|Year : 2019 | Volume
| Issue : 2 | Page : 62-65
The acceptance and practice of exclusive breastfeeding by female health professionals: Our experience in a tertiary health facility
Ibrahim Aliyu1, Taslim O Lawal2, Halima Umar Ibrahim3, Zainab F Ibrahim4
1 Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
2 Department of Paediatrics, Federal Medical Centre, Birnin Kebbi, Nigeria
3 Department of Paediatrics, Federal Medical Centre, Birnin Kudu, Nigeria
4 Department of Nursing, Aminu Kano Teaching Hospital, Kano, Nigeria
|Date of Web Publication||24-Jan-2020|
Dr. Ibrahim Aliyu
Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano
Source of Support: None, Conflict of Interest: None
Introduction: Exclusive breastfeeding (EBF) is the feeding of infants with breast milk alone in the first 6 months of life. EBF is an important component of the child survival strategy and the Baby-Friendly Initiative. Exclusively breastfed babies are often at lower risk of diarrhea disease and respiratory tract infection, and they have a better growth pattern. Over the years, there has been a progressive decline in the acceptance of EBF by breastfeeding mothers; this study, therefore, sought to determine the acceptance of EBF among health workers. Materials and Methods: This was cross-sectional and descriptive study involving female health workers who had children while working with Federal Medical Centre, Birnin Kebbi, Kebbi State, Nigeria; it was conducted between October 2017 and December 2017. Female health workers comprising doctors, nurses, pharmacists, and laboratory scientists/technicians were recruited. Pretested, structured, and self-administered questionnaires were used. Results: One hundred and twenty-three respondents were recruited for this study, and 95.1% of the respondents were aware of EBF. Among those who were aware of EBF, 61 (52.1%) correctly defined it and 82 (70.1%) practiced EBF, while among non-EBF mothers, the most common reason for not practicing EBF was the demands of their work; however, only 3 (7.3%) had good knowledge of EBF. Majority of the respondents from the clinical departments practiced EBF, and this observation was statistically significant (χ2 = 11.382, df = 4, P = 0.021). Most of the respondents from the surgery and obstetrics and gynaecology (O and G) departments could not correctly define EBF; this observation was also statistically significant (χ2 = 11.642, df = 4, P = 0.019). Conclusion: Most of the respondents in this study were aware and also practiced EBF; however, their knowledge base of EBF was dismally poor, especially those in the surgery and O and G departments
Keywords: Acceptance, exclusive breastfeeding, health workers, knowledge, practice
|How to cite this article:|
Aliyu I, Lawal TO, Ibrahim HU, Ibrahim ZF. The acceptance and practice of exclusive breastfeeding by female health professionals: Our experience in a tertiary health facility. Muller J Med Sci Res 2019;10:62-5
|How to cite this URL:|
Aliyu I, Lawal TO, Ibrahim HU, Ibrahim ZF. The acceptance and practice of exclusive breastfeeding by female health professionals: Our experience in a tertiary health facility. Muller J Med Sci Res [serial online] 2019 [cited 2020 Jun 1];10:62-5. Available from: http://www.mjmsr.net/text.asp?2019/10/2/62/276682
| Introduction|| |
Exclusive breastfeeding (EBF) is the feeding of infants with breast milk alone and allowing for drugs such as syrups and multivitamins (as prescribed by the doctor) in the first 6 months of life. EBF is an important component of the child survival strategy and Baby-Friendly Initiative (BFI). Exclusively breastfed babies are often at lower risk of diarrhea disease and respiratory tract infection, and they have a better growth pattern. Over the years, there has been a progressive decline in the acceptance of EBF by breastfeeding mothers; some reasons put forward for this decline included: the erroneous perception of inadequate water content in breast milk, inadequate nutrients, and the need for mothers to resume early to their places of work.,, Health professionals have a prominent role in ensuring the success and sustenance of this laudable feeding policy; therefore, the acceptance and practice by health professionals, especially female health workers who should serve as leading examples, role models, and advocates for breastfeeding mothers, should be expectedly commendable. Therefore, this study sought to determine the acceptance of EBF by female health workers in our health center.
| Materials and Methods|| |
This was cross-sectional and descriptive study involving female health workers who had children while working with Federal Medical Centre (FMC), Birnin Kebbi, Kebbi State, Nigeria; it was conducted between October 2017 and December 2017. Female health workers comprising doctors, nurses, pharmacists, and laboratory scientists/technicians were recruited. Purposive sampling method was adopted. Using a knowledge prevalence of 31% reported by Oche et al., a sample size of 328 was calculated, and for a population <10,000 (N/1+N/n), the sample size of 126 was obtained based on a targeted population of 200 female health workers. Pretested, structured, and self-administered questionnaires were used. These were pretested among 15 selected volunteer health workers to ensure that the contents were well understood, and internal consistency was maintained with a Cronbach's alpha score of 0.75. This questionnaire contained relevant questions which tested their perception and acceptance of EBF. Ethical clearance was obtained from the Ethics Committee of FMC, Birnin Kebbi. Consent was obtained from the participants.
