CHAPTER ONE

INTRODUCTION

1. Background  to the Study

The importance of the provision of a nursing-based intervention such as breastfeeding-readiness education for mothers during the antenatal visits is crucial to achieving exclusivity among them. Janson (2010) stated that, nurse- based intervention is very important in establishing successful breastfeeding practice. Valine and Apaldia (2014) suggested that the nursing intervention consisting of breastfeeding education is helpful at improving early initiation and thereafter continuation of breastfeeding for the first two months. Despite the nutritional, economic, immunological, and psychological advantages of breast milk, breastfeeding practice appear to remain below recommended level and one thing that plays a role in breastfeeding success may be nursing intervention. According to World Health Organization (WHO) all lactating mothers should exclusively breastfeed their children for the initial six months and go on with breastfeeding up to two years (WHO, 2010). However studies have shown exclusive breastfeeding is practiced below WHO recommendation (Nasserpour, Nouhjak, & Sharifat, 2010). A target of 90% universal coverage for Exclusive breastfeeding (EBF) is recommended by WHO to prevent 13-15% of 9 million deaths of children under-five in low and middle-income countries annually (Jones, 2013). Reports from Agunbiade and Agun, 2012 in Ile-Ife town also showed that only 19% of the breastfeeding mothers practiced exclusively. On the other hand, mother’s breastfeeding practice can be enhanced with continuous interventions such as prenatal breastfeeding education. UNICEF, (2011) describes that breast milk is the standard, healthiest, simplest, and not expensive feeding way that complete all the children’s needs. Knowledge, expertise and advice of nurses are very vital in creating awareness, education and support for mothers and their babies to achieve exclusivity. Nursing intervention strategies is a significant approach to some of the challenges of breastfeeding practice, making mothers informed of the cost effective benefit of exclusive breastfeeding

The global exclusive breastfeeding rate for children aged less than six months between the years 2000 and 2007 was 38% (UNICEF, 2008). Within the same period, only 23% of infants less than six months were breastfed exclusively in West and Central Africa while  Middle East and North Africa recorded a little higher rate of 26% was (UNICEF, 2008), in  Eastern and Southern Africa; East Asia and the Pacific; and South Asia respectively prevalence of  39%, 43% and 44% were observed (UNICEF, 2008).In addition, a study in England showed that infants’ exclusive breastfeeding rate was low, and only 25% of babies remain breastfed until 6 to 8 weeks after birth and 16% of mothers continued breastfeeding for three to five months after birth (Cernadas, Noceda, Barrera, Martinez, & Garsd, 2008). In Nigeria, the practice of exclusive breastfeeding is uncommon with only 13% of infant younger than six months are being exclusively breastfed (Nigerian Demographic and Health Survey, 2008), while in Nigeria, between year 2000 and 2012 merely 15.1% of babies less than six months of age were exclusively breastfed (UNICEF, 2012). Nigeria Demographic and Health Survey 2013 later on reported a a little higher prevalence of 17% EBF rate. A study in Plateau state showed that only 6% of mothers practiced exclusive breast feeding (Amosu, 2010). Niguse, Frehiwot ,  Dinu  and Eyerus (2016) stated that mothers knowlwdge and practice regarding exclusive breastfeeding as been low despite their exposure to training programmes on exclusive programs. According to Agunbiade and Oguunleye 2012, knowledge and practice concerning exclusive breastfeeding among mothers has been low despite exposure to training programmes on exclusive breastfeeding. Tyndall, Kamai, and Changchangi (2016) stated that despite the exposure of mothers to exclusive breastfeeding training, knowledge and practice regarding exclusive breastfeeding among mothers as been low. Despite initiation of exclusive breastfeeding programmes, problem associated with poor exclusive practice seems to persist suggesting a fundamental problem. These prompted the researcher to study the effect of nursing based intervention on exclusive breastfeeding practice among pregnant women attending two primary health care centers in Ikenne local government.

