|Year : 2014 | Volume
| Issue : 2 | Page : 108-113
Breast feeding practices and associated factors in Bhaktapur District of Nepal: A community based cross-sectional study among lactating mothers
Dillee Prasad Paudel1, Sebananda Giri2
1 Department of Public Health, JN Medical College, KLE University, Belgaum, Karnataka, India
2 Department of Community Medicine, District Public Health Office, Kathmandu, Nepal
|Date of Web Publication||20-May-2014|
Dillee Prasad Paudel
Department of Public Health, JN Medical College, KLE University, Nehru Nagar, Belgaum, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Infant feeding is a major determinant of survival, future nutrition and health status of children. Breast-feeding is an unequalled way of providing ideal food for the healthy growth and development of infants. It is also an integral part of the reproductive process with important implications for the health of mothers. Exclusive breast feeding (EBF) is superior to non-exclusive breast-feeding with a protective effect against both morbidity and mortality. This study was aimed to explore the breast feeding practice and affecting factors in Bhaktapur, Nepal. Materials and Methods: Community based cross-sectional study was carried out from February to May 2007 in a rural area of Bhaktapur, Nepal. Total 333 lactating mothers having a child less than 6 months were interviewed using pretested questionnaire with her written consent. Analysis was performed in Statistical Pakage of Social Science-13 version applying appropriate statistics. Results were presented in tabular and narrative forms. Results: Among 333 mothers (mean age ± standard deviation 24.68 ± 4.16 years), majority (76.6%) were 20-30 years. Almost 83.0% were Hindus, 25.8% illiterate, 62.8% house-wives and 53.5% from joint family with low economic status. About 48.0% had a baby of 2-4 months, 86.0% avoided pre-lacteal feeding, 87.1% fed colostrums, 27.9% fed the first milk within half an hour and 55.0% practiced exclusive breast-feeding for 6 months. Child's age, education, religion, occupation, family type and knowledge level were significant (P < 0.05) factors affecting to breast feeding. Conclusion: Despite the high proportion of women initiated breast-feeding early after birth, the prevalence of EBF for 6 months was very low and a large portion had poor practice of breast feeding. Education, relationship of mother with a family member and level of knowledge were found most significant factors. Appropriate measures such as public awareness and effective counseling will support to increase better breast feeding practice.
Keywords: Associated factors, breast-feeding practice, lactating mothers
|How to cite this article:|
Paudel DP, Giri S. Breast feeding practices and associated factors in Bhaktapur District of Nepal: A community based cross-sectional study among lactating mothers. J Sci Soc 2014;41:108-13
|How to cite this URL:|
Paudel DP, Giri S. Breast feeding practices and associated factors in Bhaktapur District of Nepal: A community based cross-sectional study among lactating mothers. J Sci Soc [serial online] 2014 [cited 2020 Aug 13];41:108-13. Available from: http://www.jscisociety.com/text.asp?2014/41/2/108/132851
| Introduction|| |
Infant feeding is a major determinant of survival, future nutrition and health status of children. For almost all infants, breastfeeding remains the simplest, healthiest and least expensive feeding method that fulfills the infants' needs. The numerous benefits of breast-feeding are of public health relevance for all human community of both developing and developed countries.  The World Health Organization (WHO) and United Nations International Children's Emergency Fund (UNICEF) recommend it "breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. As a global public health recommendation, infants should be exclusively breastfed for the first 6 months of life to achieve optimal growth, development and health.  Breastfeeding also increases the maternal-infant bonding. In the long run, it may decrease the risk of breast and ovarian cancers and osteoporosis in the mother.  Breast milk is the perfect source of nutrition for the infant. Hence, improper feeding practice and unhygienic and unsafe environment are the major contributors of morbidity and mortality among children world-wide. , The millennium development goal 4 (MDG-4) is to reduce the under -five mortality rates by two-thirds between 1990 and 2015. Exclusive breastfeeding, giving the breast milk only and no other liquids, except drops or syrups with vitamins, mineral supplements or medicines, is superior to non-exclusive breastfeeding with a protective effect against both morbidity and mortality. , According to MDGs goal evaluation report, exclusive breastfeeding for 6 months become one of the most effective interventions to achieve MDG-4. 
| Materials and methods|| |
This descriptive cross-sectional study was carried out in the rural community of Bhaktapur district, Nepal. Bhaktapur is one of the smallest districts of the country, having 16 village development committees (VDCs) and two municipalities. It is situated in 27°36'-27°44' with latitude and 85°21'-85°32' east longitude. The total population of Bhaktapur district in 2006 was 258,843 and half of them were female. About 24.6% of the female population was covered by the reproductive age group (15-45 years). The crude birth rate was 28/1000 population in 2006. 
