Sociodemographic characteristics
A total of 395 working mothers were interviewed. The median age of the mothers was 29 years (IQR) of 25-34 years. The median age of the infants when mother resumed work was 3 months (IQR=3-6). More than half (52%) of the mothers had received tertiary level of education. In terms of workplace, the majority (76%) were in the private sector. At the time of data collection, only 41% of mothers were expressing breast milk either regularly or irregularly. (Table1).
Table 1: Sociodemographic characteristics of the participants
Indicator
|
Levels
|
n(%)
|
N
|
395
|
100
|
Age of mother (median years)
|
29(IQR=25-34)
|
Child age (median months)
|
4(IQR=3-6)
|
Age of child when mother resumed work (median months)
|
3(IQR=2-4)
|
Gestational Age Of Child At Birth
|
<=36 weeks
|
77(19.49%)
|
>36 months
|
313(79.24%)
|
|
Not documented
|
5(1.27%)
|
Highest level of education attained
|
No formal education
|
6(1.52%)
|
Primary
|
44(11.14%)
|
Secondary
|
136(34.43%)
|
Tertiary
|
204(51.65%)
|
|
Not documented
|
5(1.27%)
|
Parity
|
Multiparous
|
252(63.8%)
|
Primiparous
|
138(34.94%)
|
|
Not documented
|
5(1.27%)
|
Place of Work
|
Private Sector
|
302(76.46%)
|
Public Sector
|
86(21.77%)
|
Not documented
|
7(1.77%)
|
Nature of mothers' employment
|
Salaried
|
175(44.3%)
|
Self Employed
|
215(54.43%)
|
|
Not documented
|
5(1.27%)
|
Expressing Milk
|
No
|
234(59.24%)
|
Yes
|
161(40.76%)
|
|
Not documented
|
0(0%)
|
Knowledge of breastmilk expression and storage.
Almost all women (97%) had correct knowledge that expression of milk could be done using hand or breast pump but > 90% thought that there was a difference in contamination levels and volume of milk expressed between the various methods of breast milk expression. Only 62% satisfactorily knew that the Kenyan Government had directed employers to set up lactation stations at their workplaces. (Table 2).
Table 2: Knowledge on breastmilk expression.
Indicator
|
Level
|
Score
|
Frequency n(%)
|
What can be used to express breast milk
|
Not Known
|
0
|
8(2.03%)
|
Hand or Pump
|
1
|
387(97.97%)
|
|
|
|
Any difference in volume when expressing by hand or by pump
|
Yes
|
0
|
353(89.37%)
|
No
|
1
|
42(10.63%)
|
|
|
|
Any difference in contamination of milk when expressing by hand or pump
|
Yes
|
0
|
366(92.66%)
|
No
|
1
|
29(7.34%)
|
|
|
|
Is it correct to discard the first few drops of milk before expressing milk
|
Yes
|
0
|
160(40.51%)
|
No
|
1
|
235(59.49%)
|
|
|
|
Whether expressed milk is nutritious for baby
|
No
|
0
|
67(16.96%)
|
Yes
|
1
|
328(83.04%)
|
|
|
|
Handwashing is important before expressing breastmilk.
|
No
|
0
|
5(1.27%)
|
Yes
|
1
|
390(98.73%)
|
|
|
|
Cleaning the breast important before expressing breastmilk.
|
Yes
|
0
|
365(92.41%)
|
No
|
1
|
30(7.59%)
|
|
|
|
The government of Kenya has directed employers to have lactation rooms.
|
No
|
0
|
149(37.72%)
|
Yes
|
1
|
246(62.28%)
|
|
|
|
Majority of mothers (>70%) correctly stated that expressed breast milk can be stored at room temperature or refrigerated. However, there was a huge knowledge gap in terms of safe storage duration of breast milk in a refrigerator (61%) or freezer (78%). (Table 3).
Table 3: Knowledge on breast milk storage
Indicator
|
Level
|
Score
|
Frequency n(%)
|
Breast milk can be stored at room temperature
|
No
|
0
|
103(26.08%)
|
Yes
|
1
|
292(73.92%)
|
|
|
|
Breastmilk can be stored in refrigerator
|
No
|
0
|
75(18.99%)
|
Yes
|
1
|
320(81.01%)
|
|
|
|
Breast milk can be stored in a freezer.
|
No
Yes
|
0
1
|
162(48.49%))
228(58.46%)
|
How long can breast milk be stored in room air.
