Breast Feeding

THE BREAST FEEDING PRACTICES AND NUTRITIONAL STATUS OF
CHILDREN (6-24 MONTHS) IN MBALE REGIONAL

REFERRAL HOSPITAL
BY
NAMUKEMO J FRANK
14/U/1378/HND/PD
A RESEARCH REPORT SUBMITTED TO THE DEPARTMENT OF HUMAN

NUTRITION AND HOME ECONOMICS IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE AWARD OF A BACHELOR
OF SCIENCE DEGREE IN HUMAN NUTRITION AND
DIETETICS OF KYAMBOGO UNIVERSITY
AUGUST, 2017
DECLARATION
I NAMUKEMO J FRANK declare and affirm that the work presented in this report has been
duly done by me. It is a representation of results for research done by me and not duplicated
from anywhere or shared with anyone. This work k has never been presented to any institution
for any academic award.
The data, tables and figures here in reproduced are dully acknowledged and, where applicable,
permission has been sought and given by relevant authorities.
Signature: ……………………….
NAMUKEMO J FRANK
Date: …………………………….
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APPROVAL
This is to certify that Namukemo J Frank (14/U/1378/HND/PD) carried out a study about
“Breast Feeding Practices and Nutritional Status of Children (6-24 months) in Mbale Regional
Referral Hospital” under my supervision. Her report is now ready for submission to the academic
board for assessment.
Signature: ……………………………………..
Name: Mrs. Aidah Kikabi
Date: ………………………………………….
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DEDICATION
This report is dedicated to my loving parents Mr. Egesa Taddeo and Mrs. Nasirumbi Mary, who
have provided for all my needs and supported my studies up to University level. May the
Almighty God bless you.
I also dedicate this report to the Department of Human Nutrition and Home Economics of
Kyambogo University, where I have spent the last three years of my life studying and learning
new things with the help and guidance of my lecturers.
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ACKNOWLEDGEMENT
I would like to convey my gratitude to the administration of Mbale Regional Referral Hospital
for giving me an opportunity to carry out my research and data collection with them and
providing a very conducive environment throughout the data collection period.
I would also like to acknowledge the efforts of Mrs. Aidah Kikabi, my University research
supervisor for taking her time to guide me through the whole research process and correct my
report. May God bless you.
It is with profound gratitude that I acknowledge the generous help and support given to me by
my Dad who provided all the requirements for the research and my Mum who stood by me
throughout the whole research period, assisted me in the data collection process and made sure
that I was comfortable and healthy at all times.
I wish to thank the department of Human Nutrition and Home Economics at Kyambogo
University for the opportunity provided to carry out the research and get exposed to the various
existing nutrition problems in our communities.
Above all, I thank God Almighty for His provision and the strength He gave me to carry through
with the research under the grueling short period at my disposal.
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LIST OF ACRONYMS AND ABBREVIATIONS
EBF Exclusive Breast Feeding
FAO Food and Agricultural Organization of the United Nations
IMAM Integrated Management of Acute Malnutrition
IYCF Infant and young child feeding
MoH Ministry of Health
SAM Severe Acute Malnutrition
SOFI State Of Food Insecurity
UDHS Uganda Demographic and Health Survey
UNICEF United Nations Children Education Fund
WFP World Food Programme
WHO World Health Organization
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TABLE OF CONTENTS
DECLARATION..............................................................................................................................i
APPROVAL....................................................................................................................................ii
DEDICATION...............................................................................................................................iii
ACKNOWLEDGEMENT..............................................................................................................iv
LIST OF ACRONYMS AND ABBREVIATIONS........................................................................v
TABLE OF CONTENTS...............................................................................................................vi
LIST OF TABLES...........................................................................................................................x
LIST OF FIGURES........................................................................................................................xi
ABSTRACT..................................................................................................................................xii
CHAPTER ONE: INTRODUCTION TO THE STUDY................................................................1
1.1 Introduction............................................................................................................................1
1.2 Background of Study.............................................................................................................1
1.3 Statement of the Problem.......................................................................................................2
1.4 General Objective..................................................................................................................2
1.5 Specific Objectives................................................................................................................2
1.6 Research Questions................................................................................................................3
1.7 Significance of Study.............................................................................................................3
1.8 Research Indicators................................................................................................................3
1.9 Relevance of the Study..........................................................................................................4
1.9 Scope of the Study.................................................................................................................4
1.10 Operational Definitions........................................................................................................5
CHAPTER TWO: LITERATURE REVIEW..................................................................................6
2.1 Introduction............................................................................................................................6
2.2 Breast Feeding Practice..........................................................................................................6
2.2.1 Early Initiation....................................................................................................................6
2.2.2 Exclusive Breastfeeding......................................................................................................6
2.2.3 Continued Breast Feeding...................................................................................................7
2.2.4 Complementary Feeding.....................................................................................................7
2.2.5 Timely Introduction of Complementary Feeds at 6months................................................8
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2.2 Benefits of Breast Feeding.....................................................................................................8
2.3 Factors affecting Exclusive Breastfeeding.............................................................................9
2.3.1 Age of Mothers...................................................................................................................9
2.3.2 Maternal Support and Exclusive Breastfeeding................................................................10
2.3.3 Level of Education and Exclusive Breastfeeding.............................................................10
2.3.4 Level of Knowledge on Breastfeeding..............................................................................10
2.3.5 Exclusive Breastfeeding and the Nutritional Status of the Baby......................................10
CHAPTER THREE: METHODOLOGY.....................................................................................12
3.1 Introduction..........................................................................................................................12
3.2 Types of Research................................................................................................................12
3.3 Study design.........................................................................................................................12
3.4 Study Population..................................................................................................................12
3.5 Sample Size Determination..................................................................................................13
3.6 Sampling Methods and Tools..............................................................................................13
3.7 Data Collection Methods.....................................................................................................13
3.8 Data collection tools.............................................................................................................14
3.9 Data Analysis.......................................................................................................................14
3.10 Validity and Reliability of Tools.......................................................................................15
3.11 Ethical Requirements.........................................................................................................15
CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS...............................................16
4.1Introduction...........................................................................................................................16
4.2The Socio -Demographic Characteristics of Caretakers of Children 6-24 Months in Mbale
Regional Referral Hospital.........................................................................................................16
4.3The Different Breastfeeding Practices Being Carried Out By The Caretakers Of Children
Less Than Two Years................................................................................................................20
4.3.1Continued breastfeeding....................................................................................................20
4.3.2 Termination of Breastfeeding...........................................................................................21
4.3.3 Duration of Breastfeeding.................................................................................................21
4.3.4 Breastfeeding Intervals.....................................................................................................22
4.3.5The Possible Factors Affecting Exclusive Breastfeeding..................................................23
4.3.6 Breastfeeding Makes Mothers Socially Tired...................................................................26
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4.3.7 Encouragement and Support in Breastfeeding from Husband Is Good............................26
4.3.8 The Society Values Breastfeeding....................................................................................27
4.3.9 The Mother’s Knowledge about Breastfeeding................................................................27
4.3.10 Quantity of Milk Depends On Mother's Food................................................................29
4.3.11 Breastfeeding Exclusively Makes the Baby Refuse to Eat Other Foods during Weaning
....................................................................................................................................................29
4.3.12 Complementary Feeding Patterns of the Mothers...........................................................30
4.13 Age of a child at complimentary feeding...........................................................................31
4.4The Nutritional Status of the Children 6-24 Months in Mbale Regional Referral Hospital. 35
4.4.1 Dietary Diversity Score.....................................................................................................35
4.4.2 Proportion of Stunting, Wasting and Underweight In Children.......................................35
4.5 The Relationship between the Feeding Practices of Children under Two Years And Their
Nutritional Status.......................................................................................................................36
CHAPTER FIVE: DISCUSSION OF RESULTS.........................................................................38
5.1 Introduction..........................................................................................................................38
5.2 The Socio -Demographic Characteristics of Respondents Of Children 6-24 Months In
Mbale Regional Referral Hospital.............................................................................................38
5.2.1 Discussion of the Findings................................................................................................38
5.2.1.1 Age of Respondent’s......................................................................................................38
5.2.1.2 Education Level of Respondents....................................................................................38
5.2.1.3 Marital Status of the Respondents.................................................................................39
5.3 The Different Breastfeeding Practices Being Carried Out By the Caretakers of Children
Less Than Two Years................................................................................................................39
5.3.1 Initiation of Breastfeeding................................................................................................39
5.3.2 Continuous Breast Feeding...............................................................................................40
5.3.2 Possible Factors Affecting Exclusives Breastfeeding.......................................................40
5.4 The Nutritional Status of Children 6-24 Months in Mbale Regional Referral Hospital......41
5.5 The Relationship between the Feeding Practices of Children under Two Years and Their
Nutritional Status.......................................................................................................................41
CHAPTER SIX: CONCLUSION AND RECOMMENDATIONS..............................................42
6.1. Introduction.........................................................................................................................42
6.2 Conclusions..........................................................................................................................42
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6.3 Recommendations................................................................................................................43
6.3.1 The Ministry of Health......................................................................................................43
6.3.2 Health Workers.................................................................................................................43
REFERENCES..............................................................................................................................44
APPENDIX A: QUESTIONNARE...............................................................................................50
APPENDIX B................................................................................................................................59
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LIST OF TABLES
Table 4.1The socio -demographic characteristics of caretakers of children 6-24 months.........16
Table 4.2 Initiation of breastfeeding practices...........................................................................20
Table 4.3 Termination of breastfeeding.....................................................................................21
Table 4.4 Breastfeeding on demand...........................................................................................21
Table 4.5 Night breastfeeding....................................................................................................22
Table 4.6 Number of times respondents’ breastfed their children at night................................23
Table 4.7 Possible factors affecting exclusive breastfeeding....................................................23
Table 4.8 The Mother’s knowledge about breastfeeding...........................................................27
Table 4.9 The age of the child at first introduction to water......................................................30
Table 4.10 Number respondents who had introduced to food their children.............................31
Table 4.11 Frequency of consumption of the various food groups...........................................32
Table 4.12 Mean dietary diversity score for the different dietary diversity categories.............35
Table 4.13 Proportion of Stunting and Underweight In Children..............................................36
Table 4.14 Proportion of stunting and underweight by sex of children.....................................36
Table 4.15 The relationship between the feeding practices nutritional status...........................37
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LIST OF FIGURES
Figure 4.1 Showing Sex of respondents........................................................................................18
Figure 4.2 Showing Age Brackets of children...............................................................................18
Figure 4.3 Showing Weight Ranges of children............................................................................19
Figure 4. 4 Showing whether children were born from hospital...................................................19
Figure 4.5 Continued breastfeeding...............................................................................................20
Figure 4.6 Breastfeeding intervals.................................................................................................22
Figure 4.7 Breastfeeding makes mothers socially tired.................................................................26
Figure 4.8 Encouragement and support in breastfeeding from husband is good...........................26
Figure 4.9 The society values breastfeeding..................................................................................27
Figure 4.10 Quantity of milk depends on mother's food...............................................................29
Figure 4.11Breastfeeding exclusively makes the baby refuse to eat other foods during weaning 29
Figure 4.12 Giving water...............................................................................................................30
Figure 4.13 Age of a child at complimentary feeding...................................................................31
xi
ABSTRACT
The aim of the study was to establish the breast feeding practices and nutritional status of
children (6-24 months) in Mbale Regional Referral Hospital, objectives includes; to establish the
socio -demographic characteristics of caretakers of children 6-24 months, to establish the
different breastfeeding practices being carried out by the caretakers of children less than two
years, to establish nutritional status of the children 6-24 months and to establish the relationship
between the feeding practices of children under two years and their nutritional status.
A cross section analytical study was conducted on a sample of 60 respondents. Data collection
tools included structured questionnaires for mothers and children, which was used to collect
information on breast feeding practices, nutritional status and anthropometry. Checklists for
qualitative data and focus group discussions. Quantitative data was analyzed using computer
software like Statistical Package for Social Scientists (SPSS), ENA for SMART (2008) software.
Nutri-Survey and interpreted using the WHO standards (2006). The results revealed that the
nutritional status of children 6-24 months, results showed that almost all (91.7%) the children
whose nutritional status was taken, they had a normal weight at that age and at the same time had
normal weight at that age of 6-24 months, breast feeding should be initiated within the first
30minutes after birth, continued exclusively up to 6 month and can thereafter be terminated up to
2 years and that there is a significant relationship between when the child started breastfeeding
and dietary diversity score i.e. (p=0.010). There is also a significant relationship between dietary
diversity score and when the child is still breastfeeding (p=0.020). In conclusion, it was
established that breastfeeding practices affects the nutritional status of children between 6 to
24months. Good breast feeding practices helps in improving the health status of children and
therefore improving their resistance to diseases. This study highlights the factors that contributed
to adherence to the recommended breast feeding practices of exclusive breast feeding and
complimentary feeding. These were; education status of the mother, place of delivery and mode
of delivery and age and education level of the caregiver. The study recommended that the
Ministry of Health in collaboration with other non-governmental agencies such as the UNICEF
should conduct similar study from time to time to monitor. A further study on the quality and
quantity of food given to the children is very necessary. This will give a baseline data for an
effective health education programme on complementary foods in the district.
xii
CHAPTER ONE: INTRODUCTION TO THE STUDY
1.1 Introduction
This chapter gives a brief background to the research, including study objectives and problem
statement, as well as justifications, research indicators, reverence of the study and study
questions.
1.2 Background of Study

