Challenges to timely initiation of breast-feeding in rural area of District Sargodha, Pakistan

Abstract

Objective: To assess and find the barriers of timely initiation of breast feeding.
Methodology: This cross sectional study was conducted in rural area (2 Union councils) of District Sargodha with 202 child’s Mothers as sample size with systematic random sampling method. A questionnaire was developed for data collection. Frequencies for all the variables were recorded. Chi-square test of independence was used for identifying possible significant barriers influencing early initiation of breast feeding.
Results: Only 35.1% of the mothers started early breast feeding (within one hour after birth). 27.7% mothers had primary level education. Household income of the maximum (72%) study subjects was less then Rs. 10,000. 29.2% mothers were less than 20 years of age at marriage. Various barrier were highlighted for early initiation of breast feeding including number of children (p=0.00) and extended/nuclear family (p=0.00). Normal deliveries (p=0.00), deliveries at health care center/clinic (p=0.00), knowledge about the ANC (p=0.00), knowledge through media remained effective (p=0.00) and supportive, (p=0.00). Around 37.6% of females said that they were facing problems during breast feeding including low milk supply (69%) followed by sore nipples (15%), low birth weight (12%) and beast infections (4%). Another important aspect highlighted that 40.1% females provided Ghuti as baby’s first food; honey by 35.6%, green tea by 3% and Formula milk by 6.4%.
Conclusion: Low prevalence was due to lack of proper knowledge regarding the early initiation of breast feeding among the newly delivered mother , especially with cesarean delivery.

Full text

INTRODUCTION
Breastfeeding (BF) is beneficial for both mothers
1
and infants. The slogan of Global Strategy for
Infant and Young Child Feeding is to promote
breast feeding which is authorized by WHO and
2
UNICEF in year 2002.In early breast feeding
(recommended within 1 hour after birth) baby
receives colostrum which provides immunity
3
against different pathogens. Sufficient care and
4
feed is the fundamental right of the neonates. It is
mandatory to educate the mothers regarding BF i.e
within 1 hour after birth and correct sucking
5
position.Level of production of oxytocin is
6
e n h an c e d d u r in g e a r ly b r e as t f e e di ng .
Breastfeeding reduces the risk of ovarian cancer,
7
breast cancer and Type 2 diabetes. Breast feeding
8
also helpful to prevent from obesity. It is also
8
called natural method of family planning. It
reduces risk of gastroenteritis (major cause of
infant mortality), respiratory infections, childhood
leukemia, sudden infant death syndrome (SIDS),
some long term chronic diseases e.g. diabetes
9
allergy.
Development of brain is very important for the
infants which is only possible with the help of long
chain polyunsaturated fatty acids, which is present
10
in breast milk.There is limited data regarding
breastfeeding and infant feeding practices in rural
areas of Pakistan. Initiation of breastfeeding within
the first hour after delivery seems to be delayed
overall in Pakistan. According to the Pakistan
demographic Health survey, timely initiation of
breastfeeding is 18%, which is needed to be
11
improved. Hence this study was conducted to
Objective: To assess and find the barriers of
timely initiation of breast feeding.
Methodology: This cross sectional study was
conducted in rural area (2 Union councils) of
District Sargodha with 202 child's Mothers as
sample size with systematic random sampling
method. A questionnaire was developed for data
collection. Frequencies for all the variables were
recorded. Chi-square test of independence was
used for identifying possible significant barriers
influencing early initiation of breast feeding.
Results: Only 35.1% of the mothers started early
breast feeding (within one hour after birth). 27.7%
mothers had primary level education. Household
income of the maximum (72%) study subjects was
less then Rs. 10,000. 29.2% mothers were less
than 20 years of age at marriage. Various barrier
were highlighted for early initiation of breast
feeding including number of children (p=0.00) and
ex t e n ded/nuclear family (p=0 . 0 0 ). N o r m al
deliveries (p=0.00), deliveries at health care
center/clinic (p=0.00), knowledge about the ANC
(p=0.00), knowledge through media remained
effective (p=0.00) and supportive, (p=0.00).
Around 37.6% of females said that they were
facing problems during breast feeding including
low milk supply (69%) followed by sore nipples
(15%), low birth weight (12%) and beast infections
(4%). Another important aspect highlighted that
40.1% females provided Ghuti as baby's first food;
honey by 35.6%, green tea by 3% and Formula
milk by 6.4%.
Conclusion: Low prevalence was due to lack of
proper knowledge regarding the early initiation of
breast feeding among the newly delivered mother
are especially with cesarean delivery. (Rawal Med
J 202;45:930-933).
Keywords: Nutrition, infant feeding, lactation.
930
Challenges to timely initiation of breast-feeding in rural area
of district Sargodha, Pakistan
Umaira Zaib, Saleem Rana, Muhammad Ibrahim Ansari, Hafiz Azeem Akhtar,
Kaleemullah Abro, Muhammad Siddique Ansari
Instutute of Public Health, Lahore, University Institute of Public Health, Lahore SMBB Medical
University, Larkana, UIPH Larkana and Pharmacy Department, LUMHS, Jamshoro, Pakistan
Rawal Medical Journal: Vol. 45. No. 4, Oct.-Dec. 2020
Original Article

