Constraints of exclusive breastfeeding practice among breastfeeding mothers in alimosho general hospital

CONSTRAINTS OF EXCLUSIVE

BREASTFEEDING PRACTICE

AMONG BREASTFEEDING

MOTHERS IN ALIMOSHO GENERAL

HOSPITAL, IGANDO.

OBA ADEBOYE SOLOMON

2015/2401/17424N

LAGOS STATE SCHOOL OF

NURSING, IGANDO.

NOVEMBER, 2016.

CONSTRAINTS OF EXCLUSIVE

BREASTFEEDING PRACTICE AMONG

BREASTFEEDING MOTHERS IN

ALIMOSHO GENERAL HOSPITAL, IGANDO.

OBA ADEBOYE SOLOMON

2015/2401/17424N

LAGOS STATE SCHOOL OF NURSING,

IGANDO.

SUBMITTED IN PARTIAL FULFILLMENT OF

THE REQUIREMENT OF NURSING AND

MIDWIFERY COUNCIL OF NIGERIA FOR

THE AWARD OF “REGISTERED NURSE”

CERTIFICATE.

NOVEMBER 2016

CERTIFICATION PAGE

This is to certify that this research project titled: Constraints of exclusive breastfeeding

practice among breastfeeding mothers in Alimosho General Hospital, Igando. Was

carried out by Student Nurse Oba Adeboye Solomon with Index Number:

2015/2401/17424/N and examination number _______________ under my supervision.

_____________________

Itsuokor S.F. (Mrs) Qualifications:______________________

Supervisor

______________________

Aribisala P.B. (Mrs)

Principal

ABSTRACT

Breastfeeding provides a wide array of physical and psychological short-term and long-

term health benefits for mothers, infants, and young children. There is strong evidence

that infants receiving only breast milk with no other liquids or solids known as exclusive

breastfeeding, have many health benefits to mothers, babies, the environment, and

society. Exclusive breastfeeding is recommended for the first six months of life as the

best way of feeding an infant. The result of this study will increase the knowledge and

encourage mothers on exclusive breastfeeding in Alimosho General Hospital, Igando and

also show them the dangers of not practicing exclusive breastfeeding. It will also help

the Nurse to debunk myths about exclusive breastfeeding. Using a concurrent mixed

method approach, a structured questionnaire was administered to 100 breastfeeding

mothers. Breastfeeding was perceived as essential to baby's health. It strengthens the

physical and spiritual bond between mothers and their children. Exclusive breastfeeding

was considered essential but demanding. The research however reveals larger

percentage of the respondents are between 25-35 years in the study. The study showed

the major constraints to exclusive breastfeeding to be: lack of prior knowledge of

exclusive breastfeeding (81%); Nature of their job which does not allow them to practice

exclusive breastfeeding (58%); some are also of the opinion that they needed more time

to breastfeed their child exclusively (81%) and their health status (74%). In addition, the

qualitative findings showed that significant others played major roles on exclusive

breastfeeding practices. It is concluded from the study findings that exclusive

breastfeeding especially child growth plays an important role in child daily life. From

this study, it is concluded that working mothers find it extremely difficult to exclusively

breastfeed their babies according to the recommendation of World Health Organization.

Exclusive breastfeeding for up to six months requires the mother and her infant to be in

close proximity for this period and to use expressed breastmilk for separation of short

duration.

DEDICATION

I dedicate this research project to my Jewel of inestimable value, Mrs. Julianah Bolanle

Samuel-Oba who believes that hard work and prayers pays off. To the memory of my

late father, HRH Oba Samuel Folorunsho who believed so much that formal education

liberates a man.

ACKNOWLEDGEMENT

I give God almighty whole glory and adoration for his wonderful grace he has given me all through my course of study in Lagos State School of Nursing, Igando. It is neither by

my power nor wisdom that I am able to scale through these three years, but just God himself working in the life of his little child.

My special thanks to my intelligent and hardworking supervisor, Mrs. S.F. Itsuokor for

time spent correcting my write up despite her tight schedules. Ma, you are indeed a mother! May your source of knowledge never run dry.

I heartily appreciate my dynamic head of school, Mrs. P.B. Aribisala for her motherly love over the years. May God bless you beyond your expectations ma.

I owe a lot of gratitude to my amiable class coordinator, Mrs. Owolabi O.O. for her care,

love and supports. Also to her assistant, Mrs. Emmanuel O.T. May God also attend to your personal needs in Jesus name.

I will never forget those that refined me from a novice in Nursing to what I am today. The

likes of Mr. Ogunbanjo, Mr. Mathew, Mrs. Odukoya, Mrs. Ojo (hostel Matron) Miss. Olorunyomi, Mrs. Modupe, Mrs. Akande, Mrs. Oluwole, Mrs. Akolade, my very own big brother Mr. Amisu and other staff of School of Nursing Complex. May God in his infinite

mercies add more colors to your lives.

I owe an unreserved gratitude to my mother, Mrs. Bola’ Samuel-Oba for her supports all through my stay in school of Nursing. Also to my siblings “the unstoppable 7”, for their

financial supports, spiritual counselling and constructive criticism over the years, starting from Oba John Kehinde, Oba Ezekiel Olaleye, Oba Johnson Ademola, Oba Joel Adeoye, Oba Timothy Taiwo and Oba Jeremiah Kehinde. And also to wives turned

sisters’ Mrs. Eniola Oba, Dr. ‘Bukola Oba, Mrs. ‘Seun Oba and Mrs. Tosin’ Oba Without you people in my life, what would have become of me? May God lift you all up above

your expectations.

I will not forget those that made my study period memorable. Sets 2013 and 2014 school of Nursing, you guys rocks! Also the entire Sets 2014 and 2015 School of Midwifery. My roommates Ayodele Babatunde, Malick Akeem, Balogun Yusuf, Ojekunle

‘Bolu, I love you guys. My appreciation is not complete without mentioning the likes of Raphael Anusa, Oyelakin Oluwatosin, Sanni Olamilekan, Oketeru Sijuanu, Adewole

Adebusola, Olukotun Itunu, Ogunlade Damilola, Olajide Taiwo, Ajayi Olamide, Ademoye Blessing and Temitope Odufuwa. I appreciate you all.

My special thanks to Toluwalope Anise for her love, care and supports over the years and Mr. Bakare Saheed who is always motivating me. May God continue to bless you

both real good.

My sincere prayer is that may we all reap the fruits of our labour and may God continue to bless you all

Table of content

Certification Page ii

Abstract iii

Dedication iv

Acknowledgement v

Table of content vi-vii

List of tables viii-ix

List of Figures x

Chapter One

1.0 Introduction 1

1.1 Background of the study 2

1.2 Statement of Problem 3

1.3 Objective of Study 4

1.4 Significance of Study 4

1.5 Research hypothesis 4

1.6 Research questions 4

1.7 Limitation of study 5

1.8 Scope of study 5

1.9 Operational definition of terms 5

Chapter Two

Literature review

2.1 Concept of Exclusive breastfeeding 6

2.2 Benefits of exclusive breastfeeding to infants and mothers 7

2.3 Exclusive breastfeeding practices 8

2.4 Sources and knowledge of exclusive breastfeeding information 9

2.5 Attitude and knowledge of mothers on exclusive breastfeeding 10

2.6 Attitude solutions with exclusive breastfeeding practice 10

2.7 Conceptual framework 11

2.7.1 Discussion of conceptual framework 12

Chapter Three

Research methodology

3.1 Introduction 13

3.2 Study design 13

3.3 Population of study/target population 14

3.4 Sample and sampling technique 14

3.5 Research instrument 14

3.6 Validity/reliability of instrument 14

3.7 Method of data collection 15

3.8 Method of data analysis 15

3.9 Ethical considerations 16

Chapter Four

Data presentation, analysis and interpretation

4.1 Introduction 18

4.2 Respondents characteristics and classification 18-34

4.3 Data presentation and analysis according to test of hypothesis 34-40

Chapter Five

Summary, Conclusion and Recommendations

5.1 Introduction 41

5.2 Discussion of findings 41

5.3 Implications for Nursing 42

5.4 Summary 42

5.5 Conclusion 43

5.6. Recommendations 44-45

References 46-47

Appendix Questionnaire 48-50

List of tables (Respondents Characteristics and Classification)

