A STUDY TO DETERMINE FACTORS

HINDERING EXCLUSIVE
BREASTFEEDING IN MOTHERS
WITH INFANTS LESS THAN SIX
MONTHS IN LONGISA COUNTY
REFERRAL HOSPITAL
BY:

NAME : FANCY CHEBET

REG.NO:D/CM/18037/1296

RESEARCH PROPOSAL
SUBMITTED TO DEPARTMENT OF
CLINICAL MEDICINE AND
SURGERY IN PARTIAL
FULFILLMENT OF THE
REQUIREMENTS FOR THE AWARD
OF DIPLOMA IN CLINICAL
MEDICINE AND SURGERY OF
KENYA MEDICAL TRAINING
COLLEGE DURING THE 2019/2020
ACADEMIC YEAR

DECLARATION
I,FANCY CHEBET , hereby declare that this research proposal is my original work and can only be
used for scholarly purpose

NAME : FANCY CHEBET

REGISTRATION NO :D/CM/18037/1296

SIGNATURE………………………………………….. DATE………………………………………………………..

This research proposal has been submitted with the approval of the undersigned to the KENYA
MEDICAL TRAINING COLLEGE-BOMET CAMPUS

SUPERVISOR

NAME:Mr.KIRUI

SIGNATURE……………………………… DATE…………………………………………………………
DEDICATION
I dedicate this research project to my family for their encouragements ,financial and moral
support .God bless you abundantly.
AKNOWLEDGEMENT

I give my sincere gratitude to the heavenly father for giving me a divine strength and guidance
throughout this study.

My special gratitude goes to my family for their financial ,emotional and moral support throughout
the study all to all the mothers with under six months old infants in longisa referral hospital who
responded to the questionnaires which I used in the collection of data. I also want to thank Mr. Kirui
for his tirelessly support throughout the study .Special thanks also goes to the Medical
Superintendent Longisa county hospital for allowing me to carry out the study within the hospital .
TABLE OF CONTENTS
Declaration…………………………………………………………………………………………………………

Dedication…………………………………………………………………………………………………………………………………..

Acknowledgement………………………………………………………………………………………………………………………………

List of abbreviations……………………………………………………………………………………………………………………………

Operational definitions……………………………………………………………………………………………………………………

Abstract………………………………………………………………………………………………………………………………………………

CHAPTER ONE

1.0 Introduction…………………………………………………………………………………………………………………………………

1.1Problem statement………………………………………………………………………………………………………………………

1.2Justification…………………………………………………………………………………………………………………………..

1.3 Study objectives…………………………………………………………………………………………………………………………..

1.3.1 Broad objectives………………………………………………………………………………………………………………………..

1.3.2 Specific objectives………………………………………………………………………………………………………………………

1.4 Research questions……………………………………………………………………………………………………………………

CHAPTER TWO

2.0 Literature review……………………………………………………………………………………………………………………

2.1 Introduction…………………………………………………………………………………………………………………………
2.2 Review of the related literature………………………………………………………………………………………..

2.2.1Benefits of breastfeeding to infant………………………………………………………………………………………..

2.2.2benefits of breastfeeding to mother……………………………………………………………………………………………

2.3 To assess cultural factors that hinders exclusive breastfeeding……………………………………………………..

2.4 To determine the level of knowledge on exclusive breastfeeding…………………………………………………

2.5 To assess the socio-demographic factors that hinder exclusive breastfeeding……………………………..

CHAPTER THREE
3.0 Methodology……………………………………………………………………………………………………………………………..

3.1Introduction……………………………………………………………………………………………………………………

3.2 Study design…………………………………………………………………………………………………………………………………..

3.3 Study area………………………………………………………………………………………………………………………………

3.4study population………………………………………………………………………………………………………………………

3.5 Sample size determination……………………………………………………………………………………………………..

3.6 Study tool………………………………………………………………………………………………………………………………

3.7 Inclusive criteria …………………………………………………………………………………………………………………

3.8 Exclusive criteria……………………………………………………………………………………………………………….

3.9 Ethical consideration…………………………………………………………………………………………………………….

3.10 Data collection methods………………………………………………………………………………………………………..

3.11 Data analysis………………………………………………………………………………………………………………………..

CHAPTER FOUR

4.0 Study findings………………………………………………………………………………………………………………………….

4.1Data analysis…………………………………………………………………………………………………………………………………

CHAPTER FIVE

Discussion……………………………………………………………………………………………………………………………………

Social report………………………………………………………………………………………………………………………………….

Social cultural factors…………………………………………………………………………………………………………………..

CHAPTER SIX

6.0 Conclusion and recommendations………………………………………………………………………………………..

6.1 Conclusion………………………………………………………………………………………………………………………

6.2 Recommendation………………………………………………………………………………………………………….

Appendix 1 Questinnaire……………………………………………………………………………………………………………………..

Appendix 2 Budget…………………………………………………………………………………………………………………………

Appendix 3 Work plan………………………………………………………………………………………………………………….