Initiation of breastfeeding within the first hour of life, exclusive breastfeeding (EBF), breast milk
is the natural food for babies, colostrum, the yellowish sticky breast milk produced at the end
of pregnancy as the perfect food for new born, this can only be tapped through early initiation of
breast feeding. (UNICEF, 2016)
Exclusive breastfeeding is defined as feeding infants only on breast milk, be it direct from breast
or expressed, with no addition of any liquids or solids apart from drops or syrups consisting of
vitamins, mineral supplements or medicine and nothing else. (2015)
Malnutrition can be either under nutrition or over nutrition or obesity. Under nutrition is as a
result (MoH, 2016) of deficiency of proteins, energy, minerals and vitamins leading to loss of
body fat. Statistics show that 5% of children nationally are estimated to be acutely malnourished
and nearly 2% of these have sever acute malnutrition (SAM) (UDHS, 2011)
Acute malnutrition includes wasting (low weight for height) also called marasmus or nutritional
edema also; called kwashiorkor, wasting is characterized by rapid weight loss
Stunting (low height for age) is low accumulation process, it is also caused by inadequate intake
of some nutrients, it is estimated by the United Nations Children’s Fund (UNICEF) 2015to affect
161 million children worldwide, it develops after a long period of time. Micronutrient deficiency
or vitamins and mineral deficiencies, for example vitamin A, Iron and others (WFP, 2016).
According to world Food Programme, the Hunger Statistics 2016,795 million people in Sub
Saharan Africa is the region with the highest prevalence of hunger, one person in the four are
undernourished. Poor nutrition causes nearly half (45%) of deaths in children under five, 3.1
million children each year.one out of six children roughly100million in developing countries is
underweight (WFP, 2016).
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About 41% of child deaths occur in Sub-Saharan Africa from diarrhea, pneumonia, malaria and
HIV/AIDS, with under nutrition as an underlying cause of two fifths of all child deaths
(UNICEF, 2003) .The promotion and support of exclusive breastfeeding EBF is capable of
lowering child deaths by 13% (Black, 2013)
According to UDHS 2011, early initiation of breast feeding is at 53%, exclusive breastfeeding
63%, timely introduction of complementary foods 67%, whereas those who continue
breastfeeding up to 2 years 46% (UBOS, 2012). Malnutrition affects over two million children
under five years of age. The prevalence of stunting was at 33%, underweight at 14% and wasting
at 5% in children 0-59 months in Uganda. (UDHS, 2011).
According to the above, under nutrition is on a rise as a result of poor breastfeeding practices in
children under two years of age in Uganda.
1.3 Statement of the Problem

Despite breastfeeding being a major contributor to the nutritional status, few children of 3
months old are fed exclusively on breast milk (Chola et al, 2011). Although the government of
Uganda and other stakeholders like UNICEF, WHO and WFP, has put in much effort to improve
the nutritional status of children, it is still a challenge. In Mbale Regional Referral Hospital, there
is clear evidence of poor nutritional status of children below two years.
These poor child feeding practices directly affect the nutritional status of children, and therefore
this research is intended to focus on the breastfeeding practices and nutritional status of children
below 6-24 months
1.4 General Objective

To assess the relationship between breastfeeding and nutritional status of children aged 6-24
months attending Mbale Regional Referral Hospital
1.5 Specific Objectives

i. To establish the socio -demographic characteristics of caretakers of children 6-24
months in Mbale Regional Referral Hospital
ii. To establish the different breastfeeding practices carried out by caretakers of children
less than two years.
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iii. To establish nutritional status of the children 6-24 months in Mbale Regional Referral
Hospital
iv. To establish the relationship between the feeding practices of children under two
years and their nutritional status.
1.6 Research Questions

i. What are the socio -demographic characteristics of caretakers of children 6-24
months in Mbale regional referral hospital?
ii. What are the breastfeeding practices carried out by caretakers of children 6-24
months?
iii. What is the nutritional status of children 6-24 months in Mbale regional referral
hospital?
iv. What is the relationship between the feeding practices of children under two
years and their nutritional status?
1.7 Significance of Study

This study provides important baseline information on the prevalence and factors affecting
Breast feeding practices in remote setting (the study area). The findings shall be useful to Mbale
regional Referral Hospital and other Governmental and Nongovernmental organizations working
in maternal and child health programs to implement intervention to advance the breast feeding
practices in the community.
1.8 Research Indicators

Number of mothers who initiated breastfeeding early.
Number of mothers who exclusively breastfeed their children for 6 months.
Number of mothers who know about responsive feeding.

Number of children who are malnourished both underweight, wasting and stunting.
Number of mothers who know when to initiate complementary feeding.
The level of education of the parents.
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1.9 Relevance of the Study
The information or knowledge that will be obtained from this research will enable nutritionists to
know the actual burden of malnutrition pertaining in Mbale Regional Referral Hospital will form
the baseline for an interventional study.
Besides, by the examination of the feeding practices of mothers, an effective health education
programme will be drawn. This will take into consideration the local conditions, including
culture and availability of local foods so that it can be fully implemented.
Furthermore, this research will provide a wide range of individuals, policy makers, program
planners, health care providers, and community leaders, scientifically based information
necessary to develop culturally appropriate health messages for optimal infant and young child
feeding.
This research will equip the student with knowledge and skills needed in the career.
It instills confidence to the student, increasing her competence in data collection, analysis and
presentation.
This research forms an important platform in which the student puts into practice the theoretical
information and values learned during the course.
1.9 Scope of the Study

Content Scope
This study centered on the breastfeeding of children under two years in Mbale Regional Referral
Hospital, the demographic characteristics of caretakers of the children and the nutritional status
of the children 6-24 months in Mbale regional referral hospital.
Geographical Scope
This study was carried out in Mbale Regional Referral Hospital, which is located in Mbale
Municipality in Eastern Uganda. It involved people, particularly mothers, from several districts
such as Kapchorwa, Soroti, Bududa, Manafwa, Budaka etc.
Time
Time was conducted within three months, particularly from April through July, 2017.
4
1.10 Operational Definitions
Exclusive breastfeeding: it refers to when infants are not given any other food or liquid
including water during the first six months after delivery.
Stunting: it is also referred to as ‘shortness’. It is a condition characterized by low height for age
that is caused by insufficient nutrition over a long period and regular infections.
Wasting: this is also known as ‘thinness’. It is a condition characterized by low weight for
height that is caused by acute food shortage.
Malnutrition: generally refers both to under-nutrition and over-nutrition, but this study, the term
to refer solely to a deficiency of nutrition.
Nutritional Status: Nutritional status refers to the state or condition of the body as influenced
by the diet; the level of nutrients in the body and the ability to maintain normal metabolic
integrity.
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CHAPTER TWO: LITERATURE REVIEW
2.1 Introduction
This chapter provides an extensive review of literature related to the research problem/topic,
with related citations
2.2 Breast Feeding Practice

The WHO and the UNICEF recommend that all mothers should breastfeed their children
exclusively for the first 6 months and thereafter they should continue to breastfeed for 2 years or
longer (UNICEF, 2011). Breastfeeding alone with no water provides the ideal nourishment for
infants for the first six months of life as it provides all the nutrients, antibodies, hormones,
immune factors and antioxidants an infant needs to thrive. It protects babies from diarrhea and
acute respiratory infections and stimulates their immune system (WHO ,UNICEF, 2003).
The indicators of appropriate breastfeeding practices include: early initiation of breastfeeding,

exclusive breastfeeding for children under six months and continued breastfeeding at 1 year and
for 2 years or beyond (UNICEF, 2011).
2.2.1 Early Initiation

