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Journal of Pediatric and Womens Healthcare
2018 | Volume 1 | Edition 1 | Article 1001
ScienceForecast Publications LLC., | https://scienceforecastoa.com/ 1
1
Knowledge and Practices on Early Breastfeeding among
Mothers Delivering at a Teaching and Referral Hospital in
Uasin-Gishu County, Kenya
OPEN ACCESS
*Correspondence:
Boor FK, Department of Foods,
Nutrition, and Dietetics, University of
Eastern Africa, Baraton, P.O. Box 2500-
30100, Kenya.
Tel: +254721876127
E-mail: kiplagatboor@gmail.com
Received Date: 02 Nov 2017
Accepted Date: 15 Jan 2018
Published Date: 26 Jan 2018
Citation: Boor FK, Ogada IA Kimiywe
J. Knowledge and Practices on
Early Breastfeeding among Mothers
Delivering at a Teaching and Referral
Hospital in Uasin-Gishu County, Kenya.
J Pediatr Womens Healthcare. 2018;
1(1): 1001.
Copyright © 2018 Boor FK. This is an
open access article distributed under
the Creative Commons Attribution
License, which permits unrestricted
use, distribution, and reproduction in
any medium, provided the original work
is properly cited.
Research Article
Published: 26 Jan, 2018
Abstract
Background: e World Health Organization and United Nations International Children’s
Emergency Fund recommend initiation of breastfeeding within 30-60 minutes of delivery, giving
colostrum, and not giving pre and post-lacteals to newborns. Practices are however, still sub-
optimal. For instance, the prevalence of timely initiation of breastfeeding within 1 hour of birth
is 43% globally, 48% in sub-Saharan Africa, 62% in Kenya. e aim of this study was to establish
the knowledge and practices on early breastfeeding among mothers who deliver at a Teaching and
Referral Hospital, in Uasin-Gishu County, Kenya.
Methods: is was a cross-sectional study with mixed methods in data collection and analysis. A total
of 285 mothers delivering at a Teaching and Referral Hospital were consecutively sampled. Face-
to-face interviews were conducted with mothers using a researcher-administered questionnaire,
while Key Informant Interviews were conducted with the nutritionist and the nurse in charge of the
maternity ward. e early breastfeeding practices studied were time of initiation of breastfeeding,
giving of colostrum, pre and post-lacteals, as well as exclusive breastfeeding.
Results: Majority of the mothers were knowledgeable on: timely initiation of breastfeeding (74.6%),
giving colostrum (91.9%), while 99.6% and 91.2% knew that pre and post-lacteals should not be
given respectively. e mothers who practiced timely initiation of breastfeeding were 96.5%, 98.2%
gave breast milk as the rst feed, 90.5% did not give post-lacteal, while 94% gave colostrum. ere
was an association between maternal early breastfeeding knowledge and practices.
Conclusion: Most mothers had good knowledge and practiced the recommended early breastfeeding.
Keywords: Breastfeeding, Colostrum, Pre-lacteals, Post-lacteals, Breastfeeding initiation,
Knowledge, Practices
Boor FK1*, Ogada IA2 and Kimiywe J2
1Department of Foods, Nutrition, and Dietetics, University of Eastern Africa, Baraton, Kenya
2School of Applied Human Sciences, Department of Food, Nutrition, and Dietetics, Kenyatta University, Kenya
Abbreviations
BFHI: Baby Friendly Hospital Initiative; EBF: Exclusive Breastfeeding; UNICEF: United Nations
Children’s Fund; WHO: World Health Organization.
Background
Early breastfeeding practices have been shown to aect infant health, development, growth
and survival [1]. It is for this reason that the World Health Organization (WHO), United Nations
International Children’s Emergency Fund (UNICEF) and Kenya’s Ministry of health recommend
that aer delivery, optimal early breastfeeding practices should be encouraged by the healthcare
professionals in health facilities [1]. ese optimal early breastfeeding practices include: initiating
breastfeeding within 30 minutes to an hour of delivery; giving colostrum(the thick yellowish secretion
from the breast within the rst three days of the infant's life) [2]; not giving pre-lacteals(solids or
liquids given to a newborn before initiation of breastfeeding hence before colostrum, for instance
milk, honey, sugar water or herbs) [2]; not giving post-lacteals(solids or liquids given to a new born
aer initiation of breastfeeding, within three days of delivery) [2]; as well as exclusive breastfeeding
(EBF) (giving a newborn breastmilk only, and nothing else except vitamins, mineral supplements or
other prescribed medication) [3].
