Knowledge and practice of mothers regarding breast feeding: A hospital based study

Abstract

Background: Although breastfeeding is a common practice in Nepal, proper breastfeeding is on the decline due to several factors. The impact of knowledge about breastfeeding practice, i.e., duration of breastfeeding, proper techniques, proper time of weaning is poorly understood. Objective: To assess the knowledge and actual practices of mothers regarding breastfeeding. Methods: Cross sectional study was carried out on 200 mothers of under 1 year old children who attending the pediatric Out Patient Department, well baby clinic and immunization clinic at BPKIHS, Dharan. Mothers were interviewed using pre-designed questionnaire. Result: All mothers knew that they had to breast feed their babies, but they did not have adequate knowledge about the appropriate way of breastfeeding. 10% knew that they have to initiate breast feeding within ½ hour of birth, 10% had idea on prelacteal feed, 25% had idea on importance of colostrums, 15% knew the meaning of exclusive breast feeding, and 15% of the mothers had idea on importance of night feeding. 41.5% mothers initiated breast feeding within ½ hour of birth, 33% mothers gave prelacteal feed, colostrum was fed by 95%, 15% were practicing exclusive breast feeding, 90% mothers were practicing night feeds, 15% mothers practiced feeding one side at a time, 60% mothers were practicing inappropriate attachment and positioning, None of the mothers got any advice regarding breast feeding during ANC visits. Conclusion: Undesirable cultural practices such as giving prelacteal feeds, late initiation of breastfeeding after birth, delay in introduction of weaning foods and avoiding exclusive breastfeeding are still prevalent among the mothers. The maternal knowledge towards breast feeding was inadequate and there was a big gap between actual and desired practices.

Full text

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Knowledge & practice in breast feeding
__________________________________________________
Address for correspondence
Ramanand Chaudhary, Associate Professor
Department of Child Health Nursing, College of Nursing
B.P. Koirala Institute of Health Sciences Dharan Nepal
Email: ramanandachaudhary@yahoo.com,
¡ Original Article
Knowledge and practice of mothers regarding breast feeding: a hospital
based study
RN Chaudhary1, T Shah2, S Raja3
1Department of Child health Nursing, 2Department of Community Health Nursing, 3Department of
Pediatrics, BPKIHS Dharan
Abstract
Background: Although breastfeeding is a common practice in Nepal, proper breastfeeding
is on the decline due to several factors. The impact of knowledge about breastfeeding
practice, i.e., duration of breastfeeding, proper techniques, proper time of weaning is poorly
understood. Objective: To assess the knowledge and actual practices of mothers regarding
breastfeeding. Methods: Cross sectional study was carried out on 200 mothers of under 1
year old children who attending the pediatric Out Patient Department, well baby clinic and
immunization clinic at BPKIHS, Dharan. Mothers were interviewed using pre-designed
questionnaire. Result: All mothers knew that they had to breast feed their babies, but they
did not have adequate knowledge about the appropriate way of breastfeeding. 10% knew
that they have to initiate breast feeding within ½ hour of birth, 10% had idea on prelacteal
feed, 25% had idea on importance of colostrums, 15% knew the meaning of exclusive
breast feeding, and 15% of the mothers had idea on importance of night feeding. 41.5%
mothers initiated breast feeding within ½ hour of birth, 33% mothers gave prelacteal feed,
colostrum was fed by 95%, 15% were practicing exclusive breast feeding, 90% mothers
were practicing night feeds, 15% mothers practiced feeding one side at a time, 60% mothers
were practicing inappropriate attachment and positioning, None of the mothers got any
advice regarding breast feeding during ANC visits. Conclusion: Undesirable cultural
practices such as giving prelacteal feeds, late initiation of breastfeeding after birth, delay in
introduction of weaning foods and avoiding exclusive breastfeeding are still prevalent among
the mothers. The maternal knowledge towards breast feeding was inadequate and there
was a big gap between actual and desired practices.
Keywords: breast feeding, colostrum, weaning,
Introduction
After birth the health of the baby depends upon the
nurturing practice adopted by the family. The ideal
food for the young infant is human milk which has
the specific characteristics that match the growing
infants’ nutritional requirements.
Breastfeeding is a socially constructed and controlled
practice.1 It is often presented as a natural practice,
sadly corrupted and curtailed by cultures. The
Innocenti Declaration of 1990 August, Florence, Italy
presents breastfeeding as best practice for mothers
and babies. As a global goal for optimal maternal
and child health and nutrition, all women should be
enabled to practice exclusive breastfeeding, and all
infants should be fed exclusively on breast milk, from
birth to 6 month of age (March 2001).2 Breastfeeding
is nearly universal in Nepal and the median duration
of breast-feeding is long (33 months).3 But on the
contrary to the recommendations of WHO only 2/
3rd of children less than 6 months of age are

