KNOWLEDGE, ATITUDE AND PRACTICE OF EXCLUSIVE BREAST FEEDING

AMONGST MOTHERS IN ABIA STSTE UNIVERSITY TEACHING HOSPITAL, ABA

BY

ONYENRO MARYLIN AMARACHI

INDEX NUMBER:…………………..

EXAM. NO.:…………………………

PRESENTED TO

DEPARTMENT OF NURSING SCINCES

FACULTY OF HEALTH SCIENCES,
ABIA STATE UNIVERSITY, UTURU, NIGERIA

NOVEMBER, 2022
 KNOWLEDGE, ATITUDE AND PRACTICE OF EXCLUSIVE BREAST FEEDING

AMONGST MOTHERS IN ABIA STSTE UNIVERSITY TEACHING HOSPITAL, ABA

BY

ONYENRO MARYLIN AMARACHI

INDEX NUMBER:…………………..

EXAM. NO.:………………………….

PRESENTED TO

DEPARTMENT OF NURSING SCINCES

FACULTY OF HEALTH SCIENCES,

ABIA STATE UNIVERSITY, UTURU, NIGERIA

MAY, 2023
IN PARTIAL FULFILLMENT OF THE REQUIREMENTS OF NURSING AND

MIDWIFERY COUNCIL OF NIGERIA FOR THE AWARD OF “REGISTERED

NURSE” CERTIFICATE.

NOVEMBER, 2022
 CERTIFICATION PAGE

This is to certify that this project by ONYENRO MARYLIN AMARACHI with the

Examination Number ………………………….. has been examined and approved for the award

of Registered Nurse Certificate.

……………………………. ……………………….

Mrs. Ukeagu N.C Date

(Project Supervisor)

……………………………. ……………………….

DR. MRS Emonye O.P Date

(Head of Department)

……………………………. ………………………

Chief Examiner Date

 DECLARATION PAGE

This is to certify that this research project titled “Knowledge, Attitude And Practice Of Exclusive

Breastfeeding Amongst Mothers In Abia State Ubiversity Teaching Hospital, Aba,” was carried

out by ONYENRO MARYLIN AMARACHI is sorely the result of my work except where

acknowledged as been derived from other person(s) or resources.

Examination Number …………………………….

Department of Nursing, Abia State university.

Signature …………………………….

Date …………………………….
 ABSTTRACT

This research study assessed knowledge, attitude and practice of exclusive breastfeeding

amongst mothers in Abia State University, Teaching Hospital, Aba. The objective of the study is

to determine the knowledge, attitude and practice of exclusive breastfeeding among mothers. A

descriptive survey design was adopted, as a sample size of 110 was obtain from a population of

275 and a simple random sampling technique used to select 110 respondents who participated in

the study. A structured questionnaire was used to collect data and data was analyzed using

frequency, percentage and mean scores. The key findings obtained from the study was revealed

that out of the 110(100%) respondents that participated in the study, 75(68%) of mothers have

good level of knowledge of exclusive breast feeding among mothers in Abia State University,

Teaching Hospital, Aba, also thatmothers have positive attitude on exclusive breast feeding as a

total mean score of (15.24) was greater than then criterion mean score (12.5). About 59(53%) of

mothers in Abia State University, Teaching Hospital, Aba had good level of practice of exclusive

breastfeeding and also good educational level of mothers in Abia State University, Teaching

Hospital, Aba had positive effect on their knowledge, attitude and practice of exclusive breast

feeding. These recommendations were made included that the government and private health

care organization should have exclusive feeding policy that is routinely communicated to all

health care staff to enable its implementation and also initiate policies or bills that promotes girl

child education in the entire nation as this directly influences their ability and capability to learn

and practice concepts like exclusive breast feeding later in life as mothers.

Keywords: Exclusive, breastfeeding, nursing mothers, knowledge, attitude.

 DEDICATION

This project is solely dedicated to God Almighty, who gave me the strength, mercies and grace

that enabled me to finish this work.

 ACKNOWLEDGEMENT

The researcher’s profound gratitude goes to the almighty God for His mercy, grace and favour

upon my life.

My gratitude also goes to my supervisor Mrs. Ukeagu N.C who beside her tight schedule spared

time to read this research work.

I humbly acknowledge the head of my department, Mrs. S.A.J Kanu for her motherly support

and encouragement, I also acknowledge my lecturers who have contributed in different ways to

the success of my project.

I will not fail to appreciate my lovely and caring parents Mr and Mrs Francis Onyenro and my

lovely siblings Vera, Fidelia and John-Victory for their love, encouragement and financial

support during this period.

To all my respondents, I say thanks for your cooperation without which thus study would not

have been a success.

 TABLE OF CONTENTS

Cover page

Title page

Certification

Abstract

Declaration

Dedication

Acknowledgment

Table of Content

List of tables

List of figures

CHAPTER ONE

 Background to the study

 Statement of the problem

 Aim/objectives of the study

 Research questions

 Significance of the study

 Scope of the study

 Limitations of the study

 Operational definition of terms

CHAPTER 2: LITERATURE REVIEW

 Conceptual framework

 Anatomy and physiology of the breast

 Physiology of lactation

 Composition and variations of breast milk

 Concept of exclusive breast feeding

 Benefits of exclusive breast feeding

 Baby friendly hospital initiative

 Techniques and positions used in exclusive breast feeding and its

importance

 Theoretical framework

 Empirical reviews

 Summary of literature reviews

CHAPTER 3: METHODOLOGY

 Research design

 Area for the study

 Population of the study

 Sample and sampling technique

 Instrument for data collection

 Validity of the instrument

 Reliability of the instrument

 Method for data collection

 Method for data analysis

  Ethical considerations

CHAPTER 4: PRESENTATION AND ANALYSIS OF DATA

 Presentation of analyzed data

 Discussion of findings

CHAPTER 5: SUMMARY, CONCLUSION AND RECOMMENDATIONS

 Summary

 Conclusion

 Recommendation

 Implication of finding to Nursing

 Suggestion for further studies

REFERENCES

APPENDICES

Appendix I: Letter of Introduction

Appendix II: Questionaire

Appendix III: Calculation of reliability index

Appendix IV: Calculation of criterion mean and mean score of item 11 and 15
 LIST OF TABLES

Table 4.1.1: Showing knowledge of exclusive breastfeeding among mothers

Table 4.1.2: Showing attitude of mothers on exclusive breastfeeding

Table 4.1.3: Showing practice of exclusive breastfeeding among mothers

 LIST OF FIGURES

Figure 4.1: Bar chart showing the age distribution of the respondents

Figure 4.2: Pie chart showing the marital status distribution of the respondents

Figure 4.3: Bar chart showing the occupational distribution of the respondents

Figure 4.4: Bar chart showing the highest level of education distribution of theRespondents

Figure 4.5: Pie chart showing the respondent’s number of children distribution.
 CHAPTER 1

INTRODUCTION

Background to the study

Breastfeeding is the means by which nutrition is provided, for the healthy growth of the infants

by putting the nipple of the mother’s breast into the mouth of the baby, (Ogbonna, 2017). It is

also an integral part of the reproductive process with important implications for the health of

infants and mothers, (Williams, 2016).

Oddy (2016), disclosed that breastfeeding has been accepted as the most viral intervention for

reducing infant mortality and ensuring optimal growth and development of children.

They furtheropined that breastfeeding is beneficial in the prevention of morbidity and mortality

from diarrhea in infants. Vogel (2015), reported that breastfeeding provides advantages with

regards to general health, growth and development. It documents diverse and compelling

advantages for infants, mothers, families and society from breastfeeding.

These advantages include health, nutritional, immunologic, developmental, psychological,

social, economic and environmental benefits.

Exclusive breastfeeding is defined as the practice of giving no other food or drink except breast

milk for the first six months of life to the newborn (Subbiah, 2017).

World Health Organization[W.H.O] (2013), recommends exclusive breastfeeding for the first six

months of life, after which inmfants should receive nutritionally adequate and safe

complementary foods while breastfeeding continues up to two years of age or beyond.

Exclusive breastfeeding means giving infants only breast milk with no addition of other foods or

drinks, including water (World Health Organization and United Nation International Children

Fund, 2013). Exclusive breastfeeding strengthens children’s immunity, ensures child’s health

and survival and reduces their vulnerability to diseases.

(Lawoyin, 2016).

Boating (2018), reported that exclusive breastfeeding is globally recognized to be the most

effective preventive intervention for ensuring child survival and this intervention alone can

reduce child mortality by up to 13% in children under-five years in the developing world. It is

reported that an estimate of not less than 800,000 childrencould be saved every year in

developing countries withjnexclusive breastfeeding (WHO, 2013).