References………………………………………………………………………………………………………………………………..
LIST OF ABBREVIATIONS
MCH-Maternal Health Clinic

WHO-World Health Organization

EBF-Exclusive Breastfeeding

UNICEF-United Nations International Children Emergency Fund

EBM-Expressed Breast Milk

KDHS-Kenya Demographic Health Survey

MOH-Ministry Of Health
DEFINITION OF TERMS
Exclusive breastfeeding – Feeding the baby with breast milk only without giving any other food for

Six months

Knowledge - Knowing about something

Attitude - State of feeling about something

Practice - Repetition of an activity to improve skill

Post natal - Period immediately after delivery

ABSTRACT
A study to assess the knowledge of exclusive breastfeeding among all mothers with babies of 6
months and below was carried out in Longisa County Referral Hospital ,maternal and child health
clinic [MCH] .The purpose of this study is to assess the knowledge ,attitude and practice regarding
exclusive breastfeeding among post natal mothers .The study population included all mothers with
babies six months and below .The research methodology was descriptive cross sectional design with
a sample size of 40 respondents calculated as per the fishers et al formula .Study variables was
used ,that is dependent variables and independent variables .Sampling design was simple random
and data collected using structured questionnaires .Ethical consideration was adhered to so as to
protect respondents used in the study .Consent was obtained from the college and hospital
administration .Data was analysed by use of Microsoft excel 2007 and presented in form of tables
,pie charts ,bar graphs .The results of the study were presented to the hospital administration for
formulation of appropriate measures to improve exclusive breastfeeding .
Chapter 1
1.0 background of study

exclusive breastfeeding is when the baby receives only breast milk from the mother and no other
liquids or solids with an exception of drops or syrup consisting of vitamins , minerals supplements
or medicines.

Breastmilk is uncontaminated and contains all the food nutrients necessary for children in the first
few months of life . Colostrum is highly nutritious and has antibodies that protect the new born
from diseases .

Early breastfeeding has the greatest potential impact for child survival of all preventive interventions
with a potential to prevent 1.4 million deaths of children under five in the developing world[lancet ,
2008].if children breastfed exclusively for at least 6 months ,the cost of health care during the first
year of life can be remarkably increased [Batrick and Reinhold 2010].It has great health and
economic benefits .Breastfeeding is unequalled way of providing ideal nutrition for healthy growth
and development of infants .

The global public health recommendations is that infants should be exclusively breastfed in the first
6 months of life to achieve optimal growth ,development health [WHO 2008].Exclusive breastfeeding
in the first 6 months of life stimulates babies immune system and protect them from diarrheal and
acute respiration infections ,2 of the major causes of infant mortality in the developing world and
improves their response to vaccination [UNICEF 2008].

Exclusive breastfeeding extracts most of the nutrients required to support growth until six months
.vitamin D which is insufficient in breastmilk is supplemented through exposure of the baby to
sunlight for the skin to synthesize it while iron and zinc are supplemented by the prenatal stores
[Buttle ,Lopes-alcon and Garzal ,2006] .Exclusive breastfeeding reduces the mothers risk of fatal post
partum haemorrhage ,the risk of breast and ovarian cancer ,anaemia ,also acts as family planning
method .Breastfeeding allows the mother to recuperate before she conceives again[Leon-acva
2009].In many sub-saharan Arican societies ,exclusive breastfeeding is considered by far the best
feeding option for women of unknown HIV status and for most HIV positive mothers ,although it is
challenged by low acceptability and feasibility[Comes et ,2009]

The rate of exclusive breastfeeding has improved over the recent past with the global rate 37
percent [UNICEF2009 and UNICEF 2011].In the developing world less than 40percent of infants
under6 months old receive the benefits of exclusive breastfeeding .
The rate is particularly low in Africa where less than a third of infants under 6 months are exclusively
breastfed [UNICEF 2009].There has been a major increase in exclusive breastfeeding in 19 African
countries including Rwanda [88],Tanzania[41],and Malawi [57] among others [UNICEF 2011 and
UNICEF 2009].In Kenya rates of exclusive breastfeeding remain low with only 32 percent of infants
below 6 months being exclusively breastfed [KNBS and ICF macro 2010].Studies identified several
factors that influence breastfeeding practices such as inadequate knowledge of health benefits of
breastfeeding [OCHOLA 2008 Linkage 2005].

Inadequate antenatal counselling on breastfeeding [Dhandapany et el 2009] and belief that

breastmilk is insufficient [savage,canahauti and Osorno 2008] ,A range of maternal and child health
attributes marital status ,economic status , and child age also influence the practice exclusive
breastfeeding [Alemayehu Habler ,2009].To make better feeding choices ,mothers need specific
,culturally appropriate information that respond to their constrains and concerns [LINKAGES ,2006].

