The Associated Factors Hampering Mothers towards Exclusive Breastfeeding EBF through Knowledge, Attitude and Practice (KAP) Studies at Al-Sabah Children Hospital /Juba -South Sudan
R Poni Gore*, Felix Tombe Lomeling, Awad Hussein
Kareialla, Wani Bosco Fabiano, Chol Mabil D Ajang, Wahib Natale Daniel, John
Mawich Nangdor, Joshua Jockjio Thor M, Ruai Mut Koang
Department of Community Medicine,
University of Juba, South Sudan
*Corresponding author: Gore RP, Department of Community Medicine,
University of Juba, South Sudan. Tel: +211955511872; Email: roseponi196@gmail.com
Received Date: 09 June, 2017; Accepted Date: 27 June, 2017; Published Date: 04 July, 2017
Abstract
Introduction: Exclusive breastfeeding EBF is the feeding of an infant
entirely with breast milk (i.e. via lactation). EBF is an important public
health strategy for improving infant and child morbidity and mortality
indicators, The World Health Organization (WHO) &(UNICEF) recommend
exclusively breastfeeding for the first 6months of life, EBF, improves the
growth, and survival status of newborns and is best forms of prevention.
Goals: To assess the related factors hindering mother’s
knowledge, attitude and practices towards exclusive breast feeding of infants
in Juba.
Methodology
Study Design & Area: A questionnaire-based qualitative study was
conducted on a group of 123 nursing mothers from December 2013 to 30th June
2014 to evaluate knowledge attitude and practices towards EBF; The sample size
was selected randomly at AL-Sabah Hospital.
Results: Age range
54.5% of age 16-25yrs, 40.7% of 26-35yrs and finally 4% were
36-45yrs. Educational level; 38.2% basic, 19.5% secondary, 7.3% university,35%
illiterate, (tot literate 65%).Social status; 2.4% were single mothers, 92.7%
were married, 4.1% divorced/ separated and 0.8% widow. Income; 8.1%
self-employed, 12.2% employed both in private and public sector, 79.7%
unemployed. Residence area; 22.0% of mothers from Juba, 26.0% from Kator, 43.2%
from Munuki, and 9.7% from Rajaf Religion background, 93.5% Christians, 5.7%
Muslims and 0.8% no credo, bear chronic illness; 8.1% had chronic illness,
91.9% absent of chronic (medical report). ANC attendance; 77.2% regularly
attended, 11.4% irregularly, 10.6% never been to ANC, and 0.8% do not know ANC,
with house hold dependants; 16.3% had other infants, 19.5% had children of>2
years at t home, 21.1% had adults>60 years old and 43.1% had no departments.
Breastfeeding practice: 96.7% practicing breastfeeding only 3.3% not practicing
breastfeeding.
The frequency during day: 59.3%were breastfed 8 times or more,
11.8% breastfed less than 8 times, 26.0% not sure and 3.3% not breastfed. Start
of breastfeeding: 66.2% immediately after birth, 20.3% within hours, 13.8%
within days and 3.3% not breastfeeding, knowledge about duration of EBF; 17.1%
first 3 months, 67.5% first 6 months,8.1% up-to 2yrs and 7.3%
don`t know, Attitude to practice EBF; 85.4% Agree to EBF, 8.1% uncertain
and 6.5% disagree, complementary foods: 22.8% of infants introduced to
complementary food before 4 months, 37.4% between 4-6 months, 30.9%
after 6months and 8.9% do not know, while 35 % exclusively will breastfeed,
14.7% were given juice & water, 4.9% were given soup , 45.5% were given
others foods. interference breastfeeding with work productivity and payment :
27.6% of the women agree that time spent breastfeeding at work should not be
paid but 73.4% disagree with not paying the time the mother spent breastfeeding
at work place, Breastfeeding in public places: 52.8% agree when baby is hungry,
8.1% uncertain and 39.0% disagree, Knowledge about immune system of breastfed
infant: 97.6% are aware that immune system of breastfed infant is stronger than
formula-fed infant, only 2.4% do not know.
Conclusions & Recommendations
Breastfeeding mothers are faced with multiple challenges to
practice exclusive breastfeeding. Thus, scaling up of EBF among mothers
requires concerted effort at all levels of South Sudanese Society. The
promotion and acceptance of the EBF is vital in high level of poverty, Civil
War, disease burden and low access to clean water and luck of adequate
sanitation. The accessibility of Ante Natal Clinic ANC, training of Healthcare
workers and counseling mothers are crucial, also the adoption and
implementation of the WHO/UNICEF Global strategy for Infants and Young Child
Feeding (IYCF) at all healthcare levels in the States of the Republic of South
Sudan is paramount.