Table 1 Age of Respondents 18

Table 2 Occupation of Respondents 19

Table 3 Marital Status of Respondents 19

Table 4 Educational Status of Respondents 20

Table 5 Religion of Respondents 20

Table 6 Knowledge of exclusive breastfeeding 21

Table 7 Sources of knowledge of exclusive breastfeeding 21

Table 8 Duration of Exclusive breastfeeding 22

Table 9 Beneficial effect of exclusive breastfeeding 22

Table 10 Exclusive breastfeeding and Childs growth 23

Table 11 Exclusive breastfeeding is very difficult 23

Table 12 I find it difficult to breastfeed at night 24

Table 13 My child does not need breast milk after three months 24

Table 14 My relatives are not supportive when I am breastfeeding 25

Table 15 Breast milk alone satisfy my child 25

Table 16 I have not heard of exclusive breastfeeding before now 26

Table 17 I find breastfeeding painful 26

Table 18 My breast will become saggy when I breastfeed my child 27

Table 19 Nature of my job does not allow me to practice exclusive breastfeeding 27

Table 20 I need more time to breastfeed my child 28

Table 21 The quantity of breastmilk I produce does not satisfy my child 28

Table 22 Health status and exclusive breastfeeding 29

Table 23 Benefit of exclusive breastfeeding to mother and child 29

Table 24 When I breastfeed it helps prevent cancer 30

Table 25 Breastmilk helps protect my child from diseases 31

Table 26 Breastfeeding reduces the incidence of diarrhea 31

Table 27 Breastfeeding and child’s intelligence 32

Table 28 Breastfeeding will make my child develop fast 33

Table 29 Breastfeeding promotes bonding of mother and child 33

Table 30 Breastfeeding is economical 34

List of Tables (Data presentation and analysis according to test of hypothesis)

Table 1 Hypothesis One 36

Constraint to the practice of exclusive breastfeeding and breastfeeding mothers in Alimosho General Hospital

Table 2 Hypothesis Two 37

Exclusive breastfeeding and the health of the baby

Table 3 Hypothesis Three 39

Benefit of exclusive breastfeeding and mothers in Alimosho General Hospital

List of Figures

Figure 1 Conceptual Framework 11

CHAPTER ONE

1.0 Introduction

Breastfeeding provides a wide array of physical and psychological short-term and

long-term health benefits for mothers, infants, and young children. According to the

American Academy of Pediatrics (AAP, 2005) and the World Health Organization (WHO,

2001), there is strong evidence that infants receiving only breast milk with no other liquids

or solids known as exclusive breastfeeding, have many health benefits to mothers, babies,

the environment, and society. Exclusive breastfeeding is recommended for the first six

months of life as the best way of feeding an infant (AAP, 2005; WHO, 2003).

Exclusive breastfeeding in the first six months of life and continued breastfeeding

from 6-11 months, has shown to be the single most effective preventive intervention for

reducing child mortality, with the potential of saving 1.3 million lives worldwide each year

(Bai, Wunderlich, & Fly, 2011). Development of appropriate breastfeeding promotion

interventions will help to achieve the Healthy People 2020 goals of increasing the

proportion of mothers who breastfeed their infants to 82% initiating in the early

postpartum period, with 61% breastfeeding their infants at six months and 34%

breastfeeding at one year of age (U.S. Department of Health and Human Services [DHHS],

2011).

Although breastfeeding initiation rates in the United States have increased overall

because of breastfeeding promotion efforts, the proportion of infants who are exclusively

breastfed at six months after birth has increased at a much slower rate compared to that

of infants who receive mixed feedings (Rojjanasrirat & Sousa, 2010). A report by the DHHS

(2011) stated that although there are many evidence-based documented breastfeeding

promotional activities, EBF rates are still far below the stated Healthy People 2020 goals.

The continuation of exclusive breastfeeding is positively associated with the value

of skilled support and advice a woman receives on breastfeeding from healthcare

professionals (Whelan, McEvoy, Eldin, & Kearney, 2011). Implementation of culturally

sensitive awareness programs and interventions directed at populations of specific

geographic areas are essential to improving the prevalence of breastfeeding (Gill, 2009).

1.1 Background of the Study

Breastfeeding is now an endangered practice around the world, in both rich and

poor countries. There is unanimous agreement on the need for and the route to, global

support for breastfeeding through various approaches and programmes. Baby friendly

hospital initiatives are one of the most important interventions towards that goal.

Infancy, especially the first six months of life is a period of exceptionally rapid

growth and high nutrient requirements relative to body weight. Human milk is ideal and

uniquely superior food for infants for the first six months (Robert M. etal 2006, pg 131).

These recommendations stem from the compelling advantages that breastfeeding offers

infants, mothers and society.

Robert M. etal opined that human milk feeding decreases the incidence of severity

of diarrhea, respiratory illness, otitis media, bacteremia, bacterial meningitis and

necrotizing enterocolitis. Colostrum, a high protein, low fat fluid is produced in small

amounts during the first few post-partum days. It has some nutritional value but

primarily has important immunologic and maturational properties.

World Health Organizations (WHO) recommends that “infants should be exclusively

breastfed for the first six months of life to achieve optimal growth, development and health.

Thereafter to meet their evolving nutritional requirements, infants should receive

nutritionally adequate and safe complementary foods, while continuing to breastfeed for

up to two years or beyond.

United Nations Children Emergency Funds (UNICEF) states that “every year, over

one million infants die and millions of others are impaired, because they are not

adequately/exclusively breastfed” (Parul Datta 2009). Every day between 3000 to 4000

infants die from diarrhea and acute respiratory infections because of the ability to feed

them adequately as a result of infants been taken away from their mothers and thousands

more succumb to other illness and malnutrition.

Mothers should be aware that breastfeeding is the safest, cheapest and best

protective food for infants, therefore, mothers should be encourage to practice

breastfeeding exclusively for adequate growth, development and healthy living. Superiority

of human milk is due to its nutritive and protective value.

Babies should be exclusively breastfed, meaning that they receive nothing but

breast milk not even water for about six months of life. Except in rarest cases, no

additional food or fluids are necessary and they can be harmful, introducing germs,

triggering allergies and filling the stomach so that infants take less breast milk. Breast

feeding should be sustained until the baby is at least two years old, but beginning at about

six months, breast milk should be complemented with appropriate solid foods.

1.2 Statement of Problem

Breastfeeding is acknowledged as the optimal way to feed infants, and it provides

health benefits to mothers and infants. Many national and international health

organizations recommend exclusive breastfeeding for at least six months and continued

breastfeeding for at least the first year of life or as long as desired by both mother and

child (AAP, 2005; United Nations Children’s Fund, 2006; WHO, 2003). Most mothers tend

not to feed their baby exclusively before the baby attains Six months of age, which has led

to different childhood illnesses such as diarrhea, malnutrition and this accounts for

frequent visits of both mother and child to the hospital corridors. This study is thus

carried out to determine the constraints to exclusive breastfeeding practices among

breastfeeding mothers in Alimosho General Hospital in Lagos-State, South-west Nigeria

as a sample population.

1.3 Objective of the Study

The purpose of the study is to:

1. Determine the constraints as faced by mothers in practice of exclusive

breastfeeding.

2. Update the knowledge of mothers on the need to practice exclusive breast feeding

in the first six months of life.

