DECLARATION

A. Candidate

I hereby declare that this project is the original work and masterpiece without any dishonest of source or duplication of any kind whatsoever. It is purely for submission of a partial fulfillment for award of certificate by the Kenya National Examination Council.

NAME: TEYGONG J. MERCY sign ………………….. Date …………

B. Supervisor

This project has been submitted for examination through the supervisor

NAME: MR. KOTUT Sign …………… Date ………

DEDICATIONI dedicate this project to my beloved brother Mr. and Mrs. Ruben Kangongo and my mother Mrs. Susan for their greate support.

ACKNOWLEDGEMENTMy appreciation goes to Mrs. Margaret Chepkonga ( District Nutritionist Uasin Gishu district) for her moral and material support. I am grateful for their support throughout the research work. Special thanks go to my course mates for their contribution.

I wish to acknowledge sincerely Mr. Jacob Kotut for his tireless efforts, guidance and encouragement throughout the research work.

God bless you all.

ABSTRACTThe study way carried out in Uasin Gishu district hospital in the MCH clinic. This was carried to assess the number of mother practicing exclusive breastfeeding, to find the age at which mothers introduce weaning and how babies are positioned during breastfeeding. From the findings, it was clear that less than three infant in 100 infant are exclusively breastfeed up to six month of age. Many mother initiate weaning at a very tender age and some do not even have an idea on positioning their children during breastfeeding.

Different methods were used to carry out the research for example use of questionnaires, interviewing mothers and observing their practices especially on position ad attachment to the breast. A sample size of 150 lactating mothers was used after stratified random sampling method was adopted. It was also noted that if lactating mothers are given enough support from household members and the society, the number of children that will receive exclusive breastfeeding will increase.

It was also clear that poor position and attachment to the breast was responsible for early initiation of complementary feeding. Mothers should adopt the best position to ensure their babies get enough milk and they are not injured during the process

DECLARATION............................................................................................................................................... i

DEDICATION................................................................................................................................................. ii

ACKNOWLEDGEMENT................................................................................................................................. iii

ABSTRACT................................................................................................................................................... iv

CHAPTER ONE..............................................................................................................................................1

INTRODUCTION.......................................................................................................................................1

1.2 STATEMENT OF THE PROBLEM..........................................................................................................2

1.3 JUSTIFICATION OF THE STUDY...........................................................................................................2

1.4 RESEARCH QUESTIONS......................................................................................................................2

1.5 OBJECTIVES........................................................................................................................................2

1.6 SCOPE OF THE STUDY........................................................................................................................4

1.7 SIGNIFICANCE OF THE STUDY............................................................................................................4

CHAPTER TWO.............................................................................................................................................5

2.0 LITERATURE REVIEW..........................................................................................................................5

2.1 INTRODUCTION.................................................................................................................................5

2.2 AGES AT WHICH MOTHERS INTRODUCE WEANING...........................................................................5

2.3 CONTENT OF BREAST MILK................................................................................................................7

2.4 BENEFITS OF BREASTFEEDING...........................................................................................................9

2.5 BREAST CONDITIONS AND MANAGEMENT........................................................................................9

2.6 BREASTFEEDING POSITIONS USED BY LACTATING MOTHERS..........................................................10

2.7 AGES AT WHICH MOTHERS INTRODUCE WEANING.........................................................................10

2.8 COMPONENTS OF WEANING...........................................................................................................11

2.9 HOW TO INTRODUCE OTHER FOODS...............................................................................................11

CHAPTER THREE........................................................................................................................................12

3.0 METHODOLOGY...............................................................................................................................12

3.1 AREA OF STUDY...............................................................................................................................12

3.2 TARGET POPULATION......................................................................................................................12

3.3 STUDY DESIGN.................................................................................................................................12

3.4 SAMPLING PROCEDURE...................................................................................................................12

3.5 SAMPLING DESIGN...........................................................................................................................13

3.6 PILOT STUDY....................................................................................................................................13

3.7 METHODS OF DATA COLLECTION....................................................................................................13

3.8 DATA COLLECTION PROCEDURE......................................................................................................13

3.9 DATA ANALYSIS AND PRESENTATION METHOD...............................................................................13