Optimal practices such as timely initiation of breastfeeding, feeding colostrum, exclusive
Boor FK, et al., Journal of Pediatric and Womens Healthcare
2018 | Volume 1 | Edition 1 | Article 1001
ScienceForecast Publications LLC., | https://scienceforecastoa.com/ 2
breastfeeding, skin-to-skin contact between mother and newborn,
and rooming-in(newborn staying in the same room with the
mother), can prevent up to 1.4 million deaths of children under 5
years of age annually, and about 10% of the annual disease burden
[4 and 5]. Further, an association between giving of pre-lacteal feeds
and delayed breastfeeding has been reported [6]. e reduction
of neonatal morbidity and mortality may lead to the attainment of
the goal 3 targets of the Sustainable Development Goals of ending
preventable deaths of newborns and children under 5 years of age
by 2030.
Several strategies have been developed internationally and in
Kenya to promote and protect early breastfeeding. ese include
the International code of marketing of breast-milk substitutes, the
Innocenti declaration, the Global IYCF strategy, Kenya IYCF strategy
and the international Baby-Friendly Hospital Initiative (BFHI). In
Kenya, the Ministry of health standard procedures recommend health
education to mothers during the antenatal period, at delivery and aer
delivery at mother and child health clinics and at community level by
Community Health Volunteers. Several studies however, show that
the strategies advocating that mothers be supported and helped with
breastfeeding in maternity care facilities inuence early breastfeeding
practices directly at the hospital level [7], but this inuence reduces
aer the mother leaves the health facility.
e prevalence of timely initiation of breastfeeding is 43%
globally, 45% in sub-Saharan Africa, 60% in Eastern and Southern
Africa and 53% in the least developed countries [8]. In Kenya, the
rate of initiation of breastfeeding within 1 hour is 58% of children
ever breastfed, while 42% are given something before breastfeeding
(pre-lacteals). In the former Ri valley province of Kenya, where this
study was conducted, 63.7% of children ever breastfed are initiated
to breastfeeding within 1 hour [9]. Statistics indicate that early
breastfeeding practices are still sub-optimal in Kenya, specically in
Uasin-Gishu County, and this presents a challenge to meeting the
Sustainable Development Goals (SDGs) and Kenya Vision 2030 in
this area.
Early breastfeeding practices are partly inuenced by maternal
knowledge, as these help a mother make decisions on whether and how
she will breastfeed. It is therefore, important for healthcare systems to
strengthen interventions that improve maternal knowledge and skills
on the recommended practices. ere is limited literature on the early
breast feeding knowledge, and practices of mothers who deliver in
hospital, and none has been conducted in Uasin-Gishu County. It is
against this background that this study was conducted. e ndings
of this study may benet stakeholders such as the Ministries of
Health, Uasin Gishu county, as well as other organizations concerned
with infant and young child health, as it highlights the gaps in early
breastfeeding knowledge and practices among mothers delivering at
health facilities.
Methods
Research design and location
e study adopted a cross-sectional design applying mixed
methods (qualitative and quantitative techniques) in data collection,
analysis and presentation.
e study was carried out at a Teaching and Referral Hospital in
Uasin-Gishu County, Kenya from from 12th March, 2016 to 2nd April,
2016. e Teaching and Referral Hospital was selected for the study
because of its location in the region. Being the second largest referral
hospital in Kenya it serves a wide population the central and north
ri region, Nyanza and western Kenya regions and also some parts of
Uganda. It has a well-established maternity facility which has a bed
capacity of 500 beds and conducts up to 12,000 deliveries per year
(30 daily) [10]. It has operating rooms for cesarean deliveries, and a
neonatal intensive care unit which can care for 100 newborns at any
given time [10]. e standard operating procedures at the hospital
for a new delivery promote: timely initiation of breastfeeding, giving
colostrum, not giving pre and post-lacteals, rooming in, skin-to-skin
contact and exclusive breastfeeding. is is done by educating all
pregnant and lactating mothers during their visits to the clinics as
well as during delivery [11].