1.2 Problem statement

Approximately 1.5 million infants die each year as a result of lack of knowledge about exclusive
breast feeding benefits and improper infant and young child feeding practices [Nguyen 2009].The
WHO ,UNICEF and other organisations promote exclusive breastfeeding as one of the key effective
low cost interventions to enhance child survival .Numerous awareness campaigns have been
launched by national governments ,multilateral organizations ,non governmental organizations and
private sector organizations with an aim to encourage the practices [NGUYEN 2009].

Such initiatives include baby friendly hospitals initiatives [BFIH] and establishment of workplace
breastfeeding in the health facility as advocated [Dhandapany et al 2008] and there is specific data
on reasons why exclusive breastfeeding is not practiced optimally ,while there is a large body of
published materials on the factors influencing its practice has to be identified in order to target this
in program implementation .In Kenya the determinants of exclusive breastfeeding in resource poor
setting have been fully investigated .This study therefore obtained information which would lead to
better understanding of factors influencing exclusive breastfeeding in Bomet county.

1.3 Research Questi ons

1.What are the cultural factors that hinder exclusive breastfeeding

2.How does the level of knowledge on exclusive breastfeeding hinder exclusive breastfeeding

3.what are the socio-demographic factors that hinder exclusive breastfeeding

1.4 Study objecti ves

1.4.1 Broad objective

To assess the factors that hinder exclusive breastf eeding among mothers att ending
Longisa County Hospital

1.4 2 specific objectives

1.To assess the cultural factors and practices that hinder exclusive breastfeeding

2.To determine the level of knowledge of exclusive breastfeeding among mothers attending mother
and child welfare clinic in longisa county referral hospital

3.To assess the socio-demographic factors that hinder exclusive breastfeeding

1.5 Justi fi cati on of the study

Breastfeeding practices and the introduction of complimentary food are important determinants of
the nutritional status of children .When babies are exclusively breastfed for up to 6 months ,the
benefits are highest .Exclusive breastfeeding provides the best nutrition ,health and growth for
infants [WABA 2011].The practice of exclusive breastfeeding depends to a large extent on socio-
cultural belief in a society .Without breast milk ,babies are exposed to several diseases and defects
which can only be prevented naturally through breastfeeding . Supplements to breastmilk like

readymade baby food tend to complicate the growing up process of babies since it exposes them to
different diseases and risk during growth [Gross 2011].In Bomet East Sub county a survey revealed
that 29 percent of the children were exclusively breastfed up to 6 months [nutritional and mortality
survey 2011].This raises concern and suggest that there is need to assess the factors that hinder
exclusive breastfeeding ,hence it becomes necessary to carry out research on the study area.

1.6 Signifi cance of the study

With abundance of information available in support of breastfeeding and the support of major stake
holders in the improvement of health of the mother and children ,knowledge on the factors that
hinder exclusive breastfeeding is very important both to an individual ,community and the nation at
large [ARIFEENETAL 2001].This is important guide developing guidelines for nutrition care among
this group of children .This would enhance policy formation in the primary health care in the area of
improving the practice of exclusive breastfeeding among women .With improved nutritional status
,the risk of mortality among children under 5yrs can be reduced and their phycho-motor
development enhanced [Jones et al 2003].This will eventually contribute to achievement of the
millennium development goal on reduction of child mortality and morbidity .The study therefore
seeks to assess the factors that hinder exclusive breastfeeding among women attending child
welfare clinic in longisa county referral hospital.
2.0LITERATURE REVIEW
2.1 Introducti on

The literature was obtained from books ,journals an google so as to explain the factors hindering
exclusive breastfeeding.

2.2REVIEW OF THE RELATED LITERATURE

2.2.1Benefi ts of breastf eeding to the infant

Breast milk is a living substance that fulfils all the baby`s nutritional requirements in the first 6
months of life [SOCKOL,AGAGO and CLARK 2009] .Infants do not need water or other liquids such as
herbal tea to maintain good hydration even in hot climate [LINKAGE 2005], colostrum which is first
baby`s milk is the first immunization . It has high levels of antibodies , vitamin A and other protective
factors which strengthen the infant`s immune system and reduces the chances of death in the
neonatal period [Kryoen 2007].A multicenter cohot study done in India ,Ghana and Peru between
2010-2012 showed that infants who are not breastfed had a 10-fold higher risk of dying and a 3-fold
higher risk of hospitalization for any cause compared to those who had been predominantly
breastfed [Bahl et al 2005].

According to Venneman et al al 2009,breastfeeding reduces the chances of infant instant death

syndrome by up to 50 percent at all ages through infancy while a fifteen year old cohort study
hypothesised breast feeding was associated with protection against maternally perpetuated child
maltreatment ,particularly child neglect [Strathearn et al 2009].Association between breastfeeding
and a number of chronic or non-communicable diseases allergies ,obesity ,diabetes hypertension
,cancer and crohn`s have been observed by various studies [Leon Cave et al 2005].Findings of
systemic and meta-analyse suggest there is a protective effect against overweight and obesity than
against overweight [Horta et al 2007].During the world breastfeeding week 2009,breastfeeding has
endorsed as a life line and shield that protects infants in emergencies .

