TITLE PAGE

ASSESSMENT OF MOTHERS’ KNOWLEDGE AND PRACTICE OF EXCLUSIVE

BREAST FEEDING

CASE STUDY: OUT DOOR PATIENTS AT SPECIALIST HOSPITAL GASHUA,

BADE LOCAL GOVERNMENT AREA, YOBE STATE, NIGERIA.

BY

KHADIJA MUHAMMAD BIDA

U18/HSM/1027

PROJECT RESEARCH SUBMITTED TO THE DEPARTMENT OF HOME SCIENCE

AND MANAGEMENT IN PARTIAL FULFILMENT OF THE AWARD OF DEGREE

BACHELOR OF FISHERIES AND AQUACULTURE

SEPTEMBER, 2023

i
 DECLARATION

I hear by declare that this project titled: “ASSESSMENT OF MOTHERS’ KNOWLEDGE

AND PRACTICE OF EXCLUSIVE BREAST FEEDING. CASE STUDY: OUT DOOR

PATIENTS AT SPECIALIST HOSPITAL GASHUA, BADE LOCAL GOVERNMENT

AREA, YOBE STATE, NIGERIA” is my own work and has not been presented in any form

for another qualification at any other university or institution. The information derived from the

published or unpublished works of other works has been duly acknowledged in this work.

__________________________________ ______________________

KHADIJA MOHAMMED BIDA DATE

U18/HSM/1027

ii
 CERTIFICATION

This is to certify that this project titled “ASSESSMENT OF MOTHERS’ KNOWLEDGE AND

PRACTICE OF EXCLUSIVE BREAST FEEDING. CASE STUDY: OUT DOOR PATIENTS

AT SPECIALIST HOSPITAL GASHUA, BADE LOCAL GOVERNMENT AREA, YOBE

STATE, NIGERIA” was carried out by KHADIJA MOHAMMED BIDA with Matriculation

Number U18/HSM/1027 under the supervision of Mrs. Vivien O.O and has meet the statutory

regulation governing the award of Bachelors of science at the Home Science and Management

Department, Faculty of Agriculture, Federal University Gashua.

__________________________ __________________________

Mrs. VIVIEN .O.O Date

(Supervisor)

___________________________ _____________________________

Dr. OBIANA, U.V Date

(Head of Department)

____________________________ ____________________________

(External Supervisor) Date

iii
 DEDICATION
This project is dedicated to Almighty Allah Who in His wisdom made this possible and my

entire family.

iv
 ACKNOWLEDGEMENTS

My profound gratitude to Almighty Allah (S.W.T), who has been my source of all. He has

granted me this privilege to accomplish this research work.

My sincere gratitude goes to my supervisor, in person of Mrs. Vivien O.O, for her time, sound

advice, direction and suggestion towards the success of this study. I also want to thank her for

her encouragement, kind, understanding and patience in supervision towards the success of this

work. I’m privileged to have you ma.

I would like to express my love to my parents especially my late father Alh. Muhammad Ahmad

Bida and my mother Malama Aisha for their parental care, love, prayers, moral and financial

support throughout my entire life and most especially in my academic endeavors. Daddy and

mummy I love you and not to forget my Husband Mal. Hassan Sheriff Dala for his support and

love and guidance in my marital life.

My in depth gratitude goes to my able head of department, Mr. Mohammed Sabo, my sincere

appreciation goes to my departmental exam officer in person of Mr. Samuel Ogar for his time

and sound advice.

I’m indebted to all the lecturers and indeed the entire members and staffs of the department of

Home Science and Management and also all my fellow students 400 level most especially my

friends Fatima Garba Utai, Khadija Muhammad Gishiwa, and the rest for their contribution

towards the success of this research work you all are the best.

v
 TABLE OF CONTENT
TITLE PAGE....................................................................................................................................i
DECLARATION.............................................................................................................................ii
CERTIFICATION..........................................................................................................................iii
DEDICATION................................................................................................................................iv
ACKNOWLEDGEMENTS.............................................................................................................v
TABLE OF CONTENT..................................................................................................................vi
LIST OF TABLES.......................................................................................................................viii
ABSTRACT...................................................................................................................................ix
CHAPTER ONE..............................................................................................................................1
INTRODUCTION...........................................................................................................................1
1.0 Background of the Study......................................................................................................1
1.2. Global prevalence of Exclusive Breast Feeding.......................................................................2
1.3. Statement of the Problem..........................................................................................................3
1.4 Objective of the Study..........................................................................................................4
1.5 Specific objectives were to:.......................................................................................................4
1.6 Significance of the study......................................................................................................4
1.7 Definition of Key Terms............................................................................................................5
CHAPTER TWO.............................................................................................................................6
LITERATURE REVIEW................................................................................................................6
2.1 Concept of breastfeeding......................................................................................................6
2.2 Physiology of breast feeding................................................................................................8
2.3 Science of breastfeeding.....................................................................................................10
2.4 Composition of breast milk.....................................................................................................12
2.5 Maternal Nutrition................................................................................................................15
2.6 Complementary foods.........................................................................................................16
2.7 Baby friendly hospital initiatives (BFHI) and exclusive breast feeding (EBF) in Nigeria...17
2.8. Ten steps to successful breastfeeding advocated in the baby friendly hospital initiatives. 19
2.9. Breastfeeding techniques (How to breastfeed successfully)..............................................19
2.10. Expressed breast milk (EBM)...............................................................................................22
2.11. Exclusive Breastfeeding and HIV/AIDS Infection...............................................................23
2.12. Factors affecting exclusive breastfeeding in Nigeria............................................................24
CHAPTER THREE.......................................................................................................................26
RESEARCH METHODOLOGY..................................................................................................26

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3.1. Area of the study.....................................................................................................................26
3.2 Design of the Study.................................................................................................................26
3.4. Sample size and sampling technique......................................................................................26
3.5. Ethical clearance.....................................................................................................................27
3.7. Instrument for Data collection..............................................................................................27
3.8 Method of Data Collection.................................................................................................27
CHAPTER FOUR.........................................................................................................................28
4.0. RESULTS...............................................................................................................................28
4.0 DISCUSSION..........................................................................................................................39
4.1 Mothers’ knowledge and practices of EBF........................................................................39
5.2 Socio-economic factors that affected compliance of EBF.................................................40
5.3 Complementary feeding practices of the mothers..............................................................41
5.1 Conclusion...............................................................................................................................43
5.2 Recommendations....................................................................................................................43
REFERENCES..............................................................................................................................44
APPENDIX I.................................................................................................................................48
APPENDIX II................................................................................................................................49

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 LIST OF TABLES

Table 2.1 Exclusive breastfeeding and median duration of breastfeeding a global and regional
overview 8

Table 2.2 Top 5 countries for breastfeeding 9

Table 2.3 Comparative nutritive value of human milk and cow’s milk nutrient per 100g of fluid
milk. 10

Table 2.4 Benefits of exclusive breastfeeding 14

TABLE 4.1 DEMOGRAPHIC INFORMATION 28

Table. 4.2 Knowledge About Exclusive Breastfeeding 30

Table 4.3: Exclusive Breast Feeding Knowledge

35

Table 4.4 Level of Practice of Exclusive breastfeeding EBF 35

viii
 ABSTRACT
This study assessed mothers’ knowledge and practice of exclusive breastfeeding in
Gashua, Bade local government area, Yobe state, Nigeria. Seventy (70) lactating mothers
were selected during their postnatal care visit at the Specialist Hospital Gashua in Bade
LGA who participated in the study. Ethical clearance was obtained from the Chief Medical
Officer in the Hospital and mothers’ consent was sought through the clinic head.
Interviewer administered questionnaire was used to obtain information on the mothers’
socio-economic characteristics, knowledge and practices of exclusive breastfeeding
(EBF). The results obtained showed that 83.4% of the respondents had adequate
knowledge of EBF. About 46.6% of the respondents who had adequate knowledge of EBF
practiced it.. Over 90% of the respondents in both health center fed their children
colostrum. A total of 89.14% of the respondents practiced prelacteal feeding.

ix
 CHAPTER ONE

INTRODUCTION

1.0 Background of the Study

Exclusive breastfeeding (EBF) for the first 6 months of life improves the growth, health and

survival status of newborns and is one of the most natural and best forms of preventive medicine.

EBF plays a pivotal role in determining the optimal health and development of infants, and is

associated with a decreased risk for many early-life diseases and conditions, including otitis

media, respiratory tract infection, diarrhea and early childhood obesity. It has been estimated that

EBF reduces infant mortality rates by up to 13% in low-income countries. The importance of

breastfeeding as a determinant of infant nutrition, child mortality and morbidity has long been

recognized and documented in the public health literature. In response to this, the Nigerian

government established the Baby-Friendly Hospital Initiative (BFHI) in Benin, Enugu,

Maiduguri, Lagos, Jos and Port Harcourt with the aim of providing mothers and their infants a

supportive environment for breastfeeding and to promote appropriate breastfeeding practices,

thus helping to reduce infant morbidity and mortality rates. Despite these efforts, child and infant

mortality continues to be major health issues affecting Nigeria. The infant mortality rate for the

most recent five-year period (1999-2003) is about 100 deaths per 1,000 live births and EBF rates

in Nigeria continue to fall well below the WHO/UNICEF recommendation of 90% EBF in

children less than 6 months in developing countries. The low rate of EBF in Nigeria may, in part,

be due to traditional beliefs, practices and rites. For example, in Yoruba and Benin communities,

EBF is considered dangerous to the health of the infant who is thought to require water to quench

thirst or stop hiccoughs. A more detailed understanding of the factors associated with EBF in

Nigeria is needed to develop effective interventions to improve the rates of EBF and thus reduce

infant mortality. The purpose of the present study is assess the knowledge and practice of

1
exclusive breastfeeding in North-East Nigeria using Gashua, Bade Local Government as a study

area.

1.2. Global prevalence of Exclusive Breast Feeding

The percentage of infants who are breastfed varies considerably among regions and countries.

Demographic and Health Survey (DHS) data from surveys carried out between 1984 and 1990

(Perez-Escamilla, 2010) indicate that in Africa, the rate of breastfeeding in each country ranged

from 92% to 99% where as in Latin America and the Caribbean, the range was much wider from

77% to 940% compare to range across the developing countries (Saadeh ,1993b) cited by

WHO,2012. In western pacific region, the rate was 63-89% and 73-94% in South East Asia.

