FACTORS INFLUENCING TIMELY WEANING AMONG MOTHERS WITH

CHILDREN AGED 0-6 MONTHS ATTENDING MCH CLINIC IN LIKONI SUB

COUNTY HOSPITAL, IN LIKONI SUB COUNTY,MOMBASA COUNTY

KRCHN SEPTEMBER 2019

NAME: MAINGI MUNYASYA
REG.NO: D/NURS/20028/281

1
 DECLARATION.
I…maingi…munyasya..i hereby declare that this is my original work and has not been submitted
for diploma or any other award in university or collage for learning process.
NAME:MAINGI MUNYASYA
REG NO:D/NURS/20028/281
Signature........................ Date:5/1/2023

2
 APPROVAL.
This research has been submitted with my approval from my college supervisor.
Supervisor name:MR MULWA
Signature.................................... Date........................

3
 DEDICATION
This research is dedicated to my parents for their continued support ,encouragement and
financial support.It is also dedicated to my research supervisor Mr Mulwa for his tireless
guidance ,inspiration and support throughout the study.

4
 ACKNOWLEDGEMENTS
I would like to sincerely acknowledge the almighty God for giving me his strength through out
the study period ,my loving parents for their moral and financial support,my research supervisor
Mr Mulwa for his close supervision,guidance and inspiration through out the research period.I
wish to sincerely thank the leadership of LIKONI sub county hospital for allowing me to collect
data from their hospital and lastly to my friends for moral support.

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Table of Contents

DECLARATION. ii

APPROVAL. iii

DEDICATION iv

ACKNOWLEDGEMENTS v

LIST OF FIGURES xi

Figure 4.2 Gender Distribution n=32 31 xi

Figure 4.3 Religion n=32 32 xi

4.4 Level of education.n=32 33 xi

4.6 Awareness of contributing factors n=32 34 xi

4.8 Importance of knowledge on Urti. n=32 35 xi

Figure 4.11 Type of house. (n=32) 37 xi

Figure 4.12 Source of fuel. (n=32) 38 xi

Figure 4.13 Air pollution experienced. (n=32) 38 xi

LIST OF TABLES xii

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Table 4.1 showing Age distribution. the interval should be same 30 xii

Table 4.2 showing marital status. 33 xii

Table 4.3 showing where respondents heard of Urti. 35 xii

Table 4.4 showing response on sharing knowledge acquired.n=32 36 xii

Table 4.10 Response on some of environmental factors(n=32) 36 xii

Table 4.14 Response on air pollution.(n=32) 39 xii

Table 4.15 Airpollution control. (n=32) 39 xii

LIST OF ABBREVIATIONS. xiii

DEFINITION OF KEY TERMS xiv

ABSTRACT xv

CHAPTER ONE 17

INTRODUCTION 17

1.1 PROBLEM STATEMENT 21

1.2 JUSTIFICATION OF THE STUDY 21

1.3 STUDY OBJECTIVES 22

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 1.3.2 Specific Objectives 22

1.4 Research Questions 23

1.5 Study Area 23

1.6 SIGNIFICANCE OF THE STUDY 23

CHAPTERTWO 24

LITERATURE REVIEW 24

2.1 INTRODUCTION 24

2.2 Knowledge Level of mothers on weaning 24

2.3 Maternal Employment Factor 28

a)Marital status 29

c)Religion 31

CHAPTER THREE 33

STUDY METHODOLOGY 33

3.1 INTRODUCTION 33

3.2 STUDY DESIGN 33

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 3.3 STUDY AREA 33

3.4 STUDY POPULATION 34

3.5 INCLUSION AND EXCLUSION CRITERIA 35

Exclusion Criteria 35

3.6 SAMPLING TECHNIQUE 35

3.7 SAMPLE SIZE DETERMINATION 35

3.8 DEVELOPMENT OF DATA COLLECTION TOOL/INSTRUMENT 39

3.9 DATA COLLECTION PROCEDURE 39

Validity 39

Reliability 40

QUESTIONNAIRE 40

CHAPTER FOUR 51

4.0. DATA ANALYSIS AND DESIGN 51

4.1. INTRODUCTION 51

4.2: SOCIO-DEMOGRAPHIC DATA 51

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 Figure 4.1: Level of Education 52

4.3. KNOWLEDGE OF MOTHERS ON EARLY WEANING 55

4.4. CULTURAL FEEDING PRACTICES OF MOTHERS TO THEIR

CHILDREN 58

4.5. MATERNAL RELATED FACTORS CONTRIBUTING TO EARLY

WEANING 59

CHAPTER FIVE 63

DISCUSSION AND INTERPRETATION 63

5.1 INTRODUCTION 63

5.2 SOCIO-DEMOGRAPHIC DATA 63

5.3 KNOWLEDGE LEVEL OF MOTHERS ON EARLY WEANING 64

5.4 CLIENT RELATED FACTORS CONTRIBUTING TO EARLY WEANING

64

5.5 INSTITUTIONAL RELATED FACTORS 65

5.6 CONCLUSIONS AND RECOMMENDATIONS 65

5.7 RECOMMENDATIONS 66

REFERENCES 68

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 LIST OF FIGURES
Figure 4.2 Gender Distribution n=32 31
Figure 4.3 Religion n=32 32
4.4 Level of education.n=32 33
4.6 Awareness of contributing factors n=32 34
4.8 Importance of knowledge on Urti. n=32 35
Figure 4.11 Type of house. (n=32) 37
Figure 4.12 Source of fuel. (n=32) 38
Figure 4.13 Air pollution experienced. (n=32) 38

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 LIST OF TABLES
Table 4.1 showing Age distribution. the interval should be same 30
Table 4.2 showing marital status. 33
Table 4.3 showing where respondents heard of Urti. 35
Table 4.4 showing response on sharing knowledge acquired.n=32 36
Table 4.10 Response on some of environmental factors(n=32) 36
Table 4.14 Response on air pollution.(n=32) 39
Table 4.15 Airpollution control. (n=32) 39

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 LIST OF ABBREVIATIONS.

ARI- Acute Respiratory Infections

CDC - Centre for Disease Control
ET AL- And Others
KEMRI - Kenya Medical Research Institute
KMTC- Kenya Medical Training College
LRTI- Lower Respiratory Tract Infection
NGOs- Non Governmental Organizations
URTI- Upper Respiratory tract Infection
USA – United States of America
WHO- World Health Organization

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 DEFINITION OF KEY TERMS
Acute – Severance of a disease
Children- This is a male or female under- five years’ old
Morbidity rate- Total number of population affected with occurrence of a
particular disease.
Mortality rate- Number of deaths
Prevalence- A number of existing cases of a disease
Respondent- A mother or care giver of the under-five.
URTI- A common viral infection that affects the nose, throat and airways.

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 ABSTRACT
The study was done to determine factors influencing early weaning among mothers attending
MCH clinic at LIKONI Sub county Hospital,LIKONI Sub county in Momabasa County. The
specific objectives of the study was to, determine the demographic related factors influencing
early weaning among mothers with children aged 0-6 months attending MCH clinic at LIKONI
Sub county hospital,To assess the client related factors influencing timely weaning among
children aged 0-6 months attending MCH clinic at LIKONI Sub county hospital,Mombasa
county,To determine Institutional related factors influencing timely weaning among mchildren
aged 0-6 months attending MCH clinic in LIKONI Sub county hospital,Mombasa county.A
descriptive cross-sectional design study was used. The study area was LIKONI Sub county
hospital and the study population was caregivers with children below six months at LIKONI
Sub county Hospital, the sampling method used was simple random sampling. The sample size
of 26 care givers with children below six months was used. The data collection tool used was a
questionnaire with open and closed ended questions; validity was assured by making questions
clear as possible hence reliability done to ensure consistency during data collection. Data
analysed using scientific calculator and presented in form of tables , graphs and pie charts. The
permission to carry out the research was granted by the Kenya medical training college and
approved by medical superintended.I recomment the government to take an initiative of health
educating all mothers attending antenatal clinics on healthy and comprehensive breastfeeding
infants exclusively upto 6 months of age.The government should should aim to train more
community health volunteers and community health extension workers to coordinate health
activities within the community in guiding many people with home deliveries on importance of
exclusive breastfeeding.All women attending MCH clinics should be compehensively counselled
on importance of Family planning to provide adequate child spacing and give enough for
children to breastfeed upto at least two years.