2.2.2 Benefi ts of breastf eeding to the mother

Studies across the world have revealed enormous benefits of exclusive breastfeeding for both
infants and the mothers .A study carried out in Chittagong ,Bangledesh by Mihrhar showed that
infants who were exclusively breastfed for up to 6 months had a significantly lower prevalence of
diarrhoea and acute respiratory tract infections .Exclusive breastfeeding reduces risk of mother to
child HIV transmission.
For the first 6 months of life exclusive breastfeeding remains the most appreciate option for many
HIV infected mothers in Sub-saharan Africa although its acceptability and feasibility have to be
improved by promoting it as the best feeding option for all infants [Came et al 2009]. In a study
carried out by llia et al in Harare Zimbabwe between 1997 and 2000,mixed breastfeeding quadrated
mother to infant HIV transmission and was associated with a 3 times greater risk of transmission and
death by age of 6 months when compared to exclusive breastfeeding in the same study. Exclusive
breastfeeding contracts the uterus after delivery, delays ovulation hence it is a way family planning
method ,conserves the iron stores when the mother have amenorrhoea and reduces risk of breast
cancer .Exclusive breastfeeding promotes weight loss during postpartum period hence protecting
mother against maternal overweight or obesity and also facilitates rapid return to nonpregnant
weight[Hatsu ,Mc Donald and Anderson 2008].

2.3TO ASSESS CULTURAL FACTORS THAT HINDERS EXCLUSIVE BREASTFEEDING

2.3.1 Socio- economic factors

According to xu et al 2009 ,mother`s return to their normal employment was negatively associated
with exclusive breastfeeding in China ,in contrast no association was observed regarding the place of
residence and current employment of women In a study among women who delivered at a
maternity unit in a government medical college and hospital in India ,while in Kenya mothers from
higher socio-economic status were less likely to exclusively breastfed based on owners of television
and telephones [Ochola 2008].In Tanzania findings of a study by shirima et al 1998-1999 showed
that socio-economic factors had significant association with exclusive breastfeeding in different
setups in order to develop context specific interventions to promote exclusive breastfeeding[ochola
2008]

2.3.2 contextual factors

A study in San Paulo Brazil Venanzio and Montero ,2006 IN 2006 showed that the place of delivery
was not associated with exclusive breastfeeding .these findings contrasts those of a mauritious study
by Jahangeer et al where public health institutions have adapted the BFHI,therefore encouraging
proper breastfeeding initiation and successful exclusive breastfeeding for 6 months [jahanger,khan
2009].Inn Canada 2006 in a study by al Sahib SVD was positively associated with exclusive
breastfeeding while CS was negatively associated with exclusive breastfeeding . As stipulated by the
study ,pain discomfort associated with CS may prevent mother breastfeeding.

2.3.3 Cultural factors

In India ,the believe that mothers milk is not ready until 2-3 days postpartum delays initiation of
breastfeeding while colostrium is generally dicarded [Bandyopadhyay 2009] among lebanise women
concerns that the mother could potentially harm her infant through breastfeeding were rooted in a
number of cultural beliefs among them having an inherited mobility produce milk having `bad milk`
and transmission of abdominal cramps to infant through breast milk[Osman,Zein and Wick
2009].Other obstacles of exclusive breastfeeding include perception of insufficient breast milk ,fear
of dying or becoming too sick to breastfeeding [Field at al 2008].These findings agree with those of
many studies in China [XUet al 2009] and Kenya [Ochola 2008] which have perceived breast milk
insufficiency as a reason for not exclusively breast feeding for 6 months .There is need to identify the
cultural factors that may negatively affect exclusive breastfeeding in different communities so that it
may be addressed during promotion of appropriate breastfeeding practices.
2.4 To determine the level of knowledge on exclusive breastf eeding among mothers
att ending child welfare clinic in longisa county referral hospital

2.4.1 Promoti on, support and protecti on of breastf eeding

Promotion, support and protection of breastfeeding has a route in a joint [UNICEF -WHO meeting in
1979 and infant and young child feeding during which an international code in the market of infant
formula and other breastmilk substitutes was recommended and later adopted in 1981 by world
health assembly [Sockol et al 2007].In 1990 the innocent declaration was adopted and called for all
women to be enabled to practice exclusive breastfeeding for all infants[UNICEF 2008].The BFHI had a
measurable impact on increasing exclusive breastfeeding with 19000 facilities in 150 countries being
designed as baby friendly [UNICEF ,WHO 2006].the impact however is mainly at health facility and is
not sustained beyond it[Braun et al 2003, Coutinto et al 2005].Community based strategies for
promotion and support of breastfeeding have had a significant beneficial effects on the rates of
exclusive breastfeeding .The challenge is to implement them on large scale and to sustain change
and commitment currently observed in over 120 countries by UNICEF and its partners including
WABA and WHO with an aim of promoting exclusive breastfeeding for the first 6 months .WABA`s
advocacy package and website [UNICEF press centre ,2008] are also initiatives that have contributed
promotion ,protection and support of breastfeeding .