Study population
e study targeted mothers 15-49 years of age who had delivered
at the Teaching and Referral Hospital but had not been discharged
from the hospital aer delivery. e average number of births per day
in the Teaching and Referral Hospital is 30, with an average of 900 per
month [10]. All the targeted mothers with newborns 0-72 hours of
age that were delivered at the teaching and referral hospital, and not
yet discharged were included in the study. e mothers who delivered
through cesarean section, were too weak to respond to questions and
those who declined to give informed consent were excluded from the
study.
Sample size
e sample size was 283 newborn-mother pairs calculated
based on a standard normal deviate at 95% condence level (1.96),
an estimated proportion of mothers in Ri valley who initiate
breastfeeding within one hour at 69.4% [9], and a desired level of
precision of 0.05 for a target population less than 10,000.
A further ten percent of the calculated sample size was added to
cater for non-response.
In addition, two key informants (1 Nurse in charge of the
maternity ward and 1 Nutritionist) participated in the study.
Sampling techniques
e Teaching and Referral Hospital was purposively selected
because it has a well-established maternity facility, and serves a large
population in the North Ri region of Kenya. Cluster sampling
was used when selecting the mothers to be interviewed. Mothers’
dormitories were divided into clusters, then the clusters were
randomly selected. All mothers in the randomly selected cluster
were interviewed to participate in the study until the sample size was
achieved.
3.90%
22.30%
73.90%
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
Low knowlwdge
(0-3)
Average
knowledge (4-6)
High knowledge
(7-8)
Percentage
Knowledge scores
Maternal Knowledge Scores
Figure 1: Maternal knowledge scores on early breastfeeding,
Boor FK, et al., Journal of Pediatric and Womens Healthcare
2018 | Volume 1 | Edition 1 | Article 1001
ScienceForecast Publications LLC., | https://scienceforecastoa.com/ 3
e two key informants were purposively selected because they
were the most knowledgeable on early breastfeeding practices at
the maternity ward. is is because they had worked in this ward
for a period of more than one year and were also in charge of their
respective specialties at the ward.
Data collection instruments and procedures
One time face to face interviews were conducted with mothers at
the hospital using a validated researcher-administered questionnaire
[12 and 13]. ese elicited information on:
1. Maternal and newborn socio-economic and demographic
characteristics.
2. Early breastfeeding knowledge among mothers on: the
importance of breastfeeding; timely initiation of breastfeeding;
colostrum; pre-lacteals; and post-lacteals.
3. Maternal early breastfeeding practices such as time of
breastfeeding initiation, giving colostrum, any pre-lacteal feeds given,
any post-lacteal feeds given, skin-to-skin contact, and rooming-in.
To enhance the validity and reliability of the questionnaire, a pre-
test was conducted with 28 mothers who did not participate in the
main study, but had similar characteristics as the study participants.
During the pre-test, data was collected twice at an interval of two
days from the same participants. A comparison was then made
between the responses obtained from both interviews and correlation
coecient of 0.90 (0.80-0.99; 95% CI) was achieved. is indicated
adequate reliability of the questionnaire [14].
In addition, two Key informant interviews (KII) were conducted
with the nutritionist in her oce and the nurse in charge of the labor
ward at the nurse’s station. Two pre-tested KII guides were used
and these elicited information on the prevalent early breastfeeding
practices among mothers delivering at the hospital, the policies and
standard operating procedures of promoting early breastfeeding
at the hospital, and the early breastfeeding challenges faced by the
healthcare sta and mothers delivering at the hospital.
