Knowledge and Practice of Exclusive Breastfeeding Among Mothers of Children Under One Years in Boudha

doi:10.21203/rs.3.rs-608449/v1

Breast milk is the best nutrition for babies to achieve proper, growth and development and is said to be the first immunization, but in content of Nepal only one in two child less than age of six months is exclusively breastfed. So this study helped to find the knowledge and their practice regarding exclusive breastfeeding in women living Boudha area.

Methodology: This is quantitative study, done by simple random sampling method. Data collection was done by interviewing 194 mothers in community by using structure questionnaire. The data was entered in SPSS v.22, after cleaning and coding, data were analyzed using chi-square statistical test as well as basic descriptive statistics.

Results: This study was conducted among mothers of children under 1 year. Total responded were 194 with mean age and standard derivation of 26, 4.01. The minimum age of 16 years and maximum age of 36 years. Majority of the respondents are literate. Most of the respondents 48.5% are house wife, 44.3% monthly earning is below Rs 25000. All the respondents 100% do breast fed their babies. Good numbers of respondents 96.4% have high knowledge on breastfeeding. There is association between knowledge and practice (P value 0.06) and association between education and knowledge (P value 0.00) as well as there is association between occupation and knowledge (P value 0.047). Moreover, the current study found that there is no association between education and practice.

Conclusion: Present study shows that knowledge of exclusive breastfeeding among mothers living in Boudha are good compare to practice. There should be awareness program needed to address to improve their practice also.

Public Relations

Breastfeeding

knowledge and practices

Breastfeeding is the most paramount way of providing most ideal food for the normal growth and development of infant. Many studies have demonstrated that exclusive breastfeeding for a period six months is the essential way of feeding infants. Subsequently after the period of six months’ baby can start complementary or supplementary food along with breastfeeding up to two years of age and beyond.

WHO and UNICEF recommend initiation of breastfeeding within the first hour of life, exclusive breastfeeding (that is the infant only receives breast milk without any additional food or drink, not even water), and no use of bottles teats or pacifiers. (1)

Breast milk is the ideal food for a baby; it contains all the nutrients examples carbohydrates, protein, fat, water in their right proportion. Breast milk does not only provide essential feed for babies but it equally contains antibodies that help to fight infections. These antibodies are very important because they are necessary to strengthen the immune system.

Breast milk provides all the energy and nutrients that the infant needs for the first month of life and it promotes sensory and cognitive development. Exclusive breast feeding lessens infant mortality due to common childhood illnesses such as diarrhea, pneumonia, and help for a quicker recovery during illness. Breast feeding contributes to the health and well-being of mothers, it helps to space children, reduce risk of Ovarian cancer and breast cancer, increase family and national resources is a secure way of feeding and is safe for environment.

Study Design

The current study is a Quantitative Community based cross sectional which used Simple Random Sampling method.

Research Setting

Boudha is a small locality resided within the capital city of Kathmandu, Nepal. Located about 11 km from the center and northeastern outskirts of Kathmandu. The total population of Kathmandu in 2019 is roughly approximated to 985000. Boudha is ethnically culturally diverse, Hinduism and Buddhism are two primary religions in the city, and Nepali is the most commonly spoken language as well as Nepal Bhasa and English. (6)

Sample Selection

One ward of Boudha is selected using simple random sampling

Data Collection Tool

Interview with the community people by using structure questionnaire

Sample Size:

According to the National Health Survey Book of Nepal the prevalence of exclusive breast feeding is 66% so, the current study took 66% as the prevalence factor, 7% error with 95% confidence interval.