- All female health workers breastfeeding or who had ever breastfed a child.
- Females who declined consent to participate in the study
- Those who were on leave at the time of the study.
Data were analyzed using the Statistical Package for the Social Sciences (SPSS), version 16.0 (SPSS Inc., Chicago, Illinois, USA). The data were presented as frequencies and means, and categorical variables were compared using the Chi-square and Fisher's exact tests where applicable. P < 0.05 was chosen as statistically significant.
| Results|| |
The age groups of the respondents were classified as follows: <20 years (7, 5.7%), 20–40 years (103, 83.7%), and >40 years (13, 10.6%).
Their working experiences were stratified into 1–5 years (76, 61.8%), 6–10 years (22, 17.9%), 11–15 years (12, 9.8%), 16–20 years (8, 6.5%), and >20 years (5, 4.1%).
The departments involved in this study were pediatrics (42, 34.1%), medicine (8, 6.5%), surgery (18, 14.6%), and O and G (31, 25.2%), whereas the minor departments constituted (24, 19.5%).
The staff compositions in this study were doctors (14, 11.4%), nurses (89, 72.4%), laboratory scientists
(5, 4.1%), pharmacists (4, 3.3%), and other staffs (11, 8.9%).
One hundred and seventeen (95.1%) respondents were aware of EBF, whereas six (4.9%) were not. However, 116 (94.3%) reported that they were taught EBF, whereas seven (5.7%) were not. Furthermore, 80 (69.0%) respondents were taught at school, 35 (30.2%) were taught at the hospital, whereas 3 (0.9%) were informed through the media.
Among those who were aware of EBF, 61 (52.1%) of them correctly defined it, whereas 56 (47.9%) were incorrect; 82 (70.1%) respondents practiced EBF, whereas 35 (29.9%) of them did not; among the non-EBF mothers, the reasons for not practicing EBF were: the demands and the need for resumption to work (18, 51.4%), their believes that breast milk lacked adequate nutrients (1, 2.9%), and lack of enough water in breast milk (1, 2.9%), whereas those who were not aware of EBF were only 15 (42.9%).
One hundred and fifteen (93.5%) respondents were aware that there was enough water in breast milk; however, 8 (6.5%) were not, but 85 (69.1%) respondents had no knowledge of the advantages of EBF, 29 (23.6%) had fair knowledge, whereas only 3 (7.3%) had good knowledge of EBF.
[Table 1] shows that majority of the respondents from the clinical departments practiced EBF, and this observation was statistically significant (χ2 = 11.382, df = 4, P = 0.021). Majority of the respondents correctly defined EBF except those in the surgery and O and G departments; this observation was also statistically significant (χ2 = 11.642, df = 4, P = 0.019). Most of the respondents in all the departments were aware that breast milk contained sufficient water for the newborn; this observation was also statistically significant (Fisher's exact test = 9.032, P = 0.023).
|Table 1: Comparing their department of respondents and their practice and understanding of breastfeeding|
Click here to view
[Table 2] shows that most of the respondents irrespective of years of working practiced EBF; however, almost equal proportions of the correct and incorrect definition of EBF were observed among the respondents. Majority of the respondents were aware of the water content in breast milk; however, these observations were not statistically significant (Fisher's exact test = 9.744, P = 0.33; Fisher's exact test = 1.030, P = 0.933; and Fisher's exact test = 1.095, P = 0.894, respectively).
|Table 2: Comparing their working experience of respondents and their practice and understanding of breastfeeding|
Click here to view
EBF was most incorrectly defined among those who were taught in the hospital and those taught through the media; however, this observation was not statistically significant (Fisher's exact test = 4.450, P = 0.070) [Table 3].
|Table 3: Comparing their source of information and understanding of exclusive breastfeeding|
Click here to view
| Discussion|| |
This study explored the practice of exclusive breastfeeding among female health-care workers; they are often in the forefront as advocates of EBF. About 95.1% of respondents in our study were aware of EBF; this observation was similar to that reported by Utoo et al. and Sadoh et al. whose respondents were all aware of EBF, but it was higher than the 60% reported by Oche et al. This disparity was expected because these studies involved health-care workers, whereas Oche et al. focused more on childbearing mothers in Kware rural community. Dun-Dery and Laar also reported a 99% awareness of EBF among city-dwelling working-class mothers, whereas Metiboba et al. reported 95.3% awareness among mothers in Anyigba, North Central Kogi State, Nigeria; therefore, differences in educational qualification may be contributory. However, only 52.1% of our respondents could correctly define EBF; this observation was similar to that reported by Chale et al. in Mwanza city, Northwestern Tanzania.
