CHAPTER ONE

INTRODUCTION

1.1 Background

Breastfeeding of human infants has been a common feature of all cultures and all times because our very survival depends on it. In contrast, other modes of infant feeding: what is fed, when, how and by who have differed according to both time and place (WHO, 2020).

The world health organisation recommends exclusive breastfeeding of infants for the first six months using on demand feeding and with initiation within the first hour of birth. Nutritionally adequate, safe and appropriate complementary foods should be introduced after six months. Breastfeeding should be encouraged for up to two years (Ulak et al., 2021). Exclusive breastfeeding for six months of age is recommended for HIV positive mothers with abrupt cessation of breastfeeding and introduction of safe and appropriate weaning and other foods. When implemented in both developed and resource poor developing countries, these recommendations have been shown to reduce both morbidity and mortality and also provide more pronounced benefits to the mother (Kruger and Gericke, 2011; Ulak et al, 2021).

Breastfeeding is accepted as the natural and optimal means of nourishing an infant and of preventing morbidity and mortality. The superiority of breast milk has been confirmed: it is the best (Kruger and Gericke, 2011). Colostrum, the yellowish, sticky breast milk produced at the end of pregnancy, is recommended by WHO as the perfect food for the newborn, and feeding should be initiated within the first hour after birth (WHO, 2021).

Globally, an average of about 35% of infants between ages of child bearing age are breastfed exclusively. The nutritional, immunologic, and economic advantages of breastfeeding are well recognized. In the 2019 Paediatric Nutrition Surveillance System (PedNSS), 61.7% of infants were ever breastfed, 27.0% were breastfed for at least 6 months, and 18.5% were breastfed for at least 12 months (CDC, 2011). Poor breastfeeding and complementary feeding practices have been widely documented in developing countries with only about 39% of infants exclusively breastfed for the first six months.

In the USA breastfeeding report card 2020, exclusive breastfeeding rates were 33% at 3 months and 13.3% at 6 months. A similar report in 2011 indicated exclusive breastfeeding rates at 35% at 3 months and 14.8% at 6 months.

In India, according to 2015-2016 report, 58% of infants under four months were exclusively breastfed while 46% of those under 6 months were breastfed exclusively (WHO, 2021).

In Ghana, only 8% of children under four months of age are breastfed and 45% are given some form of supplementary feeding by age three months (Awumbila, 2013).

In Nigeria, according to Nigeria Demographic and Health Survey (KDHS) 2018-2019, 32% of children under the age of six months are exclusively breastfed an improvement from 13% in 2013 (Kimani-Murage et al, 2011).

Urban poor settlements or slums provide distinct challenges with regards to child health and survival. Slums in sub-Saharan Africa expand at a fast rate with majority of urban dwellers living in slum settlements. They are characterized by poor environmental sanitation and livelihood conditions and as such urban slum dwellers tend to have very poor health indicators contrary to the long-held belief that urban residents are advantaged with regards to health outcomes (Kimani-Murage et al, 2011). In Nigeria, slum children are reported to be sicker and to have higher mortality rates than any other sub-group in Nigeria including the rural areas. Therefore, infants born to mothers that reside in the urban slums may be exposed to sub-optimal breastfeeding and complementary feeding practices.

Despite efforts by Health Service Providers (HSPs) to increase the percentage of breastfed babies, not much success has been achieved because feeding practices are directly related to varied economic, socio-cultural and religious factors in the community and to various dynamics prevailing at the household level (Awumbila, 2013). Sub-optimal breastfeeding and complementary feeding practices are associated with various factors including maternal age, marital status, education level and occupation; antenatal and maternity health care; health education and media exposure; culture, socio-economic status and area of residence; and the infant's birth weight, birth order and use of pacifiers (Kimani-Murage et al, 2011).

1.2 Problem statement

Optimal infant feeding means that mothers are empowered to initiate breastfeeding within one hour of birth, breastfeed exclusively for the first six months and continue to breastfeed for two years or more, together with nutritionally adequate, safe and age-appropriate feeding of solid, semi-solid and soft foods starting in the sixth month.

