ANTHROPOMETRIC ASSESSMENT OF EXCLUSIVELY AND NON-EXCLUSIVELY

BREASTFEED BABIES 1-6 MONTHS UMUAHIA NORTH RURAL AND URBAN

AREA

BY

ODEBEATU ROSE UCHENNA

MOUAU/HNUD/16/95709

DEPARTMENT OF HUMAN NUTRITION AND DIETETICS

COLLEGE OF APPLIED FOOD SCIENCES AND TOURISM

MICHAEL OKPARA UNIVERSITY OF AGRICULTURE, UMUDIKE

OCTOBER, 2021

1
ANTHROPOMETRIC ASSESSMENT OF EXCLUSIVELY AND NON-EXCLUSIVELY
BREASTFEED BABIES 1-6 MONTHS UMUAHIA NORTH RURAL AND URBAN
AREA

BY

ODEBEATU ROSE UCHENNA

MOUAU/HNUD/16/95709

A PROJECT SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS

FOR THE AWARD OF BACHELOR OF SCIENCE (B.Sc.) DEGREE TO THE
DEPARTMENT OF HUMAN NUTRITION AND DIETETICS, COLLEGE OF APPLIED
FOOD SCIENCES AND TOURISM, MICHAEL OKPARA UNIVERSITY OF
AGRICULTURE, UMUDIKE

OCTOBER, 2021

2
 APPROVAL PAGE

This project titled “Anthropometric Assessment of Exclusively and Non-Exclusively

Breastfeed Babies 1-6 Months Umuahia North Rural And Urban Area” has been approved
for the award of Bachelor of Science Degree (B.Sc.) in Human Nutrition and Dietetics, College
of Applied Food Science and Tourism, Michael Okpara University of Agriculture, Umudike
Nigeria.

Mrs. C. P. Ezeibe _________________ ____________________

(Project Supervisor) Signature Date

3
 CERTIFICATION
We hereby certify that this project work on “Anthropometric Assessment Of Exclusively And
Non-Exclusively Breastfeed Babies 1-6 Months Umuahia North Rural And Urban Area”
was carried out by Odebeatu Rose Uchenna with the registration number
MOUAU/HNUD/16/95709 under the supervision of Mrs. C. P. Ezeibe and was found worthy
for the award of Bachelor of Sciences (B.Sc) Degree in Human Nutrition and Dietetics in the
Department of Human Nutrition and Dietetics, College of Applied Food Sciences and Tourism,
Michael Okpara University of Agriculture, Umudike, Abia State.

……………………….. ………………………

Mrs. C. P. Ezeibe Date

Project Supervisor

……………………….. ………………………
Prof. O. C. Nzagwu Date
Head of Department

External Supervisor ……………………………………….

Date

4
 DEDICATION
I dedicate this project to God Almighty for the wisdom to carry out this work effectively.

5
 ACKNOWLEDGEMENTS
The successful completion of this research was made possible through the efforts and
commitment of so many whom I owe my appreciation. My foremost thanks go to the Almighty
God, who makes all things possible to them that believe Him.
I am heartily thankful to my supervisor, Mrs. C. P. Ezeibe, whose encouragement, insightful
criticisms, supervision and support aided in successful completion of this work.
My heartfelt gratitude and appreciation goes to all the lecturers in Department of Human
Nutrition and Dietetics, Michael Okpara University of Agriculture, Umudike, especially, Prof.
C.A. Echendu, Prof. O.C. Nzeagwu, Prof. J.U. Anyika-Elekeh, Dr. U.V. Asumugha, Dr. E.J.
Umoh, Dr. P.O. Ukegbu, Dr. H.O. Okudu, Dr. A.D. Oguizu, Dr. H. N. Herny-Uneze, Dr. H. N.
Ezenwa, Dr. J. N. Okoli, Mr. I. O. Okorie, Mrs. C.A. Uzokwe, Mr. I. Ijioma, Mrs. I. C.
Asomugha, Mr. G.O. Iheme, Mrs. E.M. Okonkwo, Mrs. C. P. Ezeibe, Mr. Nkwoala C.C., Mrs.
Onyebueke, Mrs. Mgbaja, Ms. Chioma Umahi, Ms. C. P. Nwamadi, and Ms. V. C. Ogu, for their
contributions in the success of my academic pursuit.
I remain indebted to my beloved parents, Mr. and Mrs. Odebeatu Angela whose love, care,
support and prayers have seen me throughout my undergraduate study. I owe a lot of thanks to
my brothers, sisters, friends and well-wishers.

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 TABLE OF CONTENTS
Cover Page
Title Page i
Approval Page ii
Certification iii
Dedication iv
Acknowledgment v
Table of Contents vi
List of Tables ix
Abstract x

CHAPTER 1
INTRODUCTION
1.1 Statement of Problem 4
1.2 General objective 4
1.2.1 Specific objectives 5
1.3 Significance of the study 5

CHAPTER 2
LITERATURE REVIEW
2.1 Exclusive Breastfeeding 6
2.2 Exclusive Breastfeeding Trends in the Developing World 7
2.3 Exclusive Breastfeeding Practices in Nigeria 8
2.4 Benefits of Exclusive Breastfeeding for Infants and Mothers 8
2.5 Professional Working Mothers and Exclusive Breastfeeding 10

CHAPTER 3
MATERIALS AND METHODS
3.1 Study Design 16
3.2 Area of Study 16
3.3 Population of the Study 16
3.4 Sampling and Sampling Techniques 16
3.4.1 Sample Size 16
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3.4.2 Sampling Procedure 17
3.5 Data Collection 17
3.5.1 Questionnaire Administration 17
3.6 Data Analysis 17
3.7 Statistical Analysis 17

CHAPTER 4
RESULTS AND DISCUSSION
4.1 Socio-Economic and Demographic Characteristics 19
4.2 Knowledge and Awareness of Respondents Towards Exclusive Breastfeeding 23
4.3 Attitude of Subjects Towards Exclusive Breastfeeding 25
4.4 Practice of Exclusive Breastfeeding 27
4.5 Relationship Between the Socio-Economic Characteristics on
Exclusive Breastfeeding Practice 29
4.6 Relationship Between the Socio-Economic Characteristics
Of The Parents and the Nutritional Status of the Children 30
4.7 Anthropometric Status of Exclusively and Non-Exclusive Infants
In Umuahia North LGA 33

CHAPTER 5
CONCLUSION AND RECOMMENDATIONS
5.1 Conclusion 36
5.2 Recommendation 36
References
Questionnaire

