Factors Influencing Initiation of Breast Feeding among Post- Partum Mothers in a Teaching Hospital of Osun State, Nigeria

Factors Influencing Initiation of Breast Feeding among Post-
Partum Mothers in a Teaching Hospital of Osun State, Nigeria.
B. L. Ajibade(RN,Ph.D,FWACN).1 Oladeji M.O (RN, MSc).2 E.A.Oyedele(RN,M.Ed, FWACN).3
Amoo P.O (RN,RM,MSc)4 MakindeO.Y(RN,RM,MSc)5
1,2,4&5 Ladoke Akintola University of Technology, Ogbomoso. College of Health Sciences, Department of
Nursing, Osun State, Nigeria.
3. Department of Nursing, Faculty of Basic Medical Sciences, University of Jos, Jos, Plateau State.
Correspondence To:-Dr. B. L. Ajibade, Email badelawal@yahoo.com
LAUTECH, OSOGBO, C/O P. O. BOX 1120, Osogbo, Osun State, Nigeria.
Abstract
INTRODUCTION:- Breastfeeding is well recognized as the best food source for infants. It has been advocated
as a cost effective means of improving the child’s health, mother’s health and mother - infant bonding. The study
was carried out to determine the factors that influence the initiation of breast feeding among post partum mothers
in a teaching hospital of Osun State, Nigeria.
METHOD: - A descriptive cross sectional research design was used, with 317 respondents selected randomly.
Data were collected using a self-designed questionnaire. The data were analyzed using statistical product and
service solutions window version 21. Six research hypotheses were set and analyzed while only one research
questions was answered.
RESULT: Results showed that maternal age was the only factor found to influence breast feeding initiation.
Majority of respondents lack adequate understanding of the factors that are major predictors of breast feeding
initiation.
CONCLUSION:- It was concluded that mothers should be given health information on factors that can
influence initiation of
Keywords:Factors influencing, Initiation, Post partum mothers, breast feeding.
INTRODUCTION
There is a universal consensus about the fundamental importance of breastfeeding of children’s
adequate growth and development and for their physical and mental health. Breastfeeding, particularly exclusive
breastfeeding, and appropriate complementary feeding practices are universally accepted as essential elements
for the satisfactory growth and development of infants as well as for prevention of child-hood illness. This has
culminated in a publication by the World Health Organization (WHO) recommending that infants up to 6 months
of age should be exclusively breastfed(1). Infant Mortality Rate (IMR) is regarded as an important sensitive
indicator of health status of a community. It reflects the effectiveness of interventions for improving maternal
and child health(2). Major part of Infant Mortality Rate is contributed by a neonatal mortality rate. It has been
said that 50% infant deaths occurs within the neonatal period3,4,5.. Exclusive breast-feeding is the most natural
and scientific way of feeding infants in the first 6 months of life6. Breast feeding can contribute to the reduction
of mortality and morbidity7. Benefits of breast-feeding like a decrease in the incidence, severity of infectious
diseases such as diarrhea, respiratory tract infections, otitis media and urinary tract infection, decreased
incidence of types 1 and 2 diabetes mellitus, overweight, obesity and asthma were reported8. Too early
introduction of breast milk substitutes and too late introduction of semi-solid complementary feeds are common
and are responsible for rapid increase in the prevalence of under nutrition between 6 – 24 months9. Some studies
reveal factors positively associated with exclusive breastfeeding, such as higher maternal educational level,
gestational age greater than 37 weeks, mothers with previous experience of breastfeeding10. There are also
studies that relate factors leading to interruption of exclusive breastfeeding such as low family income, low
maternal age, prim parity and mothers returning to work. Several studies intended to define determinant
variables in the success or failure of breastfeeding which could ease the planning of promotional strategies12,13. It
was established that socio-demographic variables like maternal education, paternal education and socioeconomic
status have positive association for influencing decision on exclusive breast feeding14. Number of
antenatal visits taken, older maternal age15 and low birth weight16 reported positive impact on breast-feeding
initiation. Association was found between breastfeeding pattern and variables, classically considered as
supportive for breastfeeding such as three or more antenatal visits, breastfeeding advice receiving during
antenatal visits, during post natal visits delivery interval 24 months or more, and birth weight 2500gms or more14.
