CHAPTER ONE

INTRODUCTION

1.1 Background to the study

According to Joshi, (2014)Undernourishment of children continues to be a public health issue in developing nations. Recent figures from the United Nations Children's Fund state that 11.4 percent of children under five in Sub-Saharan Africa are wasted, 43% are stunted, and 25% are underweight. While Asia continues to be the region where child malnutrition is most prevalent, Africa is the only continent where it is increasing.. According to the 2020 Nigerian Demographic and Health Survey, the country's infant mortality rate is 75 fatalities for every 1,000 live births, its neonatal mortality rate is 40, and its under-five mortality rate is 157 for every 1,000 live births. Malnutrition has been linked, either directly or indirectly, to 60% of the 10.9 million deaths among children under five that occur each year, according to UNICEF and the WHO. During the first year of life, more than two thirds of these deaths which are frequently linked to improper feeding practices—occur. A child's poor diet can have a lasting effect on an adult's health. Undernutrition throughout childhood is linked to reduced adult height, poorer academic performance, lower adult income, and low birth weight in their offspring.. Millions of malnourished youngsters are also more likely to develop chronic illnesses as adults and contract infectious infections as children. Although growth faltering can occur as early as three months of life, children between the ages of six and twenty-four months are the most vulnerable. During a baby's first six months of life, breast milk is the most comprehensive and sustainable form of nourishment, especially in developing nations where malnutrition and associated complications are rare. According to global consensus, exclusive breastfeeding for the first six months of life and sustained breastfeeding until the kid turns two years old and older constitutes the best breastfeeding practices for newborns and young children.

Moreover The most widely recognised method of feeding a baby is breastfeeding. Among all preventive measures, breastfeeding and supplemental feeding have the single most influence on child mortality (19%)(Akinremi & Samuel, 2015). A key public health priority today is protecting, promoting, and supporting breastfeeding, as the Global Strategy for Infant and Young Child Feeding highlights. The following are the breastfeeding recommendations from UNICEF and the WHO: Breastfeeding should begin within the first hour of the baby's birth; it should be exclusive for the first six months; it should be continued for at least two years; beginning in the sixth month, safe, age-appropriate, responsive supplemental feeding should also be provided (www.unicef.org; access Universal (90%) coverage of exclusive breastfeeding is estimated to prevent around 13% of all deaths among children under five years of age in low and middle income countries (Joshi, 2014).

 According to Black et al., (2013) Failure to exclusively breastfeed for six months is linked to an increased risk of childhood mortality and morbidity, according to the Series on Maternal and Child undernutrition. According to the same series, breastfed babies have a minimum of a six-fold increased chance of surviving in the first few months compared to non-breastfed babies, and a child who receives just breast milk has a 14-fold lower risk of dying in the first six months compared to a child who does not receive breast milk.. In the past, health practitioners have typically believed that breastfeeding is the best feeding method for newborns. It is the mother's and her child's initial line of contact. Previous research supports the benefits of breastfeeding for both moms and babies. These benefits include giving babies the nutrition they require, enhancing their immune systems, assisting mothers in losing weight after giving birth, and encouraging the uterus to return to its pre-pregnancy position (Tanash, 2014). In addition, infants can absorb and digest breast milk more easily than baby formula (The Office on Women’s Health, 2012). For the first six months of a baby's life, the World Health Organisation (WHO) advises nursing as the primary food source and urges mothers to think of breastfeeding as their sole option for feeding. In addition to breastfeeding, moms should consider using additional sources of nutrition (such water, other liquids, or solid baby food) for their infants between the ages of six months and two years (WHO, 2013). The 2020 Healthy People objectives have established a goal of raising the proportion of breastfed infants by 2020 to 81.9% for those who have breastfed for the first time, 60.6% for those who have breastfed for six months, 34.1% for those who have breastfed for twelve months, 46.2% for those who have breastfed exclusively for three months, and 25.5% for those who have exclusively breastfed for six months (United States Breastfeeding Committee, 2013).Globally, sub-optimal breastfeeding still accounts for an estimated 1.4 million deaths in children under five years annually.