3. To create a background for future researches on constraints of practice of exclusive

breastfeeding.

1.4 Significance of the Study

The result of this study will increase the knowledge and encourage mothers on

exclusive breastfeeding in Alimosho General Hospital, Igando and also show them the

dangers of not practicing exclusive breastfeeding. It will also help the Nurse to debunk

myths about exclusive breastfeeding.

1.5 Research Hypotheses

There is no constraint to the practice of exclusive breastfeeding among breastfeeding

mothers in Alimosho General Hospital, Igando.

There is no significant relationship between exclusive breastfeeding and the health

of the baby

There is no benefit of exclusive breastfeeding to mothers in Alimosho General

Hospital

1.6 Research Questions

I. Are there constraints to the practice of exclusive breastfeeding faced by

breastfeeding mothers in Alimosho General Hospital?

II. Do breastfeeding mothers in Alimosho General Hospital practice exclusive

breastfeeding?

III. Is exclusive breastfeeding beneficial to mothers in Alimosho General Hospital?

1.7 Limitations of study

This study is limited to Alimosho General Hospital, Igando.

1.8 Scope of study

This research will be conducted on breastfeeding mothers in Alimosho General

Hospital including those that have nursed a baby in the past two years.

1.9 Operational definition of terms

I. Breastfeeding: Breast milk (including milk expressed or from a wet nurse).

II. Constraints: A statement or action that shows hindrances why someone refused to

accept something.

III. Exclusive Breastfeeding: is defined as the “newborn receiving only breast milk and

no other liquids or solids except for drops or syrups consisting of vitamins, minerals,

or medicines” (Joint Commission, 2010, Set-05a).

IV. Solid or semi-solid foods: Any food or liquid including non-human milk and

formula

CHAPTER TWO

Literature Review

2.1 Concept of exclusive breastfeeding

According to World Health Organization exclusive breastfeeding means ‘that the

infant receives only breast milk. No other liquids or solids are given – not even water –

with the exception of oral rehydration solution, or drops/syrups of vitamins, minerals or

medicines’.

Breast milk is the natural and original first food for babies, it provides all the energy

and nutrients that the infant needs for the first months of life, and it continues to provide

up to half or more of a child’s nutritional needs during the second half of the first year,

and up to one-third during the second year of life.

WHO recommends ‘that infants should be exclusively breastfed for the first six

months of life to achieve optimal growth, development and health. Thereafter, infants

should receive nutritionally adequate and safe complementary foods, while continuing to

breastfeed for up to two years or more’.

Breast milk contains all the nutrients infant requirements in the first six months of life.

It protects against common and widespread childhood diseases such as diarrhea and

pneumonia, and may also have long term benefits such as lowering mean blood pressure

and cholesterol, and reducing the prevalence of obesity and type-2 diabetes.

To enable mothers to establish and sustain exclusive breastfeeding for 6 months, WHO

and UNICEF Recommend:

i. Initiation of breastfeeding within the first hour of life.

ii. Exclusive breastfeeding – that is the infant only receives breast milk without any

additional food or drink, not even water.

iii. Breastfeeding on demand – that is as often as the child wants, day and night.

iv. No use of bottles, teats or pacifiers.

2.2 Benefits of Exclusive Breastfeeding for Infants and Mothers

Breastfeeding is an unsurpassed method of providing ideal food for the healthy

growth and development of infants. It is also a fundamental part of the reproductive

process with imperative implications for the health of mothers. Breastfeeding served and

continues to serve as an appropriate method through which newborns are offered

essential nutrients necessary for optimal growth and intellectual development.

Breast milk is regarded as ideal, natural and protective food for newborns. Given

that prolonging people’s lives (by reducing mortality) and preventing disease (by reducing

morbidity) are some of the goals of public health (Brulde, 2011), breastfeeding or exclusive

breastfeeding has been recognized as an efficient advance to the achievement of these

goals.

In a study by Vennemann and colleagues (2009) breastfeeding was found to be

protective against sudden infant death syndrome by reducing the risk by 50% at all ages

during infancy; these benefits have been reported to exhibit those responses relationship,

that is, health gains increased with increase in duration and exclusivity.

Infants when exclusively breastfed for the optimal duration of six months are

considerably protected against the major childhood diseases conditions viz. diarrhea,

gastrointestinal tract infection, allergic diseases, diabetes, obesity, childhood leukemia

and lymphoma, inflammatory and bowel disease (WHO, 2012; American Academy of

Pediatrics,2012). In particular, the risk of hospitalization for lower respiratory tract

infections during the first year of life is reduced by 72% when infants are exclusively

breastfed for more than 4 months (American Academy of Pediatrics, 2012, p. 828). Duncan

et al (2009, p. 867) also found exclusive breastfeeding to be protective against single and

recurrent incidences of otitis media. Infants who were given supplementary foods prior to

4 months had 40% more episodes of otitis media than their counterparts.

Breast milk promotes sensory and cognitive development, and protects the infant

against infectious and chronic diseases. Exclusive breastfeeding reduces infant mortality

due to common childhood illnesses such as diarrhea or pneumonia, and helps for a

quicker recovery during illness.

These effects can be measured in resource-poor and affluent societies (Kramer et al,

2001). Breastfeeding contributes to the health and well-being of mothers; it helps to space

children, reduces the risk of ovarian cancer and breast cancer, increases family and

national resources, is a secure way of feeding and is safe for the environment (WHO, 2001).

Breastfeeding reduces the mother's risk of fatal postpartum hemorrhage and

premenopausal breast and ovarian cancer. Frequent and exclusive breastfeeding

contributes to a delay in the return of fertility and helps protect women against anemia

by conserving iron. Breastfeeding provides frequent interaction between mother and

infant, fostering emotional bonds, a sense of security, and stimulus to the baby’s

developing brain (WHO, 2001).

2.3 Exclusive breastfeeding practices

Despite high rates of initiation of breastfeeding, exclusive breastfeeding practices

are not common in developing countries. Only approximately one third of infants under

six months are exclusively breastfed. There are however variations in different regions

(UNICEF 2006b).

East Asia so far has the highest rates of exclusive breastfeeding at 43%, with

Eastern and Southern Africa at 41%. The region with the lowest reported exclusive

breastfeeding rates is Western and Central Africa at 20% (UNICEF 2006b). Despite the

low rates of exclusive breastfeeding in sub Saharan Africa, the available data indicate that

these rates improved between 1990 and 2004 gong from 15% to 32% (UNICEF 2006b).

This rise is attributed to Baby Friendly Hospital Initiatives practices and breastfeeding

promotion and support programmes that have been well established.

A study by Abrahams and Labbok (2009), examined the impact of Baby Friendly

Hospital Initiatives on exclusive breastfeeding trends. Data for this study were obtained

from demographic and health surveys of 72 developing countries. Results of this study

indicated annual significant increases in the rates of exclusive breastfeeding after the

introduction of Baby Friendly Hospital Initiatives compared to before its introduction.

2.4 Sources and Knowledge of Exclusive Breastfeeding Information

Formal breastfeeding policies in hospitals, staff and physician training in

breastfeeding management, and rooming-in have been shown to positively affect

breastfeeding promotion efforts (Kovach, 2002). Strategies such as the Baby-Friendly

Hospital Initiative (BFHI), peer counselling, paternal support, and education of the

mothers and health care professionals have been used to promote breastfeeding in the

U.S. (Martens, 2000; Philipp et al., 2001).

A study showed that a 1.5-hour mandated breastfeeding education intervention of

nursing staff significantly increased the compliance of the BFHI and breastfeeding beliefs

over a 7-month period at the intervention site compared to control site. The rates of EBF

also increased by 23% (31% vs.54%), and fewer nurses offered supplementation (45% vs.

87%) after the intervention (Martens, 2000).