Some researchers15 in their study did not find any association between breastfeeding advice received during
antenatal and delivery intervals. If was observed that there are a lots of new born that did not get breastfeeding at
birth due to some maternal problems like parity, education and working status16. A younger maternal age
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especially under the age of 18 years is thought to be related to a significantly shorter duration of actual of
intended breast-feeding. Older mothers, typically women over the age of 30 years are reported to be more likely
to initiate breastfeeding, and to this act for a longer period of time17. Previous findings suggest that young age
and low income have a negative impact on the successful outcomes of breastfeeding17. Maternal education was
positively associated with the duration of breast-feeding. Non- smoking mothers were more likely to breastfeed
linger than smoker20. Nevertheless, it is always prudent to consider that as an eating habit, breastfeeding is
intrinsically related to social cultural and traditional pattern of a given population. This fact justifies need for
regional studies that allows more efficient action in regard to measures for intervention, based on knowledge of
local reality. Therefore, the objective of this study was to assess factors influencing initiation of breast feeding in
newborn infants in a State University Teaching hospital in Nigeria.
Theoretical Frame Work: - For This Study Theory of Planned Behavior was adopted. The theory of planned
behavior (TPB) provides a frame - work for visualizing by which psycho-bio-social factors can influencing
breast feeding initiation. According to the TPB, behavior is a function of intention to perform the behavior (e.g.
planned duration of breast feeding). In addition to attitude and perceived control, the TPB postulates a link
between beliefs of those who provide social support.
Some authors17 in their research works discovered there was no relationship between marital status and
breastfeeding practice among post-partum women. It was equally observed that maternal education was not
associated with breast feeding initiation. Morrow,Guerero, Shults et al17. opined that there was no relationship
between marital status and breast feeding practice, equally there was no relationship between maternal
educational level and breast feeding initiation.
Research Question: - What is the level of knowledge of mother on initiation of Breast feeding in infants?
Research Hypotheses:- for the purpose of this research six null hypotheses were set and tested at 0.05 level of
significance and they were:-
(1) There is no significant relationship between age of the mother and the initiation of
breastfeeding at post partum
(2) There is no significant relationship between marital status of respondents and the initiation of
breast feeding of post-partum.
(3) There is no significant relationship between the maternal educational level and breast-feeding
initiation at post-partum.
(4) There is no significant relationship between maternal employment status and breastfeeding
initiation at post partum.
(5) There is no significant relationship between number of children and initiation of breastfeeding
at post-partum.
(6) There is no significant relationship between the psychological state of mothers and the
initiation of breast feeding at post partum.
METHODOLOGY
Research Setting:- Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State is one of
the tertiary health institutions in Osun State concerned with both curative and palliative health care delivery,
research and education of health students. It was located in Ajegunle behind Idi - Seke of Olorunda Local
Government of Osun State Capital, Osogbo. The institution is owned by both Oyo and Osun State governments.
It came into existence by an edict that was gazette in 1997 and was amended in 1999 by the Osun State military
administration of LT. Col. Anthony Obi. The hospital is comprised of several units and wards, such as the
accident and emergency, antenatal unit, post-natal unit, female and male medical wards, female and male
surgical wards, pediatric medical and surgical wards, eye, ear, nose and throat unit, burns unit, intensive care unit,
orthopedics ward, mental health/psychiatric unit, special baby care unit, HIV/AIDS unit, etc.
For the purpose of this research, the infant welfare and post-natal unit were used. The yearly attendance
of patients in the two units was put at 1517 by the medical record.
Design of the Study:- This study was carried out using a cross – sectional descriptive design among 317
mothers that were selected consecutively for a period of four (4) months (January – April, 2013). They were
mothers who delivered at LTH or brought their children to the infants’ welfare clinic.
Research Population: - The populations used for the study were lactating mothers whose babies were within 1
day to 6 weeks.
Inclusion criteria: - (1) Mothers who delivered at the labor ward of LTH and initiated breastfeeding
within 30 minutes of delivery.
(2) Mothers that brought their children to the infant welfare clinic with the children’s age not more than
6 weeks.
Exclusion Criteria: - (1) Mothers with health problem post natally.
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(2) Mothers with children with health problems.
Sample Size Determination: - The previous year clinic attendant was used to determine the sample size.
Yamane calculation method was employed. It states thus
n = N
1 + N (e) 2 where
n = Sample Size = ?
N = Population Size = 1517
e = Level of precision= 0.05
Therefore, n = 1517
1 + 1517(0.05)2 n = 316.5
The sample size n = 317.
Sample and Sampling Technique - Simple random Technique was used to select the respondent at the post
natal ward and infant welfare clinic between January and April, 2013, until the required sample size of 317 was
attained.
Research Instrument: Researcher self- designed instrument was used for the research. The instrument was
divided into 3 sections (A - C). Section “A” was on the demographic information, and consisted of 6 items;
Section “B” was on knowledge of mothers about the initiation of breastfeeding, it consisted of 6 items while the
last part of the instrument “C” was on factors influencing initiation of breastfeeding, and it consisted of 7 items.
