Comparison of Knowledge, Attitudes and Practices on Exclusive Breastfeeding between Primiparous and Multiparous Mothers Attending Wajir District Hospital, Wajir County, Kenya
Mohamed, Mahat Jimale
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Exclusive breastfeeding (EBF) is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. Failure to exclusively breastfeed for six months is associated with increased risk of childhood mortality and morbidity. There is paucity of information that analyses the disparity in Knowledge, Attitudes and Practices (KAP) among primiparous and multiparous mothers. This study aimed to compare the KAP of EBF between primiparous and multiparous mothers attending Wajir County hospital, Wajir County. In a cross-sectional comparative analytical study, KAP on EBF were assessed based on structured researcher-administered questionnaires, Key Informant Interviews (KIIs) and Focus Group Discussions (FGD) for a total of 280 mothers; primiparous (n=140) and multiparous (n=140) with infants 0-5 months of age. The KIIs were conducted with the healthcare providers at Wajir District Hospital while FGDs were conducted with mothers exclusively breastfeeding and those not exclusively their babies. Data were entered and analyzed using SPSS. Descriptive statistics was used to describe the study population demographic characteristics, knowledge, attitudes and practices of both primiparous and multiparous mothers. T-test was used to test for significant differences between primiparous and multiparous for continuous data. Chi-square test and odds ratio were used to test the association between EBF and categorical variables. Statistical significance was set at p< 0.05. Qualitative data was transcribed, and common themes identified. Results showed high maternal knowledge on breastfeeding in both group mothers. The attitudes towards EBF were also positive. Nonetheless, high maternal knowledge and positive attitude did not necessarily translate into the practice of EBF. This was attributed to socio-cultural factors deeply rooted in the community that influenced infant and young child feeding practices. Overall, the prevalence of EBF was 45.5% (primiparous women 39.4% and multiparous women 49.3%) with no significant differences between the mothers. The low EBF rate may be attributed to the over 50% of mothers getting breastfeeding information from traditional birth attendants (TBAs) and family/friends/relatives compared to 38% receiving the same information from health facility. Additionally, cultural practices that propagate the early introduction of prelacteals were hindrances to EBF practices. The study established no significant relationship between maternal knowledge and EBF practice. In contrast, maternal attitude score was significantly associated with the practice of EBF. Those mothers with a positive attitude towards EBF were more likely to EBF (chi-square test; p=.001).). There was no significant relationship in maternal sources of information and parity (chi-square test; p>0.05). The study showed that infants’ age and morbidity as well as maternal morbidity and breastfeeding complications had significant negative associations with exclusive breastfeeding. There was no association between maternal socio-economic and demographic characteristics with exclusive breastfeeding. It is recommended that Ministry of Health (MOH) design effective community based programmes to improve breastfeeding practices by establishing or strengthening community-based structures (mother to mother breastfeeding support groups, community health workers, volunteers and Traditional Birth Attendants) and linking them to the health facilities for training, support and monitoring. The study also recommends MOH to maximize on the opportunities of integrating EBF campaigns with other community based interventions like community based management of severe acute malnutrition; malnutrition screening, social protection and food security programmes.