To enable mothers establish and sustain exclusive breastfeeding, World Health Organization

(WHO) and United Nation International Children Fund (UNICEF) recommended initiation of

breastfeeding within the first hour of life and equally launched the baby friendly initiative in

1991 to strengthen maternity practices of breastfeeding (Subbiah, 2017).

Armstrong and Reilly (2016), disclosed that globally, rate is 38%, however the World Health

Assembly ion 2012 set a target to increase the rate of exclusive breastfeeding by at least 50% by

2025.

Studies carried out in Enugu, a city located in Eastern part of Nigeria, revealed the exclusive

breastfeeding rate to be 33.3%, likewise studies carried out in Ibadan, Nigerian revealed that

exclusive breastfeeding rate dropped from 57.4% at one month to 23.4% at six months. Those

reduced rate of exclusive breastfeeding accounts for the increase in infant morbidity and

mortality which result from varying severity of gastroenteritis and malnutrition (Yaguo and

UchenwaOnyenegecha, 2018).
Abdulmaleek&Shehu (2016), disclosed that their study on knowledge, attitude and practice of

exclusive breastfeeding among multi-gravida women attending antenatal clinic in Federal

Medical Center, Umuahia, that 68.4% knew exclusive breastfeeding, 47.2% practiced it and

69.6% of the mothers had positive attitude toward it.

Sola O. (2016), disclosed that that the mother’s knowledge about exclusive breastfeeding

determines their attitude towards it and the attitude of the mother or other people in turn dictate

their practices of exclusive breastfeeding. How much people know about the maintenance and

benefits of exclusive breastfeeding will go a long way in influencing their input and practice to

ensure successful breastfeeding (Ajibjuah, 2017).

Statement of the problem

The researcher in the course of her study observed that most of the children under age of 2years

appeared to be malnourished and present with gastroenteritis. On history taking, it was observed

that most of the mothers didn’t breastfeed their babies exclusively, but settle for breast milk

substitutes (infant formula), which the consequences probably account for their frequent visit to

the hospital as a result of physical and psychological health problems such as diarrhea,

malnutrition, poor growth, weight loss and otitis media.

Despite the health awareness created in health centers and hospitals by health practitioners to

mothers that have prompted baby friendly initiative, some mothers are still not breastfeeding

their babies exclusively. In view of the above, the researcher became curious and interested to
carry out the study to determine the knowledge, attitude and practice of exclusive breastfeeding

amongst mothers in Abia State University Teaching Hospital, Aba.

Objectives of the study.

The aim of this study is to determine the knowledge, attitude and practice of exclusive

breastfeeding among mothers. It specifically seeks to:

1. Access the level of knowledge of exclusive breastfeeding among mothers in Abia State

University Teaching Hospital, Aba.

2. Identify the attitude of mothers on exclusive breastfeeding in Abia State University

Teaching Hospital Aba.

3. Ascertain the level of practice of exclusive breastfeeding among mothers in Abia State

University Teaching Hospital, Aba.

Research Questions.

1. What is the level of knowledge of exclusive breastfeeding among mothers in Abia State

University Teaching Hospital, Aba.

2. What is the attitude of mothers on exclusive breastfeeding in Abia State University

Teaching Hospital, Aba.

3. What is the level of practice of exclusive breastfeeding among mothers in Abia State

University Teaching Hospital, Aba.

Significance of the study

1. It is hoped that at the end of the study the result may help increase the knowledge of

mothers, families and society on benefits and concept of exclusive breastfeeding.

2. The findings of the study may provide clinical data on exclusive breastfeeding and enrich

the existing body of the knowledge.

3. The result of the study may provide more scientific evidence to health care givers in

advocating the practice of breastfeeding and solve breastfeeding problems in special

situations.

4. The result of the study may lead to development of positive attitude among mothers,

families and the society towards exclusive breastfeeding.

5. Findings from this study may be of great benefits to public health as data from this study

may be useful in planning and organizing enlightenment campaigns, seminars and

workshops on exclusive breastfeeding.

6. The result of the study may also be of immense benefit to the researchers as it may serve

as valuable information for further research on the other hand, it will add to existing

literature.

Scope of the study

This study covered the following areas:

 Knowledge

 Attitudes and

 Practice of exclusive breastfeeding

 Antenatal mothers in Abia State University Teaching Hospital, Aba

Operational Definition of Terms.

Knowledge: this means understanding of awareness of a particular fact or situation through

education or experience.

Attitude: This is a way of thinking and feeling about something or a practice.

Practice: This is to do something again and again or regularly in order to gain a benefit.

Breastfeeding: This means putting the nipples of the mother’s breast into the mouth of the baby

to suckle breast milk.

Exclusive breastfeeding: This means the practice of giving no other food or drink except breast

milk for the first six months of life to the newborn.

 CHAPTER TWO

LITERATURE REVIEW

The review of related relevant literature were done under the following sub-headings:

- Conceptual review

- Anatomy and physiology of female breast

- Physiology of lactation

- Composition and variations of breast milk

- Concept of exclusive breast feeding

- Benefits of exclusive breast feeding

- Baby friendly hospital initiative

- Technique and positions used in breastfeeding and its importance

- Theoretical review

- Empirical review

- Summary of literature review

CONCEPTUAL REVIEW

Anatomy and physiology of the female breast

The breasts are accessory glands of the female reproductive system. The female breast is small

and immature until puberty. Therefore, they grow and develop under the influence of oestrogen

and progesterone. They are hemispherical or pear shaped gland supported by and attached tom

the front of the chest wall between the 3 rd and 6th ribs on either side of the sternum by ligaments.

Positioned over the pectoral muscle of the chest wall by fibrous strands called copper’s ligament

(Anne & Wilson, 2018). They disclosed that the breast is a modified sweat gland, which
specialize to secrete milk and the shape of the breast depends largely on the individuals’ races

and also the breast functional state as it enlarges during pregnancy and in the lactating mothers.

Structure of the breast

Waugh and Grant (2018), stated that the mammary glands consists of glandular tissue, fibrous

tissues and fatty tissues. Each breast consists of about 20 lobes of glandular tissue, each lobe

being made up of a number of lobules that radiate around the nipple. The lobules consist of

cluster of alveoli that open into small ducts, and these unite to form excretory ducts, called

lactiferous ducts. The lactiferous ducts converge towards at the center of the breast where they

form reservoirs for milk. Leading from each lactiferous sinus, is a narrow duct called lactiferous

duct that opens on the surface at the nipple. They further disclosed that the external part of the

breast comprises of the soft smooth skin, areola and nipple. The areola is the pigmented area

surrounding the nipple which is about 2.5cm-10cm in diameter and the surface of each areola is

made up of Montgomery’s gland (small,fine lumps and papillae). The gland of Montgomery or

Montgomery’s tubercles secretes oily substances that help to lubricate and protect the nipple

during lactation as the substance is the saliva resisting lubricant. The subcutaneous tissue of the

areola contains circulating and radiating smooth muscle bundles which cause erection of nipple

in response to stimulation.

Anne and Allison (2018), opined that the other component of the external part of the breast is the

nipple, which is a small conical or cylindrical eminence at the center of the breast surrounded by

a pigmented areola and contains erectile tissue which becomes more rigid during menstruation,

sexual excitement, pregnancy and lactation.

Diagram of the breast.
Blood supply and drainage

Arterial supply is by the internal thoracic artery, external mammary artery and anterior

intercostal arteries, axillary arteries and venous drainage is from corresponding veins, while

lymph drainage is mainly in the superficial axillary lymph vessels and nodes.

Innervation of the breasts is by the 4 th, 5th and 6th thoracic nerves which contain sympathetic fiber

(Waugh & Grant, 2018).

Physiology of lactation

Pillary and Davis (2018), opined that lactation is the process by which milk is synthesized and

secreted from the mammary glands of the postpartum female breast in response to an infant

sucking at the nipple. Breast milk provides ideal nutrition and passive immunity for the infant,

encourages mild uterine contractions to return the uterus to its pre-pregnancy size (i.e

involution), and induces a substantial metabolic increase in the mother, consuming the fat

reserves stored during pregnancy.

Karimi et al (2018), disclosed that the mammary gland is composed of milk-transporting

lactiferous ducts which expand and branch extensively during pregnancy in response to

oestrogen, growth hormone, cortisol and prolactin. The pituitary hormone, prolactin is

instrumental in the establishment and maintenance of breast milk supply. It also is important for

the mobilization of maternal micro-nutrients for breast milk.

