Knowledge attitude and practice regarding breast feeding mothers of Bundelkhand region of Uttar Pradesh

INTRODUCTION

In India breast feeding is a cultural norm apart from being a physiological and ideal way of infants feeding. Breastfeeding is a basic human activity, vital to infant and maternal health and it has massive economic value to households and societies. Breastfeeding gives the early protection against illnesses, complete nutrition and promotes growth and development of the infants.¹ It has been proved that early initiation of breastfeeding lowers the risk of postpartum haemorrhage and anaemia to the mothers, boosts their immunity and reduces the incidence of certain diseases like diabetes and cancer.² Babies who are not breast fed are around fifteen times more likely to get GI infections like diarrhoea and approximately three times more chances to get respiratory tract infections.³ Exclusive breast feeding (EBF) is defined as infant feeding with human milk without the addition of any other liquids or solids (no water, no juice, no nonhuman milk, and no foods) except for vitamins, minerals, and medications until six months. WHO and UNICEF recommend that infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development, and health. After that infants should be given nutritionally rich and safe complementary foods, while breastfeeding should be continued up to two years or more.⁴

In India, there are several factors that influence the breast feeding practices directly or indirectly such as cultural, rural/urban residence, socio-economic factors, religious values, education level, psychological status, and mother’s occupation.⁵ It has been seen that breastfeeding practices have declined in recent years globally as a result of changes in living patterns, urbanization, and socio-economic factor, marketing of infant milk formulae, advertisements, and maternal employment outside the home.⁶

Breastfeeding Promotion Network of India (BPNI) was born to protect, promote and support breastfeeding in 1991.⁷ In 2005, the Government of India has launched National Rural Health Mission (NRHM) which intends to implement Integrated Management of Neonatal and Childhood Illnesses (IMNCI) through the existing healthcare delivery system.⁸ Further in 2013, NHM has been launched which has a component of RMNCH+A focuses on several life stages including neonates and children.⁹

In developing countries the most common reason for poor health status of children is lack of exclusive breast feeding.¹⁰ Indian women have very less access to counselling services on infant and young children feeding. The key informants to the mothers are family and friends, which is very doubtful regarding their adequacy. Strategies aimed to behaviour change of breastfeeding among nursing mothers are information, education, and communication. The present study was done to examine the infant feeding practices, knowledge and attitude towards breast feeding among nursing mothers of Bundelkhand region.

Objective

To assess the socio-demographic characteristics, knowledge, attitude and practice of the mothers regarding breast feeding.

METHODS

A cross-sectional study was conducted to find out the Knowledge, Attitude and Practice regarding breast feeding mothers, who had attended the immunization clinic at Department of Paediatric, GAMC, Banda for the immunization of their child.

Period of study

The present study was conducted for a period of nine month from July 2019 to March 2020.

Study population

The all children’s in the age group of 0-6 month attending to immunization clinic of Pediatric department, GAMC, Banda.

Sample size

Total 160 children in the age group of 0-6 months came at immunization clinic of pediatric OPD, GAMC, Banda.

Data collection

The scheduled method was used for data collection. The questionnaire was predesigned and pretested. The questionnaire include, demographic characteristics (age, sex, residential area, education level and occupation, personal profile) knowledge and attitude towards breast feeding i.e. when it should be started, how many feed should be given to the baby in a day etc. An informed consent was obtained from the study subjects or their relative before interview.

Inclusion criteria

All full term infant who delivers either normal or by caesarian section coming for immunization.

Exclusion criteria

The infants who were seriously ill.

Statistical analysis

The data was collected then entered in MS excel and then transferred to trial version of SPSS 20.0. The data was analyzed using appropriate statistical tools. Pie chart was drawn for gender. The number and percentage of age, residential area, education level, occupation, type of family, knowledge about breast feeding i.e. when it should be start, how many times feed to baby etc. were assessed.

RESULTS

Table 1 shows maximum number of mothers (38.75%) belong to the age group of 25-30 years followed by 21-25 years (26.87%), 18.12% belong to <20 years and 16.25% belong to >30 years age group respectively. Approximately 45% of mothers were educated up to intermediate or above followed by high school (21.25%), middle (13.75%), and primary (11.87%) while 8.75% of mothers were illiterate. Approximately 46% fathers were educated up to intermediate or above followed by high school (19.37%), middle (13.31%), and primary (11.25%) while 8.12% of fathers were illiterate. 60% of the mothers were housewife followed by government employee (14.37%), private sector (13.75%) and 11.87% in other jobs. 29% of the fathers were working in private sector followed by laborer (25%), government employee (21.87%), and 11.87% have involved other jobs while 13.12% were unemployed.

Total number of children studied during the study period were 160 out of which 54.37% were male and 46.62% were females (Figure 1).

Table 2 shows that 41.25% of the mothers having knowledge that breast milk provide sufficient nutrition, 28.12% knew that it provides immunity, 48.75% knew about its beneficial effects for the child and 33.75% knew about its other importance while 14.37% were not having any knowledge of breastfeeding.