8
 LIST OF TABLES

4.1 Demographic Characteristics of the subjects 20

4.2 Socio-Economic Characteristics of the subjects 22
4.3 Knowledge And Awareness Of The Subjects On Exclusive Breastfeeding 24
4.4 Attitude of Subjects Towards Exclusive and Non-Exclusive Breastfeeding 26
4.5 Practice of Respondents Towards Exclusive Breastfeeding 28
4.6: Relationship Between the Socio-Economic Characteristics
of the Parents and the Nutritional Status of the Children 31
4.7: Relationship Between the Socio-Economic Characteristics and Exclusive
Breastfeeding Practice 32
4.8: Anthropometric Status of Students 35

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 ABSTRACT

The study focused on anthropometric assessment of exclusive and nonexclusive breastfeed babies 0-6
months in Umuahia North rural and urban areas. Cross sectional research design was adopted. The study
would comprised of breastfeeding mothers in Umuahia North rural and urban areas in Abia State. The
study revealed that many 66.5% of the subjects were between the ages of 18-35 years while a few (0.8%)
were 56 years and above. More than half (67.0%) of the subjects had four children only while few 3.8%
had only one child. A little above half (58.6%) of the subjects lived in corrugated iron sheet buildings
while few (0.8%) of the subjects lived in thatch houses. Borehole was the source of water supply for some
53.6% of the subjects as only 4.6% reported stream/river/pond as their source of water supply. pit latrine
54.4% was the prevalent type of toilet among the subjects as 3.8% used buckets. Many (62.8%) of the
subjects had secondary education while 0.4% had no formal education. Trading/business was the main
occupation of more than half (54.4%) of the subjects with few 4.2% of them civil/public servants. A little
above half (50.2%) of the subjects earned a monthly income between N16, 000-N49, 999 whereas only
few earned below N5, 000 monthly. Result shows that a vast majority (99.6%) of the subjects were aware
about exclusive breastfeeding while few 0.4% have not heard about it. Majority 82.0% of the subjects
reported hospital/health centers as their source of awareness with a further 8.4%, 5.0% and 4.2%
reporting friends/relatives, radio and television and television respectively. Many 65.3% of the subjects
had a fair knowledge on exclusive breastfeeding with a further 26.4% having poor knowledge while 8.3%
had good knowledge on exclusive breastfeeding. This study revealed that 26.4%, 65.3% and 8.3% of the
mothers had poor knowledge, fair knowledge and good knowledge on exclusive breastfeeding this result
could be due to most of them having secondary education. the attitude of the subjects towards exclusive
breastfeeding was examined. The findings showed that the subjects agreed that breastfeeding a baby with
only milk and no water is the best food for the child for 6 months (4.06±1.34) and that a mother can
express her breast milk to be given to a baby if she is not around (3.50±1.12). However, there were
undecided about children breastfed with only milk being more intelligent than children breastfed with
water (2.55±0.15) and that there is no need practicing exclusive breastfeeding because even those that
teach about it do not practice it (3.00±0.18). The study recommended increased awareness through others
sources and foster work place policies as this will help improve the knowledge attitude and practice of
exclusive breastfeeding among mothers.

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 CHAPTER 1

INTRODUCTION

Breast milk is known to be the best food for the infants because it contains all the nutrients in the

correct proportions. It is readily produced, easily digested and assimilated, has the correct

temperature and is always available at no cost. Exclusive breastfeeding (EBF) is defined as

infant’s consumption of human milk with no supplementation of any type (no water, no juice, no

non- human milk and no foods) except for vitamins, minerals and medications.

Breastfeeding creates an inimitable psychosocial bond between the mother and baby (Okolo and

Ogbonna, 2015), enhances modest cognitive development (Mbada et al., 2013) and it is the

underpinning of the infant’s wellbeing in the first year of life (Okolo and Ogbonna, 2015; Mbada

et al., 2013) even into the second year of life with appropriate complementary foods from 6

months (World Health Organization (WHO), 2018).

According to Subbiah (2018) breastfeeding is the ideal method suited for the physiological and

psychological needs of an infant. It is estimated by the World Health Organization (WHO, 2015)

that sub-optimal breastfeeding, especially non-exclusive breastfeeding in the first 6 months of

life, results in 1.4 million deaths and 10% of the disease burden in children younger than 5 years

of age. Exclusive breastfeeding (EBF) for the first 6 months of life improves the growth, health

and survival status of newborns (WHO, 2018) and is one of the most natural and best forms of

preventive medicine (WHO, 2001). Ip et al. (2017) opined that EBF plays a pivotal role in

determining the optimal health and development of infants, and is associated with a decreased

risk for many early life diseases and conditions, including otitis media, respiratory tract infection,

diarrhoea and early childhood obesity.

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Based on empirical evidence on the benefits of breastfeeding to the mother and baby WHO

(2015) has recommended 2 year breastfeeding; first 6 months exclusive breastfeeding; more than

8 times breastfeeding of the baby per day in the first 3 months of an infant’s life.

American Academy of Pediatrics (AAP) (2015) reported that breast feeding provides advantages

with regard to general health, growth and development. Gartner, et al. (2015) documents diverse

and compelling advantages for infants, mothers, families, and society from breastfeeding and use

of human milk for infant feeding. These advantages include health, nutritional, immunologic,

developmental, psychological, social, economic, and environmental benefits. During

breastfeeding, approximately 0.25-0.5 grams per day of secretory immuno-globulin (IgA)

antibodies pass to the baby via the milk (Aliyu et al., 2016). Williams et al. (2016) reported that

breastfeeding lower cholesterol and C-reactive protein (CPR) (CRP is a critical component of

the immune system, a complex set of proteins that our bodies make when faced with a major

infection or trauma) levels in adult women who had been breastfed as infants, this may decrease

the risk of cardiovascular disease in later life.

Breastfeeding promotes health for both mother and infant and helps to prevent disease (Oddy et

al., 2014) longer breastfeeding has also been associated with better mental health through

childhood and into adolescence. Armstrong and Reilly (2015) stated that breastfeeding appears

to reduce the risk of extreme obesity in children.

Ip et al. (2017) asserted that exclusive breast feeding apart from being beneficial to the baby,

has also been shown to have significant short and long term health benefits for the mother, and

was associated with lactational amenorrhoea (Aliyu et al., 2016) which is an important choice for

postpartum family planning. Also mothers who do not breast feed are more likely to develop

12
postpartum depression, obesity, type 2 diabetes mellitus, breast cancer and hypertension

(HortaBernado et al., 2017).