Early initiation means breastfeeding the new born within the first hour of life. Exclusive breast
feeding means receiving only breast milk by the infant in the first six months of life, the infant
receives no other liquid or solid with the exception of oral rehydration solution or drops/syrups
or vitamins minerals or medication. (UNICEF, 2016)
Breastfeeding has many health benefits for both to the mother and the baby, it contains all the
nutrients an infant needs for the first six months of life.it protects against diarrhea and common
childhood illness such pneumonia, and also have longer term health benefits for the mother
and child such as the risk of overweight and obesity in childhood and adolescence, it has been
associated with higher intelligence quotient(IQ) in children. (WHO, 2016)
2.2.2 Exclusive Breastfeeding

Infants should be exclusively breastfed for the first six months of life to achieve optimal
growth, development and health. Thereafter to meet their evolving nutritional requirements .they
6
should receive nutritionally adequate and safe complementary foods while continuing to breast
feed for up to two years. (Lutter, 2011)
The mother should breastfeed her baby immediately after delivery, the skin to skin contact and to
create the bond. If the first feed is delayed for longer than one hour, breastfeeding is less likely to
be successful. The advantages of breastfeeding on demand, there is earlier passage of meconium,
baby gains weight faster, larger volumes of milk, and less incidence of jaundice (MoH, 2014).
Exclusive breastfeeding is defined as giving nothing else but breast milk not even water during
the first six months of an infant’s life, it is Accessible, Feasible, Affordable, Sustainable and Safe
(AFASS). It protects the infants from infections; infants who are not
Exclusively breastfed in the first two to three months are six times more likely to die of
infections than those who are not (FANTA 2, 2010).
2.2.3 Continued Breast Feeding

The first two years of life are critical stages for a child's growth and development. Any damage
caused by nutritional deficiencies during this period could lead to impaired cognitive
development, compromised educational achievement and low economic productivity (Grantham-
mc gregor etal, 2007). Poor breastfeeding and Complementary feeding practices, together with
high rates of morbidity from infectious diseases are the prime proximate causes of malnutrition
in the first two years of life. Breastfeeding confers both short-term and long-term benefits to the
child. It reduces infections and mortality among infants, improves mental and motor
development, and protects against obesity and metabolic diseases later in the life course (Murage
et al, 2011)
2.2.4 Complementary Feeding

Complementary feeding is the transition from exclusive breast feeding to family food; typically
it covers the period from 6 to 18-24 months of age and is a very vulnerable period. At six months
breast milk is no longer enough to meet the nutritional needs of the infant, it is a time when
malnutrition starts in many infants, contributing significantly to a high prevalence of
malnutrition in children under five years of age worldwide. WHO estimates that two out of five
children are stunted in low income countries. (Xiadong, 2012)
7
Complementary feeding should be timely, meaning that all infants should start receiving food in
addition to breast milk from six months on wards. It should be adequate meaning complementary
food s should be given in amounts, frequency, and consistence and using a variety of foods to
cover the nutritional needs of the growing child while maintaining breastfeeding. Foods should
be prepared and given in a safe manner, meaning that measures are taken to minimize the risk of
contamination with pathogens. It should be appropriate, meaning that foods are given in
appropriate texture for the age of the child and applying responsive feeding following the
preference and psycho-social cues. (WHO, UNICEF, 2004)
2.2.5 Timely Introduction of Complementary Feeds at 6months

According to current recommendations (WHO, 2008), complementary feeding should be
introduced into the child’s diet at the age of 6 months. Early introduction of
complementary foods increases infant morbidity and mortality while late introduction of
complementary foods is harmful to the health of the baby because infant growth slows down and
the risk of malnutrition and micronutrient deficiency increases (PAHO/WHO, 2003).The
introduction of complementary foods should therefore not be before 17 weeks but should not be
delayed beyond 26 weeks USAID/UNICEF/WHO, (2010).
In most cases, mothers practice early introduction of complementary feeding. According to

UDHS (2011), 14 percent of infants under age of 6 months were given complementary foods and
the trend of early introduction increased from 6 percent among children aged 0-1 months to 24
percent among those in 4-5 months age bracket. Likewise a study done by Agedewet al., (2014)
also revealed that 59.6% of the infants had been introduced to foods early before the age of 6
months. However another study in the slums of Dhaka City showed that although
complementary feeding is started early by some mothers, majority (64%) started at 6 months
while only 19.2% started at 4-5 months (Akhtar et al,2012).
2.2 Benefits of Breast Feeding

Breastfeeding has numerous health benefits for both mother and infant. From the first hour of a
baby’s life throughout age, breastfeeding protects against illness and death irrespective of
whether the child is born in a high income or low income, a rich or poor family. It acts as the
8
first immunization i.e. immediate skin-to-skin contact and breastfeeding in the first hour of life
significantly reduces newborn mortality.
Breastfeeding effect has been credited in early childhood development as it supports healthy
brain development, increased intellectual quotient and better school performance.
Breastfeeding offers countless benefits to the mother among which are improving child spacing,
reducing the risk of post- partum hemorrhage, decreased risk of breast and ovarian cancer and
come cardiovascular diseases.
To both mother and infant breast milk reduces the risk of non-communicable diseases including
childhood diseases like childhood asthma, obesity, diabetes, and heart diseases later in life.
Unlike other type of feeding in infancy and childhood breast milk provides a natural, renewable
food that needs no packaging, transportation, storage, or cooking making it environmental
friendly.
2.3 Factors affecting Exclusive Breastfeeding

The literature on determinants of breastfeeding has consistently identified lower maternal age as
a predictor of lower breastfeeding rates. (Tesfaye, 2012)A young mother with her first child may
find it difficult to believe that she can breastfeed successfully .Breastfeeding fails easily in a
young school girl who has a baby that she really did not want. The young mother feels shy to
breast feed and this impairs milk secretion (Kimberly, 2013).
2.3.1 Age of Mothers

The young mothers to a large extent usually perceive their breasts in terms of their attractiveness
rather than their function (Rinker et al, 2008). Several mothers with a child at the end of a large
family give up breastfeeding rather easily although they had no difficulties with the earlier
children, (Barbra, 2007). Age of above 25 years has been repeatedly associated with longer
duration of breastfeeding (Scott, 2001).It is probable that older women know more about the
benefits of breastfeeding and have more realistic outcome expectations (Bland, 2002) If a young
woman is interested in breastfeeding, she should talk to women who have done it successfully.
Experienced mothers can be an enormous help to the first time mother
9
2.3.2 Maternal Support and Exclusive Breastfeeding
Single mothers have great difficulty in supporting themselves and caring for the baby especially
if they are young. Single mothers have less family support these support activities outside the
home such as having to work might prevent exclusive breast Feeding (Ezem, 2003). It is often
best if the mother and the baby can stay together and be supported as a family. This can at least
improve the consistency of breastfeeding`
2.3.3 Level of Education and Exclusive Breastfeeding

A woman’s educational and social class affect her motivational to breastfeed but the way it
affects is different in different parts of the world. In many industrialized countries in the west,
breastfeeding is more common among the educated and upper class women (Pawan, 2015) .On
the other hand, in the third world countries, the educated and upper class women are more likely
to feed their infants artificially. Generally educated women tend to breastfeed less and are likely
to introduce supplement ally feeding earlier than those with little or without education (Ashmika,
2013). This is attributed to the fact that better educated women are more likely to work away
from home which makes breastfeeding difficult. The KDHS in 2014 found an inverse
relationship between education and mean duration of breastfeeding.
2.3.4 Level of Knowledge on Breastfeeding

Having adequate information about breast feeding and failing to experience problems during
breastfeeding period are found to influence mothers to breastfeed their infants (Niguse, 2016).
One of the elements of empowerment of breastfeeding in women is by equipping women with
sufficient knowledge to make decisions (Joan, 2012). Breastfeeding choice and success is usually
associated with a higher knowledge on breastfeeding
2.3.5 Exclusive Breastfeeding and the Nutritional Status of the Baby

Breast milk is the natural food for infants during the first six months of their life .It contains all
the nutrients a baby needs for the first t six months of life, Breast milk contains anti-bodies to
protect the child against infections (DicQie et al, 2013). There is less gastroenteritis, fewer
respiratory and ear infections among breastfed infants .In 2013 (WHO) emphasized that Infants
fed on breast milk have a less risk of atopic eczema ,asthma, (Duijits, 2010) low rates of obesity,
diabetes and coronary heart disease in the latter life.
10
The suckling mechanism is vigorous and encourages the health development of gums and jaws.
(Penny et al, 2005).Breastfeeding is important for physical and neurological development. There
is also a possible decrease in the level of cot deaths and a possible increase in intelligent
quotient. Some scholars suggest that long term intelligence or cognitive scores increase with the
mothers’ choice to breastfeed and with duration of breastfeeding
Globally breastfeeding is a must right of every mammal including all humans because of its
countless benefits. Surprisingly only 39% of all infants worldwide are breastfed WHO 2003.An
indicator that traditional patterns of both exclusive breastfeeding and other nutritional care values
of infants have been subjected to erosion (Whalen, 2010) Although wet nursing rarely receives
reinforcement from programs despite the fact that stated that when a mother was unable to
breastfeed a wet nurse would be required.
However, breastfeeding is learned behavior in many societies especially in the developing

countries where women still believe that colostrum is pus or poison and should not be given to
the baby. This statement was supported by (Ergenekon, 2001) when he added that colostrum in
African communities is viewed as bad milk and is more likely to cause stomachache to babies
.This untruthful and baseless lies misled mothers into feeding their children artificially either
partially or completely on formulars (Darcia, 2011)because they believed they didn’t have
enough (Gill et al, 2004).this was because milk let down was stimulated by putting the baby to
suckle, emphasized breastfeeding as an optimal feeding for babies because of its benefits like
protection against diseases and this is why scholars went ahead to build a strong base for
declaration, protection and support for breastfeeding
11
CHAPTER THREE: METHODOLOGY
3.1 Introduction
This chapter discuss how the research was designed and conducted, define the study population
and discuss methods used in data collection and analysis.
3.2 Types of Research
The study adopted both a qualitative and quantitative research methods
Quantitative research is the systematic empirical investigation of observable phenomena via

statistical, mathematical or computational techniques. The process of measurement is central to
quantitative research because it provides the fundamental connection between empirical
observation and mathematical expression of quantitative relationships.
Qualitative research is an expletory research. It aims at developing an understanding of the

background reasons of a particular phenomenon.
3.3 Study design

This study was conducted using both cross sectional and descriptive designs. A cross sectional
design refers to the type of research design where data can be collected different respondents at a
single point in time. This research design was preferred because it was cheap in terms of time
and resources as the data was collected simultaneously from respondents at single point in time.
A descriptive study design is one that describes characteristics of a population. It was chosen
because could be used in explanation of the determinants of the current situation in the study
group.
3.4 Study Population

