Adigrat University

College of Medicine and health sciences

Department of Nurse
Assessment of factors that affect early initiation of breast feeding among
women of reproductive age group in Adigrat town from August to
September 2006 E.C.

Name of investigators
1. Kahsay G/medhin
2. Samrawit Kahsay
3. Tadesse Desta
4. Selamawit Berihu
5. Tesfay Zeru
Advisor:
Yemanebrhan (MSC)

Research proposal to be submitted to Nursing department for the

fulfillment requirement for BSC degree in Nursing

August 2006 E.C

Adigrat, Tigray, Ethiopia

Assessment of factors that affect early initiation of breast

feeding among women of reproductive age group in
Adigrat town from August to September 2006 E.C.

Name of investigators
1. Kahsay G/medhin
2. Samrawit Kahsay
3. Tadesse Desta
4. Selamawit Berihu
5. Tesfay Zeru

Advisor:
Yemane Brhane (MSC)

ACKNOWLEDGEMENT
First and foremost we would like to thank God for his guidance throughout our life.
Secondly, we would like to convey our gratefulness to our research advisor Ato Yemane Brhane
for his patience with our inadequacies as he is guiding us through the research.
We acknowledge with gratitude the contributions and co-operation made by employees
of Adigrat Health center for their willingness to provide the necessary information during
this initial study.

ACRONYMS
EBF

Exclusive Breast Feeding

EIBF

Early Initiation of Breast Feeding

MDG

Millennium Development Goal

UNICEF

United Nations Childrens Fund

WHO

World Health Organization

SUMMARY

TABLES OF CONTENTS
ACKNOWLEDGEMENT.......................................................................................................ii
ACRONYMS.........................................................................................................................iii
SUMMARY............................................................................................................................iv
TABLES OF CONTENTS......................................................................................................iv
UNIT ONE...............................................................................................................................4
INTRODUCTION...................................................................................................................4
1.1.

Background of the Study...........................................................................................4

1.2.

Statement of the problem..........................................................................................4

1.3.

Significance of the Study..........................................................................................4

UNIT TWO..............................................................................................................................4
LITERATURE REVIEW.........................................................................................................4
UNIT THREE..........................................................................................................................4
OBJECTIVE OF THE STUDY...............................................................................................4
3.1.

General Objective......................................................................................................4

3.2.

Specific Objectives....................................................................................................4

UNIT FOUR............................................................................................................................4
METHODS AND MATERIALS.............................................................................................4

UNIT ONE
INTRODUCTION
1.1.

Background of the Study

As early initiation of breast feeding is crucial to the health of the child and to decrease child
mortality UNICEF has promoted breast feeding initiation within half an hour of child birth
as an important strategy to reduce prenatal and infant mortalities and morbidities and by
extension to support the achievement of millennium development goals (MDG) (Unicief,
2006).
Breast feeding can contribute to the reduction of mortality and morbidity kumar,2006).
Benefits of breast-feeding like a decrease in the incidence, severity of infectious diseases
such as diarrhea, respiratory tract infections, otitis media and urinary tract infection,
decreased incidence of types 1 and 2 diabetes mellitus, overweight, obesity and asthma
were reported 8. Too early introduction of breast milk substitutes and too late introduction
of semi-solid complementary feeds are common and are responsible for rapid increase in
the prevalence of under nutrition between 6 24 months 9. Some studies reveal factors
positively associated with exclusive breastfeeding, such as higher maternal educational
level, gestational age greater than 37 weeks, mothers with previous experience of
breastfeeding Ramachandran(2004).
In many parts of the world, the rates of early initiation of breast feeding are extremely low
17% in Eastern Europe and central Asian countries and 33% in Asia pacific highest rates
(about 50%) are in Latin America, the Caribbean, east and North America. In south Asia,
24%- 26% of babies born in Bangladesh, India and Pakistan are brought within the 1 st hour
of birth where as the corresponding rate for sirlanka is 75%. The effect of breast feeding
patterns is reflected in the neonatal mortality rates ( WHO, 2005)
Different factors such as busy maternity, centers with inadequate man power, and social
support may hinder early initiation of breast feeding. The aim of this study however is to
explore particularly the role of psychological support offered by companions on breast
feeding initiation among first line mothers, to develop extension of health education on the
matter to bring behavioral changes.

1.2.