Data analysis and presentation
Data was analyzed using Statistical Package for Social Sciences
Maternal and infant demographic and socio-economic
characteristics
N=283
N %
Age of mother in complete years
Mean ± SD (28.89±6.67)
15 – 24 81 28.7
25 – 34 145 51.2
35 – 44 55 19.4
45 -47 2 0.7
Total 283 100
Marital Status of mother
Married 156 55.1
Single 123 43.5
Separated 4 1.4
Total 283 100
Parity
Mean ± SD (2.38±1.51)
1 – 2 181 64
3 – 4 69 24.4
More than 5 33 11.6
Total 283 100
Level of education
Completed college/university 109 38.7
Completed Secondary 83 29.4
Completed primary 59 20.9
No formal education 31 11
Total 283 100
Occupation of mother
Housewife 101 35.7
Self-employed 74 26.1
Professional 54 19.1
Student 45 15.9
Farmer 9 3.2
Total 283 100
Infants’ age in hours
Mean ± SD (45.30±18.70)
0-24 hours 36 12.7
25-48 hours 100 35.4
49-72 hours 147 51.9
Total 283 100
Sex of infants
Male 163 57.6
Female 120 42.4
Total 283 100
Table 1: Maternal and infant demographic and socio-economic characteristics.
*Multiple response.
Aspects of knowledge N=283
N %
Importance of breastfeeding*
Knew that breastmilk is
nutritious 208 74.6
Knew that it protects against
infections 64 22.9
Knew that it prevents pregnancy 3 1.1
Do not know any importance of
breastfeeding 4 1.4
Maternal knowledge on baby’s
rst feed
Knew that breast milk only
should be the rst feed 281 99.6
Knew that Pre-lacteals should
be rst feed 2 0.4
Time of initiation of
breastfeeding
Within 30 minutes 204 72.1
Within 1hour 6 2.1
More than 1hour 73 25.4
Newborns should be given
colostrum
Yes 260 91.9
No 23 8.1
Post-lacteal feeds should not
be given to newborns
Yes 25 8.8
No 257 91.2
Appropriate age to introduce
other foods
Correct (at 6 Months) 236 83.4
Incorrect 47 16.6
How often to breastfeed the
baby
On demand 164 58
At specic times 119 42
Exclusive breastfeeding is
recommended
Yes 258 91.2
No 25 8.8
Table 2: Maternal knowledge on early breastfeeding practices.
*Multiple responses given.
Boor FK, et al., Journal of Pediatric and Womens Healthcare
2018 | Volume 1 | Edition 1 | Article 1001
ScienceForecast Publications LLC., | https://scienceforecastoa.com/ 4
(SPSS) version 23.0. Descriptive statistics including means,
frequencies, percentages, and standard deviation were generated
for demographic and socio-economic characteristics of the study
participants, as well as their knowledge and practices. Chi-square
was used to determine the association between categorical data
such as the early breastfeeding knowledge and practices. Statistical
signicance was set at p<0.05. e key informant interviews were
transcribed verbatim and content analysis conducted by categorizing
into key pre-determined themes: the prevalent early breastfeeding
practices among mothers delivering at the hospital; the policies and
standard operating procedures of promoting early breastfeeding at
the hospital.
Logistical and ethical considerations
Ethical clearance was obtained from the Kenyatta University
Ethical Review Committee, ethical review number KU/R/
COMM/51/566 and the Institutional Research and Ethics Committee
of Moi University, approval number 0001541. A research permit
was obtained from the Kenyan National Commission for Science,
Technology and Innovation (NACOSTI).
Voluntary, informed consent in the form of signatures or thumb
prints, was solicited from all participants. ose who declined
to participate were excluded from the study. e participants’
condentiality and anonymity was ensured by use of codes as
identication rather than names.
Results
A total of 315 mothers were eligible to participate in this study.
Out of these, 285 consented while 30 declined to participate and were
therefore excluded. e questionnaire was administered to all 285
mothers who were recruited to participate in the study aer signing
the consent form. Out of the 285 questionnaires, 2 were incomplete,
therefore 283 questionnaires were analyzed. e response rate was
99.3%, a response rate of more than 60% is considered adequate [15].
For the qualitative data, 2 key informants were interviewed and both
responded adequately to the questions asked.
Demographic and socio-economic characteristics of the
participants
e mean age of the mothers was 28.9±6.7 years, with the youngest
and the oldest mother being 15 years and 47 years respectively (Table
1).
About half (51.2%) of the mothers were between 25-34 years
of age. Slightly more than half (55.1%) were married, while 64.0%
had between 1 to 2 children. e mean number of children being
2.38±1.51. Slightly over a third of the mothers (38.7%) had college
or university level of education, while 11% did not have any formal
education. About a third (35.7%) of the women were housewives.
e mean ages of the infants was 45.30±18.70 and was determined
in hours since delivery. Half of the infants (50.8%) were 49-72 hours
of age, 32.9% were 25-48 hours of age while 16.3% were less than 24
hours of age. ere were more male infants (57.6%), than females
(42.4%).