The study population was children under two years of age and their respective mothers attending
to Mbale Regional Referral Hospital. The target population was children below two years
because they are vulnerable to the consequences of poor breastfeeding practices. The study also
targeted the respective mothers because they were in the right position to give valid and reliable
data about breastfeeding practices.
12
3.5 Sample Size Determination
The sample size was calculated using the fisher method as a standard. The fisher method was
used because its bias free when estimating the sample size. The initials used were n to represent
sample size, p to represent prevalence estimate of breastfeeding in Uganda which is at 62% Z to
represent a confidence level equivalent to a constant of 1.96 and D to represent the margin error
which is 0.05.
n= Z2 pq
D2
n= (1.96)2 *0.62*0.38
(0.05)2
362 respondents
However due to time and financial constraints, only 60 respondents were sampled
3.6 Sampling Methods and Tools

Simple Random sampling technique was employed. A simple random sampling technique was
used because it is free from classification errors, requires minimum knowledge of population
other than the frame and the data collected is easy to interpret.
Inclusion Criteria was that all normal mothers were paired with their normal infants aged 6-24
months attending Mable Regional Referral Hospital and who fully consent while exclusive
Criteria was mothers who were sick and unable to give responses, mothers who might be paired
with infants aged 6-24 months but were not accepted to consent to participate in the interview
and mothers with sick children or children with infirmities were not be sample
3.7 Data Collection Methods

The researcher used Interviews and Focus group discussions to collect data from the
respondents.
Interviews an interview is an oral questionnaire where the investigator gathers data through
direct verbal interaction with participants, for example mothers & medics. Information was
obtained through inquiry and recorded by enumerators. The method gave detailed first-hand
information within as short period of time and it enabled the researcher to get information from
various sources. The researcher interviewed high ranking officers like the senior staff of the
13
hospital to solicit information on the research variables since because they are believed to be
knowledgeable and thus, are capable of providing in-depth information regarding the mother’s
breastfeeding behavior.
Observation method. This involved use of eyes and recorders to collect data. It’s the most
effective method of data collection. Mothers were observed carefully to see those who breastfed
their children during the interactions and how they did it.
Focus Group Discussion. Focus group discussion is a method in which all the participants come
together and share ideas. Two sessions were conducted about breast feeding practices and
nutrition status of children. In these discussions open discussions and questions were posed in a
non -judgmental manner.
Anthropometric measurement is a measurement of body dimensions that were used to indicate

nutritional status.
3.8 Data collection tools

The instruments the researcher used for collecting data were questionnaire format and interview
guide, MUAC tapes, weighing scales, height boards.
Structured and Semi-structured questionnaires were designed properly in accordance with the
study objectives for specific, concise and also detailed information from the respondents.
Length measurements; Length board (infantometer) was used to take length since children who
participated in study were less than 2years of age.
Weight measurements: An electric bathroom weight scale and Salter was used to take weights of
children as recommended by the Ministry of Health (2010).
MUAC measurements: A UNICEF MUAC tape for children between 6 months to 24 months was
used for taking MUAC readings
3.9 Data Analysis

The researcher used thematic way to analyze the data gathered and collected from the field.
Thematic data analysis is a qualitative analysis method that pinpoints, examines and records
patterns or themes within data. It’s a reliable method for analyzing qualitative data. The data
collection was analysed under two types of software. It was organized according to themes
14
identified from research questions and analyzed using content analysis. The data was analyzed
using the Statistical Package for Social Scientists (SPSS) Version 16.0 and the Emergency
Nutrition Assessment (ENA) for SMART Software.
3.10 Validity and Reliability of Tools

Validity of tools
Validity of instruments refers to the ability of a tool to accurately measure all important aspects.
To ascertain validity of the data collected the questionnaires to be pre-tested. This involved using
different tools to yield similar results. It’s an effective method of data validity. Content validity
of the questionnaires was established through panel of 2 judges competent in the field of IYCF
and nutrition.
Reliability of Tools
To ensure that instruments give out the best results, the researcher triangulated the study by using
different tools to get the same information. The questionnaires was first pre-tested using a small
number of respondents to test appropriateness of the questions and to ensure that the questions
can be clearly understood. Test-retest method was used to test consistency in producing the same
results. The participants of the pre-test comprised of 3 children aged 6-24 months that were
randomly sampled from MRRH. A big number of respondents was involved in the study to
increase reliability of the research.
3.11 Ethical Requirements

A letter from the university that allowed the study to go on was obtained, acceptance latter from
the human resource manager Mbale Regional Referral Hospital, Participants consent was sought
and every respondent was given freedom to participate freely to get the right information. The
data got was kept confidential.
The researcher assured the respondents of their privacy and hence confidentiality of the
information obtained and was further promised that no information could be released without
seeking first their consent. Hence, was duly bound to protect the identity of the respondents by
using code names and hence generally treated the information duly got with confidentiality
15
CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS
4.1Introduction
This chapter presents the data that was analyzed using SPSS and ENA for nutrition assessment
results. The data has been presented using frequency table and percentages to characterize the
various variables in the study
4.2The Socio -Demographic Characteristics of Caretakers of Children 6-24 Months in

Mbale Regional Referral Hospital
Table 4.1The socio -demographic characteristics of caretakers of children 6-24 months

Variable Characteristics Frequency (N) Percentage (%)
Male 29 48.3
Sex
Female 31 51.7
Below 2kg 3 5.0
2-2.5kg 13 21.7
Weight ranges 2.6-3kg 12 20.0
3-4kg 29 48.3
5 3 5.0
Yes 50 83.3
Hospital
No 10 16.7
Below 18 5 8.3
18-21 17 28.3
Age brackets 22-26 24 40.0
27-32 11 18.3
Above 32 3 5.0
None 4 6.7
Primary 15 25.0
Education level Secondary 21 35.0
Tertiary 9 15.0
University 11 18.3
Gender of Male 3 5.0
caretaker Female 57 95.0
Traditionalist 2 3.3
Catholic 16 26.7
Religion
Pentecostal 24 40.0
Muslim 18 30.0
Single 6 10.0
Cohabiting 4 6.7
Marital status
Married 42 70.0
Divorced/ Separated 8 13.3
Source of income Employed (salaried) 22 36.7
16
Own savings 13 21.7
Waged labour (casual) 5 8.3
Family contribution 9 15.0
Domestic helper 11 18.3
2 5 8.3
3 20 33.3
Family size 4 9 15.0
5 22 36.7
Above 5 4 6.7
Source: Primary data
Table 4.1 shows that majority (40%) of the respondents had their ages ranging between 22-
26years, followed by 18-21 at (28.3%), 27-32 at (18.3% )then below 18 years and above 32 years
being( 8.3% )and( 5% )respectively.
Table 4.1 shows that majority (35%) attained a secondary level of education, (25%) attained a
primary level of education, and (18.3%) attained university education in various disciplines,
(15%) and (6.7%) attained tertiary and no education respectively.
Results in Table 1 shows that majority of the respondents (40%) were Pentecostals, 30% were
Muslim, (26.7%) were catholic and (3.3%) were traditionalists. This implies that majority of the
respondents were Pentecostals
According to Table 4.1, over (70%) of the respondents were married, (13%) were
divorced/separated while single and cohabiting were (10%) and (6.7%) respectively. This
implies that most of the children (76.7%) are under the care of both parents while very few of the
children (23.3%) are under the care of single parents
Table 4.1 shows that most( 36.6%) of the respondents are employed and are salaried,( 21.7%)
depend on own savings, 18.3% are house helps, (15%) depend on family contribution and only
(8.3%) do casual work to earn a living. This means that at least all respondents have a source of
income though the sources of income for majority of them are not reliable to sustain their
families.
The results in Table 4.1reveal that most families (36.7%) where the children were coming from
had 5 members, (33.3%) having 3 members in the household, (15 %) having at least 4 members
17
and 2 and above 5 members having (8.3%) and (6.7%) respectively. This implies that most
families have a number that can be easily sustained
Figure 4.1 Showing Sex of respondents
Figure 4.1shows that majority (95%) of the respondents were females while the least (5%) were
males, this clearly indicates that more women participate in issues of child care compared to men
Figure 4.2 Showing Age Brackets of children
According to Figure 4.2, it shows that majority (51.7%) of the children were between 6-
12months,( 26%) 18-24 months and the least (21.7%) being 13-18months. Basing on gender of
the children results revealed that more female (51.7%) compared to (48.3%) male participated in
the study.
18
Figure 4.3 Showing Weight Ranges of children
Figure 4.3 shows that majority of the children (48.3%) were born with a birth weight ranging
between 3-4kg, followed by (21.7% )having 2-2.5kg,( 20%) having 2.6-3kg while below 2kg and
5kg were the same with (5% )each.
Figure 4. 4 Showing whether children were born from hospital
According to the Figure 4.4, majority of the children (83.3 %) were born from the hospital while
a few of the children (16.7%) were not born from a health facility probably at home with the help
of family member or traditional birth attendants
19
4.3The Different Breastfeeding Practices Being Carried Out By The Caretakers Of
Children Less Than Two Years.
Table 4.2 Initiation of breastfeeding practices

Breastfeeding initiation Frequency (N) Percentage (%)
Within 30 minutes after birth 49 81.7
Within one hour after birth 7 11.7
Within two hours after birth 4 6.7
Total 60 100.0

According to the table 4.2 above, majority of the respondents, (81.7%) initiated breastfeeding
within 30 minutes after birth, (11.7%) initiated within one hour after birth. The remaining 6.7%
reported having initiated breastfeeding within two hours after birth.
4.3.1Continued breastfeeding
Figure4.6 below indicate that at the time of the study over 61.7% of the respondents were still
breastfeeding their children while 38.3% had stopped breastfeeding their children, this is due to
the fact these children who were no longer breastfeeding were above two years.
Figure 4.5 Continued breastfeeding
20
4.3.2 Termination of Breastfeeding
Table 4.3 Termination of breastfeeding

Termination of Frequency (N) Percentage (%)
breastfeeding
below 1 months 6 10.0
3-6months 4 6.7
8months 2 3.3
1year 2 3.3
above 1year 9 15.0
Total 23 38.3
Still breastfeeding 37 61.7
Total 60 100.0
Source: Primary Data
The table 4.3 above shows that 15% of the respondents had stopped breastfeeding their children
above one year, 10 % below 1 month, 6.7% at 3-4 months while 8 months and 1 year each 3.3%.
4.3.3 Duration of Breastfeeding

