TITLE: INVESTIGATING FACTORS THAT PREVENT EXCLUSIVE BREAST

FEEDING AMONG POSTNATAL MOTHERS IN ELDORET TOWN.

INSTITUTION :AFRICAN INSTITUTE RESEARCH AND DEVELOPMENT STUDIES.

PRESENTER : ATHEMBO AUSTINE OGEMBO.

INDEX NO : 5341040032.

COURSE NAME :DIPLOMA IN DIETETIC MANAGEMENT.

COURSE CODE : 2426.

SUPERVISOR :MR EDWIN KIPYEGO

SUBMITTED TO :FULFILLMENT FOR THE AWARD OF PARTIAL INDIPLOMA IN

DIETETIC MANAGEMENT

PRESENTED TO:KENYA NATIONAL EXAMINATION COUNCIL

SERIES:JULY 2020

1
DECLARATION.
This is my original work and has not been presented for a degree or any other award in any other
learning institution.
Student.
Name: AUSTINEOGEMBO
Index number:5341040032
Signature: …………………………

Supervisor.
Name: EDWINKIPYEGO
Signature: ……………………….

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DEDICATION
This work is dedicated to my loving and caring mother, MAGRETOGEMBO and
STANFORD‘You kept nudging me onwards on this road of study and always encouraged me in
tough times. You believed, prayed and had faith that I could make it’

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ACKNOWLEDGMENT.
My sincere gratitude goes to my supervisor: MREDWINKIPYEGO for her valuable time, patience
and constant guidance throughout the study period. Her contribution in developing research ideas,
encouragement, in depth discussions of the subject and mentorship is also gratefully
acknowledged. I would also like to thank staff members of African Institute Research And
Development Studies for their support. Last but not least, I shall remain eternally grateful to my
parents, siblings, relatives and friends for their support during the entire period of writing this
proposal.

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ABSTRACT
Giving infants only breast milk without any liquid or solid note ven water with exception of oral
rehydration solution or drops of syrup vitamins, minerals or medicine is the World Health
Organization (WHO) recommended way of feeding infants of age zero to six months. There is a
lot that has been done on EBF but there still remain slack of information in area as related to the
application of EBF recommendations in various regions. Various studies reveal low incidences of
EBF which implies non compliance to recommendations among mothers.

This study is designed to investigate factors that prevent EBF among mothers in Eldoret town.
This study will be carried out in Moi Teaching and Referral Hospital in Eldoret, UasinGishu
County.

The objectives are to find out the knowledge of post-natal mothers on the importance of EBF, find
out the possible medical conditions that may hinder EBF and finally to find out why post-natal
mothers prefer formulas to breast milk.

The study will involve the administration of questionnaire which will be used as a tool for data
collection. The target population for this study are mothers with infants of age between zero to six
months and the sample size determination will be gotten using the Fisher formula. The eligible
respondents for this study will be seventy seven who will be willing to participate and will be
achieved using the probability sampling technique. The data collected will be coded, entered and
analyzed using a statistical package for social sciences (SPSS) which function on a window
operating system.

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ABRREVIATIONS AND ACRONYMS
ARV – Antiretroviral

BF – Breastfeeding

CDC – Center of Disease control

CDCP – Center of Disease Control and Prevention

EBF – Exclusive Breastfeeding

GIT – Gastrointestinal tract

HIV – Human Immuno –virus

HSV – Herpes Simple Virus

ICF – Infant Child Feeding

IFPs – Infant Feeding Practices

IPF – Infant Powdered Formula

IQ – Intelligent Quotient

KNBS – Kenya National Bureau of Statistics

MDG - Millennium Development Goals

NHA – National Health Agency

SPPS - Statistical Package for Social Sciences

WBC – White Blood Cell

WHO – World Health Organization

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DEFINATION OF TERMS

Breast feeding: Feeding the infant and young child on breast milk

Exclusive breastfeeding: Is giving only breast milk to infant allowing oral rehydration salts
(ORS), drops, syrups, (vitamins, minerals, medicines) and nothing else usually done to an infant
from 0 to six months old.

Feeding practice: Is the performance of the mother pertaining to giving an infant and young child
food such as breastfeeding, semi-solid and soft food

Infant formula: manufactured food designed and marketed for feeding to babies and infants under
12months of age, usually prepared for bottle-feeding or cup-feeding from powder or liquid.

Infant: This is a child whose age ranges from 0-12 months

Malnutrition: lack of proper nutrition caused by not having enough to eat, not eating enough of
the right thing.

Optimal breastfeeding: This means beginning breastfeeding within the first hour of birth and
continuing to EBF for six months and introducing semi-solids, solids and soft foods that are
culturally appropriate as from six months while breastfeeding is continued until two years and
beyond.

Popular culture: Is the accumulated store of ideas, beliefs and practices held by a large number of
people

Postnatal period: period immediately after birth.

Pre-lacteal feeds: Semi-solids and liquids that are given to an infant before lactation is established
usually between birth and first three days of life.

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Contents
DECLARATION...........................................................................................................................................1
DEDICATION...............................................................................................................................................3
ACKNOWLEDGMENT................................................................................................................................4
ABSTRACT...................................................................................................................................................5
ABRREVIATIONS AND ACRONYMS.......................................................................................................6
DEFINATION OF TERMS...........................................................................................................................6
1.7: LIMITATION OF THE STUDY.........................................................................................................1
1.8: ASSUMPTION OF THE STUDY.......................................................................................................1
1.9: CONCEPTUAL FRAME WORK.......................................................................................................1
CHAPTER 2: LITERATURE REVIEW........................................................................................................4
2.1: Exclusive breastfeeding recommendations..........................................................................................4
2.2: Benefits of exclusive breastfeeding.....................................................................................................4
2.3: Medical condition that hinder exclusive breastfeeding........................................................................5
2.3.1: Maternal conditions that may justify temporary avoidance of breastfeeding................................6
2.3.2: Maternal conditions during which breastfeeding can still continue, although health problems
may be of concern..................................................................................................................................6
2.4: Demographic factors and exclusive breastfeeding...............................................................................7
2.5: Infant formulas....................................................................................................................................7
2.6: Maternal knowledge on exclusive breastfeeding.................................................................................8
2.7: Culture and exclusive breastfeeding....................................................................................................9
CHAPTER 3:...............................................................................................................................................11
RESEARCH METHODOLOGY.................................................................................................................11
3.1: Research Design................................................................................................................................11
3.2: Study area..........................................................................................................................................11
3.3: Population and sample.......................................................................................................................11
3.3.1: Sample size determination..........................................................................................................12
3.3.2: Exclusion criteria........................................................................................................................12
3.3.3: Inclusion criteria.........................................................................................................................13
3.4: Sampling procedure...........................................................................................................................13
3.5: Data collection method......................................................................................................................13
3.5.1: Pretesting of instruments............................................................................................................13
3.5.2: Data collection procedure...........................................................................................................14