CHAPTER ONE

INTRODUCTION

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The origins of the word ‘weaning' are traceable to the Anglo-Saxon expression “wenian”
meaning “to become accustomed to something different”. Weaning from breastfeeding is
considered a natural and inevitable stage in the development of a human child. Weaning is a
complex process involving adjustment to a range of nutritional, immunological, biochemical, and
psychological changes. Weaning may mean the complete cessation of breastfeeding (‘abrupt' or
final wean) or, the beginning of a gradual process of the introduction of complementary foods to
the infant's diet .The very first introduction of foods other than breast milk is, by definition, the
true beginning of weaning . Breast Milk is the ideal food for infants. It is safe and clean and
contains antibodies which help protect against many common childhood illnesses. Breast Milk
provides all the energy and nutrients that the infant needs for the first months of life, and it
continues to provide up to half or more of a child's nutritional needs during the second half of the
first year and up to one-third during the second year of life Breastfeeding without any
supplementation. Partial breastfeeding is recommended until the infant is at least 12 months old,
and thereafter for as long as a woman and her child choose to continue. Partial breastfeeding is
defined as breastfeeding while also providing other sources of nutrition, usually beginning at
approximately six months of age. At this time, soft puréed meats, infant cereal, and then puréed
fruits and vegetables may be introduced slowly. Cow's milk and fruit juice are not recommended
until a child is at least 12 months old .From a strictly nutritional perspective, weaning is the
gradual process of transitioning infants from mother's milk to complementary foods and,
ultimately, to an older child's diet. In this sense, weaning begins with the introduction of solids
around the middle of the first year. Complete weaning, or complete cessation of breastfeeding,
ideally should be a gradual process accomplished over a long period preferably baby-led.

Around the age of 6 months, an infant's need for energy and nutrients starts to exceed what is
provided by breast milk, and complementary foods are necessary to meet those needs. An infant
of this age is also developmentally ready for other foods. If complementary foods are not
introduced around the age of 6 months, or if they are given inappropriately, an infant's growth
may falter. A child of weaning age has a small stomach but needs plenty of food for growth and
activity. There are two main ways of making sure these children get enough which is a very
frequent feeding and using foods with a high concentration of nutrients. A very good first food to
give a baby, along with breast milk, is a soft, thick, creamy porridge, made from the staple food

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of the community. Every community has a main staple food. It is often the first food that people
think of when asked about their diet. The staple food contains starch, and it is eaten by most of
the people in the community at most meals. It is usually less expensive than other types of food.
The staple varies from country to country. It may be rice (for over 3 billion people around the
globe, wheat maize, cassava yam, and potato.

For the average healthy infant, meals should be provided 4–5 times per day, with additional
nutritious snacks offered 1–2 times per day, as desired. The appropriate number of feedings
depends on the energy density of the local foods and the usual amounts consumed at each
feeding. If energy density or amount of food per meal is low, more frequent meals may be
required.

There is a study in Saudi Arabia revealing that the mean age at supplementation with solid foods
was 5.3% in a month. Literate mothers started supplementation with solids earlier than illiterate
mothers

The American Academy of Pediatrics (AAP) recommends feeding infants only breast milk for
the first 6 months after birth. After 6 months, the AAP recommends a combination of solid foods
and breast milk until the infant is at least 1 year old.Weaning can be a dangerous time for babies.
In many places, babies of weaning age do not grow well. They often fall ill and get more
infections, especially diarrhoea, than at any other time. Babies who are malnourished may get
worse during the weaning period and may become malnourished for the first time during
weaning. Poor feeding and illness stop many children of weaning age growing well. This shows
up on the growth chart as poor weight gain or, in more serious cases, as weight loss.Education
status of the mother has been identified as an important social determinant of health for children.

WHO has recommended that complementary feeding be introduced after the age of 6 months.
The European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)
recommends introducing complementary feeding not before 17 weeks and no later than 26
weeks. In the Netherlands, Jeugdgezondheidszorg (preventive Youth Health Care) is a
government-funded program for monitoring children’s health and development, and providing

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health promotion and disease prevention at set ages; the care is offered for free. Approximately
95% of children in the Netherlands participate in this preventive Youth Health Care (henceforth
YHC) program. In line with ESPGHAN guidelines, the YHC guideline suggests introducing
complementary feeding after the age of 6 months.

Despite the inconsistencies in the current guidelines regarding when to introduce complementary
feeding, all guidelines agree that complementary feeding should not be introduced before the age
of 6 months. Although introducing complementary feeding earlier may contribute to more rapid
weight gain during infancy and increased risk of childhood obesity in affluent populations,the
introduction of complementary feeding before 6 months is common in many countries. For
instance, the percentage of infants introduced to complementary feeding before the age of 6
months was 37% in a birth cohort born in 2015 and 2016 in Northwest Italy, 30% across the UK
in 2016 and 40% among infants born between 2017 and 2018 participating in a national study in
the US.No study has reported the prevalence of introducing complementary feeding before 6
months in the Netherlands.

According to WHO, weaning is the process of gradually introducing infants to what

would be its adult diet and withdrawing supply of its mother’s milk. It can also be
described as the gradual introduction of formula feeds to an infant or the transitional
period from breastfeeding to adult diet (Kuria, 2013). Breast milk provides
immunology that is the major benefit of breast milk.Other advantages include early
digestible, more hygiene than formula, strength, psychological bond between the
mother and the child, less expensive,rarely causes overweight and lower incidences of
sudden infant deaths(Unger,2015).Recent studies have provided good evidence in
developed countries breastfeeding protects against gastrointestinal
infections,respiratory tract infections as well as reduced food allergies in infants with
genetic predisposition (Startwort,2012).

Children who are weaned early are at risk of interactions of several infections like
gastrointestinal infections, malnutrition and neglect from parents since there is no time

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for breastfeeding. The socio-economic status of the families is poor hence cannot
afford enough suitable food for children and they practice poor levels of hygiene
contributing to further becoming ill (Suzanne, 2014). The early weaned child is
predisposed to malnutrition and childhood diseases like diarrhea. The infant may also
lack maternal bonding; poor weaning practices are associated with increased risk of
diarrhea (WHO,2009).The American academy of pediatrics recommends feeding a
baby milk only for the first six months of life and continue breastfeeding until the
child is at least one year old as long as they both want to continue.
In Africa, prevalence of breastfeeding practice in Mauritius has risen from 72% to
93.4% as found in this study while only 17.9% breastfed their children exclusively for
the 6 months (Johannes, 2013). In view of early weaning was positively associated
with rural residents,working mothers. This has exposed the child to risk of infection
and as well results in mortality and morbidity.According to Ghanaian national
survey,shows that 80% of children were weaned early and 8% suffered malnutrition;
40% were wasted, 52% stunted according to national center for health
statistics(NCHS,2013).