Region with indication of higher rates in rural areas than urban (WHO, 2011). In many cultures,

Colostrum is reportedly withheld up to 3 to 4 days, primarily because it is believed to be harmful

to infants probably due to its laxative influence. In Northern Pakistan, Colostrum is expressed

and discards in this situation; the new born may be fed for a few days by a lactating relatives or

wet nurse or given gruel which often lead to diarrhea (WHO, 2011).

In some cultures, pre-lacteal foods are given until true milk has come; in part of Malaysia,

mashed ripped banana is fed to the baby the first day of delivery. Often, this is undertaken in part

to clean out the meconium (WHO, 2011). The discarding of colostrum may be widespread;

however, there is considerable variability within culture with regards to actual practice. In a

recent study of 248 mothers in Bangladesh, no infant was totally deprived of colostrum and

almost 30% of infants were breastfed within the first 24 hours of birth. The exclusive

breastfeeding rates for infant less than four months of age are generally lower than desired

ranging from 19% in Africa to 49% in South-East Asia. Only a few countries reported a

prevalence of more than 45%. In West Africa where water supplementation is prevalent, the rate

of EBF is less than 10%. These estimates are constant with most other reports (Saadeh, 2011). It

2
was indicated that at present, most breastfeeding mothers in developing countries particularly

Nigeria uses fluid and other breast milk substitutes within the first four months of infants’ life..

1.3. Statement of the Problem

Although a lot of efforts have been made WHO which motivated the Nigeria government into

taking steps towards decreasing the child mortality rate. EBF rate remains low in Nigeria and fall

short of the expected levels needed to achieve a substantial reduction in child mortality.

Antenatal care was strongly associated with an increased rate of EBF. Appropriate infant feeding

practices are needed if Nigeria is to reach the child survival Millennium Development Goal of

reducing infant mortality from about 100 deaths per 1000 live births to a target of 35 deaths per

1000.

Exclusive breast feeding (EBF) has important protective effects on the survival of infants and

decreases risk for many early-life diseases. The purpose of this study was to assess the factors

associated with EBF in Nigeria and Bade Local Government Area.

The levels are far below the program target of 90% of women exclusively breastfeeding their

infants in the first 6 months of life, which is associated with a reduction of 10% of under-five

deaths. The key factors that were associated with higher rates of EBF included antenatal clinic

visits, household wealth and gender. Also of importance were the types of addition liquids and

foods given to young infants that resulted in the low EBF rates. These could be due to so many

factors such as poverty, culture and may be climate. (W.H.O. 2015).

A substantial improvement of EBF can be achieved in Nigeria by avoiding the practice of

mothers giving water to their babies in addition to breast milk. (W.H.O. 2015)

EBF promotion programs targeted at mothers, with special focus on poor and illiterate families,

mothers who delivered at home and mothers who have had no antenatal clinic visits is not

adhered to in the study area. There was no documented rate of EBF in the study area Gashua,

3
but it was obvious that the women did not adhere to strict EBF. Hence knowledge,

understanding and practices of EBF were also function of different cultures and social groups.

This made EBF practices unpopular to many lactating women in the study area due to

inadequate knowledge, lack of credibility and misconception regarding EBF. The World Health

Organization recommends that complementary foods for infants should be derived from locally

available foods.

1.4 Objective of the Study

The general objective of this study was to assess the mothers’ knowledge and practice of

exclusive breastfeeding in Gashua the study area.

1.5 Specific objectives were to:

1. Determine the mothers’ knowledge of exclusive breastfeeding (EBF) in the study area,

2. Determine the mothers’ practice of exclusive breastfeeding (EBF) in the study area,

3. Determine the factors affecting compliance to EBF in the study area.

1.6 Significance of the study

The findings of the study will show-case the rates of EBF in the study area. This will aid the

health workers and the government on how and where to plan community based breastfeeding

intervention programs for promoting, protecting and supporting EBF. This will enhance full

benefit of EBF in the study area, Bade Local Government, Gashua. The results will also be a

guide for them when organizing nutrition and health education to target vulnerable groups. This

will make breastfeeding programs in the area well organized and effective. The findings will

also sensitize mothers and health workers on the need and the benefits of initiating

breastfeeding which will contribute to the long life span and thus reduce mortality rate. This

will help to enhance the rate of timely initiation of infants to breast milk immediately after

delivery. However, it will also help to reduce infant morbidity and mortality rate due to

neonatal starvation. Early breastfeeding initiation also aids convolution of uterus and return of
4
pre pregnancy shape in mothers, thus it’s wide application or practice will boost both maternal

and child survival in the area.

The study will serve as a channel to create awareness to the Government and other health

providers on the delivery of nutritional and health education for both the government, health

workers, lactating mothers and the general public on the benefits of EBF for the first six

months of infant’ life . This will reduce the rate of early introduction of complementary

feeding, and bottle feeding rate. It will also to a large extent reduce infant under nutrition

emanating from diluted formula.

1.7 Definition of Key Terms

 Mother: A Woman in relation to her child or children.

 Knowledge: Information, and skills acquired through experience or education; the

theoretical or practical understanding of a subject.

 Exclusive Breast Feeding: Means that an infant receives only breast milk from his or her

mother or a wet nurse, or expressed breast milk, and no other liquids or solids, with the

exception of oral rehydration solution, drops or syrups consisting of vitamins, minerals

supplements or medicines.

 Infant: A very young child or baby.

5
 CHAPTER TWO
LITERATURE REVIEW
2.1 Concept of breastfeeding
Breastfeeding is described by World Health Organization (2003) as a natural way of feeding an

infant the breast milk from the mother. It is a cost effective way of providing ideal nourishment

for the healthy growth and development of infants. It is also a natural resource that has a major

impact on child’s health, growth and development. Breastfeeding has become adapted to the

need and way of life of different mammalian species particularly to the maturity of the new

born, special nutritional requirement, protection, bonding, sensory stimulation and other

various biological considerations (UNICEF, 2009, 2012 and 2016, Derick & Jellieffe, 2010).

Researchers have explained that the composition of breast milk and the length of lactation of

different species appear to have been modified and adapted to the need of that particular

creature (Cameroon & Hofvander. 2015, vol4 pg 6-8). Due to the ample benefits of

breastfeeding to mother child, WHO (2002, 2011, 2016, 2019) recommended that every child

should receive exclusive breastfeeding (optimal breastfeeding) from birth to six months of life.

The odds of mothers practicing EBF were relatively low in all geopolitical regions but much

lower in North East and North West geopolitical regions. Mothers who lived in these regions

were less likely to practice EBF than those who lived in the North Central geopolitical regions.

These findings are similar to those reported from countries in Southeast Asia where the rate of

EBF was significantly associated with particular sub-national geographical area. Multivariate

multilevel binary logistic regression analysis revealed that the following factors were

significantly associated with EBF after controlling for confounders: (a) decreased child age in

months; (b) geopolitical region; (c) antenatal clinic visits; (d) household wealth, and (f) gender.

A recent study in East and Southeast Asia found that region, household wealth and sex of the

baby were positively associated with EBF. Evidence from Edo and Oyo State in Nigeria also
6
supported the finding that younger age, sex of the baby and antenatal contacts with health centers

predicted improved EBF and was based on the 24 hour recall, and the day to day variability in

food intake might lead to an over estimation of EBF. (WHO Global Health Report, 2016).

EBF rates in Nigeria are amongst the lowest in the world, and even compare poorly with other

neighbor-ing countries in the region. Nigeria lags behind Ghana (53.4%), Republic of Benin

(43.1%) and Cameroon (23.5%) [25-27]. A substantial improvement of EBF can be achieved in

Nigeria by avoiding the practice of mothers giving water to their babies in addition to breast

milk. EBF promotion programs should target all mothers, but with special focus on poor and

illiterate families, mothers who delivered at home and mothers who have had no antenatal clinic

visits. In addition, further research is required to describe the feeding pat- terns and dietary

intake related to complementary feeding, and their effects on children’s growth. Finally,

intervention studies, including peer counseling using cluster randomized controlled trials, are

needed to improve EBF among mothers and those having their first baby in Nigeria.

(WHO,2016).

Exclusive breastfeeding (EBF) means giving breast milk in response to all the child’s need for

food, drink, suckling and perhaps comfort or soothing. It is usually practice on demand with no

other food or drink given to the infant other than breast milk and medication for the first six

months of life, after which continued breastfeeding is accompanied with appropriate

complementary foods for two years and beyond (WHO & UNICEF, 2010). Exclusively

breastfed child could be fed by its’ own mother, wet nurse or expressed breast milk with no

additional food or drink given to him for the first six months of life. The recommendations for

EBF include initiation of breastfeeding within an hour of birth, breastfeed exclusively for the

first six months and adequate complementary food with continued breast feeding for two years

or beyond. Exclusive breast feeding is one of the cardinal components of Baby Friendly

7
Hospital Initiatives (BFHI) aimed at protecting, promoting and supporting breast feeding for

optimal maternal and child survival. (NHIC Lagos 2017).

Table 2.1: Exclusive breastfeeding and median duration of breastfeeding a global and

regional overview

Total Countries Infants EBF

Total No Median
No of of the in the rate <4
Of duration of
Infants Region region Months
Countries Breastfeeding
(m) Included included of age

(No) (%) (%) (%) Month

23.3 46 25 54 71 19 21
The Americans 16.0 35 14 40 38 34 10
South-East
Asia 42.2 10 5 50 93 49 25
East
15.5 22 11 50 84 36 19
Mediterranean
Europe 11.5 50 4 8 19 16 11
Western
Pacific 28.7 27 2 7 7 33 14
World Total 137.2 190 61 32 58 35 18
Source: WHO 2010

2.2 Physiology of breast feeding

During pregnancy, particularly in the second trimester, the process of lacto- genesis begins.

This is the period the breast makes the colostrum. At this first stage, high level of progesterone

inhibits milk production however, it is not a medical concern if a pregnant woman leaks

8
 Table 2.2: Top 5 countries for breastfeeding

% EBF 0- 4 % EBF0-6
Country months Country Months

Rwanda 94.4 Rwanda 88.4

Kiribati 80.0 Kiribati 80.0
Madagasca
r 77.1 Benin 70.1
Benin 76.9 Madagascar 67.2
Korea,
China 76.7 North 65.1

Sources: UNICEF, 2012.

Colostrum before birth (Riordon, 2005, WHO 2017). With pregnancy advancement, the

estrogen prompts the ductal system to proliferate and grow while the progesterone responds for

the increase in size of the lobes, lobules and alveoli. As a result, the breast, increases in size

and the areola becomes larger and darker making the breast to become more erect. The breast

begins its secretary phase filling the alveoli with colostrum, as a result becomes more distended

and heavier ready for breast feeding. This process continues until delivery (Riordon, 2005).