Most respondents, 61.7% with children below 6-months and (38.3%) of the respondents whose
children where between 6-24 months were also still breastfeeding.
Table 4.4 Breastfeeding on demand

Demand breastfeeding Frequency (N) Percentage (%)
Yes 47 77.3
No 13 21.7
Total 60 100.0

Table 4.4above indicates that majority (77.3%) of the children were breastfed on demand while
21.7% of the children were not breastfed on demand. This revealed that most caretakers had the
knowledge on breastfeeding on demand.
21
4.3.4 Breastfeeding Intervals
Figure 4.6 Breastfeeding intervals
25
20
15
10
5
0
Two Three Four Five Six times Seven More
times times times times times than
eight
times
According to figure 4.6 above , majority (22) of the children were breastfed more than eight
times, (8) breastfed five times a day, (6)of the children were breastfed seven times, while six
times, four times, three times, and two times at (5), (5), (3)and (1) respectively. This implies that
most of the children were breastfed according to the breastfeeding recommendation for children
Table 4.5 Night breastfeeding

Breastfeeding at night Frequency (N) Percentage (%)
Yes 42 64
No 2 3.3
Total 41 68.3
No longer breastfeeding 19 31.7
Total 60 100.0

According to the table 4.5 above majority (64%) of the children were breastfed at night while
3.3% of the children were not being breastfed at night by the time the study was conducted.
22
Table 4.6 Number of times respondents’ breastfed their children at night
Number of times Frequency (N) Percentage (%)
2-3 times 16 26.7
4-5times 16 26.6
6-7 times 8 13.4
Total 41 68.3
Not breastfeeding at
19 31.7
night
Total 60 100.0

Table above 4.6 shows that children who were breastfed 2-3 times and 4-5times were more
26.7% while those breastfed 6-7 times at 13.4%. This implies that children are appropriately
breastfed at day and night.
4.3.5The Possible Factors Affecting Exclusive Breastfeeding
Table 4.7 Possible factors affecting exclusive breastfeeding

Variables X-tics Frequency Percent
Agree 23 38.3
Don't have enough
Strongly agree 5 8.3
breast milk
Disagree 32 53.3
Agree 12 20.0
Have a physical problem
on the breast
Disagree 42 70.0
Agree 24 40.0
Baby needs more than
breast milk
Disagree 16 26.7
Agree 12 20.0
Embarrassing to
breastfeed in public
Disagree 38 63.4
Agree 6 10.0
Breastfeeding is
inconvenient to me
Disagree 47 78.3
Agree 16 26.7
Breastfeeding makes my
breast lose shape
Disagree 29 48.3
23
Agree 21 35.0
Breastfeeding is time
consuming
Disagree 30 50
Agree 11 18.3
I cannot breastfeed
because of work
Disagree 41 68.3
Family, relatives and Agree 21 35.0
friends encouragement is Strongly agree 33 55.0
good on breastfeeding Disagree 6 10.0
Health message on Agree 15 25.0
breastfeeding during Strongly agree 41 68.3
antenatal visits are good Disagree 4 6.7
Health messages on Agree 25 41.7
breastfeeding during Strongly agree 33 55.0
postnatal visits are good Disagree 2 3.3
Agree 16 26.7
The society values
breastfeeding
Disagree 8 13.3
Source: Primary Data
Table 4.7 above showed that majority (53%) of the respondents disagreed that not having enough
breast milk is not a factor affecting exclusive breastfeeding while about 46% agreed that not
having enough breast milk affects exclusive breastfeeding.
According to the table 4.7 above (70%) of the respondents disagree that a physical problem on
the breast is not a reason enough to affect exclusive breastfeeding while 30% agree that a
physical problem on a breast can hinder exclusive breastfeeding
Table 4.7 above shows that over( 70%) of the respondents agreed than a baby needs more than
breast milk to grow well during the first six months of life, while( 26.7%) of the respondents
disagreed with this reinforcing that infants less than six months only need breast milk and
nothing else.
According to the table 4.7 above, it shows that over (63.4%) of the respondents disagreed about
the idea that breastfeeding in public is embarrassing while about (36.7%) of the respondents
agreed that breastfeeding in public is embarrassing.
According to the above table 4.7, majority (78%) disagreed with the belief that breastfeeding is
inconvenient to them as mothers. When further some mothers asked confessed that it is actually
not breastfeeding that makes the mother not comfortable. About 21.7% of the mothers agreed
24
that breastfeeding was inconveniencing them as others claimed they had to struggle to work and
at the same time breastfeed
According to the above table 4.7 majority (51.7%) of the mothers agreed that breastfeeding
makes their breasts lose shape while 48% disagreed that breastfeeding does not make their
breasts lose shape but rather the way you position and attach the baby that makes the breast
maintain or lose its shape
According to the table 4.7 above, those who agreed and those who disagreed about breastfeeding
being time consuming were equal all at (50%)
The table 4.7 above indicates that (68%) of the mothers disagreed that work cannot make them
not breastfeed while about 31% of the respondents agreed that they could not breastfeed because
of work
The above table 4.7 indicates that over( 90%) of the respondents agreed that family, relatives and
friend’s encouragement is good during breastfeeding as they said it is a key motivation while
only (10% )of the mothers still disagreed that this support and encouragement is actually not
relevant during breastfeeding
According to the table 4.7 above, it shows that majority( 93% )of the respondents agreed that
health messages on breastfeeding during antenatal visits were really good in encouraging
breastfeeding, while (6.7%) disagreed that these messages were not good to them in regard to
breastfeeding
The table 4.7 above indicates that majority (97%) of the respondents agreed that health
messages on breastfeeding during postnatal visits were good in reinforcing knowledge and
support in regard to breastfeeding while only (3.3% )disagreed that these messages did not help
reinforce breastfeeding.
25
4.3.6 Breastfeeding Makes Mothers Socially Tired
Figure 4.7 Breastfeeding makes mothers socially tired
The figure 4.7 above indicates that majority (65%) of the respondents disagreed about the belief
that breastfeeding makes the mother socially tired while few (35%) agreed that breastfeeding
makes the mother socially tired. This indicates that more of the respondents were aware of the
wrong information that would interfere with normal breastfeeding practices.
4.3.7 Encouragement and Support in Breastfeeding from Husband Is Good
Figure 4.8 Encouragement and support in breastfeeding from husband is good
According to the figure 4.8 above, it shows that over (90%) of the mothers agreed that
encouragement and support on breastfeeding from their husbands was good and attributed this
male involvement in breastfeeding to the fact that the new guidelines which made it compulsory
for men to accompany wives for antenatal really helped a lot while only (10%) disagreed with
the fact that encouragement from their husbands on breastfeeding is good
26
4.3.8 The Society Values Breastfeeding
Figure 4.9 The society values breastfeeding
The figure 4.9 above indicates that over 86.7% of the respondents agreed that society valued
breastfeeding while 13.3% disagreed on the view that society valued breastfeeding
4.3.9 The Mother’s Knowledge about Breastfeeding
Table 4.8 The Mother’s knowledge about breastfeeding

Variable X-tics Frequency Percent
Agree 26 43.3
Breastfeeding encourages
more milk
Disagree 11 18.3
Both small and large Agree 25 41.7
breasts produce sufficient Strongly agree 22 36.7
quantities of milk Disagree 13 21.7
It is very important that the Agree 27 45.0
infants are given Strongly agree 28 46.7
colostrums Disagree 5 8.3
Agree 20 33.3
Breastmilk protects infants
from illness
Disagree 2 3.3
Agree 18 30.0
Breastfed infants are
healthier
Disagree 7 11.7
Frequent and prolonged Agree 24 40.0
breastfeeding prevents Strongly agree 22 36.7
pregnancy Disagree 14 23.3
27
The table 4.8 above shows that over (82.6%) of the respondents agreed that breastfeeding
encourages more milk production; this showed that they had knowledge about the role of
breastfeeding in encouraging continuous milk production. Only (18.3%) disagreed that
breastfeeding does not encourage more milk to be produced, this means that these few did not
have this important knowledge or they knew it but just became negligent
The above table 4.8 indicates that over (87% )of the respondents agreed that both small and large
breasts produce sufficient quantities of milk while (21.7% )disagreed and argued that the
quantity of milk one produces depends on the size of the breasts.
According to the above table it shows that majority (91%) of the respondents agreed that it is
important that infants are given colostrum while only( 8.3%) disagreed and argued that it is not
very important to give infants colostrum.
The table 4.8 above indicates that over (96.7%) agreed that breast milk protects infants from
illnesses due to the antibodies contained in the breast milk while only (3.3%) disagreed that
breast milk does not protect infants from illness
The table 4.8 above indicates that over (88.3%) of the respondents agreed that breastfed infants
are healthier than those who are not breastfed while (11.7%) of the respondents disagreed that
breastfed infants are not healthier.
The table 4.8 above indicates that majority (76.7%) agreed that frequent and prolonged
breastfeeding prevents pregnancy, this is due to the fact that lactation amenorrhea benefits only
those who are consistent with breastfeeding while only 23.3% of the respondents disagreed that
frequent and prolonged breastfeeding does not prevent pregnancy
The table 4.8 shows majority (58.3%) agreed that breastfeeding women are likely to develop
cervical and breast cancer while( 41% )of the respondents did not agree that women are less
likely to develop cancer of the breasts and cervix and argued that they all had equal chances of
having cervical Complementary feeding patterns of the mothers and breast cancer
28
4.3.10 Quantity of Milk Depends On Mother's Food
Figure 4.10 Quantity of milk depends on mother's food
The figure 4.10 above indicates that majority (91%) of the respondents agreed that the quantity
of milk produced depends on the mother’s food while only 8.3% disagreed that milk production
does not depend on the amount of food
4.3.11 Breastfeeding Exclusively Makes the Baby Refuse to Eat Other Foods during
Weaning
Figure 4.11Breastfeeding exclusively makes the baby refuse to eat other foods during
weaning
The figure 4.11 above shows that over 63% of the respondents breastfeeding exclusively makes
the baby refuse to eat other foods during weaning while 36.7% disagreed about the point that
29
exclusive breastfeeding makes the baby refuse other foods at weaning but rather argued that
delayed introduction is what could lead to refusal of complementary foods.
4.3.12 Complementary Feeding Patterns of the Mothers
Figure 4.12 Giving water
The figure 4.12 above shows results

of No whether respondents gave water
17%
to their children before six months
or Yes not, the results reveal that over
83%
83% of the caretakers gave water,
while 16.7% had not given anything
apart from breast milk. In the first case
where mothers gave their children water before six months, they reported that they felt children
were thirsty and therefore gave water. While those who had not given anything reported that
midwives had advised them during antenatal visits.
Table 4.9 The age of the child at first introduction to water

