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TITLE PAGE

KNOWLEDGE, ATTITUDE AND PRACTICE OF EXCLUSIVE BREASTFEEDING AMONG FEMALE BANKERS IN ABAKALIKI METROPOLIS

BY

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

DECEMBER,2018

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APPROVAL PAGE

This is to certify that the research work, "knowledge, attitude and practice of exclusive breastfeeding among female bankers in abakaliki metropolis" by ---, Reg. No. ---/H2007/01430 submitted in partial fulfillment of the requirement award of a Higher National Diploma on --- has been approved.

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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

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.
My warmest gratitude goes to my parents for their moral, spiritual and financial support throughout my study in this institution.
My appreciation goes to some of my lecturers among whom are Mr. ---, and Dr. ---. I also recognize the support of some of the staff of --- among whom are: The General Manager, Deputy General manager, the internal Auditor Mr. --- and the ---. Finally, my appreciation goes to my elder sister ---, my lovely friends mercy ---, ---, --- and many others who were quite helpful.

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Breastfeeding is a recognized means of ensuring optimal nutrition for the infant. Exclusive breastfeeding is defined as feeding an infant child breast milk only, and for optimal nutrition it is recommended that infants be exclusively breastfed for the first 6 months of life. Without workplace support, exclusive breastfeeding is difficult for working mothers who return to work. The aim of this study was to examine the knowledge, attitude, and support for exclusive breastfeeding among female bank workers in Abakaliki metropolis, Ebonyi state Nigeria. This was a cross-sectional descriptive study. A total of 210 mothers from all banks in Abakaliki metropolis, Ebonyi state were selected using systematic sampling, with a response rate of 95%, so we had 200 respondents. A pretested, structured, self-administered questionnaire adapted from previous studies was used for data collection. The mean age of the respondents in this study was 33 years (range 21- 50 years). Of the 200 respondents 188 (94%) had a good knowledge of exclusive breastfeeding and 173 (86.5%) of them reported that the hospital was their source of information. More than 180 (90%) respondents had a positive attitude towards exclusive breastfeeding. Exclusive breastfeeding was practiced by 112 (56%) of the respondents, however, only 57 (28.5%) practiced exclusive breastfeeding for up to 6 months post delivery. The major source of breastfeeding support came from the baby’s father for 88 (44%) respondents while the least breastfeeding support came from the workplace for three (1.5%) respondents. The duration of maternity leave was mostly 3 months, and less than 20 (10%) respondents reported having support for breastfeeding at the workplace.
In spite of the good knowledge of exclusive breastfeeding among the respondents as well as their positive attitude, the exclusive breastfeeding rate up to 6 months postpartum was very low. This may be related to the inadequate breastfeeding support from the various support systems especially in the workplace, as demonstrated in this survey. There should be advocacy for a government policy for a mandatory 6 month maternity leave for all working mothers.

 

TABLE OF CONTENTS
COVER PAGE
TITLE PAGE
APPROVAL PAGE
DEDICATION
ACKNOWELDGEMENT
ABSTRACT

CHAPTER ONE
1.0          INTRODUCTION

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

CHAPTER TWO
LITERATURE REVIEW

1. THE CONCEPT OF EXCLUSIVE BREASTFEEDING
2. THEORETICAL FRAMEWORK
3. EXCLUSIVE BREASTFEEDING IN DEVELOPED COUNTRIES
4. EXCLUSIVE BREASTFEEDING IN DEVELOPING COUNTRIES
5. EXCLUSIVE BREASTFEEDING IN NIGERIA

CHAPTER THREE
3.0       RESEARCH METHODOLOGY

1. STUDY AREA
2. STUDY POPULATION
3. SAMPLE SIZE
4. SAMPLING METHOD
5. DATA MEASURES
6. DATA ANALYSIS
7. ETHICAL ISSUES

CHAPTER FOUR
4.0       RESULT AND DISCUSSION
4.1       RESULT
4.2       DISCUSSION
CHAPTER FIVE

1. CONCLUSION
2. REFERENCES

 