In Nigeria, studies indicate that an estimated 8400 infant deaths per year are due to sub-optimal breastfeeding practices (GHAI, 2011). Data from KDHS 2018-09 indicate that only 32% of infants below six months are exclusively breastfed. Most Nigerian mothers prefer mixed feeding rather than exclusive breastfeeding. Studies reveal that Nigeria loses 76 billion every year treating three major but preventable diseases caused by improper breastfeeding. These are Otitis media, lower respiratory tract infections and gastrointestinal illnesses (Kibet, 2021). These illnesses impact directly on the infant's nutrition, health and growth.

In view of this incompatibility, there is a need to determine the suitable health education techniques that can prompt mothers to practice the ideal feeding methods for their infants in order to reduce morbidity, mortality and improve infant health respectively.

1.3. General Objectives

To assess the factors influencing the choice of infant feeding practice among women of child bearing age in Lagos, attending Lagos State Primary Health Centre.

1.4. Specific Objectives

1. To determine the choice of infant feeding practice among women of child bearing age in Lagos attending Lagos State Primary Health Centre.

2. To establish the relationship between social-demographic factors and choice of infant feeding practice among women of child bearing age in Lagos attending Lagos State Primary Health Centre.

3. To establish the effect of culture on choice of infant feeding practice among women of child bearing age in Lagos attending Lagos State Primary Health Centre.

4. To establish the infant factors influencing choice of infant feeding practice among women of child bearing age in Lagos attending Lagos State Primary Health Centre.

1.5 Research questions

1. What are the choice of infant feeding practice among women of child bearing age in Lagos attending Lagos State Primary Health Centre?

2. How do social-demographic factors affect choice of infant feeding practice among women of child bearing age in Lagos attending Lagos State Primary Health Centre?

3. How does culture affect choice of infant feeding practice among women of child bearing age in Lagos attending Lagos State Primary Health Centre?

4. How do infant factors affect choice of infant feeding practice among women of child bearing age in Lagos attending Lagos State Primary Health Centre?

1.6 Significance of the study

Infant feeding practices are important determinants of nutrition and health status of children. Poor breastfeeding practices, especially the lack of exclusive breastfeeding during the first 6 months of life and inadequate complementation are important risk factors for infant and childhood morbidity and mortality.

The study aimed to assess the knowledge, attitude and practices of mothers related to infant feeding practices, its benefits and introduction of supplements. As a result it will create awareness among mothers and improve standards of nutrition in infants and young children.

1.7 Justification of the study

The study sought to investigate the factors influencing the feeding practices of infants. It was hoped that it would add more knowledge to what was being practiced. The results of the study were expected to provide mothers with a better understanding of the correct feeding methods for their infants. The research would also identify problems with infant feeding and suggest significant policy statements through its recommendations on age-appropriate infant feeding practices. As such, it could enable policy formulation in the country that will sustain the recommended standards of infant feeding.

1.8 Scope of the study

This study investigated the factors influencing the choice of infant feeding practice among women of child bearing age. The study focused on women of child bearing age attending Lagos State Primary Health Centre, Lagos state.

1.9 Operational definitions

Colostrum feeding- Feeding an infant on the first fluid secreted by the breast for the first three or four days after delivery until lactation begins.

Complementary feeding- Introducing semi-solid and soft solid foods for infants after 6 months in addition to breast milk.

Exclusive breastfeeding- Feeding an infant on breast milk only continuously for six months without giving any other fluids even water with the exception of vitamins, minerals and medicines.

Infant feeding- Exclusively breastfed, predominantly breastfed, mixed fed or not breastfed.

Mixed feeding- Breastfeeding a child while giving non-human milk or food-based fluids and solid foods.

Predominant feeding- Feeding an infant on breast milk and other liquids such as water, water based drinks, fruit, juices, oral rehydration solution.