Maternal knowledge on the recommended early
breastfeeding practices
e majority of the mothers knew the importance of breastfeeding,
with 74.6% knowing that breast milk is nutritious (Table 2), and
the least (1.1%) knowing that it prevents pregnancy by delaying
amenorrhea. Almost all mothers (99.9%) knew that breast milk is
Maternal early breastfeeding practices
N=283
N %
Time of breastfeeding initiation after
delivery
0-30 minutes 84 29.7
31-60 minutes 189 66.8
After one hour 10 3.5
Total 283 100
First feed
Breast milk 278 98.2
Non-breast milk
(pre-lacteal) 5 1.8
Total 283 100
Baby fed colostrum
Yes 266 94
No 17 6
Total 283 100
Post-lacteal feeds given
Yes 27 9.5
No 256 90.5
Total 283 100
Bottle Fed
Yes 19 6.7
No 264 93.3
Total 283 100
Skin to Skin care
Yes 276 97.5
No 7 2.5
Total 283 100
Rooming-in
Within one hour 262 92.6
After one hour 21 7.4
Total 283 100
Exclusive breastfeeding
Yes 256 90.5
No 27 9.5
Total 283 100
Mother skill on positioning and attaching
the baby to the breast
Correct 254 89.7
Incorrect 29 10.3
Total 283 100
Table 3: Maternal early breastfeeding practices.
Aspects of knowledge and practices N=283
Knowledge Practices Pearson’s Chi-
square P value
Yes No
Timely initiation to breast
milk n(%) n(%)
Yes 204(72.1) 6(2.1)
0.28 0.599
No 70(24.7) 3 (1.1)
First feed
Yes 278(98.2) 4(1.4)
55.80 0.000*
No 0(0.0) 1 (0.4)
Post-lacteals given
Yes 10(3.5) 15(5.3)
25.01 0.000*
No 20(7.1) 238(84.1)
Give colostrum
Yes 255(90.1) 5(1.8)
94.50 0.000*
No 11(3.9) 12(4.2)
Table 4: Association between maternal knowledge and practices.
*Signicant at p<0.05.
Boor FK, et al., Journal of Pediatric and Womens Healthcare
2018 | Volume 1 | Edition 1 | Article 1001
ScienceForecast Publications LLC., | https://scienceforecastoa.com/ 5
the only recommended rst feed for the baby aer a safe delivery.
For timely initiation of breastfeeding, most of the mothers (72.1%)
knew that breastfeeding should be initiated within 30 minutes aer
delivery, while 25.4% did not know the appropriate time to initiate
breastfeeding. e majority of the mothers (91.9%) knew that a baby
should be fed on colostrum while 8.1% reported that colostrum is
not important. For post-lacteals, a majority of the mothers (91.2%)
knew that these should not be given to newborns, while 8.8% thought
that post-lacteals could be given to the newborns aer initiation
of breastfeeding. A similar observation was made with exclusive
breastfeeding, as 91.2% knew that it is recommended to exclusively
breastfeed.
e KII ndings pointed out that mothers received information
from the healthcare personnel. “ere are manuals used to educate
mothers. We also provide brochures and the Mother and child health
(MCH) booklets to the mothers. At the back of each booklet there are
short well-written instructions on how to breastfeed, the positioning of
the baby to the breast and what to do to enable them to produce enough
breast milk” (KI1, 2016). It was also indicated that the information is
given both at antenatal and postnatal clinics. “We educate mothers
verbally during prenatal and post-natal visits in groups and one on one
when the need arises” (KI1, 2016).
Maternal knowledge scores on early breastfeeding
In reference to Mucheru et al. (2016) where low knowledge ranged
between 0 – 40%, average knowledge 50-70% and high knowledge 80-
100%, the knowledge score was calculated for all mothers on aspects
of early breastfeeding (Figure 1).
