design is used in this research. Specifically the survey

method is applied considering the fact that data is generated using structured

questionnaire.

28
3.2 AREA OF THE STUDY

The area of the study is Gwargwarwa Hospital, which is a hospital under

Nassarawa Local Government Area. The hospital provides services to expectant mothers,

deliveries and all primary level of care, and referral system as appropriate.

The hospital is situated in Brigade Nassarawa, Kano. Majority of the population

are predominately Hausa.

3.3 TARGET POPULATION

The target populations are mothers attending the hospital within the second quarter 2013.

The available record shows that the target population of mothers attending Gwagwarwa

hospital from April – October 2013 is 100.

3.4 SAMPLING TECHNIQUE

Fifty (50) representing 50 % of the target population of 100 is engaged as the sample.

Random sampling technique using Yes/No ballot papers was employed to select the

respondents. Those who picked yes were engaged as subjects of the research.

29
3.5 INSTRUMENT FOR DATA COLLECTION

The instrument used for this study is a researcher modified likert scale type of

questionnaire. Responses obtained were collapsed into two distinct categories i.e. agree

and disagree.

3.6 VALIDITY/RELIABILITY OF INSTRUMENTS

The questionnaire was submitted to the research supervisor and subjected to scrutiny for

validation by experts before administration.

3.7 METHOD OF DATA COLLECTION

The questionnaires were distributed to the respondents over a period of 4 weeks. Two (2)

research assistants were engaged in the administration of the questionnaires. This was

necessary because not all the subjects attended the clinic on the same day.

3.8 METHOD OF DATA ANALYSIS

The data collected were presented in a tabular form and analyzed using simple frequency

and percentages.

30
 CHAPTER FOUR

4.0 RESULT/ANALYSIS OF DATA

The data collected for this study were statistically analyzed and presented in this

chapter. Frequency and percentage tables were used in the presentation.

SECTION 1

1. Table 1: The age of the respondents.

AGE RANGE FREQUENCY PERCENTAGE

16-20 years 15 30%
21-30 years 20 40%
31-40 years 10 20%
41 years and above 5 10%
TOTAL 50 100%

Table 1 is indicative of the age range of respondents. 15(30%) of the respondents

fall within the age range of 16-20years, while 20(40%) falls within 21-30years, 10(20%)

falls within 31-40 years, 5(10%) falls within 41years and above.

The predominant age range is 21-30 years which is the productive age while from

41 years and above reproduction is declining; hence few are expected to be lactating.

2. Table 2: Distribution of Respondents by Religion.

RELIGION FREQUENCY PERCENTAGE
Islam 35 70%

31
Christianity 15 30%
Others 0 0
TOTAL 50 100%
Table 2 shows the distribution of respondents by religion where 35 (70%) of the

respondents were Muslims, while 15 (30%) are Christians.

Majority of the respondents are Muslims which is expected because the major

inhabitants of the area of study are Hausas who practices Islam, while 30% which is also

a reasonable number are Christians.

3. Table 3: Highest Educational Status of Respondents.

HIGHEST EDUCATIONAL FREQUENCY PERCENTAGE

STATUS
Primary 12 24%
Secondary 20 40%
Tertiary 10 20%
Qur’anic only 8 16%
TOTAL 50 100%

Table 3 shows the level of education of the respondents. 20 (40%) have secondary

education, 12 (24%) have primary education, 10 (20%) have tertiary education and 8

(16%) have Qur’anic education.

Majority of the respondents have formal education perhaps in table 2.1 that is why

70% of the respondents are aware of exclusive breastfeeding either in the hospital, media

or other sources.

4. Table 4: The Number of Children of the Respondent

NO OF CHILDREN FREQUENCY PERCENTAGE

32
1-5 15 30%
6-10 30 60%
11 and above 5 10%
TOTAL 50 100%
Table 4 shows the number of children of the respondents. 30 (60%) of the respondents

have 6-10 children, 15 (30%) have 1-5 children, while 5 (10%) have 11 children and

above.

Majority of the respondents have about 6-10 children which show that they have the

knowledge and experience of lactation. While the respondents with 11 and above

children are less because it is expected that from 11 children and above reproduction is

declining and most of them are not expected in the post-natal clinic.

5. Table 5: Occupation of the Respondents

Occupation FREQUENCY PERCENTAGE

Full-time housewife 20 40%
Civil servant 20 40%
Petty trader 10 20%
TOTAL 50 100%

Table 5 is indicative of the occupation of the respondents. 20 (40%) of the respondents

are full-time housewives, 20 (40%) are civil servants, while only 10 (20%) are petty

traders.