Pillary and Davis (2018), disclosed that near the fifth week of pregnancy, the level of circulating

prolactin begins to increase, eventually rising to approximately 10-20 times the pre-pregnancy
concentration as the level of prolactinplateus in late pregnancy, at a level high enough to initiate

milk production. However during pregnancy, the combination of oestrogen and progesterone

circulating in the blood appears to inhibit milk secretion by making the mammary gland cells

unresponsive to this pituitary hormone called prolactin. The blockade against prolactin is

removed at the end of pregnancy by the expulsion of the placenta as it leads to decline of the

level of progesterone and hormone production from the ovaries are also reduce. While sufficient

oestrogen remains in circulation to promote the secretion of the prolactin by the pituitary gland

for adequate production of breast milk as lactation commences. They further opined that when

the infant suckle, sensory nerve fibers in the areola trigger a neuroendocrine reflex that results in

the release of oxytocin from the posterior pituitary, which stimulates myoepithelial cells to

squeeze milk into the suckling mouth of the baby on the mother’s nipples. The baby’s continuous

sucking at one breast may cause an increase in milk flow from both, so that milk drip in the un-

suckled nipple. Although prolactin and oxytocin act independently on different cellular

receptors, their combined action is essential for successful lactation as this enhances milk

production or secretion and expulsion respectively (Pillary and Davis, 2018).

Composition and variations of Breast milk

Karimi (2018), disclosed that the composition of the breast milk is dependent on the type or

stage of the human breast milk, as it varies. They opined that the following are types of human

breast milk;

a. Colostrum or early milk: is produced in the late stage of pregnancy till 5 days after

delivery; and is rich in protein and antibodies that provide passive immunity to the baby.
 Colostrum is a thin yellowish fluid, which is the same fluid that leaks out of the breast

during pregnancy after the fifth day, colostrum is replaced by transitional milk.

b. Transitional milk: It occurs after colostrum and lasts for approximately two weeks. The

content of transitional milk includes high levels of fat, lactose and water-soluble

vitamins. It contains more calories than colostrum. Transitional milk changes to mature

milk approximately after 2 weeks.

c. Mature milk: This is the final milk that is produced. 90% of it is water, which is

necessary to keep the infant hydrated. The other 10% is comprised of carbohydrates,

proteins and fats which are necessary for both growth nand energy.

There are two types of mature milk namely; the foremilk and the hind milk.

Foremilk is a type of mature milk found during the beginning of the feeding and contains

water, vitamins and proteins while hind milk is a type of milk that occurs after the initial

release of milk. It contains higher levels of fat and is necessary for weight.

Both fore milk and hind milk are necessary when breastfeeding to ensure the baby is

receiving adequate nutrition to grow and develop properly.

Pilbury and Davis (2018), disclosed that despite the variation in the various stages or types of

human breast milk, that there is an estimated average range for the constituent of human breast

milk as follows;

Macronutrient content: The macronutrient (i.e overall water, fat, protein and carbohydrate)

composition of breast milk is robust even across different populations of women despite

variations in maternal nutritional status. Water makes up about 87.8% of human breast milk and

the average of other macronutrient that constitutes breast milk and the average of other

macronutrient that constitutes breast milk is 1.2 g/dl for protein, 3.6g/dl for fat, 7.4g/dl for
protein and 7.4g/dl for lactose (the main carbohydrate in breast milk). The approximate energy

content of breast milk is 70kcal/dl and is significantly associated with the fat content of breast

milk. The most abundant proteins in breast milk are casein, x-lactatbumin, lactoferrin, secretory

immunoglobin IgA, iysozyme and serum albumin.

Micronutrient content: This consists of vitamins and minerals present in various amounts in the

human breast milk. Vitamin A, D, C, E, B1(thiamine), B2(riboflavin), B12(pantothenic acid),

biotin acid, folic acids with less vitamin K and breast milk is full of some minerals. Some of the

minerals in human breast milk are iron, zinc, calcium, sodium, chloride, magnesium and

selenium.

Bioactive factors:

Breast milk contains various bio-factors (e. g. living cells, antibodies, cytokines, growth factors,

oligosaccharides, hormones). Bioactive factors are elements which have an effect on biological

processes and thus impact bodily functions or conditions and untimely on health. Breast milk

contains various growth factors which have sufficient effect on the developing baby’s gut, blood

vessels, nervous system and endocrine system. Amongst other components of the breast milk are

bifidus factors, and antitypsin factors.

Concept of Exclusive Breastfeeding

Tyndall (2016), defined breast feeding as the feeding of an infant or baby or young child with

breast milk directly from the female human breasts(i.e via lactation) not from a baby bottle or

other container. It is also an integral part of the reproductive process with important implications

for the health of the infants and mothers. Breast feeding is the means by which nutrition is

provided for the healthy development and growth of infants by putting the nipple of the mothers

breast in to the mouth of the baby, (Ogbonna, 2017).

Exclusive breastfeeding could be defined as an act of breastfeeding a baby from 0-6 months of

life with breast milk without any form of food or drink, not even a dummy or pacifier

(Armstrong & Reilly, 2016). Exclusive breastfeeding is the consumption of human milk by an

infant with no supplementation of any type including infant formula, cow’s milk, juice sugar,

water, except for vitamins, minerals and medications (Oche, 2017).

Subbiah 2017, defined exclusive breast feeding as the practice of giving no other food or drink

for the first six months of life to the newborn. Exclusive breastfeeding strengthens children

immunity, ensures child health and survival, and reduces their vulnerability to diseases

(Lawoyin, 2016).

Benefits of Exclusive Breastfeeding

Gartner (2015), opined that exclusive breastfeeding is beneficial to the mother, child and

government in the following ways:

a. Benefits of exclusive breastfeeding to the mother.

 It reduces the hormone oxytocin, which helps uterus to return to its pre-pregnancy size

and may return uterine bleeding after birth, hence, prevents involution and prevention

of postpartum haemorrhage.

 It lowers the risk of breast and ovarian cancer.

 It promotes bonding and reduces the risk of child abuse.

 It provides quick recuperation from child birth and prevents postpartum depression.

 It saves time and money as the mother does not wait in order to buy and measure

formula or pacifier, but naturally feed the baby with her breast.

 It reduces workload for the mother as the mother does not have to sterilize her nipples

or warm bottle and teats, make formula feed, warm the mixture, washout and re-

sterilize the bottle and teat.

 It saves the mother from the physical and psychological stress of nursing a baby who

is ill as exclusive breastfeeding enhances the baby’s protection from several illnesses

 Exclusive breastfeeding also helps the mother not to get pregnant during the process of

lactation, thereby, allowing adequate time for involution to occur.

b. Benefits of exclusive breastfeeding to the child.

 It helps protect a child from developing allergies as secretory IgA (only available

in breast milk) also helps to prevent allergic reactions to a baby’s intestinal tract.

Without this protection, inflammation can develop and the wall of the intestine can

become “leaky”. This allows undigested proteins to cross the gut where they can

cause an allergic reaction and other health problems.

  It may protect a child from becoming obsessed as exclusively breastfed babies

contain more leptin in their system, a hormone that is believed to play a role in the

regulating of appetite and fat, in turn helps to reduce the child’s risk of being

obsessed or overweight.

 It optimizes a child’s physical and mental growth and development as the child

physically grows and develops adequately. The cognitive development of the child

is likely to be optimized as the polyunsaturated fatty acids and lactose found in

breast milk are known to be likened to early brain development yielding possible

increase in intelligent quotient of the child.

 It provides total food security for the child, which means that exclusive of a child

provides enough food to maintain a healthy and productive life which is more

readily available, affordable and nutritious for infants up to six months of age.

Hence, the food security helps to preventr malnutrition and micronutrients

deficiencies.

c. Benefits of exclusive breastfeeding to the government

 Exclusive breastfeeding helps in family planning and as a result reduces over

population problems such as overcrowding.

 It helps to decrease the pollution of air, water and land from the production and

utilization of artificial baby milk and used tins.

 Helps to reduce maternal morbidity and mortality rate, attributed to post-partum

haemorrhage as reduces number of mothers with such risk.

  It decreases child morbidity and mortality rate as the number of children with

cases of malnutrition and other related diseases atre reduced through exclusive

breastfeeding.

Baby Friendly Hospital Initiative

Ndiokwelu (2016), disclosed that baby friendly hospital initiative as an initiative launched in

1991 by WHO and UNICEF to encourage hospitals to promote practices that support

breastfeeding. They came with “some steps to successful breastfeeding”, which form the

foundation of the baby friendly hospital initiative. The baby friendly hospital initiative was

developed to promote support for exclusive breastfeeding, hence, it was pertinent to establish

that facility providing maternity services and care for the newborn infants should adopt the

following:

- There must be a written breastfeeding policy for all health care staff to comply.

- All health care staff should be trained on the skill necessary to implement this policy.

- Inform all pregnant women about the benefits of breastfeeding and its management.

- Breastfeeding should be initiated half to one hour from birth.

- How to maintain lactation even if they are separated from their infants.

- No other food or drink should be given to infants except breast milk.