Mothers were scored on the 8 questions as shown in Table 2. Each
correct response scored one point while an incorrect response was not
awarded any score. A total score was calculated for each participant
based on the right answers. erefore, each mother could score a
maximum of 8 points and a minimum of 0 points. Most mothers had
a high knowledge on recommended breastfeeding practices as 73.9%
scored a total of 7-8 points out of the possible maximum of 8. e
mean maternal knowledge score for all mothers’ based on individual
mother’s total score was high at 6.75 with a standard deviation of
±1.26 (Figure 1).
Maternal early breastfeeding practices
Majority of the women initiated breastfeeding within one hour
of delivery, with 29.7% initiating within 30 minutes, and 66.8% of
mothers initiating aer 30 minutes but within an hour aer delivery
(Table 3).
Similarly majority of the mothers (98.2%) had fed the newborns
with breast milk as the rst feed aer delivery, while 1.8% had given
pre-lacteals aer delivery. Most newborns (94.0%) were fed on
colostrum, while 90.5% were not given any post-lacteals other than
breast milk aer breastfeeding initiation.
e KII ndings also indicated that culture and cultural beliefs
played a role in inuencing the use of pre and post lacteals by mothers
in early breastfeeding stages. According to (KI2, 2016), “ere is a
belief that when a baby has been delivered, they have to be given a local
herb or local concoction aer birth. Mothers believe that it washes the
digestive system of the baby. Usually, the mother-in-law comes aer
the baby has been delivered and secretly gives the concoction”. It was
also reported that “Some mothers think that colostrum is dirty and
therefore not safe for the baby and so they discard it. In fact, it is the
mother-in-law or the mother’s mother who encourage them to express
the colostrum and discard it” (KI1, 2016).
Association between maternal knowledge on early
breastfeeding and their practices
Chi-square test was used to test for association between maternal
knowledge on early breastfeeding and their practices (Table 4). e
aspects of knowledge and practices were timely initiation to breast
milk, rst feed of the baby, giving post-lacteals and giving colostrum
to the baby. ere was no association between a mother’s knowledge
on timely initiation to breastfeeding and her practicing timely
initiation to breastfeeding (chi-square: 0.28; p=0.599). Signicantly a
higher proportion of mothers knew that breast milk is the baby’s rst
food, they also gave breast milk as the rst feed (chi-square: 55.80;
p=0.000); knew that post-lacteals should not be given to a baby, and
did not give pre-lacteals to the babies (chi-square: 25.01; p=0.000).
knew that a baby should be given colostrum, they also gave colostrum
to the babies (chi-square: 94.50; p=0.000).
e ndings showed that there was an association between early
breastfeeding knowledge and maternal practices.
Discussion
e international baby-friendly hospital initiative (BFHI) aims
to promotes and protect maternal and child health by ensuring that
mothers are supported and helped with breastfeeding in maternity
care facilities [7]. Giving mothers’ information about the benets of
breastfeeding might inuence those who have not already made a
decision, or those whose decision is not nal [17].
e ndings of the current study indicate that women were
knowledgeable on most aspects of early breastfeeding. Mothers’
knowledge on timely initiation was high, where mothers knew that it
should be started within an hour of birth. ese results are similar to
one conducted in Nyando-Kenya which also indicated that mothers’
knowledge on the importance of giving colostrum was high which
is in agreement with the ndings of this study. Mothers knew that
pre-lacteals should not be given to the baby, and that babies should
not be introduced to other feeds before six months. e study also
reported a high percentage on the mothers knowledge on exclusive
breastfeeding. A study in in Ethiopia which indicated that women
knew that giving pre-lacteal was a means of cleaning the babies
stomach diered with the ndings of the current study [21].
e early breastfeeding practices which include timely initiation,
giving colostrum, and practicing rooming-in have positive benets
to the infants. ese are the reduction of neonatal morbidity and
mortality, according to FAO, (2007) as cited by a study conducted in
India [5]. Exclusively breastfed infants can experience extra benets if
breastfeeding starts within an hour of birth [19]. A study conducted
in Nigeria, stated that early breastfeeding has the potential to foster
successful establishment and duration of breastfeeding [20]. e
study ndings indicated that most mothers practices timely initiation
to breastfeeding within an hour aer delivery, which was similar to an
Kenyan study which reported that most of the participants initiated
breastfeeding within one hour [21]. e Kenyan study however,
covered data on children 0-1 month whereas this study covered the
rst 72 hours of birth. e higher rates of timely initiation can be
attributed to the fact that the mothers delivered at a health facility
which is most likely to implement the recommended practice.