In Kenya a lot of factors have a role to play contributing to early weaning due to the
fact that mothers are labor burdened especially at home where they have little time left
them to breastfeed thus this has forced them to introduce other foods so that the baby
can be attended by a babysitter or house help. A survey done by Kenya Demographic
and Health Survey, 32% of children under the age of six months are exclusively
breastfed improving from 12% to 13%. Young mothers do not enjoy breastfeeding
because they don’t want to interfere with their bodies and breast shape
(Elizabeth,2011).

1.1 PROBLEM STATEMENT

Despite the well documented benefits of exclusive breastfeeding on child survival,

growth and development, uptake of the exclusive breastfeeding for six months as

19
recommended remains low. According to the Kenya Demographic Health Survey in
2014, reported that 99% of children have ever been breastfed and 61% of children less
than the age of 6 months are exclusively breastfed. Over 92% of the mothers reported
introducing complementary foods after one week of the infant’s life.

Complementary feeds introduced to infants may have too much fats and carbohydrates
leading to infection; therefore risk of death from infectious diseases in the absence of
breastfeeding, also obesity,poor muscle development and low resistance to infections
therefore risk of death from infectious diseases in the absence of breastfeeding
(WHO,2014).

This study therefore aimed at determining factors hindering exclusive breastfeeding

and make recommendations that will guide the promotion of exclusive breastfeeding
practices by mothers nursing young infants aged 0-6 months in Likoni Sub county
Hospital.

1.2 JUSTIFICATION OF THE STUDY

Child survival interventions are designed to address the most common causes of
childhood deaths that occur. The third sustainable development goal (SDGS) aims by
2020 to end preventable deaths of the newborns and children under 5 years of age with
all countries aiming to reduce neonatal mortality to at least as low as 12%per1000
live births(2030).

According to the Kenya Demographic Health Survey, the proportion of children

younger than age of 6 months who were exclusively breastfed has markedly increased
from 32% in the 2008-2009 to the current 61% in 2014(KDHS, 2014). The proportion
of children less than age 6 months using a bottle with nipple has also noticeably
decreased from 25% in 2008-2009 to 11% in 2014. The median duration of any
breastfeeding in Kenya is 21 months.Differences in the median duration of the
breastfeeding by background characteristics are small except by region. The median
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duration of any breastfeeding is longer in Eastern (24.5months) and the shortest in
North eastern (19.4 months).

On best recommendation the study determines the number of children who are
exclusively breastfed and the number of children who were not exclusively breastfed.
The study will be unique as it gives the intervention to problems associated with poor
breastfeeding methods among mothers in Likoni.

The study will also benefit the researcher as a partial fulfillment for the award of a
diploma in Kenya Registered Community Health Nursing.

1.3 STUDY OBJECTIVES

1.3.1 Broad Objective

To Assess factors influencing timely weaning among mother's with children aged 0-6
months attending MCH clinic in Likoni Sub county Hospital.

1.3.2 Specific Objectives

1.To Assess Demographic factors influencing timely weaning among mothers with
children aged 0-6 months attending MCH clinic at LIkoni Sub county Hospital.
2.To find out client related factors influencing timely weaning among mothers with children
aged 0-6 months at LIkoni Sub county Hospital.

3.To Assess Institutional related factors contributing to early weaning among mothers
with children 0-6 months at LIkoni Sub county Hospital.

1.4 Research Questions

1.What are the demographic factors leading to early weaning among mothers with
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children aged 0-6 months attending MCH clinic at LIkoni Sub county hospital?
2.What are clients related factors influencing timely weaning in infants aged 0-6 months
attending MCH clinic at LIkoni Sub county hospital?

3.What are the Institutional related factors influencing early weaning among mothers
with infants aged 0-6 months?

1.5 Study Area

The study area will be the MCH/FP clinic in Likoni sub county Hospital. MCH/FP
clinic is one of the departments of the hospital. It comprises ten different rooms in
which different forms of services are offered. The kind of services offered in the clinic
include weighing of the babies,monitoring of growth and development, triage of sick
children, treatment of the sick children, antenatal and postnatal
clinic,PMTCT,immunization and nutrition clinic.

1.6 SIGNIFICANCE OF THE STUDY

The study aims to find out the factors influencing early weaning in children aged 0-6
months among mothers attending MCH clinic and the important role played by the
healthcare providers in educating and promoting women to practice regular
breastfeeding to all children aged 0-6 months.
Around the age of 6 months, infants need energy and nutrients provided by breast
milk and complementary feeds cannot meet these needs.
More important, when mothers gradually wean their children, allows the child and
mother to adjust to this enormous change.Emotionally,most mothers have mixed
feelings about weaning. Gradual weaning allows mother’s milk supply to decrease at a
more natural rate lowering the risk of engorgement and breast infection (mastitis).

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 CHAPTERTWO

LITERATURE REVIEW

2.1 INTRODUCTION

The chapter comprises review of findings of previous studies carried out by different
researchers.It was based on relevant information matching with the specific
objectives.
According to WHO, weaning is the process of gradually introducing infants to what
will be its adult diet and withdrawing supply of breast milk. It is also described as the
gradual introduction of formula feeds to an infant or the transient period from
breastfeeding to adult diet (Kuria,2013).

Breast milk provides immunology that is the greatest benefit of breastmilk.Other

advantages include early digestion, more hygiene than formula, strengthens
psychological bond between mother and the child, less expensive, rarely causes
overweight and lower incidences of death (Startwert, 2011). Studies recently have
provided good evidence in developed countries breastfeeding protects against
gastrointestinal infections, respiratory infections as well as reducing food allergies in
the infants with genetic predisposition(Startwert,2011).
1.CLIENT RELATED FACTORS INFLUENCING EARLY WEANING AMONG MOTHERS
WITH CHILDREN AGED 0-6 MONTHS ATTENDING MCH CLINIC AT LIKONI SUB
COUNTY HOSPITAL

2.2 Knowledge Level of mothers on weaning

A research conducted on infants’ feeding in the Central region of China with 1520
mothers who delivered in four different hospitals in the city, sub urban and rural areas
revealed that 50.5%of the mothers were not weaning their children where 96% of
them were educated. 49.5%of the mothers had started their babies on formula, 52.3%
of the mothers were able to define exclusive breast feeding correctly.
It was concluded that knowledge on the practice of exclusive breastfeeding was
increasing. A study also conducted in Turkey on early weaning revealed that lack of
knowledge on exclusive breastfeeding was a key factor including weaning. Out of 891
mothers who delivered in University Hospital only 54% breastfed their babies
exclusively.46% of the mothers had already started their infants on formula feeds
(Gordonet al, 2010).

A study done in rural Jamaica on the impact of the knowledge and attitude in
breastfeeding in 11 health centers. The prevalence of breastfeeding initiation was
98.2%; 22% of the mothers who initiated breastfeeding practiced it exclusively for at
least six months. No difference occurred between exclusively breastfeeding and early
weaning mothers in terms of knowledge on breastfeeding (Leiaetal,2013). A study
done in IkotOmin,Nigeria carried out to assess knowledge on exclusive breastfeeding.
It was concluded that women in Ikot Omin practiced exclusive breastfeeding and
focusing on the health workers should continue to encourage exclusive
breastfeeding(Essien etal, 2010).

In Sikol estate Nigeria one in eight samples of 179 mothers were selected and the
information regarding their knowledge on breastfeeding was obtained. A total of
321% of the mothers had adequate knowledge on breastfeeding with 53% of the
initiating breastfeeding after birth. Only 31% of the mothers practiced exclusive
breastfeeding; it was concluded that knowledge on exclusive breastfeeding was low
(Oche et al,2011).