Age Frequency (N) Percentage (%)
1 month 8 13.3
2-4months 25 41.7
5-6months 22 36.7
Above 6 months 4 6.7
Total 60 100
The table 4.9 above shows that 41.7% of the children were given water between 2-4months,
36.7% were given between 5-6months while 13.3% and 6.7% at 1 month and above 6 9onths
respectively.
30
Table 4.10 Number respondents who had introduced to food their children
Whether food was introduced or Frequency (N) Percentage (%)
not
Yes 51 85.0
No 9 15.0
Total 60 100.0
By the time the study was conducted, over 85% of the children had been given other foods
besides breast milk, while only 15% reported to have not started other foods by the time of the
study; this was due to the fact that the children had already started taking water.
4.13 Age of a child at complimentary feeding
Figure 4.13 Age of a child at complimentary feeding
According to the
30
25 above figure 4.13, it
20 revealed that
15
10 majority (48.3%)
5 started other foods
0
at 6months, 23%
1-3 months 4-5 months 6 months Above 6
months above six months
while 4-5months
and 1-3months at 8.3% and 5%. These results indicate that most of the children were started on
other foods at the appropriate time though majority was given water before six months.
31
Table 4.11 Frequency of consumption of the various food groups
Selected Number of times Frequency (N) Percentage (%)
food
groups
None 10 16.7
Once a week 11 18.3
Grains and 2-4 times 10 16.7
cereals
5-6 times 6 10.0
group
Daily 23 38.3
Total 60 100.0
None 14 23.3
Once a week 16 26.7
Root 2-4 times 17 28.3
tubers and
starches 5-6 times 5 8.3
Daily 8 13.3
Total 60 100.0
None 9 15.0
Once a week 15 25.0
Vitamin A 2-4 times 11 18.3
rich foods 5-6 times 6 10.0
Daily 19 31.7
Total 60 100.0
None 12 20.0
Once a week 9 15.0
Green 2-4 times 10 16.7
leafy
vegetables 5-6 times 6 10.0
Daily 23 38.3
Total 60 100.0
None 13 21.7
Once a week 24 40.0
Fruits and 2-4 times 6 10.0
other
vegetables 5-6 times 4 6.7
Daily 13 21.7
Total 60 100.0
None 15 25.0
Eggs Once a week 19 31.7
2-4 times 10 16.7
32
5-6 times 2 3.3
Daily 14 23.3
Total 60 100.0
None 15 25.0
Once a week 15 25.0
Legumes/P 2-4 times 7 11.7
ulses 5-6 times 7 11.7
Daily 16 26.7
Total 60 100.0
None 15 25.0
Once a week 11 18.3
Milk and 2-4 times 8 13.3
milk
products 5-6 times 4 6.7
Daily 22 36.7
Total 60 100.0
None 27 45.0
Once a week 11 18.3
Fats and 2-4 times 10 16.7
oil 5-6 times 4 6.7
Daily 8 13.3
Total 60 100.0
None 18 30.0
Once a week 20 33.3
Meat and 2-4 times 15 25.0
products 5-6 times 5 8.3
Daily 2 3.3
Total 60 100.0
None 9 15.0
Once a week 11 18.3
2-4 times 9 15.0
Sugars
5-6 times 7 11.7
Daily 24 40.0
Total 60 100.0
The table 4.11 above shows that majority (38.3%) of the respondents gave their children foods
from the cereal and grains group daily while only 10% never gave their children from this group
the week in which the study was conducted. This was due to the fact that some children had not
33
been started on complementary feeds. The table further shows that majority (28.3%) of the
children had been fed on root tubers and other starches while only 8.3% consumed these 5-6
times a week
The above table 4.11 shows that majority (31.7%) of the children consumed vitamin A rich foods
daily while 15% consumed none in this category and 25% consumed vitamin A rich foods once a
week.
The table 4.11 above shows that majority (38.3%) consumed green leafy vegetables daily while
only 10% consumed from this group 5-6 times a week.
According to the table 11 above, it shows that majority (40%) of the children ate fruits and other
vegetables once a week while very few (6.7%) consumed fruits and other vegetables 5-6 times a
week
The table 4.11 above shows that majority (31.7%) of the children consumed eggs daily, 25.0%
did not consume eggs at all, 23.2% of the children consumed eggs daily while only 3.3%
consumed 5-6times a week.
The table 4.11 above shows that 26.7% of the children consumed legumes and pulses daily
while, 25% consumed once a week. The remaining 11.7% consumed 2-5times and 5-6 times a
week, 25% did not consume at all within that week when the data collection was conducted.
The above table 4.11 shows that majority of the children (36.7%) consumed milk and milk
products daily, 25% never consumed from this food group, 18.3% consumed once a week,
13.3% consumed milk and milk products 2-4 times a week while the remaining 6.7% consumed
5-6 times a week.
The table 4.11 above shows that majority of the respondents (45%) never consumed fats and oils,
18.3% consumed once a week, 16.7% consumed fats and oils 2-4times, 13.3% consumed daily
and only 6.7% consumed 5-6 times a week
The table4.11 above shows that 33.3% of the children consumed meat and meat products once in
the week, 30% never consumed from this group, 25% consumed 2-4times a week, 8.3%
consumed 5-6% while only 3.3% consumed daily.
34
The table 4.11 above shows that majority (40%) of the children consumed sugars daily, 18.3%
consumed once a week, 15% consumed 2-4times and another 15% never consumed from this
group while 11.7% consumed 5-6times a week
4.4The Nutritional Status of the Children 6-24 Months in Mbale Regional Referral
Hospital
4.4.1 Dietary Diversity Score

Results of the analysis of dietary diversity showed 5-8 as the highest dietary diversity score with
28 (46.7%) and mean dietary diversity score of 7.01 (0.87) and 1-4 as the lowest with 12 (20%)
and mean dietary diversity score of 3.13 (0.42). The dietary diversity score of 9-14 has 20
(33.3%) with mean 10.13 (0.88). The overall mean dietary diversity score was 10.01 (1.44)
Table 4.12 Mean dietary diversity score for the different dietary diversity categories
DDS Category Frequency(n) Percentage (%) Mean DDS (SD)
1-4 12 20 3.13(0.42)
5-8 28 46.7 7.01(0.87)
9-11 20 33.3 10.13(0.88)
Total 60 100 10.01(1.44)
For Mean DDS (SD); Values are means and Standard Deviation
4.4.2 Proportion of Stunting, Wasting and Underweight In Children

From table 4.12 below, majority of the children, (83.3%) had normal height for age z –scores
and (16%) were stunted i.e. having z- scores less than –2 standard deviations. There were no
children with severe stunting (i.e. having < -3 z scores) and no children with greater than +2 z
scores.
Almost all the children whose nutritional status was taken i.e. (91.7%) had a normal weight for
age and (8.3%) were underweight. There were no overweight children and no children having
less than –3 z scores for weight for age among the children who underwent the study as shown
by the table below
35
Table 4.13 Proportion of Stunting and Underweight In Children
Nutritional Index Frequency (n) Percentage (%)
Height for age z scores
Stunted (<-2 z-score ) 10 16
Normal (≥ -2 ≤ +2 z 50 83.3
score)
Total 60 100
Weight for age z scores
Underweight (˂ -2 z score) 5 8.3
Normal (≥ -2 ≤ +2 z score) 55 91.7
Total 60 100
The study also examined the proportion of stunting and underweight by sex of the children. The
chi-square analysis did not show any statistically significant association with either stunting or
underweight and sex of the children (p>0.05) as shown in table 5 below
Table 4.14 Proportion of stunting and underweight by sex of children

Variable Stunted Underweight
Yes (%) No (%) P* Yes (%) No (%) P*
Sex of children
Girl 2(4) 22(44) 5(10) 21(42)
0.257 0.328
Boy 3(6) 28(56) 1(2) 18(36)
4.5 The Relationship between the Feeding Practices of Children under Two Years And
Their Nutritional Status.
Results from table 15 below show a significant relationship between when the child started
breastfeeding and dietary diversity score i.e. (p=0.010). There is also a significant relationship
between dietary diversity score and when the child is still breastfeeding (p=0.020). Results also
reveal that dietary diversity score is significantly associated with what age did stop breastfeeding
(p=0.000). Findings also revealed a significant relationship between at what age did you start
breastfeeding and dietary diversity score i.e. (p=0.001). The study further shows a significant
relationship between dietary diversity score and do you breastfeed your child on demand
(p=0.011). Results also reveal that dietary diversity score is significantly associated with the
number of times you breastfeed the child in a day (p=0.020).
36
Table 4.15 The relationship between the feeding practices nutritional status.
Variable X-tics Frequency Mean(SD) P-Value
When the child Within 30 minutes after birth 49 5.31(0.60) 0.010
started Within one hour after birth 7 4.63(0.92)
breastfeeding Within two hours after birth 4 4.16(0.86)
Child still Yes 37 3.25(0.50) 0.020
breastfeeding No 23 .35(0.71)
below 1 months 6 4.23(1.09) 0.000
What age did 3-6months 4 1.36(0.68)
stop 8months 2 3.25(0.70)
breastfeeding 1year 2 2.11(0.54)
above 1year 9 5.30(0.63)
1-3months 3 3.90(0.83)
At what age did
4-5months 5 2.50(0.54) 0.001
you start
6months 29 5.42(0.53)
breastfeeding
Above six months 14 3.28(1.06)
Do you Yes 47 5.36(0.68)
breastfeed your 0.011
No 13 4.38(0.69)
child on demand
Two times 1 2.73(1.44) 0.020
Three times 3 5.00(0.00)
The number of
Four times 5 3.01(0.22)
times you
Five times 8 5.66(0.86)
breastfeed the
Six times 5 2.90(1.41)
child in a day
Seven times 6 4.25(0.50)
More than eight times 22 5.31(0.60)
CHAPTER FIVE: DISCUSSION OF RESULTS
5.1 Introduction
This chapter presents the discussion of the study findings as per research objectives.
5.2 The Socio -Demographic Characteristics of Respondents Of Children 6-24 Months In

Mbale Regional Referral Hospital
5.2.1 Discussion of the Findings
5.2.1.1 Age of Respondent’s