Sample size=Z ² pq/ d ² = (1.96) ^{2 *} 0.66 * 0.34 /0.0049

=176

Non response rate 10% of 176

=17.6

Total sample size is 194

Distribution of respondents according to Socio demographic characteristics:

Totally 194 mothers having children under one years were interviewed, with mean age and standard deviation of 26, 4.01. Minimum age was 15-19 years and maximum age was 25-29 years. 64.4% belongs to nuclear family whereas 35.6 %as joint family, 24.7% of the respondents have secondary level of education and only 9.3% have university degree. The majority of the respondents 49.5% were Hindu, 40.2% were Buddhist and rest 10.3% were Christian. Almost 48.5% of the women were housewife and only 1% supported her family by farming.44.3% had monthly income of below 25000 whereas only 7.7% had more than 75000. (68.6%) of the respondents reported that their annual income was sufficient for less than three months and only 0.5% reported that their monthly income would be sufficient for 6-12 months.

Table 1: Summarize the demographic characteristics of the participants in this study.

Table 1: Frequency distribution of the demographic characteristics of the study participants n=194
Variables	Subgroup	Study Participants
		Frequency/ Count	Percentage
Age Group Mean age= 26
15-19		14	7.2
20-24		43	22.2
25-29		97	50.0
30 and above		40	20.6
Family Type
Nuclear		125	64.4
Joint		69	35.6
Education
Illiterate		24	12.4
Literate		26	13.4
Primary		47	24.2
Secondary and Higher Secondary level		79	40.7
university degree		18	9.3
Religions
Hindu		96	49.5
Buddhist		78	40.2
Christian		20	10.3
Occupations
Agriculture		2	1
Government employee		28	13.9
Business		16	8.2
Labor		43	9.8
Housewife		94	48.5
Others		36	18.3
Income
below 25000		86	44.3
25000 – 50000		68	35.1
51000 - 75000		25	12.9
greater than 75000		15	7.7
For how many months your family monthly income is sufficient
Sufficient monthly income		Frequency	Percent
<3months		133	68.6
3-6 months		60	30.9
6-12 months		1	.5
Do you have to take permission from your family for seeking of health services during pregnancy
Yes		129	66.5
No		65	33.5
Who is decision maker in your family for seeking of health services
Husband		93	47.5
father/mother-in-law		34	17.5
Self		67	35.0
With whom you go for health checkup
Husband		90	46.4
mother-in-law		20	10.3
Friends		34	17.5
Alone		37	19.1
Others (Aunty, Father, Mother, Sister, Sister-in-law)		13	6.7
What is the distance from your home to the nearest hospital or health facility
1-3km		71	36.6
more than 3-5km		94	48.5
more than 6-8km		29	14.9
Total		194	100%

(66.5%) of the respondent’s responses that they take permission from family for seeking health service during pregnancy and 33.5% does not. (47.5%) reported that their husband is decision maker for seeking health services whereas 17.5% said their father/mother in law and 35% reported self. During pregnancy 46.4% of women visited health services with their husband, 19.1% visited alone and 6.7% with others relatives of the family. (48.5%) of the respondents had reported that it will take more than 3-5 Km to reach a health facility, 36.6% said 1-3 Km and only 14.9% said more than 6-8 Km.

Table 2: Summarized the basic information of baby

Table 2: Frequency distribution of the general information of baby n=194
Variables	Subgroup	Study Participants
		Frequency/ Count	Percentage
Gender of baby
Female		106	54.6
Male		88	45.4
Age of baby
1 month - 6 months		111	57.2
7 months - 12 months		83	42.8
Delivery type
Normal		123	63.4
Caesarean		71	36.6
Place of delivery
Government hospital		72	37.1
Private hospital		91	46.9
Home		15	7.7
Health post		16	8.2
Total		194	100

According to table 2 describes general information of babies. Among 194 children 54.6% 0f babies were female and 45.4% were male. (57.2%) 0f babies were belongs to age group of 1months- 6months whereas 42.8% comes under 7-12months. (63.4%) of women had normal delivers while 36.6% had caesarean delivery, 46.9% of delivery was done in private hospitals, 37.1% at government hospitals, 8.2% at health post and 7.7% had home delivery.