Statement of the problem

Worldwide about four million babies die annually in the first four weeks of life i.e the
neonatal period. The vast majority of these neonatal deaths occur in the developing world,
mainly from preventable causes (international center from diarrheal disease research, 2006)
The highest numbers of neonatal deaths are observed in the south central Asia countries and
the highest rates are generally in the sub-Saharan Africa.
As WHO global data bank on infant and young child feeding (2005) noted in Ethiopia at a
national level there is 30.9% delay of early initiation of breast feeding. And in Tigray in
particular there is 47.1% of delay of early initiation of breast feeding.
This data shows there is significant delay of early initiation of breast feeding which can
affect children and community as a whole programmes to reduce neonatal and infant
morbidity and mortality are designed to identify and select interventions which have the
most potential to impact mortality.
Hence, this study is initiated to assess of factors that affect early initiation of breast feeding
among women of reproductive age group in Adigrat town.

1.3.

Significance of the Study

It is clearly known that assessment of factors that affect early initiation of breast feeding can
reduce gross problems that occur in children and mothers breast feeding initiation is key
element of quality care in community and family health by helping the family to have
giving breast milk and early and exclusively by reducing expenditure of money and other
materials by making children free of allergy through breast milk and develops better
immunity.
The study may add knowledge on understanding what factors that affecting early initiation
of breast feeding among women of reproductive age group.
The result of this study can greatly generate information and knowledge to assist in
formulating and designing appropriate interventions strategy that are effective to achieve the
desired change of behavior and attitude of mothers in particular and community in general.
Furthermore, this research can be utilized as baseline in future related researches.

UNIT TWO
LITERATURE REVIEW
Early initiation of breast feeding is characterized by putting the infant to the breast within
one hour of birth and is measured using the indicator timely initiation of breast feeding.
EBF means that the infant receives only breast milk, and rate of exclusive breast feeding is
the percentage of infants aged less than 6 months who receive only breast milk and no other
solid or liquid including water with the exception of drops syrups consisting of vitamins or
mineral supplements or medicines.
WHOs Team highlighted the mortality impact using pooled analysis from several countries
that documented a greater chance of dying from infectious diseases throughout the first year
of life for non breast fed infants, with the greatest risk for younger infants in the first two
months of life non breast fed infants had an almost 6 fold greater risk of dying from
infectious diseases than breast fed infants (international center for diarrhea disease research,
2006)
The 2003 guide for essential practice for pregnancy child birth, post partum and new born
care of WHO identified early and exclusive breast feeding (EBF) as a key component of
care. The impact of early initiation and EBF in the first month of life on mortality has
recently been documented. In many parts of world the rate of EIBF are extremely low 17%
in Eastern Europe and central Asia countries and 33% in Asia pacific highest rate 50% are
in Latin America the Caribbean. However for many countries no data are available. In south
Asia, 24-26% of babies born in Bangladesh, India and Pakistan are breast fed within the
first hour of birth, where as the corresponding rate for Sri Lanka is 75% (WHO, 2010).
Mothers do not initiate breast feeding or discontinue breast feeding early for variety of
reasons. Aluwaria (2005) found that mothers stopped breast feeding in the first month post
partum because of sore nipples, infant difficulty with latch and perception that they were not
producing enough milk to satisfy their infants. Social barriers to breast feeding working
outside the home, length of maternity leave and embarrassment of breast feeding in public,
have been identified as factors affecting breast feeding initiation and duration.
In total 51.4% mothers initiated breast feeding. This gradually declined to 22.1% at 14
weeks postnatal. Mothers attributes significantly associated with initiated breast feeding

included having previously breastfed, complete third level education, decision to breast fed
made early in pregnancy, being a none smoker, having a mother who also breast fed,
belonging to higher societal class and 24 years or older. However after controlling for all
these variables in regression model only the following factors remained significant:
Having previously breastfed, completed third level education and decision to breastfed early
in pregnancy. Therefore, as decisions on infant feeding method are made to or early in
pregnancy, efforts to increase breastfeeding rates will have to occur at societal level. Health
sector initiatives can only have limited effect in addition, creative methods must be
developed and employed to encourage women from lower socio economic groups to
breastfeed (WHO, 2010).
Timely initiation of breast feeding was relatively high at 56% in 2000 in Bolivia the
significant increase to 76% by 2003 suggested that this is relatively easy behavior to change
at scale when communities with health providers are sensitized through training to its
important in infant health while timely initiation breast feeding was at lower level in
Madagascar in 2000 the pattern of increase was similar to that of Bolivia topping out in
2004 at 78% the fact that timely initiation of breast feeding is a onetime activity may also
make it more susceptible to change than the repeated actions necessary to carry out
exclusive breast feeding up to the age of 6 month. In Madagascar cost effectiveness analysis
demonstrated that carrying out this large scale intervention yielded behavior change results
economically (ibid).
Lack of timely routine follow up care and post partum home health visit, lack of family
and broad societal supports, media portrayal of bottle feeding as normative Misinformation
and lack of guidance and encouragement from health care professionals as some of the
many obstacle mothers face when attempting to initiate and continue breast feeding. The
lack of financial support as well as lack of opportunity to observe breast feeding in societies
can make it difficult for new mothers to attempt to breast feed. More over misinformation
from health providers and minimal decision about the process and benefits of breast feeding
compared with formula feeding contribute to low breast feeding and increase maternal
frustration and confusion regarding breast feeding (Moore, 2006).