- Rooming in should be practiced 24 hours per day (should stay together)

- Breastfeeding on demand should be encouraged.

- Do not give any artificial teats or pacifiers to infants on breastfeeding.

- Establish breastfeeding support group and refer mothers to join them after discharge from

the clinic or hospital.

Techniques and positions used in breastfeeding and its importance

Sola (2016), opined that to perform exclusive breastfeeding especially for a first time parent, it

might seem complicated. In order for breastfeeding to be done properly, a breastfeeding mother

has to have knowledge of some techniques such as the following:

- The mother should make sure the surrounding is convenient for her and her baby. Most

mothers prefer a glider or a cozy chair with arm rests.

- She should talk and smile to her baby while breastfeeding to promote bonding and make

sure the baby is happy and free.

- The mother should hold the baby against her breast or be supported with a pillow or she

should sit on a comfortable chair or support her legs with a stool.

- To breast feed, she should start by pressing a little milk into the baby’s mouth. If only the

baby nozzles or removes the mouth from the mouth, stroke the cheek nearest to the nipple

and the baby will turn towards it.

- The baby may or may not be satisfied after sucking from one breast. If he/she is still

hungry or still needs to suck, the other breast should be offered.

- When the baby stops sucking, he or she should be held over the mother’s shoulder and be

placed on the back to enable him/her release any air which may have been swallowed.

This is called belching or flatulence. It is done before laying the baby on the bed to

prevent the baby from throwing up. It is also important to find a comfortable position for

both the baby and the mother. They further disclosed that some positions to consider

include:

The cradle-hold breastfeeding position: this is the first hold many mothers will try,

often soon after their babies are born. To start, cradle your baby’s in the cross of your
arm with baby’s nose opposite your (the mother) nipple. Use that hand to support baby’s

bottom. Turn baby on his or her side so that baby is belly to belly to you. Then raise your

baby to your breast.

The cross-cradle hold or cross over hold: This is similar to cradle position, but the

arms are positioned differently. Instead of the baby’s head in the crook of the arm, the

hand is used in the crook of the arm, using the hand of that arm to support your breast.

Your opposite arm should be put around the back of your baby. Support your baby’s

head, neck and shoulder by placing your baby’s head with the thumb and index finger at

your baby’s ear level. This position allows a more complete control during breastfeeding.

This position is used for newborn.

The side-lying position: this position is comfortable for mothers who have had a

caesarean section because the baby does not put pressure on the mother’s abdomen. It is

also a great way for a mother to get some rest while nursing her baby but she need to

return her baby to the crib or bassinetbeforefalling asleep in order to prevent any

accident.

The clutch or football hold: this is called the under arm or Dutch hold. It is good for

mothers who had a caesarean section and also for mothers with large or small babies.

Mothers with twins who want to feed the babies at the same time may also choose this

position. The football hold allows babies take more milk easily which is also good for

mothers with a forceful milk ejection reflex (or let down).

THEORETICAL REVIEW

The basis of this study was founded on the established self-efficacy theory by Bandura, which

provides a useful framework for researching on the knowledge, attitude and practice of exclusive

breastfeeding amongst mothers. (Bandura 1997)

Self-efficacy theory was used as the foundation for this study and it was originated by Bandura

1997. The concept of self-efficacy is based on the social cognitive theory that an individual

believes that they are capable of making things happen. Self-efficacy was defined as “people’s

benefits about their capabilities to produce effects”. There was further expansion of this concept

by exploring how thoughts, feelings and actions affect the behavior or practice and are vital

factors in achieving goals. In addition to motivation, incentive and perseverance, perception,

consciousness, cognition, learning, memory and emotion all play significant parts in self-efficacy

(Bandura, 1997).

Enactive mastery experiences are those learnt through personal experiences and interplay of

several factors can affect enactive mastery experiences. For example, pre-existing knowledge

and task difficulty is two of these factors. Other factors include the ability of an individual to

assess their own performance before, during and after a task. Thus self-monitoring occurs and

reconstruction of enactive mastery experiences by thoughtful reflection allows the individual to

access their goal attainment. When a mother is breastfeeding, the amount of efforts utilized on

breastfeeding experience, her level of commitment and her knowledge of exclusive

breastfeeding. She also evaluates the difficulty of the task. She then evaluates whether the

outcome is as expected which is a healthy infant.

Vicarious experience is gained through the observation of others undertaking a task, this is also

known as modelling. The knowledge and credibility of the model is a vital factor in the degree of
influence of vicarious experiences and modelling is further supported by verbal persuasion. This

involves the mother envisioning others who had similar characteristics i.e breastfeeding. In

observing them, she gains knowledge about exclusive breastfeeding, thus she is more likely to

engage in exclusive breastfeeding which is a positive attitude that lead to positive outcome.

Verbal and social persuasion is the third source of self-efficacy. Social persuasion generally

manifests as direct encouragement or discouragement from another person. The supportive

verbal persuasion of the partner, parents, friends and verbal support of health professionals can

influence the attitude and practice of exclusive breastfeeding. Exclusive breastfeeding and

practice can be improved by verbal persuasion. Lately, somatic experience is the fourth source of

self-efficacy and is physiological. Situations which are interpreted by the individual as

demanding or stressful can undermine performance or practice and produce the feared outcome.

This is because the perception of stress activates fear, anger, sorrow or a mixture of these

feelings. In breastfeeding, a mother with a history of breastfeeding challenges such as nipple

pain, cracked nipple may develop fear subsequently, which may hinder exclusively breastfeeding

the child by the mother. So, finally on the theory of self-efficacy, it tends to establish the

relationship between knowledge, attitude and practice one exclusive breastfeeding among

mothers as largely elucidates the determination of knowledge, attitude and practice of exclusive

breastfeeding amongst mothers.

Empirical reviews

Cascone (2019), reported after carrying out their study on evaluation of knowledge, attitude and

practice about exclusive breastfeeding among women in Italy, that 71% of the respondents had

good knowledge of exclusive breastfeeding, while 64.6% has positive attitude towards exclusive
breastfeeding but only 33.3% of them had practiced exclusive breastfeeding for at least six

months.

Nassir (2016), disclosed after the study on knowledge, attitude and practice regarding exclusive

breastfeeding among mothers attending Abia State University Teaching Hospital, Aba, as a total

of 600 mothers were included in the study, the result showed that the overall mothers’

breastfeeding knowledge was good among the women, more than half of them (55.3%) and

excellent among 30.7% of them while it was poor among 41% of the mothers. Positive attitude

towards breastfeeding was reported among 62.2% of the participants while negative attitude was

reported among more than one-third of them (37.8%). Amongst the mothers who participated in

the study, (24.7%) breast fed their babies for the first 6months; of this number only 7.3%

practiced exclusive breastfeeding.

Alketbi (2018), opined after their study on knowledge, attitude and practice of breastfeeding

among women visiting Primary Health Care Clinics on the island of Abu Dhabi, United Arab

Emirates, using a self-administered questionnaire in a cross-sectional study, where the

participants were 344 women. About 95% of the participants have better knowledge of exclusive

breastfeeding, while 68% of the participants have positive attitude towards exclusive

breastfeeding and only 38% of the women had a good practice of exclusive breastfeeding.

Gurung et al (2018), disclosed after their study on knowledge, attitude and practice towards

exclusive breastfeeding among mothers in Pokhara-Lekhnath, a cross sectional descriptive study,

in which out of 140 mothers, 69(49.3%) had good knowledge of exclusive breastfeeding and

122(87.1%), have positive attitude towards exclusive breastfeeding while 77(55%) practice of

exclusive breastfeeding was good.Safdar et al(2017), reported after a descriptive cross-sectional

study on the assessment of knowledge, attitude and practice of exclusive breastfeeding among
lactating mothers: a case of Children Hospital of Lahove, Pakistan, that 384 lactating mothers

participated as the study result indicate that 81.3% of lactating others have good knowledge

about exclusive breastfeeding, while 35.9% of lactating mothers have neutral attitude towards

breastfeeding and about 31.8% of them performed the practice of exclusive breastfeeding, hence

they concluded that mothers have good knowledge, neutral attitude and poor exclusive

breastfeeding practices.

Niguse et al (2016), reported after study on knowledge, attitude and practice towards exclusive

breastfeeding among lactating in MizanAman town. South-western Ethiopia: descriptive cross

sectional study that 314 mothers participated in the study, as the result of the study showed that

even though 93.6% of study participants heard about EBF, only 34.7% were knowledgeable

about the recommended duration. About 89.5% had a positive attitude, but only 59.3% believed

that only EBF is enough for children upto six months and 26.4% of children were exclusively

breastfed for six months.