Although breastfeeding promotion or intervention programs have focused on

educating the mothers, family members, and employers about the benefits of supporting

breastfeeding, not much attention has been paid to the health professionals influencing

these target groups. Surveys evaluating health care professionals’ knowledge and

attitudes about breastfeeding revealed that these professionals do strongly advocate to

their clients that breastfeeding is the optimum method of infant feeding (Pascoe et al.,

2002).

Support from governmental programmes, health professionals, and education in

schools is very significant for the promotion of exclusive breastfeeding and for bringing

about changes in person’s behavior. Valuable educational efforts require knowledgeable

health professionals to compel these efforts; consequently, students majoring in health

sciences such as public health, nutrition and home economics should be comprehensively

educated and trained to support and advocate breastfeeding.

2.5. Attitude and knowledge of Mothers on Exclusive Breastfeeding Practice

Research showed that a large number of mothers are not practicing Exclusive

breastfeeding as a result of poor knowledge which result in poor attitude towards it. For

instance, Chetley (2003) identified negative perception of lack of sufficient milk, fear of

weight gain, breast sagging, pain, sleep deprivation, exhaustion or maternal employment

as the problems highlighted by poor attitude of mothers who are not positive towards

exclusive breastfeeding.

In the same vain inadequate knowledge or inappropriate practice of breastfeeding

were identified as those factors which can lead to undesirable consequences which also

affect mother's attitude. Nevertheless, Mennela (2001) realized from his study that women

who continued breastfeeding exclusively were more determined to success and overcome

any barrier, relying mostly on family support and proper time management.

2.6. Attitude Solutions with Exclusive Breastfeeding Practice

Although exclusive breastfeeding is an important behavior that has seen identified

as related to improved health of mothers, infants and children as well as lower health care

cost. Exclusive breastfeeding based on available evidence, achievements of these goals are

still far from the desired progress. Exclusive breastfeeding practices including initiation

and duration are influenced by multiple inter woven factors which include health,

psychosocial, cultural, political and economic factors. Among these factors, decision

regarding exclusive breastfeeding in low-income countries are influenced by education,

employment place of delivery, family pressure, cultural values, and spouse support within

the home.

To further explain, much research which looks at exclusive breastfeeding behavior

shows that there are complex relationships to it which involves not only incentive, but

disincentives as well. Often the disincentives outweigh the advantages for many women.

These disincentives form any barriers to compliance with the breastfeeding

recommendations. These common factors which affect exclusive breastfeeding practice

are the mother returning to work outside of the home, the support of the other within the

home and mother psychological health (Chudasama, Patal and Kavishwar, 2009).

Gundelman et al, (2009) identified lacking job flexibility and psychosocial stress as the

barriers to exclusive breastfeeding practice by working; mothers.

Further explanation puts in that one of the problems continually encountered by

working mothers which tends to reduce the rate of exclusive breastfeeding is sex-specific,

and therefore, cannot be viewed as gender neutral in child bearing. The act of

breastfeeding becomes even more difficult because many do not consider exclusive

breastfeeding to be critical for baby survival. Thus specific legislation on breastfeeding of

the right to pump milk, lactation at work, extra package to boost breastfeeding working

mothers still remain a mirage.

Socioeconomic characteristics

Occupation

Education level

Income sources

Access to health care

Ownership of selected items

Maternal characteristics

Child spacing

Marital status: spousal support

Mode and place of delivery

Breast feeding policies

WHO

Exclusive breastfeeding

Breast milk only

Other feeding methods

Mixed feeding

Replacement feeding

Socio-cultural factors

Traditions

Cultural practices

Maternal perception

2.7 Conceptual framework

The study will be guided by the following conceptual framework

Figure 1

Independent variables

Moderating variables

Dependent Variable

Intervening variables

2.7.1 Discussion of conceptual framework

The conceptual framework illustrates the association of exclusive breastfeeding and

social economic characteristics, social-cultural factors and maternal characteristics as

factors that influence it practice. The practice or non-practice of exclusive breastfeeding

is further influenced by breast feeding policies such as World Health Organizations policy

on Infant and Young Child Feeding and the strategies adopted at the national level to

promote its implementation. However, those not adhering to the exclusive breastfeeding

recommendation may practice mixed feeding; giving the child other foods alongside the

breast milk or may practice replacement feeding especially in the context of HIV/AIDS

whereby the child is never breast fed but rather is given formula milk or other type of

breast milk substitute.

CHAPTER THREE

RESEARCH METHODOLOGY

3.1 INTRODUCTION

This chapter describes the procedures and methods that was used in this research

study which include the description of research design, the study population, sample and

sampling technique, instrument and data collection and method of data analysis.

Research methodology is the application of steps, strategies and procedures for

gathering and analysing data in a research investigation in a logical and systematic way

(Burns and Grove 2010).

3.2 STUDY DESIGN

According to Burns and Grove (2010) a research design is a blueprint for conducting

the study that maximizes control over factors that could interfere with the validity of the

findings.

The design guides the researcher to plan, implement the study so as to achieve the set

goals and is referred to by Polit and Beck (2006) as “a general plan for addressing research

questions, including specifications for enhancing the studies’ integrity”.

For the purpose of this study since it is determining what is happening in the

present, a cross-sectional survey based study was adopted with a self-administered

questionnaire. Cross-sectional studies entail the collection of data from the cross-section

of the population at a given time.

The study setting is Alimosho General Hospital. This hospital is owned by Lagos

State Government and was established in the year 2012. It is located along LASU/ Isheri

Road, Igando.

It comprises of various units such as Emergency unit, the wards (Male and Female),

the Outpatient department (Medical and surgical), Pharmacy unit, laboratory unit, etc. It

also consists of several clinics such as Eye clinic, Dental clinic, Physiotherapy clinic.

A Maternal and child complex which was opened in the year 2012 comprises of

emergency unit, pre and post-natal ward, a theatre, paediatric unit etc, and clinics like

Antenatal clinic, Child Welfare clinic.

3.3 POPULATION OF STUDY/TARGET POPULATION

The women of reproductive age were chosen in which every woman was given equal

opportunity including their health workers.

3.4 SAMPLE AND SAMPLING TECHNIQUE

The sampling technique that was used in this study was a convenient method in which

women who attended Post Natal clinic were selected, especially those that can read and

write, including their health providers.

3.5 RESEARCH INSTRUMENT

The instrument used for data collection was detailed questionnaire to gather information

from women of reproductive age.

The questionnaire made up of 4 sections, section A deals with demographic data, (age,

occupation, level of education, marital status) section B deals with the knowledge of

women about Exclusive breastfeeding, section C deals with constraints of exclusive

breastfeeding, while section D deals with benefits of exclusive breastfeeding to mother

and child.

3.6 VALIDITY AND RELIABILITY OF INSTRUMENT

The research instrument was subjected to content validity before administered on the

respondents. This allows the researcher to evaluate the content validity. Reliability to

regards the consistency of the results obtained from the instrument used in this research.

Reliability is achieved when the same research process is repeated and reproduces results

within stated confidence limits. Bells (1993) cited in (Eriksson, 2002) states that the

reliability of an investigation is satisfying if another researcher can conduct the same

research and draw the same conclusions. This has to do with the ability of a research

finding to replicate itself if a parallel study is conducted. For the purpose of this study,

Cronbach’s Alpha was used to test the reliability of research item employed in this study.

The result from the reliability test shows Cronbach Alpha to be 0.943. This is an

acceptable level according to Sekeran, (2003) who set a minimum benchmark of 0.70.

Therefore, the instrument developed for measuring constraints of exclusive breastfeeding

practice among breastfeeding mothers in Alimosho General Hospital, Igando, Lagos.

Constructs was judged to be sufficiently reliable.