33
 SECTION 2

Table 2.1 the knowledge of exclusive breastfeeding

1) I am not aware of AGREE DISAGREE

exclusive breast feeding Frequency Percentage Frequency Percentage
15 30% 35 70%

Table 2.1 shows that 15 (30%) of the respondents are not aware of exclusive

breastfeeding while 35 (70%) of the respondents are.

Majority of the respondents are not aware of exclusive breastfeeding. This does not

support data from earlier table in which majority of the respondents are educated or it is

perhaps a reflection of deliberate attempt to claim ignorance as an excuse for not

practicing exclusive breastfeeding.

Table 2.2

2) I learnt about exclusive AGREE DISAGREE

breast feeding in the Frequency Percentage Frequency Percentage
hospital 30 60% 20 40%

Table 2.2 shows that 30 (60%) of the respondents learnt about exclusive breastfeeding in

the hospital, while 20 (40%) learnt about exclusive breastfeeding elsewhere.

These shows that the hospital is practicing the exclusive breastfeeding policy by creating

awareness to all lactating mothers that attends post natal clinic. Hence it is expected that

majority of the respondents learnt about exclusive breastfeeding in the hospital.

34
Table 2.3

3) I got the information of AGREE DISAGREE

exclusive breast feeding Frequency Percentage Frequency Percentage
through the media 10 20% 40 80%

Table 2.3 shows that only 10 (20%) got the information of exclusive breastfeeding from

the media while 40 (80%) got the information from other sources.

This is perhaps because most of the respondents are civil servant and few are petty

traders hence have less time to listen to the media and it could be so because most of the

respondents have less information on exclusive breastfeeding.

Table 2.4

4) I got the information AGREE DISAGREE

through friends and Frequency Percentage Frequency Percentage

family members 20 40% 30 60%

Table 2.4 is an indicative that 20 (40%) of the respondents got the information exclusive

breastfeeding through friends and family members, while 30 (60%) got the information

elsewhere.

It is expected that minority of the respondents got the information of exclusive

breastfeeding through friends and family members because most of the respondents got

the information of exclusive breastfeeding in the hospital.

35
 SECTION 3

Table on frequency of breastfeeding

1) I breastfeed 3 times a day. AGREE DISAGREE

Frequency Percentage Frequency Percentage
5 10% 45 90%

Table 3.1 shows that 5 (10%) of the respondents feed their babies 3 times a day, while 45

(90%) do not breastfeed their babies 3 times a day. This is perhaps because majority of

the respondents breastfeed on demand because most of the respondents are full-time

housewife.

Table 3.2

2) I breastfeed on demand. AGREE DISAGREE

Frequency Percentage Frequency Percentage
40 80% 10 20%

Table 3.2 shows that majority 40 (80%) of the respondents breastfeed on demand, while

10 (20%) do not breastfeeding on demand. This is perhaps because only few of the

respondents are petty traders who might be busy with their trading.

Table 3.3

3) I breastfeed only when I AGREE DISAGREE

am at home. Frequency Percentage Frequency Percentage
30 60% 20 40%
Table 3.3 shows that 30 (60%) of the respondents breastfed only when they are at home,

while 20 (40%) breastfeed even when they are not at home.

36
In table 3.3 majority of the respondent’s breastfeed only when at home. This is perhaps

because they lack much information on exclusive breast feeding.

Table 3.4

4) I breastfeed only when my AGREE DISAGREE

breast is full. Frequency Percentage Frequency Percentage
10 20% 40 80%

Table 3.4 shows that 10 (20%) of the respondents breastfeed only when their breast is full

while 40 (80%) do not.

In table 3.4 only 10 (20%) breastfeed when their breast is full, because only few of the

respondents do not breastfeed on demand. This might be perhaps that they are working

class women and are busy until when the breast is full they breastfeed.

37
 SECTION 4

Table 4.1 Table on onset of exclusive breastfeeding practice

1) I start exclusive AGREE DISAGREE

breastfeeding right at birth Frequency Percentage Frequency Percentage
to 6 months. 23 46% 27 54%

Table 4.1 shows that 23 (46%) of the respondents exclusively breastfeed from birth to 6

months, while 27 (54%) do not practice exclusive breastfeeding.

It is perhaps that majority of the respondents will not practice exclusive breastfeeding

because majority of them are civil servant and not supported by their husbands to practice

exclusive breastfeeding.

