Exclusive Breastfeeding in Rural Areas.ppt

Understanding the perception and awareness of rural mothers on exclusive breastfeeding

1. BY
THOMAS GLORY
21/GNS/167
SUPERVISOR: VORONDO K. STEPHEN
SEPTEMBER, 2024
1
AWARENESS AND PERCEPTION ON EXCLUSIVE
BREASTFEEDING AS A BIRTHCONTROL METHOD AMONG
PREGNANT WOMEN ATTENDING ANTENATAL CLINIC IN
RURAL COMMUNITIES: CASE STUDY OF PRIMARY
HEALTHCARES, MANDO AND HAYIN BANKI

2. Introduction and
Background
Breastfeeding is defined as the process of feeding the infant or the baby using
the mother’s milk through the expressed breast milk, or direct nipple-baby mouth
contact (Robinson et al., 2018).
Exclusive breastfeeding (EBF) is defined as giving breast milk only to the infant,
without any additional food or drink, not even water in the first six months of life,
with the exception of mineral supplements, vitamins, or medicines (WHO.WHA
Global Nutrition Targets 2025, Hossain et al., 2018).
A lot of factors ranging from cultural, social and economic conditions have been
identified as possible hindrances to an effective practice of exclusive
breastfeeding (Tampah-Naah & Kumi-Kyereme 2013, Fosu-Brefo & Arthur 2015).
The worldwide practice of exclusive breastfeeding is influenced by several
factors including the maternal knowledge (awareness), and perception. This
study will help look into the maternal awareness and perception on exclusive
breastfeeding as a contraceptive method, and its benefits at large.
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3. Problem Statement
Recent powerful "Exclusive Breastfeeding" advocacy campaigns
have raised breastfeeding awareness significantly. Hospitals and
other medical facilities are best equipped to educate expecting and
nursing women on the benefits of exclusive breastfeeding as well as
the steps to take to make it a reality. (Wang and Cao, 2019).
Following the survey that was done in 2017 by the National Demographic and
Health Survey (NDHS), the use of Exclusive Breastfeeding as a birth control
method is generally low, adding up to only 5% (Johnson, 2017), despite the
widespread of knowledge of Exclusive breastfeeding globally, of about 97%.
As a result, I want to research the understanding and impression ofpregnant
women visiting the prenatal clinic at Primary Health Cares, Mando and Hayin
Banki on exclusive breastfeeding as a birth control approach.
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4. Research Question
This study aims at addressing the following four questions:
1. What is the level of awareness of pregnant women attending
antenatal clinic at Primary Health Cares, Mando and Hayin Banki
towards exclusive breastfeeding as a birth control method?
2. What are the perceptions and experiences of pregnant mothers
regarding the use of exclusive breastfeeding as a birth control
method?
3. What are the factors influencing maternal awareness and
perception of exclusive breastfeeding as a birth control method
among pregnant women attending antenatal Clinics at Primary Health
Cares, Mando and Hayin Banki?
4. What are the ways to educate pregnant mothers on exclusive
breastfeeding towards birth control as a method?
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5. Objectives of the study
The objectives of this study are:
1. To examine the level of awareness among pregnant women
attending antenatal clinic at Primary Health Cares, Mando and Hayin
Banki on exclusive breastfeeding as a birth control method.
2. To find out the perceptions and experiences of the pregnant women
regarding the use of exclusive breastfeeding as a birth control method.
3. To examine the factors influencing maternal awareness and
perception of exclusive breastfeeding as a birth control method among
pregnant women attending antenatal clinics at Primary Health Cares,
Mando and Hayin Banki.
4. To proffer solutions on ways to educate mothers on the need of
exclusive breastfeeding as a way of controlling birth.
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6. Purpose of the Study
i. This research will help the health sector
considerably by demonstrating the value of
prenatal education.
ii. The findings of this study will also have
implications for pregnant women by highlighting
the value of exclusive breastfeeding, prenatal
education, and family planning.
iii. In addition to being useful for future research
and reference, the results from this study will be
used by the Nigerian government to formulate
policies to support exclusive breastfeeding.  
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7. Review of Literature Concepts
This conceptual and empirical literature review examines previous research conducted on key objectives
related to exclusive breastfeeding in order to shed light on the current knowledge and understanding
surrounding these topics.
According to UNICEF (2015), Exclusive breastfeeding is an act of feeding whereby “infant receives only
breast milk (includes breast milk which has been expressed or from a wet nurse) and nothing else except
for Oral Rehydration Salt (ORS), medicines, vitamins and minerals”. UNICEF and WHO (2016) recommend