Aliyu et al. (2016) in their words stated that the benefits of exclusive breast feeding are well

established especially in poor communities where early introduction of foods other than breast

milk is of particular concern because of the risk of pathogen contamination and inadequate

preparation of breast milk substitutes leading to increased risk of morbidity and malnutrition.

“Not breast feeding” is associated with a significant 65% increase in diarrhoea incidence in 0-5

month old infants and a 32% increase in 6-11 month old infants (Lamberti et al., 2014). Lack of

knowledge and confidence was found by several authors (Chezem et al., 2018; Thulier and

Mercer, 2015) as the main reasons among mothers for less than optimum breastfeeding duration.

Perception of insufficient milk and work outside the home was cited by (Dearden et al., 2015;

Bunik et al., 2014) as common reasons for premature weaning or not breast-feeding exclusively.

In many African societies, exclusive breastfeeding is influenced by various socio-economic,

cultural and biological factors. According to Rio et al. (2012), the probability of initiating

breastfeeding is a complex function of individual, social, cultural and clinical factors.

The prevalence of EBF increased in almost all regions in the developing world, with a major

improvement seen in West and Central Africa where the prevalence doubled from 12% to 28%,

while more modest improvements were observed in South Asia where the increase was from

40% in 1995 to 45% in 2014 (Cai et al., 2012).

Assessment of exclusively and non-exclusively breastfed babies (0-6 months) lacks information.

This present study therefore seeks to examine the anthropometric assessment of exclusively and

non-exclusively breastfed mothers in Umuahia North rural and urban areas.

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1.4 STATEMENT OF PROBLEM

The first 1000 days of life have been reported as a critical window of opportunity as major

developmental processes take place within this period. The increasing rates of infant and young

child morbidity and mortality caused by malnutrition and infectious diseases have made it

important for serious attention to be paid to this group.

Promotion of exclusive breastfeeding (EBF) for the first 6 months of the infant’s life has been

identified as one of the most effective strategies for reducing infant morbidity and mortality in

resource limited settings (that is human and infrastructural constraints). Studies carried out in

Nigeria clearly demonstrated the lack of awareness and knowledge on EBF and have also shown

that lack of knowledge also affect the attitude and practice of the mothers towards EBF.

Also, various studies have indicated a significant difference among employed and unemployed

mothers with regard to exclusive breastfeeding and also revealed that unemployment of the

mothers is a predictor of exclusive breastfeeding. While a lot of studies have been carried out to

assess knowledge and practice of exclusive breast feeding among mothers in developed nations

of the world and some African countries, only little has been done in Nigeria and non in

Umuahia North rural and urban areas. Thus, this lack of information promoted this present study

which seeks to assess the knowledge, attitude and practice of exclusive breastfeeding among

working class mothers in Umuahia North rural and urban areas.

1.5 General objective

The general objective is for anthropometric assessment of exclusive and nonexclusive breastfeed

babies 0-6 months in Umuahia North rural and urban areas.

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1.2.1 Specific objectives

The specific objectives are to:

1. evaluate the knowledge of respondents towards exclusive breastfeeding

2. evaluate the attitude of respondents towards exclusive breastfeeding

3. ascertain the practice of respondents towards exclusive breastfeeding

4. determine the relationship between their knowledge and attitude on practice of exclusive

breastfeeding.

5. determine the relationship between the socio-economic characteristics and exclusive

breastfeeding practice.

6. Determine the anthropometric status of exclusively and non-exclusive infants in Umuahia

North LGA

1.6 Significance of the study

The result of this study will reveal the practice of exclusive breastfeeding among working class

mothers and also throw more light on their knowledge and attitude.

Findings will benefit the government in the development, implementation and monitoring of

strategic policies and interventions aimed at improving infant and young child feeding practices.

Findings will also benefit non-governmental organization and international agencies, by

providing vital statistics on the critical area of need in the knowledge, attitude and practice of

mothers which will help them in advocacy, it will also equip the health workers and nutrition

educators with basic knowledge on the area of need of the public this will assist them in

designing the most appropriate strategy to reach them. Finally, findings will benefit the general

public and mothers in particular.

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 CHAPTER 2

LITERATURE REVIEW

2.1 EXCLUSIVE BREASTFEEDING

According to WHO (2014) exclusive breastfeeding means ‘that the infant receives only breast

milk. No other liquids or solids are given not even water with the exception of oral rehydration

solution, or drops/syrups of vitamins, minerals or medicines’.

Breast milk is the natural and original first food for babies, it provides all the energy and

nutrients that the infant needs for the first months of life, and it continues to provide up to half or

more of a child’s nutritional needs during the second half of the first year, and up to one-third

during the second year of life (Danso, 2014).

WHO (2015) recommends ‘that infants should be exclusively breastfed for the first six months

of life to achieve optimal growth, development and health, thereafter, infants should receive

nutritionally adequate and safe complementary foods, while continuing to breastfeed for up to

two years or more’. Breast milk contains all the nutrients infant requirements in the first six

months of life.

Exclusive breastfeeding provides the best start in life (UNICEF, 2015). Since 1990, global

breastfeeding rates have risen by 15%. In Nigeria, a study in Epe local government area of Lagos

State revealed that the percentage of breastfeeding rose from 2% in 1990 to 14% in 2015

(Omotola, et al., 2015). The benefits of breastfeeding are well documented in the literature (Ene-

obong, 2001; Frazer and Cooper, 2018; UNICEF, 2015; Nwachukwu and Nwachukwu, 2017;

WHO, 2017).

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Breastfeeding exclusively does not allow the infant to be exposed to potentially unsafe food or

water. It also saves an estimated six million lives of infants every year (UNICEF, 2015). Over

3,000 lives of infants will be saved every day if breastfeeding continues alongside appropriate

complementary feeding until at least two years of age (UNICEF, 2015). The incidence and

success of breastfeeding have been attributed to several factors including the provision of

accurate information and continuous support to the breastfeeding mothers (Wambach et al.,

2015; Edegbai, 2001). In a related study, it was reported that 37% of the mothers admitted that

they had been advised to breastfeed immediately after delivery, but only 24% of the sampled

mothers actually did so. The status of breastfeeding dropped from 37% in the neonatal period to

14% at the end of the sixth month of exclusive breastfeeding (Omotola et al., 2015). Successful

breastfeeding depends on mothers’ knowledge, attitudes and beliefs about breastfeeding. Since

breastfeeding behaviour of a mother is an important predictor of infant and child nutrition, health

and development, it becomes necessary to assess mothers’ knowledge, attitudes, beliefs and

practices of exclusive breastfeeding (Ene-obong, 2001).