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 3.6: Ethical consideration.........................................................................................................................14
3.7: Data analysis.....................................................................................................................................14
CHAPTER FOUR........................................................................................................................................15
DATA ANALYSIS, PRESENTATION, AND INTERPRETATION OF STUDY FINDINGS...................15
4.1 Response rate......................................................................................................................................15
4.2 Demographic and socioeconomic characteristics of respondents.......................................................15
4.2.1 Age Distribution of Sampled Children........................................................................................15
4.2.2 Sex of the sampled children.........................................................................................................16
4.2.3 Education level of the mother......................................................................................................16
4.2.4 Maternal occupation....................................................................................................................16
4.2.5 Monthly household level of income.............................................................................................17
4.2.6 Mothers Maternal age..................................................................................................................18
4.3.1 Infant feeding practices...................................................................................................................18
4.3.1 Breastfeeding initiation....................................................................................................................18
4.3.4 Reason for giving the baby liquid....................................................................................................19
4.3.5 Who influences mother’s choice of breastfeeding...........................................................................19
4.3.6 Mothers knowledge on exclusives breastfeeding.............................................................................20
4.4 Place of Delivery................................................................................................................................20
4.5 Type of Delivery................................................................................................................................21
4.6 Source of food in the household.........................................................................................................21
CHAPTER FIVE..........................................................................................................................................23
SUMMARY, CONCLUSION, AND RECOMMEDATION OF THE STUDY FINDINGS.......................23
5.0 Introduction........................................................................................................................................23
5.1 Summary............................................................................................................................................23
5.2 Conclusion..........................................................................................................................................23
5.3 Recommendation................................................................................................................................24
5.4 Suggestions for further research.........................................................................................................24
REFERENCES.............................................................................................................................................25
APPENDICES..............................................................................................................................................31
1: QUESTIONNAIRE..............................................................................................................................31
Budget......................................................................................................................................................35

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 CHAPTER ONE

1:0 INTRODUCTION

This chapter explains the background of the research while describing the problem from
worldwide and local perspective. It also highlights the objective as well as the purpose and
significant of the study and the Scope of study of which the study was derive from.

1.1: BACKGROUND OF THE STUDY

Breast feeding is accepted as the natural form of infant feeding. For postnatal mothers to
exclusively breast fed, it is important to understand the factors that influence exclusive breast
feeding. The aim of the study is therefore to identify some of the factors hindering exclusive
breast feeding Eldoret.

Since 2001, WHO guidelines have stated that babies should be exclusively breastfed until they are
six months old, something most mothers and babies are physically able to do. In the crucial first
few months, breast fed children are six time more likely to survive than children who are not
breastfed.

Global, only 36% of younger than six months are exclusively breast fed and in developing
countries, poor feeding practices including lack of exclusive breast feeding until six months and
failure to initiate breast feeding in the first hour contributes to the deaths of 800,000 children
below five years of age each. Breast feeding experts now see an opportunity for galvanizing
action. Maternal and child health is riding high on the global health agenda with nutrition as a core
focus.

In May 2012, the World Health Assembly adopted six global nutrition targets to be achieved by
2025, one of them exclusive breast feeding (htp://dx.doi.org/10.2471/BLT.14.0204114).

Indonesia is a case in point, in 2009 it enacted a law calling for every baby to be exclusively breast
fed for the first 6 months of life unless there are medical reasons not to do so Although rates of
exclusive breast feeding increased from 32% in 2007 to 42% in 2012 (IDHS2012) health. Experts
in the country say that implementation of the law remains spoor and that formula companies
continue to push breast milk substitute to mothers of very young infants.

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In 1981, the international code of marketing of breast milk substitutes was adopted by countries at
the World Health Assembly to ensure that formula was not promoted to mothers. However update
of the code has been dismal, only 37 (19%) of the 199 countries are reporting to WHO have fully
implemented there commendations (WHO 2011).

The potential impact of optimal exclusive breast feeding practices is especially important in
developing country situations with a high burden of diseases and low access to clean water and
sanitation. But no-breastfed children in industrialized countries are also at greater risk of dying, are
sent study of post-neonatal mortality in the United States found 25% increase in mortality among
no-breast fed infants. In the UK Millennium Cohort survey 6 months of exclusive breast feeding
was associated with 53% decrease in hospital admission for diarrhea and 27% decrease in
respiratory tract infections.

In Africa, more than 95% of infants are currently breast-fed but feeding practices are often
inadequate. Consequently the rate of exclusive breast feeding is low particularly in West Africa.
The rate of bottle feeding is high in some countries, that is exceeding 30% in Tunisia, Nigeria,
Namibia and Sudan. In Kenya data from the Kenya Demographic Health survey shows that in
2003, the exclusive breast feeding rate stood at 13% which rose to 32% in 2008. Out of
approximately 1.5 million children born each year in Kenya, only 500 thousand of them are
exclusively breast fed. This means that over 1 million babies are exposed to the unnecessary risk of
malnutrition and increased illness which impact negatively on the countries will to achieving
MDG4, that of reducing mortality. In Eldoret town, study findings show that Eldoret mothers are
not achieving the recommended six months of exclusive breast feeding. This implies that Eldoret
mothers are giving infants alternative feeds at an early age. It is in response to this, that a study will
be conducted which aims at investigating what might be the cause of improper and inadequate
exclusive breast feeding among mothers with infants of age between 0-6 months in Eldoret town.

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1.2: STATEMENT OF THE PROBLEM

The availability of infant formulas in the market is one of the major problems that hinderexclusive
breast feeding in Kenya. An infant feeding practice in Kenya (IFPS1982) whichincluded across
sectional survey of a weighted sample of 980 low and middle income Nairobi mothers who had
given birth in the previous18 months found that most women breastfeed their infants for long
periods, but many introduce alternate feeding especially infant formulas in the first four months of
life. Eighty six percent and fifty percent of the infants were breast fed at 6 and15 months
respectively, but 50% of the two months old and 63% of the four months old were receiving
substitute mostly infant formulas. (EliotT.Cetal,1985)

Infant formula has been increasingly used as breast milk substitute as a result of maternal
occupation, death, illness and some mothers deliberately deciding not to breast feed. This happens
despite WHO and National Health Agencies (NHA) recommending exclusive breast feeding
during the first six months of infancy. Following this, infant formula is increasingly being
associated with infant health complication and even infant deaths.