3.7 METHOD OF DATA COLLECTION

The researcher will take permission from the principal of the school to administer

her questionnaire; the research will have to distribute the questionnaires randomly among

the patients. Details of the study will be explained to the respondents and their consent

will be sought before they participate.

3.8 METHOD OF DATA ANALYSIS

Analysis of the data collected was done manually through coding and tabulation of the

responses derived from each questionnaire according to the variables involved. The

analysis was done through the conversion of the raw scores into percentages for easy

interpretation of the demographic characteristics of respondents with respect to age, sex,

marital status, level of education among others.

The coding was to facilitate easy cross tabulation and was presented in the form of tables

showing broad distribution of the items in order to further enhance our data analysis.

Finally, in the test of hypotheses, However, Pearson Moment Correlation Coefficient

(PPMC) were used to test the formulated hypotheses because correlation analysis is

completely concerned with the strength of the relationship between two variables. (i.e the

degrees of closeness of relationship between two variables). Some relationships among

variables are much stronger than others while some may be rather weak.

The statistical formula for the correlation is given below:

Σxy - ΣxΣy

n

Σx2 - (Σx)2 (Σy2 -( Σy)2

n n

Where:

n= the total no of the data

(Σx) = sum of independent variable (population)

(Σy) = sum of the dependent variable

(Σxy)= sum of the product of x and y

(Σx2) = sum of the squares of x

(Σx)2 = square of the sum of x

(Σy2) = sum of the squares of y

3.9 ETHICAL CONSIDERATIONS

The following ethical issues will be observed during the process of conducting this study;

In accordance with ethical principles guiding research involving human subjects.

This study will be conducted after obtaining approval from the management of

Alimosho General Hospital, Igando and Lagos State School of Nursing.

The respondents will be fully informed about benefits to be derived from this study,

this will enable them to give voluntarily informed consent.

All the respondents will be given choices devoid of preferential treatment.

The researcher will not influence or impose his opinion on the respondents.

Anonymity and confidentiality will be endured by using questionnaire that does not

require respondents to divulge their identity.

All information given will not be used against the respondents.

CHAPTER FOUR

DATA PRESENTATION, ANALYSIS AND INTERPRETATION

4.1 INTRODUCTION

In this chapter attempt is made to present the empirical findings resulting from the

analysis of the data gathered in order to address the research questions and hypotheses.

A total of 100 copies of questionnaires which was retrieved from the respondents were

found usable out of the 150 copies of questionnaires administered. The questionnaires

and the research hypotheses were analyzed using Chi-square.

4.2 RESPONDENTS CHARACTERISTICS AND CLASSIFICATION

This section is concerned with thoughtful, charming and incredibly helped the

demographic characteristics of respondents. It covers variables such as respondents’ Age,

Occupation, Marital Status, Educational Status and Religion of Respondents in the study.

The key findings of this research are presented in tables below:

TABLE 1: AGE OF RESPONDENTS

Frequency Percent

15-25 YEARS 39 39.0

25-35 YEARS 57 57.0

35-50 YEARS 4 4.0

Total 100 100.0

Source: Field work, 2016

From table 1, 39% of the respondents were between the ages 15-25 years, 57% were

between the ages 25-35 years and 4% were between the ages 35-50 years. The research

however reveals larger percentage of the respondents are between 25-35 years in the

study.

TABLE 2: OCCUPATION OF RESPONDENTS

Frequency Percent

Civil Servant 10 10.0

Trading 4 4.0

Schooling 3 3.0

Others 83 83.0

Total 100 100.0


The table presented above reveal the occupation of the respondents, it however reveals

that 10% are Civil servant, 4% are trader, 3% are student while 83% involve in other

activities respectively in the study.

Table 3: MARITAL STATUS OF RESPONDENTS

Frequency Percent

Single Mothers 57 57.0

Married 39 39.0

Divorced 4 4.0

Total 100 100.0


The table presented above reveals the marital status of the respondent, 57% are single

mothers, 39% are married while 4% are divorced, and it thus reveals that single mothers

dominate the sampled population in the study.

TABLE: 4 EDUCATIONAL STATUS OF RESPONDENTS

Frequency Percent

Primary 14 14.0

Secondary 57 57.0

Tertiary 29 29.0

Total 100 100.0


Educational background of the respondents as represented on the table 4 obviously,

shows that 14% possess primary school leaving certificate, 57% of the respondents are

WAEC/GCE certificate holder while 29% possess B.SC/HND certificate. This purely

means that majority of the respondents are WAEC/GCE certificate holder. Thus, the

results gathered could be used to draw reasonable conclusions.

Table 5: RELIGION OF RESPONDENTS

Frequency Percent

Valid

Christian 39 39.0

Islam 57 57.0

Traditional 4 4.0

Total 100 100.0


The table presented above reveals the religion of the respondents, it reveals that 39% are

Christians, 57% are Islam and while 4% are traditional worshiper, it thus reveals that

majority of the respondents are Islam in the study.

KNOWLEDGE OF EXCLUSIVE BREASTFEEDING

Table 6: Have you heard of exclusive breastfeeding

Frequency Percent

Valid

Yes 90 90.0

No 10 10.0

Total 100 100.0


The table presented above is aimed at knowing if the respondents have heard of exclusive

breastfeeding, 90% have heard, while 10% do not aware, it thus revealed majority of the

respondents aware of exclusive breastfeeding as revealed in this study.

Table 7: If yes, from which source did you get your information from?

Frequency Percent

Antenatal Clinic 60 60.0

Postnatal Clinic 26 26.0

Print Journal 3 3.0

Electronic Media 4 4.0

Church/Mosque 7 7.0

Seminar Nil Nil

Total 100 100.0


The table presented above is aimed at knowing the source of respondents’ information,

60% source information from antenatal clinic, 26% from postnatal clinic, 3% from print

journal, 4% from Electronic media, 7% from church/mosque while none source

information from seminar, it thus revealed majority of the respondents use the antenatal

clinic as source of information in this study.

Table 8: How long do you think a child should be breastfed before introduction of

other foods?

Frequency Percent

Valid

6 months 86 86.0

9 months 11 11.0

12 months

Others

2

1

2.0

1.0

Total 100 100.0


From the above table 86% of the respondents confirmed that a child should be breastfed

exclusively for six months before introduction of other foods, 11% confirmed nine months,

2% confirmed twelve months while 1% of the respondents confirmed by others. This

implies that majority of the respondents confirmed that a child should be breastfed

exclusively for six months before introduction of other foods in this study.

Table 9: Do you think exclusive breastfeeding is beneficial to

the mother

Frequency Percent

Valid

Yes 88 88.0

No 12 12.0

Total 100 100.0


From the above table, 88% of the respondents asserted that exclusive breastfeeding is

beneficial to the mother and 12% did not agree to this statement in this study.

Table 10: Do you think exclusive breastfeeding is essential for your

child’s growth?

Frequency Percent

Valid

Yes 76 76.0

No 24 24.0

Total 100 100.0


From the above table, 76% of the respondents agreed that exclusive breastfeeding is

essential for child’s growth and 24% did not agree to this statement. This implies that

majority of the respondents believes that exclusive breastfeeding is essential for child’s

growth that would prevent them from diseases in this study.

CONSTRAINTS OF EXCLUSIVE BREASTFEEDING PRACTICES

Table 11: Exclusive breastfeeding is very difficult

Frequency Percent

Valid

Yes 36 36.0

No 62 62.0

Not sure 2 2.0

Total 100 100.0


From the above table, 36% of the respondents confirmed that exclusive breastfeeding is

very difficult, 62% confirmed that exclusive breastfeeding is not difficult to practice while

2% of the respondents are not sure. This implies that exclusive breastfeeding is not

difficult to practice in this study.