At birth, the prolactin level is high. The delivery of placenta sudden inhibits pregnancy

hormones as a result, milk production begins. Human milk is not stored in a large volume as

cow does. Breast feeding depends on two maternal reflexes. The infant’s actual suckling

stimulates the milk production hormone, prolactin which triggers the alveolus to produce milk

which collects in the lumen. The milk- let-down-reflex is stimulated by oxytocin which causes

the constriction of my-epithelial cells surrounding the alveolus. This action forces the milk

from the lumen into the lacteal sinuses and finally into the areola where the infant draws the

milk easily (Hanson, 2004 reviewed 2018 cited by WHO 2020). Scientific research has

revealed that let down-reflex is very sensitive to maternal stress, anxiety tiredness
9
embarrassment and as such may be inhibited. It is facilitated if the mother is happy and

confident of her ability to breast feed.

2.3 Science of breastfeeding

Breast milk is the first natural food for babies which have been declared to receive exclusively

for the first six month of life by World Summit for children. After this, nutritionally adequate

and safe complementary foods are recommended to ensure healthy growth and development

(WHO, 2005,2010 and 2013). The length of exclusive breastfeeding (EBF) is usually based on

total dietary intake, (Energy and micronutrients) physical and cognitive development. Other

consideration was based on risk of short term morbidity and mortality as well as maternal

nutrition and health. However, in actual practice, the outcome is limited to energy intake and

growth (weight and length) (Daly & Hartmann, 2005).

It has been well established through research that breast milks production is related to infant

demand and extremely plastic in such a way that the more the mother breastfeed the more milk

is produce. The length of EBF is scientifically based on where the energy of breast milk meets

with the requirement of infants within the first six months of life (Brown. Dewey & Allen,

2010). The World Health Organization (WHO) recommended that energy intake should be

based on total energy expenditure required for growth and development. The new estimate of

energy

10
Table 2.3: Comparative nutritive value of human milk and cow’s milk nutrient per

100g of fluid milk

Human Cow’s

Energy (Kcal) 77 65
Protein (g) 1.1 3.5
Fat (g) 9.5 4.9
CHO (g) 10.9 8.9

H2O (g) 85.2 87.9

Total ash (g) 0.2 0.7
Calcium (g) 33 118
Phosphorus (mg) 14 93
Magnesium (mg) 4 12
Sodium (mg) 16 50
Potassium (mg) 51 114
Iodine (mg) 3 4.7
Zinc (mg) 0.3 – 0.5 0.3 – 0.5
Vitamin A (Iμ) 240 140
Vitamin E (Iμ) 0.2 – 0.5 0.02 – 0.25
Vitamin D (Iμ) 2.1 1.3
Vitamin K (mcg) 1.5 6.0
Ascorbic acid (mg) 4.3 1.1
Thiamin (mg) 0.01 0.03
Riboflavin (mg) 0.04 0.17
Niacin (mg) 0.2 0.1
Folacin (mcg) 5.2 5.5

Vitamin B6 (mg) 0.01 0.064

Vitamin B12 (mcg) 0.03 0.4
Source (WHO, 2011, 2013).

11
Requirement based on total energy deposition for breastfed infants are very similar to that

provided by breast milk during the first six months of life (Butte, 2005). In addition breast fed

infants have normal growth pattern when compare with predominantly breastfed infants.

(Whitehead & Paul 2002).

2.4 Composition of breast milk

Biologically, human milk is a highly complex and unique secretion with many marked

differences from milk of other species. The composition and output of human milk varies with

many factors including the stages of lactation, maternal nutrition and individual variation

(Derrick & Jellieff, 2012). Colostrum is the first secretion of breast milk. It contains vital

components such as anti-body-rich protein especially secretory immunoglobin A (IgA) and

lacto-ferrin. Colostrum contains less fat than mature milk but have more micronutrients

particularly NaCl and Zinc which are anti-infective. Biochemically, colostrum has laxative and

protolithic influence which enables it to clear out meconium and also supply some doses of

micronutrients to the infant (Glass, Svennerholm & Stoll., 2014).

Fat is the main sources of calories in the human milk. In addition, supplies fat soluble vitamin

and essential fatty acids. The fat content of breast milk varies with the time of sucking, there is

a threefold increase in fat in hind than in fore milk. Breast milk in contrast of formulae contain

long chain poly unsaturated fatty acids (Omega-3 fats) such as Arachidonic and docadexaenoic

fatty acids known for proper functioning of brain, immune system as well as uptake of fatty-

soluble vitamins (Oddy, Holt & Sly 2012). Triglycerides which are the main constituent of

breast milk fat can split spontaneously at 4 oC into di- and monoglycerides. It thus releases free

fatty acid as sources of energy for the infant in contrast to cow milk and other formulae that

requires enzymatic reaction of lipase. In addition, the cholesterol level of human milk is high

compare to other milks. Reiser and Sidelmen, (2012) explained that high level of cholesterol is

12
needed in early weeks of life to ensure proper development of enzymes, hormones and

myelination of the central nervous system. Interestingly, breast milk contains palmitic acid in 2

positions which is precipitated and excreted as calcium palmitate soap. This prevents

hypocalcaemia in breastfed infants (Gyorgy, 2012).

It was known for years that cow’s milk contain about three times more protein than human.

However, human milk protein (whey) forms soft and flocculent curd while that of cow form

tough and rubbery curd which is hard to metabolize. Mother’s milk contains 60-80 percent

whey protein which is more bio-available to the infant. Other protein present in human milk

includes lactoferrin lysosome, bifidus factor, immunoglobin and leucocytes which have anti-

infective influence protecting the child from early childhood illnesses (WHO, 2011). Almost all

the carbohydrate in human milk is in the form of lactose which metabolizes to glucose and

galactose in the infant body. These metabolic substrates are essential for the brain, growth and

development of infants. Lactose decreases the amount of unhealthy bacteria in the stomach and

improves the absorption of calcium, phosphorous and magnesium, a situation that controls

rickets in children (Derrick & Jellieffe, 2012).

The level of vitamins and minerals in human milk is affected by maternal nutritional status

particularly water soluble vitamins. Human milk contains higher level of Vitamin A, ascorbic

acid and Vitamin E than does cow milk. Vitamin K is lower in human milk. However,

absorption is facilitated by other nutrient such as calcium (Derrick & Jellieffe, 2012).The

concentration of mineral is over three times greater in formula (cow milk) than in human milk,

however, in human milk is a specific binding factor for greater absorption of such minerals. For

example, while a baby only absorbs 5-10 percent of iron in formula she absorbs 50-75 percent

from mothers’ milk.

13
 Table 2.4 Benefits of exclusive breastfeeding

Benefit for infant Benefit for mother

Perfect food for infant Returns uterus to pre-pregnancy shape

Guarantees safe, fresh milk Promotes less post-partum bleeding

Enhances immune system Reduces the risk of maternal obesity

Protects against infectious and non-infectious Eliminates the need for preparing and

diseases mixing formula

Protect against food allergies and intolerance Saves money not spent on formula

Decreases risk of diarrhea and respiratory Decreases risk of breast and ovarian cancer

track infections Increases bonding with infant

Promotes correct development of jaw, teeth Enhances self-esteem in the maternal role

and speech pattern Delays the menstrual cycle thus enhances

Decreases childhood obesity child-spacin

Increases cognitive function

Increases bonding with mother.

14
2.5 Maternal Nutrition
The composition and volume of breast milk produced by mothers of different nutritional status

is a major issue of pediatrics and public health importance. The fundamental issues are the

nutritional adequacy of such milk for young infants in terms of calories, proteins, vitamins and

minerals and the physiological and practical efficacy of supplementing the mineral or infant

diet when and if necessary. (Jellieffe, 2010). The recommended dietary allowance of energy for

a lactating mother producing normal milk volume of 700-850 per day is 500 kcal above her

normal needs for the first three months of lactation. This recommendation is based on 80%

efficiency which maternal dietary energy is converted to energy in breast milk (WHO, 2002).

To maintain such allowance, a lactating mother require a constant provision of balanced diet

from variety of foods to supply sufficient nutrients needed to support the baby through breast

milk. The increase need of protein required in lactation is achieved by intake of one pint of

milk daily which provides 18 to 20g of protein. In developing countries, less privilege women

restore to legume or pulse as main source of protein. It was advised that women should be

encouraged to obtain their nutrients from a well-balanced varied diet rather than from vitamin

and mineral supplements. This recommendation should be compatible with the women’s

economic status and food preferences. (SCN, 2011).

An estimation of volume of breast produced by mothers of different nutritional status in

developed and developing countries has been undertaken in variety of countries in Asia, Africa

and New Guinea. The result reported that despite of method of collection of sample and

analysis, the volume reported from mothers in developing countries was below those reported

from well nourished countries in Europe and North America. (Bailey, 2010). Volume reported

varied and seems to be lowest in communities with poor level of nutrition and in adequate

living facilities. Also it was recognized in practice that the milk output of extremely

15
malnourished mothers in famine declines and ultimately ceased with fatal consequences on the

baby (Jellieffe, 2012). However, a study carried out on the effect of breast milk output on

supplementation of mothers diet, Goplan (2009), showed an increased in volume secreted from

420-540ml in poorly malnourished India women following protein supplementation from 61-

99g daily. Similar results were obtained in western Nigeria by Bassir (1975), using a vegetable-

protein supplementation, 30g of soya flour daily. However, it was indicated that successful

lactation does not depend only on adequate maternal diet but also upon sufficient maternal rest,

freedom from disease, anxiety stress and the desire to nurse the baby (WHO).

2.6 Complementary foods

From 6 months onwards, infants need safe and adequate complementary foods along side with

continued breast feeding. As a baby grows and become more active, an age is reached when

breast milk alone is not sufficient to meet the child’s nutritional needs. So complementary

foods aim to fill the gap between the total nutritional need of the child and the amount provided

by breast milk (WHO, 2011). To keep young children healthy during this period,

complementary foods should be affordable, sustainable, age appropriate and safe and should be

fed in adequate amount to complement the total nutritional requirement of the child. How much

a complementary food is estimated by calculating the gap between the nutrients provided by

the breast milk and the child’s total nutritional requirement. Adequate and safe complementary

food should be given three times to breastfed babies aged 6-7 months, increasing to five times

daily by 12 months. Few spoons are usually introduced at a start and gradually increase the

amount and variety (WHO, 2011).