2.2 EXCLUSIVE BREASTFEEDING TRENDS IN THE DEVELOPING WORLD

There is a wide range of variation in the practice of exclusive breastfeeding among developing

countries, with the rates documented being: Brazil (58%), Bangalore (40%), Iran (Zahedan)

(69%), Iran (28%) Beruwala (Kalutara) (15.5%), Lebanon (10.1%), Nigeria (20%), Bangladesh

(34.5%), Jordan (77%) (Batal et al., 2015; Salami, 2016; Mihrshahi et al., 2017; Sokol et al.,

2017; Oweis et al., 2015; Madhu et al., 2015; Roudbari et al., 2015; Olang et al., 2015; Wenzel

et al., 2014; Olatubi, 2016).

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Labook et al. (2016) reported that an increase rate of exclusive breastfeeding from 46% to 53%

among infants younger than 4 months and from 34% to 39% for those younger than 6 months.

Higher growth was acknowledged in urban areas (30% to 46%) than rural ones (42% to 48%).

2.3 Exclusive Breastfeeding Practices in Nigeria

Nigeria Demographic and Health Survey (NDHS) (2013) stressed that only 17 percent of

children under age 6 months are exclusively breastfed. This is an improvement from the 2008

NDHS, when the figure was 13 percent. Supplementing breast milk with water, other liquids, or

foods starts at an early age in Nigeria. More than half of children received water in addition to

breast milk in the first three months of life. Furthermore, contrary to the recommendation of

exclusive breastfeeding, 47 percent of children under age 6 months were given plain water, 5

percent received other milk, and 23 percent were fed complementary foods in addition to breast

milk (National Population Commission and ICF International, 2014). Contrary to

recommendations, 9 percent of children age 0-1 month, 16 percent of children age 2-3 months,

and 38 percent of children age 4-5 months are given complementary foods in addition to

breastmilk (National Population Commission and ICF International, 2014).

The Saving Newborn Lives program (SNLP) (2014) reported that Nigeria has one of the poorest

exclusive breastfeeding rates in Africa. Efforts are being made to help mothers by increasing

community awareness about the benefits of early and exclusive breastfeeding and addressing

harmful practices, such as discarding colostrum that may prevent optimal infant feeding (Federal

Ministry of Health (FMH) 2014).

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In Nigeria, while breastfeeding initiation is on the increase at health facilities after delivery, the

sustained practice of EBF once the mothers return home has remained low (Awi et al., 2017;

Agunbiade and Ogunleye, 2012; Agbo et al., 2013).

2.4 Benefits of Exclusive Breastfeeding for Infants and Mothers

According to Fewtrell (2015) early initiation of breastfeeding is important for both the mother

and the child. Early suckling stimulates the release of prolactin, which helps in the production of

milk, and oxytocin, which is responsible for the ejection of milk. It also stimulates contraction of

the uterus after childbirth and reduces postpartum blood loss. The first liquid to come from the

breast, known as colostrum, is produced in the first few days after delivery (Leon-Cava, 2015;

WHO, 2017). Colostrum is highly nutritious and contains antibodies that provide natural

immunity to the infant. It is recommended that children be fed colostrum immediately after birth

(within one hour) and that they continue to be exclusively breastfed even if the regular breast

milk has not yet started to flow. EBF during the first year of a child’s life ensures the provision

of certain biological and psychological needs and therefore increases the probability of survival

during this critical stage of development (Natural Resources Defence Council (NRDC) 2015).

Studies (Subbiah, 2018; Young et al., 2014) have shown that breastfeeding during the early

stages of a child’s development stimulates the immune system and improves the child’s

responses to inoculation. Reduction in the incidence of gastrointestinal (GI) diseases, respiratory

infections, ear infections and improvements in dentition have been observed in children who

have been breastfed exclusively for six months or more. Breast milk has been shown by various

studies (Arifeen et al., 2001; Story and Parish, 2008; Young et al., 2014; Caramez da Silva et al.,

2012) to contain antibodies and enzymes that stimulate an infant’s growth and development.

Consequently, children who are breastfed are less prone to childhood cancers, childhood

19
diabetes, asthma, gestational diseases, allergies, leukemia and lymphoma, as well as neurological

disorders.

In terms of maternal health, breastfeeding has a number important health benefits. Awi and

Alikor (2017) reported that breastfeeding in the first hour of birth facilitates the expulsion of

placenta, reduces postpartum haemorrhaging and also expedites the recovery from the trauma of

childbirth and labour. Additionally, breastfeeding helps the mother’s uterus to return to its pre-

pregnancy size (Tyndall et al., 2016). Furthermore, women who breastfeed return to their pre-

birth weight more easily. In later life, nursing mothers are offered some degree of protection

from both breast and ovarian cancer and also osteoporosis (Lipworth et al., 2015; National

Institute of Child Health and Human Development (NICHHD) 2015; Gajalakshmi et al., 2015).

In fact, there is a direct correlation between length of time a mother breastfeeds and the

protective effect against breast cancer (Moeller et al., 2015).

2.6 Professional Working Mothers and Exclusive Breastfeeding

Numerous studies have revealed that one of the barriers to breastfeeding is work status. With

enlarged urbanization and industrialization, more and more women have joined the work force.

An estimated 50% of women employed in the workplace are of reproductive age and return to

work within one year of their infants’ births (Wyatt, 2015). According to the Ross Mother’s

Survey (2015), only 22% of women employed full-time breastfed their infants compared to

35.4% of mothers who were not employed (Libbus and Bullock, 2015). According to the

Nigerian Bureau of Statistics (2014) women constitute roughly half of Nigerian’s population and

thus potentially half of its work force. As a group, they do as much work as men if not more.

However, the types of work they do as well as the condition under which they work and their

access to opportunities for advancement differs from men. In Nigeria, current employment

20
among women of reproductive age increased from 59% in 2008 to 62% in 2013 (National

Population Commission and International Children Fund International (NPC and ICF), 2014).

Sources and Knowledge of Exclusive Breastfeeding Information

According to Kovach (2015) formal breastfeeding policies in hospitals, staff and physician

training in breastfeeding management, and rooming-in have been shown to positively affect

breastfeeding promotion efforts (Kovach, 2015). Strategies such as the Baby-Friendly Hospital

Initiative (BFHI), peer counselling, paternal support, and education of the mothers and health

care professionals have been used to promote breastfeeding in the U.S. (Martens, 2015; Philipp

et al., 2001).