CHAPTER FOUR..........................................................................................................................................14

4.0 DATA ANALYSIS AND PRESENTATION..............................................................................................14

4.1 INTRODUCTION...............................................................................................................................14

4.2 THE NUMBER OF MOTHERS PRACTICING EXCLUSIVE BREASTFEEDING...........................................14

4.3 AGES AT WHICH MOTHERS INTRODUCED WEANING......................................................................15

4.3 POSITION USED DURING BREASTFEEDING.......................................................................................16

CHAPTER FIVE............................................................................................................................................17

5.0 DISCUSSION.....................................................................................................................................17

5.1 INTRODUCTION...............................................................................................................................17

5.2 NUMBER OF MOTHERS PRACTICING EXCLUSIVE BREASTFEEDING..................................................17

5.3 AGE AT WHICH MOTHERS INTRODUCES WEANING.........................................................................17

5.4 POSITION DURING BREAST FEEDING...............................................................................................17

CHAPTER SIX..............................................................................................................................................18

6.0 CONCLUSION AND RECOMMENDATION..........................................................................................18

6.1 CONCLUSION...................................................................................................................................18

6.2 RECOMMENDATION........................................................................................................................18

REFERENCES..............................................................................................................................................20

Appendix I: questionnaire an interview questions for lactating mothers practices in uasin gishu district hospital......................................................................................................................................................21

CHAPTER ONE

INTRODUCTION

To breastfeed is to suck or draw into the mouth by creating practical vacuum in the mouth (Merriam-Webster dictionary) its first known use was in 1903.

Practices are any activities involved during a particular event hence breastfeeding practices are all activities involved during breastfed e.g its initiation, frequency and duration of each breastfeed, introduction of complementary feeds among other activates.

Other words used to mean breast feeding include lactation, sucking, nursing, sucking, and wet nursing (this is where, who is not the real mother of the baby breastfeeds the child). According to (G. Ward law and A. Smith, 2009)33% of North American mothers are still exclusively breastfeeding at four months. At six months 20% are still practicing the same while at 1 year only 18% are breastfeeding

Introduction of complimentary food (weaning) too early, poor positioning of the child at the breast, and consequently poor attachments, use of bottles to give feeds among other are observed in nursing mothers hence for this study to enable mothers have required knowledge during breastfeeding.

Trends over the past fifteen years have shown no significant change in nutritional status of children under five years of age were stunted, 22% were underweight and 6% were severely malnourished

(Kenya demographic health survey)

As per the 2003 KDHS, 30% were severely malnourished. In Kenya poor breastfeeding and infant feeding practices contribute to more than ten thousand deaths per year. This findings has prompted the need for study on breastfeeding practices of nursing mothers attending MCH clinics at Uasin Gishu district hospital

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1.2 STATEMENT OF THE PROBLEM

In Kenya an uncountable high number of children i.e. 1-8 million are classified as chronically undernourished, chronic and acute malnutrition, micronutrient deficiencies and infectious diseases are prevalent, particularly among rural population and those in urban poor.

1.3 JUSTIFICATION OF THE STUDY

Exclusive breastfeeding rates at six months are less than 3% and only around half (52%) according to national strategy of infant and young child feeding (2007-2010). Complementary feeding are also introduced too early to most infants.

The poor practices are closely linked to lack of information by nursing mothers. Exclusive breast feeding protects against common childhood diseases such as diarrhea and acute respiratory infection. However this potential is not realized. This implication that 97% of Kenyan infants are being exposed to an increased risk of diseases and have lowered immunity because they are given food other than breast milk bef0re they are six months old.

1.4 RESEARCH QUESTIONS.

1. What is the number mothers practicing exclusive breastfeeding for up to six months?

2. At what age do mothers introduce weaning to their children?

3. What are the position mother’s uses during breastfeeding?

1.5 OBJECTIVES

General objective of the study.

Nutritional assessment, of mothers attending maternal child health clinic (MCH) at Uasin Gishu district hospital.

