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DECEMBER,2018

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DEDICATION
This project is dedicated to Almighty God for his protection, kindness, strength over my life throughout the period and also to my --- for his financial support and moral care towards me.Also to my mentor --- for her academic 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

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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. In Anambra state of 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 an abnormal delivery. This study assessed the altitude and perception towards exclusive breastfeeding (EBF), as well as factors associated with the practice among working mothers both in Anaocha and Awka South LGA of Anambra State of 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. 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.
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. STATEMENT OF PROBLEM
2. AIM AND OBJECTIVES OF THE STUDY
3. SCOPE OF THE STUDY
4. SIGNIFICANCE OF THE STUDY
5. LIMITATION OF THE STUDY
6.  RESEARCH QUESTIONS
7. DEFINITION OF TERMS

CHAPTER TWO
2.0      LITERATURE REVIEW

1. REVIEW OF THE STUDY
2. IMPORTANCE OF EXCLUSIVE BREASTFEEDING
3. PHYSIOLOGIC AND PSYCHOSOCIAL BENEFITS OF BREASTFEEDING
4. PUBLIC HEALTH BENEFITS OF BREASTFEEDING
5. IMPACT OF EXCLUSIVE BREASTFEEDING (EBF)
6. THE ROLE OF THE NURSE IN PROMOTING EXCLUSIVE BREASTFEEDING
7. REVIEW OF PREVIOUS STUDIES  

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 AND DISCUSSION
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 according to [3]. The human milk in the right proportion also helps in robust and all round development of re infant [4]. 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 [3].
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 [1], 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 [2], 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 necessitate 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 [5]. 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 Anaocha and Awka South LGA of Anambra State of Nigeria in order to give recommendations that will help improve the rate of exclusive breast feeding.

1.1                                           BACKGROUND OF THE STUDY
Exclusive breastfeeding (EBF) is defined as “an infant’s consumption of human milk with no supplementation of any type (no water, no juice, no nonhuman milk, and no foods) except for vitamins, minerals, and medications until six months”[1].  Exclusive breastfeeding (EBF) for six months is important for both infant and maternal health. Infants who are not exclusively breastfeed are more likely to develop gastrointestinal infections, [7] not only in developing but also in industrialized countries. The risk of mortality due to diarrhea and other infections can increase many-fold in infants who are either partially breastfed or not breastfed at all [1].  During the first two months of life, infants who are not breastfed are nearly six times more likely to die from infectious diseases than infants who are breastfed; between 2 and 3 months, non-breastfed infants are 4 times more likely to die compared to breastfed infants [7].
Breast feeding is the very stage of improving child’s survival. Breast milk as food for infants is very beneficial for the all round growth of a child. It enhances the physical, mental and social growth of a child. Breast milk contains many nutritional values like antibodies which boost the immunity of a child, prevents child mortality and morbidity. Breast milk has a enormous impact on the health of infants, most especially those who weighed less at birth. It has been discovered that breast milk is far more nutritious than processed milk. Aside from the benefits of breast milk on an infant, breast feeding creates an inevitable bond between a mother and her child [8].
World Health Organisation and united Nations International Children Emergency recommended breast milk as an ideal food for infants, and that is why in the past decades, these organisations have been encouraging mothers worldwide to embrace the practice of breastfeeding, particularly exclusive breastfeeding [2].
Breast milk is an ideal way of providing food for the health, growth and development of infants, and it is also an integral part of the reproductive process with important implications for the health of nursing mothers. A recent review has shown that on a population basis exclusive breastfeeding for six months is the optional way of feeding infants. Thereafter infants should receive complementary foods with continued breastfeeding UI) to two years of age or beyond [7].
Breast milk is the natural 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 entre of a child’s nutritional needs during the second half of the year and up to one-third during the second year of life [2]. Breastfeeding pronates sensory and cognitive development and protects the infants against infection and chronic disease. Exclusive breastfeeding reduces infants’ mortality due to common childhood illnesses such as diarrhoea and pneumonia and helps for a quicker recovery during illness [9]. Breastfeeding contributes to the health and wellbeing of others. 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. While breastfeeding is a natural act, it is also a learned behavior [1]. An extensive study has demonstrated that mothers and other caregivers require active support for establishing and sustaining appropriate breastfeeding practices. WHO and UNICEF bunched the Baby -friendly Hospital Initiative (BFHI) in 1992. To strengthen maternity practices to support breastfeeding based on the foundation of the ten steps to successful Breastfeeding to protect, promote and support Breastfeeding [1].
Exclusive breastfeeding in the first six months of life stimulates baby’s immune systems and protects them from diarrhoea and acute respiratory infection; two of the major causes of infant mortality in the developing world and improves their responses to Vaccination.
Also exclusive breastfeeding according to WHO entails feeding an infant with just breast milk (and syrups if need be) for six months and after that period of time give the infant complementary food. It has been revealed by a study that infants who are not fed with breast milk at the first 60 days of their birth are likely to die from infection than those who breastfed [2].
Particularly in unhygienic conditions however breast milk substitutes carry a high risk of infection and can be fatal in infants. Yet only slightly more than one-third of all infants in developing countries are exclusively breastfed for the first six months [4].
The food and Nutrition Research Institute Department of service and Technology (FNRI DOST) recommends “Breastfeed infants exclusively from birth to six Months and then, give appropriate foods while continuing breastfeeding” [4]. The promotion protection and support of breastfeeding is an exceptionally cost-effective strategy for improving child survival and reducing the burden of childhood disease particularly in developing countries [6].
Scientific evidence has guided the development of international recommendations for optimal infant feeding practices which include exclusive breastfeeding for six months, that is, milk only with no other liquids or foods given, and continued breast feeding up to two years of age or beyond with timely addition of appropriate complementary foods [10]. Compliance state the above recommendation has significant child health and nutritional benefits. The Belbgio child survival study Group has identified optimal breastfeeding in the first year of life as one of the most important strategies for improving child survival [10]. Increasing optimal breastfeeding practices could save as many as 1.5 million infant lives every year given the significant protection that breastfeeding provides infants against diarrhoea disease, pneumonia and neonatal sepsis [2]. Improved breastfeeding practice can also have a positive effect on birth spacing, which attributes to child survival [3].
Not minding the enormous benefits of EBF, Nigeria mothers for reasons best known to them do not practice EBF. Some of them who sluggishly try to practice it might just do it partially not up to six months, while some could be based on their cultural beliefs as some traditions in Nigeria see EBF as being unnecessary and some this obnoxious idea of their breast sagging due to breastfeeding.
Based on the many factors that could hamper the practice of breastfeeding in Nigeria, this study is aimed at discovering the attitude and perception of working mothers in Anaocha and Awka South LGA of Anambra State of Nigeria, and to know their thoughts on the practice of exclusive breastfeeding.