2.4.2 Maternal age

In a study to examine the association between solid and formulae with the pattern and duration of
breastfeeding in upssalar, Sweden, Hornel, Hotrvander and Kylberberg [2009] reported that mothers
below 24 years were less likely to breastfeed than older mothers. Maternal age has been widely
reported as a variable affecting maternal choices [Dennis 2006 a very et al 2006].In Kenya, cosmetic
reasons were especially cited [Nairobi-Buruburu]. Among young women who felt that their breast
would either or become too big .Old women were perceived as needing more supervision and
direction with regard to infant and young child feeding[MOH ,2011] social pressure on women also
pose a major problem to breastfeeding since society expects women to maintain a youthful figure
regardless of age and parity .This has pushed many young girls into forfeiting breastfeeding
.Breastfeeding for many young mothers is embarrassing ,untrendy and waste of time they could
rather spend making fun with peers .Ironically no research so far has linked exclusive breastfeeding
with breast sagging .A study by Brian Linkler et al 2008 actually indicates breastfeeding has no
adverse on breast aesthetics.

2.5 TO ASSESS THE SOCIO-DEMOGRAPHIC FACTORS THAT HINDER EXCLUSIVE

BREASTFEEDING

2.5.1 Status of exclusive breastf eeding in Kenya

Initiation of exclusive breastfeeding is universal with 99% of children under 6 months being
breastfed and the duration is also long with 53.6%. Children 20-23 months old still breastfeeding
.KNBS and ICF macro ,2010].exclusive breastfeeding is however not common. There has been an
increase in exclusive breastfeeding and at 6-8 months the prevalence is 3.6%.KNBS and ICF macro
,infant and young child feeding program UNICEF 2009 and this together with efforts by other
agencies may have contributed to the increase prevalence currently at 37%.Exxclusive breastfeeding
in Kenya is among the lowest in East African region where prevalence is 47%[UNICEF 2011]

2.5.1 MATERNAL FACTORS

There is evidence showing that maternal characteristics such as education influence breastfeeding
practices in Tanzania to Shirina ,Gabre -Medhinand Griener 2005 .Duration of breastfeeding is mainly
associated with information and knowledge about breastfeeding .Maternal level of education has
also been reported to be positively associated with intraction ,exclusiveness and duration of
breastfeeding [Al Sahab et al 2010 Alemayu ,Hardar and Hable ,2009].In a study by Alemayehu et al
in Ethiopia 2005.Exclusive breastfeeding was associated with current marital status and economic
status[ALEMAYEHU et al 2009].In Kenya ,limited knowledge about breastfeeding ,pressure from
family and friends to introduce complimentary foods to excessive demand and maternal time
against other competing responsibilities have been shown to negatively influence the practice of

exclusive breastfeeding [Ochola 2008].Other maternal characteristics that have been shown to have
significant association with exclusive breastfeeding include maternal age ,higher parity and
experience of breastfeeding problems ,for example a prospective cohort study in Nigeria in 2006 ,
2007 ,older maternal age and higher parity were significantly associated with exclusive breastfeeding
[Ekugbu et al 2011]while in western Tanzania ,Nkala and Msuya in 2010 established the women who
had no problems related to breast were likely to exclusively breastfed [Nkala and Msuya
2011].Maternal characteristics vary widely within different contexts while there is limited data on
factors influencing exclusive breastfeeding in Kenya .Review of available literature did not reveal any
study showing the influence of maternal characteristics that may have on exclusive breastfeeding in
the study.

2.5.2 SUMMARY OF LITERATURE REVIEW

In summary exclusive breastfeeding for infants less than 6 months of age has increased in different
parts of the world [UNICEF 2009] Less so in Saharan Africa .The increase however falls short of WHO
recantation of exclusive breastfeeding for 6 months ,studies have shown that maternal
characteristics ,socio-economic factors contextual factors are believes and norms about
breastfeeding practices influence exclusive breastfeeding in varying magnitude in different setups .A
research of literature review however revealed that there is limited information on the factors that
influence exclusive breastfeeding practices in Africa well as in Kenya .This study therefore aimed at
investigating breastfeeding practices among mothers of infants 0-6 months in Longisa County
Referral Hospital.
CHAPTER THREE
3.1 INTRODUCTION

This chapter will describe the methodology used in the study

3.2 STUDY DESIGN

A descriptive study design was used due to limited time available to carry the research and it is
economical .I wanted to identify the factors influencing exclusive breastfeeding amoung mothers
attending child welfare clinic in longisa county referral hospital in infants between 0-6 months .

3.3 STUDY AREA

This research was conducted in Longisa referral hospital at MCH/FP unit.

3.4 STUDY POPULATION

Study population included mothers with infants 6 months and below who are attending MCH/FP at
longisa county referral hospital since they are at a high risk of being introduced to complementary
feeds before 6 months of life which can have several effects on their lives.