that babies should be given only breast milk for the first six months of their lives, after which breastfeeding
should be continued in addition to appropriate complementary food until the baby is 24 months old.
In a study to examine the level of awareness of pregnant and lactating mothers on exclusive breastfeeding,
Dukuzumuremyi et al., (2020) did a systematic review of peer-reviewed literature from the online
databases. According to the study's findings, mothers with a high degree of awareness about the benefits
of exclusive breastfeeding know that only breast milk, especially in the first six months after delivery, is
essential for a baby's nourishment. From this study, it is clear that awareness is an important factor
influencing the prevalence of exclusive breastfeeding.
In a study to examine the perception and practices of exclusive breastfeeding, Kamath et al., (2016)
conducted a cross-sectional study of 188 mothers, using a well-structured questionnaire. This study
showed that the more the mothers are informed of the benefits of exclusive breastfeeding, the more they
practice it. More emphasis should therefore, be made on providing quality education to the mothers during
their antenatal clinic visits, as a way of boosting their perception on exclusive breastfeeding.
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8. Theoretical Framework
THEORETICAL FRAMEWORK OF HEALTH BELIEF MODEL (HBM)
The health belief model is a psychological framework for investigating and encouraging health
services, such as exclusive breastfeeding and birth control. The concept presupposes that
people's beliefs and attitudes are important determinants of their behaviours connected to their
health (Ghanbarnejad et al., 2022). According to this theory, differences in uptake behaviour
may be explained by beliefs about the following sets of variables:
Perceived susceptibility- If someone perceives that the health issue, that is, birth control is
personally relevant, they are likely to practice the control methods (Ghanbarnejad et al., 2022).
Perceived benefits- Refers to patients’ belief that a given treatment will cure an illness or help
to prevent it (Ghanbarnejad et al., 2022). Women are likely to embrace exclusive breastfeeding
if they are aware of its benefits.
Perceived barriers- refer to the negative aspects of health-oriented actions which serve as
barriers to action (Ghanbarnejad et al., 2022). Barriers of practicing exclusive breastfeeding
among mothers could be lack of adequate knowledge on the benefits of Exclusive
Breastfeeding, and the maternal perception on the practice.
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9. Research Design
For this investigation, the researcher employed a survey research design.
This is so because a sampling of people's thoughts and points of view is part
of the study's design. Dillman, Smyth, and Christian (2014) explained that
survey design is a meticulous process of constructing and organizing
questionnaires to gather information systematically from a sample of
individuals. It is a crucial component of empirical research, providing a
structured means to collect data, measure variables, and draw meaningful
conclusions. Surveys offer an efficient means to collect data from a large
number of participants in a relatively short time. This scalability makes
surveys cost-effective compared to other data collection methods, such as
interviews or experiments. Survey design is particularly valuable when
researchers aim to quantify attitudes, opinions, or behaviors. The structured
nature of surveys allows for the collection of quantitative data, enabling
statistical analysis and generalization to a larger population (Fowler, 2013).
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10. Setting
The study was conducted in two primary healthcare centres in Kaduna North LGA – PHC Mando
and Hayin Banki. Mando Kaduna (Figure 1) is located on latitudes (100 and 200N) and longitudes
(70 and 450E) and altitude of 632m and above sea levelin the Northern Guinea Savanna of
Nigeria (GPS, 2019).
Hayin Banki a suburb of Kaduna metropolis (Figure 2), is located in Kaduna North Local
Government area and lies between coordinates Latitude: 10° 33' 12" N. Longitude: 7° 26' 29" E.
Lat/Long and elevation of 631 meters above sea level. (Garba and Abiola, 2022).
From a personal point of view, the population of Mando and Hayin Banki is diverse, with a mix of
ethnic groups and religions represented. The both are a rapidly growing community, with new
residents moving in from other parts of Kaduna State and Nigeria. The population of Mando and
Hayin Banki is mostly rural, with many residents living in small villages and farming communities.
The majority of the population that uses the primary health care system in Mando and Hayin
Banki is made up of women and children. The use of primary health care services in Mando and
Hayin Banki is highest among women of childbearing age and young children. The population
that uses the primary health care system in Mando and Hayin Banki is made up of people from all
socio-economic backgrounds.
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11. Population and sample