Psychometric Properties of Instrument: This involved the validity and reliability of the instrument. The face
validity and content validity of the instrument were carried out by showing the instrument to Gynecologists and
the experts in the field of Maternal and Child Health Care. They confirmed the face validity and content validity
of the instrument. Those items that were believed to be ambiguous and not relevant to the study were jettisoned.
Reliability of the instrument was determined through pre-test among 20 post-natal mothers in State
Hospital, Asubiaro, Osogbo. The cronbatch’s coefficient yielded 0.785. This depicted 79% reliability, which
means the instrument, could be used for the study.
Procedure for Data Collection - The instrument designed for the research was administered to the respondents
having selected them through the issuance of numbers. The researcher assistants who had been trained in the
transliteration of the items on the instrument administered the instrument to the randomly selected respondents at
each clinic for the infant welfare and at the post-natal ward. Each respondent was allowed to spend between 10
and 15 minutes in answering the items on the instrument and same was collected here and there.
Method of Data Analysis: Data collected were validated and analyzed using the statistical product and problem
solutions (SPSS) version 21. The only research question was answered using frequency and percentages while
the null hypotheses were analyzed and tested using the chi-square (x2) analysis.
Ethical Consideration: The research instrument was reviewed by the ethical committee of LTH and necessary
forms were filled after which the approval was given to conduct the research. The respondents were given an
informed consent to sign. They were made to realize that filling of the instrument was free and they would not be
reprimanded if they refused to answer the instrument.
RESULTS
A total of 317 questionnaires were administered to the mothers that delivered at LTH and those that
brought their baby to infants’ welfare clinic of the hospital for immunization. The age distribution of the
respondents (table 1) showed that more than half of the mothers 51% were within 26-33 years of age, 29% were
within 18-25 years of age while 14% were within 34 and 41 years of age, and 6% were above 42 years of age. 80%
of the respondents were married, 6% of respondents were single, 3% divorced, and the remaining 3% were
widows. In term of the educational level of respondents, 44% of respondents were graduates of higher
institutions, 36% had only secondary education certificates while 14% had primary school education, and 6%
had no formal education. Regarding the ethnicity of the respondents, majority of them were Yoruba 236(74%).
The explanation for this was that the hospital is situated in South West of Nigeria which is predominantly
occupied by Yoruba. 21% of respondents were Igbos while the remaining 4% (14) respondents were Hausa. The
employment status of the respondents table 1 showed that 43% were employed by government, 31% employed
themselves, involved petit trading, 8% (24) of the respondents were students while 18%(57) were not employed
at all. On the basis of the number of children (table 1), 60% (190) had either one(1) or two (2) children, 33% of
the respondents had either three (3) or four(4) children while just 7% had either five (5) or more than five
children.
Concerning the knowledge of mothers about the initiation of breastfeeding. Majority of the respondents
87% displayed good knowledge of breastfeeding initiation when they agreed that breast feeding initiation occurs
when the child is put to the breast between minute to thirty minutes after birth (Table 2). They equally agreed
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that initiation of breastfeeding allows for immediate skin to skin contact between the new born baby and the
mother, 91% believed that it encourages skin contact, while 8% sees no reason for early skin contact. 91% of
respondent agreed that initiation of breast milk would afford the baby to be given colostrums that contains
antibiotics that prevents the baby from infection (table 2), 96% of respondents agreed that initiation of
breastfeeding encourages early bonding between the mother and the baby, while 4% did not support this
assertion (see table 2).
On factors influencing initiation of breast feeding, table 3 showed that 66% (187) of respondents agreed
that psychological state of the mother could influence the initiation of breast feeding, closely followed by the age
at marriage which accounted for 58%(165) Educational level of the mother carried 47%(133), Employment
status of the mother accounted for 43%(122) while marital status accounted for 32%(92) and number of children
was the least factor that would influence initiation of breast feeding among mothers (table 3). In testing the
hypotheses 1 to 6, hypotheses 1-5 showed no significant relationship among the variables analyzed but
hypotheses 6 showed that there was a significant relationship between psychological states of mothers and the
initiation of breastfeeding (table 4). The result in table 4 with reference to hypothesis 1 showed that 58% of the
respondents agreed that age at marriage could influence the initiation of breastfeeding, 42% of respondents did
not see age at marriage as factor that can influence breast-feeding. To validate whether to or not to reject the null
hypothesis that there is no significant relationship between age at marriage and initiation of breast-feeding, chisquare(
x2) analysis was carried out. The calculated chi-square (0.54) was below the critical value of 0.05
significant level (3.84), suggesting that differences in responses were not statistically different from one another.
On marital status, 32% of the respondents agreed that it influences the initiation of breastfeeding while 68% did
not agree, The calculated value of chi-square for the responses of the respondents was 55.8, which is greater than
the critical value of the 0.05 significant level (3.84); the null hypothesis could not be rejected (table 3).