In Kenya, it is reported that only about32% of lactating mothers exclusively breastfeed their babies
during the first six months of infancy. (Kenya National Bureau of Statistics, 2010). This leads to
use of breast feeding substitute such as dairy milk, sweetened liquids and infant formula milk.

The existence of in adequate exclusive breast feeding today is therefore a potential indicator of
increased infant mortality rate in Eldoret since most mothers prefer using infant formulas which
provide less in terms of nutrients compared to breast milk.

It is important that research be done so that possible long term solution can be found. It is in light
of this perspective that this study aims at using available resources to intrinsically investigate
possible causes of the problem and provide a long term solution to this problem hindering adequate
exclusive breast feeding of infant

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1.3: THE PURPOSE OF THESTUDY

The study will be carried out to investigate possible factors that prevent exclusive breast
feeding in Eldoret town.

1.4: GENERAL OBJECTIVES

To investigate and come up with solutions to factors that prevents exclusive breastfeeding.

SPECIFICOBJECTIVES

To find out the knowledge of postnatal mothers on the importance of exclusive breast feeding.

To find out the possible medical condition that may hinder postnatal mothersfrom exclusive breast
feeding.

To find out why postnatal mothers prefer formulas to breast milk.

RESEARCH hypothesis.

What do postnatal mothers know about the importance exclusive breast feeding?

Is there real any medical condition postnatal mothers might be suffering from?

Why do you postnatal mothers prefer breast milk substitutes? HO: Postnatal mothers have no
knowledge on the importance of exclusive breastfeeding

H1: postnatal mothers have knowledge on the importance of exclusive breastfeeding

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1.7: LIMITATION OF THE STUDY
The generalization of this study finding will not be inclusive of mothers with children above six
months of age.

1.8: ASSUMPTION OF THE STUDY

The study will assume that all respondents of the study will be in good health and hence respond
as expected without any health impediments

1.9: CONCEPTUAL FRAME WORK

A CONCEPTUAL FRAMEWORK OF FACTORS AFFECTING BREASTFEEDING
PRACTICES

Breast feeding practices

Attributes of the Attributes of the

Individual infant Attributes of the mother
level factors mother/infant dyad

Feature of the environment

Group level
factors Hospital and Home family Work Community
health services environment environment environment

Public policy environment

Attributes of society culture, economy

Society level
factors  Cultural norms ie breastfeeding, child feeding and parenting
 Role of women and men in society
 Food system

Adapted and modified from Hector Debra et al., 2005, pg 52

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 The conceptual framework indicates three levels of factors that influence breastfeeding
practices: individual, group and society.
Individual level factors relate directly to the mother, infant, and the ‘mother-infant dyad’. They
include the mother’s intention to breastfeed, her knowledge, skills and parenting experience, the
birth experience, health and risk status of mothers and infants, and the nature of early interaction
between mother and infant.
Group level factors are the attributes of the environments in which mothers and infants find
themselves, the attributes that enable mothers to breastfeed. Environments with a direct influence
on mothers and infants include:

 the hospital and health facilities environment, in which practices and procedures such as
infants routinely rooming-in with mothers to allow demand feeding, postpartum skin-to-
skin contact and providing professional support with breastfeeding technique difficulties
influence the early feeding experience and the follow-up care and support,

 the home and peer environment, where physical and social factors such as size of
household, parity, family circumstances, partner attitudes and support, and peer support
affect the time, energy and resolve that mothers have for breastfeeding.

 the work environment, in which policies, practices and facilities such as work hours and
flexibility, facilities and policies that enable on-site expressing and storing of breast milk
influence mother’s ability to combine work and breastfeeding.

 the community environment, which signals the extent to which breastfeeding is

recognized as a norm, and reinforced by facilities and policies in public places, for
example parenting rooms in shopping centers and entertainment venues, ‘breastfeeding
friendly’ public transport, restaurants

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  the public policy environment, which modifies how each of these environments influence
mother’s feeding decisions. For example, benefits such as maternity and paternity leave,
childcare allowances and health insurance have a significant impact on the hospital,
homeland work environments that in turn, influence infant feeding decisions directly
Societal level factors influence the acceptability and expectations about breastfeeding and
provide the background or the context in which mothers’ feeding practices occur. These include
cultural norms regarding breastfeeding, child feeding, and parenting; the role of women in
society, including how working outside the home is valued; the extent to which men’s social role
includes support for breastfeeding mothers; the extent to which exposing breasts for feeding is
complicated by cultural norms regarding sexuality; and the economic importance of products
such as breast milk substitutes and complementary foods in the food system
Group level and societal level influences may interact in either positive or negative ways with
maternal knowledge
and skills. For example, a mother may be predisposed to breastfeed, but a non-supportive
environment in the hospital may lead to her deciding to stop breastfeeding early. Similarly, even
if breastfeeding is still occurring at hospital discharge, a lack of support at home or in the
community may also lead to her stopping early. Again, broader societal attitudes about sexuality,
and especially breasts, can influence the manner and degree of community support.

3
CHAPTER 2: LITERATURE REVIEW

2.1: Exclusive breastfeeding recommendations

Exclusive breastfeeding is defined as, “an 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 medication. (Gartner LM et al., 2005). WHO recommends mothers to
exclusively breastfed infants for the child’s first six months of life to achieve optimal growth,
development and health. Thereafter, they should be given nutritious complementary foods and
continue breastfeeding up to the age of two years or beyond (WHO 2011).

Infants who are exclusively breastfed for six months experience less morbidity from
gastrointestinal infections than those who are partially breastfed as three or four months and no
deficits have been demonstrated in four growth among infants from either developing or
developed countries who are exclusively breastfed for six months or longer. (Kramer MS et al.,
2012).WHO and UNICEF currently recommends exclusive breastfeeding for the first six months
of life with continued feeding through the first year among HIV positive mothers, provided that
they or their infants receives ARV drugs during the breastfeeding period. (WHO 2010)

Promotion of early initiation of breastfeeding has the potential to make a major contribution to
the achievement of the child survival millennium development goal; 16% of neonatal deaths
could be saved if all infants are breastfed from day 1 and 22% if breastfeed started within the
first hour.( Edmond KM et al., 2006). Only 35% of infants worldwide are exclusively breastfeed
during the first four months of life developing countries. The EBF rate among children aged less
than six months are at 39%. (UNICEF, 2009)

2.2: Benefits of exclusive breastfeeding

Initiating exclusive breastfeeding early in life is associated with greater appetite regulation later
in childhood leading to reduction of early overweight. (Disantis et al., 2011).When EBF is
initiated early and is continued for six months, it reduces the risk of severe malnutrition, cough
incidences, hypoxemia incidences and duration in children with pneumonia, diarrhea, GIT
condition, respiratory conditions, infections and anemia. (Cervantes- Rios et al., 2012; Chisti et

4
al., 2011; Lahariya, 2008; Sawasdivord and Taexiriyakal, 2011; Hortaetal., 2007; Quigley et al.,
2007.)