A study done to determine factors influencing the knowledge and practices among
lactating mothers with infants aged 0-6 months at Ahero sub-district hospital in
Nyando Kenya.It was done on 117 breastfeeding mothers at the maternal child health.
In many West African countries breastfeeding is usually adequate exclusively for 3
months of age. After this period it may become increasing nutritional demand of the
growing infants thus the weaning process there is always need to introduce soft, easily
swallowed foods to supplement the infants’ feeding in early life (Ona Fiok et al,
2013). Studies in several communities of Gambia, Egypt and Cameroon depicted that
60% newborns were given sugar, water and tea within a month of life. The reasons
given for water supplementation varies with cultures which include water is necessary
for life. It quenches thirst, relieves colic pain (UNICEF,2006).

A study on infant feeding practices and nutritional status of children in North western
Nigeria showed that despite the practices of hand washing before preparing foods,
61% of them washed their hands sometimes, followed by 28% washed always while
11% never did(Matthew,2009).A study conducted to inves jutigate mothers’nutritional
weaning,101 children in public health centers in I chean showed 41.6% of the infants
were breastfeeding,43% of them were bottle fed and 14.9% were mixed fed right after
birth (ElNoor,1992).

In Nairobi Kenya a research was done that revealed that 2% of the babies were given
supplementary feeds by 4 weeks of age, 13% by 8 weeks, 58% by 3 months and 91%
by 4 months. Most of the babies were weaned on porridge, cow’s milk and soft food
like matoke.The main reason that the mothers gave for initiating weaning was that the
infants were not satisfied with breast milk (Koasourek, 2014).

A study project done in Mombasa showed food intake and feeding habits vary by
ecological zones and by reasons, poor households, less land and production of less
food. Breastfeeding was very successful and practiced for a period of time of 16-24
months. On average, cows’milk and occasionally goats’ milk were introduced when
infants were aged 1-4 months
b)HIV status of the mother
The fear of transmitting HIV through breast milk is a factor that contributes to decline
in breastfeeding. HIV mothers could be targeted by distributors of infant food
products. A four country study on breastfeeding in selected African countries
concluded that there has been reduction on support of breastfeeding as a result of fear
and misinterpretation of the UNAIDS / WHO / UNICEF guidance related to HIV and
breastfeeding (Miriam et al, 2013).A recent study in Zimbabwe indicates that
postnatal transmission of HIV can be halved from14% to 7% by exclusive
breastfeeding in the first 3 months of life (Joly, 2014).

The risk of HIV infection in breastfed babies is smaller than risk of non-breastfed
babies getting other infectious diseases in present conditions in developing countries
(Paget et al,2013). If a HIV positive mother decides to breastfeed, some evidence
exists in favor of exclusive breastfeeding (Sterchen et al, 2012). It remains unclear
why breastfeeding for at least 6 months is better than mixed feeding. Possible
explanation includes reduction in dietary antigen and pathogens which are assumed to
prove an inflammatory response after infants get integrity. The promotion of bacterial
intestinal microflora by breast milk which increases resistance to infection
(Contsandiset al, 2010).

C) psychological factors
Both obesity and depression have been associated with differences in lactation
physiology, and these conditions are associated with reduced breastfeeding
duration.13–16 Obesity and insulin resistance are associated with differences in
prolactin levels,onset of lactogenesis,and the human milk fat layer transcriptome.In
addition, obesity is associated with poor milk production.With respect to depression
and lactation, women with symptoms of depression and anxiety had lower oxytocin
levels during feeding in a recent study, and several other neuroendocrine mechanisms
may link maternal mood disorders with breastfeeding difficulties.Furthermore,,
disruption of oxytocin physiology results in dysregulated stress responses and poor
feeding Thus, maternal health conditions may disrupt lactation, leading to early,
undesired weaning.

The prevalence of such disrupted lactation is not known. We therefore sought to

define the prevalence of early, undesired weaning that mothers attribute to lactation
dysfunction, which we defined as difficulties with latch, pain, and milk supply. We
used data from the Infant Feeding Practices Study (IFPS) II to estimate the proportion
of women who experience disrupted lactation and to estimate associations between
demographic characteristics and disrupted lactation. We hypothesized that the
prevalence of disrupted lactation would be increased among women with increased
maternal body mass index (BMI) or depressive symptoms, independent of
sociodemographic confounders.

2.3 Maternal Employment Factor

Returning to work presents a social factor that may influence women’s decision to
discontinue breastfeeding. In fact, maternal employment is often linked to premature
weaning due to barriers found in the work environment. According to Johnston and
Esposito (2013),employed women who return to work after giving birth must cope
with the “ecosystem” of the work environment, which includes attitudes of coworkers,
length of maternity leave, length of working shifts, and hourly wages or salary. In
their study, the researchers found that women who were employed had a 9% lower
rate of breastfeeding at 6 months postpartum than women who were unemployed.
Johnston and Esposito also found that supportive work environments increase
breastfeeding duration. Before returning to work, the employed women in their study
felt it was necessary to meet with their managers to discuss breastfeeding. Women
who were offered longer maternity leave were more likely to maintain breastfeeding
upon their return to work and reported having an easier transition that combined both
their breastfeeding needs and work obligations. Moreover, women with higher wages
and flexible work schedules were more likely to have longer duration of breastfeeding
than women with lower wages and inflexible schedules. Johnston and Esposito’s
findings are supported by the results of a qualitative study that indicate women who
are confident in their ability and committed to breastfeeding are most likely to be
successful in their breastfeeding endeavors (Avery et al., 2009).

See

DEMOGRAPHIC RELATED FACTORS INFLUENCING EARLY

WEANING AMONG MOTHERS ATTENDING MCH CLINIC IN LIKONI
SUB COUNTY HOSPITAL
A study done in Iraq communities showed that socio-economic characteristics of a
community affect infants’ feeding practices and weaning in terms of length of time an
infant is breastfed.The data obtained in this study showed the impact of socio class.
Mothers in higher socio-economic levels started bottle and supplementary feedings
earlier.Mothers in middle and low socio-economic classes started supplementary
feeding at 3-8 months while in low socio-economic class started weaning at 4-9
months (Darwish,2013).

A study carried out in the United States of America found that only 38% of the
mothers did not wean their children early for 8 months and 14.8% at 6 months which
were influenced by the following:-American society does not give mothers time to
stay at home so breastfeeding would be mothers’ long maternity leave or otherwise
mothers to stay at home to breastfeed would be easier, misconceptions about weaning
where certain drugs that the mothers have to take may not be compatible with
breastfeeding(Carolyne,2014).