Table 3: Knowledge on breastfeeding

Table 3: Frequency distribution regarding knowledge on breastfeeding n=194
Variables	Subgroup	Study Participants
		Frequency/ Count			Percentage
Have you ever heard about colostrum
Yes		148			76.3
No		46			23.7
What should be done with colostrum
Should be fed		133			68.6
Should be discarded		8			4.1
Don’t know		53			27.3
Knowledge of the mothers regarding the importance of colostrum feeding to baby
Yes				No		No idea
Develop immune system 134 69.1%				46 23.7%		14 7.2%
Help to prevent allergy 79 40.7%				102 52.6%		13 6.7%
Help to prevent jaundice 54 27.8%				127 65.5%		13 6.7%
When should be breastfeeding be initiated after birth?
within 1 hour		123			63.4
within 24 hours		59			30.5
Don’t know		12			6.2
Do you know about the advantage of breastfeeding
Yes			184		94.8
No			10		5.2
Breast feeding benefits
			Yes		No
Prevent from ovarian and breast cancer			44 23.9%		140 76.1%
Breast feeding is nutritious and protective for the baby against infection			170 92.4%		14 7.6%%
acts as a natural contraception provided it is prolong and exclusive			73 39.7%		111 60.3%
Breastfeeding increases the bonding between mother and child			129 70.1%		55 29.9%
helps to lose weight post pregnancy			28 15.2%		156 84.8%
What is the minimum time you should breast feed in a day
more than 5 times			13		6.7
more than 8 times			29		14.9
more than 10-12 times			137		70.6
don’t know			15		7.7
What is minimum time you should breastfed baby at one time
5 minutes			21		10.8
10 minutes			44		22.7
15 minutes			102		52.6
don’t know			27		13.9
Do you know about the fore milk and hind milk
Yes			83		42.8
No			111		57.2
Do you know the signs of fully fed of baby
Yes			191		98.5
No			3		1.5
Signs			Yes		No
Wet burp			113 59.2%		78 40.8%
Fall asleep			118 61.8%		73 38.2%
Baby body feels relaxed and loose			72 37.7%		119 62.3%
Stops crying			91 47.6%		100 52.4%
Stop sucking			129 67.5%		62 32.5%
Do you heard about exclusive breastfeeding
Yes			159		82.0
No			35		18.0
If yes, where did you get that information
Friend			10		5.2
Radio/TV			33		17.0
Health institution			123		63.4
Family			9		4.6
Others (FCHV, Nutrition, Nutrition program, Nutrition program)			19		9.8
How long a child should be fed only breast milk
2 months			1		.5
4 months			15		7.7
6 months			167		86.1
don’t know			11		5.7
In your opinion, is it sufficient to breastfeed only till 6 months
yes		137			70.6
no		57			29.4
Do you know the right time to introduce complementary food
Yes		159			82.0
No		35			18.0
Total		194			100

Table 3 summarizes about the knowledge of mothers who has been interviewed regarding breast feeding. Among them 76.3% of mothers have heard about colostrum rest 23.7% haven’t heard, 68.6% respondent said colostrum milk should be fed, 27.3% said don’t know and 4.1% said discarded. (69.1%) respondent responses that colostrum develops immune system, 52.6%. Among respondents 52.6% didn’t agree colostrum prevents allergy while 40.7% agreed and 6.7% have no idea. (65.5%) mothers don’t know that it helps to prevent jaundice, 27.8% have known rest 6.7% don’t have any idea regarding this. Mothers who responded that breastfeeding should be initiated within 1 hours after births are 63.4% besides 3.1% said after 2 hours. (94.8%) have knowledge about advantage of breastfeeding and 5.2% don’t have. (76.1%) doesn’t know that breastfeeding prevents different forms like ovarian and breast cancer whereas 23.9% have known about it. (92.4%) accept that breastfeeding is nutritious and protective for the baby against infection while 7.6% doesn’t agree; 60.3% mothers disagree that bf acts as a natural contraception provided it is prolonging and exclusive where 36.7% agreed. (70.1%) of mothers responded agree bf increase the bonding between mothers and child but 29.9% disagree. Regarding breastfeeding helps to lose weight post pregnancy 84.8% disagreed only 15.2% agreed. (70.6%) responded response that baby should breast feed more than 10-12 times in a day, 14.9% said more than 8 times, 7.7% didn’t know and 6.7% said more than 5 times. (52.6%) mothers said that baby should be breast feed 15 minutes at one time, 22.7% reply 10 minutes, 13.9% said don’t know and 10.8% said 5 minutes. (57.2%) mothers responded that they don’t know about hind and fore milk and 42.8% have known about it. (98.5%) mothers responded they know the signs of fully fed of baby where 59.2% said wet burp, 61.8% said fall asleep, 37.7% said baby body feels relaxed and loose, 47.6% said stop crying and 67.5% said top sucking. About exclusive breastfeeding 82% of mothers have knowledge about it rest 18% don’t have. (56%) of mothers get knowledge about exclusive breastfeeding from health institutes whereas 20% from radio/ TV, 12% from others like (nutrition program, FCHV) etc., 6% from family and rest 6% from friends.