Specific objectives of the study are

1. To assess number of mothers practicing exclusive breastfeeding.

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2. To determine the age at which mothers introduce weaning.3. To establish how babies are being positioned during breastfeeding

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1.6 SCOPE OF THE STUDY

This study will give adequate knowledge on optimal breastfeeding practices among mothers, families and community at large. Misinformation e.g. widespread belief among mothers that breast milk alone is not adequate to support proper growth for infants in the first six months of life will be addressed.

The study was limited to breastfeeding mothers attending (MCH) in the distr. The content scope was limited to assessing the number of mothers practicing exclusive breastfeeding, age at which they introduce weaning and the way mothers position babies during breastfeeding.

1.7 SIGNIFICANCE OF THE STUDY.

This study will encourage adequate support for breastfeeding and address social and cultural beliefs and practices effectively. The mother will have correct information on infant feeding and fully aware of consequences of her baby and her well-being for not initiating breastfeeding

The study will also help the hospital to become baby friendly by ensuring that 75% of mothers who deliver in health facilities are initiated on exclusively breastfeeding and receive support necessary for them to continue with the practice for six months. It will also help the government with documentation and surveillance on breastfeeding performance in the country.

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CHAPTER TWO

2.0 LITERATURE REVIEW

2.1 INTRODUCTION

Breastfeeding is the natural and most suitable for young infants. However, the normal mature milk does not come into the breast and so the baby can suck from the breast as soon as it is born according to feeding the child (Oniango 1998).

A study in 1985 by Ruth k. Oniango shows that in most Kenyan communities, colostrum was always given to infants because it was believed that it protect the infant against illnesses which is true. Breast milk is therefore good for the baby.

Breast milk is able to meet nutritional and energy requirements of a baby according to perspectives in nutrients sixth edition of (wardlaw Hemp 2004) energy requirements are as follows; 0 – 3 months is ($9×weight in kgs) + 75, 4 – 6 months is ($×weight in Kgs)+44 while at 7 – 12 months, it is ($9×weight in kgs)- $7 daily.

2.2 AGES AT WHICH MOTHERS INTRODUCE WEANING

The global strategy for infant and young child feeding was developed by WHO and UNICEF .i.e. World Health Organization and United Nation Children’s Fund respectively. Jointly and launched in 2002 to revitalize world attention to the impact that feeding practices have on nutritional status, growth, development and health and thus the survival of infants and young children.

In Kenya a high number of children .i.e. 1.8 million are classified as chronically undernourished. Chronic and infectious diseases are prevalent. In 2003, 30% children under 5 years were stunted, 20% were underweight and 6% severely malnourished according to Kenya Demographic and health survey (KDJS) to over 10,000 deaths per year. This findings has also revealed that;

Less than three in every 100 Kenyan infant are exclusively breast fed within the first half hour of birth and for the first six months.

Median duration in months of breast feeding of children under three years of age is 20 months.

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The percentage of breastfed babies 0->12 months of age from bottles is 27.6% up from 17.7% in 1998.

The dark skin and the nipples is called areola. In the areola are small glands called Montgomery’s glands which secrete an only fluid to keep the skin healthy. Inside the breast are alveoli which are very small sacs made of milk secreting cells. There is also a hormone called prolactin which make cells produce milk.

Around the alveoli are muscle cells which contract and squeeze out milk. Hormone oxytocin makes muscle cells to contact, small ducts carry milk from alveoli to the outside. The larger ducts beneath the areola dilate during feeding and hold the breast milk temporally during the feed.

The secretory alveoli and ducts are surrounded by supporting tissues and fat. This fats and tissue gives the breast its shape which make most of the difference between large and small breasts.

There are two stages;

Milk production/lactotogenesis.

Milk is made in mammary glands of the breast which contain cells arranged in lobules. The synthesis is stimulated by prolactin released from anterior pituitary glad which in turn stimulate process of sucking by the infant. Milk formed is not produced until the baby suckles. When a baby suckles, sensory impulses from the nipples to the brain secretes prolactin which goes through the blood to the breast, thus making secreting cells to produce milk.

The reflex can be inhibited by mother’s metal state. If she is tensed or tired, the reflex fails and milk is not released. After about two weeks of breastfeeding the reflex become automatic and can be triggered simply by hearing the baby crying.

A mother may notice:

A squeezing or tingling sensation in her breast just before she feeds her baby or during a feed. Milk flowing from her breast when she thinks about her baby or hears the baby cry.