Keywords: Al-Sabah Children Hospital; Civil War; Complementary Food;
Exclusive Breast feeding EBF; Illiteracy; Lactating Mothers; The World Health
Organization (WHO); United Nations Children’s Fund (UNICEF)
1. Introduction and Literature Review
Exclusive Breastfeeding EBF is the feeding of an infant or young
child with breast milk directly from the mother’s breast (i.e. via lactation)
rather than using infant formula. It is an important public health strategy for
improving infant and child morbidity and mortality, as well as maternal
morbidity and helping to control health care costs [1] with the exception of
oral rehydration solution, drops or syrups consisting of vitamins, minerals
supplements or medicine. Historically, abandonment of breastfeeding began in
higher socioeconomic level followed by a decrease in lower socioeconomic
levels. As the trend was reversed, women in the upper socioeconomic levels were
the first to show an increased incidence of breast feeding followed by
progression down class line. A significant boost to breastfeeding came from the
American Academy of Pediatrics (AAP), which in 1978 recommended that all
Physicians encourage mothers to breast their babies. The World Health
Organization (WHO) and United Nations Children’s Fund (UNICEF) recommend that
every infant should be exclusively breastfed for the first six months of life,
with breastfeeding continuing for up to two years of age or longer. Exclusive
Breastfeeding (EBF) for the first 6 months of life improves the growth, health
and survival status of newborns [2]. And EBF is one of the most natural and
best forms of preventive medicine. EBF plays a pivotal role in determining the
optimal health and development of infants, and is associated with a decreased
risk for many early life diseases and conditions, including otitis media,
respiratory tract infection, Diarrhea and early childhood obesity [3].
It is estimated that sub-optimal breastfeeding, especially
non-exclusive breastfeeding in the first 6 months of life, results in 1.4
million deaths and 10% of the disease burden in children younger than 5 years
of age [4]. EBF reduces infant mortality rates by up to 13% in low-income
countries [5]. Some African countries like Nigeria and Ghana have established
the Baby-Friendly Hospital Initiative (BFHI) with the aim of providing mothers
and their infants a supportive environment for breastfeeding and to promote
appropriate breastfeeding practices, thus helping to reduce infant morbidity
and mortality rates [6].
Numerous variables may influence breastfeeding such as race,
politics, maternal age, maternal employment, level of education of parents,
socio-economic status, insufficient milk supply, infant health problems,
maternal obesity, smoking, parity, method of delivery, maternal interest and
other related factors, Some researchers have proposed that lack of suitable
facilities outside of the home, inconveniences; conflicts at work, family
pressure and ignorance adversely affect the willingness of women to practice
EBF [7]. The need to return to work has also been implicated as a factor
interfering with EBF [8]. In late 1900s Breastfeeding was discovered to have
unrecognized emotional and health benefits for baby and mothers [9] also
contains all the nutrients that an infant need in the first 6 months of life,
including fat, carbohydrates, proteins, vitamins, minerals and water [10,11].
It is easily digested and efficiently used. Breast milk also contains bioactive
factors that augment the infant’s immature immune system, providing protection
against infection, and other factors that help digestion and absorption of
nutrients. Powdered infant formula it may be unsafe in other ways. Life
threatening infections in newborns have been traced to contamination with pathogenic
bacteria, such as Enterobacteria sakazakii, found in powdered
formula [12]. Soy formula contains phyto-oestrogens, with activity
similar to the human hormone Oestrogen, which could potentially reduce
fertility in boys and bring early puberty in girls when the oxytocin reflex is
active, therefor breastfeeding helps prevent growth faltering and stunting,
particularly as it reduces the risk of illnesses [13]. Breastfeeding protects
against weight loss due to diarrhea, and in some studies children exclusively
breastfed were shown to be less likely to be stunted [14]. Due to its large
impact on reduction of infectious diseases, breastfeeding plays a role in
reduction of stunting, as infectious diseases are important determinants of
stunting. However, breastfed children will still become stunted if they do not
receive an adequate quantity and quality of complementary foods from the age of
six months onwards [15]. A more detailed understanding of the attitude of
mothers to EBF and their knowledge of the importance of breastfeeding in South
Sudan is needed to develop effective interventions to improve the rates of EBF
and thus reduce infant mortality rate that is the highest in the World.
1.1 Scope of the problem
Data suggest that infant mortality in developing countries is
5-10 times higher among children who have not been breastfed or who have been
breastfed for less than six months. It is estimated that some optimal
breastfeeding especially non-exclusive breastfeeding in the first six months of
live results in 1.4 Million deaths and 10% of disease burden in children
younger than five years [16]. The Global Strategy for Infant and Young Child
Feeding, according to WHO, two-thirds of under-five deaths that occur in
infancy are mostly related to poor feeding practices. Globally, less than
40% of infants under six months of age are exclusively breastfed, despite the
well documented benefits of breastfeeding [17]. In developing countries only
38% of infants aged less than six months are exclusively breastfed [18]. According
to the 2010 Sudan household survey only 45% of the babies in Southern Sudan are
exclusively breastfed for the first six months of life. On a press report
released by UNCIEF on the breastfeeding week, 1-7, August 2013, they
said most mothers in South Sudan do not breastfeed their children exclusively
because of inadequate information on the importance of early initiation and
EBF, inadequate support from families and communities, lack of counseling to
new mothers on breastfeeding and heavy workload that keeps them away from their
children for long hours [19].
1.2 Statement of the problem
One of the biggest threats to infant feeding is complacency.
With competing priorities, disease specific funding, and interest in
technologies, campaigns and products, the attention breastfeeding receives is
very small, given the magnitude of the problem and the potential impact.