(86.1%) mothers said that baby should be fed only breast milk till 6 months, 7.7% said 4 months, 5.7% said don’t know and .5% said 2 months; (67%) mothers disagreed that baby should not give any other food/liquid(water) to child under six months’ rest 33% agreed they can. Among them 53% of mothers said they can give lito, 27% said water, 19% said others (cereals, lactogen, etc.) 2% said rice. (82%) of mothers have knowledge about right time to introduce complementary food whereas 18% don’t have.

Table 4: Feeding Practice

Table 4: Frequency distribution on feeding practice n=194
Variables	Subgroup	Study Participants
		Frequency/ Count	Percentage
Have you ever breastfeed your child
Yes		194	100.0
Did you feed only breast milk for six months
Yes		136	70.1
No		51	26.3
Don’t remember		7	3.6
When did you breastfeed the baby first time after birth
within 1 hour		126	64.9
after 1 hour		20	10.3
after 2 hours		16	8.2
within 24 hours		32	16.5
Did you feed colostrum milk to your baby
Yes		143	73.7
No		51	26.3
If no, why
Milk doesn't come		14	7.2
Baby couldn't suck		11	5.7
Due to caesarean mother couldn’t feed		26	13.4
Total		51	26.3
did you feed anything other than breast milk after you started breastfeeding
Yes		51	26.3
No		136	70.1
don't remember		7	3.6
If yes, what was that
Formula milk		45	88.0
Water		6	12.0
What are you feeding to your child till date
Only breast milk		84	43.3
Milk of cow or buffalo and breast milk		13	6.7
Water and breast milk		12	6.2
Other complementary food		85	43.8
How many times do you breastfeed your child in a day
more than 5 times		28	14.4
more than 8 times		36	18.6
more than 10-12 times		130	67.0
Do you know when is weaning ceremony organized
5 months		64	33.0
After the completion of 6 months		110	56.7
7 months		11	5.7
8 months		9	4.6
Total		194	100

Table 4: Summarized about practices of mothers regarding exclusive breastfeeding and complementary feeding. As we interviewed mothers having child under one years so 100% 0f them have done breast feeding. Among them 70.1% have feed only breast milk till 6 months, 26.3% didn’t rest 3.6% didn’t remember. After birth 64.9% of mother’s breastfeed child within 1 hours, 16.5% feed within 24 hours, 10.3% feed after 1 hours and 8.2% feed after 2 hours. (73.7%) of mothers have feed colostrum milk to their baby but 26.3% didn’t; Among them 13.4% of mothers told that due to caesarean she couldn’t feed, 7.2% stated milk doesn’t come and 5.7% expressed baby couldn’t suck.