73.75% mothers replied that breastfeeding should start within one hour, 14.37% said that it should be started within 1-6 hour, 9.23% within 1-3 days while 4.37% said that should be started after one week. 77.50% mothers having the knowledge and benefit of colostrum, rest were unaware while 41.87% accepted that they fed colostrum to their baby while 59.13% had not given colostrum to their baby.

Table 3 shows 38.12% of the mothers started breastfeeding within one hour, 46.87% between 1-6 hour, 11.25% between 1-3 days while 3.75% says that they started breastfeeding after one week.

Table 4 shows 60% of the mothers breastfed their babies on demand, 33.75% regularly breastfed their babies while only 6.25% randomly fed their babies. 83.75% mothers did not give anything before breast milk while 22.25% accepted that they fed their babies either cow/goat milk or honey or plain water before breast milk. 40.62% mothers gave breast milk to their babies, rest fed either cow milk or other formula feed along with the breast milk.

DISCUSSION

Breast feeding is a fundamental factor influencing long term health of new born babies and infants. The government of India launched National Health Mission in 2013, one of the programmatic components of which is the Reproductive‑ Maternal‑ Neonatal‑ Child and Adolescent Health (RMNCH + A) which envisages the promotion of health and wellness of new born and children through the existing health care delivery system.⁹

In our study maximum number of mothers (38.75%) belonged to the in age group of 25-30 years followed by 21-25 years. A total of 160 children were studied during the study period in which 54.37% were male and 46.62% were females. Similar finding in previous studies were observed.¹¹ 45% of mothers who were included in the study were educated intermediate or above followed by high school 21.25%, middle 13.75%, and 11.87% primary while 8.75% of mothers were illiterate. Vinay et al reported in their study that 45% of mothers were educated up to secondary, 34% intermediate, 21% educated up graduate and above while 4.34% mothers were illiterate.¹¹

There were approximately 46% of fathers of the baby who included in the study were educated up to intermediate or above followed by high school 19.37%, middle 13.31%, and 11.25% primary while 8.12% of fathers were illiterate. Parent’s educational status have positive impact on breastfeeding practices.¹² Approximately 29% of the fathers were working in private sector followed by labourer 25%, government employee 21.87%, and 11.87% in other jobs while 13.12% were unemployed. The employment of mothers has some negative effect on breastfeeding while father’s employment has no role on breastfeeding practices.¹³

About 41.25% of the mothers having knowledge about nutritional aspect of breast 28.12% knew that it provides immunity while 48.75% said that breast milk is beneficial for the child and 33.75% said that its other importance. 14.37 were not having adequate knowledge about breastfeeding. Similar findings were observed in different studies conducted by Sultania et al and Mohd et al.^14,15

The 73.75% of the mothers replied that breastfeeding should start within one hour, 14.37% said that it start between 1-6 hour, 9.23% between 1-3 days while 4.37% said that it start after one week. The findings were higher than a study conducted by Girish et al that 38% mothers were not aware of duration of exclusive breast feeding.¹⁶ Various other studies done in different parts of India showed that the rates were higher for initiation of breast feeding within 1 hour (68.7%) and (74.2%) within 6 hours.^17,18

77.50% of the mothers having the knowledge and benefit of regarding colostrum, rest were unaware while 41.87% mothers accepted that they fed colostrum to their baby while 59.13% did not fed colostrum. Even though mothers were fully aware of the importance of colostrum even they have discarded it in our study, whereas Singh et al reported that 71.4% mothers did not provide colostrum to their babies.¹⁹

In this study 60% of the mothers breastfed their baby on demand, 33.75% regularly breastfed their baby while only 6.25% say that they fed randomly. 83.75% of the mothers did not give anything before breast milk to their baby while 22.25% accepted that they give their baby either cow/goat milk or honey or plain water to their baby before breast milk. Different studies from various parts of India have reported different rates of pre lacteal feeds viz. 4.3%, 32.03%, 27%, 50.81%.^14,20‑22 Family customs and pressure from relatives might be the possible reasons for giving pre lacteal feeds. Cow/goat milk was the most commonly used prelacteal feed followed by honey and plain water.

CONCLUSION

Early initiation of breastfeeding is not only essential for the child, but also for mothers as well. It saves infants’ lives, creates bonds between mother and child, helps to reduce post-partum hemorrhage and increases secretion of breast milk. The participants have good knowledge and attitude regarding breastfeeding but there was a noticeable deficit in the use of this knowledge in the breastfeeding practices which points towards the gap in the education and counselling of women regarding breast feeding.

Recommendations

There is a need to strengthen public health information, education and communication campaigns to promote breast‑feeding. Steps should be taken to improve access to practical demonstration of methods and various issues related to breastfeeding.

ACKNOWLEDGEMENTS

We would like to express our gratitude to all the mothers who participated in this study.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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