Working mothers are kept away from their children by the schedules of their
long working hours and hence have limited time to nurture their babies properly
aggravate poor attitude towards breastfeeding. Breastfeeding has economic
benefits, is also the least expensive. For many poor households, the high cost
of breast milk substitutes, feeding and sterilizing equipment, fuel, represents
a drain on scarce household resources. Plus, cost of health care for the sick
infant.
1.3 Justification for the Study
The study is being conducted to encourage and influence the
attitude of EBF practices which count on awareness on importance of EBF,
breast milk is the adequate ‘baby food’ that contains sufficient nutritional
contents necessary for the growing of healthy babies, non-practice of EBF
complicate the healthy growth of infants.
Goal: To ensure that every mother in South Sudan value the
importance of EBF for the optimal growth, survival and development of healthy
infants.
General Objective: To assess the related factors hindering mother’s
knowledge, attitude and practices towards exclusive breastfeeding of infants in
Juba.
1.4 Specific Aims:
· To
determine the prevalence of EBF in Juba / South Sudan.
· To
evaluate pattern of Exclusive Breastfeeding (EBF) among lactating mothers
attending Al-Sabah Children Hospital.
· To
compare exclusive breastfeeding between working and non-working mothers.
· To
identify the major problems hindering EBF among the study group.
· To
identify the relationship between the age of mother and the attitude to
breastfeeding of infants.
1.5 Research hypothesis
· Educated
mothers tend to exclusively breastfeed their infants more than the uneducated
mothers.
· Mothers
who attend ANC are more likely to exclusively breastfeed compared to those who
do not attend.
· Elderly
Mothers exclusively breastfeed Infants more than young breastfeeding mothers in
Juba.
2. Methodology
2.1 Study design and data collection
A questionnaire-based qualitative study was conducted on a group
of 123 nursing mothers from December 2013 to 30th June 2014 to elicit
information about knowledge attitude and practice towards EBF by using a
properly designed questionnaire given to Breastfeeding mothers at Al-Sabah
children Hospital in Juba.
2.2 Study Area
Al-Sabbah Children Hospital was established in 1983-1984 through
the support of Kuwait government to the people of Southern Region (former
Sudan). It is located opposite All Saints Cathedral on the way from Juba
Teaching Hospital on the right side after Mobil roundabout. The Hospital was
under the administration of the Islamic Organization until 2005, when the
management was handed over to Central Equatoria Government (CEG). The hospital
is made up of five departments with five medical officers. It daily receives
100-150 outpatients at the Clinic because it is the only Children
Hospital in Juba County and has inpatient capacity of one hundred (100) mbeds
only.
2.3 Population, Sample size and Sampling
technique
The sample size was one hundred and twenty-three (123)
participants selected randomly from the population of breastfeeding mothers
attending clinics at the Hospital. These mothers come from different Payams
(Districts) of Juba County.
2.4 The Duration of Study
December 2013 to 30th June 2014.
Questionnaire design: The questionnaire consisted primarily of closed and open
ended questions format and multiple responses for ease of completion and
analysis. A structured questionnaire was self-administered by literate mothers
and interviewer-administered for those who were illiterate. The resulting
questionnaire consisted of 25 questions, categorized on two sections:
· Background information on the
mother’s demography that includes age, Education, marital status, occupation,
residence, Religion, chronic illness, ANC visits.
· Background of the child which
includes sex, date of birth (age), other children<2years and elderly people
at home, whether mothers breastfeeds or not and why not? commencement of other
foods, breastfeeding initiation, duration of EBF, attitude on EBF sum of time
spent on breastfeeding and breastfeeding interference with work productivity,
breastfeeding in public places, and immunity.
The subjects: The sample of the nursing mothers’ population consisting of
mothers aged 16 to above 45 years who were nursing their infants six months and
below participated in the study.
2.5 Inclusion and Exclusion Criteria
· Inclusion
criteria; mothers who have already delivered their baby and the child is
between 0-6 month of age were considered in this study.
· Exclusion
Criteria: Pregnant mothers or mothers with children who are above six months of
age.
2.6 Data Analysis
The questionnaire responses were collected and analyzed using
Statistical Package for Social Scientist (SPSS) version 16.0. Chi-square tests
were used to evaluate relationship between different selected variables (e.g.
find association between level of education and EBF, Age of mother and attitude
to EBF). The critical value for significance was set at P<0.05 for all
analyses. The findings were presented in tables and pie charts.
2.7 Ethical Considerations
Researchers were granted approval by the University of Juba,
Department of Community Medicine, and prior consents were obtained from the
Hospital Chief Executive Officer (CEO) and all participants who took part in
the study.
3. Results
According to the study, 54.5% of breastfeeding mothers were in
the age range 16-25, 40.7% of the mothers were of age range 26-35yrs
and finally 4% were in the range 36-45yrs as shown in the (Table 1).
Based on the educational level 38.2% attended basic education,
19.5% attended secondary, 7.3% attended university and 35% never attend any
formal education in average 65% of the breastfeeding mothers attended formal
education (Table 2).
The study shows that 2.4% were single mothers, 92.7% were
married, 4.1% divorced/ separated and only 0.8%widower. (Table 3).
Exploring the income of the study group, the study reveals that
8.1% were self-employed, 12.2% employed both in private and public sector,
79.7% were unemployed (Table 4).