|
>9 hours
|
0
|
123(31.14%)
|
8 hours
|
1
|
272(68.86%)
|
|
|
|
How long Breastmilk can be stored in a refrigerator in hours
|
8 hours or 9 months
|
0
|
242(61.27%)
|
Up to 72 hours
|
1
|
153(38.73%)
|
|
|
|
How long can Breastmilk be frozen
|
1 month or 24 hours
|
0
|
309(78.23%)
|
9 months
|
1
|
86(21.77%)
|
|
|
|
Expressed breast milk is nutritious if stored at room temperature
|
No
|
0
|
84(21.27%)
|
Yes
|
1
|
311(78.73%)
|
|
|
|
Expressed breast milk is nutritious if stored in a refrigerator.
|
No
|
0
|
115(29.12%)
|
Yes
|
1
|
280(70.89%)
|
|
|
|
Expressed breast milk is nutritious if frozen for 9 months
|
No
|
0
|
173(43.8%)
|
Yes
|
1
|
222(56.2%)
|
|
|
|
Refrigerated milk has a different smell from fresh breast milk
|
No
|
0
|
186(47.09%)
|
Yes
|
1
|
209(52.91%)
|
|
|
|
Can baby refuse to take stored milk because of smell
|
Yes
|
0
|
153(38.47%)
|
No
|
1
|
242(61.27%)
|
|
|
|
A scoring system was used to analyze responses to closed ended questions on Knowledge:
1= correct response, 0= Incorrect response (consistent with Academy of Breastfeeding Medicine)(16). Any mothers who did not know the answer was considered to have an incorrect response. A median score was used to distinguish between satisfactory and poor knowledge. (Figure 1).
Satisfactory knowledge on breast milk expression was attained by 43% (170) of mothers while 47% (186) had satisfactory knowledge on storage. When combined, only 34% (135) of mothers had satisfactory knowledge on breastmilk expression and storage (Figure 2).
Working in the public sector and attaining tertiary level of education was significantly associated with satisfactory knowledge on expression and storage of breastmilk (Table 4).
Table 4: Factors associated with knowledge of breast milk expression and storage. (multivariate analysis).
Term
|
AOR
|
95%CI
|
p-value
|
Age
|
Mother's age
|
1.09
|
1.03-1.14
|
0.001
|
|
<36 weeks
|
ref
|
|
|
Gestation Period
|
>36 weeks
|
0.89
|
0.49-1.63
|
0.701
|
|
Primary
|
ref
|
|
|
Level of education
|
Secondary
|
1.81
|
0.78-4.61
|
0.188
|
|
Tertiary
|
4.47
|
2.01-11.07
|
0.001
|
Multiparous
|
ref
|
Parity
|
Primiparous
|
1.1
|
0.63-1.91
|
0.742
|
|
Private sector
|
ref
|
|
|
Place of Work
|
Public sector
|
2.26
|
1.33-3.85
|
0.003
|
Attitude towards breast milk expression and storage.
The majority working women (94%) agreed that breastmilk expression could be done using hand technique. Pain during breast milk expression was experienced by 50% of mothers and 66% thought it was cumbersome.
Majority (87%) of the mothers agreed that proper storage of breast milk would help them succeed in exclusive breastfeeding however, 76% of them thought it was an expensive venture. Majority (75%) felt that they had inadequate facilities at work to support breast milk expression. (Table 5).
Table 5: Attitudes towards breast milk expression and storage
Breast milk expression/ storage
|
Agree
|
I don`t know
|
Disagree
|
|
|
Other feeds should be introduced to the baby after 6 months
|
386(97.72%)
|
0(0%)
|
4(1.01%)
|
|
|
Breast milk expression can allow mothers to achieve exclusive breastfeeding for 6 months
|
333(84.3%)
|
12(3.04%)
|
44(11.14%)
|
|
|
Breast milk expression is painful
|
198(50.13%)
|
33(8.35%)
|
159(40.25%)
|
|
|
Breast milk expression is cumbersome/ fussy
|
260(65.82%)
|
15(3.8%)
|
115(29.11%)
|
|
|
Breast milk expression can be done at the workplace
|
229(57.97%)
|
9(2.28%)
|
152(38.48%)
|
|
|
Your workplace has facilities that support breast milk expression
|
91(23.04%)
|
3(0.76%)
|
296(74.94%)
|
|
|
Breast milk expression can be done by hand
|
373(94.43%)
|
4(1.01%)
|
13(3.29%)
|
|
|
Proper storage of breast milk can help achieve six months of exclusive breastfeeding
|
344(87.09%)
|
13(3.29%)
|
33(8.35%)
|
|
Stored breast milk is safe for infants to drink
|
301(76.2%)
|
19(4.81%)
|
70(17.72%)
|
|
Storing breast milk is expensive
|
301(76.2%)
|
19(4.81%)
|
70(17.72%)
|
|
Stored breast milk has less nutritional value compared to milk that baby feeds directly from the breast
|
177(44.81%)
|
31(7.85%)
|
182(46.08%)
|
|
It is safe to store expressed breast milk for up to 8 hours at room temperature
|
247(62.53%)
|
58(14.68%)
|
85(21.52%)
|
|
It is safe to freeze expressed breast milk for up to 9 months
|
101(25.57%)
|
86(21.77%)
|
203(51.39%)
|
|
I would like to know how to properly express and store breast milk
|
367(92.91%)
|
0(0%)
|
23(5.82%)
|
|
Practice of breast milk expression and storage
The mothers who expressed breast milk were 41%, majority of whom were taught by health care professionals (63%). Hand expression was done by 50% of the mothers. Storage of breastmilk at room temperature was preferred by majority of the mothers at 49% compared to storing in a refrigerator at 34% and freezing at 16%. Baby bottles were used as storage containers by 55% of mothers. Mothers with refrigerators at home were 76% and at work were 35% but 77% preferred expressing breastmilk from home. (Table 6).