Initiation of EBF within one hour of delivery ensures that the child got to consume colostrums
which is the initial special breast milk produced within the first two days after delivery and is
rich in antibodies, anti- effective proteins, WBC and growth factors. (WHO, 2005)The breastfed
children have less digestive troubles, colic pains and best working immune system. (Cohen et al.,
2012).Breastfeeding for four months and longer has better outcomes on fine motor skills at age
one and three years; higher adaptability at age of two years and higher communication skills at
ages one and three years. (Oddyetal., 2011)

Exclusive breastfeeding in the first six months of life is particularly beneficial for mothers and
infants. Positive effects of breastfeeding on the health of infants and mothers are observed in all
settings. Breastfeeding reduces the risk of acute infections such as diarrhea, pneumonia, ear
infection, Haemophilus influenza, meningitis and urinary tract infection (WHO, 2005). It also
protects against chronic conditions in the future such as type I diabetes, ulcerative colitis, and
Crohn's disease. Breastfeeding during infancy is associated with lower mean blood pressure and
total serum cholesterol and with lower prevalence of type-2 diabetes, overweight and obesity
during adolescence and adult life (WHO, 2007). Breastfeeding delays the return of a woman's
fertility and reduces the risks of post-partum hemorrhage, pre-menopausal breast cancer and
ovarian cancer (Leon-Cava et al 2002.).

2.3: Medical condition that hinder exclusive breastfeeding

It is not safe for mothers with active, untreated tuberculosis to breastfed until they are no longer
contagious. (Gartner LM et al., 2005).Breast pain often interferes with successful BF. It is cited
as the second as the second most common cause for abandonment of exclusive breastfeeding.
(WooldridgeM. 1986)Factors such as viral load on the mothers’ milk complicate breastfeeding
recommendations for HIV positive mothers. (Molandetla., 2008)

Breastfeeding by an HIV –infected mothers poses a 5 – 20% chance of transmitting HIV to the
baby. ( WHO. 2004; Lawrence RM et al., 2004). Breastfeeding can be difficult for victims of
rape or sexual abuse; for example it may be a trigger for posttraumatic stress disorder (Kendall-
Tackett et al., 2012, Katy 2009).Breast milk insufficiency is cited as the main reason for early

5
commencement of complementary feeding as revealed in a study done in Nakuru by Webb et al.,
(2012).

2.3.1: Maternal conditions that may justify temporary avoidance of breastfeeding

 Severe illness that prevents a mother from caring for her infant, for example sepsis.
 Herpes simplex virus type 1 (HSV-1): direct contact between lesions on the mother's
breasts and the infant's mouth should be avoided until all active lesions have resolved.
 Maternal medication:
 sedating psychotherapeutic drugs, anti-epileptic drugs and opioids and their
combinations may cause side effects such as drowsiness and respiratory
depression and are better avoided if a safer alternative is available (WH0, 2003);
 radioactive iodine-131 is better avoided given that safer alternatives are available
a mother can resume breastfeeding about two months after receiving this
substance;
 excessive use of topical iodine or iodophors (e.g., povidone-iodine), especially on
open wounds or mucous membranes, can result in thyroid suppression or
electrolyte abnormalities in the breastfed infant and should be avoided;
 cytotoxic chemotherapy requires that a mother stops breastfeeding during therapy.

2.3.2: Maternal conditions during which breastfeeding can still continue, although health
problems may be of concern

 Breast abscess: breastfeeding should continue on the unaffected breast; feeding from the
affected breast can resume once treatment has started ( WHO, 2000).
 Hepatitis B: infants should be given hepatitis B vaccine, within the first 48 hours or as
soon as possible thereafter (WHO, 1996).
 Hepatitis C.
 Mastitis: if breastfeeding is very painful, milk must be removed by expression to prevent
progression of the condition (WHO, 2008).
 Tuberculosis: mother and baby should be managed according to national tuberculosis
guidelines (WHO, 1998).

6
  Substance use(Background papers to the national clinical guidelines for the management
of drug use during pregnancy, birth and the early development years of the newborn;
Commissioned by the Ministerial Council on Drug Strategy under the Cost Shared
Funding Model; NSW Department of Health, North Sydney, Australia. 2006.)
 maternal use of nicotine, alcohol, ecstasy, amphetamines, cocaine and related
stimulants has been demonstrated to have harmful effects on breastfed babies;
 alcohol, opioids, benzodiazepines and cannabis can cause sedation in both the
mother and the baby.

2.4: Demographic factors and exclusive breastfeeding

Demographic factors that influence exclusive breastfeeding include: maternal age, marital status,
mothers level of education and mothers attendance of antenatal clinic. A Study done in Norway
by Lande et al., (2003).Maternal eye was found to have a significant positive trend on exclusive
breastfeeding at four months, breastfeeding at 6 months and timely introduction of solids, semi
solids and soft foods. However, in another study done by Mihrshahi et al. (2010) in Bangladesh,
order maternal eye was a risk factor for bottle feeding.

