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TITLE PAGE

BY

DESIGN AND CONSTRUCTION OF AN ATTITUDE OF WORKING MOTHERS TOWARDS EXCLUSIVE BREAST FEEDING IN GENERAL HOSPITAL UGHELLI

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EE/H2013/01430
DEPARTMENT OF ---
SCHOOL OF ---
INSTITUTE OF ---

DECEMBER,2018

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APPROVAL PAGE

This is to certify that the research work, "design and construction of an attitude of working mothers towards exclusive breast feeding in general hospital ughelli" by ---, Reg. No. EE/H2007/01430 submitted in partial fulfillment of the requirement award of a Higher National Diploma on --- has been approved.

By
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Supervisor                                                  Head of Department.
Signature……………….                           Signature……………….        

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 Engr. ---
External Invigilator

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DEDICATION

This project is dedicated to Almighty God for his protection, kindness, strength over my life throughout theperiod and also to my --- for his financial support and moral care towards me.Also to my mentor --- for heracademic advice she often gives to me. May Almighty God shield them from the peril of this world and bless their entire endeavour Amen.

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ACKNOWLEDGEMENT

The successful completion of this project work could not have been a reality without the encouragement of my --- and other people. My immensely appreciation goes to my humble and able supervisor mr. --- for his kindness in supervising this project.
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In delta state Nigeria, periodic national surveys report the practice of exclusive breastfeeding (EBF) in the general population to be over 50 %. However, little is known about EBF among professional working mothers, particularly its duration after maternity leave. Female workers are entitled to 12 weeks (84 days) of maternity leave with full pay in Nigeria, and this can be extended by two additional weeks in case of a caesarean or abnormal delivery. This study assessed the prevalence of EBF, as well as factors associated with the practice among professional working mothers in Nigeria.
In this work, the study was descriptive cross-sectional in design and employed a multi-stage sampling technique to sample 369 professional working mothers. The study was planned and implemented between January to July 2015. Study-specific structured questionnaires were used in the data collection over a period of one month. Some factors including demographic characteristics, types of facilities available at workplace to support breastfeeding, challenges to exclusive breastfeeding at the workplace and mother’s knowledge base on EBF, were assessed. Exclusive breastfeeding is defined as feeding infants with only breast milk, without supplemental liquids or solids except for liquid medicine and vitamin or mineral supplements.

TABLE OF CONTENTS
COVER PAGE
TITLE PAGE
APPROVAL PAGE
DEDICATION
ACKNOWELDGEMENT
ABSTRACT
GLOSSARY
CHAPTER ONE
1.0      INTRODUCTION
1.1      BACKGROUND OF THE PROJECT

1. AIM OF THE STUDY
2. OBJECTIVE OF THE STUDY
3. SCOPE OF THE STUDY
4. SIGNIFICANCE OF THE STUDY
5. PURPOSE OF THE STUDY
6. LIMITATION OF THE STUDY
7. STATEMENT OF PROBLEM
8. DEFINITION OF TERMS
9. RESEARCH QUESTIONS

CHAPTER TWO
LITERATURE REVIEW

1. OVERVIEW OF THE STUDY
2. THEORITICAL REVIEW OF THE STUDY
3. THEORIES ON ATTITUDE REVIEWED
4. REVIEW OF PREVIOUS STUDIES
5. BENEFITS OF EXCLUSIVE BREASTFEEDING TO THE CHILDREN IN NIGERIA

CHAPTER THREE
3.0        RESEARCH METHODOLOGY

1. INTRODUCTION
2. RESEACH DESIGN
3. POPULATION OF THE STUDY
4. SAMPLE AND SAMPLING TECHNIQUE
5. DATA COLLECTION PROCEDURE
6. VALIDATION OF INSTRUMENTS AND RELIABILITY

CHAPTER FOUR
4.1        RESULT ANALYSIS
CHAPTER FIVE

1. CONCLUSION AND RECOMMENDATION
2. REFERENCES

ABREVIATIONS AND THEIR MEANING

ABC	Affective, Behavioural and Cognitive
BAQ	Breastfeeding Attitude Questionnaire
BSES-SF	Breastfeeding Self- Efficacy Scale Short Form
CINAHL	Cumulative Index to Nursing and Allied Health Literature
CRC	Convention on the Rights of the Child
EBF	Exclusively Breastfed
IBFAN	International Baby Food Action Network
IBM	International Business Machines Corporation
KELA	The social Insurance Institute of Finland
MHCC	Maternal Health Child Care Clinics
NGO	Non-Governmental Organization
SPSS	Statistical Package for the Social Sciences
TPB	Theory of Planned Behavior
UNICEF	United Nations Children’s fund
WIC	Woman, Infant and Children
WHO	World Health Organization