3.5 SAMPLING SIZE DETERMINATION

Simple random method were used to recruit the subjects to the study.The representative sample
was obtained randomly using sample lottery method .randomizing of the days of the data collection
was done each day.Questionnares were administered ,sample size determination was done using
Fisher`s formumar 1991 whereby n=z2pq/D2 where

n=desired sample size when the population is more than 10000

z=normal standard deviation usually set at 1.96 which responds to 95% confidence level

p=means population of the target estimate to have similar characteristics .If there is no
reasonable estimate 50%[0.5] is used.

q=1.0-p

D=It is the degree of error permissible [0.05]

n=z2 pq/D2

n=1.962[0.5][1-0.5]/0 052

=384.16

For population less than 10,000 then this formula is used

nf=n/1+[n/N] whereby

nf=desired sample size when the population is less than 10000

n=desired sample size when the population is more than 10000

N=estimate of the population [for my study it is 45 ]

nf=384 / { 1+[384/45] }

nf=40.29

nf=40

3.6 STUDY TOOL

A presented self administered questionnaire was used to collect information required .The
questionnaire was presented to the mothers who were willing to participate in the study and were
attending MCH/FP in longisa county referral hospital.

3.7 INCLUSIVE CRITERIA

The study involved mothers who had infants below 6 months who were attending MCH/FP clinic in
longisa county hospital who were willing to take part in the study and right to withdraw at any time.

3.8 EXCLUSIVE CRITERIA

Mothers who attend MCH/FP clinic and had infants above 6 months also HIV/AIDS positive mothers
were excluded.

3.9 ETHICAL CONSIDERATION

Permission to conduct the study was sought from the relevant authorities . Dignity was maintained
between the researcher and the client to ensure that there will be no physical or psychological
harm .Information received will be treated with confidentiality and voluntary consent was gotten
from the respondent.

3.10 DATA COLLECTION METHODS

Questionnaires were used in the collection of data .The researcher used simple random sampling
method where their were a total of 40 raffle papers in a container , those that picked yes raffle were
allowed to participate in the study while those that picked no raffle did not participate .There were
12 yes and 28 no raffle papers within the container everyday a total of 12 clients in a day.

3.11 DATA ANALYSIS

Data collected was analysed using the statistical package of social science and the data findings were
presented using tables ,graphs and chats.

CHAPTER FOUR
4.0DATA ANALYSIS AND PRESENTATION

4.1INTRODUCTION

Data was collected and presented inform of tables, graphs and charts

Demographic data

Table 1: Age of respondent

Age of respondent No.of respondents percentage

15-19 years 8 20%
20-24 years 12 30%
25-29 years 8 20%
30-34 years 7 17.5%
35 years and above 5 12.5%
TOTAL 40 100%

The table show that the highest percentage of respondents were in the ages of 20-24 years which
translate to 30% followed by 15-19 years at 20% and the least is above 35 years which is 12.5% . This
is clear indication that all the ages were involved in the study of factors influencing exclusive
breastfeeding among infants less than 6 months in Longisa county hospital
 Level of education

13%
Primary
Secondary
Tertiary
25%
62%

The highest percentage of 62.2% of respondents had attained primary level education ,25% had
attained secondary level education. Tertiary level was represented by 12.5 %. This means that
everybody who was involved in the study on factors hindering exclusive breastfeeding in Longisa
county hospital had at least attained primary level of education which is recommendable.

OCCUPATION OF RESPONDENTS

Table 2: Occupati on of Respondent

Occupati on of respondent No.of respondents Percentage

Employed 8 20%
Self employed 14 35%
Unemployed 18 45%
TOTAL 40 100%

Majority of the residents 45 % were unemployed meaning that they had enough time to exclusively
breastfed their infants .Those who were self -employed were represented by 35 % and those who
were employed were represented by 20% .The 20% who were employed are the ones likely to
introduce weaning early to their infants .

MARITAL STATUS OF THE RESPONDENTS

 Marrital Status
60%

50%

40%

30%

20%

10%

0%
Married Single Separated Widowed

Married Single Separated Widowed

Figure 2: Marital status of the respondents

Out of 40 mothers 20 [50%] were married 12[30%] were single and 6[15%] were separated and
2[5%] were widowed .This is a clear indication that most of the mothers who were involved on this
study of factors hindering exclusive breastfeeding were married.

REASONS FOR MOTHERS NOT TO BREASTFED EXCLUSIVELY

70%

60%

50%

40%

30%

20%

10%

0%
Insufficient breastmilk Work Demand Lack of information

Series 1 Series 2 Series 3

Figure 3: REASONS FOR MOTHERS NOT TO BREASTFED EXCLUSIVELY

The study investigated as to why mothers did not breastfeed exclusively and found that 60% had
insufficient breast milk ,work demand represented by 30 % and lack of information 10% as shown
above.