The study was conducted from January to March 2007 among the lactating mothers having a child of age 0-6 months. Sample size was calculated by using the proportion based statistical formula; n = z2 p (1 − p)/d2 with considering 5% absolute error at 95% of the confidence interval level. On the basis of 68.3% proportionate level of exclusive breast feeding (EBF) practice reported by Nepal Demographic and Health Survey 2001,  the minimum sample size was 333. Three VCDs; Sipadol, Nangkhel and Chitapol were selected randomly as study site and participants were selected by stratified random sampling technique. Participation in the study was voluntary and informed consent was obtained. Pre-tested structured questionnaire was used as data collection tools. Data were checked and re-checked throughly for its consistency and reliability and analysed using Statistical Pakage of Social Science version 13. Descriptive statistics; percentage, mean and standard deviation were calculated and bivarate analysis; Chi-square (χ2 ) tests was applied to examine the association. Strength of association was measured by odds ratio (OR). The criterion for statistical significance was set at test value P < 0.05. Analyzed data were disseminated in tables, graphs and narrative form.
| Results|| |
All together 333 mothers were participated in the study. Among them, more than three-quarter (76.6%) were 20-30 years age and 17.1% were teen ager. Nearly half (48.0%) women had the baby with 2-4 months and two-fifth had less than 2 months. Almost 83.0% of the participants were Hindus followed by Buddhist (13.8%) with least number of Muslims (0.3%). Almost one-quarter of the participants were illiterate. More than three-fifth (62.8) was house wives and very few (2.7%) were labors. The participants from different types of family (nuclear vs. joint) were more or less equal. Nuclear family are the family having the family members from two vertical generation (father, mother and their children), whereas joint family are those where more than two generations (grandmother/father, husband wife and children are present). Almost same numbers were from the low-level economic status (< Rs. 5000/month) as shown in [Table 1].
|Table 1: Socio-demographic profi le of mothers and children participating in the study (N = 333)|
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Breast-feeding practice and perceived behavior
More than three-quarter of mothers were delivered in institution either hospitals or primary health-care center. Almost 86.0% did not used any type of pre-lacteral feeding while remaining of others used different types of pre-lacteral feeding including ghee/honey, glucose water, cow/buffalo milk and other extra things. Most of the participants (87.1%) used to feed colostrums to their baby. More than one-quarter fed the first milk within half an hour whereas few (14.4%) fed after 24 h of delivery. About 55.0% used to feed the EBF for 6 months while least number (1.2%) used EBF only for 2 months. Most of the participants (94.6%) had good relation with family member. Very less (6.3%) participants perceived the deterioration of facial and physical beauty due to the breast feeding and did not willing to proper breast feeding [Table 2].
Level of breast feeding practice
The proper breast-feeding practice of mothers to their baby with exclusive breast-feeding was considered as the good practice and who fed in-exclusively with an improper way was considered as poor practice. Almost 56.0% had good practice of breast feeding [Table 3].
|Table 3: Level of breast feeding practice by accumulation of all practice related variables|
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Factors affecting breast-feeding
Breast-feeding is the most important task of mother for giving the life of baby during the infancy period. Various factors affect to break the exclusive breast-feeding though it is necessary for promotion of baby's health. Age of the child, Education of the mother, religion, occupation, family type, relationship of mother with family member, perceived change of beauty due to breast feeding and level of knowledge of mothers were found to be significant (P < 0.05) factors affecting to breast-feeding in Bhaktapur district.
Education and level of knowledge were found as most important factors affecting to follow the good breast-feeding practice. Mothers having some schooling were 2.44 times more likely (χ2 = 12.53, P < 0.01) to follow better practice then the women having no schooling. Similarly mothers having good knowledge on breast feeding and caring of baby were 4.58 times more likely (χ2 = 39.95, P < 0.001) to have good practice of breast-feeding then the mothers who had poor knowledge. Perception on changing and physical beauty due to breast-feeding and relationship of mother with family members were other important factors affecting to breast-feeding practice. Mothers who did not perceive the change of beauty due to breast-feeding were 3.40 times more likely (χ2 = 6.77, P < 0.01) to have good practice of breast feeding than the mother who perceived. Similarly, mothers who had good relationship with family members were 3.51 times more likely (χ2 = 6.01, P < 0.02) to have good practice of breast feeding than the mother who had poor relation. Age of the child, religion, occupation and family types were found to be other more factors affecting to breast feeding practice. Mothers having the baby < 3 months were 1.58 times more likely (χ2 = 4.14, P < 0.05) to have good practice of breast feeding than the mothers who had the baby of age more than 3 months. Similarly, mothers who were from Hindu religious background were 1.95 times more likely (χ2 = 5.2, P < 0.05) to have good breast feeding practice than the mothers from other religions. Mothers who were house wives were 1.58 times more likely (χ2 = 4.14, P < 0.05) to have good practice than the mothers having other occupations including business, service, farming and labor. Finally, mothers who were from joint family were 1.6 time more likely (χ2 = 4.49, P < 0.05) to have good practice than the mothers who were from nuclear family as shown in [Table 4].
| Discussion|| |
This study revealed that most of the deliveries; nearly four in every five were institutional delivery, which was in-line with the study reported from Kerala and Wardha, India, , but opposed of the similar studies conducted in other parts of India and Nepal. Studies conducted in West-Bengal ,, showed that more than four-fifth deliveries were in home. A study in rural Uttar Pradesh revealed that only one out of five women had an institutional delivery. 