Oche et al (2017), disclosed after study on knowledge and practice of exclusive breastfeeding in

Kware, Sokoto State, Nigeria., that out of 117 mothers, a total of 54(31%) of the mothers had

adequate knowledge of exclusive breastfeeding with 94(53%) of them initiating breastfeeding

immediately after birth. Only 55(31%) of the mothers practiced exclusive breastfeeding. Out of

the 53 mothers that stopped breastfeeding, 85% of them did so between 16-20 months. They also

disclosed that the level of education is a major determinant of the knowledge of exclusive

breastfeeding among mothers, as women with secondary and tertiary education are more

educated on exclusive breastfeeding.

Sola et al (2016), opined following their study on knowledge, attitude and practice of exclusive

breastfeeding among mothers attending an Infant Welfare Clinic in Osogbo, Osun State, Nigeria
that using a cross sectional study design, a total of 328 nursing mothers participated as majority,

about 97.6% of the respondent were aware of exclusive breastfeeding.

Akpor et al (2016), disclosed after the study of knowledge and practice of exclusive

breastfeeding amongst mothers attending Infant Welfare Clinic, Ekiti State University Teaching

Hospital, Ado-Ekiti using a survey descriptive design in which 120 members participated in the

study, majority (63%) of the participants in the study were well aware as they were able to define

exclusive breastfeeding and 66.3% are aware of the benefits of exclusive breastfeeding, as

almost half of the participants, 46.3% breast fed their babies exclusively.

Abdulmaleek and Shehu (2016), reported after a cross sectional descriptive survey study on

knowledge, attitude and practice of exclusive breastfeeding among multigravida women

attending antenatal clinic in Aminu Kano Teaching Hospital, that 360 women participated in the

study as the study showed that 68.4% knew the correct definition and duration exclusive

breastfeeding. 91.2% of the respondents know the benefits of the colostrum to the baby, while

out of 95.2% that know what exclusive breastfeeding is, majority 81.2% have good knowledge

as believed that exclusive breastfeeding has benefits to both the infants and the mothers.

Yaguo and Uchenna-Onyenegeocha (2018), disclosed after a descriptive cross-sectional hospital

based study was carried out on the knowledge and practice of exclusive breastfeeding among

mothers seen at the Port Harcourt Teaching Hospital, that a total of 300 mothers participated in

the study, as 98% of the respondents has heard about exclusive breastfeeding. Knowledge of the

correct meaning of exclusive breastfeeding was 91.3% while awareness of the benefits of

exclusive breastfeeding was 69.3%. 35(11.7%) practiced exclusive breastfeeding for the first six

months. More than half (57.7%) of the respondents initiated breastfeeding within 1 hour of

delivery.
Summary of literature review

The review of various relevant literature as it concerns the study, led to the education of the

anatomy and physiology of the female breast, which is an accessory gland of the female

reproductive system and is involved in the physiology of lactation as it synthesizes and secretes

milk as the baby suckles the nipple. The human milk produced are of different variations and

composition, such variation as colostrum, transitional milk and mature milk, while the

composition of milk are micronutrient, macronutrient bio-factors, bifidus factor and antitrypsin

factor. Breastfeeding was disclosed to be a means by which the nutrition is provided for the

healthy growth and development of the child by sucking milk from the mothers breast and the

child is said to be exclusively breastfed from 0-6 months without any other form of food or

drink. The benefits account for the healthy wellbeing of the mother and the child. Baby friendly

Hospital Initiative was launched by the WHO and UNICEF to encourage hospitals to promote

the practices that support breastfeeding and certain steps essential for successful breastfeeding.

Also the techniques for breastfeeding which enhance convenience and healthy breastfeeding are

essential and positions such as cradle hold breastfeeding position, cross cradle hold, side lying

position and clutch breastfeeding position which allows its indications/. The study was based on

a theoretical framework centered on self-efficacy theory by Bandura. Review of results of

previous research work on the knowledge, attitude and practice of exclusive breastfeeding

among mothers was vast to aid develop a credible literature for the study.

The reviews were done in different parts of the worldand also in different parts of the country,

but there is no researchAbia State University Teaching Hospital, Aba, and that is the gap that this

research will fill.

 CHAPTER 3

METHODOLOGY

This chapter explained the methods that was used for this study under the following headings;

 Research design

 Setting

 Population of the study

 Sample and sampling technique

 Instrument for data collection

 Validity of the instrument

 Reliability of the instrument

 Method of data collection

 Method of data analysis

 Ethical considerations

Research design

The design used for this study is a descriptive survey design. A descriptive survey design is that

method in which the researcher collects data using an instrument such as questionnaire,

administers it on a sample drawn from a given population

The design was suitable as it was used in gathering information and assessing the knowledge,

attitude and practice of Exclusive Breastfeeding amongst mothers in Abia State University

Teaching Hospital, Aba.

Setting

The setting for the study of was Abia State University Teaching Hospital, located at Umueze

Road Abayi, Aba, Abia State. It is a Government owned Teaching Hospital in Aba South Local

Government Area of Abia State, Nigeria. It is in Aba South Senatorial District. It is located also

to a mini market known as “Ahia-Nkwo”.

Aba has a land mass of about 20km2.

Generally, the area lies within the tropical rain forests with a large mangrove swamp dotted

island along the coast of Nigeria. There are many private and public primary and secondary

schools, Churches, private clinics and this government health facility that is been used for the

study.

Population for the study

The population that was studied is mothers who come for health services liked immunization,

antenatal care, family planning, maternity and other services at Abia State University Teaching

Hospital, Aba. The weekly average attendance of mothers to Abia State University Teaching

Hospital, Aba is estimated to be 275 mothers, hence the target population of mothers for the

study in Abia State University Teaching Hospital, Aba. (Clinic Register, 2019-2020)

Sample and sampling technique

The sample size was 110 mothers, which is 40% of the population. This percentage method is in

line with the submission of Nwanna (2006), as cited in Elechi (2012), showing that in a sample
of a few hundreds, 40% of the population is a representative of the study population. (see

appendix)

The sampling technique adopted was a simple random sampling by balloting without

replacement, using 110 pieces of folded papers, written “YES” were chosen for the study. This

method was used because it gives every one of the target population an equal chance of being

selected as part of the study sample.

Instrument for data collection

A structural questionnaire was the instrument used for data collection. The questionnaire consists

of four sections: section A, B, C and D. the questionnaire contains a total number of 20 items for

the four sections respectively. Section A contains the demographic data and Section B comprised

of questions on knowledge, Section C comprised of questions on Attitude and Section D

comprised of questions on Practice, constructed completely from the research questions to assess

the knowledge, attitude and practice of exclusive breastfeeding among mothers in Abia State

University Teaching Hospital, Aba. Nominal scale of TRUE/FALSE was the scale used to

measure the knowledge and practice of exclusive breastfeeding among mothers in Section B and

D of the questionnaire, while Likert Scale of four(4) points, which include: Strongly Agree (SA),

Agree(A), Disagree(D), and Strongly Disagree(SD), was used to measure the attitude of mothers

on exclusive breastfeeding. In section C, the Likert scale used were allocated scores as follows:

SA(4), A(3), D(2), SD(1) as maximum score of 20 and minimum score is 5 for each item on

section C.

Validity of the instrument

The researcher secured validity of the instrument used for the instrument by formulating and

submitting the constructed questions to her project supervisor and other research based lecturers

for scrutinizing, edification, and corrections to ascertain that the questionnaire suites the level of

the respondents and in line with research questions as its content covers the scope of the study

avoiding ambiguity. The supervisor and other research based lecturers effected some corrections

and these were reflected into the final copy of the questionnaire, hence, the face and content

validity of the instrument was ensured before the instrument was distributed.

Reliability of the instrument.

Pilot study was carried out in testing the reliability of the instrument used on the 10% of the

sample size(11). The test retest method was used as the researcher pre-tested the instrument by

administering 11 copies of the questionnaire to mothers in Federal Medical Center, Umuahia,

with the same feature of the target population and after two weeks another 11 copies were

distributed to the same people which was not part of the study population, thereby re-testing

them and reliability index of the instrument as calculated using Pearson Moment Correlation

Coefficient was 0.81. (See appendix)

Method of data collection

Due permission was obtained from the Chief Nursing Officer in charge of Abia State University

Teaching Hospital, Aba, before initiating the study. The purpose of the study was explained and

informed consent from the selected mothers was obtained to enhance participation in the study.

A self-administered questionnaire was given to obtain their responses in the health facility.
The total of 110 questionnaires was distributed to 110 respondent(s) over three(3) alternative

days respectively. The researcher retrieved 110 copies (100%) of questionnaire after several

hours tom give the mothers (respondents) enough time to fill the questionnaire in the health

facility. Hence, on the three(3) alternative days of the week, the entire questionnaires were

retrieved completely by the researcher.

