CHAPTER ONE

INTRODUCTION

1.1 Background

The World Health Organization (WHO 2017) defines exclusive breastfeeding (EBF) as the procedure whereby infants receive only breast milk from a mother or wet nurse expressed to a child, with no other liquids or solids inclusive not even water for the first six months with the exception of oral rehydration solutions, syrups of vitamins and minerals, or medication. Exclusive breastfeeding of infants for the first six months of life is considered a global public health goal that is linked to the reduction of morbidity and mortality in infants especially in low middle-income countries (Alamirew et al., 2017). International agencies and policy makers adopted a declaration in August, 1990, which affirmed that all infants should be exclusively breastfed from birth till four months of age. Subsequently, the WHO recommendations amended the breastfeeding declaration to six months in 2001(WHO 2017). Global public health recommendation by the WHO and the United Nations Children’s Fund (UNICEF) requires infants to receive only breast milk for the first six months of life coupled with lactation and other complementary food for up to two years or beyond (Wallenborn et al., 2017). Knowledge about breastfeeding recommendations is important as it may influence breastfeeding practices especially for first-time mothers (Rozario et al., 2017). Globally, approximately 34.8% of infants are exclusively breastfed for the first six months of life (Weldearegay et al., 2017). Exclusive breastfeeding is the first prized gift from mother to the baby that exists to benefit the baby, mother, and community (UNICEF 2010). Exclusive breastfeeding has numerous benefits in terms of providing energy, protein, water, and other nutrients required for the development of an infant (Chowdhury  et al., 2015). Other benefits of EBF include growth improvement as well as enhanced development of the immune system and cognitive ability of children (UNICEF 2016). Breast milk carries antibodies from the mother that helps in combating diseases and in addition helps prevent future harm and reduces spending on future health care (Nyobe et al., 2018). More so, breast milk also provides a healthy weight balance thereby reducing children’s risk of becoming overweight (Ngongalah et al., 2018). Evidence-based research has proven that some deaths can be prevented through proper breastfeeding methods where improved lactation rates can save globally over 800,000 children under five years annually (Victoria et al., 2018). Due to these benefits, the WHO and UNICEF recommend that all mothers should breastfeed their children exclusively for the first six months and thereafter continue to breastfeed for as long as the mother and child desires, with appropriate and sufficient weaning food included after six months of life (UNICEF 2016). Non-compliance to adequate lactation practices is a public health threat and concern with major causes of deaths and morbidity in infants and young children (WHO 2020). Furthermore, failure to exclusively breastfeed for the first six months of life can result in 1.4 million deaths and 10% of disease burden in children younger than five years according to Black et al. and Gejo et al. (Allen et al., 2018). When an infant is inadequately breastfed, the child becomes more exposed to risk factors and health complications such as frequent gastrointestinal infections and poor brain development coupled with lower and upper respiratory tract infections (Tromp et al., 2017). Approximately 41% of under 05 death’s occurrence in Sub-Saharan Africa (SSA) is linked to inadequate breastfeeding in combinations with other diseases which causes about 30% of diarrhea deaths and 18% of acute respiratory deaths (WHO 2017). Promoting proper feeding practices is one of the main programmed areas that the Department of Nutrition for Health and Development in Cameroon focuses on by providing counselling courses and guidance for the protection, promotion, and support of infant and young child feeding (Woldie et al., 2021). Promoting and striving to increase the trends of EBF in Cameroon are also done by implementing the National Breastfeeding Sensitization Plan by the Ministry of Public Health Cameroon (2016) in partnership with WHO in Cameroon. Exclusive breastfeeding is a well-acknowledged and cause-effective intervention against malnutrition related illnesses in children (Walker et al., 2021). Despite the documented importance and advantages of practicing EBF, the practice is still not widespread with an unsatisfactory level recorded across the globe and most especially in developing countries (Gedamu et al., 2016]. More is yet to be done to narrow this gap and sustain EBF practices. Still, the associated factors vary within different countries and even within the same country where a gap still exists (Gedamu et al., 2016). In Cameroon, about 92% of children less than six months old are exposed to breastfeeding, but of these, less than 50% are exclusively breastfed for six months and about 88.8% receive colostrum (UNICEF 2018). This study was designed to assess adherence and to identify determinants influencing the shortened time to exclusively breastfed in Yaoundé, Cameroon, using a survival analysis approach. Interventions such as maternity leave and nursing breaks for working mothers were introduced although they are not fully implemented where only 42 countries (23%) meet or exceed the recommendation of 18 weeks’ leave for breastfeeding mother (Rollins et al.,2016). Findings from this study are needed to provide and update information on the current situation and also make recommendations on what can be done to comply with the six months exclusive breastfeeding plan as recommended by the WHO (WHO 2019).

1.2 Statement of the Problem.

In Cameroon according to World Health Organization (WHO) report, the overall practice of exclusive breastfeeding (EBF) stands at 36%, with the highest rates of EBF found in East  (43%) and the lowest rates of EBF in West (20%) (WHO 2011, UNICEF 2012).However, recent analysis on the global prevalence of EBF across 140 countries shows an increase in the developing world from 33% in 1995 to 39% in 2010 among infants aged 0-5 months. (Wardlaw at al., (2012)).

In Regional hospital Buea, only 20  in fifty  Cameroon children below the age of six months are exclusively breastfed with only half the proportion of the children in South Western district exclusively breastfed (34%). It is no wonder then that the under-five and infant mortality rates stand at 128 and 79 per 1,000 live births respectively, which is very high by developing world standards. (Economic Policy Research Center, 2012).

In Cameroon, Yaounde a study was carried out on random selected individuals were 403 in number. In the study it was found out that majority of women were aware of the compliance with EBF why some practice it and few lack the knowledge. 

However, lactating mothers are unaware of the benefits of EBF and risk associated with bottle feeding, this therefore prompt the research to further investigate how much knowledge EBF of the Regional Hospital Buea has towards the practice. So the new born babies health problems can be avoided there by reducing infant mortality 

 1.3 Research questions

1. What level knowledge do mothers attending ANC at the regional hospital Buea have on exclusive breastfeeding?
2. What are the importance of exclusive breastfeeding among mothers attending antenatal care at the RHB?
3. What are the challenges faced by mothers attending ANC at the regional hospital Buea with respect to exclusive breastfeeding.

1.4 Objectives

 1.4.1 General objective.

To assess the factors affecting the effective practice of exclusive breastfeeding among mothers attending antenatal care (ANC) at the Regional Hospital Buea.

1.4.2 Specific Objectives

1. To assess the knowledge of mothers attending ANC at the Regional Hospital Buea on exclusive breastfeeding.
2. To find out if mothers attending ANC at the Regional Hospital Buea know the importance of exclusive breastfeeding.
3. To identify the challenges faced by mothers who attend ANC in the practice of exclusive breastfeeding at the Regional Hospital Buea.