Breastfeeding practices and growth

Niger J Paed 2015; 42 (4):335 – 339

ORIGINAL

Okolo AA

Breastfeeding practices and

Omoyibo E

Chimah UO

growth

DOI:http://dx.doi.org/10.4314/njp.v42i4.10

Accepted: 10th August 2015

Abstract : Background: Breast-

of delivery, 25% of mothers gave

feeding is vital for the growth and

pre-lacteal feeds. 49.5% of babies

Okolo AA

(

)

development of infants and young

were optimally breastfed; of these,

Department of Child Health,

68.7%

mothers

had

initiated

University of Benin Teaching Hospital

children. Early initiation within

Benin City, Nigeria.

the half hour of birth fosters opti-

breastfeeding within an hour of

Email: angelneneo@yahoo.com

mal breastfeeding practice, pro-

birth (p=0.001). Underweight and

motes growth and development.

stunting was only seen among ba-

Omoyibo E, Chimah UO

Objective: To evaluate breastfeed-

bies of mothers who did not prac-

Department of Pediatrics,

ing practices and the growth of

tice optimal breastfeeding.

Federal Medical Centre Asaba

infants.

It was observed that babies’

Nigeria.

Method:

This

was a

cross-

weights were not documented rou-

sectional survey at three immuni-

tinely in the road to health chart of

sation clinics in Asaba metropolis

the immunization cards after the

of Delta state. Using a structured

measurements were taken. This

questionnaire, we assessed breast-

was a missed opportunity for coun-

feeding practice of attendees and

selling and health promotion.

the growth of babies and docu-

Conclusion:

Early initiation of

mented information on the socio

breastfeeding increases the prob-

demographic

characteristics,

ability of optimal breastfeeding

breastfeeding practices, previous

practice and prevents infant mal-

weights of infants’ and their An-

nutrition. Even though growth was

thropometric measurements.

assessed, the information was not

Results: There were 97 mother-

utilized for feed back to the moth-

infant/ pairs. 49 males, 48 fe-

ers at the well-baby clinics, growth

males; giving a male to female

monitoring and promotion was not

ratio of 1:1.

20.6% were neo-

supported at the well-baby clinics

nates, 74.2% were less than 6

in the health centres.

months while 25.8% were older.

About 50% of the mothers initi-

Key words: Breastfeeding

ated breastfeeding within an hour

Initiation; Growth.

Introduction

prtein, and fat, and it also provides vitamins, minerals,

digestive enzymes, and hormones to the baby . Its

1,2

Breastfeeding is the gold standard of nutrition for infant

benefits for infant nutrition, growth and development,

and young child survival and development. Mothers’

reduced morbidity and mortality, and prevention of long

breastfeeding babies of the same age seem to have about

-term chronic diseases is widely recognized and cannot

be over emphasised

1,3,4

the same composition of breast milk provided the

. Black and co-workers in 2008,

mother is not severely under nourished . Severe mater-

reported that suboptimum breastfeeding, especially non-

nal malnutrition is not common except in situations of

exclusive breastfeeding in the first 6 months of life,

war, famine, natural disasters such as earth quake, tsu-

results in 1.4 million deaths and 10% of the disease bur-

nami etc. Milk remains the primary source of nutrition

den in children younger than 5 years in low-income and

middle-income countries like Nigeria .

for new-borns before they are able to eat and digest

other foods; older infants and toddlers may continue to

be breastfed, either exclusively or in combination with

Malnutrition is a major underlying factor causing deaths

among children . As much as fifty six percent of deaths

other foods . Breastfeeding (BF) practice is said to be

optimal when breastfeeding has been initiated within the

among children in West African sub region could be

averted if children were not malnourished . Preventing

hour of birth, thereafter exclusive breastfeeding is prac-

ticed in the first six months of life, thereafter,

breast-

malnutrition would be better achieved by getting it right

feeding is continued thereafter up till age two years

from the outset when a child is born with the practice of

whilst suitable complementary foods are added. Breast

optimal breastfeeding and this would help to increase

milk contains appropriate amounts of carbohydrate,

the number of children surviving beyond their 5th birth-

336

day.

Methodology

According to UNICEF’s state of the world’s children

2014, only 15% of children aged less than 6 months are

This was a hospital - based descriptive study on the

exclusively breastfed in Nigeria which is far below the

breastfeeding practice by mothers of healthy breastfed

90% recommendation by WHO/UNICEF for children

babies and the growth of their babies. The study was

less than 6 months in developing countries; while only

carried out in October 2014 on a cross section of moth-

35% are still breastfeeding at the age of 2 . This contrib-

ers who brought their babies for immunization at the

utes to the high malnutrition rates observed among chil-

primary health care (PHC) clinics, Secondary level hos-

dren in Nigeria where 24%, 36% and 10% of under five

pital and tertiary level hospital at Umuagu PHC, St Jo-

years old children are underweight, stunted and wasted

sephs’ Catholic Hospital and the Immunisation clinics of

respectively .

the Federal Medical Centre (FMC) Asaba.