Peer support significantly decreases the risk of discontinuing EBF in a study done in low and
middle income countries (sudfel et al., 2012) A study done in Britain and Ireland showed that
maternal employment was the reason why employed mothers who returned to work within EBF
period failed to start breastfeeding as recommended (Hawkins et al., 2007). Maternal
employment had a negative impact on EBF and duration of breastfeeding as recommended (Al-
sahab et al., 2010; Rojjauascrirat et al., 2010). A study done by Duncan et al.,1993 found next
pregnancy as a factor preventing mothers from exclusively breast feeding

2.5: Infant formulas

Despite recommendation that babies be exclusively breastfed for the first six months, less than
40% of infants below this age are exclusively breastfed worldwide. (WHO, 2011). The
overwhelming majority of American babies are not exclusively breastfed for this period. In 2005,
under 12% of babies were breastfed exclusively for the first six months ( CDCP, 2008) with over
60% of babies of two months of age being fed formula and approximately one in four breastfed
infants having infant formula feeding within one two days of birth. (CDC, 2005)

7
Advocates oppose us of infant formulas, especially in developing countries. They are concerned
that mothers who use formula will stop breastfeeding and become dependent upon substitutes
that are unaffordable or less safe (ZoeWilliams et al., 2013; JoannaMoorhead, 2007). Though
efforts including the Nestle’ boycott, they have advocated for bans on free samples of infants
formula and for the adoption of pro-breastfeeding codes such as the international code of
Marketing Breast milk Substitutes by the World Health Assembly in 1981 and the Innocenti
Declaration by WHO and UNICEF Policy-makers in August in 1990 ( Joanna Moorhead, 2007)

Pre-lacteal feeding such as feeding glucose water, infant milk formulae, cows’ milk and water
before lactation is established is a common practice as shown in various studies. (Lakatiet al.,
2010; Liqian et al., 2007; Akuse and Obinga, 2002).A UNICEF estimate that a formula fed child
living in unhygienic condition is between six and twenty five times more likely to die of a
diarrhea and four times more likely to die of pneumonia than a breastfed child. (UNICEF 2007)
In 2010, Abbot Laboratories issued a voluntary recall of about five million similar brand powder
infant formulas that were sold in the United States, Puerto Rico and some Caribbean countries
after the presence of some common battle was detected in the product. (Abbott Press release,
2010). Use of powdered Infant Formula (IPF) has been associated with serious illness and even
death due to infection with EnterobacterSakazakii and other microorganism that can be
introduced to PIF during its production. (WHO 2007)

The use and marketing of infant formulas has come under scrutiny. Breastfeeding including EBF
for the six months of life is widely advocated as ideal for babies and infants. (WHO 2011)
Studies have found that infants in developed countries who consume formula are at increased
risk for acute otitis media, gastroenteritis and severe lower respiratory tract. (Stanley I petal,
2007).Some studies have found an association between infant formula and lower cognitive
development, including iron supplementation in baby formula being linked to lowered IQ and
other neuro development delays. (McCann JC et al., 2005; Kerr et al., 2008)

2.6: Maternal knowledge on exclusive breastfeeding

Maternal level of education as shown by studies done in Kenya (Morgan et al., 2010) and
Pakistan (Memon et al., 2010) found out that mothers cessation of breastfeeding was negatively
influenced by lower educational level. According to KNBS and ICF Macro 2010, 92% of
mothers in Kenya attended antenatal clinic and a lower43% of the mothers delivered at health

8
facilities. The depicted scenario may cause the initiation of breastfeeding pattern to be influenced
by the mother’s uninformed decision on EBF.( Gaye et al., 2012)

In Sri Lanka, mothers with primary education were found to be more likely to exclusively
breastfeed than mothers with no education. (Senarath et al., 2007). Mothers with college level of
education were associated with the largest number of positive exclusive breastfeeding practices.
(Hendricks et al., 2006).Lower maternal education was cited in India as a factor causing
postnatal mothers to practice non diversity of infant and young child feeding. (Senarath et al.,
2012).Mothers are aware of the benefits of exclusive breastfeeding but do not exclusively
breastfeed as recommended. (Naanga, 2008; Vereijen et al., 2011; Kimani et al., 2011). In a
study in Nigeria by Agunbiade and Ogunleye (2012), EBF was perceived as essential but very
demanding thus leading to low rate.

Mothers‟ practice on introduction of solids, semi-solids and soft foods in Kenya, is that of early
commencement as from 2 months (Naanyu, 2008; Machariaet al., 2004).Althoughmajority of
women knew general benefits of breast-feeding a number of beliefs were widely held and would
tend to interfere with exclusive breast-feeding(Afzalet al., 2002)

2.7: Culture and exclusive breastfeeding

Mothers base their infant feeding decisions on an array of factors which include cultural beliefs
(Pak, Aliya and Elinor, 2009). Jellife (1968) pointed out, “… all different cultures, whether in a
tropical village or in a highly urbanized and technologically sophisticated community, contain
some practices and customs which are beneficial to the health and nutrition of the group, and
some which are harmful. No culture has a monopoly on wisdom or absurdity.” Pre-lacteal
feeding is a popular culture as reflected in various studies done in India, Ethiopia and Tanzania
(Dakshayani and Gangadhar, 2008; Alemayehu, Haidar and Habte, 2009; Shirima, Greiner,
Kylberg and Gebre-Medhin, 2001). Additionally early introduction of complementary feeding is
common in many cultures and frequently, such feedings are viewed as a means of socializing the
infant into the family's diet culture (Pak et al., 2009).
It is with this backing that this research will attempt to make these barrier factors known to

enhance coming up with ways to improve compliance to exclusive breastfeeding and to ensure

that breast milk is prioritize in infant feeding.

9
There is little literature review particularly on the consequences of using infant formula as a

substitute of breast milk and this knowledge gap might steer the abandonment of exclusive

breastfeeding as many mothers will opt to depend on substitute instead of breast milk. As much

as mothers know that they should breastfed exclusively for the first six months, there is little

literature on how these mothers can be informed on the importance of EBF and this knowledge

gap increases possibility of cessation of EBF and therefore this study will actually prove that

inadequate information on the importance EBF is a factor that prevents exclusive

breastfeeding. .These knowledge gap makes it quite difficult for mothers to comply with infant

feeding recommendations and contributes to inadequate EBF.

10
CHAPTER 3:

RESEARCH METHODOLOGY

3.1: Research Design

A research design is a detailed plan of how research will be carried out. (DeVos, 1998). It
therefore gives the avenue through which the answers to the set objectives and research questions
will be obtained as well describing the variables of the study. (Orodho, 2004)

This study will therefore, employ the use of qualitative descriptive research design. This will be
appropriate because the study will involve case studies in which they will be examined on factors
that might be influencing their behavior on EBF and there will also be simultaneous data
collection and analysis.

Qualitative descriptive design tends to draw from naturalistic inquiry which purports to a
commitment to studying the breastfeeding in its natural state thus no pre-selection of study
variables and no manipulation of variables.

3.2: Study area

This study will be conducted in Eldoret town. Eldoret is the fifth largest town in Kenya and has
been identified as one of the fastest growing town in Kenya.

The area is a cosmopolitan with people of various socio-economic, races, different cultures and
ideologies, religions and political aspirations. It has a population of 289,380 in the 2009 census.
(GoK- population- PDF).

Eldoret town is chosen because it has got a diversified population and it is convenient to the
researcher while conducting the research study. Eldoret town has various health facilities. There
is one major referral hospital (MTRH) and other sub county hospitals like UasinGishu District
hospital, Huruma District hospital and other private hospitals like Mediheal.