Method of data analysis

Data collected using the questionnaire was analyzed usingdescriptive statistics of percentage(s)

and mean(s). the mean score criterion is 12.5 so if the sum of the total number of respective

items is below 10, it signifies negative attitude and if equal to or above 12.5, it signifies positive

attitude of mothers on exclusive breastfeeding. Data statistics were presented using Pie chart, Bar

charts and frequency tables to compare variables where necessary.

Ethical consideration.

The researcher observed the code that governs research by collecting and submitting a letter of

introduction from the school to Abia State University Teaching Hospital, Aba Nursing Chief,

seeking permission to carry out the study and verbal approval was obtained. The purpose of the

study was explained to the respondent(s) and consent was given as their right towards the study

was explained. The researcher ensured confidentiality of information and maintained anonymity

of the respondent(s).
 CHAPTER 5

PRESENTATIN AND ANALYSIS OF DATA

This chapter discussed the major finding of

Presentation of data analysis

Discussion of findings

Presentation of Data (or results)

Fig 4.1: A Bar Chart showing the age distribution of the respondents

The above bar chart (Fig 4.1) on item 1 shows the age distribution of respondents, that 12(10%)

of the respondents were aged <20 years, but 48(43.6%) respondents with the age range of 21-30

years and 46(41.9%) of the respondents were aged between 31-40 years, which accounts for the

majority. The respondents between ages of 41 and above are the least in number 4(3.6%).
Fig 4.2 A Pie Chart showing the marital status distribution of the respondents

The Pie chart above (Fig 4.2) on item 2 clearly shows the marital distribution of the respondents,

as 21(19.1%) of the respondents are single, but 79(71.8%) of the respondents which accounts for

the majority are of the respondents married and 7(6.4%) of the respondents were divorced and

are the least and 3(2.7%) of the respondents are widows and are the second least in number in the

marital status distribution.

Fig 4.3 A Bar Chart showing the occupational distribution of the respondents.

The above bar chart (Fig 4.3) on item 3 explicitly shows details of the distribution of the

respondents’ occupation, in which 41(37.2%) of the respondents account for the highest, who are

traders, but 6(5.6%) of the respondents are farmers, which account for the least in the

occupational distribution and 20(18.2%) of the respondents are housewives, while 28(25.5%)

were civil servants, accounting for the second largest and 15(13.5%) of the respondents were

students.
Fig 4.4 A Bar Chart showing the levels of educational distribution of the respondents.

The bar chart (Fig 4.4) on item 4 above, shows the levels of education of the respondents as

8(7.2%) had primary, which accounts for the least in the table, while 49(44.5%) had secondary, it

accounts for the majority of the respondents and 35(31.8%) had graduate/tertiary as their highest

level if education, which accounts for the second largest in the educational level distribution and

respondents of post graduate status, made up of 18(16.5%), accounting for the second least

number of respondents in the level of education distribution.

Fig 4.5 A Pie Chart showing the respondents number of children distribution

The pie chart (Fig 4.5) on item 5 above, also shows respondents’ number of children distribution,

as 32(29.1%) had less than two children or only two (2) children, which accounts for the second

largest in the distribution, while 61(55.4%) had the range of three(3) to five(5) children, it also

accounts for the largest in the distribution and 17(15.5%) had only six(6) children or more than

six(6) children.
Table 4.1.1 Knowledge of Exclusive Breast Feeding Among Mothers

Item 6 on table 4.1.1 shows that out of 110(100%) that participated in the study, majority of the

respondents which is 88(80%) responded “True” that exclusive breastfeeding is feeding your
baby only with ONLY breast milk without any other food or water until 6 months, but 22(20%)

responded “False” to the statement.

Item 7 on the table above shows that, 67(61%) responded “True”, that the first milk or colostrum

is good for your baby, while 44(39%) responded “False” to the fact that the breast milk or

colostrum is good for your baby.

Item 8 shows that, majority of the respondents which is 72(65%) responded “True” that

exclusive breastfeeding for 6 months prevents children from the risk of diarrhea, while 38(35%)

responded “False” to the statement.

Item 10m shows that, 82(75%), which is majority responded “True”, that breastfeeding should

start immediately or before 30 minutes after birth or delivery, while 28(25%) responded “False”

to the fact that breastfeeding should start immediately or before 30 minutes after birth or

delivery.

Finally, table 4.1.1 shows that from the total responses on the knowledge of exclusive

breastfeeding among mothers, 373 responses were affirmative and 177 responses were negative

with an average of 75 representing (68%) who responded true knowledge and 35 representing

(32%) who responded false knowledge respectively. It shows that 75(68%) of mothers responded

true to items on knowledge of exclusive breastfeeding while 35(32%) responded false to the

items.
Table 4.1.2 Attitude of Mothers on Exclusive Breastfeeding.

Item 11n on table 4.1.2 above shows that, from the 110 total respondents that participated in the

study, about 21 of the respondents with score of 21 strongly disagreed that they believe that

breastfeeding their baby until 6 months is easier than artificial feeding, 17 responded with score

of 34 also disagreed, but 34 respondents with score of 102 agreed that breastfeeding their babies
until 6 months is easier than artificial feeding and 38 respondents with score of 152 strongly

agreed with the statement as the total score for item 11 was 309 and mean score is 2.81.

Item 12 on table 4.1.2 above shows that, about 15 respondents with score of 15 strongly

disagreed that they prefer breastfeeding their baby on demand and NOT when they want to 9

respondents with a score of 18 also disagreed, but 24 respondents with the score of 72 agreed to

the item: and majority of the respondent 62 with score of 248 strongly agreed with the statement

as the total score for item 12 was 363 and mean score is 3.21.

Item 13 on table 4.1.2 above shows that, about 13 respondents with score of 13 strongly

disagreed that the feel breast milk alone is sufficient for the baby during the first six months of

life, 10 respondents with score of 20 also disagreed but majority of the population, 47

respondents with score of 141 agreed that they feel breast milk alone is sufficient for the baby

during the first 6 months of life and 40 respondents with score of 160 strongly agreed with the

statement as the total score for item 13 was 334 and mean score is 3.02.

Item 14 on table 4.1.2 above shows that, 19 respondents with score of 19 strongly disagreed that

they think child less than 6 months who is exclusively breast fed is healthier than a child of same

age who takes additional food. 15 respondents with score of 30 also disagreed, but majority of

the population, 40 with score of 120 agreed that they think a child less than 6 months who is

exclusively breast fed is healthier than a child of the same age who takes additional food, and 36

respondents with score of 144 strongly agreed with the statement as the total score for item 14

was 313 and mean score for the item is 2.85.

Item 15 on table 4.1.2 above shows that, respondents with score of 4 strongly disagreed that they

preferred to breast feed their babies until 6 months as its increases the bond between them and
their babies, 9 respondents with 18 also disagreed, but 41 respondents with score of 123 agreed

that they preferred to breast feed their babies until 6 months as it increases the bond between

them and their babies while majority of the population 56 with score of 224 strongly agree with

the statement given the total score for item 15 as 369 and mean score for the item is 3.35

Finally, the sum of the mean scores of items 11 and 15 is 15.24 and the mean score is 12.5.

Table 4.1.3 Practice of Exclusive Breastfeeding among Mothers.

Item 16 on table 4.1.3 above shows that from the total of 110(100%) respondents who practiced

in the study, 42(38%) responded “True” that they breastfeed their babies without any food or
water for until 6 months while majority of respondents 68(62%) responded “False” to this

statement.

Item 17 on table 4.1.3 above shows that majority of the respondents 75(68%) responded “True”

that they often breastfeed their children exclusively until they are satisfied, while 35(32%)

responded “False” to the fact that they often breastfeed their children exclusively until they are

satisfied.

Item 18 on the table 4.1.3 above shows that, majority of the respondents 72(65%) responded

“True” that they usually commence breast feeding immediately after delivery while 38(35%)

responded “False” to the fact they usually consider breastfeeding immediately after delivery.

Item 19 on table 4.1.3 above shows that, majority of the respondents 62(56%) responded “True”

that they breastfeed their own children on demand regularly until 6 months. While 48(44%)

responded “False” to the statement.

Item 20 in table 4.1.3 above shows that, 42(38%) respond “True” that they started giving their

children complementary food after 6 months to avoid diarrhea while majority of the respondents

68(62%) responded “False” to the fact that they started giving their children complementary food

after 6 months to avoid diarrhea.

Finally, table 4.1.3 shows that on the total, responses on the practice of exclusive breastfeeding

among mothers were 293 for “True”(Good) and 2.57 for “False” (poor) respectively. The

analysis of the average response shows that 59(53%) of mothers responded “True” and 51(47%)

respond “False” on the items of the practice of exclusive breastfeeding.

CHAPTER 5

DISCUSSION OF FINDINGS

This chapter discussed the major findings of the research work which was done under the

following:

Discussion of findings, limitation of the study, implication of study, summary,

conclusion,recommendation and suggestions for the study.