Factors influencing initiation of breast feeding

According to WHO global data bank on infant and young child feeding (2005):
In India in 2005, pain and tiredness 25 (25%), no milk ignorance and advice by elders was
25 (25%), 21(21%), 22(22%) 32(32%) respectively.

Time of initiation of first breast

feeding in an urban set up of India was Time of first feed <2 hours 6(6%), 2-12 hours
37(37%), 13-24 hours 25(25%)
In 2000 in Tigray early initiation of breast feeding was 31.4% whereas in 2005 it was
52.9%. Initiation of breast feeding with in 1 hour after birth was 1.7 times more common in
Tigray. In Gonder 19% of mothers started breast feeding on the 3 rd day of delivery and
consequently a significant higher proportion of newborns were offered prelacteal feeds
Nutrition education to raise awareness of mothers regarding initiation of exclusive breast
feeding directly prepostlacteal feeds needs to be implemented. A new health package to be
implemented could be a proper vehicle to reach the rural population, which doesnt have
access to health services (Zewditu, 2004)
Karen (2005) noted that regardless of the cause of delayed initiation of breast feeding its
health impact and other negative of results can be prevented by giving health information
dissemination making and creating supporters in breast feeding helping in companion ship
in breast feeding for the reproductive age group and the whole family and community. Early
initiation of breast feeding is important in health of neonates and other reproductive health
programme to improve the quality of health. In addition Karen also mentioned in his paper
that potential mechanism of early initiation of breast feeding could affect neonatal mortality
by at least 4 mechanisms.
1. The lower rate of mortality in early initiation of may have occurred because mothers
who suckle their offspring shortly sustaining. However the effect of early initiation
persisted after controlling for established breast feeding patterns.
2. Early feeding with non human milk proteins may severally disrupt normal GI
functions.
3. Early human milk is rich in a variety of immune and non-immune competent that are
important for early gut growth and resistance to infections.

4. Promotion of warmth and protection may reduce the risk of death from hypothermia.
The benefits of breast feeding for the health and wellbeings of mother and baby are well
documented. WHO recommends early / within 1st hour of giving birth) initiation of breast
feeding. A recent trial has shown that early initiation of breast feeding could reduce neonatal
mortality by 22% which could contribute to the achievement M D G. Over all one million
infant could be saved each year by early initiation of breast feeding within one hour. Early
initiation of breast feeding could save as many million lives each year by reducing death
mainly due to diarrheal disorders and respiratory infections in children (Jana, 2099).
The impact of early initiation of breast feeding on infant mortality and its economic
advantages are well known. Yet little attention has been paid by health care practitioners and
policy makers to this preventive strategy except for annual campaign to high light its
importance such as the world breast feeding week (ibid).
Few trials have been conducted to identify interventions that might improve the breast
feeding initiation thereby saving lives worldwide this aims to evaluate and compare.
1. The effectiveness of intervention that aim to enable women to initiate breast feeding
early.
2. The appropriateness of these intervention secondary outcomes such as duration and
exclusivity of breast feeding and
3. Effects of the interventions (ibid).

UNIT THREE
OBJECTIVE OF THE STUDY
3.1.

General Objective
-

To assess factors that affect early initiation of breast feeding in Adigrat town
whose age are in child bearing.

3.2.

Specific Objectives
1. To assess prevalence of early initiation of breast feeding
2. To identify factors that could be responsible for delaying of initiation of breast
feeding
3. To determine the time of initiation of first breast feed.

UNIT FOUR
METHODS AND MATERIALS