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Milk flowing from her breast when her baby comes off the breast during a feed. Flow deep sucks and swallowing by the baby which shows that breast milk is flowing into his mouth.

Although oxytocin and prolactin go equally to both breasts, sometimes one breast stops making milk. There is a substance in milk which can reduce or inhibit milk production. If a lot of milk is left in the breast, the inhibitor stops the cell from secreting.

This helps protect the breast from harmful effects of breastfeeding for some other reasons. If breast milk is released by sucking the inhibitor is also removed. Then the breast makes more milk.

2.3 CONTENT OF BREAST MILK

1) Lactose (6.8%)

Breast milk contains more lactose than any other milk. Babies and young children have enzyme lactose that digest lactose in the first few months of life. They do not have enough enzymes analysis need to digest starch so it is difficult for young babies to digest feeds from cereals.

2) Fats (3.3%)

This is the main source of energy. The fat in human milk is easier to digest because the acids are arranged differently in triglycerides than those in cow’s milk. Breast milk contains enzyme lipase which helps to digest fat.

3) Proteins (1.5%)

The proteins in breast milk forms soft light curds which are digestible. Breast milk contains essential amino acids while artificial often do not contain enough e.g. breast milk contains large amounts of amino acid taurine important for growth of the baby’s brain.

4) Vitamins

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Milk from well-nourished mothers contains enough vitamins and so their babies do not need extra vitamins .i.e. if a mother is undernourished, there will be less vitamins e.g. vitamin A

5) Minerals (0.2%)

Breast milk contains the right amount of minerals e.g. calcium, phosphate for a baby. Iron from milk is well absorbed and does not help bacterial growth.

6) Water (88.2%)

Breast milk contains enough water for the baby. It is not necessary to give the baby extra water even in a hot – dry climate.

Colostrum is breast milk that women produce in the first few days after delivery. It is thick and yellowish or clear in colour and contains more protein than mature milk. It is antibody rich which protects an infant against allergy and infection, many white cells protecting against infection, plugative which clear meconium (the first dark stool) and also prevent jaundice.

Mature milk is the breast milk that is produced after a few days. The quantity becomes larger and breast feels full, hard and heavy.

Foremilk is the milk produced early in a feed.

Hindmilk is the milk produced later in a feed. It looks whiter than foremilk because it contains more fat. This is an important reason not to take a baby off a breast too quickly (Gloria 2004)

Exclusive breastfeeding is where an infant is given only breast milk without any other foods or drinks.

Partial breastfeeding means the baby breastfeeds part of the time but has artificial food or drinks. This type is normal from the age of six months when the baby starts weaning foods.

Token breastfeeding is where the child breastfeeds sometimes but only get small amount of breast milk.

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2.4 BENEFITS OF BREASTFEEDING

It is affordable hence reduces family expenditure on infant food Provides all nutrients in the right proportions as need for the infant’s growth. Free from contamination, fresh and the baby feed anywhere at any time. Human milk contains specific immunoglobin A (1gA). It has anti-allergic properties for infants who are at risk of developing

allergies. Breastfeeding helps the mother recover quickly since it makes the uterus to

contrast leading to less bleeding. Also it delays next pregnancy hence reasonable spaced children thus

improving mothers health of her children.

Reason for not breastfeeding exclusively for six months according to Human Nutrition 2nd Edition by Mary E. Barasa include; rejection of the breast by the baby, painful nipples, insufficient milk in mother returning to work, misinformation, social concerns and medical conditions e.g. infants with phenylketonuria, mothers with active untreated TB and HIV/AIDs and also there with chemotherapy medication.

This can be caused by the mother regularly being away for too long and using bottles to feed the infant hence the mother should create time to be with her child more frequently and feeding from the cup so that the baby does not confuse bottle teats and breast nipple.

Painful nipples can be due to poor attachment to the breast; thus improving baby’s position is the only option. After a feed, a mother rubs a little expressed milk over the nipple and areola to promote healing.

The mother can feel embarrassed while nursing in public. Building confidence in a mother to know what she is doing is good in promoting a healthy society.