According to the study 22.0% of the mothers were from Juba
Payam, 26.0% were from Kator Payam, 43.2% were from Munuki Payam, and 9.7% were
from Rajaf Payam (Table 5).
In context of the religion, majority about 93.5% were Christian,
5.7% were Muslim and 0.8% were non religious (Table 6).
In regards to ANC visits it shows that 77.2% regularly attended,
11.4% irregularly attended, 10.6% of no ANC attended, and 0.8% do not know
(Table 8).
The target groups of infants in the study were of age ranging
1day-6months. The study shows that majority about 35.8% infants were
born in Dec 2013, from June 2014 the percentage was 64.2% (Table 10).
Immunization status of the infant; the finding reveal that,
majority 80.5% were immunized with 19.5% of the infant not given any vaccine
(Table 11).
Having dependent or other people at the home; it was found that
16.3% had other infants at their homes, 19.5% of the respondents had children
of less than two years of age at their home, 21.1% had adults greater than
sixty years old and 43.1% had no any other departments in their homes (Table
12).
3.1 Breastfeeding Practice
A high level of Breastfeeding practice exists in the study group
with 96.7% breastfeeding according to respondents; only 3.3% of the women were
not practicing breastfeeding (Table 13).
For those who were breastfeeding, 59.3%were breastfed 8 times or
more. 11.8% breastfed less than 8 times, 26.0% do not know the number of times
they breastfeed their infant and 3.3% were not breastfeed (Table 14).
3.2 Reasons for not Breastfeeding
The following were the reasons given by the mothers of the 3.3%
of infants who were not breastfeed; abandonment by the mother (0.8%), breast
lump(swelling)0.8%, no enough milk (0.8%), and oral candidiasis (0.8%) (Table
15).
According to our finding 30.1% of the infants were breastfed
2-10 times, 15.4% were breastfed 11-20 times, 51.2% do not know the number of
times their infant breastfed and finally 3.3% were not breastfed completely
(Table 16).
3.3 Initiation of Complementary Foods
In 22.8% of the infants their mothers introduced complementary
food before four months, 37.4% between four and six months, 30.9% after six
months and 8.9% do not know when to start giving complementary food (Table 17).
3.4 Exclusive Breastfeeding Practices
35 % exclusively breastfed, 14.7% were given juice and water,
4.9% were given soup and 45.5% were given others foods. (Table 18).
3.5 Start of Breastfeeding
The knowledge of mothers about the initiation time for
breastfeeding was tested and the responses were as follows; 66.2% immediately
after birth, 20.3% within hours, 13.8% within days and 3.3% do not know the
time for initiation of breastfeeding (Table 19).
3.6 Duration of EBF
Responses to the participants’ knowledge were 17.1% first three
months, 67.5% first six months, 8.1% up-to two years and 7.3% do not know for
how long the exclusivity of breastfeeding should be practiced (Table 20).
3.7 Attitude of Respondent to EBF
Agree 85.4% to EBF, 8.1% were uncertain and 6.5% disagree with
exclusive breastfeeding (Table 21).
Time spent breastfeeding and its interference with work
productivity: 27.6% of the women agree that time spent breastfeeding at
work should not be paid but 73.4% disagree with not paying the time the mother
spent breastfeeding at work place (Table 22).
3.8 Whether Breastfeeding interferes with
work Productivity
44.7% of the women consented that breastfeeding or expressing
breast milk at work will interfere with work productivity while 55.3% said this
practice does not interfere with work productivity at all (Table 23).
Breastfeeding in public places: 65% of the mothers agree
that the baby can be fed anywhere whenever it feels hungry, 8.1% were uncertain
and 39.0% disagree with breastfeeding their baby in public places (Table 24).
Knowledge about immunity when breastfeeding infant: 97.6% of the
mothers have the knowledge that the immune system of breastfed infant is
stronger than formula-fed infant, only 2.4% do not know about this important
fact (Table 25).
Education correlation with exclusive Breastfeeding: Basic
15.4%, Secondary 6.5%, University 3.3% exclusively breastfed and 9.8% of the
non-educated mothers exclusively breastfed (Table 26).
Antenatal Care (ANC) correlation with exclusive breastfeeding:
Regularly attended 25.2%, irregularly attended 6.5%, No ANC attended 2.4%, and
0.8% of the mothers who do not know ANC exclusively breastfed (Table 27).
Age Correlation with exclusive breastfeeding: According to the
findings 17.9% of the age group 16-25 exclusively breastfed their infants,
16.3% of the age group 26-35, 0.8% of the age group 36-45 exclusively
breastfed their infants and there were no respondent in the age group above 45
(Table 28).
4. Discussion
This study aimed to determine the prevalence of exclusive
breastfeeding, knowledge, and attitude and associated factors affecting it.