Table 12: I find it difficult to breastfeed my child at night

Frequency Percent

Valid

Yes 66 66.0

No 31 31.0

Not sure 3 3.0

Total 100 100.0


From the above table, 66% of the respondents confirmed that child breastfeeding is very

difficult at night, 31% confirmed that child breastfeeding is not difficult at night while 3%

of the respondents are not sure. This implies that exclusive breastfeeding is difficult to

practice at the night in this study.

Table 13: My child does not need breast milk after three months

Frequency Percent

Valid

Yes 25 25.0

No 73 73.0

Not sure 2 2.0

Total 100 100.0


From the above table, 25% of the respondents confirmed that child does not need

breastmilk after three months, 73% confirmed that child needs breast milk after three

month while 2% of the respondents are not sure. This implies that child’s needs

breastmilk after three months in this study.

Table 14: My relatives are not supportive when I am breastfeeding

Frequency Percent

Valid

Yes 17 17.0

No 79 79.0

Not sure 4 4.0

Total 100 100.0


From the above table, 17% of the respondents confirmed that some of relatives are not

supportive whenever I am breastfeeding, 79% confirmed that some relatives are supportive

whenever I am breastfeeding while 4% of the respondents are not sure. This implies that

majority of relatives are supportive whenever I am breastfeeding in this study.

Table 15: Breastmilk alone satisfy my baby

Frequency Percent

Valid

Yes 61 61.0

No 37 37.0

Not sure 2 2.0

Total 100 100.0


From the above table, 61% of the respondents confirmed that breastmilk alone satisfy

their baby, 37% confirmed that breast alone did not satisfy their baby while 2% of the

respondents are not sure. This implies that only breastmilk is satisfies respondents’

babies in this study.

Table 16: I have not heard of exclusive breastfeeding before now

Frequency Percent

Valid

Yes 81 81.0

No 16 16.0

Not sure 3 3.0

Total 100 100.0


From the above table, 81% of the respondents confirmed the unawareness of exclusive

breastfeeding before now, 16% confirmed the unawareness of exclusive breastfeeding

before now while 3% of the respondents are not sure. This implies that majority of the

respondents are not aware of exclusive breastfeeding before now in this study.

Table 17: I find breastfeeding painful

Frequency Percent

Valid

Yes 18 18.0

No 80 80.0

Not sure 2 2.0

Total 100 100.0


From the above table, 18% of the respondents confirmed that breastfeeding is very painful,

80% confirmed that breastfeeding is not painful while 2% of the respondents are not sure.

This implies that majority of the respondents confirmed that breastfeeding is not painful

in this study.

Table 18: My breast will become saggy when I breast feed my child

Frequency Percent

Valid

Yes 26 26.0

No 69 69.0

Not sure 5 5.0

Total 100 100.0


From the above table, 26% of the respondents confirmed that breast becomes saggy when

breastfeeding child, 69% confirmed that breast does not saggy when breastfeeding child

while 5% of the respondents are not sure. This implies that breast would not saggy when

I breastfeed my child in this study.

Table 19: Nature of my job does not allow me to practice exclusive

breastfeeding

Frequency Percent

Valid

Yes 58 58.0

No 40 40.0

Not sure 2 2.0

Total 100 100.0


From the above table, 58% of the respondents confirmed that the nature of my job does

not allow me to practice exclusive breastfeeding, 40% confirmed that the nature of my job

does not allow me to practice exclusive breastfeeding while 2% of the respondents are not

sure. This implies that majority of the respondents confirmed that the nature of their job

does not allow to practice exclusive breastfeeding in this study.

Table 20: I need more time to breastfeed my child

Frequency Percent

Valid

Yes 81 81.0

No 17 17.0

Not sure 2 2.0

Total 100 100.0


From the above table, 81% of the respondents confirmed that they need more time to

breastfeed their child 17% of the respondents need no time to breastfeed their child while

2% of the respondents are not sure. This implies that majority of the respondents need

more time to breastfeed their child in this study.

Table 21: The quantity of breastmilk I produce does not satisfy my child

Frequency Percent

Valid

Yes 26 26.0

No 64 64.0

Not sure 10 10.0

Total 100 100.0


From the above table, 26% of the respondents confirmed that the quantity of breastmilk I

produce does not satisfy my child, 64% confirmed that the quantity of breastmilk I

produce satisfies my child while 10% of the respondents are not sure. This implies that

the quantity of breast produces by majority of respondents satisfies their child in this

study.

Table 22: The state of my health will not allow me to breastfeed my

child exclusively

Frequency Percent

Valid

Yes 74 74.0

No 24 24.0

Not sure 2 2.0

Total 100 100.0


From the above table, 74% of the respondents confirmed that the state of their health does

not allow to breastfeed their child exclusively, 24% confirmed that that the state of their

health does not allow to breastfeed their child exclusively while 2% of the respondents are

not sure. This implies that majority of the respondents does not breastfeed their child

exclusively in this study.

BENEFIT OF EXCLUSIVE BREASTFEEDING TO MOTHER AND CHILD


The table presented above is aimed at ascertaining that breastfeeding allows my uterus

fall back in place, 44 percent strongly disagreed, 39 percent agreed, 1 percent undecided,

7 percent disagreed while 9 percent strongly disagreed with the statement. It is pertinent

Table 23: Breastfeeding allows my

uterus fall back in place

Frequency Percent

Strongly Agree 44 44.0

Agree 39 39.0

Undecided 1 1.0

Disagree 7 7.0

Strongly Disagree 9 9.0

Total 100 100.0

to know through the opinion of the respondents that breastfeeding allows my uterus fall

back in place in this study.

Table 24: When I breast feed, it helps prevent cancer

Frequency Percent


Agree 39 39.0

Undecided 3 3.0

Disagree 8 8.0


Total 100 100.0


The table presented above is aimed at ascertaining that when I breast feed, it helps prevent

cancer, 37 percent strongly disagreed, 39 percent agreed, 3 percent undecided, 8 percent

disagreed while 13 percent strongly disagreed with the statement. It is pertinent to know

through the opinion of the respondents that when breastfeed, it helps prevent cancer in

this study.

Table 25: Breast milk helps protect my child from diseases

Frequency Percent


Agree 40 40.0

Undecided 2 2.0

Disagree 12 12.0


Total 100 100.0


The table presented above is aimed at ascertaining that breast milk helps protect my child

from diseases, 35 percent strongly disagreed, 40 percent agreed, 2 percent undecided, 12

percent disagreed while 11 percent strongly disagreed with the statement. It is pertinent

to know through the opinion of the respondents that breast milk helps protect child from

diseases in this study.

Table 26: When a child is well breastfed, it reduces the incidence of diarrhoea

Frequency Percent


Agree 30 30.0

Undecided 4 4.0

Disagree 15 15.0


Total 100 100.0


The table presented above is aimed at ascertaining that when a child is well breastfed, it

reduces the incidence of diarrhoea, 44 percent strongly disagreed, 30 percent agreed, 4

percent undecided, 15 percent disagreed while 7 percent strongly agreed, it is pertinent

to know through the opinion of the respondents that when a child is well breastfed, it

reduces the incidence of diarrhoea in this study.

Table 27: A child that is exclusively breastfed demonstrates high intelligence later

in life

Frequency Percent


Agree 31 31.0

Undecided 2 2.0

Disagree 8 8.0


Total 100 100.0


The table presented above is aimed at ascertaining that A child that is exclusively

breastfed demonstrates high intelligence later in life, 49 percent strongly disagreed,

31percent agreed, 2 percent undecided, 8 percent disagreed while 10 percent strongly

agreed, it is pertinent to know through the opinion of the respondents that a child that is

exclusively breastfed demonstrates high intelligence later in life in this study.