Target population
The target population of this study comprises of pregnant women attending antenatal at Primary
Healthcare Centres, Mando and Hayin Banki, Kaduna State.
Sampling size determination
A study sample is only a selective segment of the population from which conclusions are drawn.
Essentially, it is the part of a whole that best represents the total and exhibits characteristics that are
similar to those of the whole. Sample size, a critical component of research design, refers to the
number of participants or observations included in a study. Determining an appropriate sample size is a
delicate balance, aiming to provide sufficient statistical power for meaningful conclusions while
considering practical constraints (Creswell & Creswell, 2017).
The researcher employed convenient sampling approach to estimate the sample size for this
investigation. The researcher conveniently chose 80 pregnant women out of the total population of
pregnant women attending antenatal in the two health facilities (primary healthcare centres, Mando
and Hayin Banki) as the sample size for this study. According to Omole et al., (2023), a sample of
convenience is one in which elements were selected from the target population based on their
accessibility or convenience to the researcher.
Therefore, the study sample for this research comprises of 80 pregnant women attending antenatal in
primary health care centres, Mando and Hayin Banki.
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12. Data Collection
Instrument for Data Collection
In this study, the research tool used was a questionnaire. The survey that was available to the
participants included several questions in it. The questionnaire was divided into five sections; the first
sought demographic or personal information from respondents, followed by the respondents’ level of
knowledge and awareness of pregnant women on exclusive breastfeeding, the third section sought the
perceptions and experiences of pregnant women in rural communities towards exclusive breastfeeding
as a birth control method, factors influencing maternal awareness and perception of exclusive
breastfeeding as a birth control and the ways to educate pregnant mothers on exclusive breastfeeding
towards birth control as a method in rural communities in line with the objectives of the study were also
included in respective sections. Participants have to tick the appropriate box in the column to respond.
Method of Data Collection
Prior to the dissemination of questionnaire, a form of rapport and brief health talk was established
so as to gain access and cooperation of respondent. The researcher used questionnaire method to
obtain pertinent and relevant information from the respondent based on the objectives of the research
study. The questionnaires were disseminated by the researcher and were obtained back from the
respondent for analysis of the result. On the other hand, questionnaire was interpreted for the
uneducated respondent and those who are not confident enough to fill out the questionnaire.
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13. Validity and Reliability and/or
Trustworthiness
Validity of instrument
Face and content validity of the questionnaire was done by the project
supervisor from the department of nursing in Nigerian Airforce College
of Nursing Sciences (NAFCONS) and all necessary corrections were
made before the instruments was administered to the respondent.
Reliability of the instrument
The data was gathered through a validation approach in which items or
questions were gathered from medical practitioners and persons with
knowledge on the subject. The Pearson Correlation Coefficient was
used to evaluate the instrument's dependability. The study instrument
was reasonably reliable, as evidenced by its co-efficient value of 0.68.
According to Omole (2023), a suitable dependability ranges from 0.67
to 0.87.
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14. Data Analysis
A simple percentage method was used to analyze data
collected from the respondents using tables for
percentage presentation and a brief interpretation.
Data collected via the questionnaire are tabled in serial
order and presented using percentages. A description
of the presented data was written in prose form before
analysis. This was done to ease understanding for
proper analysis.
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15. Ethical Considerations
The Department's Project Committee gave its approval
to the study. The process of data collection for the
study was guided by the social sciences research
ethics: confidentiality, anonymity, non- maleficence to
participants, beneficence, voluntariness, and
translation of protocol to local language for easy
communication. There was no bias in selection of study
participants and respondents were treated with dignity
and respect. Participant also had the right to withdraw
from the research anytime they are not comfortable
with the process.
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16. Presentation of Data
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Demographic Distribution of Respondents
 