A study Martens (2015) showed that a one and half hour mandated breastfeeding education

intervention of nursing staff significantly increased the compliance of the BFHI and

breastfeeding beliefs over a 7-month period at the intervention site compared to control site. The

rates of EBF also increased by 23% (31% vs.54%), and fewer nurses offered supplementation

(45% vs. 87%) after the intervention. Although breastfeeding promotion or intervention

programs have focused on educating the mothers, family members, and employers about the

benefits of supporting breastfeeding, not much attention has been paid to the health professionals

influencing these target groups. Surveys evaluating health care professionals’ knowledge and

attitudes about breastfeeding revealed that these professionals do strongly advocate to their

clients that breastfeeding is the optimum method of infant feeding (Pascoe et al., 2015).

Support from governmental programmes, health professionals, and education in schools is very

significant for the promotion of exclusive breastfeeding and for bringing about changes in

person’s behaviour. Valuable educational efforts require knowledgeable health professionals to

compel these efforts; consequently, students majoring in health sciences such as public health,

21
nutrition and home economics should be comprehensively educated and trained to support and

advocate breastfeeding.

Breastfeeding benefits for community

Breastfeeding has many benefits for the community including: 1) breast milk contains no

waste or pollution; 2) food support programs, such as the WIC program could reduce costs by

encouraging breastfeeding and decreasing formula use; 3) breastfeeding mothers will have

healthy babies, therefore they will have less absence from work, because they do not have to stay

home as frequently because their children are healthier (Breastfeeding Moms, 2012).

Factors Influencing Breastfeeding

There are many factors that influence the practice of breastfeeding including: psychosocial

factors (such as knowledge and attitudes), demographic characteristics, hospital practices, and

environmental support. These factors differ by nation; therefore, the effect of these factors on the

rate of breastfeeding differs by nations and individual circumstances.

Psychosocial factors

Knowledge and attitudes (psychosocial factors) are important factors that influence

breastfeeding prevalence in general (Chambers et al., 2017). Mothers obtained their knowledge

about breastfeeding from different resources such as: physicians, books or articles about

breastfeeding, internet, and from mother to mother (Tanash, 2014). Health care providers should

be aware that their own beliefs and attitudes toward breastfeeding may affect a woman’s choice

to breastfeed (Auger, 2013). Mothers’ trust their health care providers; therefore, care providers

opinions regarding a particular issue such as breastfeeding could be considered.

Demographic characteristics: Maternal age, maternal level of education, and family

22
income.

According to CDC (2014), there is a significant association between breastfeeding rates and

socio-demographic characteristics for mothers including maternal age, maternal education level,

and family income. It has been found that breastfeeding rates increased with increasing maternal

age for all race-ethnicity groups. Older mothers are more likely to choose breastfeeding than

young mothers (Wang, 2016; Kennedy-Stephenson, 2014). However, low level of maternal

education has been liked with low breastfeeding rates (Bertini et al., 2018). Also, breastfeeding

rates were higher among mothers who have high family incomes than for mothers who have low

family income (Wang, 2016; Kennedy-Stephenson, 2014).

Hospital practices

To improve breastfeeding rates it is important to involve healthcare providers in the process of

encouraging mothers to choose breastfeeding for their children. A published joint statement from

World Health Organization and United Nations International Children Emergency Fund (WHO

and UNICEF) (2018) to improve breastfeeding rates recommended that all healthcare facilities

encourage breastfeeding choice

Starting breastfeeding within an hour after delivery, supplementing newborns with

formula, and using bottles before discharge

Initial breastfeeding within at least one hour after delivery reduces neonatal mortality by 22%,

and it could prevent more than one million newborn deaths every year all over the world (Jana,

2015). In developing countries, initial breastfeeding reduces deaths due to diarrheal disorders and

lower respiratory tract infections in children. It could save about 1.45 million lives each year

(Jana, 2015). Also, many infants receive supplemental formula at the nursery after delivery

whether due to the hospital policy or maternal request. Further, researchers concluded that

23
supplementing newborns with formula is associated with short exclusive breastfeeding duration

(Shenoi et al., 2012) . In addition, WHO recommends avoiding using bottles before hospital

discharge, and during the breastfeeding establishment time. Using bottles leads to nipple

confusion, because it provides a larger amount of milk in less time than mother’s breast which

requires more energy from the baby to get enough milk. Therefore, bottles will reduce the

sucking time from the mother’s breast (Tanash, 2014). Also, research has found that replacing

bottles by cups or tubs has been linked with increased breastfeeding prevalence (Collins et al.,

2015).

Environmental factors

Commercial incentives for formula feeding

Howard et al. (2015) found that breastfeeding initiation and duration over a two week period is

not affected by this commercial formula gift (Howard et al., 2015). On the other hand, other

findings indicated that commercial formula samples are associated with decreasing the duration

of exclusive breastfeeding at all times, but does not affect the duration of non- exclusive

breastfeeding (Donnelly et al., 2015).

Mothers returning to work outside the home after delivery

Gibbs (2014) concluded that returning to work among breastfeeding mothers is associated with

earlier weaning for their babies. Employers providing a private place for breastfeeding

employees to express breast milk may encourage more working mothers with infants to

breastfeed at work.

Biomedical factors

WHO provides a list of medical conditions for both mothers and babies that affect breastfeeding

(WHO, 2015). This report suggests permanent avoidance of breastfeeding for mothers who have

24
HIV, and temporary avoidance of breastfeeding for mothers who have: herpes simplex virus type

1 (HSV-1); illnesses that prevent mothers from taking care of their babies such as sepsis; and

maternal medications that could affect the infants health. WHO provides, also, a list of health

conditions including: breast abscess, hepatitis B, hepatitis C, mastitis, and tuberculosis, that

mothers with these conditions could continue breastfeeding but they should consider bottle

feeding instead. Also, infants with specific medical conditions including classic galactosemia,

maple syrup urine disease, and phenylketonuria, should not receive breast milk or any other milk

except specialized formula according to doctors’ orders. On the other hand, other conditions

including infants born weighing less than 1500 g (very low birth weight), infants born at less

than 32 weeks of gestational age (very pre-term), and newborn infants who are at risk of

hypoglycaemia, may need other food in addition to breast milk for a limited period ( WHO,

2015).