The World Health Organization in 1996 advocated that complementary feeding should start

from six months of the infant life. This is the period the child no longer satisfy its nutritional

need from breast milk alone. At this stage, nerves and muscles in the mouth develops to let the

16
baby munch, bite and chew. This is equally the time the child develops teeth to control its

tongue better. At that stage, the child can put things in the mouth indicating interest in new

taste. The digestive system is also mature to digest range of foods. Introducing complementary

foods too early deprive the infants’ full benefits of EBF which exposes them to early childhood

diseases while late complementary feeding retards growth hence can trigger the onset of

malnutrition.( NSC 2011).

During the period of complementary foods, a baby is gradually become accustomed to eating

family foods, usually at 2 years or beyond. Breast milk is gradually replaced with family food

although a child may still sometimes suckle for comfort. Complementary food could be special

for example a mother may specially prepared porridge or pap for her baby while the rest of the

family eat cassava or could be usual family foods that has been modified to make them easy to

eat and provide adequate nutrients for the baby (WHO, 2011). Adequate complementary foods

usually consist of staple foods (cereals, legumes, starchy roots and tuber), oil seeds, dark green

vegetables, fruits, animal foods, milk foods fat and oil and moderate sugar. Their preparation in

double, tipple and quadruple combination enables the child gets sufficient energy and micro

nutrients for healthy growth and development (WHO, 2011).

2.7 Baby friendly hospital initiatives (BFHI) and exclusive breast feeding (EBF) in Nigeria.
There has been exciting evidences in the past years concerning the biochemical, anti-infective,

emotional and economic benefits of breast feeding. With these ample evidences, there was

intensive curiosity to achieve successful breastfeeding globally by year 2000. In quest of that,

the World Health Organization (WHO) and United International Children Emergency Fund

(UNICEF) launched the Baby Friendly Hospital Initiatives (BFHI) in 2010. The BFHI is a

global effort involving 160 countries of which 95 are in developing countries where Nigeria

belongs (UNICEF, 2011). The key strategy in this initiative is to transform care of new born

17
infants in maternity hospitals by supporting, promoting and protecting proper infant feeding

practices starting from EBF.

In view of many benefits to mothers and children afforded by breastfeeding, governments set

goals and rates for breastfeeding practice. The Nigeria government appointed six University

Teaching Hospitals as BFHI centers i.e. Enugu, Port-Harcourt, Benin, Lagos, Jos and

Maiduguri with the objective of reducing infant malnutrition, morbidity and mortality rates as

well as promoting the health of mothers (Salami, 2006). Since the inception of BFHI in 2000 in

Nigeria, series of programs, seminars, workshops and conferences aimed at promoting

breastfeeding practices have been organized to educate mothers and the general public about

the practice of EBF. There has been ample evidence from developed and developing countries

as defined according to United Nations to suggest that implementation of the BFHI produced

significant increase in initiation rate of EBF particularly where the rate were low prior to

implementation. According to UNICEF (2010), 20,000 hospitals in 150 countries have become

baby friendly; more than 60 countries have law or regulation implementing the international

code of marketing breast milk substitute (ICMBS) and many countries adopted national

breastfeeding authority (policy). It was recorded in country profile 2002, that currently Nigeria

has 1147 existing baby friendly facilities (BFF) more than other countries in West Africa, this

has steadily increased to 1340, ( NPC report on health in Nigeria 2013)

Despite all these efforts the practice of EBF in Nigeria is far from optimal (100%). The rate is

very slow, irregular and fluctuates (Obinna, 2013). Baby Friendly Hospital Initiative may not

have positive effect since pregnant women in most developing countries still deliver their

babies at home, private clinics or with brief stay if delivered in Baby Friendly Hospital (BFH).

This is typical of Nigeria society. There is need for intensive nutrition education to mothers,

18
government and the general public to enhance the need for support, promotion and protection

of exclusive breastfeeding in Nigeria.

2.8. Ten steps to successful breastfeeding advocated in the baby friendly hospital
initiatives
• Having a written breastfeeding policy that is routinely communicated to all staff.

• Providing training and implementation of skills to all health staff.

• Informing all pregnant women about the benefits and management of breastfeeding.

• Promoting initiation of breastfeeding within half an hour after birth.

• Showing mothers how to breastfeed and maintain lactation even if they are

separated from their infants.

• Providing breast milk only unless medically indicated.

• Allowing mother and their infants to remain together 24 hours a day at least for the

first six months of life (rooming-in)

• Encouraging breastfeeding on demand.

• Providing no artificial teats or dummies.

• Fostering establishment of and referral to breastfeeding support

groups. Sources: WHO/UNICEF, 2012.

2.9. Breastfeeding techniques (How to breastfeed successfully)

Here are important points for breastfeeding mothers. To carry them out successfully, they need

the attention of health workers at birth and follow-up during post natal to ensure that they learn

and apply these techniques. At birth, the full-term baby breathes on its own and within some

minutes makes sucking motion showing readiness to feed. Within the 30 minutes of birth, the

mother should put the baby at breast to achieve a good start of breastfeeding. The first 45-

minutes are also a critical period for bond formation, physical and emotional tie between the

mother and the infant which persists throughout infancy. If the mother cannot breastfeed

19
immediately the new born should wait instead of receiving artificial teats (wrong impression)

which may cause him resist breastfeeding later. (WHO 2015, 2012, 2009).

At the beginning of breastfeeding, the mother should relax and positioned herself so that she

and the baby will both be comfortable so that the baby suckles without having his breathing

obstructed. She needs to learn how to squeeze the areola between two fingers so that she can

slip enough of it into the baby’s mouth to promote good pumping action. She also need to learn

how to make the baby let go (stop) – “don’t pull!”, Break the suction by shipping a finger

between his gum or holding his nose for a second. (WHO 2013).

• If the infant is hungry, the mother should allow him to suck longer because the

suckling stimulates the release of hormone that promotes milk production to ensure

greater milk supply at the next nursing. It also promotes the contraction of uterus to

return to pre-pregnancy size and also stops post-partum bleeding in mothers.

• The mother should learn to apply the rooting reflex which makes the infant turn his

mouth towards the side he was touched. If the mother wants the infant to be nursed,

she should not touch his other check or he will turn his head away from the nipple

towards her hand but if she touches his check with the nipple, the infant turns and

take the breast.

• The mother must learn to relax and go with let-down (milk ejection) reflex which

makes the breast milk flow. At first, baby’s actual sucking stimulates the milk let

down reflex, but when it has well-established, the sound of the baby’s crying may

be enough to trigger it. Let down reflex occur for the baby to obtain breast milk

easily if not he will get tired before it. Milk let down-reflex is said to be well

established when a mother is nursing the baby at one breast and milk drips from the

20
 other. A glass of water prior nursing can help while some people advocate moderate

intake of beer or wine in late afternoon feeding when the mother may be tense.

• The draught reflex which occurs later during nursing session draws milk from the

hindmost-milk-producing gland after the fore milk has been released; the mother

should allow and encourage the infant to continue nursing at that breast after the

draught reflex has occurred. This helps the baby to get enough milk particularly

hind milk which is richer in fat and thus provides satiety for the infant.

• The mother should ensure that the nipple rest well-back on the baby’s tongue, lips

and gum so as to maintain sucking and swallowing reflex together.

• Although, the baby can suck half of the milk from breast within two minutes and 80

to 90% of it within four minutes, he should continue suckling for ten minutes or

more. Sucking and removal of milk stimulates lactation. After that the baby can be

give the other breast to finish satisfying his hunger. The mother should start nursing

session on alternate breasts to ensure that each breast emptied regularly. When the

baby is noticed nearly fully, hold him upright to allow him expel any swallowed air

(burping) then, give him another chance to nurse.

• For the first ten days of birth, the mother should have enough help and support at

home so that she can take enough rest for hours. Adequate rest and plentiful fluid

intake are indispensable to successful lactation.

• Demand feeding (feeding session) should not be less than six times a day to

promote optimal milk production and infant growth. The mother can express breast

milk, store in refrigerator or freezer, to use it later. A mother who nurses her baby

12 times a day during the first six months of life ensures that supply of milk keeps

21
 up with demand so as to maintain successful breastfeeding later on. The midnight

feeding should not be skipped even if the baby is inclined to sleep through it.

• In case of a working mother who substitute formula while at work. To be sure not

to suppress lactation should express the amount of the breast milk the baby would

suck even if she does not expect to use it. In that way, the breast maintain

producing that quantity of milk (Whitney and Hamilton, 2013).

2.10. Expressed breast milk (EBM)

The baby nursing from its own mother is the most ordinary way of obtaining breast milk.

However, breast-milk can be expressed and feed to the baby with feeding cup, spoon, and

bottle or through a nasogastric tube if the baby is sick (Breastfeeding Guidelines, 2012).

Expressed breast milk (EBM) is relevant when direct breastfeeding is not possible may be the

mother is away from the baby for few hours or in some health cases. In any case, by EBM, the

baby is maintained the benefits of breast milk even though she is fed by someone else or by

other means. Expressed breast milk (EBM) is also a good means to relieve engorged breast and

enhance milk supply. In addition, EBM is use to prolong breastfeeding and maintain temporary

milk supply when the mother is unable to breastfeed because she is on medication that can be

harmful to the child or other similar conditions (Jaome, 2012).

If EBM is to be used only for once in a while, for comfort or in a rare case, the mother may be

able to express such quantity using ordinary hands. However, a full time working breastfeeding

mother or other counterparts may need manual breast pump or an ultra- fast hospital grade

electric pump to pump faster and sufficiently. With good pumping habits, particularly in the

first 12 weeks when the milk supply is being established, it is possible to produce enough

milk to feed the baby for as long as the mother wishes (Baker, 2013).

22
Expressed breast milk is best stored in plastic bottle with secure tops to seal in freshness. The

date it was expressed is usually written on the bottle before putting in the refrigerator or freezer

to convey its freshness at the time of use. Refrigerated milk kept at the back of the fridge away

from the door at the temperature of 40C 390F or lower is best used within 3-5 days. Frozen milk

last for 2 weeks in ice box of a fridge at a temperature of -15 0C 50F and 3-6 months in

combined refrigerator and freezer with separate doors at -18 0C 00F (Breastfeeding Guidelines,

2004). Expressed breast milk can also be stored for a while (few hours) at a room temperature

(250C, 770F). Research suggests that long term freezing destroys some antibodies in breast milk

but it is still much healthier and offer better protection from disease than does formula milk

(Breastfeeding Guideline, 2007).