1.3                                    AIM AND OBJECTIVES OF THE STUDY
The main aim of this study is to know the attitude and perception of working mothers towards exclusive breastfeeding (EBF) in Nigeria (a case study of Anaocha and Awka South LGA of Anambra State).  
The objectives of the study are:

1. To examine the factors that can hinder the practice of Exclusive Breast Feeding in Anaocha and Awka South LGA of Anambra State.
2. To ascertain the extent at which working mothers in Anaocha and Awka South LGA of Anambra State are well enlighten about Exclusive Breast Feeding.
3. To determine ways nurses in Anaocha and Awka South Local Government Area of Anambra State can be encouraged to practice Exclusive Breast Feeding.
4. To determine some challenges to exclusive breastfeeding at the workplace and mother’s knowledge base on EBF

1.4                                           SIGNIFICANCE OF THE STUDY
This study is important in that it helps in changing the attitude and knowledge of working mothers regarding exclusive breastfeeding, to explore types of attitudes towards exclusive breastfeeding and to identify the possible challenges experienced during exclusive breastfeeding period.
The study will also serve as a means of providing knowledge for workers and professional teams to comprehend the reasons behind early termination of exclusive breastfeeding by new mothers, hence revising a new most competent course to boost exclusivity of breastfeeding amongst mothers. At the end this study will highlight the importance and impact of exclusive breastfeeding.

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
Due to the reduction in the rate of breastfeeding among working mothers in Anaocha and Awka South Local Government Area of Anambra State this study discovered some problems associated with this.
One of such problem is the high level of poverty in the country. Some working mothers have this notion that it is only the rich mothers that can practice EBF; reason being that a mother who is breastfeeding must feed very well. She is expected to feed at least 8 times in a day. Considering the economic situation of things, which mother has the food in her kitchen to feed up to such number of times?
In addition to the aforementioned point, in many homes in Nigeria, some mothers are the bread winners in their homes. This makes them go out to hustle for money; thereby not having the needed time for to breast feed their babies.
Another problem of this study is the fact that some cultural beliefs in Nigeria kick against Exclusive Breast Feeding. A good example is the Yoruba culture which so much belief it is unnecessary to feed a child with just breast milk.
Also, the problem of poor sensitization of nursing mothers on the nitty-gritty of Exclusive Breast Feeding poses a challenge, as some nursing mothers have various negative feelings about Exclusive Breast Feeding. This is common to nursing mothers who live in the rural parts of the country.
These are some of the problems observed could affect the attitude and perception of working mothers in Anaocha and Awka South Local Government Area of Anambra State towards Exclusive Breast Feeding.

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 do working mothers in Anaocha and Awka South Local Government Area of Anambra State had concerning exclusive breastfeeding?
2. What were the attitudes working mothers of Anaocha and Awka South Local Government Area of Anambra State 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 mothers 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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