In Kenya according to the Kenya Demographic Health Survey 32% of children under
age 6 months were the only ones exclusively breastfeeding. Urban poor settlements
and slums present unique challenges with regards to child health survival. This
predisposes infants born to mothers who live in slums to suboptimal breastfeeding and
early introduction to complementary feeding(Kimon, 2014).

a)Marital status

Single mothers have great difficulty supporting themselves and caring for the baby
especially if they are young. Single mothers have less family support; without this
support, activities outside the home such as having to work may enable them to wean
early. It is often best if the mothers and babies can stay together and be supported as a
family they can breastfeed atleast partially (Ebrahim, 1991).
An increasing trend for babies to be born to cohabiting and unmarried parents or to
single women (Kiernan & Pickett, 2014) suggests many women may not have the
support of a spouse or partner. Single women are at greater risk for early breastfeeding
cessation. In a study by Kiernan and Pickett (2016), a greater degree of parental
bonding with the infant of married parents was found to be associated with increased
duration of breastfeeding. The father’s opinion is often taken into account by the
mother in her decision to breastfeed. Women who are both unmarried and parenting
alone may not have a support system that helps sustain breastfeeding (Johnston &
Esposito, 2015; Kiernan & Pickett, 2014).
b)social cultural practices
Despite the fact that mothers know the exact age to wean their infants, majority of the
mothers do not practice exclusive breastfeeding due to cultural beliefs and
practices.Weaning from a breast is a natural inevitable stage in a child's development.
It is the switching of an infant's diet from breast milk to other foods and fluids.In most
cases, choosing when to wean is a personal decision. World Health Organisation and
United Nations Children Emergency Fund (2012) recommends exclusive
breastfeeding for the first 6 months. The early introduction of mixed feeding began in
the early 19th century western society, where prominent contemporary physicians
such as the American Pediatric Society founders-Emmett and Lewis recommended
that, weaning begin at around 9-12 months for a child or when the canine teeth had
grown because infant mortality rate had increased. Mothers identified cultural factors
influencing their decision to mix-feeding their babies, which included pressures by
their elders and families to supplement because it was a traditional practice, a belief
that breast milk is an incomplete food that does not increase the infant's weight, and
the taboo of prohibiting sexual contact during breast feeding. It is believed that herbal
fluids, saline, water and honey were used by mothers, mother-in-law's and TBAS as
gastric cooling agents during the first 3 days of birth and that it also “cleanses” the
new born by promoting elimination of meconium which is believed to be harmful.In
Uganda, it has been reported that almost 70% of the children are already on
supplementary foods by the sixth month of life although breast feeding continues well
into the second year for most children. The traditional weaning foods and weaning
practices in Uganda and indeed in many developing countries are reported to be
inadequate. In Kajiado hospital in kenya, monthly reports show that in September
2017, 70 mothers came for postnatal care but only 29 practiced exclusive
breastfeeding for children below six months, 32/50 and 24/45 were partially weaned
in the months of October and November respectively. Despite the efforts made on
exclusive breastfeeding, cultural beliefs and practices have greatly influenced the
weaning of children before the age of 6 months. Consequently, there is little
information on cultural beliefs and practices associated with weaning of infants and
young children in the country.

c)Religion

The Islamic Holy Book, the Quran recommends that mothers breastfeed their children
for 2 years if possible and states that every infant has the right to breastfeed. That, if a
mother is unable to breastfeed she and the husband can decide to get her to have a wet
nurse to feed the infant (Jessica,2007).Islam has codified the relationship between the
wet nurse and the infants.
For instance,highest number of population are Islam.During their fasting month of ramadhan
mothers may lack enough milk to breastfeed their children hence introducing formula feeds.

3.INSTITUTIONAL RELATED FACTORS INFLUENCING TIMELY WEANING

AMONG MOTHERS WITH CHILDREN AGED 0-6 MONTHS ATTENDING MCH
CLINIC IN LIKONI SUB COUNTY HOSPITAL.
The World Health Organization recommends that breastfeeding be initiated within one hour of
birth. Early initiation of breastfeeding provides benefits for both the baby and the mother. The
Baby Friendly Hospital Initiative (BFHI) was designed to promote early initiative of
breastfeeding, preferably immediately after birth and initiation of breastfeeding within one hour
of birth was one of the ten steps of successful breastfeed. (WHO 2011).Despite the universal
recommendation that infants be exclusively breastfed from birth to six months of age, only 39%
of newborns in the developing world are put to the breast within one hour of birth about 37% of
infants under six month of age are exclusively breastfeed as mentioned earlier.(Miriam etc al'
2013).Poor parental adherence to exclusively breastfeeding and premature complementary
feeding is common in many developing countries with high rates of morbidity from infectious
diseases and proximate causes of malnutrition in the first two years of life.
A substitute and/or complement to breast milk, infant formula is offered in maternity hospitals,
due to the shortage of pasteurized milk in the milk bank, infant formula is offered at a suitable
dilution. After hospital discharge, at home, the mothers replace or complement breast milk with
infant formula or whole cow’s milk or porridge, whose dilution is not suitably performed by
some of these mothers. Thus, it is not meeting the guidelines specified on the product labels,
which could undermine the food security and nutritional status in a critical period of
development, where the child already has vulnerable health conditions.
Cesarean section has been associated with delayed onset of lactogenesis and sub optimal
breastfeeding outcomes, which include delayed or lower rates of breastfeeding initiation, and
ceasing exclusive or total breastfeeding durations before recommended durations of 6 and 24
months, respectively. However, evidence for associations between cesarean section and
suboptimal breastfeeding outcomes have been mixed, which may reflect confounding between
the evolutionarily novel pathways by which cesarean section influences feeding outcomes at
different stages of lactation, as well as with other maternal and infant factors that influence
cesarean risk and breastfeeding practices.

Directly, scheduled or unscheduled cesarean sections may hinder successful breastfeeding

initiation due to the lack of exposure to parturient hormonal surges, infant drug exposures,
maternal-infant separation, more limited skin-to-skin contact and post operative pain and
mobility limitations, which may impair latching, maternal-infant bonding, infant alertness and
olfactory learning. Early difficulties establishing breastfeeding may in turn lead mothers to cease
breastfeeding altogether, or lead to early and increased reliance on complementary feeding—
including formula supplementation which may displace breast milk intake, leading to down
regulated milk production and ultimately earlier than intended full weaning. Indirectly, cesarean
section may alter infant gut microbial colonization and promote more rapid postnatal weight
gain, which may be perceived as warranting earlier or increased complementary feeding.
 CHAPTER THREE

STUDY METHODOLOGY

3.1 INTRODUCTION

This chapter describes the steps which will be taken to achieve the study objectives.
They include study area, study population, study design, sample size determination
procedure, data collection tools and instruments and ethical considerations.

3.2 STUDY DESIGN

The research design to be used will be based on casual comparative type of research
where it will determine the reasons or the causes for the current state of the
phenomenon under study hence the causes of early weaning in children aged 0-6
months. A descriptive cross-sectional study design will be used. Descriptive study
entails collecting data in order to answer questions concerning the current state of the
subject under study.The study aims at determining factors contributing to early
weaning in children aged between 0-6months.

3.3 STUDY AREA

MCH/FP CLINIC-This is one of the departments in the hospital which offers different
services such as:
Antenatal care; is essential for protecting the health of women and their unborn
children. Through this form of preventive health care, women can learn from skilled
health personnel about healthy behaviors during pregnancy, better understand warning
signs during pregnancy and childbirth, and receive social, emotional and
psychological support at this critical time in their lives. Through antenatal care,
pregnant women can also access micronutrient supplementation, treatment for
hypertension to prevent eclampsia, as well as immunization against tetanus. Antenatal
care can also provide HIV testing and medications to prevent mother-to-child
transmission of HIV. In areas where malaria is endemic, health personnel can provide
pregnant women with medications and insecticide-treated mosquito nets to help
prevent this debilitating and sometimes deadly disease.

Integrated family planning and immunization- services may offer an opportunity to

reach many women who are taking their children to be immunized and who may also
want to access family planning.

Child immunization services involve multiple timely contacts with mothers during the
first year postpartum. Some of the vaccines offered include At birth: BCG (Bacillus
Calmette–Guérin vaccine)
Week 6 and 10: Rotavirus vaccine (Rotarix)
Week 6, 10 and 14: Oral polio vaccine; DPT, Hepatitis B and HIB; Pneumococcal
vaccine (PCV 10)
6 months: Measles vaccine, Vitamin A.
9 months: Measles vaccine, Yellow Fever vaccine.The WHO recommended schedule
for the first year of life includes vaccinations at birth, 6 weeks, 10 weeks, 14 weeks,
and 9 months,and 18 months.Some of the family planning methods offered include;
Long acting contraception - the implant or intrauterine device (IUD)
hormonal contraception - the pill or the Depo Provera injection.
barrier methods - condoms.
emergency contraception.
fertility awareness.