Frozen milk is best thawed either in bowel of warm water, run under warm tap water or

defrosts in the microwaves. It is better that expressed breast milk is fed to the baby by someone

else rather than the mother so that the baby will learn how to associate direct feeding with the

mother and bottle feeding with other people. It is also important to delay the use of feeding

bottle to feed EBM until the baby is up to 4-6 weeks to avoid nipple confusion.

2.11. Exclusive Breastfeeding and HIV/AIDS Infection

Strategies to limit post-natal transmission of HIV/AIDS have a negative impact on continued

breastfeeding particularly in countries where HIV/AIDS prevalence is high. The most recent

guidelines from WHO (2011) advices exclusive breastfeeding unless where replacement

feeding is acceptable, feasible, affordable, sustainable and safe (AFASS) and that HIV/AIDS

infected mothers continue breastfeeding beyond six months of age if replacement feeding is not

AFASS (WHO, 2010). This statement is not widely disseminated or implemented, earlier

discontinuation of breastfeeding still spill over in wider population of women of HIV/AIDS-

negative or unknown status. The availability of ready to use therapy foods (RUTF) has enabled

23
some HIV/AIDS prevention programs to encourage breastfeeding cessation at 6 months and

uses of RUTF as breast-milk substitute thereafter (Vander Horst, 2011).

Researches have explained that breast milk protects from HIV/AIDS infection. High level of

long chain unsaturated fatty acid in breast milk including eicosadienoic and arachidonic are

associated with reduced risk of HIV in children and reduced viral shedding of HIV virus in

breast milk. World Health Organization (WHO) explained that exclusive breastfeeding (EBF)

protects against diarrhea and other infections (Ahmed, Roa, Sack, Khan & Haque 2013). In

addition, when compare with mixed feeding, EBF is associated with reduced risk of HIV

transmission in a study in South Africa and increased free survival in a study in Zimbabwe

(Coutsoudis, Pillay, Sponer, Kuhn & Coovadia 2019.). In the latter study, early mixed feeding

was associated with a 4-fold increased risk of breastfeeding associated HIV/AIDS transmission

from first six months. Several explanation for the increased risk of HIV/AIDS transmission

associated with early mixed feeding have been proposed including increased gut inflammation

and permeability to infection, higher viral load in breast milk and frequent breast problems

among mothers who mix feed.

2.12. Factors affecting exclusive breastfeeding in Nigeria

In Nigeria, breastfeeding is a common practice among mothers. However, the new life style

and the emergency of working class mothers have caused a decline in breastfeeding pattern.

The global economic recession which is also of national concern has increased the number of

women participating in the labor market. This economic challenge reduces the proximity of

mother with the infant shortly after post-partum due to resumption of duties (Haider, Ashworth,

Kabir &Huttley, 2000). Also the intensive advertisement and promotion of infant formula and

other breast milk substitute has discouraged many women toward breastfeeding and created

24
tendency to early shift to bottle feeding. This practice is prevalent in urban areas and cities and

recently adopted as modern-urban-lifestyle.(Kabir 2000).

Ill-health and strategy to limit mother-to-child (vertical) transmission of infections such as

HIV/AIDS, hepatitis and other conditions where the immune system may be compromised has

decline the rate of breastfeeding. The effect is usually replacement of breast milk with infant

formula or early cessation of breast milk as recommended by (WHO, 2011). The cultural

attitude of compromising breast milk with water, pre-lacteal foods, discarding of colostrum and

inadequate support of mothers by family members remain obstacles to the upliftment of EBF

rate in Nigeria (Adetugbo & Irinoye, 2015). The wrong attitude of some Nigeria women

particularly the youths lowers the rate of EBF. Some perceive breastfeeding is an “old fashion”,

others sees EBF as a second “labor” while some thought it sags breast faster. However, due to

ignorance of the superior qualities of breast milk, several Nigeria mothers still retort to

artificial feeding (Obinna, 2012). Other factors include insufficient and bad breast milk

syndrome, and frequency of crying of the baby which increases the tendency to early shift to

complementary feeding.

25
 CHAPTER THREE

RESEARCH METHODOLOGY

3.1. Area of the study

Bade Local Government is located in the town of Gashua, among other communities of Bade

local government area are Dogona, Katuzu, Lawan Fanami, Lawan Musa, Sarkin Hausawa,

Tagali, Sugum, Dawayo, Zango Musa, Zango Umaru, and Giwo Kura. It has an area of 772

square km, its population is 139,782 as at 2006 census. The Bade and Duwai languages are

spoken in Bade Local Government. Bade Local Government was created in the year 1976. It is

on Latitude 12.7161, Longitude 10. 6434, 12 degree 42`58`North, 38`36` East, Bade Area is

103,000 hectares, (1,030.00 sq ml).

3.2 Design of the Study

Design of the study was a cross sectional survey. A type of observational study that analyze data

from population or a representative subset at a specific point in time.

3.3 Population of the study

The population of the study will be all lactating mothers attending their post-natal clinic at the

Specialist Hospital Gashua of Yobe state during the time the study.

3.4. Sample size and sampling technique

Purposive sampling was put to use in this research. Purposive sampling refers to a group of non-

probability sampling techniques in which units are selected because they have characteristics that

is needed in the sample. In other words, units are selected on purpose. It is common in

qualitative research and mixed-method research. It is particularly useful if you need to find

information rich cases or make the most out of limited resources.

26
3.5. Ethical clearance
The researcher obtained ethical clearance from the Chief Medical Officer (CMO) and sought

the consent of the mothers through the clinic head after explaining the purpose and method of

the study.

3.7. Instrument for Data collection

The instrument used in this study was a well-structured interviewer questionnaire to elicit

information from the mothers on their knowledge and application of knowledge in EBF.

3.8 Method of Data Collection

Two trained research assistants who are trained nurses within the facilities assisted the

researcher in the administration of questionnaires. A structured questionnaire was used to

collect data. The questionnaire elicited information on socio-economic characteristics,

knowledge and practice of EBF of the mothers. 70 questionnaires was printed and administered

on 4 visits during the post-natal clinic days. Only 63 of the questionnaires were returned out of

which 3 were wrongly filled and unsuitable for the research; therefore, they were discarded.

27
 CHAPTER FOUR

DATA PRESENTATION AND DISCUSSION

4.0. RESULTS

TABLE 4.1 DEMOGRAPHIC INFORMATION

Variables Frequency Percentage

Age range Less than 20 years 10 16.7%
20-24 years 13 21.7%
25-30 years 25 41.7%
30-34 years 7 11.7%
35-39 years 5 8.3%
Greater than 40 years 0 0
Total 60 100%
Marital status Married 36 60%
Single 4 6.7%
Divorced 10 16.7%
Widow 10 16.7
Total 60 100%
Educational Status No formal education 3 5%
Primary Education 14 23.3
Secondary Education 26 43.3
(WAEC)
Tertiary Education 17 28.3
Others please specify 0 0
Total 60 100%
Occupation Civil Servant 17 28.3%
Petty trader 13 21.6%
Business woman 8 13.3%
Artisan 20 33.3%
unemployed 02 3.3%
Others 0
Total 60 100%
Income per month Below 20, 0000 17 28.3%
20,000-40.000 33 55%
Above 40,000 10 16.7%
Total 60 100%
Point of receiving Home 4 6.7%
antenatal care Maternity home 21 35%
Private clinic 5 8.3%
Government hospital 26 43.3%
Traditional birth attendant 4 6.7%
others please specify 0 0
Total 60 100%

28
Facility of Baby Home 6 10%
delivery? Maternity home 14 23.3%
Private clinic 4 6.7%
Government hospital 30 50%
Traditional birth attendant 6 10%

others please specify 0 0

Total 60 100%
Baby’s Birth Weight 2.5-2.9kg 29 48.3%
3.0-3.4kg 16 26.6%
3.5-3.9kg 9 15%
4.0-4.4kg 1 1.7%
4.5 and above 0 0
Below 2.5 kg 5 8.3%
Total 60 100%
Source: Field Survey, 2023

Table 4.1 shows the demographic information and socio-economic characteristic of the

respondents. In the study areas, 16.7% of the respondents are less than 20 years while a larger part

of the population were with the average child bearing age at 25- 35yrs (41.7%), part of the lactating

mothers were within the ages of 35-39yrs (8.3%). 43.3% of the of the respondents had secondary

education. Also 13.3% of respondents engaged in one business or trade (21.6%). Half of the

respondents received between N20, 000- N40, 000 monthly

The birth weight distribution of the children as shown in Table 4.1 reveals that about half of the

children 48.3% weighed between 2.5 to 2.9 kg at birth, while 15% of the children 3.5-3.9kg and

1.7% weighed 4.0-4.4kg. The result also revealed that half of the women (50%) delivered their

children at the government hospital.

29
Table. 4.2 Knowledge About Exclusive Breastfeeding

Variables Frequency Percentage

Where do you receive Government hospital 26 43.3%
breastfeeding private clinic 9 15%
information? mass media 6 10%
Seminar workshop 4 6.7%
friends/relationship/neighbors 10 16.7%
Do not receive at all 4 6.6%
others please specify 1 1.7
Total 60 100%
How did you hear Have never heard it before 4 14.8%
about exclusive antenatal clinic 35 40.7%
breastfeeding/ mass media 6 25.9%
friends/neighbors/relations 10 22.2
seminar/workshop 4 3.7%
Others please specify 0 0
Total 60 100%
What do you Feeding infants with breast milk 46 76.6%
understand by only for the first 6 months of life
exclusive Feeding infant with breast milk 4 6.7%
breastfeeding? only for the first 4 months of life.