3.3: Population and sample

The target population for this study will be postnatal mothers with infants of age zero to six
months since they are generally aware of issues regarding the aspect of the study and therefore
understand and respond to the enquiries and participate effectively in the study.

11
3.3.1: Sample size determination
The size of the sample to be used for the study will be approximately eighty postnatal mothers
which will be determined using the following formula as recommended by Fisher et al., 1998

2
Z  PQ
n
 2

Where n= desired sample size

Z= standard numerical deviation responding to 95% confidence interval
σ= degree of accuracy desired (12%)
P=proportion of eligible respondents in the study
Q = 1-P
Since the target population from the formula is less than 10000, the formula will be modified to
obtain a sample size of 64 postnatal mothers. The errors associated with research that emanate
from non -response, missing data entry will be accommodated by an allowance of attrition of
20% respondents.
1.96 2  0.60  0.40
n = 0.12 2 = 64 respondents.
By adding attrition of 20% of the sample size,
64 20
= 100 = 13 respondents.
Hence 64+13 =77 respondents

3.3.2: Exclusion criteria

The mothers with children aged zero to six months who resides in Eldoret town but will be
having infants too ill and need immediate medical intervention or those who will be unwilling to
participate in the study will be excluded.

12
3.3.3: Inclusion criteria
The mothers with children age zero to six months who resides in Eldoret town attending the
major health facility in Eldoret and who will be willing to participate in the study will be eligible
respondents.

3.4: Sampling procedure

This research will employ the use of probability sampling technique. Probability sampling, that
is, simple random sampling will be suitable since it will give every mother with a child below six
months of age an equal chance of being chosen for the study.

Purposive sampling will be used to select the health facilities with the largest mean monthly
attendance amongst health services offered to mother and child. Purposeful sampling will also be
used to obtain dates to visit health facilities.

Every mother with a child aged between zero to six months seeking health services on the day
the health facility will be visited will have equal chance to be chosen for the study.

3.5: Data collection method

The data needed for this research will be collected between the first week of January to the
second week of January. Administration of questionnaire will be employed to the respondent. A
structured questionnaire with description directing the respondents on what they are required to
do with regard to collecting data.

The questionnaire will be designed in a way that only simple response by a mark on the designed
box against the closed options. The information that will be gathered during study will include
data on infants’ and mothers’ characteristics, mothers’ level of knowledge on infant feeding
guidelines and current practice of mothers regarding exclusive breastfeeding.

3.5.1: Pretesting of instruments

The research instruments, that is the structured and semi structured questionnaire will be
administered to a group of ten mothers at Huruma District hospital in Eldoret town to ensure
validity and reliability before the actual time of the study and data collection. This will help in
trying to understand the expected response or errors and hence make the necessary adjustment.

13
3.5.2: Data collection procedure
Questionnaires will be given to the respondents and they will be expected to tick on the choices
they will pick based on questions on the questionnaire. The researcher will provide guidance all
throughout the data collection period.

3.6: Ethical consideration

Ethics will be considered during the research time. Compliance with the rules and regulations of
the place of the study including asking for permission of entry into health facilities, permission
from African Institute Research and Development Studies and county medical health officer in
Eldoret town.

The respondents will be explained to about the study objectives and request to participate and
once they will consent verbally, they will be assured of confidentiality of information they will
give.

3.7: Data analysis

The data will be coded, entered and analyzed using a statistical package for social sciences

(SPSS) version 16 (2007) which functions on a window operating system platform..Chi square

will be computed because it will enable easy acquisition of the measures of central tendency

(means, mode and median).The package will enable the computation of the result needed and to

determine whether there will be any relationship between variables.

14
CHAPTER FOUR

DATA ANALYSIS, PRESENTATION, AND INTERPRETATION OF STUDY FINDINGS

4.1 Response rate

A total of 120 mothers visiting the MCH clinic were interviewed during data collection which
represented 100% response rate, focus discussion was also undertaken on five mothers at the
MCH during the last day of data collection

4.2 Demographic and socioeconomic characteristics of respondents

The study sought to determine the demographic and socioeconomic characteristics of the
respondents based on age of both the mother and the child, sex of the children, marital status,
education level, occupation, source of income of the mothers and monthly household level of
income. These enable the study analyze their influence on exclusive breastfeeding.

4.2.1 Age Distribution of Sampled Children

Respondents were required to indicate the age of three sampled children. Findings are shown in
table 4.1

Table 4.1 Age Distribution of Sampled Children

Age of children in complete months F r e q u e n c y P e r c e n t a g e

1 m o n t h 6 5 %
2 m o n t h s 1 0 8 . 3 %
3 m o n t h s 2 1 1 7 . 5 %
4 m o n t h s 2 9 2 4 . 2 %
5 m o n t h s 1 9 1 5 . 8 %
6 m o n t h s 3 5 2 9 . 2 %
T o t a l 1 2 0 1 0 0 %
Table 4:1 shows the age distribution of the sample children; 5% were aged one month, 8.3%
were 2 month old, 17.5% were 3 month old, 24.2% were 4 months old , 15.8% were 5 months
and 29.2% were 6 months old.

15
4.2.2 Sex of the sampled children
Mothers visiting the MCH clinic were required to indicate the sex of the children . The findings
are shown in table 4.2

Sex of the children F r e q u e n c y P e r c e n t a g e

M a l e 7 2 6 0 %

Female 48 40%

T o t a l 1 0 0 %

Table 4.2 shows the sex of the sampled children where 60% were male and 40% were female

4.2.3 Education level of the mother

The respondents were required to indicate their highest level of education. The findings are show
in Table 4.3

Table 4.3 Education level of the mother

Mothers education leve l F r e q u e n c y P e r c e n t a g e

Not formal education 2 0 1 6 . 7 %

Primary 24 20%

Secondary 46 38.3%

College and above 30 25%

T o t a l 1 2 0 1 0 0 %

Table 4.3 shows that mothers without formal education were 16.7% primary level were 20%,
secondary level were 38.3% whereas those who were college and above were 25%

4.2.4 Maternal occupation

Mothers were required to show their occupation. The findings are shown in table 4.4 below

16
Table 4.4 mother’s occupation

Maternal Occupation F r e q u e n c y P e r c e n t a g e

E m p l o y e d 4 7 3 9 . 2 %

Business 31 25.8%

Farmer 20 16.7%

Unemployed 22 18.3%

1 0 0 %
Total 120

Table 4.4 shows mothers occupation and the results were that 39.2% of the mothers employed,
25.8% were business women 16.7% were farmers while 18.3% were unemployed