3.4 STUDY POPULATION

The targeted population will be mothers with children aged under 6 months attending
mother and child health clinic in Likoni sub county Hospital. The total number of
respondents will be 284 (two hundred and eighty four respondents).

3.5 INCLUSION AND EXCLUSION CRITERIA

Inclusion Criteria

The study will include all mothers attending a mother and child health clinic
(MCH)clinic with children less than 6 months practicing early weaning.
All mothers who will give informed consent to participate in the study.

Exclusion Criteria

All mothers with children under 6 months attending MCH(mother and child health
clinic) who are practicing exclusive breastfeeding.
All mothers attending MCH/FP clinic with children above 6 months and all mothers
who will decline to give informed consent.

3.6 SAMPLING TECHNIQUE

A simple random sampling method will be used in this study.This method of sampling
involves giving a number to every subject or members of the accessible population,
placing the numbers in a container and then letting them pick any number at random.
The subjects corresponding to the numbers picked will be included in the sample. The
procedure will continue until the required number of respondents will be achieved.

3.7 SAMPLE SIZE DETERMINATION

This displays the number of people to be interviewed in the study. The sample
determination will be done using Fish eret al method of 1998 to obtain the sample size
thus
 n=Z2PQ

d2

n=the desired sample size (if the target population is

greater than 10,000) Z=the standard normal deviation at
the required confidence level
P=population in the target population estimated to have parameter
characteristics of 0.5 or 50%
d=the level of
statistical
significance I-P
(usually constant 1-
0.5 =
0.5)Therefore:-
n=Z2PQ

d2

n = (1.96)2 x (0.5) x =0.9604

(0.5)

0.0 0.0025 = 3
52 8
4

Since the target population is less than 10,000, the required sample size will
be smaller hence the final sample estimation nf will be calculated

nf = 384

1 + 384

284

1 +284 =1 +384 = 384

 284 284 284 285 =
1.36

384

1.36 = 282.35

nf =282 respondents

The desired sample size is 282 respondents but due to financial constraints,
limited time and resources, the researcher is not able to cover 282
respondents hence 10% of the population will be used to represent the
whole population of the study.
 100%= 282 respondents

10% = ?

10x 282

100 = 28.2

=28 respondents

3.8 DEVELOPMENT OF DATA COLLECTION TOOL/INSTRUMENT

Data collection tools will be by use of questionnaire.The two types of questions are
open and closed ended. Open questions describe a wide range of information while
closed ended questions describe limited information.Therefore,questionnaires are used
to collect information since a wide range sample could be collected. The structured
questionnaire will capture socio-demographic data and other respondents’ related and
organizational factors influencing or contributing to early weaning in children aged 0-
6 months among mothers attending MCH/FP clinic in Likoni Sub county Hospital.

3.9 DATA COLLECTION PROCEDURE

The study will use questionnaires with structured and unstructured questions because
questionnaires are economical and the researcher will not have to be present to
interview the respondents hence saving time and also helping in preventing
interviewer bias.

Validity

Validity is the accuracy and meaningfulness of the interferences which are based on
the research results. Validity is the degree to which results obtained from the analysis
of the data actually presented the phenomena under study. It has to do with how
accurately the data obtained in the study represents the variables of the study.

Reliability

Reliability is a measure of the degree to which the instrument yields constant results or
data after repeated trials. Reliability in research is influenced by random errors. As
random errors increase, reliability decreases.Random error is the deviation from a true
measurement due to factors that have not been effectively addressed by the researcher.

QUESTIONNAIRE

A QUESTIONNAIRE ON THE FACTORS CONTRIBUTING TO EARLY WEANING IN

CHILDREN AGED 0-6 MONTHS AMONG MOTHERS ATTENDING MCH CLINIC IN
LIKONI SUB COUNTY HOSPITAL,MOMBASA COUNTY.

INSTRUCTIONS

1. The questionnaire is meant for study purposes only.

2. Do not write your name or address on the questionnaire.

3. All information obtained will be kept private and confidential.

4. All answers to be given according to instructions provided.

SECTION A:DEMOGRAPHIC RELATED FACTORS INFLUENCING

EARLY WEANING AMONG CHILDREN AGED 0-6MONTHS ATTENDING
MCH CLINIC IN LIKONI SUB COUNTY HOSPITAL

1.What is your age in years?

a)19-24 years [ ]

b)25-30 years [ ]

c) 31–35 years [ ]

d)36–40 years [ ]

e)Above 40 years [ ]

2.What is your level of education?

a)Primary [ ]

b)Secondary [ ]

c)College [ ]

d)University [ ]

e)Others(specify)………………………………………………………………
 3. What is your occupation?

a) Employed [ ]

b) Unemployed [ ]

c Others(specify)
) ……………………………………………………………….

4.What is your marital status?

a)Single [ ]

b)Married [ ]

c)Divorced [ ]

d)Widowed [ ]

5.How many children do you have?

a)1-2 [ ]

b)2-4 [ ]

c)4-6 [ ]

d)More than 6 [ ]

6.Where did you deliver?

a)Hospital [ ]

b)Home [ ]

SECTION B: CLIENT RELATED FACTORS INFLUENCING EARLY

WEANING AMONG CHILDREN AGED 0-6MONTHS ATTENDING MCH
CLINIC IN LIKONI SUB COUNTY HOSPITAL
7. Do you know what exclusive breastfeeding is?

a) Yes [
]

b) No [
]
 If yes from your own understanding,what is exclusive breastfeeding?

…………………………………………………………………………………
….

…………………………………………………………………………………
….

a) Yes [ ]

b) No [ ]

Can a baby survive on breast milk

alone?

a)Yes [ ]
b)no
b)No [ ]
8. Have you heard about weaning?

9.

10. Did you offer other foods to the baby 0-6months?

a) Yes [ ]
b) No [ ]

i. If yes in (10) above,what do you give to the infants?

a)Water [ ]

b)Sugarywater [ ]

c Others(specify)
) ……………………………………………………………….

d)Don’t know [ ]

ii. If yes,why was your baby given supplements?

a)My doctor told me but never said why [ ]

b)My doctor recommended it [ ]

a)Each time after feeding [ ]

b)Each time before feeding [ ]

c)Sometimes after feeding [ ]

When Do you breastfeed your child?

a)On demand [ ]

b)1-5 times a day [ ]

c)6-10 times a day [ ]

d)Never breastfeed [ ]
11. How often do you clean breasts before breastfeeding?

12.12.

a Yes [ ]
)
No [ ]
b
)
i If yes in(13)above,what might it be?
.
a Breast swelling [ ]
)
b Breast lumps [ ]
)

c Others(specify)
) ………………………………………………………………

d No condition [ ]
)

Do you have other problems that hinder you from breastfeeding?

a)Yes [ ]

b)No [ ]
13. Do you have any condition that makes you not to breastfeed?

14.14.
 i. If Yes in(14)above,specify

…………………………………………………………………………………
……...

…………………………………………………………………………………
………

SECTION C:SOCIAL CULTURAL FACTORS INFLUENCING EARLY WEANING AMONG

CHILDREN AGED 0-6 MONTHS ATTENDING MCH CLINIC IN LIKONI SUB COUNTY
HOSPITAL

15.What cultural beliefs and practices influence child feeding in your community?