2.5 BREAST CONDITIONS AND MANAGEMENT

Recognition and management of these conditions are important both to relieve the mother and enable breastfeeding to continue. These conditions include; flat and inverted nipples, engorgement, blocked ducts and mastitis and finally sore nipples.

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Flat and inverted nipples

Proper positioning will slowly improve the condition, and if the baby cannot suckle effectively during the first days, the mother should express her milk and feed it to her baby with a cup. Expression keeps the breast soft so that it is easier for the baby to attach and it keeps the supply.

Engorgement

Milk removal by suckling or expressing is necessary to avoid development of mastitis or an abscess. After a feed, put a cold compress on her breast in order to reduce oedema.

Nipple tissue and sore nipples

Commonly cause is poor attachment to the breast hence proper attachment relieves it. Rubbing a little expressed breast milk over the nipple and area within her finger to promote healing.

2.6 BREASTFEEDING POSITIONS USED BY LACTATING MOTHERSProper positioning leads to a good attachment to the breast, for this to be achieved, the baby’s head and body should be in line, held close to the mothers body and his whole body supported and the body should be able to approach the breast nose to nipple.

The mother should support her breast with her finger against her chest below her breast, her first finger supporting the breast with thumb above. Her fingers should not be too near to the nipple.

2.7 AGES AT WHICH MOTHERS INTRODUCE WEANINGIn Kenya, complementary foods are introduced as early as the first month and by six months. 45% of infants are already receiving complementary food. Unfortunately, those foods are low in energy and micronutrients. Too early introduction of other foods is inappropriate because;

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The baby’s digestive system is still developing hence the food brings discomforts to the baby e.g. upsets.

The baby is exposed to infections through contaminated foods and utensils.

The baby may encounter allergies from these new foods. Introduction of these foods may make the baby stop gaining weight at a

healthy rate hence may become underweight.

2.8 COMPONENTS OF WEANING High in energy: it is good to add sugar, oils and fats in food. Easy to digest foods. Hygienically prepared. Not expensive and easy to prepare. Should vary and also interesting.

2.9 HOW TO INTRODUCE OTHER FOODS Give one food at a time in order to give the baby a chance to get used to

new flavors. Start with very small a mounts just a tea spoon. Let the baby taste the food first and see whether it likes it. Use a cup and a spoon for feeding. Keep meal time as pleasant as possible. A baby should be breastfed first then offered soft foods.

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CHAPTER THREE

3.0 METHODOLOGY

Introduction

Research methodology is an operational frame with which the facts are placed so that their so that their meaning can be clear. This chapter entails the study area, study, design, target population, research instruments e.g. interviews questionnaires observation and data collection procedures and instruments.

3.1 AREA OF STUDY

Uasin gisgu district hospital in uasin gishu county rift valley province. The hospital has adequate health workers and its mission to promote high quality preventive, creative and rehabilitative health care service to all people while the vision is to provide healthcare system that is accessible and affordable.

This hospital has an outpatient department i.e. maternal child health clinic responsible for pre natal and post natal care for mothers and babies. In this clinic, ante natal services are provided e.g. immunization and vitamin A supplementation together with nutrition and hygiene education.

3.2 TARGET POPULATION

The study population will be targeting all nursing mothers attending ANC clinic at the uasin gishu district hospital. This clinic attends to about 1000 nursing mothers and their babies.

3.3 STUDY DESIGN

The research design for this study was cross-sectional survey it is a method where data is collected at one point in time from a random sample. This can be a single interview undertaken in a short time, a small population within an enclosed area.

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3.4 SAMPLING PROCEDURE

A suitable sampling procedure that has no favors and biasness was used during research.

3.5 SAMPLING DESIGN

The researcher selected uasin gishu hospital since the area is familiar and wanted to manage the increased poor breastfeeding practices being exercised.

Probability sampling technique was used as the appropriate method to get a sample frame. This technique was also used in selecting study participants. This was carried out in MCH clinic by interviewing mothers. Observing their practices while at clinic and questionnaire filling with help of a health worker stratified random sampling method was used where mothers were put to straps basing on the number of children. Lastly simple sampling was used to get sample from individual status.

