ABSTRACT

Background: Exclusive breastfeeding (EBF) is the best nutrition for children during the first six months of life. However, EBF remains a challenge. The aim of the cross-sectional study was to assess Knowledge, Attitude and Practice of Exclusive Breastfeeding among mothers in the Buea Town community. Method:  Using a structured self- administered questionnaire validated by the research supervisor, data was collected from 100 conveniently sample mothers and analyzed using SPSS version 21.0. Result: out of 100 sample mothers 81% had good knowledge on Exclusive Breastfeeding, 30% practice exclusive breastfeeding for six months and 90% face challenges of short maternal leaves in practicing Exclusive breastfeeding for the appropriate require months. Conclusion: The majority of mothers knew about Exclusive Breastfeeding and have a positive attitude towards EBF but did not know the recommended duration or that EBF is beneficiary for six months. Recommendation: we suggest improving access to information about recommended infant feeding guidelines and fulfilling the minimum enabling condition.

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Over the last couple of decades, there has been an increasing interest in the promotion of exclusive breastfeeding as the ‘best’ feeding method for newborns. To a large extent, it has been inspired by mounting scientific evidence on the importance of exclusive breastfeeding in reducing infant morbidity and mortality. In resource-limited settings where poor and sub-optimal breastfeeding practices frequently result in child malnutrition which is a major cause of more than half of all child deaths (Sokol et al., 2007), exclusive breastfeeding is regarded as imperative for an infant’s survival. Indeed, of the 6.9 million under-five children who were reported dead globally in 2011, an estimated 1 million lives could have been saved by simple and accessible practices such as exclusive breastfeeding (WHO, 2012). Consequently, the WHO and UNICEF (1990) have recommended exclusive breastfeeding for six months, followed by the introduction of complementary foods and continued breastfeeding for 24 months or more.

Humans and apes (all hominoids) have had similar defining features of their reproductive physiology including lactation and breastfeeding throughout history (Kennedy, 2005); yet detailed anthropologic work on ancient breastfeeding practices and patterns has rather been scanty (Sellen, 2009), a death that is partly blamed on the male centred perspectives that focus primarily on male activities to the neglect of female related ones such as breastfeeding and childbirth (Stuart-Macadam and Dettwyler,1995). Even so, breastfeeding has been reported as an age-old practice that has been critical not only to the physiology, growth, and overall well-being of neonates but to the physiology and health of women as well (Stuart-Macadam and Dettwyler, 1995). Indeed, scarcely does society exist without some form of infant breastfeeding; for it is one of the practices among human societies that transcend the boundaries of time and place. The practice has been a method of feeding to which infants have not only adapted but lived for most of the human existence on earth (ibid). It was also over the course of several centuries, significantly practised, respected, and the primary attractor of many artistic works such as paintings, drawings, and sculptures (Tonz, 2000; Sellen, 2009).

In many ancient societies, breastfeeding practices were often guided by traditions, ancient medical literature etc. For instance, the Susruta, an ancient Indian medical text recommended that “in the six months of its birth the child should be fed on light and wholesome rice” (Fildes, 1986 p.16). Similar ancient medical texts such as the Ayur Vedic stipulated the use of breast milk as the sole food for babies until the end of the first year (ibid, 2008). Besides, early religious scriptures such as the Bible and the Quran also had and still have some recommendations on breastfeeding practices. In Isaiah chapter 66 verse 11, it is mentioned ‘that ye may suck, and be satisfy with the breast of her consolations; that ye may milk out and be delighted with the abundance of her glory’ (Bible, the book of Isaiah 66:11). The Quran similarly stipulates that ‘the mothers shall give suck to their children for two whole years, (that is) for those parents who desire to complete the term of suckling……. And if you decide on a foster suckling mother, there is no sin on you, provided you pay the mother what you agreed on a reasonable basis (Quran 2:233). Indeed, until the 19^th century,  in virtually all human societies and almost every child was breastfed regardless of the sociocultural environment and economic status (Soko et al., 2007). Even when mothers were not in a position to breastfeed owing to sickness, death, etc. other women were made to breastfeed the newborn. Over time, these women, called wet nurses became readily and widely available for breastfeeding services, especially for affluent families. According to Stevens, Patrick and Centuryry, breastfeeding was the norm.