The findings revealed that majority of the respondents were aged between (22-26) years and this
age bracket predicted a big change on the rate of breastfeeding of children and their nutritional
37
status. Most the respondent’s ensured that there is adequate breast feeding since they followed
the best breastfeeding practices such as initiation of breastfeeding and continued breastfeeding.
This finding is related with (ANON, 2003). From the literature he stated that the young mothers
to a large extent usually perceive their breasts in terms of their attractiveness rather than their
function (Rinker et al, 2008). Several mothers with a child at the end of a large family give up
breastfeeding rather easily although they had no difficulties with the earlier children,. Age of
above 25 years has been repeatedly associated with longer duration of breastfeeding (Scott,
2001). It is probable that older women know more about the benefits of breastfeeding and have
more realistic outcome expectations (Bland, 2002) If a young woman is interested in
breastfeeding, she should talk to women who have done it successfully. Experienced mothers can
be an enormous help to the first time mother.
5.2.1.2 Education Level of Respondents

The study also revealed that majority of the respondent’s education levels was secondary level
and this education level had an effect on breastfeeding of child on their nutrition status. This
study was in agreement with (Ashmika, 2013) from the literature, revealed that A woman’s
educational and social class affects her motivational to breastfeed but the way it affects is
different in different parts of the world. In many industrialized countries in the west,
breastfeeding is more common among the educated and upper class women (Pawan, 2015) .On
the other hand, in the third world countries, the educated and upper class women are more likely
to feed their infants artificially. Generally educated women tend to breastfeed less and are likely
to introduce supplementary feeding earlier than those with little or without education (Ashmika,
2013). This is attributed to the fact that better educated women are more likely to work away
from home which makes breastfeeding difficult. The KDHS in 2014 found an inverse
relationship between education and mean duration of breastfeeding.
5.2.1.3 Marital Status of the Respondents
The study furthermore revealed that majority of the respondent’s marital status was married and
this predicted a big change on of the effect on the breastfeeding of children and their nutrition
status. This enables the respondent’s to follow best breastfeeding practices such as initiation
breastfeeding practice and continued breastfeeding. This findings was related with Ezem, (2003)
38
from the literature, revealed that Single mothers have great difficulty in supporting themselves
and caring for the baby especially if they are young. Single mothers have less family support
these support activities outside the home such as having to work might prevent exclusive breast
Feeding (Ezem, 2003). It is often best if the mother and the baby can stay together and be
supported as a family. This can at least improve the consistency of breastfeeding.
5.3 The Different Breastfeeding Practices Being Carried Out By the Caretakers of
Children Less Than Two Years.
5.3.1 Initiation of Breastfeeding

The findings revealed that 81.7% of the children initiated breastfeeding within 30 minutes after
birth and this findings was in agreement with UNICEF, (2016) and WHO, (2016) from the
literature, revealed that Early initiation means breastfeeding the new born within the first hour of
life. Exclusive breast feeding means receiving only breast milk by the infant in the first six
months of life, the infant receives no other liquid or solid with the exception of oral rehydration
solution or drops/syrups or vitamins minerals or medication. Breastfeeding has many health
benefits for both to the mother and the baby, it contains all the nutrients an infant needs for the
first six months of life, it protects against diarrhea and common childhood illness such
pneumonia, and also have longer term health benefits for the mother and child such as the
risk of overweight and obesity in childhood and adolescence, it has been associated with higher
intelligence quotient(IQ) in children.
5.3.2 Continuous Breast Feeding

The findings also revealed that most of the children were breastfeed up-to two years of age and
this was revealed as continued breast feeding with 62% and this implied a healthy nutritional
status of children. This findings was in agreement with (Grantham-mc gregor et al, 2007 )and
(Murage et al, 2011) from the literature, the first two years of life are critical stages for a child's
growth and development. Any damage caused by nutritional deficiencies during this period
could lead to impaired cognitive development, compromised educational achievement and low
economic productivity). Poor breastfeeding and Complementary feeding practices, together with
high rates of morbidity from infectious diseases are the prime proximate causes of malnutrition
in the first two years of life. Breastfeeding confers both short-term and long-term benefits to the
39
child. It reduces infections and mortality among infants, improves mental and motor
development, and protects against obesity and metabolic diseases later in the life course.
5.3.2 Possible Factors Affecting Exclusives Breastfeeding

The findings revealed that one of the possible factors affecting exclusive breastfeeding was that
caretakers cannot breast feed when they are at work and this has left very many mothers leaving
breast feeding at the early age. This findings was in agreement with Ezem, (2003), Single
mothers have great difficulty in supporting themselves and caring for the baby especially if they
are young. Single mothers have less family support these support activities outside the home
such as having to work might prevent exclusive breast Feeding. It is often best if the mother and
the baby can stay together and be supported as a family. This can at least improve the
consistency of breastfeeding.
The findings revealed that over 70% of the caretakers agreed that babies need more than breast
milk to grow well during the first six months of life, this findings was in agreement with the
finding with Xiadong, (2012) from the literature, he said that Complementary feeding is the
transition from exclusive breast feeding to family food; typically it covers the period from 6 to
18-24 months of age and is a very vulnerable period. At six months breast milk is no longer
enough to meet the nutritional needs of the infant, it is a time when malnutrition starts in
many infants, contributing significantly to a high prevalence of malnutrition in children under
five years of age worldwide. WHO estimates that two out of five children are stunted in low
income countries. (Xiadong, 2012)
5.4 The Nutritional Status of Children 6-24 Months in Mbale Regional Referral Hospital
Results of the analysis of dietary diversity showed 5-8 as the highest dietary diversity score with
28 (46.7%) and mean dietary diversity score of 7.01 (0.87) and 1-4 as the lowest with 12 (20%)
and mean dietary diversity score of 3.13 (0.42). The dietary diversity score of 9-14 has 20
(33.3%) with mean 10.13 (0.88). The overall mean dietary diversity score was 10.01 (1.44)
This finding is in line with the (UBOS, 2012) which shows that the rate of malnutrition in central
region especially underweight is low at 3.5%
40
5.5 The Relationship between the Feeding Practices of Children under Two Years and
Their Nutritional Status.
Results show a significant relationship between when the child started breastfeeding and dietary
fibre intake i.e. (p=0.010). There is also a significant relationship between dietary fibre intake
and child still breastfeeding (p=0.020). Results also reveal that dietary fibre intake is
significantly associated with the age did stop breastfeeding (p=0.000). Findings also revealed a
significant relationship between at what age did you start breastfeeding and dietary fibre intake
i.e. (p=0.001). The study further shows a significant relationship between dietary fibre intake
and do you breastfeed your child on demand (p=0.011). Results also reveal that dietary fibre
intake is significantly associated with the number of times you breastfeed the child in a day
(p=0.020).
This is in line with Black et al, (2008) who reinforced the importance of breastfeeding and
complementary feeding in saving lives of children under five years of age. Breastfeeding support
tops the table of life-saving interventions, 13% of children under five deaths could be saved
through exclusive and continued breastfeeding until two years of age, and another 6% through
appropriate complementary feeding (Jones et al, 2003). The significance of feeding practice is
greatest with the youngest; where one-fifth (22%) of all neonatal deaths could be prevented by
early initiation of exclusive breastfeeding (breastfeeding within the first hour)
41
CHAPTER SIX: CONCLUSION AND RECOMMENDATIONS
6.1. Introduction
This chapter presents the conclusions of the study basing on the study objectives as they are
drawn from findings. The researcher also made some recommendations basing on the findings
from the study.
6.2 Conclusions
Basing on objective one; Demographic characteristics of caretakers of children 6-24 months, the
results showed that majority of the children were born in hospitals with majority of them
weighing between 3-4 Kgs at birth. It was also revealed that most of the respondents were
females who were in the age bracket of 22-26years and completed at least secondary level of
education which implies that basing on their education level, they don’t have expert knowledge
about breast feeding which means that when it comes to breast feeding requirements of children,
they need to first be trained the breast feeding basics in order to have an improved breast feeding
practices among young children to improve their nutritional status
According to objective two; the different breast feeding practices carried out by caretakers of
children less than two years; findings showed that breast feeding should be initiated within the
first 30minutes after birth, continued exclusively up to 6 month and can thereafter be terminated
up to 2 years. During this period of breast feeding, the child is fed on demand as long as the child
feels like breast feeding. This means that the child should be breast fed at all the time because
breast milk is the only food that provides the child with all the necessary dietary needs which
helps in growth and development both intellectually and psychologically. So it is very essential
for a child of 2-24 months to have enough breast milk.
Basing on objective three; the nutritional status of children 6-24 months, results showed that
almost all (91.7%) the children whose nutritional status was taken, they had a normal weight at
that age and at the same time had normal weight at that age of 6-24 months. This means that
those children were well breast fed which results into normal growth of the children both
physically and intellectually.
For objective four; the relationship between feeding practices of children under two years and
their nutritional status, it was revealed that children who are breast fed from within the first 30
42
minutes after birth for exclusive breast feeding up to six month and beyond, they have a normal
growth rate both in height and weight which corresponds with the age they are in. this means that
to have a health and well brought up child, there must be exclusive breast feeding at least for six
months such that a child can have a healthy start in life.
6.3 Recommendations
6.3.1 The Ministry of Health
The Ministry of Health in collaboration with other non-governmental agencies such as the
UNICEF should conduct similar study from time to time to monitor the nutritional status of
children under two years and the kind of feeding practices their mothers use.
There is the need for the Ministry of Health and non-governmental agencies to introduce an
intervention of health education immediately. This can be done by specifically using
interpersonal communication to get family members to understand the recommended infant
feeding practices.
A further study on the quality and quantity of food given to the children is very necessary. This
will give a baseline data for an effective health education programme on complementary foods in
the district.
6.3.2 Health Workers
Midwives and nurses must help the mothers to initiate breastfeeding early (within 30 minutes
after delivery) and must assist women who deliver through caesarean sections to initiate
breastfeeding within the first one hour after delivery.
Health workers should explain the meaning of exclusive breastfeeding to the mothers and
discourage mothers from introducing artificial milk and water to the children below the age of 6
months during antennal and child welfare clinics.
Again health workers should encourage mothers to introduce complementary foods when their
children are 6 months old. This can be done during antennal and child welfare clinics
Health workers should educate mothers on the importance of eating fruits and encourage them to
give their children fruits every day.
Therefore, the health workers can have special health educational talks at the communities where
doubts and confusions can be cleared for easy participation.
43
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49
APPENDIX A: QUESTIONNARE
I am Namukemo J Frank, a third year student pursuing a Bachelor of Science degree in Human
Nutrition and Dietetics of Kyambogo University. As part of my academic requirement, I am
conducting a study about the breast feeding practices and nutritional status of children (6-24
months) in Mbale Regional Referral Hospital.
You are kindly requested to participate in this study as one of my respondents. The information
obtained from the study will be used for academic purposes only and a high level of
confidentiality will be maintained.
Instructions: please Circle the possible answer and fill in the spaces provided.
Participant ID No
Date
SECTION A: BIO DATA AND SOCIAL –DEMOGRAPHICS CHARACTERISTICS
1. FOR THE CHILD:
1. Date of birth of the child

2. Age of child in months
(1) 6-12months (2) 13-18months
(3) 18-24months (4) others (specify)
3. Sex of the child:
(1) Male (2) Female
4. Birth weight :
(1) Below 2 kg (2) 2 -2.5 kg
(3) 2.6-3kg (4) 3-4 kg
(5) Others (specify)
50
5. Was the child delivered in the hospital?
(1) Yes (2) No
6. Has the child been suffering from any diseases recently?
(1) Yes (2) No
7. If yes, which one?
2. FOR THE CARE TAKER

1. Age:
(1) Below 18 (2) 18-21
(3) 22-26 (4) 27-32
(5) Above 32years
2. Educational background
(1) None (2) Primary education
(3) Secondary (4) Tertiary education
(5) University
3. Gender
(1) Male (2) Female
4. Religious background
(1) Traditional religion (2) Catholic
(3) Pentecostal (4) Moslem
5. Marital status
(1) Single (2) Co-habiting
(3) Married (4) Divorced/Separated
(5) Widow
6. What is your main Source of income?