4.2.5 Monthly household level of income

The respondents were required to indicate the household level of income. The findings are
shown in table 4.5

Table 4.5 : Monthly household level of income

Maternal Occupation F r e q u e n c y P e r c e n t a g e

< 5 0 0 0 2 3 1 9 . 2 %

5000-10000 58 48.3%

10000-20000 18 15%

20000-30000 11 9.2%

>30000 10 8.3%

1 0 0 %
Total 120
Table 4.5 shows the monthly household level of income , those who earned <50000 shs were
19.2% between 5000-10000 were 48.3% 10000-20000 constituted 15% 20000-30000 were 9.2%
while 8.3% were those mothers earning >3000/

17
4.2.6 Mothers Maternal age
Mother were required to indicate their age and the findings are shown below in Table 4.6

Mothers’ age in years F r e q u e n c y P e r c e n t a g e

< 2 5 1 8 1 5 %

26-30 20 16.7%

31-35 34 28.3%

36> 48 40%

1 0 0 %
Total 120
Table 4.6 shows that 40% of respondents aged above 36years, 31-35 years were 28.3%, 26-30
years were 16.7% while 15% age below 25.

4.3.1 Infant feeding practices

The study sought to estatable infant feeding practices based on initiation of breastfeeding, types
of liquid given before the infant is six months reason for early initiationof complementary
feeding, person influencingmother’s choice of breastfeeding and mothers knowledge on
exclusive breastfeeding

4.3.1 Breastfeedinginitiation
The respondents were required to indicate whether they breastfeed the baby immediately he/she
was born .the findings are shown in table 4.8

Table 4.8 Breastfeeding initiation

T y p e o f l i q u i d F r e q u e n c y P e r c e n t a g e

C o w ’ s M i l k 9 2 7 6 . 7 %

Formula milk 9 7.5%

Medicines/Herbs 10 8.3%

Water 9 7.5%

1 0 0 %
Total 120
Table 4.9 shows that 76.7% of the mothers gave cow’s milk to their babies 8.3% gave
medicine/herbs, while those giving formula milk and water were both 7.5%

18
4.3.4 Reason for giving the baby liquid
Respondents were required to give reasons of giving the infant liquid. The findings are shown in

Reason of giving the baby liquid F r e q u e n c y P e r c e n t a g e

C h i l d i l l n e s s 2 6 2 1 . 7 %

Mother illness 12 10%

Insufficient milk production 70 58.2%

Sore nipple 12 10%

1 0 0 %
Total 120

Table 4.11 shows that 55% of the mothers gave their babies other liquids other than breast milk
because perceived insufficient breast milk production, those who gave due to child illness were
21.7% mothers’ illness and sore nipples were both at 10%.

4.3.5 Who influences mother’s choice of breastfeeding

Respondents were required to indicate the person who influences their choice of breastfeeding
which necessitates introduction of complementary foods before the infants is six months. The
findings are shown in

Table 4.11 who influences mother’s choice of breastfeeding

Maternal Occupation F r e q u e n c y P e r c e n t a g e

Mothers own decision 6 6 5 5 %

Mother-in-law 20 16.7%

Husband 10 8.2%

Friends 24 20%

1 0 0 %
Total 120

Table 4.11 shows that 55% of mothers interviewed introduce other foods before the child is six
months due to their own decision, 16.7% are influence by mothers-in-laws, their husbands 8.3%
and those influenced by their friends to do so were 20%.

19
4.3.6 Mothers knowledge on exclusives breastfeeding
Respondents were required to indicate their knowledge on duration of exclusive breastfeeding

The findings are shown in the table below

Table 4.12 mother’s knowledge on exclusive breastfeeding

Knowledge on exclusive breastfeeding F r e q u e n c y P e r c e n t a g e

A t 2 m o n t h s 0 0 %

At 4 months 20 16.7%

After 6 months 40 33.3%

Don’t know 60 50%

1 0 0 %
Total 120
Table 4.12 shows that 50% of mothers don’t have knowledge on duration of exclusive
breastfeeding, 33.3% indicating that they are supposed to introduce other foods at 6 months
while 16.7% of the respondents indicating at 4 months.

4.4 Place of Delivery

Mothers were required to indicate their place of delivery. The findings are shown in Table 4.8

Table 4.13 mothers place of delivery

place of delivery F r e q u e n c y P e r c e n t a g e

H o s p i t a l 8 8 7 3 . 3 %

Home 32 26.7%
1 0 0 %
Total 120
Table 4.13 shows that 73.3% of the mothers interviewed delivered in hospital while 26.7%
delivery at home.

The respondents were required to indicate their religion. The findings are shown in table 4.16

20
Table 4.16 Maternal cultural characteristics

Maternal cultural characteristics F r e q u e n c y P e r c e n t a g e

C h r i s t i a n 1 0 0 8 3 . 3 %

Muslim 20 16.7%

1 0 0 %
Total 120

Table 4.16 show that majority of the respondents were Christian 83.3% and reports that their
religion does not influence exclusive breastfeeding at all, while Muslims were 16.7%

4.5 Type of Delivery

Respondents were required to indicate their type of delivery to the current child. The findings are
shown Table 4.14

Table 4.14 Type of Delivery

Type of delivery F r e q u e n c y P e r c e n t a g e

N o r m a l 1 0 6 8 8 . 3 %

Cesarian Section(CS) 14 11.7%

T O T A L 1 2 0 1 0 0 %

Table 4.14 shows that mothers who delivered normally constituted 88.3% while those who
underwent caesarian section during their delivery were 11.7%.

4.6 Source of food in the household

Respondents were required to indicate their commonly source of food in the household. Findings
are shown in Table 4.15

Table 4.15 Household source of food

21
Source of food in the Household F r e q u e n c y P e r c e n t a g e

P u r c h a s e 2 8 2 3 . 3 %

Household farm 92 76.7%

Donations 0 0%

T O T A L 1 2 0 1 0 0 %

Table 4.15 show that 76.7% of the respondents obtain their food in the household from
household farm, 23.7% are purchasing while no one get food from donations.

22
CHAPTER FIVE

SUMMARY, CONCLUSION, AND RECOMMEDATION OF THE STUDY FINDINGS

5.0 Introduction
This study aimed at determining the factors that contributes to early cessation of exclusive

Breastfeeding for the first six months. This chapter focuses on the summary, conclusion,
recommendation and suggestions for further studies

5.1 Summary
The main objective of this study was to determine the factors that contribute to early cessation of
EBF at MCH at Aghakan Hospital Kisumu. Descriptive research design was used in the study
and the study and the study and the study population included all mothers with infants aged
between 0-6 months visiting the MCH clinic and a sample size of 12 respondents was used. A
questionnaire was also used in data collection with an interview guide.