Ninety-seven percent of the mothers were practicing breastfeeding with only
three percent who had not breastfed because of breast swelling, oral
Candidiasis, scars breast milk and abandonment by the mother. This study
revealed that the prevalence of exclusive breastfeeding practice for infant in
their first six months of life was thirty- five percent (35%), this finding is
lower than the 2010 Sudan household survey which found out that forty-five
percent of the babies in Southern Sudan were exclusively breastfed [19]. Our
finding is much higher than in Lebanon (10%), almost equal to Bangladesh (36%)
and lower than the exclusive breastfeeding prevalence in Ethiopia (49%)
(51,52). This decline in the trend of exclusive breastfeeding blamed is on the
mothers not adhering strictly to the World Health Organization recommendation
of EBF for the first six months. In addition to socio-cultural practices of
early introduction of water, infant formula, soup, porridge and others before
six months of age.
This is confounded by misleading advertisement of formula milk
in the market which might have contributed negatively to exclusive
breastfeeding. Although 67.5% of the participants had adequate knowledge on the
definition of EBF, the practice was relatively lower (35.0%) compared to the
WHO recommendations for exclusive breastfeeding in developing countries. The
average knowledge of the respondents about exclusive breastfeeding is about
seventy-six (76%).Our study participants highly valued the immune benefits of
breastfeeding 97.6%. It was found out that majority of the respondents had
positive attitude towards exclusive breastfeeding (85.4%) but only 33.4% of
them exclusively breastfed.
We found that those participants who were mixed or formula feeding
were more likely to have negative attitudes towards breastfeeding (13.6%),
including thinking that breastfeeding was embarrassing and difficult in public
Places (39%), it may be difficult if someone else feeds/cares for the child,
and physically painful and uncomfortable and were likely to be influenced by
the negative attitudes of family members or friends. Other studies that have
evaluated the relationship between attitudes towards breastfeeding and
breastfeeding intention have found that partner or friend/family support is
important as is confidence or prior experience and fear of pain in deciding not
to breastfeed. Mothers between the ages group 16-25 years showed the
highest percentage (17.9%) of exclusive breastfeeding in this study which was
significantly (p<0.05) different from mothers in the age group 26-35 years (16.3%)
and age group 35-45 (0.8 %). This finding disapproved our third research
hypothesis “elderly mothers were more likely to exclusively breastfeed compared
to young mothers, this may be attributed to higher frequency registered in this
age group, in addition to good advices given by grandmothers who are perceived
to be key decision makers when it comes to good parenting. Maternal literacy
(25.2%) was observed to favor exclusive breastfeeding significantly (p<0.05)
was compare to illiterate mothers (9.8%). This may be due to their
understanding of the health implication of exclusive breastfeeding on infant’s
health. This is in the support of the finding in Job, Plateau state Nigeria
[20].
Our finding is contrary to the result obtained from Ethiopian
demographic health survey, which indicated a declining trend of exclusive
breastfeeding with the higher maternal education status [21]. This study has
indicated a significant difference among employed mothers (6.5%) with
unemployed mothers (28.5%) with regard to exclusive breastfeeding. It also
revealed that unemployment is a predication of exclusive breastfeeding which is
consistent with the finding of the case study done in Wad Medani Sudan [22].
This might be explaining by the fact of less maternity leave (two month after
delivery in our context), which makes employed mothers to have less opportunity
to stay at home, compromising exclusive breastfeeding. Mothers also may have to
leave their babies to search for a job. These finding calls for course of
action to initiate breastfeeding friendly working environment, as well as the
extension of maternity leave to encourage mothers to exclusively breastfeed
their babies to improve child health outcome.
Our study shows that the religion of mothers exclusively
breastfeeds, with the majority about 93.5% were Christian, 5.7% were Muslim and
0.8% were not practicing specific Creed, this need farther investigation how
the Religion may affect EBF? This current study showed that mothers who do not
have chronic illness constitutes (91.9%) out of which a third (32.5%)
exclusively breastfed compared to 8.1% of those mothers who had chronic
illnesses, and thy undergoing decline of breast milk production due to the
stress of illness and might be due to medical advice causing them to opt for
mixed feeding. The current study showed that the Attendance of Antenatal Care
(ANC) clinic (88.6%) enhanced mothers’ knowledge and appreciation of the
demands and benefits of exclusive breastfeeding, and empowers them to resist
external interferences and pressures. Out of the above percent about a third
(31.7%) exclusively breastfed, this could be due to the health Education about
exclusive breastfeeding they received on their ANC visits. Though majority of
the mothers attended ANC at least eight percent of them did not had their
infants immunized. According to our finding as the age of the infant approached
six months, the rate of exclusive breastfeeding decreased significantly, which
is similar to other studies done in Uganda, Sudan and Ethiopia [21-23].
This might be due to the fact that postpartum care is traditionally given in
the first few months after birth where mothers remain at home, creating a
chance to exclusively breastfeed their infants. The other possible reason is
that the mother might have introduced complementary feeds for their infant’s
due to the assumption that breast milk alone could not satisfy their needs as
the infant gets older. as the age of the child increases the rate of exclusive
breastfeeding decreases as explained by the short birth interval since some
mothers had other children of less than two years at home. There was an
association between presence of other dependents (elders and toddlers) at home
and exclusive breastfeeding, mothers not having other dependents (15.4%) have
higher rate of exclusive breastfeeding compared to those who had other
dependents (13.8%); This could be due to competition for the available
resources at home, overworking of the mothers leading to reduced breast milk
production as a result complementary foods are introduced early.