assess the knowledge and barriers of timely
initiation of BF.
METHODOLOGY
This cr o s s s e c t i o nal d e scriptive study was
conducted in rural area (2 Union councils) of
Di s trict Sarg odha with sample size of 202
(calculated on prevalence rate 13% with 5%
refusal rate) and systematic random sampling
method was used. Mother Child pairs fewer than 6
months of age were included and mothers who
have mental disability, complicated delivery and
having children with congenital anomalies were
excluded.
A questionnaire was developed consisting of three
sections; socio demographic, antenatal, natal and
postn a ta l infor m a ti on and f ee di n g relat e d
knowledge variables. Data was collected via polio
program mapping and informed consent was taken
and full autonomy and research ethics were abode.
Statistical Analysis: SPSS version 16 was used for
analysis. Chi-square test of independence was used
for identifying possible significant barriers. p<0.05
was considered significant.
RESULTS
Out of the total 202 selected subjects 35.1% of the
mothers started early breast feeding within one hour
after birth while 53.3% mothers started after one day
by 53.3%. Some of the mothers 11.4% (23) have
started breast feeding within 24 hours after birth.
Among selected study population, 72.8% mothers
were unemployed and among the employed women
54.5% have started early initiation of BF. 63% of the
sub j ec ts h a ve m o nthl y hou s eh old i ncom e
<10,000Rs while only 9% have >25,000 Rs.
monthly income (Table 1).
A to t a l o f 3 5. 6 % w om e n r ep o r te d norma l
deliveries and 15.3% females were undergone
emergency caesarean. A considerable proportion
of the study sample 49% adopting willingly
caesarian (Table 2). Both of the factors places of
delivery and delivery assisted by an expert
professional found significantly associated with
early initiation of BF.
Table 1. Socio-demographic of study participants.
931 Rawal Medical Journal: Vol. 45. No. 4, Oct.-Dec. 2020
Challenges to timely initiation of breast-feeding in rural area

Table 2. Delivery Information and Breast feeding Statistics
(n=202).
Fig. Knowledge through print/electronic media regarding
BF (n=202).
Out of all mothers, 39.1% said that antenatal care
was very important for the newborns while
according to 30.7% mothers' it was not important. A
considerable proportion 30.2% of mothers had no
idea about the antenatal care and its importance for
newborns. And 36.6% mothers reported that they
have performed antenatal care visit during last
Pregnancy. The maximum of the females consulted
Nurses and doctors for antenatal care (40.1%) while
a significant proportion received no antenatal care
are at their own within family (46.1%). Out of the
total study population 42.6% females said that they
got knowledge regarding breast feeding through
print and electronic media advertisement while
57.4% have never seen such advertisement
anywhere (Figure).
DISCUSSION
A published study provide the similar results that
96.9% of the mothers started earlier initiation of BF
and positively related to various factors including
type of delivery, residential area, younger age of
mother at marriage, parental education and
2
household income. The current study has also
provided that number of children also significantly
associated with early initiation of BF (p<0.05).
18.8% female with primipara has started early
breast feeding while 45.9% mother having more
than one child started early breast feeding. Similar
results have been provided by a study according to
that delayed in onset of breast feeding was fond
3
associated passively with primipara. Another
research has highlighted the similar results that in
extend type of families motivation, support and
knowledge regarding early start of BF was much
4
better as compared with the nuclear type family.
Only 3% mothers initiated breast feeding within 1
5
hour after birth.
A study showed that females with vaginal deliveries
have high percentage of early start of breast feeding
as compared with the other types. Only 3.3%
females start early BF who visited private clinic or
6
others. Some of the study participants know about
the importance of ANC but not often put their
knowledge into practice and delayed start of BF,
avoidance of colostrum and prelacteal feeding
7
remained serious problem. Mothers who got
932 Rawal Medical Journal: Vol. 45. No. 4, Oct.-Dec. 2020
Challenges to timely initiation of breast-feeding in rural area

Author Contributions:
Conception and design: Umaira Zaib, Saleem Raza
Collection and assembly of data: Muhammad Siddique, Kaleem
Analysis and interpretation of data: Umaira Zaib, Azeem
Drafting of the article: Muhammad Ibrahim Ansari
Critical revision of article for important intellectual content: Saleem
Raza
Statistical expertise: Umaira Zaib, Muhammad Ibrahim Ansari
Final approval and guarantor of the article: Umaira Zaib
Corresponding author email: Muhammad Ibrahim Ansari:
cadetccl@yahoo.co
Conflict of Interest: None declared
Rec. Date: Feb 13, 2020 Revision Rec. Date: Jun 22, 2020 Accept
Date: Sept 30, 2020
Knowledge through advertisement and early
initiation of breast feeding remained significant to
each other (p<0.05).
Results of a study published in America showed that
health care providers had limited education
regarding infant feeding. Health systems should set
up a baby friendly atmosphere that supports and
encourages breastfeeding through different sources
8
inc l u ding differe n t types of media. It w a s
recommended by the study that there should be
intervention at HCP level with special focus on the
9
barriers regarding early initiation of BF. The
satisfactory management of those conditions is
basic, as if not treated they frequently lead to early
10
weaning. Prelacteal feeds, green tea, animal milk
11
and formula milk should be avoided.
CONCLUSION
This study showed a low prevalence of early
initiation of breastfeeding in mothers. This low
prevalence was due lake of proper knowledge
regarding the early initiation of breast feeding
among the newly delivered mother and especially
with cesarean delivery and various other barriers
also involved in this regard.
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