e ndings of this study indicated that use of pre-lacteals was
Boor FK, et al., Journal of Pediatric and Womens Healthcare
2018 | Volume 1 | Edition 1 | Article 1001
ScienceForecast Publications LLC., | https://scienceforecastoa.com/ 6
very low among the mothers, despite the challenge of mother-in-laws
and caretakers bring to the hospital some concoctions to the hospital
as reported by the key informants. e rate of giving colostrum was
very high in this study as indicated by the study ndings, the ndings
contrasted with studies in Southern Ethiopia, and Nigeria, where
some women considered colostrum as expired milk and gave pre-
lacteal feeds instead and discarded the colostrum, some even viewed
it as pus, and that breastfeeding was commenced aer 3 – 6 days [18
and 22].
e rate of rooming-in according to the study ndings was
good as the World Health Organization emphasizes it and that the
activities of the rst three days aer birth have a signicant eect on
successful breastfeeding. It improves maternal attachment, increases
breastfeeding rates signicantly, it also reduces incidences of abuse,
abandoning of the infant and failure to thrive [23]. Mothers practiced
skin-to-skin care where babies were placed in close body contact with
their mothers aer birth. A study in the United Kingdom suggested
that neonatal sta must encourage and empower parents to care for
and form an attachment with their new baby because this will not
only boost parents' condence in handling their babies whilst in
hospital but will also increase their competence when the baby is
discharged [24].
Limitations of the Study
e study did not observe the early breastfeeding practices
but relied on information reported by the mothers. Probing and
collecting the data within 72 hours of delivery was however done to
minimize recall bias.
Conclusions
Generally, from the study’s ndings, the rate of initiation of
breastfeeding is high, and the use of post and pre-lacteal feeds is low
possibly due to the maternal education conducted at the MCH clinics.
is can also be attributed to a higher rate of women practicing skin-
to-skin contact and rooming-in. e provision of the brochures on
early breastfeeding practices by the hospital as reported by the key
informants may have inuenced their practices on early breastfeeding.
e good maternal practices are expected to have a positive outcome
for the babies and their mothers. However gaps exist on the inuence
of culture towards giving traditional herbs (pre and post-lacteals).
Recommendations
e healthcare personnel should continue with education even
aer mothers have been discharged from the hospital, however they
should strengthen areas such post-lacteal education to avoid the
inuence of culture.
Acknowledgements
e authors wish to thank all the participants who consented to
participate in the study, and the management of the Teaching and
Referral Hospital for giving authority to conduct the study in their
health facility.
Funding
e study was funded by the authors.
Availability of Data and Materials
Data and materials will not be shared by the author because
the health facility hasn’t granted authority and also to preserve
participants condentiality.
Authors’ Contributions
FKB conceived and designed the study, supervised data
collection, performed data analysis, data interpretation and
manuscript preparation. IO critically reviewed it for intellectual
content, participated in the designing and supervision of the study
and manuscript preparation. JK participated in the designing and
supervision of the study as well as manuscript preparation. e
authors read and approved the nal manuscript.
Ethics Approval and Consent to Participate
Ethical clearance was obtained from the Kenyatta University
Ethical Review Committee, ethical review number KU/R/
COMM/51/566 and the Institutional Research and Ethics Committee
of Moi University, approval number 0001541. A research permit
was obtained from the Kenyan National Commission for Science,
Technology and Innovation (NACOSTI).
Voluntary, informed consent in the form of signatures or thumb
prints, was solicited from all participants. ose who declined to
participate were excluded from the study. e participants were
guaranteed of condentiality and anonymity by use of codes as
identication rather than names.
Authors’ Information
Department of Foods, Nutrition, and Dietetics, University of
Eastern Africa, Baraton, Kenya. P.O. Box 2500-30100, Eldoret-Kenya.
Department of Food, Nutrition, and Dietetics, Kenyatta
University, Kenya. P.O. Box 43844-00100, Nairobi-Kenya.
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