         AOR:  Adjusted odds ratio
EBF: Exclusive breastfeeding
OR:  Odds ratio
CI: Confidence interval
ERC: Ethics Review Committee
IBM: International Business Machines
SPSS:  Statistical Package for Service Solutions

 CHAPTER ONE
1.1                                                        INTRODUCTION
Essentially, mother's milk has antibodies which are not present in infant formula. These antibodies are what protect the body and the boost the immune system of infant to enable them fight disease. The human milk in the right proportion also helps in robust and all round development of re infant (Jones, 1993: Tiwari, Zahariya and 2008). Hence absence of such antibodies and lack of adequate nutrients and vitamins in infant's formula, also the easy contamination of bottles and other artificial feeding methods exposes the infants to various diseases like respiratory tract disease, skin infection, diahorrea which is a serious problem in infants (Jone, 1993).
Exclusive breastfeeding is encouraged and recommended to all mothers worldwide with efforts being made both in the private and public sector as a way of achieving the Millennium Development Goals (MDGs) on improving maternal health. These efforts are also directed at reducing infant morbidity and mortality related to mixed-feeding as breast milk is very vital for the newly born babies. According to UNICEF (2010), exclusive breastfeeding is giving baby breast milk only and nothing else, not even sips of water except for medicines prescribed by the doctor or nurse for the first six months of life.
According to World Health Organization (2006), in 1991, United Nations International Children’s Fund (UNICEF) and World Health Organization (WHO) began an international campaign called  Baby Friendly Hospital Initiative. This initiative was meant to promote, protect and support breastfeeding. Most hospitals in Nigeria have Baby Friendly Initiative. One of the ten steps for Baby Friendly Initiative states that there should be no advertising of formula products used for babies under six months. In line with this agreement, Nigeria prohibits the advertisement of such products on all media in an effort to promote exclusive breastfeeding.
Consequently, this necessited the Innocent Declaration commendation of 1990 by WHO/UNICEF Policy makers that all infants should be fed exclusively on breast milk from birth to 6 months of age (Galtry, 2003). However, this clarion call is to be answered by all mothers, in our contemporary society women are actively involved in paid job which has strict laws and codes of conduct which may not enable them have adequate time, to practice exclusive breastfeeding. In this study the researcher sets out to unravel those socio-economic determinates of exclusive breastfeeding among working mother's in General Hospital Ughelli in order to give recommendations that will help improve the rate of exclusive breast feeding.