Table 1. Demographic distribution of
respondents
 
Demographic information Frequency Percentage (%)
Age (in years)    
Below 20 19 25
20-24 32 42.11
25-30 21 27.63
31-35 4 5.26
Above 35 0 0
Marital Status    
Single 9 11.84
Married 65 85.53
Separated 0 0
Widowed 2 2.63
Level of Education    
None 24 31.58
Primary 29 38.16
Secondary 17 22.37
Tertiary 6 7.89
Occupation    
Housewife 31 40.79
Farming 22 28.95
Trading 18 23.68
Civil servant 5 6.58
Number of Children    
None 8 10.53
1 12 15.79
2 18 23.68
3 24 31.58
4 and above 14 18.42
Primary Healthcare    
Mando 54 71.05
Hayin Banki 22 28.95

17. Presentation of Data (Cont’d)
17
Resarch question 1
What is the level of awareness of pregnant women attending antenatal clinic at
Primary Health Cares, Mando and Hayin Banki towards exclusive breastfeeding as a
birth control method?
Table 2. Respondents’ level of knowledge and awareness on exclusive
breastfeeding
 
Variable Frequency (n)Percentage (%)
Have you heard of exclusive breastfeeding?    
Yes 57 75
No 19 25
What do you understand by exclusive breastfeeding    
Feeding the baby with breast milk and water only 14 18.42
Feeding the baby with breast milk only 44 57.89
Feeding the baby with breast milk, pap and water 9 11.84
Feeding the baby with breast milk, formula and water 8 10.53
Feeding the baby with breast milk, water and soft food like indomie 1 1.37
When should a baby be breastfed?    
Morning, afternoon and night 12 15.79
On demand 46 60.53
Only when crying 16 21.05
At night 2 2.63
Discarding of the first milk or colostrum is the best practice?    
Yes 47 61.84
No 29 38.16
Breast milk alone is enough for an infant during the first 6 months of life?   
Yes 52 68.42
No 24 31.58
Is exclusive breastfeeding cost effective?    
Yes 55 72.37
No 21 27.63
Are you going to practice exclusive breastfeeding?    
Yes 49 64.47
No 27 35.53
Are you aware that exclusive breastfeeding can delay the return of your
menstrual periods after child birth?
   
Yes 55 72.37
No 21 27.63

18. Presentation of Data (Cont’d)
18
Research question 2
What are the perceptions and experiences of pregnant mothers regarding
the use of exclusive breastfeeding as a birth control method?
Table 3. Respondent’s perceptions and experiences on the practice of
exclusive breastfeeding
 
Variable Frequency (n)Percentage
(%)
Have you used exclusive breastfeeding as a method of birth control?    
Never used
59 77.63
Used exclusive breast feeding
17 22.37
If you have never used exclusive breastfeeding as a method of birth control,
why haven’t you?
   
I’m yet to have my first baby
8 13.56
Inconvenience
6 10.17
Health issues
2 3.39
Lack of support
4 6.78
Lack of knowledge about its effectiveness
19 32.20
Desire to become pregnant again
20 33.90
Other
0 0
If you have used exclusive breastfeeding as a method of birth control, select
your experience.
   
Very satisfied
6 35.29
Somewhat satisfied
1 5.88
Neither satisfied nor Dissatisfied
3 17.65
Satisfied
7 41.18

19. Presentation of Data (Cont’d)
19
Research question 3
What are the factors influencing maternal awareness and perception of
exclusive breastfeeding as a birth control method among pregnant women
attending antenatal Clinics at Primary Health Cares, Mando and Hayin Banki?
 
Table 4. Factors Influencing Maternal Awareness of Exclusive
Breastfeeding.
   
Variable Frequency
(n)
Percentage (%)
Have you heard health care provider discuss exclusive breastfeeding
as a birth control method during your antenatal visits?
   
Yes 57 75
No 19 25
How important is it for health care providers to promote exclusive
breast feeding as a method of birth control?
   
Very important 59 77.63
Somewhat important 11 14.47
Not very important 6 7.89
Were there any cultural or social factors that have affected your
usage of exclusive breastfeeding as a birth control.
   
Culture does not support family planning
9 11.84
Influence from friends
4 5.26
Lack of knowledge about exclusive breastfeeding
19 25
Lack of support
6 7.89
Low income
5 6.58
My religion teaches against family planning
22 28.95
Unsupportive partner
11 14.47

20. Presentation of Data (Cont’d)
20
Research question 4
What are the ways to educate pregnant mothers on exclusive
breastfeeding towards birth control as a method?
Table 5. Ways of Educating Pregnant Women on Exclusive
Breastfeeding.
 
Variable Frequency
(n)
Percentage
(%)
Your knowledge of exclusive breastfeeding came mostly from.    
Family/friends
1 1.75
Health care providers
55 96.49
Media (radio, TV, Internet)
1 1.75
Others
0 0