Several programmes aimed at reducing neonatal and

Ethical consideration

infant mortalities have been designed to identify those

interventions that could have great potential in reducing

Ethical approval was obtained from the tertiary level

mortality. The Bellagio child survival study group iden-

hospital Ethical Committee and informed consent of the

tified breastfeeding as the lead intervention to improve

respondents was obtained.

child health and survival; with estimates that optimal

breastfeeding could prevent 13% of all deaths of chil-

Subjects

dren below 5 years .

It is a well-established fact that babies who initiate

All mothers who brought their babies for immunization

breastfeeding within one hour of life are more likely to

during the period of the study at the various immuniza-

have longer chance of exclusive breastfeeding and to be

tion centres at Umuagu PHC, St Joseph’s Hospital and

optimally breastfed. This will improve the nutritional

FMC Asaba and gave consent for the study were re-

status of the infant, promote optimal growth and devel-

cruited and the questionnaire was administered to them.

opment and in the long run reduce morbidity and mor-

Their identities were coded.

tality. Hence, WHO and other organizations recommend

delaying for at least the first hour, routine newborn care

Data collection

procedures that separate mother from her baby such as

bathing and weighing

9,10

. This will allow the mother and

Information on the bio data, ante natal, perinatal and

her new-born baby uninterrupted skin-to-skin contact

breastfeeding pattern of the babies was obtained from

until the first breast feed . Delay in initiation of breast-

the mother/ care giver who brought the baby for immu-

feeding is associated with substantial morbidity and

nization using a structured questionnaire. The SECA

mortality . Evidence abounds that early initiation of

5,6

Basinet Infant weighing Scale was the standard scale

breastfeeding and exclusive breastfeeding are both

utilised at these centres. The current weight, length and

linked with substantially lower neonatal mortality,

6,11,12

head circumference of the babies were taken.

hence mothers are encouraged to adopt this practice.

Babies were weighed by means of the SECA infant

Globally, over one million new-born infants could be

weighing scale with the capacity of measuring the

saved each year by initiating breastfeeding within the

weight from 0 to 20 kg in 100g dimensions. The scale

first hour of life .

was standardized using a 5kg standard weight after

Hence, this survey is being carried out to evaluate the

every 20 measurements were taken. All babies were

breastfeeding practice amongst mothers and to relate it

weighed naked.

to the growth of their healthy infant who has not suf-

Supine length was taken with the aid of an improvised

fered from frequent morbidities as diarrhoea or acute

infant meter made by the attachment of a non-expansible

respiratory tract infections. Mothers who initiate breast-

steel measuring tape to a Tee Square with a moveable

feeding within the first hour of delivery of their babies

frame attached at the long arm of the Tee square. Babies

are more likely to breastfeed their babies exclusively as

were placed supine with their head touching the short

recommended and have healthier babies with better nu-

arm of the Tee square which was marked as 0 cm, feet

tritional status.

were held together and stretched on the long arm of the

Tee square to avoid any flexion at the hip/knee joint.

Aim: To assess breastfeeding practices and the growth

The moveable frame was adjusted on a horizontal frame

of infants of mothers attending immunization clinics at

to touch the feet of the babies on the perpendicular plane

three immunization centres in Oshimili South LGA of

and the length was read from the steel tape. Length was

Delta State.

measured to the nearest 0.5cm.

Specific

Head circumference was measured with the aid of a non-

- To evaluate the time of initiation of breastfeeding and

expansible measuring tape as the maximum circumfer-

its relationship to optimal breastfeeding.

ence of the head with the tape passing above the supra-

- To see if the time of initiation of breastfeeding signifi-

orbital ridges and over the maximum occipital protuber-

cantly affects the weight and length of the infants.

ance. Head circumference was measured to the nearest

0.1cm.

Optimal breastfeeding practice in this context involves

337

early initiation of breastfeeding, exclusive breastfeeding

Fig 2: Bar chart showing the time of initiation of breastfeed-

for the first six months of life, thereafter, with addition

ing.

of complementary foods breastfeeding continues to 2 yrs

of age. Optimal breastfeeding practice was based on

what is expected at the current age of the child.

Frequency

(%)

Overweight means weight for age greater than the 97

centile using the WHO chart.

Underweight means weight for age less than the 3 cen-

tile using the WHO chart.