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Knowledge & practice in breast feeding
exclusively breast fed.3 Numerous barriers to breast-
feeding like lack of accurate information and lack of
appropriate knowledge among the population in
general have been identified. According to a
published survey4, a major barrier to successful in-
hospital breast-feeding is inconsistency in information
and nursery practices related to breastfeeding
management. This study was carried out based on
the fact that knowledge of mothers and their
appropriate practice regarding breastfeeding is
limited, then focusing on women’s point of view
towards breast-feeding.
Methods
A cross sectional study was carried out in pediatric
OPD and immunization clinic of BPKIHS. The study
subjects were lactating mothers having children aged
under 1 year of age, who attended their children for
vaccination and for the treatment of other minor
illnesses. The purposive sampling technique was used
to select the study subjects. Information regarding
patients’ demographics, knowledge and practice
towards breastfeeding were collected from these
mothers on a pre-designed and pretested proforma.
Before collecting the information, permission was
taken from the institute authority and verbal consent
was taken from the respondents. The data was
entered in SPSS 10.5 software package and
analyzed.
Results
The results of this study are presented in the below
mentioned tables and figures.
Characteristics
200 respondents considered for this study were
mothers of children under one year of age. The
background characteristics are shown in table 1.
Table 2 shows the age and sex distribution of the
children.
Table 1: Participants’ characteristics
n = 200
S.N. Background Frequency Percent
1. Age (Years)
15 - 25 yrs 132 66.0
25 - 35 yrs 59 29.5
35 - 45 yrs 94.5
Mean Age: 23.93 Years
2. Education completed
Illiterate 41 20.5
Literate 31.5
Less than high school 127 63.5
More than high school 29 14.5
3. Occupation
Housewife 188 94.0
Employed 12 6.0
4. Religion
Hindu 196 98.0
Muslim 31.5
Christian 00.0
Buddhist 10.5
5. Place of residence
Urban 50 25.0
Rural 150 75.0
6. Number of children
One 115 57.5
Two 53 26.5
Three 23 11.5
Four 94.5
7. Place of delivery
Home 112 56.0
Health centre 21 10.5
Hospital 67 33.5
Table 2: Biological Characteristics of Children
n = 200
S.N. Variables Frequency Percent
1. Sex
Male 113 56.5
Female 87 43.5
2. Present age
(in Month)
<6 month 45 22.5
6 - 12month 155 77.5
Knowledge of breastfeeding
Mother’s knowledge on various aspects of
breastfeeding was seen. Appropriate knowledge was
not adequate.