Source:

Field

work,

2016

The

table

presented above is aimed at ascertaining that breastfeeding will make my child develop

fast, 44 percent strongly disagreed, 39 percent agreed, 1 percent undecided, 7 percent

disagreed while 9 percent strongly disagreed with the statement. It is pertinent to know

Table 28: Breastfeeding will make my child develop fast

Frequency Percent


Agree 39 39.0

Undecided 1 1.0

Disagree 7 7.0


Total 100 100.0

through the opinion of the respondents that breastfeeding will make my child develop fast

in this study.

Table 29: Breastfeeding promotes bonding of mother and child

Frequency Percent


Agree 39 39.0

Undecided 3 3.0

Disagree 8 8.0


Total 100 100.0


The table presented above is aimed at ascertaining that breastfeeding promotes bonding

of mother and child, 37 percent strongly disagreed, 39 percent agreed, 3 percent

undecided, 8 percent disagreed while 13 percent strongly disagreed with the statement. It

is pertinent to know through the opinion of the respondents that breastfeeding promotes

bonding of mother and child in this study.

Table 30: Breast feed helps me save money as I don’t need to buy breastmilk.

Frequency Percent


Agree 40 40.0

Undecided 2 2.0

Disagree 12 12.0


Total 100 100.0


The table presented above is aimed at ascertaining that breast feed helps me save money

as I don’t need to buy breastmilk, 35 percent strongly disagreed, 40 percent agreed, 2

percent undecided, 12 percent disagreed while 11 percent strongly disagreed with the

statement. It is pertinent to know through the opinion of the respondents that breast feed

helps me save money as I don’t need to buy breastmilk in this study.

4.3 DATA PRESENTATION AND ANALYSIS ACCORDING TO TEST OF HYPOTHESES

The Pearson's correlation is used to find a relationship between at least two continuous

variables. The value for a Pearson's can fall between 0.00 (no correlation) and 1.00 (perfect

correlation). Other factors such as group size will determine if the correlation is significant.

Generally, correlations above 0.80 are considered pretty high, as presented on the table

below:

The Range of r Interpretation

r = 1

Perfect negative correlation

1< r 0.8

Strong negative correlation

0.8 < r 0.5

Fair negative correlation

0.5 < r < 0

Weak negative correlation

r = 0

No correlation

0 < r < 0.5 Weak positive correlation

In this sub-section, the research hypotheses geared towards achieving the stated

objectives of the study were tested using Pearson Product Moment Correlation (PPMC)

analysis statistical tool at 0.05 level of significance.

HYPOTHESIS ONE

Ho: There is no constraint to the practice of exclusive breastfeeding among

breastfeeding mothers in Alimosho General Hospital, Igando.

N X Y XY X2 Y2

1 32 38 1216 1024 1444

2 28 35 980 784 1225

3 21 10 210 441 100

4 19 17 323 361 289

TOTAL 100 100 2729 2610 3058

Table 1: constraint to the practice of exclusive breastfeeding and breastfeeding mothers

in Alimosho General Hospital

0.5 r < 0.8

Fair positive correlation

0.8 r < 1

Strong positive correlation

r = 1 Perfect positive correlation

Variable N SUM r-cal P-value Df r-task

value

Decision

Constraint to the

practice of

exclusive

breastfeeding (X)

4 X:100

X2:2610

XY:2729

0.9243 0.05 3 0.878

Breastfeeding

mothers in

Alimosho

General Hospital

(Y)

4 Y:100

Y2:3058

Rejected

Result

Ho is rejected. This implies that there is practice of exclusive breastfeeding among

breastfeeding mothers in Alimosho General Hospital, Igando.

Decision

From the above hypothesis tested, this implies that there is high positive practice of

exclusive breastfeeding among breastfeeding mothers in Alimosho General Hospital,

Igando.

HYPOTHESIS TWO

Ho: There is no significant relationship between exclusive breastfeeding and the health of

the baby

N X Y XY X2 Y2

1 39 15 585 1521 225

2 33 8 264 1089 64

3 12 36 432 144 1296

4 16 41 656 256 1681

TOTAL 100 100 1937 3010 3266

Table 2: Exclusive breastfeeding and the health of the baby

Variable N SUM r-cal P-value Df r-task value Decision

Exclusive

breastfeedin

g (X)

4 X:100

X2:3010

XY:1937

0.9008 0.05 3 0.878

Health of the

baby (Y)

4 Y:100

Y2:3266

Rejected

Result

Ho is rejected. This implies that exclusive breastfeeding guarantee good and sound health

of a baby

Decision

From the above hypothesis tested, this implies that there is high positive relationship

between exclusive breastfeeding and the health of a baby.

HYPOTHESIS THREE

Ho: There is no benefit of exclusive breastfeeding to mothers in Alimosho General Hospital

N X Y XY X2 Y2

1 20 42 840 400 1764

2 15 36 540 225 1296

3 35 10 350 1225 100

4 30 12 360 900 144

TOTAL 100 100 2090 2750 3304

Table 3: Benefit of exclusive breastfeeding and mothers in Alimosho General Hospital

Variable N SUM r-cal P-

value

Df r-task

value

Decision

Benefit of

exclusive

breastfeedin

g (X)

4 X:100

X2:2750

XY:2090

0.9145 0.05 3 0.878

Mothers in

Alimosho

General

Hospital

4 Y:100

Y2:3304

Rejected

Result

Ho is rejected. This denotes that the benefit of exclusive breastfeeding and mothers in

Alimosho General Hospital.

Decision

From the above hypothesis tested, this implies that there is high positive relationship

between benefit of exclusive breastfeeding and mothers in Alimosho General Hospital.

CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATIONS

5.1 INTRODUCTION

This chapter presents a summary of the major findings of the study. It also examines the

constraints of exclusive breastfeeding mothers in Alimosho General Hospital, Igando,

Lagos State. The Chapter one covers the general introduction to the study; also

description of the problem, objective of the study, research questions, significance of the

study, scope and definition of terms used in the study. Chapter two elucidate on literature

review as well as theoretical framework. Chapter three describes the research

methodology. It contains explanation of the research design, population of study,

sampling technique, and sample size, instrument of data collection and method of data

analysis. Chapter four covers data analysis and interpretation while chapter five present

the discussion of findings, Nursing implications, summary, conclusion and

recommendations.

5.2 DISCUSSION OF FINDINGS

The result is in line with Chetley (2003) who believed that, few women or mothers

are constraint by negative perception of lack of sufficient milk, fear of weight gain, breast

sagging, pain, sleep deprivation, exhaustion or maternal employment as the problems

highlighted by poor attitude of mothers who are not positive towards exclusive

breastfeeding. This has often been attributed exclusive breastfeeding as the major problem

which had hindered effective and successful practicing exclusive breastfeeding. The extant

research showed that a large number of mothers are not practicing exclusive breastfeeding

as a result of poor knowledge which result in poor attitude towards it.

Besides, in the same vain inadequate knowledge or inappropriate practice of

breastfeeding were identified as those factors which can lead to undesirable consequences

which also affect mother's attitude. UNICEF (2006b) opined that exclusive breastfeeding

practices are not common in developing countries especially Nigeria, only approximately

one third of infants under six months are exclusively breastfed. There are however

variations in different regions. There is benefit of exclusive breastfeeding to mothers in

Alimosho General Hospital.

According to Vennemann and colleagues (2009) breastfeeding was found to be protective

against sudden infant death syndrome by reducing the risk by 50% at all ages during

infancy; these benefits have been reported to exhibit those responses relationship, that is,

health gains increased with increase in duration and exclusivity.

Infants when exclusively breastfed for the optimal duration of six months are

considerably protected against the major childhood diseases conditions viz. diarrhea,

gastrointestinal tract infection, allergic diseases, diabetes, obesity, childhood leukemia

and lymphoma, inflammatory and bowel disease (WHO, 2012).

5.3 IMPLICATIONS FOR NURSING

Nurses should endeavor to imbibe the habit of health educating pregnant women

appropriately during each antenatal visit. This will help them practice exclusive

breastfeeding after delivery.