1.2 Statement of the Problem                                                

The rate of infant morbidity and mortality as a result of poor exclusive breastfeeding among mothers as been high (Onah , Osuorah , Ebenebe , Ezechukwu , Ekwochi  & Ndukwu,  2014). The incidence of of childhood communicable disease and infection in infants has significantly increased as a result of poor exclusive breastfeeding knowledge and practice among mothers (Talayero, Lizan-Garcia, Puime, Muncharaz, Soto, Sanchez-Palomares, Serrano & Rivera, 2006). The incidence of diarrhea and lower respiratory tract infections has been persistently high due to poor knowledge and practice regarding exclusive breastfeeding among mothers (Rivera, 2006). According to UNICEF (2013), exclusive breastfeeding knowledge and practice in Nigeria is significantly low. Knowledge and practice of mothers regarding exclusive breastfeeding as been low (Chola, 2011; Rea, 2009).  Problems associated with poor exclusive breastfeeding practice such as infections, diarrhea, upper respiratory tract infections, childhood obesity, low immunity, sudden infant death syndrome and malnutrition has significantly increased due to poor knowledge and practice regarding exclusive breastfeeding among mothers. The researcher through clinical experience as observed high incidence of malnutrition, childhood obesity and infection and diarrhea. These may be attributed to poor knowledge and practice regarding exclusive breastfeeding and it may also be attributed to a gap in the type of training programme offered to mothers on exclusive breastfeeding. Hence the need for a study on the effect of nursing based intervention on exclusive breastfeeding practice among pregnant women attending two primary health care centers in Ikenne local government

Objective of the Study

The main objective of this study is to evaluate Nurse-based intervention on exclusive breastfeeding practice among pregnant mothers attending Antenatal clinic in Ikenne LGA of Ogun state Nigeria. The specific objectives are to:

1. assess level of knowledge of pregnant mothers on exclusive breastfeeding pre intervention;
2. determine the baseline practice of exclusive breastfeeding among pregnant mothers;
3. determine influence of nurse-based intervention on the practice of exclusive breastfeeding among pregnant women post intervention and
4. determine influence of nurse-based intervention on the knowledge of exclusive breastfeeding among pregnant women post intervention.

1.4 Research Questions

In order to acquire data for this work, the Research questions were posed.

1. What is the level of knowledge of pregnant women on exclusive breastfeeding pre intervention?
2. What is the baseline practice of exclusive breastfeeding among pregnant mothers attending Antenatal clinic in Ikenne LGA of Ogun state?

1.  Hypotheses

The following research hypotheses were tested:

HO₁ There is a significant difference in pregnant mother’s knowledge level of exclusive      

        breastfeeding practice pre and post intervention between control and experimental

        group.

HO₂ There is a significant difference in pregnant mothers practice level of exclusive

        breastfeeding pre and post intervention between control and experimental group.

1. Scope of the Study

The researcher studied the effect of a nurse-based intervention on the knowledge and practice regarding exclusive breastfeeding among pregnant women.

1.6 Significance of the Study

1. The findings of this study may reveal the effect of nursing based intervention on exclusive breastfeeding practice.
2. Information from this study may be useful in planning strategies and intervention to improve mother and child’s health
3. The study may be beneficial to nurses because the training program may help translate available knowledge into clinical decision making during antenatal clinic visit
4. The study may be of great benefit to nurses as the outcome may increased time required for nurses’ to give quality nursing care to patient.
5. It may also provide data for further studies

1.8 Operational Definitions of Terms

Effect: Outcome of a nursing based program on exclusive breastfeeding  measured by knowledge and practice score of mothers.

Nursing Based intervention: This is educating and counseling pregnant mothers on definition of exclusive breastfeeding, benefit of exclusive breastfeeding to mother, child and the community as a whole and also the involvement of support group like husband involvement, involving of previously exclusively breastfed mothers to encourage new mothers to exclusively breastfeed for the first six months of life and continue for the next two years.

Breastfeeding:  is the feeding of infants and little children with milk from a woman’s breast

Exclusive breastfeeding: feeding the baby with only the breast milk, no addition of any other food or water, for the first 6months of life

Pregnant women: multiparous women within 36 gestational weeks and above in Ikenne local government

Practice: initiation of breastfeeding within 30miutes to one hour of delivery, Frequency of breastfeeding, breastfeeding on demand, expressing breast milk to feed baby when not around.