(1) Employed (salaried) (2) Own savings
(3) Waged labor (casual) (4) Family contribution
(5) Domestic helper (6) others (specify)
7. What is the size of your family?
51
(1) 2 (2) 3
(3) 4 (4) 5
SECTION B: BREAST FEEDING PRACTICES
1. When did you start breastfeeding this child?

(1) A few hours after delivery (2) the second day
(3) The third day (4) the fourth day
2. Are you still breastfeeding your child?

(1) Yes (2) No
3 If no, at what age did you stop breastfeeding the child?
Specify (Months)
4. Do you give water to your child?
(1) Yes (2) No
5 .If yes, at what age did you start?
Specify (Months)
6. Have you started giving other foods to your baby?
(1) Yes (2) No
7. If yes, at what age did you start?
Specify (Months)
8. Do you breast feed your child whenever she / he want?
(1) Yes (2) No
9. On average, how many times do you breastfeed your child in a day?
(1) Two times (2) Three times
(3) Four times (4) Five times
(5) Six times (6) Seven times
10. Do you breast feed your child at night?
52
(1) Yes (2) No
11. If yes, how many times do you breastfeed?
(1) Two times (2) Three times
(3) Four times (4) Five times
(5) Six times (6) Seven times
Possible factors affecting exclusive breastfeeding
Please tick in the box of the most appropriate answer only
Statement/phase Agree Strongly Disagree

Agree
1 I don’t have enough breast milk
2 I have physical difficult and problem on my

breast
3 The baby needs more than breast milk
4 It’s embarrassing to breastfeed in public
5 Breastfeeding causes mothers to be socially tired
6 Breast feeding is an outdated old practice
7 Breastfeeding is inconvenient to me
8 Breastfeeding makes my breasts to lose shape
9 Breast feeding is time consuming
10 I cannot breast feed because work.
Support of breastfeeding
53
Statement Agree Strongly Disagree
agree
1 Encouragement and support in breast feeding from

husband is good.
2 Family, Relatives and friends encouragement is good

on breast feeding.
3 Health messages on breastfeeding during antenatal

visits are good.
4 Health messages on breastfeeding during post natal

visits are good.
5 The society values Breastfeeding
Mothers level of Knowledge on Breast feedings
Key messages Agree Strongly Disagree

agree
1. If the baby suckles more the breast makes more milk
2. The quantity of milk depends on the mothers food
3. Both small and large breasts produce milk in sufficient

quantity
4. It is very important that the infants are given

colostrum.
5. Breast milk protects infants from illness
6. Breast fed infants are healthier
7. Breast feeding exclusively makes the baby to refuse

to eat other foods during weaning
8. Frequent and prolonged breastfeeding prevents
54
pregnancy after birth
9. Breastfeeding women are less likely to develop

cancer of the cervix and breasts
55
Did you vaccinate your child for the following diseases? (Tick where applicable)
PERIOD VACCINE PROTECTS AGAINST Yes No Dozes Date

given
At Birth BCG Tuberculosis
Polio 0 Polio
At 6 Polio 1 Polio
DPT-HebB+Hib1 Diphtheria/Tetanus/Whooping
Weeks
Cough /Hepatitis
B/HaemophilusInfluenzae type B
PCV1 Pneumonia
At 10 Polio 2 Polio
DPT-HebB+Hib Diphtheria/Tetanus/Whooping Cough/
Weeks
2 Hepatitis B/HaemophilusInfluenzae type
B
PCV2 Pneumonia
At 14 Polio 3 Polio
DPT-HebB+Hib Diphtheria/Tetanus/Whooping
weeks
3 Cough /Hepatitis
B/HaemophilusInfluenzae type B
PCV3 Pneumonia
9 Months Measles Measles
Vitamin A 1) Yes 2) No
De-worming 1) Yes 2) No
SECTION C: NUTRITIONAL ASSESSMENT
1) Weight (Kg)
2) Recumbent length ( cm)
56
3) MUAC (cm)
How often have you given the child the following foods in the past?
Tick the column for the number of times depending on whether the food item in the list was
eaten in the last 7days.
Food group Food list Number of times the food group was eaten
None Once a 2-4 5-6 Daily

week time time
Grains and cereals posho, porridge, bread,

millet, rice, sorghum
,mandazi, chapatti
Root tubers and starchy Irish Potatoes, cassava,

vegetables sweet potatoes, yams
Vitamin A Rich foods. Ripe mango, pumpkin

,pawpaw, passion fruit
Green leafy vegetables Dodo ,nakati, sukuma,

spinach, carrots,
tomatoes
Fruit and other vegetables Jackfruit, passion,

pineapple, pawpaws,
bananas
Eggs Eggs
Legumes/pulses Beans, groundnuts,

cowpeas, peas, simsim
Milk and milk products Cow’s milk, yoghurt,

bongo ,ice cream
Fats and oil Pork oil/ beef tallow,
57
cooking oil, shear nut
,margarine, butter oil
Meat and meat substitute Fish, beef, pork, any

group other meat types.
Sugars Honey ,sugar
58
APPENDIX B
FOCUS GROUP DISCUSSION GUIDE

BREASTFEEDING PRACTICES
1) Did you exclusively breastfeed your child for the first six months?
2) What is your experience in breast feeding?
3) What problems have you faced during breastfeeding?
4) What are your opinions on breastfeeding a child only without giving any feeds or water?
COMPLEMENTARY FEEDING PRACTICES OF MOTHERS
5) Why do you think you need to introduce feeds after six months?
6) What challenges have you faced during complimentary feeding?
59
7) What common feeds have you used during complementary feeding?
8) What is the common way of introducing complementary feeds?
THANK YOU SO MUCH.
60

Breast Feeding

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THE BREAST FEEDING PRACTICES AND NUTRITIONAL STATUS OF

CHILDREN (6-24 MONTHS) IN MBALE REGIONAL

A RESEARCH REPORT SUBMITTED TO THE DEPARTMENT OF HUMAN

Name: Mrs. Aidah Kikabi

EBF Exclusive Breast Feeding

FAO Food and Agricultural Organization of the United Nations

IMAM Integrated Management of Acute Malnutrition

IYCF Infant and young child feeding

MoH Ministry of Health

SAM Severe Acute Malnutrition

SOFI State Of Food Insecurity

UDHS Uganda Demographic and Health Survey

UNICEF United Nations Children Education Fund

WFP World Food Programme

WHO World Health Organization

Table 4.1The socio -demographic characteristics of caretakers of children 6-24 months.........16

Table 4.2 Initiation of breastfeeding practices...........................................................................20

Table 4.3 Termination of breastfeeding.....................................................................................21

Table 4.4 Breastfeeding on demand...........................................................................................21

Table 4.5 Night breastfeeding....................................................................................................22

Table 4.6 Number of times respondents’ breastfed their children at night................................23

Table 4.7 Possible factors affecting exclusive breastfeeding....................................................23

Table 4.8 The Mother’s knowledge about breastfeeding...........................................................27

Table 4.9 The age of the child at first introduction to water......................................................30

Table 4.11 Frequency of consumption of the various food groups...........................................32

Table 4.13 Proportion of Stunting and Underweight In Children..............................................36

Table 4.14 Proportion of stunting and underweight by sex of children.....................................36

Figure 4.1 Showing Sex of respondents........................................................................................18

Figure 4.2 Showing Age Brackets of children...............................................................................18

Figure 4.3 Showing Weight Ranges of children............................................................................19

Figure 4. 4 Showing whether children were born from hospital...................................................19

Figure 4.5 Continued breastfeeding...............................................................................................20

Figure 4.6 Breastfeeding intervals.................................................................................................22

Figure 4.7 Breastfeeding makes mothers socially tired.................................................................26

Figure 4.8 Encouragement and support in breastfeeding from husband is good...........................26

Figure 4.9 The society values breastfeeding..................................................................................27

Figure 4.10 Quantity of milk depends on mother's food...............................................................29

Figure 4.12 Giving water...............................................................................................................30

Figure 4.13 Age of a child at complimentary feeding...................................................................31

1.2 Background of Study

1.3 Statement of the Problem

1.4 General Objective

1.5 Specific Objectives

1.6 Research Questions

1.7 Significance of Study

1.8 Research Indicators

Number of mothers who exclusively breastfeed their children for 6 months.

Number of mothers who know about responsive feeding.

1.9 Scope of the Study

2.2 Breast Feeding Practice

The indicators of appropriate breastfeeding practices include: early initiation of breastfeeding,

2.2.1 Early Initiation

2.2.2 Exclusive Breastfeeding

2.2.3 Continued Breast Feeding

2.2.4 Complementary Feeding

2.2.5 Timely Introduction of Complementary Feeds at 6months

In most cases, mothers practice early introduction of complementary feeding. According to

2.2 Benefits of Breast Feeding

2.3 Factors affecting Exclusive Breastfeeding

2.3.1 Age of Mothers

2.3.3 Level of Education and Exclusive Breastfeeding

2.3.4 Level of Knowledge on Breastfeeding

2.3.5 Exclusive Breastfeeding and the Nutritional Status of the Baby