Globally, Cai, Wardlaw, & Brown, (2012) discovered that 39% of infants 0-5 months were breastfed exclusively. Also, the regions with high rates of infants exclusively breastfed for less than 6 months were west Africa (52%), as well as South Asia (47%). Hence SubSaharan Africa recorded the lowest coverage of 37% were Nigeria is among, (WHO, 2012). Many centers have studied about knowledge attitude and practice of exclusive breast feeding among nursing mothers but little is known in this area about the Knowledge Attitude and Practice of exclusive breast feeding among nursing  mothers in Oghara Delta state Hence the study..

1.2 STATEMENT OF PROBLEM

In many cultures, it is not the standard to breastfeed. With varied degrees of success around the world, proponents of six months of exclusive breastfeeding have voiced worries about women' apparent unwillingness to follow WHO and UNICEF recommendations (Ajayi, 2012).Among other benefits, exclusive breastfeeding lowers a mother's risk of breast cancer, boosts IQ, fosters a close relationship between mother and child, and shields kids from a variety of diseases (WHO and UNICEF, 2017). However, just 2 out of 5 newborns globally receive their first 6 months of nourishment from their mothers alone (UNICEF, 2015). Approximately 40% of newborns under six months old worldwide exclusively breastfeed, indicating that the practice rate is still quite low (WHO AND UNICEF, 2017).

Even though 95% of Nigerian women breastfeed their children, only a small percentage of nursing mothers in the country exclusively breastfeed their infants—approximately 17% to 25% of infants younger than six months old receive this type of care (Nte and Njepuome, 2015). The rate of exclusive breastfeeding is low; it fell from 28% in 1999 to 17%, while Nigeria's rate of exclusive breastfeeding has increased from 12% to barely 25% during the past ten years (National Bureau of statistics, 2014). One of the main causes of mortality among children under five is malnutrition, which can be avoided by exclusive breastfeeding. It also has a significant impact on the child's growth, development, and well-being. It is crucial to realise that improper feeding habits have a close relationship with malnutrition, which is the primary cause of infant mortality. If women adhered totally to the practice of exclusive breastfeeding, the number of nutrition-related diseases in our society JUNE be decreased. (Labbok, 2001). Of the one million children under five that die each year, half are attributable to malnutrition; Nigeria is one of the six countries that accounts for half of these deaths (National Nutrition and Health Survey, 2014). As a result of chronic malnutrition, 37% of children under the age of five are stunted, or too small for their age, according to the 2017 study. Nigeria has only reduced under-five death by an average of 1.2% year since 1990; in order to attain the Sustainable Development Goals by 2020, the country must reduce under-five mortality by 10% annually (Nigeria Demographic and Health Survey, 2013).

The introduction of solid meals prior to six months of age has been linked to heightened infection rates, decreased supply of breast milk, disturbance of the microbiome, and potential obesity.However, over 50% of newborns in Nigeria are fed supplemental nutrients too soon (Binns, 2011). Some infants are given non-breastmilk to feed on before initiating breast feeding (pre-lacteal feeds), and others are given non-breast milk to feed on after breastfeeding has been initiated (post-lacteal feeds)(WHO, 2008). These meals frequently provide inadequate energy, protein, or micronutrients (iron, vitamin A, zinc, and iodine), which leads to undernutrition and increased infant morbidity and death. (Ugwu and Obi, 2010).According to NNHS(2014), 71% of Nigerian children are predominantly breastfed, meaning that aside breast milk they might have received either water or non-milk liquids. Such practices are also found in Delta State, as established by Mathew, Amodu, Sani and Solomon (2009), The majority of infants were introduced to complementary foods significantly earlier than the six-month benchmark, with 41.2% doing so in the third month and 17.8% doing so at less than two months. This demonstrates that the compliance rate is below the 90% intended compliance rate set by the World Health Organisation and the United Nations Children's Funds (UNCF).Only 23.7% of infants under the age of six months are exclusively breastfed, according to the results of the National Bureau of Statistics (NBS) and United Nations Children's Fund (UNICEF) fifth round Multiple Indicator Cluster Survey conducted in Nigeria in 2016–2017.According to the 2014 NNHS data, the probability of exclusively nursing children is notably greater in the South West (40%) and much lower in the North West (10%). In the same vein, Anigo, Owolabi, Dehinde and Hassan (2015) investigated the state of malnutrition among women and children in Kaduna, Nasarawa, and Niger states. They found that over 50% of Kaduna women used prelacteal feeding, and that the state had a higher prevalence of severe acute malnutrition (SAM) among children 0-59 months of age (276.6%). Therefore the study examines knowledge, attitude and practices of exclusive breast feeding among nursing mothers in oghara Delta state