In Africa, an estimated 84% of children younger than 2 months are being exclusively breastfed. By age 4 to 5 months, however, only 49% continue to receive exclusive breastfeeding (Ghana Statistical Service & ICF Macro, 2009). To understand the dynamics of the practice, several studies have been conducted in Ghana and many parts of the world. Many studies have focused on factors and barriers to exclusive breastfeeding (Aidam et al., 2005; Otoo et al., 2009; Senarath et al., 2010). Some too have looked at the health outcomes of exclusive and nonexclusive breastfeeding (Duncan et al., 2009; Coutsoudis et al., 1999; Kramer, 2003); while others have also studied the potential role of husbands in breastfeeding decisions (Arora et al., 2000; Susin, et al., 2008). Much fewer attempts, however, have been made at investigating how the family might influence exclusive breastfeeding practices, especially in sub-Saharan Africa.

Perhaps, one of the things for which early breast milk substitutes would continue to be remembered is the soaring infant mortality that attended to its use. Countless artificially fed infants suffered from infectious diseases e.g diarrhoea and died more often than their breastfed counterparts. In the southern part of Germany where infants were customarily fed with a mixture of flour, water and animal milk, infant mortality skyrocketed to 400 deaths per 1000 live births, a proportion that was four times the mortality rate in Norway (Palmer,2009).

Storage facilities and knowledge about the energy requirements for infants made breast milk substitutes a relatively safer alternative (Crowther et al., 2009). But even so, artificially fed babies bore a substantial risk of morbidities and deaths compared with breastfed ones. In Boston for instance, a study in 1910 reported a sixfold likelihood of death among artificially fed babies than breastfed ones (Palmer, 2009).

1.2 Problem statement

Infants below 6 months of age have not yet fully developed to make use of other foods. Besides, breast milk has been well-established among Public Health scientists; hence the recommendation for EBF for all children under six months old. However, efforts to promote EBF have either in most cases achieved less than desired outcomes or run into severe problems. One contributory factor to such outcomes is that public health intervenes more often and is tailored to meet the individual needs of breastfeeding mothers without taking into account the wider impact of family influence on behaviour and decision-making This perhaps is conceivable given the poor understanding of family influences on infant feeding particularly in rural areas, by not respecting breastfeeding, poor knowledge about decision-making on the nutrition choices, time constraint, etc. An in-depth understanding of family structures in rural communities is thus central to the development of comprehensive approaches to health interventions and education services in Cameroon. Thus this study sought to assess the Knowledge attitude and practice of exclusive breastfeeding among mothers in the Buea town community.

1.3 Rationale

The purpose of this study was to assess knowledge, attitudes and practice of exclusive breastfeeding among mothers. Previous studies carried out on topics related to the breast have proven that there is a gap in the literature when it concerns the challenges faced by women in practising exclusive breastfeeding which is one of the objectives of this study.  The results of this study will help the medical personnel working hand in hand with these women during ANC and IWC to make sure that education is geared towards achieving good nutrition for these children immediately after birth and to make sure that women understand the importance of breastfeeding and how it should be practised following the national breastfeeding policies.

Most studies on exclusive breastfeeding have targeted women of childbearing age as a whole. This is one of the few studies to explore the knowledge and practice of EBF among breastfeeding mothers in the Buea Town Community. Mothers in the semi-urban area usually have the challenge of practising exclusive breastfeeding because of work-related time constraints and other sociocultural factors. During my community placement at the Buea Town Community, I noticed that exclusive breastfeeding was low and thus the results from this study will help identify the challenges faced by these mothers in the practice of exclusive breastfeeding.

1.4 Research Questions

1. What knowledge do mothers have concerning exclusive breastfeeding?
2. What are the perceived practices carried out by mothers on exclusive breastfeeding?
3. What are the challenges faced by mothers in performing exclusive breastfeeding?

1.5 Research objectives

1.5.1 General objective

The general objective of this study was to assess the knowledge, attitude and practices of Exclusive Breastfeeding among mothers in the Buea Town Community.

1.5.2 Specific objectives

1. To assess the knowledge of mothers on exclusive breastfeeding.
2. To determine the perceived practices of mothers towards exclusive breastfeeding
3. To assess the challenges faced by mothers in performing exclusive breastfeeding