CHAPTER FIVE
The main objective of the study was aimed at assessing factors that hinder exclusive breastfeeding
among mothers attending longisa county hospital .The data collected indicates that most of the
residents were aging 20-24 years represented by 30% .In addition ,most of them had attained at
least primary level of education .The study showed that half of the residents were unemployed and
most of the respondents were married represented by 20[50%].It was also found that most of the
respondents had 1-2 children which were represented by 52.5% .Rest of the respondents were their
first child represented by 47.5% .This is a clear indication that women of reproductive age in the
region are at their early 20s and delivered at a very young age . In addition ,it shows that women are
more willing to attend child welfare clinic when their children are in their tender age compared to
the later ages .

The study also showed that most of the mothers, when they were working away from home
25[62.5%]did not carry their babies with them ,while 15[37.5%]were taking their babies to work . It
was further investigated on the information they were given regardless of breastfeeding which
showed that 26[65%]were told about exclusive breastfeeding ,7[17.5%]were not told about
exclusive breastfeeding ,5[12.5%]were about expression of breast milk while 2[5%] were not told
anything to do with breastfeeding .This supports the study done by Li et al 2005 ,who revealed that
majority of the mothers received health education on breastfeeding from health professionals
during their pregnancies as other studies found a positive association between the level of maternal
education and exclusive breastfeeding duration[Scort et al 2004,li et al 2005 ,Gudnadottir et al 2006
and Senarath 2007.

SOCIAL REPORT

The study found that most children were breastfed though few stopped breastfeeding, the time they
stopped breastfeeding was 4 months [15%],5 months[10%],6 months [5%]and the highest number
had not stopped breastfeeding[70%].The influence of feeding practices , decisions was investigated
and it indicated that most of the mothers-in-law ,own decision , health workers , the mother and
husband and according to the rapid assessment of beliefs and attitudes in Kenya ,mothers -in-law
were the most consulted and the most trusted source in Kipsigis community.

They were reported as being authoritative family figure[MOH,2011].In the introduction of extra
foods and drinks including water to the baby ,it was found that most mothers started at the age of 6
months [40%] 1-3 months 12[30%] ,4-5 months 9[22.5%] and less than 1 month3[7.5%].It was found
that they had people who took care of the babies such as grandmothers, house-helps, and others
including siblings.

Further, the researcher found that the babies were fed with expressed milk, porridge and cow`s
milk .This was supported by Lakatu ,A bimmss Stevenson 2009,who in a cross section study
undertaken in Nairobi Kenya where half of the mothers were in formal paid employment and the
rest self-employed. Working mothers were able to breastfed exclusively .Early introduction of
complementary foods was high with 40% of the mothers having introduced complementary feeds at
one month .The reason as to why mothers did not breastfed exclusively was investigated and results
showed that breastmilk was insufficient ,work demand, and lack of information among the listed
reasons.

SOCIAL CULTURAL FACTORS

On the social cultural ,the study investigated whether babies need water during the first 6 months of
life .It was found that an average of 20[50%] arqued that the baby need water because it hinders
dehydration. A range of socio-cultural factors which have been reported to hinder exclusive
breastfeeding ,a study reported all cultural norms of giving infants concotions and customs such as
giving water to every stranger entering the house including the newborns [de Paulomm et al
2001].Further the study investigated on whether Kipsigis culture hinders breastfeeding and it was
found that majority of the respondents 26[65%]said that the culture doesn`t hinder exclusive
breastfeeding while 14[35%]said it hinders breastfeeding .This is because some believed that they
cannot exclusively breastfed since babies need food to be stronger.
CHAPTER SIX
6.0 CONCLUSION AND RECOMMENDATIONS

6.1CONCLUSION

The main aim of the study was to know the factors that hinder exclusive breastfeeding among
mothers attending longisa county hospital .Most of the mothers have knowledge on exclusive
breastfeeding however mothers think that breast milk is insufficient for their babies in the first 6
months .Traditions in Kipsigis culture and work demand were cited factors that hinder exclusive
breastfeeding .Influence on breastfeeding was mother`s own decision although their mothers-in-law
have influence on breastfeeding

6.2 RECOMMENDATIONS

Since marital status was found to be the main factor in successful exclusive breastfeeding strategies
spouse and other family members need to understand what exclusive breastfeeding entails with full
support for success.
There is also need for support interventions and follow up to the breastfeeding mothers by
knowledge and skilled workers in the community .The county government and national government
should provide more job opportunities to reduce unemployment rates which were one of the factors
influencing exclusive breastfeeding.

Health education should be reinforced in the child welfare clinic on the importance of exclusive
breastfeeding . Health education will make mothers understand the advantages of exclusive
breastfeeding ,also giving mothers moral and psychological support during the period.