25
 CHAPTER 3

MATERIALS AND METHODS

3.1 STUDY DESIGN

A cross sectional study design was used.

3.2 AREA OF STUDY

Umuahia North rural and urban areas. Umuahia North is a Local Government Area of Abia

State, Nigeria. Its headquarters are in the city of Umuahia. It has an area of 245 km 2 and a

population of 220,660 at the 2006 census. Umuahia lies between 5.5250° N and longitude

7.4922° E. Umuahia comprises two local government areas: Umuahia North and Umuahia South.

These local governments are also composed of clans such as the Umuopara, Ibeku, Olokoro,

Ubakala and Ohuhu communities.

3.3 POPULATION OF THE STUDY

The study would comprised of breastfeeding mothers in Umuahia North rural and urban areas in

Abia State.

3.4 SAMPLING AND SAMPLING TECHNIQUES

3.4.1 Sample size

The sample size for this study was calculated using the prevalence formula for sample size

calculation. The 2013 Nigeria Demographic and Health Survey (NDHS) showed that only 17

percent of children under age 6 months are exclusively breastfed (National Population

Commission and ICF International, 2014).

Sample size (n)= Z2 p(1-P)

d2
where n = sample size
Z2 = confidence interval (95%)= 1.96
P = expected prevalence of exclusive breastfeeding in Nigeria (17%)

26
 d = precision (5%)= 0.05

(n) = 1.962x0.17(1-0.17)
0.052
= 3.8416 x 0.1411
0.0025 = 217
10% of the sample size would be added to make up for possible drop out.

21.7 + 217 = 239

3.4.2 Sampling procedure

A simple random sampling technique was used to select 239 breastfeeding mothers

3.5 DATA COLLECTION

3.5.1 Questionnaire Administration

A structured questionnaire constructed into four (4) sections was used to collect information on

socio-economic/demographic characteristics, knowledge, attitude and practice of exclusive

breastfeeding. The questionnaire was validated by lecturers of the Department of Human

Nutrition and Dietetics, Michael Okpara University of Agriculture Umudike.

3.6 DATA ANALYSIS

The knowledge and attitude of the subjects were graded; this was done by assigning ten (10)

marks for the correct answer for each knowledge and attitude question while no mark was

awarded for the wrong answer. The total was converted to percentage by adding the individual

marks dividing it by the total mark and multiplying by 100. The sores were graded thus, score

between 0-29% were be considered as poor, scores between 30-49% were considered as fair,

scores between 50-89% were considered as good while scores between 90-100% were

considered as very good.

3.7 STATISTICAL ANALYSIS

27
Statistical package for service solution IBM (SPSS version 23) was used to analyze the data.

Descriptive statistics (frequency and percentage) was obtained for the socio-economic

characteristics, knowledge and practice of exclusive breastfeeding while mean and standard

deviation was obtained for attitude. Chi-square test was used to determine the effect of socio-

economic characteristics oF exclusive breastfeeding practice. Chi-square would be used to

determine the relationship between their knowledge and attitude on practice of exclusive

breastfeeding.

28
 CHAPTER 4

RESULTS AND DISCUSSION

4.1 SOCIO-ECONOMIC AND DEMOGRAPHIC CHARACTERISTICS

Table 4.1 shows the demographic characteristics of the subjects. Many 66.5% of the subjects

were between the ages of 18-35 years while a few (0.8%) were 56 years and above. More than

half (67.0%) of the subjects had four children only while few 3.8% had only one child. A little

above half (58.6%) of the subjects lived in corrugated iron sheet buildings while few (0.8%) of

the subjects lived in thatch houses. Borehole was the source of water supply for some 53.6% of

the subjects as only 4.6% reported stream/river/pond as their source of water supply. pit latrine

54.4% was the prevalent type of toilet among the subjects as 3.8% used buckets.

29
Table 4.1 Demographic characteristics of the subjects

Variables Frequency Percent

Age
Less than 18 years 8 3.4
18-35 years 159 66.5
36-55 years 70 29.3
56 years and above 2 0.8
Total 239 100
No of children
One only 9 3.8
Two only 40 16.7
Three only 30 12.6
Four only 160 67.0
Total 239 100
Type of housing
Thatch 2 0.8
Corrugated iron sheet 140 58.6
Aluminum sheet 60 25.1
Synthetic roofing 37 15.5
Total 239 100
Source of water supply
River/ stream/pond 11 4.6
Dug well 60 25.1
Borehole 128 53.6
Public water supply 40 16.7
Total 239 100
Type of toilet
Bush 20 8.4
Bucket 9 3.8
Pit latrine 130 54.4
Water closet 80 33.5
Total 239 100

30
Table 4.2 shows the socio-economic characteristics of the subjects. Many (62.8%) of the subjects

had secondary education while 0.4% had no formal education. Trading/business was the main

occupation of more than half (54.4%) of the subjects with few 4.2% of them civil/public

servants. A little above half (50.2%) of the subjects earned a monthly income between N16,

000-N49, 999 whereas only few earned below N5, 000 monthly.

31
Table 4.2 Socio-economic characteristics of the subjects

Variables Frequency Percent

Educational qualification

No formal education 1 0.4

Primary education 79 33.1

Secondary education 150 62.8

Tertiary education 9 3.8

Total 239 100

Occupation

Civil/public servant 10 4.2

Trader/business 130 54.4

Farmer 70 29.3

Artisan 29 12.1

Total 239 100

Monthly earning

Less than N5,000 4 1.7

N5,000-N15, 999 80 33.5

N16, 000-N49,999 120 50.2

N 50,000 and above 35 14.6

Total 239 100

32
4.2 KNOWLEDGE AND AWARENESS OF RESPONDENTS TOWARDS
EXCLUSIVE BREASTFEEDING

Table 4.3 shows the knowledge and awareness of subjects on exclusive breastfeeding. Result

shows that a vast majority (99.6%) of the subjects were aware about exclusive breastfeeding

while few 0.4% have not heard about it. Majority 82.0% of the subjects reported hospital/health

centers as their source of awareness with a further 8.4%, 5.0% and 4.2% reporting

friends/relatives, radio and television and television respectively. Many 65.3% of the subjects

had a fair knowledge on exclusive breastfeeding with a further 26.4% having poor knowledge

while 8.3% had good knowledge on exclusive breastfeeding.