≤ 1 Hour

1-24 Hours

2nd Day

3rd Day

Normal weight means weight for age between the 3

Time of initiation of breastfeeding

and 97 centile using the WHO chart.

Stunting means height for age less than the 3 centile

Twenty five percent of mothers gave prelacteal feeds

using the WHO chart.

and the reason for its use was attributed to lack of breast

Normal height means height for age between the 3 and

milk at the time. Only 1 attributed it to the effect of an-

97 centile using the WHO chart.

aesthesia following a caesarean delivery. As at the time

Gestational age, as obtained historically, from mothers,

of the study, 49.5% of the babies were been optimally

was taken into cognisance when assessing the weight for

breastfed with a higher percentage (68.8%) among those

age and height for age.

who initiated breast feeding within the first hour of life.

Optimal breastfeeding practice was significantly associ-

Data analysis

ated with the time of initiation of breastfeeding. Table 1

Parametres

OBF Fre-

Non-OBF

Total

The data collected were entered into a computer IBM/

quency (%)

Frequency (%)

Frequency

SPSS package which was applied for analysis and re-

(%)

sults. Results are presented using frequency tables and

Within 1hour

33(68.8)

15(31.2)

48(100.0)

charts. Statistical significance was set at a “p” -value <

1 -24hours

13(36.1)

23(63.9)

36(100.0)

2 Day

0.05.

1(11.1)

8(88.9)

9(100.0)

3 Day

1(25.0)

3(75.0)

4(100.0)

Total

48(49.5)

49(50.5)

97(100.0)

χ2 = 15.95

Results

p value = 0.001

A total of 97mother to infant/toddler pairs were re-

None of the babies put to breast within the first 24 hours

cruited for the study. 48 were males and 47werefemales

of life was underweight however six of these babies

with a ratio of approximately 1:1. At the time of the

(7.1%) were overweight. The point in time weight of the

study, 20 (20.6%) of the babies were neonates, 72

babies was significantly associated with the time of ini-

(74.2%) were less than 6 months, while only 1 (1%) was

tiation of breastfeeding.

a year and above. The age of the mothers ranged from

Parametre

Under-

Normal

Over weight

Total

20 to 46years with a mean age of 30.5 yrs ± 5.1yrs.

weight

frequency

Frequency

frequency

(%)

More than half (59.8%) of the mothers were multiparous

(%)

and 60.8% had up to tertiary level of education. Antena-

Within 1 hour

0(0.0)

44(91.7)

4(8.3)

48(100.0)

tal clinic attendance was 97.9%.

1 -24hours

0(0.0)

34(94.4)

2(5.6)

36(100.0)

2 Day

Fig 1: Pie chart showing educational status of mothers

1(11.1)

8(88.9)

0(0.0)

9(100.0)

3 Day

Fig 1: Pie chart showing educational status of mothers

1(25.0)

3(75.0)

9(0.0)

4(100.0)

Total

2(2.0)

89(91.8)

6(6.2)

97(100.0)

χ = 17.108

NO FORMAL

PRIMARY

p value = 0.008

SECONDARY

TERTIARY

Stunting was only noticed among babies of mothers who

initiated breastfeeding on the 3 day of life and all of

them were already on mixed feeding. There was a sig-

NO FORMAL EDUCATION=2.1%

PRIMARY=3.1%

nificant association between the time to initiate breast-

SECONDARY=34.0%

TERTIARY=60.8%

feeding and babies length.

Parametre

Stunted

Normal

Total

Eighty eight percent (88%) of the study population were

frequency

Frequency

from either high or middle socioeconomic class.

(%)

About half of the mothers (49.5%) initiated breastfeed-

ing within an hour of delivery, while 4% commenced

Within 1 hour

0(0.0)

48(100.0)

breastfeeding on the 3 day of life; and all were on ad-

1 -24hours

0(0.0)

36(100.0)

2 Day

1(11.1)

9(100.0)

mission. 75% of the admission was due to prematurity

3 Day

1(25.0)

4(100.0)

while the reason for admitting the last baby was not

Total

2(2.0)

94(96.9)

97(100.0)

known to the mother.

χ = 74.229

p value ‹ 0.001

338

practice .