1.3 Objectives Of the Study

The major purpose of this study is to examine knowledge, attitude and practices of exclusive breast feeding among nursing mothers in oghara Delta state . Other general objectives of the study are:

1. To asses the knowledge of nursing mothers on exclusive breast feeding in Oghara Delta state

2. To determine attitude towards nursing mothers on exclusive breast feeding In Oghara Delta state

3. To determine the practice of nursing mothers on exclusive breast feeding In Oghara Delta state

4) To outline ways of promoting exclusive breast feeding among nursing mothers In Oghara Delta state

1.4 RESEARCH QUESTIONS

1. What is the level of knowledge of nursing  mothers on exclusive breast feeding in Oghara Delta state?

2. what is the attitude towards nursing  mothers on exclusive breast feeding In Oghara Delta state?

3. what is the practice of nursing  mothers on exclusive breast feeding In Oghara Delta state?

4) What are the ways of promoting exclusive breast feeding among nursing mothers In Oghara Delta state

1.5 HYPOTHESIS

HO1: there is no significant influence of culture on the attitude of exclusive breast feeding among nursing mothers In Oghara Delta state

1.6 SIGNIFICANCE OF THE STUDY

Goal four of the eight millennium development goals is entirely devoted to reducing child mortality by two thirds by 2020. However, progress in African countries is insufficient in 5 achieving this goal. Poor feeding practices such as sub-optimal breastfeeding is still widespread and often leads to malnutrition which is a major cause of more than half of all child deaths (Breastfeeding et al., 2015). This study will be salutary; as it will contribute to a better understanding of how essential health interventions with proven empirical efficacy such as exclusive breast feeding can be promoted. It is also hoped that this study’s outcome will contribute to the growing body of scientific knowledge on infant feeding practices and how to design and situate health interventions in rural communities. Moreover, this research will in no doubt serve as a basis for future research in Ogahara.

1.7 Scope of the Study

The study covers Ogahara. As an academic exercise, the study focuses on knowledge of exclusive breastfeeding, attitude towards exclusive breastfeeding and practice of exclusive breastfeeding among lactating mothers, expectant mothers and experienced mothers in Kaduna metropolis. The study also focuses on the factors influencing their practice and non-practice. The study will be limited to the primary and secondary data available at the disposal of the researcher.

1.8 LIMITATION OF STUDY

Financial constraint- Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

Time constraint- The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.

1.9 OPERATIONAL DEFINITION OF TERMS

  The following terms are define operationally as it was used in the study

EXCLUSIVE BREAST FEEDING: 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.

NURSING MOTHERS: A woman who is breastfeeding a day to two-year old child, although such care may extend beyond two years in certain conditions

KNOWLEDGE: Knowledge is an awareness of facts, a familiarity with individuals and situations, or a practical skill. Knowledge of facts, also called propositional knowledge, is often characterized as true belief that is distinct from opinion or guesswork by virtue of justification.

PRACTICE: Practice is the act of rehearsing a behavior repeatedly, to help learn and eventually master a skill.