4.1 Strengths and Limitations
The use of validated questionnaires, quantitative method of data
collection is the strengths of this study. However, the 24-hour recall
determining exclusive breastfeeding practice means some infants who were given
other liquids regularly may not have received them in the last 24 hours before
the interview, which may cause overestimation of the proportion exclusively breastfed.
Similarly, Children who have not been receiving other fluids regularly but had
been given liquid in the past 24-hour recall method can underestimate
the actual EBF rate in the population studied.
Several authors have questioned the validity of the 24-hour
recall method [23]. The major criticism of the 24-hour recall method is
that it misclassifies too many mothers as exclusively breastfeeding; a
proportion of mothers may be providing substances other than breast milk on an
irregular, not daily, basis. Many studies have shown that a large proportion of
infants who were exclusively breastfed in the previous 24-hours were
either not exclusively breastfed during the previous seven days, and/or, not
exclusively breastfed since birth [23]. Median duration can also be affected by
maternal recall, which might be prone to recall and social desirability bias.
Therefore, readers are recommended to take this into account during
interpretation of these findings. In addition, there are also some variables
that were not significantly associated (however known in several studies) with
the outcome of interest which might affect the precision. This might be due to
the sample size, which might not be adequate to justify the relationships
between the explanatory variables and outcome of interest. Therefore, any
interpretation of this finding should take into account.
5. Conclusions & Recommendations
Based on the findings, breastfeeding mothers are faced with
multiple challenges as they struggle to practice exclusive breastfeeding. Thus,
scaling up of EBF among mothers requires concerted efforts and adequate support
at the all levels of South Sudanese Society. The promotion and acceptance
of the practice is important in South Sudan where there is high level of poverty,
disease burden and low access to clean water and good sanitation. The
importance of availability and accessibility of Ante Natal Clinic ANC, training
of Healthcare workers and counseling mothers are crucial, also targeting
influential members of the family for proper EBF practices and the adoption and
implementation of the WHO/UNICEF Global strategy for infants and young child
feeding (IYCF) at all healthcare levels in the States of the Republic of South
Sudan is paramount to promote the growth, survival and health of infants.
|
Frequency |
Percent |
Valid Percent |
Cumulative
Percent |
16-25 |
67 |
54.5 |
54.5 |
54.5 |
26-35 |
50 |
40.7 |
40.7 |
95.1 |
36-45 |
6 |
4.9 |
4.9 |
100.0 |
Total |
123 |
100.0 |
100.0 |
|
|
Frequency |
Percent |
Valid Percent |
Cumulative Percent |
Basic |
47 |
38.2 |
38.2 |
38.2 |
Secondary |
24 |
19.5 |
19.5 |
57.7 |
University |
9 |
7.3 |
7.3 |
65.0 |
None |
43 |
35.0 |
35.0 |
100.0 |
Total |
123 |
100.0 |
100.0 |
|
Table 2: Education level of breastfeeding mothers in Juba from Dec 2013-Jun 2014.
|
Frequency |
Percent |
Valid Percent |
Cumulative Percent |
Single |
3 |
2.4 |
2.4 |
2.4 |
Married |
114 |
92.7 |
92.7 |
95.1 |
Divorced/Separated |
5 |
4.1 |
4.1 |
99.2 |
Widowed |
1 |
0.8 |
0.8 |
100 |
Total |
123 |
100 |
100 |
|
|
Frequency |
Percent |
Valid Percent |
Cumulative Percent |
Self-employed |
10 |
8.1 |
8.1 |
8.1 |
Private Sector |
5 |
4.1 |
4.1 |
12.2 |
Public Sector |
10 |
8.1 |
8.1 |
20.3 |
None |
98 |
79.7 |
79.7 |
100.0 |
Total |
123 |
100.0 |
100.0 |
|
Table 4: Occupation of nursing mothers in Juba from Dec 2013-Jun 2014.
Payam |
Frequency |
Percent |
Valid Percent |
Cumulative Percent |
Juba |
27 |
22.0 |
22.0 |
22.0 |
Kator |
32 |
26.0 |
26.0 |
48.0 |
Munuki |
52 |
42.3 |
42.3 |
90.3 |
Rajaf |
12 |
9.7 |
9.7 |
100.0 |
Total |
123 |
100.0 |
100.0 |
|
Table 5: Residence of mothers in Juba city from Dec 2013-Jun 2014.
|
Frequency |
Percent |
Valid Percent |
Cumulative Percent |
Christianity |
115 |
93.5 |
93.5 |
93.5 |
Islam |
7 |
5.7 |
5.7 |
99.2 |
None |
1 |
.8 |
.8 |
100.0 |
Total |
123 |
100.0 |
100.0 |
|
Table 6: Religion of nursing mothers in Juba from Dec 2013-Jun 2014.
|
Frequency |
Percent |
Valid Percent |
Cumulative Percent |
Yes |
10 |
8.1 |
8.1 |
8.1 |
No |
113 |
91.9 |
91.9 |
100.0 |
Total |
123 |
100.0 |
100.0 |
|
Table 7: Cases of Chronic Illness among breastfeeding mothers in Juba from Dec 2013- Jun 2014.