Table 4.2 4.1 Table on duration of exclusive breastfeeding practice

2) I continue exclusive AGREE DISAGREE

breastfeeding for 4 Frequency Percentage Frequency Percentage
months. 15 30% 35 70%

Table 4.2 shows that 15 (30%) exclusive breastfeed for 4 months while 35 (70%) do not

breastfeed for 4 months.

In table 4.2 majority of the respondent’s only breastfeed exclusively for 4 months. This is

perhaps to be so because majority of the respondents are civil servant and resume work

after 4 months of maternity leave.

38
Table 4.3 Table on correct exclusive breastfeeding practice

3) I only give water only AGREE DISAGREE

after 6 months of birth. Frequency Percentage Frequency Percentage
20 40% 30 60%

Table 4.3 shows that 30 (60%) of the respondents do not practice exclusive breastfeeding,

while 20 (40%) practice breastfeeding.

In table 4.3 majority of the respondent do not practice exclusive breastfeeding which is

perhaps because they lack much information on exclusive breastfeeding.

Table 4.4 Table on incorrect exclusive breastfeeding practice

4) I give my baby water AGREE DISAGREE

when I am not at home. Frequency Percentage Frequency Percentage
15 30% 35 70%

Table 4.4 shows that 15 (30%) of the respondents give their babies water when not at

home, while 35 (70%) do not.

In table 4.4 (30%) give water to their baby’s outside home, this is expected because they

are not supported and influenced by family members and friends to practice exclusive

breastfeeding.

39
 SECTION 5

Tables on utilization of exclusive breastfeeding practice.

Table 5.1

1) I prefer exclusive AGREE DISAGREE

breastfeeding. Frequency Percentage Frequency Percentage
20 40% 30 60%

Table 5.1 shows that 20 (40%) of the respondents prefer exclusive breastfeeding, while

30 (60%) do not prefer exclusive breastfeeding.

It is to be, probably because majority of the respondents are civil servant who are always

occupied to their work and prefer other alternative of feeding.

Table 5.2

2) I prefer bottle feeding AGREE DISAGREE

Frequency Percentage Frequency Percentage
15 30% 35 70%

Table 5.2 shows that 15 (30%) of the respondents prefer bottle feeding, 35 (70%) do not

use feeding bottle.

In table 5.2 majorities of the respondents do not use feeding bottle, this is perhaps

because 40% of the respondents are full term housewife who only breastfeed their babies

on demand.

40
Table 5.3

3) I prefer cup and spoon. AGREE DISAGREE

Frequency Percentage Frequency Percentage
10 20% 40 80%

Table 5.3 above shows that 10 (20%) of the respondents prefer cup and spoon method of

feeding, while 40 (80%) do not.

In table 5.3 majorities of the respondents do not prefer cup and spoon method of feeding

probably that is why majority of them don’t practice exclusive breastfeeding especially

for the civil servants that needs to express the breast milk in a cup.

Table 5.4

4) I prefer traditional force AGREE DISAGREE

feeding. Frequency Percentage Frequency Percentage
5 10% 45 90%

Table 5.4 shows that 45 (90%) of the respondents do not prefer traditional breastfeeding,

while only 5 (10%) prefer traditional breastfeeding.

In table 5.4 only 10% prefer traditional force feeding. This support an earlier responding

in table 6.4 in which a corresponding 5 (10%) of the respondents have painful and

cracked nipples and thus cannot attach their babies to the breast.

41
 SECTION 6

Tables on set back to exclusive breastfeeding practice

Table 6.1

1) My husband supports AGREE DISAGREE

me to practice exclusive Frequency Percentage Frequency Percentage
breastfeeding. 20 40% 30 60%

Table 6.1 shows that 20 (40%) of the respondents were supported by their husbands to

practice exclusive breastfeeding, while 30 (60%) were not supported to practice exclusive

breastfeeding.

In table 6.1 majorities of the respondents (60%) are not supported by their husbands to

practice exclusive breastfeeding no wonder the majority of the husband are not

influencers of exclusive breastfeeding which corresponds to table 8.1.

Table 6.2

2) I have much AGREE DISAGREE

information on Frequency Percentage Frequency Percentage
exclusive breastfeeding. 20 40% 30 60%

Table 6.2 shows that 20 (40%) of the respondents have much information on exclusive

breastfeeding, while 30 (60%) have less information on exclusive breastfeeding.

In table 6.2 the majority of the respondents have less information on exclusive

breastfeeding. This is because majority of the respondents are not aware of exclusive

breastfeeding this correspond to table 2.1.

