ABSTRACT
Breast feeding practice especially exclusive breast feeding (EBF) is a major determinant of child growth and development. In Cameroon, most women breastfeed their infants for long periods, but many introduce alternative feeding too early in life. The objective of this study was to explore the feeding practices on growth and developmental patterns of infants 0-6 months in the Bamenda Health District. In order to achieve the study objectives, a simple random, Convenience and purposive sampling techniques were employed to sample of 40 participants (mother’s breasts feeding their babies) from the Bamenda District Hospital using structure questionnaires. Collected data was analyzed using SPSS version 21.0. Descriptive statistics such as mean, standard deviation and percentage distribution of variables, t-test and Chi-square test were calculated. The results show that mothers practice both exclusive and complementary form of feeding their babies. It was also, observed that, infants who were exclusively breast fed, show a statistical significant difference in growth and development in weight, height, head and arm circumference at (p< 0.05). The study further revealed that, infants who were exclusively breast fed had low chances of acquiring a respiratory and diarrhea infections than they counterpart who receives complementary feeding within the first 0-6months. The study also show that the major challenges faced by mothers who exclusively fed their infants was the low breast production and inability to position the and attached the baby during breast feeding while mothers who fed their infants complementarily encountered financial difficulties in getting the fed, and had limited knowledge in getting the fed. Thus its recommended that, exclusively breast feeding should be encouraged among nursing mothers in the area.
CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
Malnutrition had been reported to be responsible, directly or indirectly, for 60% of the 10.9 million deaths annually among children under five (Ndiokwelu et al., 2014) according to the WHO (2002), Over two-thirds of these deaths, which are often associated with inappropriate feeding practices, occurring during the first year of life. No more than 35% of children worldwide were exclusively breastfed during the first four months of life; complementary feeding frequently begins too early or too late, and feeds are often nutritionally inadequate and unsafe. Malnourished children who survive are more frequently sick and suffer the life-long consequences of impaired development. Since poor feeding practices are major threat to social and economic development, they are among the most serious obstacles to attaining and maintaining health that face this age group.
Adequate nutrition during infancy and early childhood is fundamental to the development of a child’s full potential. It is well recognized that the period from birth to two years of age is a “critical window” for the promotion of optimal growth, health and behavioral development. The consequences of poor nutrition in terms of both foods and feeding behaviors, during the first two years of life include significant illnesses, delayed mental and physical development and death (FMH, 2005).
Without doubt, breastfeeding is recognized as the best feeding option for children because of its nutritive, protective, psychological and economic value. Breast feeding practice especially exclusive breast feeding (EBF) is a major determinant of child and development. Maternal breast milk is globally recognised as the only food that is wholly adoptable to infant physiology (Afoakwah et al., 2013). Breastfeeding is reportedly the single large potential public health intervention against infant mortality and if done optimally, “about 800,000 children lives could be save each year” (Black et al., 2013). The global guide lines on breast feeding put forward by the WHO recommends that breastfeeding be initiated an hour after delivery, infants should be breastfed exclusively for 6 months and complementary foods be introduced from 6 months of age, with continues breastfeeding up to 2 years (WHO and UNICEF, 2013).
The first 28 days of life (the neonate period) represents the most vulnerable period of child survival (WHO, 2014). About 45% of under five deaths in 2013 were reported to have occurred during this period and proportion of neonatal death is said to have increase in all WHO region over the last 20 years (WHO, 2013). Exclusive breast feeding confers immunity against childhood illness such as diarrhoea, pneumonia, measles and susceptibility to obesity, types-2 diabetes and high blood pressure in later life (OELD/WHO, 2012). For mothers, breastfeeding enhances bonding, reduces the risk of breast and ovarian cancers, lowers rates of obesity and aids in fertility control (OEDL/WHO, 2012). Conversely, non-exclusive breast feeding has been associated with infant mortality, an increased susceptibility to and risk of dying from pneumonia and diarrhoea; and several life-long defects such as cognitive abnormalities, poor academic performance, decreased productivity and impaired social and intellectual development (Setegn et al., 2012). Global exclusive breast feeding rate to infant below 6 months of age is less than 40%. Thus, one of the strategies of the Sustainable Development Goals is to increase exclusive breast feeding rate in infants of 0-6 months to 50% (WHO, 2015).
Studies have shown that infant weight and height gains during early postnatal life are influenced by infant feeding practices (Picciano et al., 2001).
Over the last decade, overwhelming scientific evidence supporting the integral role of breastfeeding in the survival, growth and development of a child, as well as in the health and well-being of the mother, has come to light.
Breast milk has the complete nutritional requirements that a baby needs for healthy development.
Moreover, it is safe and contains antibodies that help protect infants and boost immunity. Consequently, breastfeeding contributes to reduced infant morbidity and mortality due to diarrhoea, respiratory infections, ear infections and other infectious diseases.
For the mother, breastfeeding is economical; breast milk is always available, clean and at the right temperature. Breastfeeding also delays the return of fertility and reduces the risk of developing breast and ovarian cancers (Nancy et al., 2002).