Feeding infant with breast milk 4 6.7%

and formula only for the first 6
months of life
Feeding infants with breast milk 4 6.7%
and water only for the first 6
months of life.
Do not know what is 2 3.3%
others please specify 0 0
Total 60 100%
What are the It saves money, time and energy. 27 45%
advantages of breast It is readily available 13 21.7%
milk over formula? It contains the right amount of 10 16.7%
nutrients for infants
It prevents maternal and 5 8.3%
childhood obesity.
It protects infant from early child 3 5%
hood infections
It prevents breast and ovarian 2 3.3%
cancers in mothers
It help in child spacing 0 0
It strengthen mother and child 0 0

30
 bond
It makes children intelligent 0 0
Total 60 100%
What are the None 39 65%
disadvantages of it can endanger the mother’s 0 0
breast milk over health
formula? Breast milk alone is not enough 6 10%
for the baby.
infections can be transmitted to 11 18.3%
the baby through breast milk
others please specify 4 6.6%
Total 60 100%
How long do you 0-2months 0 0%
think breast milk 0-3 months 1 1.6%
alone is adequate for 0-4months 2 3.3%
the baby 0-5 months 17 28.3%
0-6 months 40 66.7 %
Do not know 0 0
others please specify 0 0
Total 60 100%
Source: field survey, 2023

Mothers’ knowledge on the benefits of EBF as shown in Table 4.2 revealed that almost all the women

had knowledge of EBF although from different sources. However, a notable number of 26 mothers

(43.3%) received their information from the general hospital while 14.8% of the mothers had no idea

about EBF. A remarkable number of the mothers (76.6%) agree that EBF is breast feeding infants with

only breast milk for the first 6 months of life. More so, 45% of the mothers agreed that one advantage of

EBF was that it saved money, time and energy. Although 39 (65%) stated that there were disadvantages

of EBF, 18.3% disagreed stating that infections could be transmitted from mother to child via EBF.

In addition the results show that more than half of the women (66.7%) agreed that breast milk is only

adequate for the first 6 months even though others had a different opinion.

31
Table 4.3: Exclusive Breast Feeding Knowledge

Variables Frequency Percentage

Mothers should start Strongly Agree 25 41.6%
breast feeding within Agree 24 40%
an hour of birth Do not know 1 1.7
Disagree 9 15%
Strongly disagree 1 1.7%
Total 60 100%
EBF means given to Strongly Agree 43 71.7%
baby only breast milk Agree 7 11.7%
from birth to 6 Do not know 7 11.7%
months Disagree 2 3.3%
Strongly disagree 1 1.6%
Total 60 100%
Breast milk is the best Strongly Agree 28 46.6%
form of nutrition for Agree 17 28.3%
infants. Do not know 7 11.7%
Disagree 3 5%
Strongly disagree 5 8.3%
Total 60 100%
EBF protects mother Strongly Agree 22 36.6%
and child from Agree 28 46.6%
overweight and Do not know 4 6.7%
obesity Disagree 1 1.7%
Strongly disagree 5 8.3%
Total 60 100%
Complementary foods Strongly Agree 17 28.3%
should not be given to Agree 33 55%
infants before their Do not know 3 5
first six months. Disagree 4 6.7%
Strongly disagree 3 5%
Total 60 100%
Pregnant and breast Strongly Agree 33 55%
feeding mothers need Agree 17 28.3%
extra food. Do not know 0 0
Disagree 5 8.3%
Strongly disagree 5 8.3%
Total 60 100%
Breast milk alone is Strongly Agree 43 71.6%
adequate for infants Agree 7 11.7%
for the first 6 months Do not know 0 0%
of life. Disagree 6 10%
Strongly disagree 4 6.7%
Total 60 100%

32
EBF prevents the risk Strongly Agree 37 61.6%
of breast and other Agree 13 21.6%
cancers in women. Do not know 0 0
Disagree 7 11.6%
Strongly disagree 3 5%
Total 60 100%
A child needs Strongly Agree 25 41.6%
additional food to Agree 24 40%
breast milk from 6 Do not know 1 1.7
months. Disagree 9 15%
Strongly disagree 1 1.7%
Total 60 100%
EBF children should Strongly Agree 43 71.7%
be breastfeed on Agree 7 11.7%
demand and not on Do not know 7 11.7%
schedule. Disagree 2 3.3%
Strongly disagree 1 1.6%
Total 60 100%
Mixed feeding before Strongly Agree 28 46.6%
6 months increase the Agree 17 28.3%
rate of infections and Do not know 7 11.7%
early child hood Disagree 3 5%
diseases. Strongly disagree 5 8.3%
Total 60 100%
Mothers who breast Strongly Agree 22 36.6%
feed often produce Agree 28 46.6%
more milk than others Do not know 4 6.7%
Disagree 1 1.7%
Strongly disagree 5 8.3%
Total 60 100%
EBF makes children Strongly Agree 17 28.3%
to be more intelligent. Agree 33 55%
Do not know 3 5
Disagree 4 6.7%
Strongly disagree 3 5%
Total 60 100%
Infant formula is as Strongly Agree 33 55%
good as breast milk. Agree 17 28.3%
Do not know 0 0
Disagree 5 8.3%
Strongly disagree 5 8.3%
Total 60 100%

Source: field survey, 2023

33
Table 4.3 presents sources of Information of level of acceptance on the practice of EBF. Ranging from

strongly agree to strongly disagree. 41.6% of the respondent strongly agree that mothers should starts

breast feeding within an hour of birth while only 15% disagree on that. Also 71.7% strongly agree that

breast should be given to infants exclusively for 6 months while only few of the respondent 11.7% are

oblivious of the duration for EBF. While 55% of the mothers agree that complementary foods should be

given to children before their first 6 months, 5% strongly disagreed having a different view. . In addition,

61.6% of the mothers agreed that EBF prevents the risk of breast and other cancers in women;

however, 11.6% disagreed. Even though 46.6% strongly agree that Breast milk is the best form

of nutrition for infants, 8.3% strongly disagreed. About 24% of the respondents either disagreed

or had no knowledge of the possibility of mixed feeding before 6 months increasing the rate of

infections and early child hood diseases. In addition, 18.4% of the respondents either had some

level of disagreement or had no knowledge that a child needs additional food to breast milk from

6 months of age. More so, 36.6% of the respondents strongly agree that mothers who breast feed

often produce more milk than others, in same light 28.3% also strongly agree that EBF made

children to become more intelligent. While 55% of the respondents strongly agree that Infant

formula is as good as breast milk, 8.3% strongly disagreed.

34
Table 4.4 Level of Practice of Exclusive breastfeeding EBF

Variables Frequency Percentage

Who made major Husband 17 28.3%
decision on how the Myself 23 38.6%
baby is to be fed? Mother in-law 3 5%
Grandmother 7 11.3%
Hospital staff 2 3.3%.
Friends/relations and 1 1.7%
neighbor
others please specify 7 11.3%
Total 60 100%
How soon after Within an hour 35 58.3%
delivery did you start 1-5 hours 15 25%
breastfeeding? 6-10 hours 5 8.3%
third day 0 0%
Within 24 hours 4 6.6%
Second day 1 1.7
Others please specify 0 0
Total 60 100%
What is usually the Plain warm water 11 18.3%
first thing Glucose water 5 8.3%
(food/drink) you give Breast milk 25 41.6%
to your baby after Honey 19 31.7%
delivery? Infant formula 0 0%
Herbal tea 0 0%
Other please specify 0 0%
Total 60 100%
What was the baby Plain warm water 18 30%
given before your Glucose water 17 28.3%
started breast feeding Honey 15 25%
him/her? Infant formula 10 16.6%
Herbal tea 0 0
Total 60 100%
Who recommends the Myself 19 31.6%
food/drinks given mother 20 33.3%
above? Hospital staff 5 8.3%
mother in-law 5 8.3%
Grandmother 0 0
husband 11 18.3%
friends/neighbor/relatives 0 0
others please specify 0 0
Total 60 100%

35
Why was the baby Breast milk did not flow 13 21.6%
given the immediately
food/drink above Mother not well 17 28.3%
Baby not well 7 11.6%
To evacuate meconium 10 16.7%
It is our culture 3 5%
To stop diarrhea 0 0
mother’s breast was bad 10 16.7%
Other 0 0
Total 60 100%
Since birth what Breast milk only 27 45%
have you being Breast milk and formula 13 21.6%
given to your Formula only 5 8.3%
baby? Breast milk and other foods such 10 16.7%
as pap, cerelac, nutrient etc
Breast milk and plain warm water 3 5%
Breast milk and family food 2 3.3%
others 0 0
Total 60 100%
Why do you give Breast milk alone is not 17 28.3%
formula and enough for her/him
other I have insufficient breast 13 21.6%
foods/drinks to milk.
baby before 6 My health will be affected if 1 1.7%
months? I give only breast milk
My work does not give me chance 9 15%
to breast feed her always
Baby is small and does not look 7 11.6%
healthy
Baby always cry after 18 30%
breastfeeding
My husband and other family 5 8.3%
members advised me to.
Total 60 100%
How do you I give it to baby because it is 23 38..3%
perceive nutritious and protects baby
colostrums? from infections
I don’t give it to baby because 17 28.3%
culture does not accept it
it cause diarrhea 10 16.7%
it is an old breast milk and not 5 8.3%
good for the baby
it is a bad breast milk and not 5 3.7%
good for the baby
Total 60 100%

How your baby is be Use infant formula 15 25%

36
fed if left for some use expressed breast milk 5 8.3%
hours at home? Use pap and other cereal 23 38.3%
gruel

use family food 17 28.3%

Total 60 100%
If you use expressed Refrigerator 10 16.7%
breast milk, where do freezer 10 16.7%
you store it? Food warmer 27 45%
Container with cold water 13 21.7%
On the table 0 0
others please specify 0 0
Total 60 100%
How long do you 1-3 hours 39 65%
store it there? 4-7hours 11 18.3%
7-10 hours 10 16.7%
2-5 days 0 0
2-4 weeks 0 0
weeks 3-6 months 0 0
Total 60 100%
If you stored it in Run it under warm tap water 23 38.3%
the freezer, how do for some minutes
you thaw it before Dip it in bowel of warm water 17 28.3%
giving it to the for some minutes
baby? Use hot water 15 25%
I give it to the baby like that 0 0%
others please specify 5 8.3%
Total 60 100%
Which of these food insecurity 0 0
problems do you No time to breast feed due to 5 8.3%
always experience work
during breastfeeding? Breast engorgement 5 8.3%
Nipple sore 10 16.7%
lack of support from husband and 5 8.3
other family members
Bad breast milk syndrome 5 8.3
Insufficient breast milk syndrome 30 50%
Tiredness and lukewarm health 0 0
Total 60 100%
At what stage of 0-3 months 14 23.2%
lactation do you 4-7months 6 10%
always have this 8-11 months 21 35%
problem? 12-15 months 4 6.7%
16-19 months 5 8.3
20-24 months 5 8.3%
others please specify 5 8..3%
Total 60 100%