1.1                                           BACKGROUND OF THE STUDY
The 2008 Lancet Series on Maternal and Child Under-nutrition indicated that suboptimum breastfeeding, especially not exclusively breastfeeding a child for the first six months of life, results in 1.4 million deaths and 10 % of the disease burden in children younger than five years in low-income and middle-income countries [1]. Other statistics indicate that one hundred and thirty-five million babies are delivered annually, but only 42 % (57 million) initiate breastfeeding within the first hour after birth, 39 % are breastfed exclusively during the first six months, and 58 % continue breastfeeding up to the age of two years [2]. Several studies have reported barriers accounting for this situation, including returning to work after delivery [3]. Others have stated factors that determine the success of exclusive breastfeeding even upon return to work, indicating that a supportive workplace and working environment are essential [4]. Yet, the Nigeria 2010 Population and Housing Census Report showed an increasing trend of women joining the labour force [5]. Guendelman et al. note that the challenge of balancing breastfeeding and paid work is an important reason for breastfeeding cessation in the first six months [6]. In Nigeria, the success of exclusive breastfeeding is subject to the nature of a women’s job and occupation, especially at places where women are engaged in industrial work away from home, and long working hours [7, 8]. Elsewhere, Magner, and Phillipi attribute cessation of breastfeeding within the first month to returning to work [9]. Aryeetey and Goh note that exclusive breastfeeding in Nigeria usually lasts for a median of about three months, which, incidentally coincides with the maternity leave period [10]. Cai et al. in their 2012 “global trends in exclusive breastfeeding” indicate that the early cessation of exclusive breastfeeding favours the use of commercial breast milk substitutes, often of poor nutritional quality [11]. Recently, Fosu-brefo and Arthur in their work titled “effect of timely initiation of breastfeeding on child health in Nigeria” acknowledged that interventions that improved child health and prevented childhood diseases included early breastfeeding initiation [12]. Also, the factors acknowledged locally in Ghana, Ayton and colleagues have identified several others that are harmfully associated with effective breastfeeding, such as delays in and/or failure of early breastfeeding initiation [13]. Exploring the constraints to exclusive breastfeeding practice among breastfeeding mothers in Southwest Nigeria, Agunbiade and Ogunleye note that early introduction of complementary feeding, based on false beliefs that it is only beneficial to infants less than six months, adversely affects breastfeeding initiation and sustainability [14]. In China and Western Kenya, several factors accounted for low EBF prevalence among working mothers. Early return to work, limited flexibility of work hours, lack of privacy [15], as well as a feeling of being watched and judged, lack of support including networks, tiredness and emotional support at work [16] were cited as challenges facing working mothers. Mother’s work outside the home, father’s type of occupation (demanding occupations) which may limit their support for mothers to breastfeed and shorter maternity leave regulation also hindered EBF practice among professional working mothers in Vietnam [17], who all intended to exclusively breastfeed. These studies report that although most working mothers leave the maternity ward breastfeeding exclusively, the practice is quickly abandoned, mostly due to work and employment related factors. Although breastfeeding may not be completely abandoned, its exclusivity was mostly interrupted by these factors. Some of the factors hindering exclusive breastfeeding initiation and practice in Nigeria and elsewhere include poor knowledge of mothers, lack of mother’s confidence, lack of skills about appropriate breastfeeding methods and challenges with other work problems during lactation [16, 18, 19]. These challenges may be amplified among working mothers in Nigeria, and could include giving substitutes other than maternal milk, early introduction of weaning foods, or shorter duration of EBF due to demands from work.
While data indicate that only about 36 % of infants younger than six months are exclusively breastfed in developing countries [20], national surveys concluded that Nigeria’s exclusive breastfeeding rate at six months is currently about 52 % [18]. Although higher than the national average, the exclusive breastfeeding prevalence of 60 % in the Upper West Region is lower than the desired national target. The popularity or otherwise of exclusive breastfeeding among gainfully employed women is yet to be characterized in this region of Nigeria.

1.2                                                     AIM OF THE STUDY
The current study therefore aimed to assess the prevalence, and predictors of exclusive breastfeeding among professional working mothers in General Hospital Ughelli.

1.3                                                PURPOSE OF THE STUDY
The purpose of this study was to investigate types of knowledge regarding exclusive breastfeeding; to explore their attitudes towards and identify the possible challenges they experienced during exclusive breastfeeding period.

1.4                                               OBJECTIVE OF THE STUDY
The main objective of the study was to provide knowledge for nurses and professional teams to comprehend the reasons behind early cessation of exclusive breastfeeding by new mothers, hence revising a new most competent course to boost exclusivity of breastfeeding amongst mothers. At the end of the study, student involve shall be able to highlight the importance and impact of exclusive breastfeeding.

1.5                                           SIGNIFICANCE OF THE STUDY
This study is important in that it helps in changing the attitude and knowledge nursing mothers regarding exclusive breastfeeding, to explore types of attitudes towards exclusive breastfeeding and to identify the possible challenges experienced during exclusive breastfeeding period.

1.6                               LIMITATION OF THE STUDY
Despite the advantages of excluding breastfeeding such as:  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. However, some women do not still believe in the practice, according to them it exposes them to stress more especially working mothers.

1.7                                   PROBLEM STATEMENT
Major problems faced during this research are: mothers level of knowledge, mother's attitude towards exclusive breastfeeding, mothers, level of education among others were all significant to their practice of exclusive of breastfeeding, while cultural beliefs are not associated with exclusive breastfeeding practice.

1.8                                                   SCOPE OF THE STUDY
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 fetors, 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.
This study was adopted qualitative methodology of literature review, where previous studies data was considered from the theoretical background and analysis was drawn according to the researchers’ quest.

1.9                                                  RESEARCH QUESTIONS
The research questions included:

1. What kind of knowledge the study had concerning exclusive breastfeeding?
2. What were the attitudes of the study towards exclusive breastfeeding?
3. What were the possible challenges experience during exclusive breastfeeding period?