16.Are there taboos related to food that you give to your child?(yes,No,don't know)
If yes above,explain........

17.Which foods are not culturally acceptable for children and why?

18.Where do you get information about child feeding from?

A.clinic
B.Mother in law
C.Partner
D.Media/Social gatherings

19.Do you think a training programme on child feeding would be beneficial for first time
mothers in this community?
A.Yes
B.No

If yes above,what's your reason?

SECTION D: INSTITUTIONAL RELATED FACTORS INFLUENCING EARLY WEANING

AMONG CHILDREN AGED 0-6 MONTHS ATTENDING MCH CLINIC AT LIKONI SUB
COUNTY HOSPITAL

20.How many Antenatal Clinics did you attend?

A.1-3
B.4-6
C.more than 6
D.None

21.Were you given on health education on Exclusive Breastfeeding?

A.yes
B.no

22.Where did you deliver?

A.Hospital
B.Home

23.What was your mode of Delivery?

A.caesarean section
B.spontaneous vaginal delivery

24.What was the birth Weight of your child?

A.below 2500g
B.2500-3500g
C.above 3500g
25.did you initiate breastfeeding within the first one hour?
A)yes
B)no

If not above,why?

26.Did the midwives give the baby any formula feed in the maternity?
A)yes
B)No

If yes above,what was given?explain

27.were you taught on exclusive breastfeeding at the maternity?

 CHAPTER FOUR

4.1. DATA ANALYSIS AND DESIGN

4.2. INTRODUCTION

The data collected was analyzed manually and electronically using

calculations, descriptive statistics such as frequency and percentages were
used and the data was presented in tables, charts and graphs.

4.2: SOCIO-DEMOGRAPHIC DATA

Table 4.1: Age of the respondents

Age Frequency Percentage (%)

19 -24 years 8 29%

25-30 years 15 54%

31-35 years 5 18%

36-40 years - -

TOTAL 28 100%

From the table above, most of the respondents 15 (54%) represented 25-30
years followed by 29% (8) representing age bracket 19-24 years while 18%
(5) represented age bracket 31-
35 years.
 Figure 4.1: Level of Education

35%
32%

30% 29%

25%
25%

20%
Secondary
Pe
rc
15% 14% College
en
ta Univerity
10%
ge Primary

5%

0%
Secondary Univerity Primary
College
Respondents' educational level

The graph above shows that majority of the respondents 32% (9) had
attained primary level of education, followed by those who had attained
secondary school level of education represented by 29% (8) while 25% (7)
of the respondents had attained college education and 14% (4) had
university level of education.
Figure 4.2: Respondents’ employment status

50% 46%
45%
39%
40%
35%
30%
Pe
25% Unemployed
rc Employed
20%
eb Self-employed
14%
ta
15%
ge
10%
5%
0%
Unemployed Employed Self-
employed
Respondents' employment status

The chart above depicts that majority of the respondents 46% (13) were unemployed,
39%

(11) of the respondents were employed and 14% (4) were self-employed.
Table 4.2: Respondents’ marital status

Marital status Frequency Percentage (%)

Married 20 71%

Single 5 18%

Divorced 3 11%

Widowed - -

TOTAL 28 100%

From the table above, majority of the respondents 71% (20) were married,
18% (5) were single and 11% (3) were divorced.

Table 4.3: Respondents’ number of children

No. of children Frequency Percentage (%)

1-2 15 54%

2-4 10 36%

4-6 3 10%

Widowed - -

TOTAL 28 100%

The table above shows that most of the respondents 54% (15) had 1-2 children while
36%

(10) of the respondents had 2-4 children and 10% (3) had 4-6 children.
Figure 4.3: Respondents’ place of delivery

4%

Hospital delivery
Home delivery

96%

From the chart above, most of the respondents 96% (27) of the respondents
had hospital delivery and 4% (1) had home delivery.

4.3. KNOWLEDGE OF MOTHERS ON

EARLY WEANING
Figure 4.4: Respondents’ knowledge on exclusive breastfeeding

4%

Yes
No

96%
The chart above shows that majority 96% (27) had knowledge on exclusive
breastfeeding while 4% (1) of the respondents did not have knowledge on
exclusive breastfeeding.
Figure 4.5: Responses on whether babies can survive on breast milk alone

39%
Yes
No
61%

From the chart above, majority 61% (17) of the respondents indicated that
babies can survive on breast milk alone while 39% (11) of the respondents
indicated that babies could not survive on breast milk alone.
 4.4. CULTURAL FEEDING PRACTICES OF MOTHERS TO
THEIR CHILDREN
Figure 4.6: Whether respondents offered any other foods to their babies 0-6 months

18%

Yes
No

82%

The pie chart above shows that majority 82% (23) of the respondents did
not offer any other foods to their babies 0-6 months old while 18% (5) of
the respondents fed other foods to their babies 0-6 months old.
Table 4.4: When respondents fed their children

Period of feeding Frequency Percentage (%)

On demand 20 71%

1-5 times a day 5 18%

6-10 times a day 3 11%

TOTAL 28 100%

From the table above, majority 71% (20) of the respondents breastfed their
children on demand, 18% (5) of the respondents breastfed their children 1-
5 times and 11% (3) of the respondents breastfed their children 6-10 times
a day.

4.5. MATERNAL RELATED FACTORS CONTRIBUTING TO

EARLY WEANING

Figure 4.7: Whether respondents had conditions that made them not breastfeed

7%

Yes
No

93%
 The chart above shows that majority of the respondents 93% (26) did not
have conditions that made them not breastfeed while 7% (2) had
conditions that made not to breastfeed.

Figure 4.6: Other problems hindering respondents from feeding their babies

7%

Yes
No

93%

The chart above shows that most of the respondents 93% (26) had no
problems hindering them from breastfeeding while 7% (2) had problems
hindering them from breastfeeding their babies.
Figure 4.6: Baby given supliments in 1st day

Figure 4.7: ANC clinics

Figure 4.8: ANC visits attended
 CHAPTER FIVE

DISCUSSION AND INTERPRETATION

5.1 INTRODUCTION

This chapter entails discussion and interpretation of findings in chapter four of the
study which was in line with specific objectives including client related factors
influencing early weaning, findings on cultural practices of mothers to their infants
and Institutional related factors contributing to early weaning.

5.2 SOCIO-DEMOGRAPHIC DATA

According to the study done, the findings revealed that that most of the breastfeeding
mothers interviewed 54% (15) were aged between 25 – 30 years followed by 29% (9)
respondents aged 19-24 years, 18% (5) of the respondents were aged 31-35 years.

Based on the educational level of the breastfeeding mothers interviewed, 32% (9) had
attained primary level of education, 29% (8) of the respondents had attained
secondary level of education while 25% (7) had college education and 14% (4) had
attained university education.

Most of the respondents interviewed 46% (13) were unemployed, 39% (11) were
formally employed and 14% (4) of the respondents were self-employed. According to
the findings, it was clear that most of the respondents interviewed 20 (71%) were
married, 18% (5) were single and 11% (3) of the respondents were divorcees.

According to the findings it was clear that most of the mothers interviewed 54% (15)
had 1- 2 children, 36% (10) had 2-4 children and 10% (3) of the respondents had 4-6
children.

The results of the data collected indicated that the majority of the respondents 96%
(27) delivered at the hospital while 4% (1) had delivered at home.

5.3 KNOWLEDGE LEVEL OF MOTHERS ON EARLY WEANING

According to information collected, majority of the breastfeeding mothers 96% (27)

had knowledge on exclusive breastfeeding while 4% (1) had no knowledge on
exclusive breastfeeding. 82% (23) of the mothers knew about early weaning while
18% (5) of the respondents had no knowledge on early weaning and 61% (17) of the
respondents indicated that the baby can survive with breast milk only while 39% (11)
indicated that a baby cannot survive on breast milk only.