21. Results/Findings
The majority of respondents in this study have heard of exclusive breastfeeding. A study on
knowledge of exclusive breastfeeding by Agu and Agu, (2011) pointed out that most women had
good understanding of exclusive breastfeeding. In contrast, a study in Sokoto State found that
only 31% of mothers there had sufficient knowledge of exclusive breastfeeding (Mogre et al.,
2016).
Whereas a previous study conducted in Kaduna metropolis (Yakubu et al., 2023) showed a high
level of awareness and practice of exclusive breastfeeding, the present study revealed that only
22.37% of the respondents have practiced exclusive breastfeeding despite a high level of
awareness of 75%. Another study conducted in Yobe State (Ajibuah et al., 2013) also reveals
similarly low level of practice where only 7.4% of mothers practiced exclusive breastfeeding.
The same study revealed that early initiation of breastfeeding was higher in urban than rural
communities which corroborates this present study which was also conducted in two rural
communities of Mando and Hayin Banki, Kaduna State. This shows that there is a need to bridge
the gap between knowledge and practice of exclusive breastfeeding by mothers.
Finally, this survey reveals that the major barriers to the practice of exclusive breastfeeding
were majorly socio-cultural. This corroborates the study in Yobe State where it was gathered
that social-cultural beliefs play major roles in hindering exclusive breastfeeding.
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22. Implication for Nursing
Since research plays a major role in establishing the scientific
basis for evidence-based nursing practice, it is essential for the
profession to question what is important and fundamental to its
advancement. The study also allowed the reflection on the need
to intervene strategically with regard to the promotion of
exclusive breastfeeding, as it is still undervalued, given the
advantages inherent to it, and the work can be used by nurses
as an incentive tool for mothers to try to reduce precocious
weaning.
This study shows that are many benefits for exclusive
breastfeeding that must be explained to parents so they may
decide for themselves what is better for their child. Nurses must
incorporate the best available evidence into their practice and,
depending on their experience, expertise, patients, and
resources, provide care of excellence.
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23. CHALLENGES/
CONSTRAINTS/LIMITATIONS
This study has its own limitations. The first limitation of this study was
only English articles were considered and there may be other studies
published in other languages. Also, this study has a small sample size
which is not an absolute representation of the entire population of
mothers attending antenatal in rural Primary Healthcare Centres in
Nigeria, this therefore could affect generalization of the findings of
the study.
Other challenges encountered in the course of the study are:
Financial constraints: The researcher had problem of finance in
terms of printing, photocopying and browsing to get information.
Time factor: Time for carrying out the research was limited as the
researcher had to combine going for classes, doing of assignments
and preparing for presentations with research process.
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24. Conclusion
Only a small percentage of pregnant women who attend antenatal clinics in rural
areas actually use exclusive breastfeeding as a method of birth control. This may
be largely the result of misunderstandings that individuals still have about various
forms of contraception, and education on these methods may be what is needed to
dispel myths and explain the truths or facts underlying these various forms of
contraception. Therefore, there is a need for aggressive, target-oriented
information dissemination using all of the available channels, particularly the mass
media, community opinion leaders, religious leaders, husbands, mothers,
relatives, health care professionals, and everyone else involved in practices that
promote contraception. Also, the underlying barriers can be overcome through
the necessary support from family members, health care practitioners,
government and all employers of labour. The goal here should be to dispel the
women's misconceptions and raise the bar for practise. In the end, this will result
in the benefits of contraception and lessen the complications that can arise from
having numerous children, for both the mother and the baby.
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25. Recommendations
On the basis of the conclusions drawn, the following recommendations are made:
1) Since health education remains the most viable means of reaching mothers on the
benefits derived from exclusive breastfeeding, healthcare workers should intensify health
education to provide mothers with complete and current information on the methods of
exclusive breastfeeding, to increase their knowledge of benefits derived from exclusive
breastfeeding of babies.
2) Special interventions should be made for older mothers with poor breastfeeding
practices by healthcare workers to encourage them to endure the task of breastfeeding,
through health education and nursing support to enable them to breastfeed exclusively.
3) Employers of labor should extend maternity leave for nursing mothers to 6 months to
enable them practice exclusive breastfeeding or establish day care centers within the
working environment to enable mothers’ breastfeed their babies more conveniently and
adequately.
4) Other agents of information dissemination on exclusive breastfeeding, such as the mass
media, should be equally employed to promote rural pregnant women awareness of the
benefits practice.
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26. THANK YOU FOR YOUR RAPT ATTENTION
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27. References
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southeastern Nigeria. Trop J. Med Res, 15(2):39–44.
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London: Sage publications.
Dillman, D. A., Smyth, J. D., & Christian, L. M. (2014). Internet, phone, mail, and mixed-mode surveys: The tailored design
method. John Wiley & Sons.
Dukuzumuremyi, J., Acheampong, K., Abesig, J., & Luo, J. (2020). Knowledge, attitude, and practice of exclusive
breastfeeding among mothers in East Africa: a systematic review. International Breastfeeding Journal, 15(1).
https://doi.org/10.1186/s13006-020- 00313-9
Fowler, F. J. (2013). Survey research methods. London; Sage publications.
Ghanbarnejad, A., Homayuni, A., Hosseini, Z., & Madani, A. (2022). Smoking Behavior among Students: Using Health Belief
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Mogre V, Dery M, GaaPK (2016). Knowledge, attitudes and determinants of exclusive breastfeeding practice among
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Robinson, H., Buccini, G., Curry, L., & Perez Escamilla, R. (2018). The World Health Organization
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WHO.WHA Global Nutrition Targets 2025: Breastfeeding Policy Brief 2014.
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