37
How do you know Baby grow well and healthy 20 33.3%
that your baby is not Baby does not cry for some 19 31.6%
getting enough breast times after breastfeeding
milk? Baby stool or urinate on dipper 5 8.3%
frequently
Milk drips from my breast 11 18.3%
My breast is always full 5 8.3%
Total 60 100%
How do you treat I drink enough water and other 7 11.7%
insufficient breast fluids
milk syndrome? I drink enough palm wine 3 5%
I drink enough pap 16 26.6%
I see the doctor 29 48.3%
I have never had it 0 0
others please specify 5 8.3%
Total 60 100%
What age you intend 1 month 0 0
to give your baby 2 months 0 0
other food/drinks 3 months 0 0
apart from breast 4 months 4 6.6%
milk? 5 months 11 11.3%
6 months 45 48.1%
Other 0 0
Total 60 100%
At what age will you 6 months 0 0
stop breast feeding 8-10 months 0 0
your baby? 12-months 1 0
14-16months 10 16.7
18months 28 46.6%
20-22 months 20 33.3%
23-24 months 1 1.7%
Total 60 100%
Which of these Diarrhea 21 35%
health problems Cough 5 8.3%
always affect your Cold and catarrh 3 5%
baby? Skin rashes 7 11.7%
Vomiting 19 31.7%
fussy infant obesity 0 0
Others 5 0
Total 60 100%
Source: Field Survey, 2023

38
4.0 DISCUSSION

4.1 Mothers’ knowledge and practices of EBF

More than 50% of the respondents agreed with the correct meaning of EBF and breast feeding

initiation within an hour of delivery. This result differs from a research which focused on the

attitude of adolescents towards EBF which revealed that 42% of the population fed their infants

with water and Glucose D within the first 72 hours of birth (Ojofeitimi, 2001). However, this

result obtained are higher than that gotten by Integrated Child Health Cluster Survey (2012) in

Nigeria which showed a decline of knowledge of breastfeeding initiation within 30 minutes of

delivery from 56% in 2000, to 34% in 2013 in Nigeria. There is increase in the knowledge and

awareness of mothers on breastfeeding initiation within 30 minutes of delivery in this recent time

compared with previous reports. The importance of breast feeding initiation within 30 minutes of

delivery cannot be overemphasized. It has been shown to reduce neonatal morbidity and

mortality (WHO, 2012). It also reduces postpartum bleeding in mothers, enhances convolution of

uterus as well as stimulates milk production hormones.

As many as 71.6% of the lactating mothers agreed that breast milk alone is adequate nutrition

for a child from 0-6months. This finding was similar with that of Ani, Ezekekwe and Njeze,

(2011) on the knowledge, attitude and practice of EBF among working class mothers in Enugu

urban. This also commensurate with the UNICEF (2011) recommendation that breast milk alone

is the ideal nourishment for infant for the first six months of life because it provides all the

nutrients including vitamins and minerals an infant needs. More than 50 % of the respondents

knew at least four benefits of EBF, contrary to the work done by Utoo and Ocheje, (2012) on

knowledge, attitude and practice of EBF among southern Nigerian women. More than 75% of

women in that study failed to identify at least two advantages of EBF. Mothers’ knowledge and

awareness on the benefits of EBF help them to appreciate, adopt and practice it. More than half

39
of the respondents got the EBF information during antenatal care, government hospital (43.3%)

private clinics (15%) and other from mass media, seminar workshop, friends and neighbors etc.

Despite this awareness, promotion and support of EBF, the practice of EBF still remain low with

only 17% of children younger than six months being exclusively breastfed in Nigeria (NDHS,

2012). But a more recent study in 2018 stated that EBF practice is still rated at 29% (NPC 2019)

About 76.6% of the respondents had adequate knowledge of EBF. This result was in line with

87% adequate knowledge of Ani, Ezekekwe and Njeze, (2011) but did not support the 19.2%

reported by MO Oche and Amed (2011) in Plateau state. Poor knowledge of EBF is a great

barrier to the practice of EBF (Okolie, 2010).

The major pre-lacteal feeds observed in this study among the respondents the mothers included

plain warm water (30%), glucose water (28.3%), Honey (25%) and Infant formula (16.6%) in the

rural area. The rate of prelacteal feeding observed in this study was very low relative to 90%

reported in an earlier study on EBF is undermined by the use of other liquid in rural

southwestern Nigeria (Nwankwo & Brieger, 2010).This meant that the practice was declining

with time. Pre-lacteal feeding practices increase the risk of under nutrition and its associated

outcomes. Most often prelacteal feeds are usually inadequate, inappropriate, and unsafe and also

displace the more nutritive breast milk in the child’s diet..

5.2 Socio-economic factors that affected compliance of EBF

It was observed that 43.3% that practiced EBF obtained at least secondary education. In

Uchendu, Ikefuna and Emodi (2011) study on Factors associated with EBF practice among

lactating mothers at the University of Nigeria Teaching hospital Enugu, higher maternal

education was observed as the greatest factor that positively influenced the rate of EBF. The

study put forward that education contributes positively to mothers’ acceptance and application of

techniques of EBF. It also enhanced their understanding and appreciation of the demand and

40
benefits of EBF thus empowering mothers to resist external interferences. In this study, 38.6% of

the respondents decided to practice EBF themselves while 28.3% of the respondents reported

that their husband decided the practice of EPF for their infants while only 5% were influenced by

their mother in-laws. According to Uchendu et al., (2011), younger mothers were at higher risk

of not practicing EBF. Their study among lactating mothers at university of Nigeria teaching

hospital Enugu revealed that about 52% of mothers who did not practice EBF reported family

opposition. In African cultures as well, grandmothers and mother-in -law are seen as key

decision makers when it comes to infant feeding practices and care. In most cases these advanced

mothers lack knowledge and credibility on EBF and as such discourage new mothers particularly

the primiparous ones from practicing it. Barbara, Ilse and Andre Knotnerus (2010) had also

confirmed that maternal age was a predictor of EBF. Over time mothers tend to acquire

knowledge and experience on infant feeding practices and they also realize and appreciate the

outcome of EBF on their children.

5.3 Complementary feeding practices of the mothers

A remarkable number (45) 75% of the respondents disagreed that children need complementary

foods before 6 months. It was observed that complementary foods were usually introduced too

early rather than late due to the perception that breast milk alone is not adequate for the child.

This reason was given by 28%% and 55% who strongly agree respectively in this study. This

finding confirmed that of Adetugbo (2011) on socio-cultural factors and promotion of EBF in

Osun state, Nigeria, which showed that more than 50% of the lactating mothers introduced

complementary food early due to the perception that breast milk alone is not adequate for the

infant. Job commitment was one of the reasons of some mothers introduced complementary food

early 37.3%. Salami (2006) reported a similar result in Edo state, Nigeria. This low prevalence of

41
EBF among working class mothers could be attributed to economic challenges which made

many mothers to return to work soon after delivery. This reduces the proximity of the mother

and child and resulted in early introduction of complementary food and in some cases short

breastfeeding duration. About half (48%) of the urban and 39.6% of the rural respondents used

cereal gruel mixed with formula milk as the main complementary food. Also, 16% in urban and

20.8 in the rural area used cereal gruel and legumes while 18% in the urban and 31.2% in the

rural area used modified family food. These foods item used had the attributes of complementary

foods as defined by WHO (1912).

42
 CHAPTER FIVE

CONCLUSION AND RECOMMENDATION

5.1 Conclusion
The finding of this study revealed that breastfeeding initiation was high in the study area but the

rate of EBF was very low. Adequate knowledge of breast feeding and EBF rate were slightly

higher in the urban area compared with the rural. Also adequate knowledge was associated with

EBF practice. Exclusively breastfed children achieved normal growth and development

compared with the non EBF counterparts. Exclusive breastfed children from 0-6 months in both

areas had similar growth and development. Maternal education, age, place and mode of delivery

were associated with high prevalence of EBF practices in both areas.

5.2 Recommendations
 A community based breastfeeding intervention programmes aimed at protection,

promotion and support of EBF is necessary to enhance the rate of EBF both in urban

and rural areas.

 These programmes should include effective and appropriate periodic monitoring and

evaluation systems.

 Improving the situation of women with particular attention to their nutrition,

education and health is necessary.

 An organized and effective nutrition and health education for present lactating and

other prospective mothers would create positive impact toward the rate of EBF

 The provision of crèches at the work place or market place will reduce the distance

between babies and their mothers and subsequently increase the levels of breastfeeding.

43
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47
 APPENDIX I

The Chief Medical Director,

Yobe State Specialist Hospital Gashua,
Bade Local Government area,
Yobe State.
21/01/2023.

Dear Sir,

REQUEST FOR DATA FROM THE YOBE STATE SPECIALIST HOSPITAL ON

EXCLUSIVE BREAST FEEDING AND ANTHROPOMETRIC STATUS OF INFANTS

Khadija Muhammad Bida with Reg. No. UI8/HSM/1027, is a final year student of the Home

Science and Management Department, Federal University Gashua (FUGA) who is currently

undertaking a study on “Mothers’ Knowledge On Practice Of Exclusive Breast Feeding And

Anthropometric Indices Of Their Infants In Gashua Bade Local Government Area” in partial

fulfillment of her requirements for graduation from the University.

Please, kindly accord her the necessary assistance in acquiring data in regards to the above

research from the appropriate department(s) within the Medical facility as this will enable

generate accurate and original figures. Optimistically, the research findings at the end will be

beneficial to the Gashua community and Yobe State in general.

Thank you in anticipation for your kind support.