Table 6: Practice of breastmilk expression and storage.
Indicator
|
Levels
|
n=161(%)
|
Learnt how to express breastmilk through
|
Friend
|
14(8.7%)
|
Healthcare Provider
|
101(62.73%)
|
Mass Media
|
10(6.21%)
|
Others
|
7(4.35%)
|
Relative
|
28(17.39%)
|
Not documented
|
1(0.62%)
|
Methods used to express breastmilk
|
Both Hand & Pump
|
20(12.42%)
|
Electric Pump
|
12(7.45%)
|
Hand
|
81(50.31%)
|
Manual Pump
|
48(29.81%)
|
Not documented
|
0(0%)
|
Breastmilk is stored in
|
Freeze
|
25(15.53%)
|
Refrigerator
|
55(34.16%)
|
Room Temperature
|
78(48.45%)
|
Not documented
|
3(1.86%)
|
Where express breast milk
|
Both
|
31(19.25%)
|
Home
|
124(77.02%)
|
Work
|
4(2.48%)
|
Not documented
|
2(1.24%)
|
Has a refrigerator at home
|
No
|
39(24.22%)
|
Yes
|
122(75.78%)
|
Not documented
|
0(0%)
|
Has a refrigerator at work
|
No
|
104(64.6%)
|
Yes
|
57(35.4%)
|
Not documented
|
0(0%)
|
Container for storing breastmilk
|
Baby Bottle
|
88(54.66%)
|
Others
|
23(14.29%)
|
Polythene Bag
|
3(1.86%)
|
Special Breast milk Bags
|
36(22.36%)
|
Not documented
|
11(6.83%)
|
Chi- square statistical analysis showed a statistically significant relationship between expression of breast milk and ownership of a refrigerator: p-value<0.001.
When subjected to a multivariate analysis, mothers with tertiary education (AOR 3.9 CI 1.96-8.41) were significantly associated with expression and storage of breast milk (Table 7).
Table 7: Factors associated with expression and storage of breast milk.
Indicator
|
Term
|
Univariable model
|
Multivariable model
|
OR
|
95%CI
|
p.value
|
AOR
|
95%CI
|
p.value
|
Age
|
Mother's age
|
1
|
0.96-1.03
|
0.905
|
-
|
-
|
-
|
Level of education
|
Primary
|
ref
|
|
|
ref
|
|
|
Secondary
|
1.64
|
0.79-3.64
|
0.203
|
1.6
|
0.76-3.55
|
0.229
|
Tertiary
|
3.91
|
1.96-8.41
|
0
|
3.66
|
1.81-7.95
|
0.001
|
Place of Work
|
Private sector
|
ref
|
Public sector
|
1.68
|
1.04-2.73
|
0.035
|
1.32
|
0.8-2.18
|
0.283
|
Gestation period
|
<36 weeks
|
ref
|
|
|
ref
|
|
|
>36 weeks
|
0.76
|
0.46-1.25
|
0.277
|
-
|
-
|
-
|
Exclusive breastfeed
|
No
|
ref
|
|
|
|
|
|
Yes
|
0.77
|
0.48-1.22
|
0.263
|
-
|
-
|
-
|
Reasons given by working mothers for expressing breastmilk
The main reason why mothers chose to express breastmilk was being able to delegate feeding to someone else when they were at work (24.7%). Expression of breastmilk was also beneficial to those who had been unsuccessful at breast feeding (14%). (Figure 3).