DISCUSSION OF FINDINGS
This study was based on factors influencing initiation of breastfeeding among the post-partum mothers
attending Ladoke Akintola University Teaching Hospital. 317 questionnaires were distributed among mothers in
the post-natal ward and lactating mothers attending the infant welfare clinic. All the questionnaires were
retrieved and analyzed.
The analysis revealed that slightly more than half of the respondents 51% were within the age bracket
of 26 – 33 years. Results of the study showed that majority of the respondents were married (80%). It was also
discovered that 44% were highly educated while the majority of the respondents were Yorubas. According to
table 9, 58% of the respondents agreed that maternal age was a significant predictor for the initiation of
breastfeeding6, 10,11,12,14. 32% of the respondents agreed that marital status was a significant predictor for the
initiation of breastfeeding while 68% believed that marital status could not predict the initiation of breast
feeding19, 20. 47% of the respondents agreed that the mother educational level could influence the initiation of
breast feeding10, 11, 15, 16. 43% of the respondents agreed that maternal employment had an influence on the
initiation of breast feeding14, 16. 66% of respondents agreed to the assumption that the psychological state of the
mothers could influence the initiation of breast feeding14, 16.
Present study alerts us that in spite of prevalent practice of breast feeding, promoting and strengthening
reproductive and child health services were of paramount importance, since unsatisfactory behavior, regarding
exclusive breast feeding is still observed.
Implication for Nursing Practice.
Breast feeding is of extreme importance for safe guarding the health and welfare of the growing infant
and this practice must be preserved, protected and provided by all means. Training of health workers in primary
care setting on need for appropriate and timely counseling of antenatal mothers on breast feeding must be
stressed. The quality of knowledge and support has a crucial role in the success of breast feeding promotion.
The findings of this study appear to have some value to professional midwives. Since the rates of breast
feeding are consistently lower than desired. It seems likely that Nurse-Midwives would address this problem by
designing interventions and educational programs to teach the benefits and recommendations of breast feeding.
Understanding which demographic factors predict breast feeding in early post partum period is useful when
designing these programs to ensure that limited resources are directed to groups that might be amenable to
change for example, this study indicates that younger single women with a high school level education are less
likely to breast feed than are older married college educated women.
Industrial nurses could also benefit from the findings of current study when working with large
corporations and companies by trying to influence policy change for example, the literature clearly proves that
breast feeding is the healthiest option for both mother and child, resulting in less illness for babies, which in turn
causes less of a financial drain on insurance monies and less time off work for mothers. The current study
indicates that women who return to paid employment are less likely to breastfeed, and are therefore not
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providing their child the healthiest option for infant feeding. If health educators are working with companies
trying to effect a policy change that allow more flexibility for working mothers to pump breast milk during the
work day, this information provides a strong argument for adoption of this policy, using data derived from a
local sources, rather than national or international studies.
Tables 1- Demographic Data
Age (in yr) Frequency Percentage
18-15 92 29
26 – 33 163 51
34 – 44 43 14
> 42 19 06
Total 317
Educational Status
No formal Education 19 6
Primary School 43 14
Secondary School 14 36
Higher Education 141 44
Total 317
Employment
Student 24 8
Self-employed 100 31
Employed of Government 135 43
Unemployed 57 18
Total
Marital Status
Single 19 06
Married 255 80
Separated 24 03
Divorced 11 03
Widow 08
Total 317
Ethnicity
Yoruba 236 74
Igbo 68 21
Hausa 14 04
Total 317
Number of Children Frequency Percentage
1 – 2 190 60
3 – 4 105 33
> 5 22 07
Total 317
Table 2 - Knowledge of Mothers on the Initiation of Breast feeding.
S/N ITEMS YES % NO % TOTAL
1. Breastfeeding should be initiated within the first thirty
minutes after the sixth of child.
276 87 41 13 317
2. Skin to skin contact should be done to ensure successful
breastfeeding initiation.
287 91 22 07 309
3. It is important to give the first milk (colostrums to the baby
immediately he is born).
287 91 30 09 317
4. The baby should always be put to breast on demand. 200 63 111 35 311
5. A mother is very likely to initiate breastfeeding if she is
happy with the arrival of the baby.
282 89 35 11 317
6. Initiation of breastfeeding allows for the establishment of
building between the mother and her baby.
303 96 14 04 317
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Table 3: Factors Influencing Initiation of Breast feeding
S/N ITEMS Frequency Percentage X2
1. Age at Manage 165 58 0.534 NS
2. Marital Status 92 32 55.8 S
3. Educational Status of Respondents 133 47 8.204 NS
4. Number of children 68 24 103.34 NS
5. Psychological State of Respondents 187 66 10.246 S
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