42
Table 6.3

3) My job is taking much AGREE DISAGREE

of my time. Frequency Percentage Frequency Percentage
30 60% 20 40%

Table 6.3 shows that 30 (60%) of the respondents job is taking much of their time, while

20 (40%) of the respondents job are not taking much of their time.

In table 6.3 majority of the responded are occupied by their job, which is expected to be

so, because a reasonable amount of the respondents are civil servant.

Table 6.4

4) I have painful cracked AGREE DISAGREE

nipple. Frequency Percentage Frequency Percentage
5 10% 45 90%

Table 6.4 shows that 5 (10%) of the respondents have painful cracked nipple, while only

45 (90%) do not have much painful cracked nipple.

In table 6.4 only 10% of the respondents have painful cracked nipple, no wonder about

10% of the respondent stop breastfeeding due to fear of bite or injury, this correspond to

table 7.4.

43
 SECTION 7

Tables on reasons for stopping exclusive breastfeeding.

Table 7.1

1) I stop breastfeeding AGREE DISAGREE

when the child starts Frequency Percentage Frequency Percentage
taking family food. 10 20% 40 80%

Table 7.1 is indicative of reasons for stopping exclusive breastfeeding 10 (20%) stops

exclusive breastfeeding when the baby has started taking family food, while 40 (80%) do

not.

In table 7.1 only 10 (20%) stopped exclusive breastfeeding when the child starts taking

family food. This is expected because majority of the respondents don’t practice

exclusive breastfeeding this correspond to table 4.1.

Table 7.2

2) I stop breastfeeding when AGREE DISAGREE

I am resuming work after Frequency Percentage Frequency Percentage
maternity leave (when 20 40% 30 60%
child is 3 months).

Table 7.2 shows that 20 (40%) of the respondents stops exclusive breastfeeding after 3

months maternity leave, while 30 (60%) continue exclusive breastfeeding.

44
In table 7.2 about 40% of the respondents stop exclusive breastfeeding on resuming work

from maternity leave. This might be due to their job which is taking much of their time

and they have less information on exclusive breastfeeding.

Table 7.3

3) I stop exclusive AGREE DISAGREE

breastfeeding when the Frequency Percentage Frequency Percentage
milk is not adequate to 30 60% 20 40%
satisfy the baby.

Table 7.3 shows that 30 (60%) of the respondents stop exclusive breastfeeding when their

breast milk is no longer adequate, while 20 (40%) of the respondents continue

breastfeeding.

In table 7.3 majority of the respondents stop exclusive breastfeeding when the milk is

inadequate to satisfy the baby. This is perhaps due to lack of support from their husbands.

Table 7.4

4) I stop exclusive AGREE DISAGREE

breastfeeding due to fear Frequency Percentage Frequency Percentage
of bite or injury. 5 10% 45 90%

Table 7.4 shows that only 5 (10%) of the respondents stops exclusive breastfeeding due

to fear of bite or injury, while only 45 (90%) do not stop exclusive breastfeeding.

45
In table 7.4 only 10% stop breastfeeding due to fear of injury. Perhaps it is because about

5 (10%) of the respondents this correspond to table 6.4 which have painful cracked

nipple.

46
 SECTION 8

Table on exclusive breastfeeding influencers.

Table 8.1

1) My husband influences my AGREE DISAGREE

exclusive breastfeeding and Frequency Percentage Frequency Percentage
encourages me to do so. 15 30% 35 70%

Table 8.1 shows that 35 (70%) of the respondents’ husbands do not influence exclusive

breastfeeding, while 15 (30%) do.

In table 8.1 the majority of the respondents are not influenced by their husbands to

practice exclusive breastfeeding. This is expected because majority of the respondents

stop exclusive breast feeding due to inadequate breast milk.

Table 8.2

2) My parent influences my AGREE DISAGREE

exclusive breastfeeding and Frequency Percentage Frequency Percentage

encourages me to do so. 10 30% 40 80%

Table 8.2 shows that 10 (20%) of the respondents are influenced by their parent to

breastfeed exclusively, while 40 (80%) are not influenced.

In table 8.2 80% of the respondents are discouraged by parents and are not influenced to

practice exclusive breastfeeding. This is expected because majority of the respondents

47
stopped exclusive breastfeeding after maternity leave, probably the parent are the care

givers.

Table 8.3

3) My husband’s relations AGREE DISAGREE

influence my exclusive Frequency Percentage Frequency Percentage
breastfeeding and encourage 20 40% 30 60%
me to do so.