Abbreviations
EBF: Exclusive breastfeeding
WHO: World Health Organisation

 

CHAPTER ONE
1.0                                                                                 INTRODUCTION
1.1                                                                   BACKGROUND OF THE STUDY
Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts (i.e. via lactation) rather than using infant formula from a baby bottle or other container (Await et al., 2010). Breastfeeding is the ideal method suited for the physiological and psychological needs of an infant. Under modern health care, human breast milk is considered the healthiest form of milk for babies. Breastfeeding has been accepted as the most vital intervention for reducing infant mortality and ensuring optimal growth and development of children (Gupta et al., 2010). The beneficial effects of breastfeeding in the prevention of morbidity and mortality from diarrhoea in infants have been documented. Scientific researches, such as 2012 review for the World Health Organization (WHO), have found numerous benefits of breastfeeding for the infant.
American Academy of Paediatrics (AAP), reported that breast feeding provides advantages with regard to general health, growth and development. It documents diverse and compelling advantages for infants, mothers, families, and society from breastfeeding and use of human milk for infant feeding. These advantages include health, nutritional, immunologic, developmental, psychological, social, economic, and environmental benefits.During breastfeeding, approximately 0.25-0.5 grams per day of secretory immuno-globulin (IgA) antibodies pass to the baby via the milk. Breastfeeding may decrease the risk of cardiovascular disease in later life, as indicated by lower cholesterol and C-reactive protein levels in adult women who had been breastfed as infants (Gupta et al., 2010).
The National Demographic and Health Survey (NDHS) 2013 study in Nigeria showed that while almost 70 % of children 0–23 months are predominantly breastfed (breast milk and only plain water or non-milk liquids such as juice and other liquids), only 17 % (17%) of children under age 6 months are exclusively breastfed [National Population Commission, 2013]. The aforementioned partially explains the high incidence of infant malnutrition and mortality experienced in developing countries which is mainly due to poor infant feeding practices [Ajibuah BJ, 2013].
Exclusive breastfeeding (EBF) is defined as feeding an infant child breast milk only. For optimal nutrition, it is recommended that a child be breastfed exclusively up to 6 months. As a result of rapid changes in the socio-cultural and economic situations worldwide, particularly the rapid urbanization and developing processes going on in developing countries, and the increasingly harsh economic environment, the need for income producing activity of women has increased. The educational and occupational status of the mother is an attribute that help determine the time allocation for women and children [Amosu AM, 2011]. Given the numerous benefits of breastfeeding it is important that employed women understand its importance and are given the required support at every level.
Breastfeeding promotes health for both mother and infant and helps to prevent disease. Longer breastfeeding has also been associated with better mental health through childhood and into adolescence (Oddy et al., 2010). Breastfeeding appears to reduce the risk of extreme obesity in children.
There is lack of data regarding the number of Nigerian women employed within 6 months following birth. The duration of statutory maternity leave for working mothers in Nigeria is only 3 months, and support such as facilities for breast milk pumping and storage in the workplace are not widely available. An unfavourable working environment can make it difficult for mothers to implement and continue exclusive breastfeeding. In recognition of the problems faced by working mothers in practicing exclusive breastfeeding, the World Breastfeeding Week 2015 adopted the theme, “Breastfeeding and work: let’s make it work”, to garner support from all sectors to enable women worldwide to work and breastfeed successfully [WABA, 2016].
There is paucity of data related to support systems for breastfeeding mothers in the workplace in Nigeria. A study among female resident doctors in a tertiary institution in Nigeria found the most important barrier to exclusive breastfeeding of their infants to be return to work (61% of respondents) [Agbo HA, 2013]. A mixed methods study among breastfeeding mothers in Southwest Nigeria identified barriers to breastfeeding to include: perceived hunger after feeding baby (29%), maternal health problems (27%), fear of infant addiction to breast milk (26%), breast pains (25%), pressure from mother-in-law (25%), and return to work/business (24%) [Agunbiade OM, 2012]. A mixed methods study in three Nigerian cities found return to work to be an important barrier to exclusive breastfeeding [Olayemi OD, 2014].
Due to many health benefits of breastfeeding to mothers and children, governments of many nations have set goals for breastfeeding practices and rates.
Exclusive breastfeeding (EBF) means giving infants only breast milk with no addition of other foods or drinks, including water. EBF has dramatically reduced infant deaths in developing countries by reducing diarrhea and infectious diseases. It has also been shown to reduce HIV transmission from mother to child, compared to mix feeding.
National and international guidelines recommend that all infants be breastfed exclusively for the first six months of life. Breastfeeding may continue with the addition of appropriate foods, for two years or more. WHO (2010) recommends EBF for the first six months of life, after which infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues up to two years of age or beyond. AAP states that breast feeding also has economic health benefits because breastfeeding results in reduced health care costs. The significantly lower incidence of illness in the breastfed infant also allows the parents more time for attention to siblings and other family duties and reduces parental absence from work and lost income.
The WHO recommends that national authorities in each country decide which infant feeding practice should be promoted and supported by their maternal and child health services to best avoid HIV infection transmission from mother to child. Breastfeeding with HIV guidelines established by the WHO suggest that HIV-infected mothers (particularly those in resource-poor countries) practice EBF only, rather than mixed breastfeeding practices that involve other dietary supplements or fluids(Moland et al., 2010). However, a recent study conducted by researchers from the University Of North Carolina School Of Medicine suggests that women infected with HIV can, in fact, breastfeed without transmitting the virus to their children, because components in breast milk are understood as able to kill the virus (Wahl et al., 2012).
According to the centre for disease control and prevention (CDC), one of the most highly effective preventive measures a mother can take to protect the health of her infant is to breastfeed. The success rate among mothers who want to breastfeed can be greatly improved through active support from their families, friends, communities, clinicians, health care leaders, employers, and policymakers. Given the importance of breastfeeding for the health and well-being of mothers and children, it is critical that we take action across the country to support breastfeeding.
The aim of this study was to examine the knowledge, attitude, and support for exclusive breastfeeding among female workers in Nigeria.