This study revealed that 26.4%, 65.3% and 8.3% of the mothers had poor knowledge, fair

knowledge and good knowledge on exclusive breastfeeding this result could be due to most of

them having secondary education. This finding was in agreement with the report of Gafray

(2009) who showed that 36.7% of the mothers in Sari had good knowledge and 57.2% of them

had moderate (fair) knowledge, however this finding were in disagreement with One study in

Khoram Abad (Mardany et al., 2006), which showed that 55%, 39% and 6% of mothers had

high, moderate and low levels of knowledge, respectively, about breastfeeding. In another study

conducted in Semnan (Karimi and Zareisani, 2014), it was found that 6%, 43.8% and 50% of

mothers had low, moderate and high level of knowledge, respectively. On the source of

awareness this study agrees with the reports of Haghighi and Varzande (2016) who also reported

health centers as the major source of exclusive breastfeeding awareness this underscores the need

for more action towards increasing more channels for awareness.

33
Table 4.3 Knowledge and awareness of the subjects on exclusive breastfeeding

Variables Frequency Percent

Awareness of exclusive
breastfeeding

Yes 238 99.6

No 1 0.4

Total 239 100

Source of awareness

From hospital/health centers 196 82.0

From Television 10 4.2

From friends/relatives 20 8.4

from radio and television 12 5.0

No response 1 0.4

Total 239 100

Poor knowledge 63 26.4

Fair knowledge 156 65.3

Good knowledge 20 8.3

Total 239 100.0

34
4.3 ATTITUDE OF SUBJECTS TOWARDS EXCLUSIVE BREASTFEEDING
Table 4.5 shows the attitude of the subjects towards exclusive breastfeeding. Findings showed

that the subjects agreed that breastfeeding a baby with only milk and no water is the best food for

the child for 6 months (4.06±1.34) and that a mother can express her breast milk to be given to a

baby if she is not around (3.50±1.12). However, there were undecided about children breastfed

with only milk being more intelligent than children breastfed with water (2.55±0.15) and that

there is no need practicing exclusive breastfeeding because even those that teach about it do not

practice it (3.00±0.18).

35
Table 4.4 Attitude of subjects towards exclusive and non exclusive breastfeeding

Variables Mean Std deviation Remark

Breastfeeding a baby 4.06 1.34 Agree

with only milk and no
water is the best food
for the child for 6
months

Children breast fed 2.55 0.15 Undecided

with only breast milk
are more intelligent
than children breast
fed with water

A mother can express 3.50 1.12 Agree

her breast milk to be
given to a baby if she
is not around

Breastfeeding a child 2.40 1.15 Disagree

without water makes
the child to become
wicked later in life

There is no need 3.00 0.18 Undecided

practicing exclusive
breastfeeding because
even those that teach
about it do not practice
it

it is not healthy giving 2.00 1.32 Disagree

infants expressed
breast milk

36
4.4 PRACTICE OF EXCLUSIVE BREASTFEEDING

Table 4.6 shows the practice of subjects towards exclusive breastfeeding. More than half (60.3%)

of the subjects were still breastfeeding while 39.7% were not. Some 31.0% of the subjects not

breastfeeding gave lack of time due to work as reason, while only few 2.0% gave health as

reason for not breastfeeding. a little above half (52.7%) of the subjects breastfed child on

demand with a further 34.3% breastfeeding when child starts to cry, whereas few 1.7% only

breastfeed when less busy. a vast majority (87.9%) of the subject fed child with expressed breast

milk when not around while 12.1% feed child when they come back.

37
Table 4.5 Practice of Respondents Towards Exclusive Breastfeeding
Variables Frequency Percent
Still breastfeeding
Yes 144 60.3
No 95 39.7
Total 239 100
Reason for not
breastfeeding
No time due to work 74 31.0
Inadequate breastmilk 16 6.7
Health reasons 5 2.0
No response 144 60.3
Total 239 100
Frequency of breastfeeding
On demand 126 52.7
Only when breast is full 7 2.9
When child starts to cry 82 34.3
When am less busy 4 1.7
When am at home or in 20 8.4
private
Total 239 100
Breastfeeding when not
around
With expressed breastmilk 210 87.9
Breastfeed child when I come 29 12.1
back
Total 239 100

38
4.5 RELATIONSHIP BETWEEN THE SOCIO-ECONOMIC CHARACTERISTICS OF
THE PARENTS AND THE NUTRITIONAL STATUS OF THE CHILDREN

Table 4.6 shows the relationship between the socioeconomic characteristics of the parents and

the nutritional status of the children. Similar result was obtained from the work of Anuradha et

al. (2014) who showed that no significant association was found between educational status of

parents and nutritional status of the children. In contrast to this finding, Ahmed et al. (2011)

showed that a higher proportion of children suffering from protein energy malnutrition belongs

to illiterate parents and especially that of illiterate mothers. Similarly in a study conducted by

Verma et al. (2007) literacy of mother displayed a significant (p< 0.001) inverse relationship

with malnutrition being highest (70%) among children whose mothers are illiterate.

39
 Table 4.6: Relationship between the socio-economic characteristics of the parents and the nutritional status of the children
Mothers Fathers Mother's Fathers Mothers Father's Weight for Height for Weight for age
Educational Educational occupation occupation monthly monthly height age
Qualification Qualification income income
Mothers Pearson Correlation 1
Educational Sig. (2-tailed)
Qualification N 239
Fathers Pearson Correlation .337** 1
Educational Sig. (2-tailed) .000
Qualification N 239 239
Pearson Correlation .322** .076 1
Mother's
Sig. (2-tailed) .000 .145
occupation
N 239 239 239
Pearson Correlation .041 .062 -.009 1
Fathers
Sig. (2-tailed) .429 .237 .866
occupation
N 239 239 239 239
Pearson Correlation .374** .034 .079 .013 1
Mothers monthly
Sig. (2-tailed) .000 .516 .131 .805
income
N 239 239 239 239 239
Pearson Correlation .308** .098 .085 .101 .533** 1
Father's monthly
Sig. (2-tailed) .000 .060 .103 .052 .000
income
N 239 239 239 239 239 239
Pearson Correlation -.019 -.005 .018 .056 -.077 .020
BMI for age Sig. (2-tailed) .718 .923 .731 .284 .138 .705
N 239 239 239 239 239 239
Pearson Correlation -.008 -.005 .025 .070 -.057 .002 1
Weight for height Sig. (2-tailed) .878 .918 .634 .190 .283 .964
N 357 357 357 357 357 357 357
Pearson Correlation -.063 -.022 -.008 -.042 -.049 .053 -.369** 1
Height for age Sig. (2-tailed) .223 .670 .877 .423 .348 .310 .000
N 239 239 239 239 239 239 357 239
Pearson Correlation -.055 -.019 .006 .004 -.081 .048 .855** .788** 1
Weight for age Sig. (2-tailed) .292 .715 .902 .945 .120 .356 .000 .000
N 239 239 239 239 239 239 239 239 239