This information is in line with Kenya Demographic Health Survey (KDHS) that the
proportion of younger children aged 0-6 months who were exclusively breastfed had
increased from 32% in the year 2012-2015 to the current 61% (2020) (Kenya
Demographic Health Survey, 2014). The results from data collected indicated that
82% (23) of the respondents interviewed did not offer other foods to their babies
between the ages of 0-6 months while 18% (5) of the breastfeeding mothers offered
their babies other foods. Most of the respondents 71% breastfed their babies on
demand.

5.4 CLIENT RELATED FACTORS CONTRIBUTING TO EARLY WEANING

The study done in Maternal and child health MCH/FP clinic shows that majority of
the respondents 93% (26) of breastfeeding mothers did not have conditions that made
them not breastfeed their children while 7% (2) of the respondents had some
conditions that hindered them from breastfeeding their children for example, lack of
milk, lumps and sore breasts. The study shows that socio-economic characteristics of
communities affect infant feeding practices and weaning in terms of length of time an
infant is breastfed. The data obtained showed the impact of socio class in mothers of
higher socio-economic bracket.

In Kenya according to the Kenya Demographic Health survey, 32% of children under
the age of 6 months were the only ones on exclusive breastfeeding. Urban poor
settlements and slums present a unique challenge with regards to child health survival;
predisposing infants born to mothers who live in slums to suboptimal breastfeeding
and early introduction to complementary feeding.

The fear of transmitting HIV through breast milk is a factor that contributes to decline
in breastfeeding. HIV mothers could be targeted by distributors of infant food
products. It is recommended that mothers should attend antenatal clinic and postnatal
clinic to rule out any complications to breastfeeding children.

5.5 INSTITUTIONAL RELATED FACTORS

According to the study,53% of the babies are given supplements within the first day of
life by midwives while at the maternity due to certain circumstances while
others(47%), are not.
According to the information collected,Only 48% of the population attended more
than 6 antenatal clinics,30% attended only 4-6 Anc visits,20% attended 1-3 clinics
while only 2% of the total population did not attend any Anc clinic.

Concerning mode if delivery,majority of the women(63%) delivered through caeserian

section while 37% delivered through spontaneous vaginal delivery.72% of the
mothers reported that they were not educated on exclusive breastfeeding while only
28% were educated on exclusive breastfeeding although this followed their request to
the midwives.

5.6 CONCLUSIONS AND RECOMMENDATIONS

CONCLUSIONS
Based on the discussion of findings and interpretation, the study was concluded
according to the objectives and hypothesis. According to information collected,
majority of the breastfeeding mothers 96% had knowledge on exclusive breastfeeding.
Also, 82% of the respondents knew about early weaning while 18% of the respondents
had no knowledge on early weaning. 61% of the respondents indicated that a baby can
survive with breast milk only while 39% of the respondents indicated that a baby
could not survive on breast milk only.

The data was in line with the Kenya Demographic Health Survey (KDHS) that the
proportion of younger children aged 0-6 months who were exclusively breastfed had
increased from 32% in the years 2012-2014,to the current 61%. The study done in
Maternal Child Health (MCH) clinic shows that majority of the respondents 93% did
not have conditions that made them not to breastfeed their babies while 7% of the
respondents had some conditions that hindered breastfeeding their babies for example,
lack of milk supply and sore, painful breasts.

The study concluded that socio-economic characteristics of the communities affect the
length of time for infant feeding practice and weaning in terms of the length of time an
infant was breastfed. This concurs with the Kenya Demographic Health survey which
stated that 32% of children under the age of 6 months were the only ones on exclusive
breastfeeding.

Urban poor settlements and slums present a unique challenge with regards to child
health survival; predisposes infants born to mothers who live in slums to sub-optimal
breastfeeding. HIV mothers should be targeted by distributors of infant food products.
The fear of transmitting HIV through breast milk is a factor that contributes to decline
in breastfeeding. HIV mothers could be targeted by distributors of infant food
products.

5.7 RECOMMENDATIONS
The Ministry of Health both national and county levels should formulate a policy
targeting the mothers on continuation of breastfeeding education up to 6 months of
age in MCH clinic as it has proven to have a positive outcome towards exclusive
breastfeeding.

The Ministry of Health (division of nutrition) together with the county government of
Mombasa should strengthen postnatal education on coping with breastfeeding up to 0-
6 months of age hence should eliminate early weaning; the effects are understood by
all breastfeeding mothers.

Knowledge and practice of complementary feeds and breastfeeding on demand should

be addressed by ensuring that all mothers attending prenatal and postnatal clinic
should be educated by counseling on the impact of early weaning.

Health workers in MCH should determine the maternal early breastfeeding knowledge
up to 6 months and practice after discharge.
 APPENDIX
ACTIVITY JAN septe october novem dece JAN
2022 mber ber mber 2023
2022 2022 2022

ACTIVITY january-august september october november december

2022 2022 2022 2022 2022
Development of
proposal
Ethical
consideration,sel
ection and
training of
researchers
Data
collection,data
organisation,anal
ysis and
interpretation
Data
presentation,and
final report
writing

BUDGET
ITEM QUANTITY COST PER TOTAL COST
QUANTITY
Transport 1 1500 1500
Research fee 1 200 200
Pens 12 20 240
Typing and printing 80 25 2000
Data analysis 1 1500 1500
allowance
Miscellenious 1500
TOTAL Ksh 6,940

APPENDIX II: INFORMED CONSENT FORM

I Maingi Munyasya a 3rd year nursing student at Kenya Medical Traing College, At
Kitui Campus; doing research: Factors Influencing timely weaning among mothers
with children aged 0-6 months attending MCH clinic in LIKONI Sub county
hospital,Mombasa county.In General County Referral Hospital of kitui kindly, request
for your generous support in this research work.
Researcher:
I have explained significance and the core objectives of the study to the respondents
and they have understood and consented to participate in the study.
Signature………………………………. Date ………………………….
Respondents:
The study topic, its significance and core objectives have been fully explained to the
respondent and they are ready to participate in the study.
Signature…………………………………Date………………

REFERENCES

Abrahams, S.W and Labbok, M.H (2013). Exploring the impact of body friendly
hospital initiative on trends in exclusive breastfeeding.
Adugna D.T (2014). Women’s perception and risk factors for delayed initiation of
breastfeeding in Arba Minch Zurial, Southern Ethiopia. International Breastfeeding
Journal.
Al-Binali A.M (2012). Breastfeeding, knowledge, attitude and practice among the
school teachers.
Gordon et al (2010). Infant formula feeds.
Kenya National Bureau of Statistics / CF Macro (2014). Kenya Demographic Health
Survey.
Kousourek (2014). Initiating weaning was that infants were not satisfied with breast
milk.
Miriam et al (2013). WHO / UNICEF guidance related to HIV and breastfeeding.

MOH (2013). Maternal, infant and young child nutrition. National guidelines for
health workers. Ministry of Health, Kenya.
Nyanga N. (2012). Factors influencing knowledge and practice of exclusive
breastfeeding in Nyando district, Kenya.
Oganda I.A (2014). Effectiveness of couple counseling versus maternal counseling in
promoting exclusive breastfeeding among HIV mothers.

UNICEF and WHO (2009). Baby friendly hospital initiative updated and expanded for
integrated care.
WHO (2011). The American Academy of paediatric recommended feeding a baby
milk only for the first six months of life and continuing breastfeeding up to one year
of