Discussion of findings
The discussion of findings of the study on knowledge, attitude and practice of breastfeeding

amongst mothers in Abia State University Teaching Hospital, Aba was organized in relation to

the research questions presented in the study.

Limitations of the study

a. Paucity of information: The researcher did not find enough available literatures on

previous studied conducted on the topic in Abia State University Teaching Hospital, Aba.

b. Inadequacy of sample: The sample size obtained for the study was not enough to infer

and generalize the findings to represent a larger population.

Research Question 1

Level of knowledge of exclusive breast feeding amongst mothers in Abia StateUniversity

Teaching Hospital, Aba

Table 4.1.1 shows the findings on the research question, which is that majority, 75(68%) of

mothers have good knowledge of exclusive breast feeding. This finding is in line with the result

of the study carried out on evaluation of knowledge, attitude and practice of exclusive breast

feeding in Italy; which disclosed that out of 450 women who participated in the study, majority

of them, about 71% of the participants had good knowledge of exclusive breast feeding,

(Cascone et al, 2019). However, thus finding on the study on the knowledge of exclusive

breastfeeding in Abia State University Teaching Hospital, Aba; is not in line with the findings

reported in a survey on knowledge, attitude and practice of exclusive breast feeding in Abia

State, Nigeria, which show that out of 250 mothers who practiced in the study, that majority,
62% had poor knowledge of exclusive breastfeeding, (Tyndall et al, 2016). Another key finding

from Fig 4.4, about the educational level in correlation to the good level of knowledge of

exclusive breast feeding exhibited by mothers in health care, Abia State University Teaching

Hospital, Aba, is the fact that majority of the respondents, 49(44.5%) had secondary level

education and 35(31.8%) were graduates. It can be deducted from the above that educational

level may have contributed to the good knowledge of exclusive breastfeeding amongst mothers.

This positive effect of educational level collaborates the findings obtained from the study on

knowledge and practice of EBF in Kwara, Sokoto State, which disclosed that the level of

education is a major determinant of the knowledge of EBF among mothers, as women with

secondary and tertiary education are more likely to be educated on EBE, (Oche et al, 2017).

Majority of the respondents 67(61%) according to Table 4.1.1 have good knowledge of the

benefits of first milk of colostrum to a baby, this is in conformity with the result of a study on

knowledge, attitude and practice of exclusive breastfeeding among multigravi women attending

antenatal clinic in Aminu Kano Teaching Hospital, which reported a finding that out if 250

women who practiced the study, majority (91.2%) of the respondents know the benefits of

colostrum to the baby. (Abdulmaleek and Shehu, 2016).

Research Question 2

Attitude of mothers on exclusive breastfeeding in health center, Abia StateUniversity

Teaching Hospital, Aba.

Table 4.1.2 shows that mothers have positive attitude on exclusive breastfeeding, this is in

conformity with the result of the study in evaluation of knowledge, attitude and practice of
exclusive breastfeeding among women in Italy that showed 71% of women studied, have

positive attitude towards exclusive breastfeeding (Cascone et al, 2019). Another finding from a

study that was carried out in primary health care center in Aba City, among 600 mothers is in

accordance with these finding as it was reported that 62% of the participants had [positive

attitude towards breastfeeding practice (Nassir, 2016).

Another key finding is that from Table 4.1.2, 87 mothers believed breast milk alone is sufficient

foe the baby during the first 6 months of life, which is in line with the result reported after a

study on knowledge, attitude and practice towards exclusive breastfeeding among lactating

mothers in MizanAmam town, South Western Ethiopia; where 314 mothers practice in the study,

out of which 89.5% of the lactating mothers had positive attitude to exclusive breastfeeding, only

59.3% believed that only breastfeeding with breast milk is enough for a child until 6 month

(Niguse et al, 2016). However, the finding of the study that 83(75.6%) of mothers had positive

attitude on exclusive breastfeeding in health center Abia State University Teaching Hospital,

Aba, is contrary to the result of the study that showed that majority, 84% have negative attitude

towards exclusive breastfeeding after carrying out their study on knowledge, attitude and

practice of exclusive breastfeeding in Adamawa, Nigeria involving 250 mothers (Tyndall et al,

2016).

Research Question 3

Level of practice of exclusive breastfeeding in health center, Abia StateUniversity Teaching

Hospital, Aba.
Table 4.1.3 shows that 59(53%0 of the mothers which signified majority of the 110 respondents

that participated in the study had good level of practice of Exclusive breastfeeding. This result is

similar to the finding reported on the study on knowledge, attitude and practice of EBF among

mothers in Pokhara-Lekhnath. In which out of 140 mothers, 77(55%) practice of EBF was good

(Gurung et al, 2018). The result of another study which was close to the finding of these study

showed that 328 mothers attending an infant welfare clinic in Oshobno, Osun State, Nigeria who

participated in the study, 242 (73.8%) of the respondents practiced EBF which accounts for

majority (Sola et al, 2016). The result of the study is shown in Table 4.1.3 revealed that 42(38%)

of the mothers exclusively breastfed their babies without any food or water until 6 months with

finding on the study of knowledge, attitude and practice of exclusive breastfeeding among

multigravida women attending antenatal clinic in AminuKanu Teaching Hospital, in which

women participated and it was reported that 47.2% exclusively breast fed their babies for the first

6 months of life (Abdulmaleek and Shehu, 2016).Another study findings, confirmed these result

as they reported after the studied on knowledge and practice of EBF in Kwara, Sokoto State,

Nigeria, that out of 177 mothers that participated in the study only 53(30%) of mothers breastfed

their babies until 6 months of life, (Oche et al, 2017). The result of study from 4.1.3 shows that

majority 62(56%) of mothers fed their babies on demand regularly until 6 months which is close

to the finding of the study of the knowledge and attitude and practice of EBF attending an infant

welfare clinic in Oshobo, Osun, Nigeria, which reported that 328 nursing mothers, about 75.6%

of the respondents practiced EBF on demand by the child, (Sola et al,2016). Another finding in

the study from Table 4.1.3, shows that 72(65%) of the respondents usually commence

breastfeeding immediately after delivery until 6 months, this is dissimilar to the result of the

study of knowledge and practice of EBF among mothers seen at Port Harcourt Teaching
Hospital, in which a total of 300 mothers practiced and it was reported that a little above half

(57.7%) of the respondents initiated breastfeeding within 1 hour of delivery (Yaguo and

Uchenna-Onyenegecha, 2018).

This chapter presents the summary, conclusion, recommendation and suggestions for further

studies. The subheads in this chapter are:

Summary

This is a descriptive study aimed at determining the knowledge, attitude and practice of

exclusive breastfeeding in health center, Abia State University Teaching Hospital, Aba. The

study has become necessary as most of the children under age of 2 years over time appeared to

be malnourished and present mainly with gastroenteritis which mighty be related to the child not

being exclusively breast fed by the mother.

A structured questionnaire was the instrument for data collection: the instrument was validated

and proven to be reliable. The questionnaires were distributed to the 110 respondents with a

100% retrieval rate. Data was analyzed using tables, bar and pie charts and criterion mean.

Conclusion

Exclusive breastfeeding supplies children with quality nutrients that aid minimize disease,

increase growth and development. It is noted to be an essential feeding practice that also helps in

child survival. There is a good knowledge of exclusive breastfeeding among mothers in the study

area.

Conclusively, even though exclusive breastfeeding has found universal acceptability and practice

in the study area as evidenced by good knowledge, positive attitude and good level of practice, it
is worthy to note that consistent and revalidated health education on EBF will aid to further

promote mothers health habit, child health and survival, thereby preventing any possibility of

poor knowledge of EBF, negative attitude or poor level of practice among mothers in health

center, Abia State University Teaching Hospital, Aba.

Recommendations

The following recommendations are being put forward:

1. Government and private health care organizations should have a written exclusive

breastfeeding policy that will be communicated to all health care staff to enable them

implement it.

2. Government and private healthcare organizations should endeavor to consistently train

health staff on EBF in order to update their knowledge.

3. Government and private healthcare organizations should ensure that all healthcare

personnel should be involved directly or indirectly in child birth and helping mothers to

initiate breastfeeding immediately after delivery.

4. Government should develop and implement policy that would promote girl child

education.

5. The National Primary Health Care Development Agency(NPHCDA), in collaboration

with the ministry of health and ministry of information to promote EBF using the media

to promote some advert thereby improving knowledge, attitude and practice of exclusive

breastfeeding.

Implications of the study to Nursing.

The findings of this study largely imply that public health activities and awareness as it relates to

the knowledge, attitude and practice of exclusive breastfeeding among mothers in Abia State

University Teaching Hospital, Aba has improved overtime. However, the Nurses are left with

enormous roles and responsibilities to maintain and further implement measures that would

ensure optimal level of knowledge, attitude and practice of exclusive breastfeeding among

mothers.