Most of the mothers ( > 4/5 th ) in this study were found to be the good practice of avoiding pre-lacteal feeding though few had the practice of such feeding that was consistent with the other studies reported from Nepal and India, , but far better than the study reported from Uganda. Pre-lacteal feeding within the first 3 days (nearly three fifth of the infants) and water based liquids were the most common in Uganda.  The main reason the mothers reported for giving pre-lacteal feeds was that they had to wait until the milk started flowing. Other reasons for giving pre-lacteal had to do with the baby being hungry, cleaning of the baby's throat, her own pain and exhaustion after delivery, traditions and advice from health staff.
Timing is the most important practice of breast-feeding. According to the WHO guideline,  of new-born care, every new-born baby should be the first breast feed within half an hour. Our study revealed that only one quarter of the mother used to practice the first breast feeding within half an hour, which was lesser than the WHO assumption and the reports of other studies conducted in other part of Nepal, India and Nigeria. ,,,
The first milk called "colostrum" is the most suitable food for the baby during the early period. It contains the high concentration of protein and other nutrients the body need; it also rich in anti-infective factors, which protects the baby against respiratory infection and diarrheal diseases.  Most of the participants ( > 4/5 th ) in our study used to feed colostrum to their baby which was in line with other study which showed that 95% of the mother fed the colostrum to their baby. 
Our study showed that more than half of the mothers were used to good practice of EBF for 6 months, which was better than the study reported from Karnataka India in different time. ,
With regards to the contributing factors of breast-feeding practice; this study revealed that breast-feeding practice was significantly influenced by education, age of child, religion, occupation and family type, relationship of mother with family member, perceived change of beauty due to breast feeding and level of knowledge. Education and knowledge on benefit of breast feeding play the meaningful role to influence the mothers for breast feeding. Mothers having some schooling were 2.4 times good practice of breastfeeding in this study which was in line with the reports of other study from Hong-Kong.  Similarly present study explored that, the mothers having good knowledge performed 4.6 times well-practice than the mother having low knowledge, which was slightly differ from the study conducted in Eastern Saudi Arabia. Although > 90% of women in that study had good knowledge about the benefits of breast-feeding, less than one-fifth had good practices of absolute breast feeding.  This means that there was a gap between knowledge and practice of breast-feeding among study participants.
Mothers having the infant less than 3 months had 1.6 times good practice of breast-feeding in this study, which was strongly supported by the study of William O; (infants of age 0-2 months were more likely (OR: 24, 95% C: 14.63-42.16) to breastfeed exclusively than those having the age above 2 months). 
Women from Hindu religion in this study had better practice (OR: 1.95, P < 05) of breast feeding to their babys than the women from other religions. This could be due to the more flexible cultural and social norms in Hindu religion than others. Similarly, mothers without formal job (house wives) in this study had better practice of breast feeding (OR: 1.58, P > 0.05) than the mother having formal job (service/business and other) which is in line with similar study. 
Furthermore, our study revealed that mothers from joint family and good relation with family members had better practice of breast feeding (OR: 1.6 P < 0.05) than the mothers from nuclear family and poor relation. In the joint family, more family members with three generation could present and encourage to the mother for proper caring of new baby with proper feeding. Similarly, good relation develops the harmony toward each other and willing to support the mother and baby. Our study again found that mother who did not feel the deterioration of facial and physical beauty due to the breast feeding had better practice than the mother who did not feel so. The mothers who are sincere to their own beauty could show the neglected behavior for breast feeding and motivated to bottle feeding rather than breast feeding, which could be the harmful practice for the health of both mother and baby.
| Conclusion|| |
Despite the high proportion of women initiated breastfeeding early after birth, the prevalence of EBF for 6 months of age was very low. Large portion of the mothers (nearly half) had poor practice of breast-feeding. Age of the child, education of the mother, religion, occupation, family type and relationship of mother with family member, perceived change of beauty due to breast feeding and level of knowledge were found as significant (P < 0.05) factors affecting to breast feeding. Public awareness (video show, telecast communication) and effective counseling and training (by health workers) on art and benefit of proper breast feeding will support to motivate the mother towards EBF as prescribed by WHO.
| Acknowledgement|| |
The study team wants to put the sincere thanks to all the participants and others who directly or indirectly involved and support to conclude this study.
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[Table 1], [Table 2], [Table 3], [Table 4]