Awareness about breastfeeding benefits among mothers in maternity and children hospital of Buraidah Qassim region, Saudi Arabia

INTRODUCTION

Breastfeeding is the ideal source of nourishment in the 1^st year of the baby life, it maybe continued to 18 month or more as a primary source of feeding.¹ Several studies noted that both baby and mother benefit from breastfeeding whether in short or long terms.^2,3 It's a healthy, safe and economical way of providing proper and wholistic nutrition to the newborn. Different studies have shown that breast milk is important for physical, neurological, and cognitive development of child that can reduces risks of allergies, infection, and non-communicable diseases during stages of their development.^4-6 As will as it deepens the bond between the mother and her child, and also it offers a number of health benefits to the mother, studies showed that breastfeeding reduce the risk of mothers having ovarian and breast cancers.⁴ Despite these profound advantages, it remains under-fulfilled and sometimes missed altogether. This is a common problem worldwide and locally. One of the hypothesized reasons for this is the low level of education of the mothers and a decreased level of awareness regarding these advantages. This common and mostly preventable issue requires an accurate assessment of the level of awareness towards the benefits of breastfeeding on the health of the mother and the newborn.

METHODS

All eligible mothers will be identified from the clinics. Consent/assents documents will be presented for signatures to those who express their willingness. Data pertaining to mothers demographics, awareness of benefits to the mother and newborn, awareness of risks to mother and newborn shall be collected on a case report form (copy attached). All collected data will be entered into a computerized database using IBM-SPSS and analyzed appropriately.

Sample size and sampling technique

For this prospective, non-interventional, observational, cross-sectional descriptive study, a consecutive sample of all the pediatric patient's mothers who will fulfill the above-mentioned inclusion criteria, visiting pediatrics clinics at Maternity and Children Hospital of Buraidah, Qassim Region, Saudi Arabia from 18 March 2018 to 18 April 2018 shall be taken. According to a conservative estimate, this will be between 300-500 patients.

Inclusion criteria

Pediatric patients Mothers who attend general pediatrics clinics at Maternity and Children Hospital of Buraidah, Qassim Region, Saudi Arabia from 18 March 2018 to 18 April 2018.

Exclusion criteria

Any woman who has never born a child will be excluded.

Ethical considerations

The data thus collected shall be maintained with the P.I. in accordance with the policy on data confidentiality, security, and safety of Maternity and Children Hospital of Buraidah, Qassim Region, Saudi Arabia. No data in any form is retrieved for any purpose without proper approval from appropriate individuals and/or committees/group.

Statistical considerations

Dataset will be prepared using IBM-SPPS for Windows Version 20. After performing QA of the dataset, descriptive statistics will be calculated. Outcome analysis will be performed in the light of the identified risk factors. Chi-Square tests along with Fisher's Exact Test would be used to find the relationship between dependent variables and the factors. Bi-variate analysis of the continuous data will be done using Student’s t-test for parametric distributions and relevant non-parametric tests for non-normal data sets. Multivariable binary logistic regression analysis will be performed if the sample size permitted a feasible fit of the model.

RESULTS

Data statistical analysis

Personal information

The following table shows the participants' distribution according to personal information.

Table 1 shows that the mean age of participants' is 32.7 with a standard deviation of 7.104.

93.5% of them were Saudi, while 6.5% of them were non-Saudi. And their distribution according to education level, 6% of them illiterate, 5% elementary, 10.8 middle school, 32% high school, and 46% university or higher.

Information about the child (children)

The following table shows the participants' distribution according to Information about the child (children).

Table 2 shows that 38.5% of families have one or two children, 32% of families have 3-4 children, 24% have 5-7 children, while 6% have more than 7 children. 42.8% of children are aged (2-3) years, 23% of children are aged (3-4) years, and 35% of children are aged (4-5) years. 49% of children are males, while 51% are females. 12.3% of mothers rely on breastfeeding, 21.2% of mothers rely on formula milk, while 66.5% of mothers rely on breastfeeding and formula milk together. 12.1% of mothers breastfeed less than a month, 16.6% breastfeed their children from (2-3) months, 19.9% breastfeed their children (4-6) months, 3.8% breastfeed their children from (7-9) months and 3.5% breastfeed their children (10-12) months, while 23.9% of mothers breastfeed their children more than 12 months. 37.5% of mothers stop breastfeeding their babies because inadequate breast milk, 12.6% because of their preoccupation with work, 7.3% because of mother or child's health problems. 13.9% because of the refusal of the child, and 18.1% of them stop breastfeeding their children for other reasons. 1.8% of mothers breastfeed formula milk for 1-3 months, 1.8% of mothers breastfeed ready milk for 4-6 months, 0.5% of mothers breastfeed ready milk for 7-9 months, 2.3% of mothers breastfeed ready milk for 10-12 months, while the vast majority (83.4%) of mothers breastfeed ready milk for more than 12 months.