3.6 PILOT STUDY

Due to a lot of activities at the MCH clinic and time shortage only three quarter of the desired sample were taken (ISO). This is 75% of the expected sample size. Nursing mothers were divided into groups of 5(stratus) and every number 2 was picked to represent that group in research.

3.7 METHODS OF DATA COLLECTION

The appropriate methods used were questionnaires, observation and interviewing nursing mothers. This method was easiest and cheapest.

3.8 DATA COLLECTION PROCEDURE.

Questionnaires and interviews were used in conducting the research. Observation was also important to enable the researcher judge whether mothers were giving accurate information. Mothers were also asked questions and later filled in the questionnaires given to them.

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3.9 DATA ANALYSIS AND PRESENTATION METHOD.

The data presented from questionnaires and interview questions were presented using graphs and pie charts and findings often using the same descriptive study was also used this was mainly used on the positioning and attachment of children to the mothers breast.

CHAPTER FOUR

4.0 DATA ANALYSIS AND PRESENTATION

4.1 INTRODUCTION

This chapter deals with findings of the research problem. It gives the general information of the respondents, the findings and analysis of the topic under research.

4.2 THE NUMBER OF MOTHERS PRACTICING EXCLUSIVE BREASTFEEDING

The table below shows some of the breastfeeding practices by lactating mothers.

Breastfeeding practices

Age of the child No of respondents %ge

Exclusive breastfeeding

At 6 months 15 10

Bottle feeding 0-12 months 45 30

Immediate breastfeeding

Within 1 hour of birth

23 15

Complementary feeding

7 months and above

67 45

Total 150 100

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It is evident that majority of mothers 67 i.e. 45% introduced complementary feeding at seven months while only 15 respondents i.e. 10% practiced exclusive breastfeeding at 6 months

4.3 AGES AT WHICH MOTHERS INTRODUCED WEANING.

Age of the child No of respondents Percentage

0-1 month 68 45

2-3 months 60 41

3-4 months 17 11

4-6 months 5 3

Total 150 100

Majority of mothers i.e. 45% start weaning their babies at less than 1 month i.e. 0-1 month. Those starting at 2 months are equally many i.e. 41% while those practicing exclusive breastfeeding for upto four months and six moths are 11% and 3% respectively.

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4.3 POSITION USED DURING BREASTFEEDING.

The table below shows breastfeeding positions used by lactating mothers.

Breastfeeding position No of respondents Percentage

Cradle position 80 53

Under arm position 35 23

Arm opposite the breast 20 13

No idea on positioning 15 11

Total 150 100

It is evident that majority of respondents use cradle position i.e. 51% under arm is at 23% arm opposite the breast is13% while those with no idea is 11%

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CHAPTER FIVE

5.0 DISCUSSION

5.1 INTRODUCTION

This chapter presents the discussion on the finding after data collection analysis and presentation of number of mothers practicing exclusive breastfeeding, age at which mothers introduce weaning and the position used during breastfeeding

5.2 NUMBER OF MOTHERS PRACTICING EXCLUSIVE BREASTFEEDING

The study findings demonstrated that majority of mothers i.e. 45% introduced complementary feeding i.e. 6-10 or 7-> months received these foods in the last 24 hours. It is also evident that 3 or less infants in every 100 infants are exclusively breastfed within the first hour of birth and for the first six months. This shows that the children are most likely to suffer from nutrient related problems like kwashiorkor

5.3 AGE AT WHICH MOTHERS INTRODUCES WEANING.

Majority of mothers 45% start weaning their too early i.e. at less than or equal to one month. Those starting at the age of two moths are equally many 41% while those who breastfeed exclusive for upto four and six months are 11% and 3% respectively hence children may develop allergies due to new foods and may end up becoming under weight

5.4 POSITION DURING BREAST FEEDING.

It is evident that majority of respondents use cradle position i.e. 51% under arm is at 23% arm opposite the breast is13% while those with no idea is 11%. This shows clearly that poor positioning and attachment to breast was responsible for early initiation of complementary feeding.

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CHAPTER SIX

6.0 CONCLUSION AND RECOMMENDATION

6.1 CONCLUSION

According to the research, the ages at which mothers introduce complementary food are worrying with a large percentage of 45% starting at or before the age of one month. The hospital and government should start an exclusive breast feeding promotion to inform mothers on its importance.