|
Frequency |
Percent |
Valid Percent |
Cumulative Percent |
Regularly Attended |
95 |
77.2 |
77.2 |
77.2 |
Irregularly Attended |
14 |
11.4 |
11.4 |
88.6 |
No ANC Attended |
13 |
10.6 |
10.6 |
99.2 |
Do not Know |
1 |
.8 |
.8 |
100.0 |
Total |
123 |
100.0 |
100.0 |
|
Table 8: Responses of breastfeeding mothers to ANC Visits in Juba from Dec 2013- Jun 2014.
|
Frequency |
Percent |
Valid Percent |
Cumulative Percent |
Male |
63 |
51.2 |
51.2 |
51.2 |
Female |
60 |
48.8 |
48.8 |
100.0 |
Total |
123 |
100.0 |
100.0 |
|
Table 9: Sex of breastfed infants at Al-Sabah Hospital in Juba from Dec 2013-Jun 2014.
|
Frequency
|
Percent |
Valid Percent |
Cumulative Percent |
Jun |
1 |
.8 |
.8 |
.8 |
May |
15 |
12.2 |
12.2 |
13.0 |
Apr |
13 |
10.6 |
10.6 |
23.6 |
Mar |
12 |
9.8 |
9.8 |
33.3 |
Feb |
13 |
10.6 |
10.6 |
43.9 |
Jan |
25 |
20.3 |
20.3 |
64.2 |
Dec |
44 |
35.8 |
35.8 |
100.0 |
Total |
123 |
100.0 |
100.0 |
|
Table 10: Month of Birth(age)of infants in Juba from Dec 2013-Jun 2014.
|
Frequency |
Percent |
Valid Percent |
Cumulative Percent |
no |
24 |
19.5 |
19.5 |
19.5 |
yes |
99 |
80.5 |
80.5 |
100.0 |
Total |
123 |
100.0 |
100.0 |
|
Table 11: Possession of Immunization Card by infants in Juba from Dec 2013-Jun 2014.
|
Frequency |
Percent |
Valid Percent |
Cumulative Percent |
Infants |
20 |
16.3 |
16.3 |
16.3 |
Children<2yrs |
24 |
19.5 |
19.5 |
35.8 |
Adults>60yrs |
26 |
21.1 |
21.1 |
56.9 |
None |
53 |
43.1 |
43.1 |
100.0 |
Total |
123 |
100.0 |
100.0 |
|
Table 12: Other Dependents in the house of nursing mothers in Juba from Dec 2013-Jun 2014.
|
Frequency |
Percent |
Valid Percent |
Cumulative Percent |
no |
5 |
4.1 |
4.1 |
4.1 |
yes |
118 |
95.9 |
95.9 |
100.0 |
Total |
123 |
100.0 |
100.0 |
|
Table 13: Breastfeeding Infants (Yes/No) in Juba from Dec 2013-Jun 2014
|
Frequency |
Percent |
Valid Percent |
Cumulative Percent |
no |
5 |
4.1 |
4.1 |
4.1 |
yes |
118 |
95.9 |
95.9 |
100.0 |
Total |
123 |
100.0 |
100.0 |
|
Table 14: Breastfeeding Infants (Yes/No) in Juba from Dec 2013-Jun 2014.
|
Frequency |
Percent |
Valid Percent |
Cumulative Percent |
Breastfeeding |
119 |
96.7 |
96.7 |
96.7 |
Abandon by mother |
1 |
.8 |
.8 |
97.6 |
Breast lump |
1 |
.8 |
.8 |
98.4 |
No enough BM |
1 |
.8 |
.8 |
99.2 |
Oral candidacies |
1 |
.8 |
.8 |
100.0 |
Total |
123 |
100.0 |
100.0 |
|
Table 15: Reasons for not breastfeeding infant in Juba from Dec 2013-Jun 2014.
|
Frequency |
Percent |
Valid Percent |
Cumulative Percent |
Before 4 months |
28 |
22.8 |
22.8 |
22.8 |
Between 4 & 6 months |
46 |
37.4 |
37.4 |
60.2 |
After 6 months |
38 |
30.9 |
30.9 |
91.1 |
Don't know |
11 |
8.9 |
8.9 |
100.0 |
Total |
123 |
100.0 |
100.0 |
|
Table 16: Initiation of complementary foods to Infants in Juba from Dec 2013-June 2014.
|
Frequency |
Percent |
Valid Percent |
Cumulative Percent |
Before 4 months |
28 |
22.8 |
22.8 |
22.8 |
Between 4 & 6 months |
46 |
37.4 |
37.4 |
60.2 |
After 6 months |
38 |
30.9 |
30.9 |
91.1 |
Don't know |
11 |
8.9 |
8.9 |
100.0 |
Total |
123 |
100.0 |
100.0 |
|
Table 17: Initiation of complementary foods to Infants in Juba from Dec 2013-June 2014.
|
Frequency |
Percent |
Valid Percent |
Cumulative Percent |
None |
43 |
35.0 |
35.0 |
35.0 |
water |
12 |
9.8 |
9.8 |
44.7 |
Juice |
6 |
4.9 |
4.9 |
49.6 |
soup |
6 |
4.9 |
4.9 |
54.5 |
others |
56 |
45.5 |
45.5 |
100.0 |
Total |
123 |
100.0 |
100.0 |
|
Table 18: Other fluids or foods given to infant /last 24hours in Juba from Dec 2013-Jun 2014.