40
4.7 ANTHROPOMETRIC STATUS OF EXCLUSIVELY AND NON-EXCLUSIVE

INFANTS IN UMUAHIA NORTH LGA

Table 4.5 shows the nutritional status of the children. Result from the height/length for age of the

children indicated that almost all (94.6%) of the children comprising of 94.5% male and 100.0%

female were normal while a few (5.4%) of the children were stunted. This result is in agreement

with the findings of Nnebue et al. (2016) who showed that stunting among preschool children

was 1.3% each in both males and females. In contrast to this, several researchers in Nigeria have

shown that prevalence of stunting among preschool children ranged from 14.2% to 52.7% (Goon

et al., 2008; Goon et al., 2010; Akanbi, 2011; Fetuga et al., 2011).

Result on the weight for age of the children revealed that more than half (62.2%) of the children

(comprising of 66.7% male and 59.7% female) were normal. 30.8% of the children (comprising

of 28.0% male and 35.8% female) were at risk while the same proportion (3.5%) of the children

were wasted and overweight. Comparably, this study is in line with the finding of Neelu et al.

(2010) who showed that 54.6% of infant studies were found to be normal as per their weight for

age.

41
Table 4.8: Anthropometric Status of Students

Males Females Total

Frequency % Frequency % Frequency %
Height/Length
for age
Stunted 13 9.6 0 0.0 13 5.4
Normal 123 90.4 103 100.0 226 94.6
Total 136 100.0 103 100.0 239 100.0
Weight for
age
Wasted 7 5.8 4 4.5 11 4.6
At risk 20 16.6 10 35.8 30 12.6
overweight 13 10.8 5 0.0 18 7.5
Normal 80 66.7 100 59.7 180 75.3
Total 120 100.0 119 100.0 239 100.0

42
 CHAPTER 5

CONCLUSION AND RECOMMENDATIONS

5.1 Conclusion

This study revealed that although the awareness of the subjects towards exclusive breastfeeding

was high their knowledge and attitude was moderate. The study also points at the low level of

awareness through media sources as health centers/hospitals were the major sources of

awareness. This level of knowledge and attitude could be attributable to their level of education

as studies have associated the level of education to the knowledge and attitude towards exclusive

breastfeeding.

5.2 Recommendation

This study recommends increased awareness through others sources and foster work place

policies as this will help improve the knowledge attitude and practice of exclusive breastfeeding

among mothers.

43
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Psychology, 26 (3): 229-243. 10.1080/02646830701691376.

WHO/UNICEF (2016): Innocenti declaration on the protection, promotion and support of

breastfeeding http://www.unicef.org/programme/breastfeeding/innocenti.htm. [Accessed
12/08/2021]

Wojcicki JM, Gugig R, Tran C, Kathiravan S, Holbrook K, Heyman MB: Early exclusive
breastfeeding and maternal attitudes towards infant feeding in a population of new
mothers in San Francisco, California. Breastfeed Med. 2014, 5 (1): 9-15.
10.1089/bfm.2015.0003.

World Health Organization (WHO, 2019): The global strategy for infant and young child
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 QUESTIONNAIRE

Demographic Characteristics of the Subjects

1. Age:i. Less than 18 years [ ] ii. 18-35 years [ ] iii. 36-55 years [ ] iv. 56 years and
above [ ]

2. No of children i. One only [ ] ii. Two only [ ] iii Three only [ ] Four only [ ]

3. Type of housing i. Thatch [ ] ii. Corrugated iron sheet [ ] iii. Aluminum sheet [ ]
iv. Synthetic roofing [ ]

4. Source of water supply i. River/ stream/pond [ ] ii. Dug well [ ] iii. Borehole [ ] iv.
Public water supply [ ]

5. Type of toilet i. Bush [ ] ii. Bucket [ ] iii. Pit latrine [ ] iv. Water closet [ ]

Socio-economic characteristics of the subjects

6. Educational qualification i. No formal education [ ] ii. Primary education [ ] iii.

Secondary education [ ] iv. Tertiary education [ ]

7. Occupation i. Civil/public servant [ ] ii. Trader/business [ ] iii. Farmer [ ] iv.

Artisan [ ]

8. Monthly earning i. Less than N5,000 [ ] ii. N5,000-N15, 999 [ ] iii. N16, 000-
N49,999 [ ] iv. N 50,000 and above [ ]

Knowledge and awareness of the subjects on exclusive breastfeeding

9. Are you aware of exclusive breastfeeding i. Yes [ ] ii. No [ ]

10. What is your source of awareness i. From hospital/health centers [ ] ii. From Television
[ ] iii. From friends/relatives [ ] iv. from radio and television [ ] v. No response [ ]

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V Attitude of subjects towards exclusive breastfeeding

S/NO Strongly Agree Disagree Strongly

Agree Disagree

11. Breastfeeding a baby with only milk and

no water is the best food for the child for 6
months

12. Children breast fed with only breast milk

are more intelligent than children breast fed
with water

13. A mother can express her breast milk to

be given to a baby if she is not around

14. Breastfeeding a child without water

makes the child to become wicked later in
life

15. There is no need practicing exclusive

breastfeeding because even those that teach
about it do not practice it

16. It is not healthy giving infants expressed

breast milk

PRACTICE OF EXCLUSIVE BREASTFEEDING

17. Are you still breastfeeding? i. Yes ii. No

18. What are your reason for not breastfeeding? i. No time due to work [ ] ii. Inadequate
breastmilk [ ] iii. Health reasons [ ] iv. No response [ ]

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19. What is your Frequency of breastfeeding? i. On demand [ ] ii. Only when breast is
full [ ]

iii. When child starts to cry [ ] iv. When am less busy [ ] iv. When am at home or in
private [ ] v. Breastfeeding when not around vi. With expressed breastmilk [ ] vii.
Breastfeed child when I come back [ ]

SECTION C: ASSESSMENT OF ANTHROPOMETRIC INDICES

20. Height (m)

21. Weight (Kg)

22. Mid- upper arm circumference(cm)

23. Hip circumference (cm)
24. Waist – hip circumference(cm)

53