5.2 Conclusion
According to this study, the following conclusions were drawn.

1. The most common factor why mothers introduce complementary feeds before the infant
is six months is insufficient breast milk production by the mother which was at 70% an d
the study indicates that majority of mothers 55% do so from their own decision.
2. It is evidenced from this study that educational level of the mother greatly influences the
adherence of EBF since 38.3% of mothers were secondary level and 25% were college
and above and they report of having more knowledge on EBF. Despite this, 39.7% did
not know the exact duration of EBF.
3. From the study, 58.35 of respondents were married compared to 19.2% single, 10.8%
divorced, 11.7% widowed. Married mother`s reports high breastfeeding rate and this
indicates that spousal support influences adherence and duration of EBF.
4. Despite the fact that most of the sampled mothers deliver in hospital which represented
73.3%, it indicates that 59% of sampled mothers don’t know the exact time of
introducing complementary feeds this show that health workers don’t give enough health
education to mothers during their antennal and postnatal visits.
23
 5. Material age influences adherence ton EBF has 35% of sampled mothers had children
more than two and they report of having more experience than their younger
counterparts.
6. Material occupation influence mothers choice of breastfeeding has most of the sampled
respondents were working either as employed or business women and report limited time
of breastfeeding which necessitates them to introduce other foods before the infant is six
months.
7. Socio-economic status, socio-cultural factors, type of delivery, household source of
income and sex of the child are the factors found not greatly influencing adherence of
EBF.

5.3 Recommendation
According to this study, the following recommendations were made;

1. To reduce cases of malnutrition and child infections, early introduction of complementary

feeds to infants before six months should be discouraged.
2. There is need for health education to explain to mothers the duration and importance of
EBF and should be done in MCH, Antenatal and Post Natal clinics in all health facilities
by health workers.
3. Mother to mother support groups are important for the success of exclusive breastfeeding
as they will offer a platform for mothers to share challenges of breastfeeding and also
success stories to motivate them to exclusively breastfeeding their infants for the first six
months after birth.
4. More facility based health messages should be given to all nursing mothers including the
TEN STEPS to exclusive breastfeeding.

24
5.4 Suggestions for further research
The following suggestions are made for further research

1. Based on the reported low prevalence of exclusive breastfeeding of 13% further research
should be conducted to investigate the role of community participation in promoting
exclusive breastfeeding.

Similar research is necessary at private health facilities in order to compare the infant feeding
practices with public facilities as this will enable

25
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APPENDICES

1: QUESTIONNAIRE
INTRODUCTION
My name is AthemboAustinn😖and I am a student at African Institute Research and
Development Studies. I am interested in investigating the various factors that prevents Mothers
from exclusively breastfeeding their infants between the age zero to six months in Eldoret town.
The information obtained from this study will be for the purpose of my academic study as well
as to help know some of the factors that promote inadequate exclusive breastfeeding.

CONSENT
If you consent to the study I reassure you of confidentiality in all the information you will give.
Do you consent to participate?
1. Yes

2. No

Thank you

DEMOGRAPHIC AND SOCIO-ECONOMIC CHARACTERISTICS

I would like to ask you some questions about yourself and child.

Kindly tick on the appropriate space provided. 

1.1. What is the range of your age?

15-29 30-39 Above 40

 

1.2. What is your marital status?

Married divorced separated widow Single

  
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1.3. What is your level of education?

Primary Secondary College University

   

1.4. What is your occupation?

Businessperson farmer trader professional other (specify)

   
Where do you live?

Langas Kimumu Huruma Kipkaren other(specify) …………………

    

2.0. Infant and fathers’ demography.

2.1. How old is your child’s father?

1) 15-30 2) 26-35 3)36-45 4.) Above 40

   
2.2 what is the child’s father occupation?

Self-employed skilled labor farmer other (specify)

2.3. What is your child’s birth order?

1st 2nd 3rd 4th other (specify)

2.4. what is your child’s gender?

Male  Female 

2.5. How old is your child?

1 month 2 months 3months 4 months 5months other

   

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2.6. Where was your child born?

Health facility  home 

a. Mother’s knowledge on exclusive breastfeeding?

3.1, what is the benefit of exclusive breastfeeding?

Nutritive Bonding cheap immunity other (specify)

   

3.2, is the first milk from breast after delivery good for the baby?

Yes  No 

3.2.1. If Yes, why?

Protective Nutritive other (specify)

 

3.2.2. If No, why?

Make the baby ill  is bad  other(specify) …………………….

3.3 What is the appropriate time to breastfeed the baby for the first time?

Within one hour  within 24 hours  After 3 days 

3.4 How often should the baby be breastfed in a day?

On demand 5-7 times 14-17 times 17 and more times

   

3.5 How long should a baby suckle on one breast?

10-15 times  as longs as the baby want  other(specify) ………………

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3.6 Does a baby on exclusive breastfeeding need water?

Yes  No 

3.7 Do you feed baby on milk substitutes?

Yes  No 

3.7.1 If Yes, which one? Infant formula cow’s milk others (specify) …………
 
3.7.1.1 And why?

It is cheap it is readily available it is nutritive others (specify)……………

3.7.1.1.1 What other barriers prevent a mother from exclusive breastfeeding in the first six
months? Tick against those which you think is barriers:

1. Misconception that formula is equivalent (2) Social norms (breastfeeding is undervalued)

3. Poor family and social support (4) Embarrassment about feeding in public

5. Lactation problems (6) returning to work

4. Medical condition of post-maternal mothers

4.1 Have you suffered from the following diseases before?

Tuberculosis severe illness herpes others (specify)

  

4.2 Are you suffering from the following medical conditions?

Breast abscess tuberculosis HIV/AIDS Mastitis others(specify)

 
 

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Budget

I t e m N o D e s c r i p t i o n C o s t ( K s h s )
1 I n k p e n s 1 0 0
2 I n t e r n e t c o s t s 5 0 0
3 Data collection costs 1 , 5 0 0
4 Tr av el l in g c os t s 3 , 0 0 0
5 m e a l s 6 , 0 0 0
6 Writing materials 1 , 0 0 0
7 M i s c e l l a n e o u s 2 , 0 0 0

TOTAL AMOUNT=Kshs .14, 100

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