There should be re-training of Nurses on appropriate professional conduct

towards women who are breastfeeding. Nurses should be at the forefront of campaign for

exclusive breastfeeding since this is going to help reduce infant mortality.

5.4 SUMMARY

The goal of this study was to examine constraints of exclusive breastfeeding mothers

in Alimosho General Hospital, Igando, Lagos-State. The findings showed that mothers

don’t have adequate knowledge of exclusive breastfeeding. This has often been attributed

exclusive breastfeeding as the major problem which had hindered effective and successful

practicing exclusive breastfeeding. The extant research showed that a large number of

mothers are not practicing exclusive breastfeeding as a result of poor knowledge which

result in poor attitude towards it.

Besides, in the same vain inadequate knowledge or inappropriate practice of

breastfeeding were identified as those factors which can lead to undesirable consequences

which also affect mother's attitude. UNICEF (2006b) opined that exclusive breastfeeding

practices are not common in developing countries especially Nigeria, only approximately

one third of infants under six months are exclusively breastfed. There are however

variations in different regions. There is benefits of exclusive breastfeeding to mothers in

Alimosho General Hospital. The findings from the all hypotheses are related to Brulde,

(2011) in the literature that breastfeeding is an incomparable system of providing ideal

food for the healthy growth and development of infants. It is also an essential part of the

reproductive process with imperative implications for the health of mothers. Breastfeeding

also serves as continues method through which newborns are given essential nutrients

indispensable for optimal growth and intellectual development.

5.5 CONCLUSION

Based on the researcher findings in the study, conclusion was drawn on the constraints

of exclusive breastfeeding mothers in Alimosho local government area of Lagos State. It is

concluded from the study findings that exclusive breastfeeding especially child growth

plays an important role in child daily life.

Research finding support the fact that in order for mothers to exclusively breastfeed their

babies, mothers require to appreciate the reasons that exclusive breastfeeding is best and

they require to get positive messages about exclusive breastfeeding from friends and family

members.

The popular proverb says that knowledge is power, lack of correct exclusive breastfeeding

knowledge and the inability to apply the knowledge in breastfeeding children is a very

serious threat to the practice of exclusive and adequate breastfeeding.

The fact remains that exclusive breastfeeding is practiced by a minority of women may be

attributed to a number of factors like social, economic, cultural, political factors. Cultural

factors may be crucial when promoting exclusive breastfeeding everywhere, but are

particularly crucial in traditional rural communities. Local perceptions of what constitutes

optimal infant feeding practices may differ greatly from international recommendations.

From this study, it is concluded that working mothers find it extremely difficult to

exclusively breastfeed their babies according to the recommendation of World Health

Organization. Exclusive breastfeeding for up to six months requires the mother and her

infant to be in close proximity for this period and to use expressed breastmilk for

separation of short duration. However, practicing exclusive breastfeeding may be

perceived as being non compatible with working outside of the home, thus creating an

economical barrier.

5.6 RECOMMENDATIONS

Based on the above findings and conclusion, the following recommendations were made;

That the inadequate social support systems at the household and community levels has

seen as a barrier to optimum breastfeeding. It is believed that mothers needs an enabling

environment if they are to practice optimal breastfeeding and this can only be possible

with full support at both the household and the community levels. The workload of the

pregnant and lactating woman should be addressed. Besides, government should promise

that workplace is free of harassment and discrimination against women who prefer to

breastfeed their babies through appropriate mechanisms.

That National policies on breastfeeding are important for the promotion and support of

breastfeeding at all levels. The lack of political commitment to breastfeeding promotion

and support may probably be due to ignorance of its many benefits for the individual

(mother and infant), household, community and the nation. Governments have still to

understand the health, social and economic benefits of breastfeeding.

That Nurses should be encouraged to serve as role model to other women generally to

practice exclusive breastfeeding. They should not be mere educators of this thus

promoting optimal growth in others at the detriment of their own offspring. Government

health institutions should provide crèches at places of work to encourage health personnel

to practice exclusive breastfeeding.

Healthcare providers should persistently go on board on educating general populace

regarding the importance of exclusive breastfeeding to remove family negative influence

especially women in their prenatal period.

In light of all the barriers stated above, the baby friendly initiative is the best answer to

mother practice optimal breastfeeding including exclusive breastfeeding.

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http://www.unicef.org/nutrition/files/C4D_for_breastfeeding_webinar_presentation.pdf

LAGOS STATE SCHOOL OF NURSING, IGANDO

QUESTIONNAIRE

Dear Respondents,

My name is Oba Adeboye Solomon, a final year student of the above named institution. I

am currently carrying out a research study on “Constraints of exclusive breastfeeding practice among breastfeeding mothers in Alimosho General Hospital.”.

This questionnaire is designed to collect information about “Constraints of exclusive

breastfeeding practice among breastfeeding mothers in Alimosho General Hospital, Igando, Lagos-State”. You are therefore expected to answer the following questions. All answers to the questionnaire will be treated confidential. So, please provide honest and

accurate response to these questions by ticking the appropriate box.

Oba Adeboye Solomon

Student Nurse

SECTION A (Please tick ( ) the appropriate column in the space provided) DEMOGRAPHIC DATA

1. Age: 15-25 years 25-35 years 35- 50 years

2. Occupation : Civil servant Trading Schooling Others__________

3. Marital status : Single Married Divorced

4. Educational status : Primary Secondary , Tertiary

5. Religion : Christian , Islam Traditional

SECTION B Please tick ( ) the appropriate column in the space provided KNOWLEDGE OF EXCLUSIVE BREASTFEEDING

6. Have you heard of exclusive breastfeeding? Yes No

7. If yes, from which source did you get your information from? Antenatal Clinic

Postnatal Clinic Print Journal Electronic Media Church/Mosque Seminar

8. How long do you think a child should be breastfed before introduction of other

foods? 6 months 9 months 12 months others _______

9. Do you think exclusive breastfeeding is beneficial to the mother? Yes No

10. Do you think exclusive breastfeeding is essential for your child’s growth? Yes No

SECTION C (Please tick ( ) the appropriate column in the space provided)

SECTION D (Please tick ( ) the appropriate column in the space provided)

BENEFIT OF EXCLUSIVE BREASTFEEDING TO MOTHER AND CHILD

SA= STRONGLY AGREE A= AGREE UD= UNDECIDED D= DISAGREE SD= STRONGLY

DISAGREE

S/NO QUESTION SA A UD D SD

23. Breastfeeding allows my uterus fall back in place

24. When I breast feed, it helps prevent cancer

25. Breast milk helps protect my child from diseases

26. When a child is well breastfed, it reduces the incidence of diarrhoea

CONSTRAINTS OF EXCLUSIVE BREASTFEEDING PRACTICES

S/NO Questions Yes No Not

sure

11. Exclusive breastfeeding is very difficult

12. I find it difficult to breastfeed my child at night

13. My Child does not need breast milk after 3 months

14. My relatives are not supportive when I am breastfeeding

15. Breastmilk alone satisfy my baby

16. I have not heard of exclusive breastfeeding before now

17. I find breastfeeding painful

18. My breast will become saggy when I breast feed my child

exclusively

19. Nature of my job does not allow me to practice exclusive

breastfeeding

20. I need more time to breastfeed my child

21. The quantity of breastmilk I produce does not satisfy my child

22. The state of my health will not allow me to breastfeed my child

exclusively

27. A child that is exclusively breastfed demonstrates high intelligence later in life

28. Breastfeeding will make my child develop fast

29. Breastfeeding promotes bonding of mother and child

30. Breast feed helps me save money as I don’t need to buy breastmilk

Health & Medicine

Constraints of exclusive breastfeeding practice among breastfeeding mothers in alimosho general hospital