Most of the respondents (69.0%) were taught about EBF while at school and only 30.2% were taught in the hospital; this was unlike the report of Alamirew et al. who reported that 66.4% of their respondents got information about EBF from health institutions. Therefore, a poorly organized breastfeeding training policy for female staffs in health institutions may be contributory; this observation was also documented by Chale et al. and Nigam et al. who in Indore, India, reported a lack of breastfeeding training policy in their health facilities. About 70.1% of the respondents in our study reported practicing EBF; this was similar to the 68% reported by Gladzah among female health workers in Ghana, but it was higher than the 11.1% reported by Sadoh et al. and also 17% which represented the Nigerian national average. It is worthy of note that this figure was in discordance with their ability to correctly define EBF (52.1%); therefore, this finding suggests a significant knowledge gap among the respondents. This may negatively impact on their ability to effectively support breastfeeding mothers visiting our health facility. However, among respondents who did not practice EBF, the main reason given was the need to resume back to work. This observation was similar to that reported by Dun-Dery and Laar which expressed limited workplace support as a hindrance to the practice of EBF despite a high breastfeeding initiation rate. Sadoh et al. and Stewart-Glenn made similar observations in their studies. Majority of the respondents in our study (93.5%) were aware that breast milk contained enough water; this observation was higher than the 88.9% reported by Utoo et al.; as they emphasized, this knowledge of water content of breast milk will make a good teaching for breastfeeding mothers attending the health facility; hence, this may reduce the incidence of diarrhea disease among infants. Furthermore, they also observed that there was poor knowledge on the advantages of EBF.
Health workers in the clinical department had a better understanding of EBF when compared to nonclinical departments; this observation was similar to that reported by Okolo and Ogbonna, but it differed from that reported by Chale et al. which documented poor clinical understanding and practice of EBF among nurses.
Years of working experience of the respondents did not significantly influence their understanding of EBF; this may be attributed to lack of a properly organized breastfeeding training policy such as on the job training. Otherwise, the older practitioners should have had better exposure and skills on EBF due to frequent training and retraining. Therefore, it was not surprising when most of those who were taught EBF in the hospital could not correctly define EBF.
| Conclusion|| |
Respondents in this study were aware of EBF, and a significant proportion of them practiced EBF. Importantly, most of them knew that breast milk contained enough water; however, many could not correctly define EBF; this highlights a significant knowledge gap. Therefore, there is a need for continuous medical education of health workers. This will put them in a better position for a productive health advocacy.
The heterogeneity of the respondents is a limitation in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ahn CH, Maclean WC. Growth of exclusively breastfed infants. Am J Clin Nutr 1990;33:183-92.
Aghaji MN. Exclusive breast-feeding practice and associated sfactors in Enugu, Nigeria. West Afr J Med 2002;21:66-9.
Ogbonna C, Okolo SN, Ezeogu A. Factors influencing exclusive breast-feeding in Jos, Plateau state, Nigeria. West Afr J Med 2000;19:107-10.
Iliyasu Z, Kabir M, Abuabakar IS, Galadanci NA. Current knowledge and practice of exclusive breastfeeding among mothers in Gwale local government area of Kano state. Nig Med Pract 2005;48:50-5.
Oche MO, Umar AS, Ahmed H. Knowledge and practice of exclusive breastfeeding in Kware, Nigeria. Afr Health Sci 2011;11:518-23.
Utoo BT, Ochejele S, Obulu MA, Utoo PM. Breastfeeding knowledge and attitudes amongst health workers in a health care facility in South-South Nigeria: The need for middle level health manpower development. Clin Mother Child Health 2012;9:1-5.
Sadoh AE, Sadoh WE, Oniyelu P. Breast feeding practice among medical women in Nigeria. Niger Med J 2011;52:7-12.
] [Full text]
Dun-Dery EJ, Laar AK. Exclusive breastfeeding among city-dwelling professional working mothers in Ghana. Int Breastfeed J 2016;11:23.
Metiboba S, Daniel CA, Owoyemi JO. Awareness of the benefits and practice of exclusive breastfeeding (EBF) among nursing mothers in Anyigba, North central Nigeria. World J Nutr Health 2017;5:1-5.
Chale LE, Fenton TR, Kayange N. Predictors of knowledge and practice of exclusive breastfeeding among health workers in Mwanza city, Northwest Tanzania. BMC Nurs 2016;15:72.
Alamirew MW, Bayu NH, Birhan Tebeje N, Kassa SF. Knowledge and attitude towards exclusive breast feeding among mothers attending antenatal and immunization clinic at Dabat health center, Northwest Ethiopia: A cross-sectional institution based study. Nurs Res Pract 2017;2017:6561028.
Nigam R, Nigam M, Wavre RR, Deshpande A, Chandorkar RK. Breastfeeding practices in baby friendly hospitals of Indore. Indian J Pediatr 2010;77:689-90.
Gladzah ND. Challenges of Exclusive Breastfeeding among Female Health Workers in Two Hospitals in Accra. University of Ghana. Available from: Available from: http://ugspace.ug.edu.gh
. [Last accessed on 2018 Dec 20].
Stewart-Glenn J. Knowledge, perceptions, and attitudes of managers, coworkers, and employed breastfeeding mothers. AAOHN J 2008;56:423-9.
Okolo SN, Ogbonna C. Knowledge, attitude and practice of health workers in Keffi local government hospitals regarding baby-friendly hospital initiative (BFHI) practices. Eur J Clin Nutr 2002;56:438-41.
[Table 1], [Table 2], [Table 3]