Information about breastfeeding

The following table shows the participants' distribution according to Information about breastfeeding.

In Table 3, 61% of mothers discussed the benefits and information of breastfeeding, while 39% did not. 92.4% of mothers believe that the best nutrition for a child is breastfeeding. 82.6% of the mothers believe that the best time to start breastfeeding is immediately after delivery.

20.4% of the mothers believe that the number of times a child breastfeeds during the first month is 8 or more. 75.8% of mothers believe that colostrum is beneficial for the child. 52.9% of mothers believe breastfeeding should last for at least two years. 73.3% of mothers believe that breastfeeding reduces breast cancer. 94.2% of mothers believe that breastfeeding strengthens the child's immunity. 73.4% of mothers believe that breastfeeding reduces the child's diarrhea and respiratory tract infection. 71.5% of mothers believe that breastfeeding helps to reduce the weight of the mother. 46.3% of mothers believe that hormones are not the components of breast milk. 80.4% of mothers believe that the benefits of breast milk: facilitate digestion; reduce infection, rich in food sources.

Test hypotheses

Hypotheses 1

"There is a significant difference at 0.05 level in the extent of mothers' awareness of breastfeeding due to educational level".

Through the Table 4 it is clear that the analysis of variance test result (ANOVA) indicate that there is a statistically significant difference in the extent of mothers' awareness of breastfeeding due to educational level.

Hypotheses 2

"There is a significant difference at 0.05 level in the extent of mothers' awareness of breastfeeding due to the number of children".

Through the Table 5 it is clear that the analysis of variance test result (ANOVA) indicate that there is no statistically significant difference in the extent of mothers' awareness of breastfeeding due to the number of children.

Hypotheses 3

"There is a significant difference at 0.05 level in the extent of mothers' awareness of breastfeeding due to discussing the competent doctor".

Through the Table 6 it is clear that the analysis of variance test result (ANOVA) indicate that there is a statistically significant difference in the extent of mothers' awareness of breastfeeding due to discussing the competent doctor.

DISCUSSION

Studies over the years have proven many benefits of breastfeeding to the mother and child health, however, its prevalence is nowadays not optimal.⁷ In USA studies shows that (65.1%) of children had ever been breastfed, (27%) were receiving some breast milk, exclusive breastfeeding were (7.9%).⁸ While in our study mothers who rely on formula only were (21.2%), both breastfeeding and formula (66.5%), while exclusive breastfeeding were (12.3%) Table 2. In Saudi Arabia study was done in Riyadh, only (37.5%) of the mothers practiced exclusive breastfeeding for 6 months. (31.9%) of them continued breastfeeding until 9–12 months, and (23%) continued until 18–24 months.⁹ While in our study exclusive breastfeeding were (12.3%), (19.9%) uses breastfeeding as a source of nutrition for 6 months, (3.5%) until 10-12 month and (23.9%) were more than 12 months Table 2. Regarding to the breastfeeding knowledge assessment, "Does breastfeeding protects the mother from ovarian and breast cancer?" a survey question to evaluate Malaysian women awareness about breastfeeding, (31.8%) of the answers were I don't know.¹⁰ In our study a similar question "Breastfeeding decrease the mother risk of?" one of the answers is breast cancer, mothers who answered I don’t know were (21.7%), while the wrong answers to this question were (5%) Table 3, another question "Does breastfeeding protects the infant from diarrhea?" (16.4%) chose I don’t know.¹⁰ While in this study a similar question was mentioned and (12.6%) answered don't know Table 3, on the other hand, the most prevalent barrier in initiating of breastfeeding or quitting reason is working (66.7%).¹⁰ While in our survey the most prevalent barrier is inadequate breast milk (37.5%) Table 2. Furthermore, we found that education level Table 4 and discussing with a doctor Table 6 has a relation with increase awareness, while number of children has no relation Table 5. A social media campaign study in Saudi Arabia was done to measure and improve the awareness of breastfeeding, the results show that a combination of professional breastfeeding support, public health education programs through social media could be an effective tool in improving breastfeeding in Saudi Arabia.¹¹

CONCLUSION

From this study, analysis of the collected material on the surveyed women showed that Saudi women have insufficient knowledge about breastfeeding benefits. Knowledge is improving after discussing with a doctor about breastfeeding benefits Table 6. Based on these results we highly recommend increasing the efforts to promote and endorse the benefits of breastfeeding by pediatricians and other health professionals.

ACKNOWLEDGEMENTS

The authors are grateful to the data collectors: Reem Abdulaziz Alharbi, Fatmah Ali Almohaimeed, Maram Abdullah Alharbi, Nawal Hamad Alawaji, Malak Salim Alrasheedi.

Funding: No funding sources

Conflict of interest: None declared

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

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