Table 8.3 shows that 20 (40%) of the respondents are not influenced by their husband’s

relatives to exclusive breastfeeding, while 30 (60%) of the respondents are not influenced

and are discouraged.

In table 8.3 majority of the respondents are discouraged and not influenced by their

husband’s relatives to practice exclusive breastfeeding. This is perhaps because majority

of respondents have less information on exclusive breastfeeding.

Table 8.4

4) My friends influence my AGREE DISAGREE

exclusive breastfeeding and Frequency Percentage Frequency Percentage
encourage me to do so. 10 20% 40 80%

Table 8.4 shows that 10 (20%) of the respondents were influenced by friends and

encouraged to exclusive breastfeeding, while 40 (80%) of the respondents are not

influence by friends.

48
In table 8.4 only 10 (20%) of the respondents were influenced by their friends to practice

exclusive breastfeeding, no wonder the respondent give water to their baby’s when not at

home.

49
 CHAPTER FIVE

5.0 SUMMARY

This research work is carried out on the knowledge and utilization of exclusive

breastfeeding among lactating mothers attending post natal clinic in Gwagwarwa

Hospital in Nassarawa Local Government Area of Kano state. A well structured

questionnaire was delivered to 50 participants, which were responded to.

The research work was carried under the following chapters:

Chapter one deals with background of the study, statement of the problem, scope and

limitation which shows that exclusive breastfeeding can reduce 13% of childhood death

which is the largest contribution to child survival intervention (Gupta, 2007). Moreover,

child birth is suppose to be a joyful and happy moment to the parent, but throughout the

period of practicing in the current trend, the hospital keep receiving cases of diarrhea,

vomiting and abdominal distension which are attributable to faulty feeding practice,

hence, statement of the problem.

The study was limited to lactating mothers attending Gwagwarwa Clinic (post natal

clinic), in Nassarawa Local Government Area of Kano state. Some research questions

were formulated by the researcher.

Chapter two deals with related literature of which the researcher looked into feeding

practices among communities in Nigeria typical infant feeding in Hausaland, composition

of breast milk, comparison between breast milk and animal milk were highlighted.

50
Chapter three deals with the methodology adopted, a descriptive research design was

used, the survey method was applied, the area of the study was Gwagwarwa Hospital

Kano, with the target population been the lactating mothers attending Gwagwarwa

hospital within the second (2nd) quarter 2013. A researcher modified likert scale type of

questionnaire was used and the questionnaire was subjected to expert.

Chapter four addressed the results and analysis of data. Frequencies and percentages ware

used.

5.1 CONCLUSION INCLUDING CONTRIBUTION TO KNOWLEDGE

The research discovered that majority of the lactating mothers do not have the knowledge

of exclusive breastfeeding and they have less information on the utilization of exclusive

breastfeeding. They lack much information on how to sustain and maintain lactation.

Also majority of the respondents lack support from their husbands and relatives and are

discouraged from practicing exclusive breastfeeding.

It shows that influencers of exclusive breastfeeding are discouraging the practice of

breastfeeding, but majority of the respondent learnt about exclusive breastfeeding in the

hospital hence nurses and doctors are exclusive breastfeeding influencers

In conclusion, it has shown that majority of the respondents do not practice exclusive

breastfeeding. This is in accordance with world health organization who states that not

more than 35% of the infant worldwide are exclusively breastfed during the first four

months of life.

51
Majority of the respondents stopped exclusive breastfeeding due to inadequate breast

milk. This is in accordance with Azubuike (2007) who stated that to enable mothers to

establish and sustain lactation WHO and UNICEF recommended imitation of

breastfeeding within the first four (4) month of birth and exclusive breastfeeding for six

(6) months and beyond.

The research has shown that majority of the lactating mothers are not influenced by

exclusive breastfeeding influencers to practice exclusive breastfeeding, this corresponds

with WHO breastfeeding policy to foster the establishment of breastfeeding support

group.

5.2 RECOMMENDATION/SUGGESTION FOR FURTHER STUDIES

In view of the study, the following recommendations are made:

 The antenatal clinic of Gwagwarwa should intensify health talk and other

information dissemination approaches to lactating mothers attending the clinic as

to ensure adequate information and enlightenment to the lactating mothers.

 Other sources of information such as the media should be step-up to

complement health talk in the hospital.

 The state government should consider instituting baby friendly approaches in

clinics and maternity homes outside general hospitals.

52
 There is need for the media to mount an aggressive breastfeeding (programmes,

talk shows etc) to affect family influencers to positively influence breastfeeding

practice.

53
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