1.2                                                          STATEMENT OF PROBLEM
Despite the effort and strategies that have been put in a place by WHO and UNICEF to increase awareness of exclusive breastfeeding through baby friendly hospitals initiatives in order to reduce complication associated with artificial feeding like respiratory and gastro intestinal infections. It has been observed by the researchers are still reluctant to practice exclusive breastfeeding due to work factor and environment.
Hence, the question “what is the knowledge and attitude of female bankers towards the attitude of exclusive breast feeding among female bankers in Abakaliki metropolis

1.3                                                                              AIM OF THE STUDY
The main aim of the study is to find out the knowledge, attitude and practice of exclusive breastfeeding breast feeding among female bankers in Abakaliki metropolis

1.4                                                          OBLECTIVES OF THE STUDY

1. To assess the level of knowledge and the practice of exclusive breast feeding among female bankers.
2. To ascertain the attitude of female bankers towards the exclusive breastfeeding.
3. To find out the factors influencing the practice of exclusive breast feeding among female bankers.
4. To ascertain the measures of improving exclusive breast feeding to banking industry.
5. To assess the knowledge of pregnant women on exclusive breastfeeding
6. To assess the attitudes of pregnant women toward exclusive breastfeeding.
7. To ascertain the pattern of exclusive breastfeeding practice among pregnant women.
8. To identify the factors that influences exclusive breastfeeding.