REFERENCES
1.Agho K E Dibler,M J Odaise JI &Ogbonmwan S M[2011]

2. Aidam BA Perez-Escamilla R Lartey A Aidam J- Factors associated with exclusive breastfeeding in

Accra Ghana Eur J ClinNutr 2005,59[6]789-796

3. Aidam BA,perez -Escamilla R Lartey, Lactation counselling increases exclusive breastfeeding rates
in Ghana ,American society for nutritional sciences 2005 ;00223166/05 ,169-195

4.Determinants of exclusive breastfeeding in Nigeria BMC pregnancy and childbirth 11[1],2 Doc

5. Gross J [2008] the preserved behavioural control of breastfeeding practices ,a qualitative study

6. Kenya National Bureu of Statistics [KNBS] and ICF Macro [2010] ,Kenya Demographic and Health
Survey 2008-2009,Calverton Maryland KNBS and ICF macro

7. Lancet [2008]Maternal and child under nutrition ;Global and Regional exposure and health
consequences Ochola 2008 ,Evaluation of two counselling strategies promoting exclusive
breastfeeding among HIV negative mothers in Kibera slum ,Nairobi Kenya .A randomized control trial
World Health Organization ,Exclusive breastfeeding Geneva .WHO retrieved from
http;/www.who.int/nutrition/topics/exclusive breastfeeding/en.[Accessed 11 July 2012].

8. World Health Organization infant and young child feeding ,Model chapter 4 textbooks for medical
students and allied health professionals ,Geneva WHO 2009.

9. World Health Organization [WHO 2006],Integrated Management of pregnancy and childbirth

;Geneva ,WABA 2008 retrieved from http/www.wba.Org.mylaboatus/htm# vision[Accessed on
31/05/2008]

10. World Health Organization ,United Nation Children`s Fund [2008],indicators for assessing infants
and young child feeding Geneva Switzerland.

APPENDICES
APPENDIX 1:RESEARCH QUESTIONNAIRES

Research purpose; a project submitted in partial fulfilment of the requirements for the award of the
diploma in clinical medicine and surgery in Kenya Medical Training College. All the information that
will be collected will be kept private and will be only used for this study .The form will not bear your
name . participating in this study is completely voluntary .

CONCENT

I agree to participate in the study .I have read and everything is clearly explained to me.

Put a tick…..

1. Age bracket

a).15-19years [ ]
 b). 20-24 years[ ]

c).25-29 years [ ]

d ) 30-34 years [ ]

e)35 years and above

2.Level of education

a) Primary [ ]

b)secondary [ ]

c) Tertiary [ ]

3.Occupation

a)employed

b) self-employed

c) unemployed

4.Marital status

a)single [ ]

b)married[ ]

c)divorced[ ]

d)widowed[ ]

5.When you were working away from home before your baby was six months ,were you taking your
baby with you?

a) Yes [ ]

b) No [ ]

6.If no ,who was taking care of the baby?

a)Father [ ]

b)Grandmother [ ]

c)House help [ ]

d)Others

7. When at work ,what was the baby fed on ?

a)Expressed breastmilk [ ]

b)Expressed milk [ ]
c)cow`s milk [ ]

8. Where did you deliver this child?

a)Hospital/health facility [ ]

b)home [ ]

9. Number of children

a}1-2 [ ]

b) 3-4 [ ]

c) >5 [ ]

10. Is this the 1st,2nd,or 3rd child?

a)Yes [ ]

b) No [ ]

11During pregnancy did you attend antenatal clinic?

a)Yes [ ]

b)No [ ]

12. What do you understand by the term exclusive breastfeeding?

……………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………….

Social cultural factors

13. Do you think that babies need water during the first 6 months?

a) Yes [ ]

b) No [ ]

14. Do you think Kipsigis culture hinders exclusive breastfeeding ?

a)Yes [ ]

b)No [ ]

if yes why?...................................................................................................................

15. Is you child currently breastfeeding?

a)Yes [ ]

b)No [ ]

If no how old was your child when you stopped

breastfeeding?.........................................................................................................

16. Why did you stopped breastfeeding him/her?

a)The milk was not enough [ ]

b)Work away from home [ ]

c)Breast problems [ ]

d)Others [ ]

17.Before six months ,who influenced you to stop your decision of exclusive breastfeeding?

a) Husband [ ]

b)Mother-in-law [ ]

c) Health worker [ ]

d)your own mother [ ]

e)Own decision [ ]

18.What is the appropriate time to start complementary foods?

a) Less than a month [ ]

b) 1-3 months [ ]

c)4-5 months [ ]

d)6 months [ ]

19. What do you think are the reasons for mothers not to breastfeed exclusively?

a) Lack of information [ ]

b}little milk [ ]

c)Traditional and cultural beliefs [ ]

APPENDIX 2

BUDGET FOR THE STUDY

ITEM UNIT AMOUNT

TYPING/PRINTING 2000
PHOTOCOPY 2 COPIES 800
PENS 10 100
RULERS 1 50
FOOLSCAPS 2 REAMS 800
BINDING 2 400
BUYING OF BUNDLES 300
TOTAL 4450
APPENDIX 3:WORK PLAN
ACTIVITY PERIOD
Problem identification October-December 2019
Proposal writing Dec-Jan 2020
Proposal submission Jan 2020
Data collection Jan 2020
Data analysis Feb 2020
Report writing Feb 2020
Research presentation March 2020