Nurses are very influential regarding exclusive breastfeeding success rate in relation to the

impaction rate of knowledge, attitude and practice of exclusive breastfeeding and such poses

great responsibility on the midwives to be armed with correct, detailed and recent information

about exclusive breastfeeding thereby fostering adequate dissemination of vital and accurate

health information to the populace especially the mothers.

Finally, Nurses should imbibe the habit and skills to frequently encourage mothers to always

remember the useful of exclusive breastfeeding.

Suggestions for further study.

In view of the limitations of the study, a research of the same should be carried out putting into

consideration the sample size and sort of instrument used to collect data.
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APPENDIX I
 Abia State Unversity,

Uturu,

Department of Nursing Sciences,

Abia State,

Nigeria,

16th October, 2022.

Dear respondent,

I am a student of the above school carrying out a research on Knowledge, Attitude and Practice

of Exclusive Breastfeeding among Mothers in Abia State University Teaching Hospital, Aba,

Abia State.

I therefore request for your cooperation in fulfilling the necessary information needed by this

questionnaire which is for academic purpose. Please note that your name is not required as all

information will be treated with utmost confidentiality.

Yours faithfully,

ONYENRO MARYLIN AMARACHI

Researcher
 APPENDIX II

QUESTIONNAIRE

Abia State Unversity,

Uturu,

Department of Nursing Sciences,

Abia State,

Nigeria,

16th October, 2022.

Dear respondent,

I am a student of the above School, carrying out a research study on “Knowledge, Attitude and

Practice of Exclusive Breastfeeding amongst mothers in Abia State University Teaching

Hospital, Aba, Abia State”.

I therefore request your cooperation in filling the necessary information needed by this

questionnaire which is for academic purpose. Please note that your name is not required as all

information will be treated with utmost confidentiality.

Yours faithfully,

ONYENRO MARYLIN AMARACHI

Researcher

Please tick the option that you feel suits your response in Section A, B, C and D.

SECTION A

Demographic data

1. Indicate your age group

a. < 20years ()

b. 21 – 30years ()

c. 31 – 40years ()

d. 41years & above ()

2. Indicate your marital status

a. Single ()

b. Married ()

c. Divorced ()

d. Widowed ()
 3. What is your occupation?

a. Trading/Business ()

b. Housewife ()

c. Civil servant ()

d. Student ()

4. What is your highest educational qualification?

a. Primary ()

b. Secondary ()

c. Tertiary/Graduate ()

d. Postgraduate ()

5. Indicate the number of children you have

a. < 2 children

b. 3-5 children

SECTION B

Knowledge of Exclusive Breastfeeding among Mothers.

6. Exclusive breastfeeding is feeding your baby with ONLY breast milk without any other

food or water until 6 months.

True ( ) False ( )

7. The first breast milk or colostrum is good for your baby.

True ( ) False ( )
8. Exclusive breast feeding for 6 months prevents children from risk of diarrhea.

True ( ) False ( )

9. Exclusive breast feeding is beneficial ion spacing birth

True ( ) False ( )

10. Breastfeeding should start immediately or before 30minutes after birth or delivery

True ( ) False ( )
 SECTION C

Attitude of mothers on exclusive breastfeeding.

11. I believe that breastfeeding my baby until 6 months is easier than artificial feeding.

Strongly agree ( ) Agree ( ) Disagree ( ) Strongly disagree ( )

12. I prefer breastfeeding my baby on demand and NOT when I want to until 6 months.

Strongly agree ( ) Agree ( ) Disagree ( ) Strongly disagree ( )

13. I feel breast milk alone is sufficient for the baby during the first 6 months of life.

Strongly agree ( ) Agree ( ) Disagree ( ) Strongly disagree ( )

14. I think a child less than 6 months who is exclusively breast fed is healthier than a child of

the same age who takes artificial food.

Strongly agree ( ) Agree ( ) Disagree ( ) Strongly disagree ( )

15. I prefer to breast feed my baby until 6 months as it increases the bond between I and my

baby.

Strongly agree ( ) Agree ( ) Disagree ( ) Strongly disagree ( )

SECTION D

Practice of exclusive breastfeeding among mothers.

16. I breast feed my baby without any other food or water until 6 months.

True ( ) False ( )

17. I often breast feed my child exclusively until he/she is satisfied.

True ( ) False ( )

18. I usually commence breastfeeding immediately after delivery until 6 months.

 True ( ) False ( )

19. I breast feed my child on demand regularly until 6 months.

True ( ) False ( )

20. I only started giving my child complementary food after 6 months to avoid diarrhea.

True ( ) False ( )

APPENDIX III

CALCULATION OF RELIABILITY INDEX USING THE PEARSON PRODUCT

MONENT

CORRELATION.
r= N∑xy - (∑x) (∑y)

√[N∑x2- (∑x)2] [N∑y2 - (∑y)2]

Where:

r = Pearson product moment correlation.

N = Number of pairs of scores.

∑xy = Sum of products of paired scores,

∑x = Sum of x scores.

∑y = Sum of y scores.

∑x2 = Sum of squared x scores.

∑y2 = Sum of squared y scores.

SN(Respondents) X y X2 Y2 Xy

1 51 49 2601 2401 2499

2 58 60 3364 3600 3480

3 54 52 2916 2704 2808

4 58 62 3364 3844 3596

5 49 53 2401 2809 2597

6 34 38 1156 1444 1297

7 52 58 2916 3364 3016

8 61 61 3721 3721 3721

9 60 61 3600 3721 3660

10 44 42 1936 1764 1848

11 62 58 3844 3364 3596

TOTAL N = 11 583 594 31819 32736 32113

r= 11 x 32113 - (583) (594)

√[11 x 31819 - (583)2] [11 x 32736 – (594)2

r= 353243 - 346302

√[350009 – 339889][11 x 360096 – 352836]

r= 6941 = 6941 = 6941 =

√[10120][7260] √73471200 8571.534

r = 0.8097 ≈ 0.81, therefore reliability index

= 0.81.
 APPENDIX IV

CALCULATION OF CRITERION MEAN AND MEAN SCORE OF ITEM 11- ITEM 15.

Likert scale of four (4) points was used for the above items in the study. Likert scale was

allocated scores as follows: Strongly agree (4), Agree (3), Disagree (2), Strongly disagree (1).

 CALCULATION CRITERION MEAN SCORE

Criterion mean score = Sum of scores allocated = 4+3+2+1 = 10

Then 10 divided by the number of point scale used, Likert 4 point scale, therefore 10/4 = 2.5

Then multiplied by the number of items comprising the 2nd research question

= 2.5 x 5 = 12.5

Criterion mean score is 12.5

If the sum of the mean score(s) of the respective items is 12.5 and above, then the research is

answered in affirmative, while if the sum of the mean score(s) of the respective items is less than

12.5, then the research is negative.

 CALCULATION FOR THE MEAN SCORE OF ITEM 11 – ITEM 15

The mean score on each item as obtain from the frequency (response) of the respondents

therefore represented thus:

∑ fx
Mean Score =
∑f

Where: ∑ = Summation
 f = Frequency

x = Score

1. Mean score of item 11 (from table 4.1.7)

38 x 4 +34 x 3+ 17 x 2+21 x 1
38+34 +17+21

152+102+34 +21
110

309
Mean score = = 2.81
110

2. Mean score of item 12 (from table 4.1.8)

 62 x 4+ 24 x 3+ 9 x 2+15 x 1
¿
62+24 +9+15

248+72+ 18+15
¿
110

353
Mean score = = 3.02
110

3. Mean score of item 13 (from table 4.1.9)

40 x 4+ 47 x 3+10 x 2+13 x 1
¿
40+47+10+ 13

334
Mean score = = 3.02
110

4. Mean score of item 14 (from table 4.1.10)

36 x 4 +40 x 3+ 15 x 2+19 x 1
¿
36+ 40+15+19

144+120+30+19
¿
110

313
mean score= =2. 85
110
 5. Mean score of item 15 (from table 4.1.11)

56 x 4 +41 x 3+ 9 x 2+4 x 1
56+ 41+9+ 4

224+123+18+ 4
110

369
mean score= =3 .35
110

Therefore from the above mean scores;

Total mean score = 2.81 + 3.21 + 3.02 + 2.85 + 3.85

Total mean score = 15.24

SAMPLE SIZE DETERMINATION CALCULATION

To determine the sample size, since the population (275) is a few hundreds, 40% of the

population is the sample.

40 275
40% of 275 mothers = x
100 1

40 275
x = 2.75
100 1

Hence, 40 x 2.75 = 110

Therefore, sample size is 110