Sincerely,

Research Supervisor Research Student

48
 APPENDIX II

QUESTIONNAIRE
This questionnaire is designed for study on mothers’ knowledge, and practice
of exclusive breastfeeding and anthropometric status of the infant in Bade Local
Government Area of Yobe state, Nigeria.
Please answer the questions as honest as possible your responses will be
treated with high level of confidentiality.
Thanks for your assistance in this research.
SECTION A
PERSONAL DATA
1. What is your range, age range: (i) <20 years [ ] (ii) 20-24 years [ ]
(iii) 25-30 years [ ] (iv) 30-34 years [ ] (v) 35-39years [ ] (vi) >40years
2. What is your marital status? (i) Married [ ] (ii) Single [ ] (iii) Divorced [ ]
(iv) Widow [ ]
3. What is educational status?
(i) No formal education [ ]
(ii) Primary Education [ ]
(iii) Secondary Education (WAEC) [ ]
(iv) Tertiary Education [ ]

(v) Others please specify ________________________

4. What is your occupation?
(i) Civil Servant [ ] (ii) petty trader [ ] (iii) business woman [ ]
(iv) Artisan [ ] (v) unemployed [ ] (vi) others please specify _________________
5. Income per month: (i) Below 20, 0000 [ ] (ii) 20,000-40.000 [ ]
(iii) Above 40,000 []

49
6. Where did you receive antenatal care? (i) Did not receive [ ] (ii) Governmental
hospital [ ] (iii) private clinic [ ] maternity homes [ ] (v) others please specify __
7. Where was your Baby delivered? (i) Home [ ] (ii) Maternity home [ ] (iii) private
clinic [ ] (iv) Government hospital [ ] (iv) Traditional birth attendant [ ] (v) others
please specify ________________
8. What was the Birth Weight of your Baby?
(i) 2.5-2.9kg [ ] (ii) 3.0-3.4kg (iii) 3.5-3.9kg [ ] (iv) 4.044kg [ ] (v) 4.5kg and
above [ ] (vi) below 2.5kg [ ]
SECTION B
KNOWLEDGE ABOUT EXCLUSIVE BREASTFEEDING
9. Where do you receive breastfeeding information? (i) Government hospital [ ] (ii)
private clinic [ ] (iii) mass media [ ] (iv) seminar workshop [ ] (v)
friends/relationship/neigbhours [ ] (vi) do not receive at al [ ] (vii) others please
specify ______________________
10 how did you hear about exclusive breastfeeding/ (i) Have never heard it before [ ]
(ii) antenatal clinic [ ] (iii) mass media [ ] (iv) friends/neighbours/relations [ ] (v)
seminar/workshop [ ] (vi) others please specify ___________
11. What do you understand by exclusive breastfeeding?
(i) Feeding infants with breast milk only for the first 6 months of life [ ] (ii)
feeding infant with breast milk only for the first 4 months of life [ ] (iii) feeding
infant with breast milk and formula only for the first 6 months of life [ ] (iv)
feeding infants with breast milk and water only for the first 6 months of life [ ]
(iv) do not know what is [ ] (vi) others please specify _______________
12. What are the advantages of breast milk over formula? (i) it saves money, time and
energy. [ ] (ii) it is readily available [ ] (iii) it contains the right amount of nutrients
for infants [ ] (iv) it prevents maternal and childhood obesity [ ] (v) it protects
infant from early child hood infections [ ] (vi) it prevents breast and ovarian
cancers in mothers [ ] (vii) it help in child spacing [ ] (viii) it strengthen

50
 Mother and child bond [ ] (ix) it makes children intelligent [ ] (x) it protects our
environment [ ]
13. What are the disadvantages of breast milk over formula? (i) None [ ] (ii) it can
endanger the mother’s health [ ] (iii) Breast milk alone is not enough for the baby
[ ] (iv) infections can be transmitted to the baby through breast milk [ ] (v) others
please specify ___________________
14. How long do you think breast milk alone is adequate for the baby (i) 0-2months [
] (ii) 0-3 months [ ] (iii) 0-4months [ ] (iv) 0-5 months [ ] (v) 0-6 months [ ] (vi)
do not know [ ] (viii) others please specify _________________
Please let me know what you think about these statements and your degree of
agreement or disagreement
NB: SA - Strongly Agree
A - Agree
DNK - Do not know
D - Disagree
Strongly disagree
SD -
SA SA A DNK D SD
1 Mothers should start breast feeding within an hour of birth
2 EBF means given to baby only
breast milk from birth to 6
months
3 Breast milk is the best form of nutrition for infants.
4 EBF protects mother and child from overweight and obesity
5 Complementary foods should not be given to infants before
their first six months.
6 Pregnant and breast feeding mothers need extra food.
7 Breast milk alone is adequate
for infants for the first 6 months
of life.
8 EBF prevents the risk of breast and other cancers in women.

51
9 A child needs additional
food to breast milk from 6
months.
10 EBF children should be
breastfeed on demand and not
on schedule.
11 Mixed feeding before 6 months increase the rate of infections
and early child hood diseases.
12 A child should receive breast milk for two years and beyond.
13 Mothers who breast feed often produce more milk than others
14 EBF makes children to be more intelligent.
15 EBF is very good and should be encouraged
16 Infant formula is as good as breast milk.
17 EBF can only be possible by the unemployed
18 Breast milk alone is not adequate for a child from birth to 6
months.

PRACTICE

19, Who made major decision on how the baby is to be fed? (i) Husband [ ] (ii) myself [ ] (iii)
mother in-law [ ] (iv) grandmother [ ] (v) hospital staff [ ]
(v) friends/relations and neighbourr [ ] (vii) others please specify ____________

20. How soon after delivery did you start breastfeeding? (i) Within an hour [ ] (ii) 1-5 hours [ ] (iii)
6-10 hours [ ] (iv) third day [ ] (v) within 24 hours [ ] (vi) second day [ ]
(vii) Others please specify________________________
21. What is usually the first thing (food/drink) you give to your baby after delivery?
(i) Plain warm water [ ] (ii) glucose water [ ] (iii) Breast milk [ ] (iv) honey [ ]
(v) Infant formula [ ] (vi) herbal tea [ ] (vii) others please specify ____________
22. What was the baby given before your started breast feeding him/her?
a. Plain warm water [ ] (ii) glucose water [ ] (iii) honey [ ] (iv) herbal tea [ ]

52
 (v) infant formula [ ] (vi) nothing [ ] (vii) others please specify _____________
23. Who recommends the food/drinks given above? (i) Myself (mother [ ]
a. Hospital staff [ ] (iii) mother in-law [ ] (iv) Grandmother [ ] (v) husband [ ]
(vi) friends/neighbor/relation [ ] (vii) others specify ____________
24. Why was the baby given the food/drink above (i) breast milk did not flow
immediately [ ] (ii) mother not well [ ] (iii) Baby not well [ ] (iv) to evacuate
meconium [ ] (v) it is our culture [ ] (vi) to stop diarrhea [ ] (vii) mother’s breast
was bad [ ] (viii) others please specify _____________
25. Since birth what have you being given to your baby? (i) breast milk only [ ] (ii)
breast milk and formula [ ] (iii) formula only [ ] (iv) Breast milk and other foods
such as pap, cerelac, nutrient etc [ ] (v) Breast milk and plain warm water [ ] (vi)
Breast milk and family food [ ] (vii) others please specify ___________________
26. Why do you give formula and other foods/drinks to baby before 6 months? (i)
breast milk alone is not enough for her [ ] (ii) I have insufficient breast milk [ ]
a. my health will be affected if I give only breast milk [ ] (iv) my work does
not give me chance to breast feed her always [ ] (v) baby is small and does
not look healthy [ ] (vi) baby always cry after breastfeeding [ ] (vii) My
husband and other family members advised me to [ ].
27. How do you perceive colostrums? (i) I give it to baby because it is nutritious and
protects baby from infections [ ] (ii) I don’t give it to baby because culture does
not accept it [ ] (iii) it cause diarrhea [ ] (iv) it is an old breast milk and not good

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 for the baby [ ] (v) it is a bad breast milk and not good for the baby [ ] (vi)
others please specify _________________
28. How is your baby be fed if left for some hours at home? (i) Use infant formula [ ]
a. use expressed breast milk [ ] (iii) use pap and other cereal gruel [ ]
(iv) use family food [ ]
29. If you use expressed breast milk, where do you store it? (i) Refrigerator [ ]
a. freezer [ ] (iii) food warmer [ ] (iv) container with cold water [ ] (v) on
the table [ ] (vi) others please specify _______________
30. How long do you store it there/ (i) 1-3 hours [ ] (ii) 4-7hours [ ] (iii) 7-10 hours
[ ] (iv) 2-5 days [ ] (v) 2-4 weeks 3-6 months [ ] (vi) others please specify
_____
31. If you stored it in the freezer, how do you thaw it before giving it to the baby? (i)
Run it under warm tap water for some minutes [ ] (ii) Dip it in bowel of warm
water for some minutes [ ](iii) use hot water [ ] (iv) I give it to the baby like that
[]
(v) others please specify ____________________
32. Which of these problems do you always experience during breastfeeding?
a. food insecurity [ ] (ii) No time to breast feed due to work [ ] (iii) breast
engorgement [ ] (iv) nipple sore [ ] (v) lack of support from husband and
other family members [ ] (v) bad breast milk syndrome [ ] (vii) insufficient
breast milk syndrome [ ] (viii) tiredness and lukewarm health [ ] others
please specify _______
33. At what stage of lactation do you always have this problem? (i) 0-3 months [ ]
(ii) 4-7 months [ ] (iii) 8-11 months [ ] (iv) 12-15 months [ ] (v) 16-19 months [ ]
(vi) 20-24 months [ ] (vii) others please specify _______
34. How do you know that your baby is getting enough breast milk? (i) Baby grow
well and healthy [ ] (ii) baby does not cry for some times after breastfeeding [ ]

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 (iii) baby stool or urinate on dipper frequently [ ] (iv) milk drips from my breast [ ]
(v) my breast is always full [ ] (vi) others please specify _____
35. If she is not getting enough how do you know? (i) my breast never full [ ] (ii)
baby does not grow well [ ] (iii) baby does not stool or urinate on dipper
frequently [ ]

a. others please specify _____________

36. How do you treat insufficient breast milk syndrome? (i) I drink enough water and
other fluids [ ] (ii) I drink enough palm wine [ ] (iii) I drink enough pap [ ] (iv) I
see the doctor [ ] (v) I have never had it [ ] (vi) others please specify ___________
37. How does baby feed in above condition?
a. I use breast milk only [ ] (ii) I use formula only [ ] (iii) I use breast milk
and formula [ ] (iv) I use breast milk and other food like pap, and other
gruel [ ] (v) use family food [ ] (vi) others please specify
_____________________________
38. T what age you intend to give your baby other food/drinks apart from breast milk/
a. 1 month [ ] (ii) 2 months [ ] (iii) 3 months [ ] (iv) 4 months [ ] (v) 5 months
[]
(vi) 6 months [ ] (vii) others please specify ____________________________
39. At what age will you stop breast feeding your baby?
a. 6 months [ ] (ii) 8-10 months [ ] (iii) 12-months [ ] (iv) 14-16months [ ]
(v) 18months [ ] (vi) 20-22 months [ ] (vii) 23-24 months [ ]
40. Which of these health problems always affect your baby? (i) Diarrhea [ ] (ii)
Cough [ ] (iii) cold and catarrh [ ] (iv) skin rashes [ ] (v) vomiting [ ]
a. fussy [ ]
b. infant obesity [ ] (viii) others please specify ___________________

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