Among mothers 70.1% of them didn’t feed anything other than breast milk after they started breastfeeding, 26.3% feed something and 3.6% don’t remember; where 88% feed formula milk while 12% gave water. Among 194 children 43.3% are given only breast milk till date, 43.8% are given other complementary food, 6.7% are given milk of cow or buffalo and breast milk rest 6.2% water and breast milk. Form the 43.8%, (44%) mothers give normal foods, 28% gives jaulo, 20% gives egg and 8% gives fruits. (67%) of the respondents reported that they are breast feed their child more than 10-12 times in a day while 14.4% breast feed more than five times in a day. (56.7%) of the mother were reported that weaning ceremony will be conducted after completion of 6 months, 33% said when babies are five months, 5.7% said 7 months followed by 4.6% said when babies are 8 months.

Based on Figure 1, 96.4% of the mothers have good knowledge towards breast feeding while 3.6% have poor knowledge toward breast feeding. And almost 51% of the respondents had poor practice of breast feeding while 49% have good practice of breast feeding.

Through a face to face interview with 194 mothers, the study has found that a good number of respondents 96.4% have high knowledge on breastfeeding while almost 51% of the respondents had poor practice of breast feeding while 49% have good practice of breast feeding. There is association between knowledge and practice (P value 0.06) and association between education and knowledge (P value 0.00) as well as there is association between occupation and knowledge (P value 0.047). Moreover, the current study found that there is no association between education and practice.

While according to Ulka et al. International Breastfeeding Journal 2012 exclusive breastfeeding to children till 6 months is not done properly, but there is high percent of mother who gave colostrum and initiated breastfeeding within one hour of delivery. In contrast to the current study which shows despite the knowledge of mothers on breastfeeding are high but practice was poor but the study which was published in Nepal on 2015 describes about the level of knowledge and practices of exclusive breastfeeding among mothers. During this study knowledge and practices of EBF was quite well among mothers still there is various need to address.

The major conclusion was drawn on the basis of objectives and study findings. Though many respondents knew advantages of breastfeeding to baby there were indications that certain key messages had not been addressed. The study showed that good knowledge was found in the area of expressing breast milk but still there is lack of good practice. Early introduction of other foods/drinks including semi-solid foods was common. There is necessity to promote the knowledge and practice on exclusive breastfeeding among mothers through the provision of health information and supervision from the health personnel, which could be carried out within the existing healthcare system such as the antenatal and vaccination clinics.

Ethics: Student Internal Ethical Committee SRM SPH has approved. Competing Interest: I declare no competing interest.

1. WHO | Breastfeeding [Internet]. WHO. [cited 2019 Mar 20]. Available from: http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/

2. Ulak M, Chandyo RK, Mellander L, Shrestha PS, Strand TA. Infant feeding practices in Bhaktapur, Nepal: a cross-sectional, health facility based survey. International Breastfeeding Journal. 2012;7(1):1.

3. Pun PK, Dhakal R. Knowledge and Practice on Exclusive Breastfeeding among Mothers of Under Two Year Children. International Journal of Health Sciences. 2015;(5):7.

4. Khanal V, Lee AH, Scott JA, Karkee R, Binns CW. Implications of methodological differences in measuring the rates of exclusive breastfeeding in Nepal: findings from literature review and cohort study. BMC Pregnancy and Childbirth [Internet]. 2016 Dec [cited 2019 Mar 18];16(1). Available from: http://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-1180-9

5. 00683409be59d46a238aab6e0fc0a15a4a64.pdf [Internet]. [cited 2019 Mar 19]. Available from: https://pdfs.semanticscholar.org/d80b/00683409be59d46a238aab6e0fc0a15a4a64.pdf

6. Boudhanath. In: Wikipedia [Internet]. 2019 [cited 2019 Mar 20]. Available from: https://en.wikipedia.org/w/index.php?title=Boudhanath&oldid=882608459

Knowledge and Practice of Exclusive Breastfeeding Among Mothers of Children Under One Years in Boudha

Status:

Version 1

Abstract

Figures

Introduction

Materials And Methodology

Results And Findings

Discussion

Conclusion

Declarations

References

Status:

Version 1