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Initiation of breast feeding
Only 10% mothers had idea on starting breast feeding
within ½-1 hr of birth (Table 3) and in practice 41.5%
mothers started breast feeding within ½-1hr of birth.
Data from 2006 NDHS showed that nearly 1 in 3
children were breast-fed within ½-1hr. In this study,
in 41.5% cases breastfeeding was given within 1
hour, and in 16% cases breastfeeding was given after
1 day. According to NDHS 2001 data this was noted
in 60% cases.8
Colostrum, prelacteal feed, and exclusive
breast feeding
The use of colostrum and avoidance of prelacteal
foods are cornerstones in early infant nutrition and
may be prerequisites for the establishment of future
exclusive breastfeeding. Since 2001, the WHO
recommends exclusive breastfeeding up to the age
of 6 months (World Health Assembly Resolution
55.25). Colostrum was defined as the breast milk
produced in the first five days after delivery. In this
study though only 25% mothers had knowledge on
benefits of first milk (Table 3) but in practice nearly
95% had received colostrum shown in figure 2. This
was 69 percent in data given by NDHS 2006.9 In
another study all infants had received colostrums
(94%, n = 475/504).9 Out of 200 mothers, 33% gave
pre-lacteal feed (Figure 3). Prelacteal food was
defined as food/liquid given to the infant before
initiating breastfeeding for the first time. According
to NDHS 2006, prelacteal feed is more in terai where
2 in 3 children receive them.9 Only 15% mothers
knew meaning of exclusive breast feeding (Table 3)
but in practice 23.5% (Figure 4) were practicing
exclusive breast-feeding. Mothers not able to give
exclusive breastfeed were 76.5%. Only 2/3 of
children less than 6 months are exclusively breast
fed according to NDHS 2006.9 In Bolivia, the
exclusive breastfeeding rate in infants under 4 months
of age was found to be above 50%, with 13.6 % of
infants still being exclusively breastfed at 6–9 months
of age.11 In a second study, only 30% of infants in
Bolivia had begun receiving solid foods by 4 months
of age.11
Importance of night feed
Prolactin is secreted after feed to produce next feed.
As secretion of prolactin is more at night, suckling at
night is encouraged. 15% of the mothers knew the
importance of night feed but while coming to practice
they were doing well. 90% (Figure 6) mothers were
practicing night feed. This was due to baby’s demand
even at night.
Breast feed at one side
Breast feeding at one side until whole breast is
emptied out should be the practice among mothers.
This way the baby gets the hind milk, which is
required for brain development. Only 5% mothers
knew that they had to breast feed on one side until
whole breast was emptied but 15% were practicing.
They were hospital staff or relatives of medical
personnel. 85% were feeding on both sides for 10
minutes each (Figure 5), thinking that feeding on one
side is not enough for the baby and some thought
their breast size would become unequal.
Duration of breast feeding
According to the data collected in NDHS 2006, the
man duration of breast feed in Nepal is 29 months.9
Median duration in this study was 27 months. In this
study, mothers willing to breast feed for 2 years and
more were more than double in male babies than
female babies. However, mothers did agree to breast
feed female babies too for at least 2 years. When
asked for their opinion on the ideal duration of any
breastfeeding, most mothers answered 12–24
months (85%).
Attachment and position
Improper attachment and position is one of the main
causes for lactation failure. It was seen that 60%
mothers did not have proper attachment and position
during breastfeeding and required teaching on
appropriate methods. Remaining 40% having good
attachments were multipara or had child more than
5 months old.
Use of expressed breast milk
Expressed breast milk can be used, and for working
mothers this is one way to continue breast feed even
when they are away from their babies. Only 10%
mothers knew about expressed breast milk because
they were using for their neonates admitted in NICU
care. More than 90% mothers said it cannot be used.

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Some thought milk becomes bad once it is expressed.
Others said it becomes cold and carries infection.
Breastfeeding advised during ANC
None of the mothers got any advice regarding
breastfeeding during ANC. Many mothers in
postnatal ward felt that they had not received enough
support during prenatal period. Similar problem was
seen in some other study,8 91.9 % (386/420) of the
women had not been informed about breastfeeding
before the birth of their child. On the basis of this
study, it is reasonable to advocate that in Nepal,
breastfeeding information should be supplied before
birth or perhaps even more importantly, on the
maternity ward. Breastfeeding promotion programs
on a maternity ward setting should include more than
just verbal information; e.g. rooming-in, breastfeeding
assistance and talks during hospitalization. The
maternity ward may also provide mothers with a place
to exchange ideas.
Conclusion
200 mothers from eastern part of Nepal are not
representative of the whole population of the country.
Hence a definite conclusion cannot be given from
this study. However it can be suggested from this
study that maternal knowledge and practices
regarding breastfeeding is inadequate and in some
areas, grossly deficient. There is a need for health
education program aimed at educating mothers on:
(1) Initiation of breast feeding within ½ -1 hr after
birth, (2) Exclusive breast feeding till 6 months of
age, (3) Importance of night feed and colostrums,
(4) Continue breast feeding till 2 years, (5) Feed
completely on one side at a time, (6) Use of
expressed breast milk, (7) Support for proper
attachment and positioning, and (8) dangers of bottle-
feeding. Obstetricians are likely to have more
influence on breastfeeding initiation and Pediatricians
on breastfeeding durations. One of the factors
hindering breastfeeding is that medical experts
themselves may not possess sufficient knowledge
on breastfeeding. Several factors influence success
or failure of breastfeeding, including the mother’s
and family’s commitment. Since physicians can
influence this commitment, their positive attitude and
knowledge is crucial in the prenatal period. Finally,
to change the current trends, training programmes
regarding breastfeeding should be developed for the
implementation in obstetric and pediatric residents
and also nursing staffs. This study also recommends
further study on knowledge and practice of mothers
on breastfeeding covering large sample in community
level.
Acknowledgement
The authors express their sincere thanks to research
committee of BPKIHS for providing opportunity to
carry out this research study and the mothers for
their co-operation and patience during data collection.
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