Majority of mothers introduce early weaning due to various reasons. It is important to create awareness among nursing mothers on the need to practice exclusive breastfeeding and educate general public on the same in order to give maximum support to these mothers.

It was also clear that poor position and attachment to the breast was also responsible for early initiation of complementary feeding. Mothers should adopt the best position to ensure their babies get enough milk.

6.2 RECOMMENDATION

According to the research findings, the following recommendations were made:

Improvement of awareness an optimal breastfeeding practices through advocacy and awareness creation efforts. This entails sensitizing the public on knowledge on breastfeeding practices.

Breastfeeding mothers should have apposition of support by employers under the employment act. These mothers should be given an opportunity to maintain breast feeding they can be allowed:

- Extra help from their husbands and family with household.

- Sufficient maternity leave.

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- Time off to go and breastfeed.

- To bring their babies to work.

There should also be a national monitoring and reporting system to promote efficient implementation of interventions on infant feeding. The infant feeding strategy should be integrated in to the health system.

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REFERENCES

Barasi C. Mary 2003. Human nutrition a health perspective 2nd edition.

Dudex G. Susan 2006. Nutrition essential for nursing practices, 5th edition.

Wardlaw Hamp 2004. Perspectives in nutrition 6th edition.

Oniang’o Ruth 1988. Feeding the child 1st edition.

Gordon M. Wardlaw and Anne. M smith 2009. Perspective in nutrition 8th edition

Geofrey P. Webb 2008. Nutrition A health promotion approach, 3rd edition

UNICEF (2004) strategy for infant and young child feeding 2nd edition.

WHO(2004) Global strategy for infant and young child feeding, 2nd edition

Plosalind R. Gibson 2008. Nutrition assessment a lobarotary manual 3rd editon.

Gloria Dudek 2004 dosage calculation 7th edition

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Appendix I: questionnaire an interview questions for lactating mothers practices in uasin gishu district hospital.

INTRODUCTION

I am a diploma student at Eldoret Polytechnic pursuing a diploma course in nutrition and dietetics management. I am carrying out a study on breastfeeding practices of lactating mothers.

The study will help determine the age at which weaning start in order to enlighten and create awareness on importance of breastfeeding.

I want to assure you that this information is confidential and will not be disclosed to any other person. This information will be of great importance for my research and your cooperation will be highly appreciated.

INSTRUCTIONS

Please fill in the boxes with the appropriate information using (√) and (×) where applicable.

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SECTION A: BACKGROUND OF RESPONDENTS

1) Indicate your age bracket

a) Below 20 years

b) 21 – 30 years.

c) 31 – 40 years

d) Above 40 years

2) Indicate your marital status

a) Married

b) Single

3) Indicate the number of children

a) Below five

b) Above five

c) Specify the number………………………………………..

4) What is your occupation?

a) Employed

b) Self-employed

c) Housewife

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5) What is your level of education?

a) Primary

b) Secondary

c) Tertiary

d) Illiterate

SECTION B: SPECIFIC INFORMATION

6) When did you initiate breastfeeding after delivery?

a) Less than 30 minutes

b) Less than 45 minutes

c) Less than 1 hour

d) More than 1 hour

7) For how long did you exercise exclusive breastfeeding?

a) Less than one month

b) Two or less than two months

c) Above three months and below six month

d) Up to six months

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8) Did you give any pre-lacteals?

a) Yes

b) No

9) Why did you start early weaning?

a) Return to job

b) Little milk

c) Refusal by the baby

d) Medical concerns

10) Have you experienced breast problems?

a) Sore nipples and nipple fissure

b) Flat and inverted nipples

c) Engorgement

d) Mastitis and blocked ducts

11) What are the food types you used to introduce weaning?

a) Cow’s milk

b) Porridge from maize

c) Porridge from wheat

d) Porridge from millet/sorghum

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12) For how long do you breastfeed?

a) Less than 10 minutes

b) Less than 20 minutes

c) Less than 30 minutes

d) 30 minutes and above

13) What is the breastfeeding position you use

a) Cradle position

b) Opposite the arm position

c) Under arm position

d) No idea on poisoning

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