Discussion

The presence of large numbers of multiparous women in

This study set out to evaluate the pattern of breastfeed-

this study might have influenced early initiation of

ing and the growth of the infants. It was how ever ob-

breastfeeding as establishment of lactation in mothers

served that although the weights of these infants were

improves with increasing parity and experience.

measured at each immunisation clinic visit these weights

Better nutrition enhances growth and development. In

were not documented on the road to health chart and so

this study, only a few babies were underweight or

the counselling aspect of growth monitoring and promo-

stunted and these group of babies were among those

tion with mothers was not implemented. The babies

who commenced breastfeeding more than 24 hours after

were however observed in the course of the study to be

birth. Although breastfeeding alone is not the only con-

growing well. The absence of counselling of the mothers

tributor to growth, our finding that early initiation of

did not support the need for implementation of growth

breastfeeding increases the likelihood of optimal breast-

monitoring and promotion and might have implications

feeding might support the principle that optimally

for the future attendance at growth monitoring and im-

breastfed babies may have less frequency of illness in

munisation clinics. Also this situation creates opportuni-

the first 6 months of life as EBF is known to reduce the

ties for none support of nutritional advice that addresses

frequency of diarrhea episodes and thus promote optimal

growth . About 7% of babies who initiated breastfeed-

the individual health and nutrition needs of the index

child at the Well-baby clinics where the focus should be

ing within 24 hours were in the overweight category.

disease prevention in all its ramifications. Well -baby

However, exclusive breastfeeding has been found to

reduce the risk of developing obesity

1,18

clinics are supposed to meet the individual child health

and our study

related needs, through immunisation, breastfeeding pro-

did not exclude other confounding variables like high

motion and nutritional education

and counselling to

birth weight which is a risk factor for being overweight.

meet the individual infant’s needs. Lack of growth

Generally, the better nutritional status observed among

monitoring and promotion is a missed opportunity for

the babies might have resulted from the fact that 95% of

correct implementation of the complete well -baby clinic

mothers had relatively enhanced social and environ-

package.

mental circumstances that better supported child caring

practices.

Antenatal clinic attendance was quite high (97.9%), this

The absence of previous weight records in the- road to-

could be attributed to the fact that it was a hospital-

health Chart is to be noted as this illustrates the lack of

based study and so the respondents would have been

adequate growth monitoring and promotion activities at

mainly those that seek orthodox care.

these immunization centers where this simple procedure

Majority of the mothers were less than 40 years and

helps in the better counseling session of mothers who

multiparous, this implies that breastfeeding education

utilize these clinics. Such Growth monitoring and pro-

should be focused on young women and adolescents so

motional activities should be seen as the opportunity for

as to foster the culture of breastfeeding in them.

counselling of mothers on child care practices that

The Baby Friendly Hospital Initiative (BFHI) was de-

should enhance the quality of care offered to the moth-

signed to promote early initiation of breastfeeding, pref-

ers.

erably immediately after birth. This study observed that

48 (49.5%) of mothers initiated breastfeeding within an

hour after birth. This is high compared to our national

average of 23% and what was found in Ilesha and a

Conclusion

rural community in Sokoto where only 8% of mothers

initiated breastfeeding early

13,14

. This could be attrib-

The practice of early initiation of BF as an important

uted to the fact that our study was hospital- based, in an

entry point in this study is associated with the probabil-

urban center and also majority of mothers(94.8%) had

ity of optimal breastfeeding (OBF) practice in the popu-

up to secondary level of education and so could appreci-

lation studied. OBF practice will help to prevent infant

ate what was being discussed during the Ante Natal

malnutrition and thereby contribute to reduction of mor-

Clinic (ANC) visit.

bidity and mortality in children less than five years.

Malnutrition is a major cause of morbidity and mortality

The EBF rate and optimal breastfeeding practice

in children under five years of age; therefore, early ini-

(49.5%) observed among the study population was high

tiation of breastfeeding should be promoted.

compared to the national average of 15% . This may be

due to the fact that the ANC breastfeeding education

Recommendations

was optimal amongst these mothers and enabled better

understanding of the relevance of breastfeeding as was

1. Antenatal breastfeeding education should refocus the

noticed by Okafor and colleagues

in Lagos while

importance of early initiation of breastfeeding as

studying the breastfeeding practices of mothers of young

soon as the babies are born.

children. Majority of mothers who practiced optimal

2. Growth monitoring and promotion should be imple-

breastfeeding (68.8%) initiated breastfeeding within an

mented correctly at infant welfare clinics.

hour and these had a significant association. This is in

Breastfeeding education should target adolescents

keeping with the theory that early initiation of breast-

and the young to foster this culture.

feeding increases the likelihood of optimal breastfeeding

339

Limitation of the study

Conflict of Interest: None

Funding: None

Anthropometric measurements of babies were not docu-

mented in the road to health chart during immunization

in all but one of the babies and so the growth pattern for

Acknowledgements

each infant

could not be assessed.

The Authors gratefully acknowledge the care and sup-

The study did not evaluate for the relationships of other

port provided by the health Staff to the clinic attendees

morbidities that would influence

growth of infants.

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