1.10                                               DEFINITION OF TERMS
Terms related and constantly used in this work are defined as follows:
Alveoli: Glandular tubes that appear in bundles and secrete breast milk into milk ducts.
Areola: The dark circle that surrounds the nipple.
Colostrum: Thick, sticky, yellowy “pre-milk” that is full of protein, vitamins and antibodies to sustain a newborn for her first few days of life.
Breast Pump: A device that manually or electrically helps new moms express breast milk into bottles or bags. The pump is connected to the mother’s breast with breast shields called flanges. Many moms pump to stimulate milk production or to have milk to serve their babies when they are separated.
Breastfeeding Positions: There are various ways to hold a baby while nursing known as breastfeeding positions. Some common breastfeeding positions include cradle, cross-cradle, football hold, side-lying and dangle.
Cluster Feeding: Frequent feedings within a short amount of time. Cluster feedings are often helpful at night to satiate a baby and help her sleep longer.
Engorgement: Fullness of the breasts with breast milk marked by hardened breasts, swelling, and sometimes pain. Engorgement can lead to plugged ducts and mastitis. Expressing breast milk through nursing or pumping is the best way to relieve engorgement.
Exclusive Breastfeeding: Feeding a baby only breast milk, which is advised by the American Academy of Pediatrics for at least the first six months of a baby’s life. Continued breastfeeding is recommended for one year and beyond as well.
Flat Nipple: A nipple that lays flush against the breast even when stimulated.
Fore-milk: The early milk during a feeding that contains more sugary lactose and less fat.
Hind-milk: As a feeding progresses and breasts become emptier more fat is released into the breast milk. This is known as hind-milk.
Inverted Nipple: A nipple that retracts inward towards the breast even when stimulated.
Lactation: Another word for breastfeeding.
Lactation Consultant: A trained specialist who supports new moms as they learn to breastfeed and navigate breastfeeding issues.
Lactose: A sugar found in breast milk and other dairy products.
Latch: The connection between your baby’s mouth and your areola. A good latch includes a wide mouth position over as much of the areola has possible, a cupped tongue and protruding lips that sit on top of the breast.
Let-Down: Also known as Milk Ejection Reflex (MER), this reflex stimulates the flow of milk from milk ducts out through the breasts. Let-downs are often undetectable by moms but occur within a few minutes after nursing begins.
Mastitis: An infection of the breast either from a plugged milk duct or bacteria that enters through the nipple. Mastitis can cause breasts to feel hard, sore and painful.
Milk Ducts: Channels that carry breast milk from the tissues where it is secreted (called alveoli) to the nipples.
Milk Supply: This refers to the availability of breast milk, which is based on a supply and demand stimulus. The more the breast is stimulated and then emptied, the more milk will be produced.
Montgomery glands: Bumps on the areola that secrete anti-microbial oil that lubricate and protect the nipples. It is possible that the secretion from Montgomery glands smell like a mother’s amniotic fluid and help newborns find their mother’s nipples for feeding.
Nipple Confusion: The idea that babies may have a hard time transitioning between breasts, artificial nipples (such as bottle nipples) and pacifiers.
Nursing Bra: A specially-designed bra that allows easy access to breasts to simplify nursing. Nursing bras may have nursing clasps with drop-down cups, slide-over cups or front-closures.
Plugged Ducts: A blockage in a milk duct that can lead to an infection known as mastitis. To help ease a plugged duct, use a warm compress and massage the area.
Rooting: A baby’s act of feeling around for her mother’s breast by turning her head and opening and closing her mouth (as if she’s looking for the nipple). Rooting is a sign of your baby’s hunger and often occurs when a baby smells breast milk.

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CHAPTER TWO: The complete chapter two of “design and construction of an attitude of working mothers towards exclusive breast feeding in general hospital ughelli” is available. Order full work to download. Chapter two of “design and construction of an attitude of working mothers towards exclusive breast feeding in general hospital ughelli” consists of the literature review. In this chapter all the related work on “design and construction of an attitude of working mothers towards exclusive breast feeding in general hospital ughelli” was reviewed.

CHAPTER THREE: The complete chapter three of “design and construction of an attitude of working mothers towards exclusive breast feeding in general hospital ughelli” is available. Order full work to download. Chapter three of “design and construction of an attitude of working mothers towards exclusive breast feeding in general hospital ughelli” consists of the methodology. In this chapter all the method used in carrying out this work was discussed.

CHAPTER FOUR: The complete chapter four of “design and construction of an attitude of working mothers towards exclusive breast feeding in general hospital ughelli” is available. Order full work to download. Chapter four of “design and construction of an attitude of working mothers towards exclusive breast feeding in general hospital ughelli” consists of all the test conducted during the work and the result gotten after the whole work

CHAPTER FIVE: The complete chapter five of “design and construction of an attitude of working mothers towards exclusive breast feeding in general hospital ughelli” is available. Order full work to download. Chapter five of “design and construction of an attitude of working mothers towards exclusive breast feeding in general hospital ughelli” consist of conclusion, recommendation and references.

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