Variables that may influence breastfeeding include race, 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 (UNICEF, 2008).
To enable mothers to establish and sustain exclusive breastfeeding for six months, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) recommend:
(1) Initiation of breastfeeding within the first hour of life;
(2) Exclusive breastfeeding;
(3) Breastfeeding on demand that is – as often as the child wants;
(4) No use of bottles, teats or pacifiers (Jones et al., 2003).
Although breast milk is the best nutritional choice for infants, breastfeeding may not be possible for all women. For many women, the decision to breastfeed or formula feed is based on their comfort level, lifestyle, and specific medical considerations that they might have. Complementary feeding is intended as an effective substitute for infant feeding (Stevens and Patrick, 2009). Although production of an identical product to breast milk in not feasible, every effort has been taken to mimic profile of human breast milk for normal infant growth and development. Cow milk or soy milk are most commonly used as the base, with supplemental ingredients added to better approximate the composition to human breast milk and to attain health benefits. During the first six months of infant life, providing optimal nutrition is critical as the consequences of inadequate nutrition can be very severe. The purpose of this research is to explore the feeding practices and pattern of infant’s (0-6 months) growth and development in the Bamenda Health District.
1.2 STATEMENT OF PROBLEM
The World Health Organisation, UNICEF and Cameroon Ministry of Public Health recommended that children be exclusively breastfed from birth to six months and continue breastfeeding to 24 months and beyond for optimal survival and growth and development. However, only 20% of children aged less than 6 months in the country are exclusively breastfed (Chiabi et al., 2011). This means that if no action is taking to protect, promote and support breastfeeding, thousands of Cameroon children may die due to poor feeding practices. The unnecessary introduction of water and other fluids before six months reduces intake of breast milk and energy, absorption of iron, transfer of immune factors from breastfeeding and thus increases exposure to infection agents. Thus it is important to find out the growth and developmental patterns of children 0-6 months and how they are being feed to explore if this might have a bearing on the growth and development.
1.3 GENERAL OBJECTIVE
To explore the feeding practices on growth and developmental patterns of infants 0-6 months in the Bamenda Health District.
1.4 SPECIFIC OBJECTIVES
- To ascertain the types of feeding practices provided to infants 0-6 months in the Bamenda Health District.
- To examine if nutritional feeding practices could have a bearing in the growth and developmental of infants (0-6 months) in the Bamenda Health District.
- To find out the challenges mothers of infants (0-6 months) at the Bamenda Health District face in feeding their babies.
1.5 RESEARCH QUESTIONS
- What type of feeding practices is provided to infants in the Bamenda Health District?
- Could type of nutritional practices employed by mothers have a bearing on the growth and developmental patterns of infants in the Bamenda Health District?
- What challenges do mothers of infants (0-6 months) in the PMI face in feeding their babies?
1.6 SCOPE OF THE STUDY
In this study, only mother’s/babies pairs from 0 to 6months of age and who attends Infant Welfare Clinics (IWC) in Bamenda town precisely at the Tubah Hospital, General Hospital and PMI Nkwen will be included. The factors assessed include; Demographic data, Infant’s diet and challenges faced by mothers in feeding their babies.
1.7 SIGNIFICANT OF THE STUDY
This study is aimed at exploring the feeding practices, growth and developmental patterns of infants in order to ensure that infant and young child feeding recommendations are implemented at the community. Again, the findings of this study will serve as a guide for health workers in the counselling of mothers and care givers in infant and young child feeding recommendation. Furthermore, the policy makers will find this research finding a useful tool in the formulation of guidelines in ensuring appropriate feeding of infants and young children. And lastly, research findings will also form a base line for further research in infant nutrition.
1.8 DEFINITION OF KEY TERMS
Exclusive breastfeeding (EBF): Feeding the baby with only breast milk for the first 6 months of life, without adding any other foods or drinks including water; except for oral rehydration salts (ORS) and drops or syrups containing vitamins, minerals and medicines (WHO and UNICEF, 2003).
Complementary feeding (CF): Introduction of other foods to a baby along with breast milk, when breast milk alone is no longer sufficient to meet the infant’s growth needs. Recommended from 6 months of age (WHO and UNICEF, 2003).
Optimal infant feeding: Initiation of breastfeeding within an hour of birth, EBF for the first months, then CF from six months, with continued breastfeeding up to two years (WHO and UNICEF, 2003).
Bottle-Feeding: The infant is feeding from a bottle, regardless of its contents, including expressed breast milk (WHO and UNICEF, 2003).
Pre-lacteal feeds: Any foods given to a new-born before initiating breastfeeding (WHO and UNICEF, 2003).
Optimal infant feeding: Initiation of breastfeeding within an hour of birth, EBF for the first months, then CF from six months, with continued breastfeeding up to two years (WHO and UNICEF, 2003).
BREAST FEEDING PRACTICES ON GROWTH AND DEVELOPMENTAL PATTERNS OF INFANTS 0-6 MONTHS IN THE BAMENDA HEALTH DISTRICT NORTH-WEST REGION CAMEROON.