1.5                                                          SIGNIFICANCE OF STUDY
It is hoped that at the end of the study, the result will:

1. Increase the knowledge of pregnant women on exclusive breastfeeding
2. Lead to development of positive attitude among pregnant women toward exclusive breastfeeding.
3. Support optimal mechanisms for improving fathers’ and other familial attitudes regarding exclusive breastfeeding.
4. Help reduce public misperceptions on women’s choices to exclusively breastfeed.
5. Provide more scientific evidence to health care givers in advocating the practice of exclusive breastfeeding.
6. Support effective strategies for improving public awareness regarding the benefits of exclusive breastfeeding.
7. Increase the level of knowledge on the part of nurses on how to solve breastfeeding problems and breastfeeding in special situation.
8. Offer some specific measures to the government on how to enhance and sustain exclusive breastfeeding practice so as to promote child health and reduce child morbidity and mortality as well.
9. Promote further studies on exclusive breastfeeding.
10. Provide clinical data on exclusive breastfeeding and enrich the existing body of knowledge.
11. Help in the realization of Millennium Development Goal number four (“to reduce infant mortality”).

1.6                                          RESEARCH QUESTION

1. What is the level of knowledge of female bankers towards exclusive breast feeding
2. What type of attitude is developed by female bankers towards the practice of exclusive breast feeding
3. What are the factors influencing the effective practice of exclusive breast feeding among female bankers
4. What are the benefits of exclusive breast feeding among female bankers

1.7                                                          SCOPE OF STUDY
Experts agree that breastfeeding is beneficial and have concerns about the effects of artificial formulas. Artificial feeding is associated with more deaths from diarrhea in infants in both developing and developed countries Breastfeeding declined significantly from 1900 to 1960, due to improved sanitation, nutritional technologies, and increasingly negative social attitudes towards the practice. However, from the 1960s onwards, breastfeeding experienced a revival which continues to the 2000s, though some negative attitudes towards the practice still remain. EBF for the first six months of life is estimated to lower infant death by 13%. Other dangers associated with not breastfeeding as recommended include high infant death rates caused by lowered protection against harmful bacteria and other gastrointestinal infections and slow recovery from illnesses.

1.8                                                          LIMITATION OF STUDY

1. Time factor the entire program is time consuming and the project has to be within time frame.
2. Lack of sufficient capital because of the economic situation of the country
3. Despite the favourable response rate, there are important limitations to this survey. Firstly, ten questionnaires were not returned. Although this is a small number it would have been useful to know the characteristics (e.g., age, socio-economic status, etc.) of the non-responders versus the responders so as to ascertain possible reasons for the non-response. Secondly, this was purely a quantitative study with no opportunity for participants to write down comments or express other concerns and not catered for by the questionnaire. Further surveys should include a qualitative assessment and possibly interviews so as to add more information to this field of study. Thirdly, the respondents had a few hours to complete the questionnaires before collection, as opposed to more time if it had been mailed to them or collected some days later. Fourthly, the sample was limited to one group of workers (bankers), therefore results may not be generalizable to all female workers in paid employment in Abakaliki, Ebonyi State, Nigeria. Fifthly, the study population would have had their children at different times such that recall when answering the questionnaire would have been variable.

1.9                                          OPERATIONAL DEFINITION OF TERMS
Knowledge: Clear perception fact or understanding about exclusive breastfeeding.
Attitude: Position as indicating action, feeling or mood towards exclusive breastfeeding
Practice: The way of carrying out or doing exclusive breast feeding.
Exclusive breastfeeding: Feeding of a baby with breast milk only for the first time months of life.
Breast: Mammary gland that secrets milk after giving birth
Artificial milk: Milk synthesized from plant or animals used to feed a baby.
Complementary feeding: Artificial milk given to augment breast milk after 6 months of exclusive feeding.
BFH: Baby friendly hospital initiative
SIDs: Sudden infant death syndrome

 

CHAPTER TWO
2.0  REVIEW OF RELATED LITERATURES
This chapter contain review of current and past research findings that are relevant to phenomenon under study.

2.1 THE CONCEPT OF EXCLUSIVE BREASTFEEDING
Breast milk is the only food fully adapted to the physiology of human infants (WHO, 2010) and considers the best food for the infant because it contains all the nutrients in the correct proportions. It has the correct temperature, is easily digested and assimilated, readily produced and available (Frazer & Cooper, 2012). AAP defined exclusive breastfeeding as an infant's consumption of human milk with no supplementation of any type (no water, no juice, no non-human milk, and no foods) except for…

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