|
Frequency |
Percent |
Valid Percent |
Cumulative Percent |
Immediately after birth |
77 |
62.6 |
62.6 |
62.6 |
Hours |
25 |
20.3 |
20.3 |
82.9 |
Days |
17 |
13.8 |
13.8 |
96.7 |
Don't know |
4 |
3.3 |
3.3 |
100.0 |
Total |
123 |
100.0 |
100.0 |
|
Table 19: Knowledge of mothers about starting of Breastfeeding of their infants in Juba from Dec 2013-Jun 2014.
|
|
Frequency |
Percent |
Valid Percent |
Cumulative Percent |
|
First 3 months |
21 |
17.1 |
17.1 |
17.1 |
First 6 months |
83 |
67.5 |
67.5 |
84.6 |
|
Upto 2 years |
10 |
8.1 |
8.1 |
92.7 |
|
Don't Know |
9 |
7.3 |
7.3 |
100.0 |
|
Total |
123 |
100.0 |
100.0 |
|
Table 20: Knowledge of Mothers about Duration of EBF in Juba from Dec 2013-Jun 2014.
|
Frequency |
Percent |
Valid Percent |
Cumulative Percent |
Agree |
105 |
85.4 |
85.4 |
85.4 |
Uncertain |
10 |
8.1 |
8.1 |
93.5 |
Disagree |
8 |
6.5 |
6.5 |
100.0 |
Total |
123 |
100.0 |
100.0 |
|
Table 21: Attitude of others towards EBF in Juba from Dec 2013-Jun 2014.
|
Frequency |
Percent |
Valid Percent |
Cumulative Percent |
Agree |
34 |
27.6 |
27.6 |
27.6 |
Disagree |
89 |
72.4 |
72.4 |
100.0 |
Total |
123 |
100.0 |
100.0 |
|
Table 22: Attitude of Mothers towards Payment of the time spent in Breastfeeding in Juba from Dec 2013-Jun 2104.
|
Frequency |
Percent |
Valid Percent |
Cumulative Percent |
Yes |
55 |
44.7 |
44.7 |
44.7 |
No |
68 |
55.3 |
55.3 |
100.0 |
Total |
123 |
100.0 |
100.0 |
|
Table 23: Whether Breastfeeding interferes with work Productivity in Juba from Dec 2013-Jun 2104.
|
Frequency |
Percent |
Valid Percent |
Cumulative Percent |
Agree |
65 |
52.8 |
52.8 |
52.8 |
Uncertain |
10 |
8.1 |
8.1 |
61.0 |
Disagree |
48 |
39.0 |
39.0 |
100.0 |
Total |
123 |
100.0 |
100.0 |
|
Table 24: Attitude of mothers towards Breastfeeding in Public places in Juba from Dec 2013-Jun 2014.
|
Frequency |
Percent |
Valid Percent |
Cumulative Percent |
True |
120 |
97.6 |
97.6 |
97.6 |
False |
3 |
2.4 |
2.4 |
100.0 |
Total |
123 |
100.0 |
100.0 |
|
Table 25: Knowledge of Mothers about the strong Immune system of Breastfed infant compared to Formula-fed infants in Juba from Dec2103-Jun 2014.
Education level |
Other fluids given/24hours |
Total |
|||||
None |
water |
Juice |
soup |
others |
|||
Basic |
15.40% |
4.10% |
1.60% |
1.60% |
15.40% |
38.20% |
|
Secondary |
6.50% |
2.40% |
0.80% |
9.80% |
19.50% |
||
University |
3.30% |
0.80% |
3.30% |
7.30% |
|||
None |
9.80% |
3.30% |
2.40% |
2.40% |
17.10% |
35.00% |
|
Total % |
35.00% |
9.80% |
4.90% |
4.90% |
45.50% |
100.00% |
Table26:Educationother fluids given/24hours (EBF).
ANC Visits |
Other fluids given/24hours |
Total |
|||||
None |
water |
Juice |
soup |
others |
|||
Regularly Attended |
25.20% |
8.10% |
1.60% |
4.90% |
37.40% |
77.20% |
|
Irregularly Attended |
6.50% |
0.80% |
0.80% |
3.30% |
11.40% |
||
No ANC Attended |
2.40% |
0.80% |
2.40% |
4.90% |
10.60% |
||
Do not Know |
0.80% |
0.80% |
|||||
Total % |
35.00% |
9.80% |
4.90% |
4.90% |
45.50% |
100.00% |
Table 27: ANC Visitsother fluids given/24hours (EBF).
Age group |
Other fluids given/24hours |
Total |
|||||
None |
water |
Juice |
soup |
others |
|||
16-25 |
17.90% |
4.90% |
2.40% |
2.40% |
26.80% |
54.50% |
|
26-35 |
16.30% |
4.10% |
2.40% |
2.40% |
15.40% |
40.70% |
|
36-45 |
0.80% |
0.80% |
3.30% |
4.90% |
|||
Total % |
35.00% |
9.80% |
4.90% |
4.90% |
45.50% |
100.00% |
Table 28: Age other fluids given/24hours (EBF).
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