DECLARATION

I hereby declare that this research dissertation is my original work and has never been presented in any other institution for academic qualification. NAME: .. STUDENT NO. SIGNATURE: .. DATE: This research dissertation has been submitted for review with my approval as the supervisor. SUPERVISOR: .. SIGNATURE: . DATE: ..

Acknowledgement I wish to sincely acknowledge Mr. Jacob Kotut for his tireless effots and guidance and management throughout the research work. My appreciation also goes to Mr. Chirchir William (Sosiot Health Centre Nutritionist) for his moral and material support throughout the research work. Special thanks goes to my parents for their financial support.

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DEFINATIONS OF TERMS
Knowledge Attitude Practice Breast milk : : : : A persons range of information or understanding of a subject Pertains ones opinion or way of thinking To do something or to take part in doing something Is the fertile range in women which is 15-49 years Milk produced by a mother to feed

Reproductive age:

Exclusive breastfeeding: Feeding of infants with breast milk only for six months

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ABBREVIATIONS AND ACRONYMS

EBF MDG NDHS WHO UNICEF MOH MOPHS : : : : : : : Exclusive Breastfeeding Millennium Development Goals National Demographic Health Survey World Health Organization United Nations Childrens Fund Ministry of Health Ministry of Public Health and Sanitation

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ABSTRACT
A research dissertation on knowledge, attitude and practice on exclusive breastfeeding among mothers aged between 15 - 49 in Sosiot Sub location Kericho district. It was carried out in the month of January. The objective of the study was to determine knowledge, attitude and practice on exclusive breastfeeding among mothers of reproductive age and specific objectives were: To assess knowledge on exclusive breastfeeding among mothers of reproductive age.to establish the attitudes on exclusive breastfeeding among mothers of reproductive age.to assess the practices on exclusive breastfeeding among mothers of reproductive age. The study was a descriptive cross-sectional study design- The study unit was household. The study area was selected purposively. Cluster sampling was used to cluster sub-locations within the location, respondents were selected randomly. The data collection tool was interviewer schedule. Data was analyzed manually by use of calculator for computation, presentation was by the use of tables, pie charts and bar graphs. From the study area, it was revealed that mothers had abundant knowledge (80%) on EBF but had negative attitude with 72% of the respondents saying that breast milk alone was not enough for the baby and a further 78% saying that it was impractible. Most 95% of the respondents breastfed at birth but at three months 53% had already introduced supplementary feeds. Majority 85% could not practice EBF incase of work. The researcher concluded that even though their was vast knowledge on exclusive breastfeeding, it was regrettable that they could not translate to attitude change and ultimately to its practice. Provision of proper information to all who possibly exercise influence on the mother especially spouses and mothers-in law and review of government policies regarding longer leaves for new mothers and provision of child care centers inside large institutions will help cope with this challenge

Table of Contents
Table of Contents..................................................................................................vi CHAPTER ONE........................................................................................................ 1 1.0 INTRODUCTION.............................................................................................1 1.1 BACKGROUND TO THE STUDY.......................................................................1 1.2 PROBLEM STATEMENT...................................................................................2 1.3 STUDY JUSTIFICATION...................................................................................2 1.4 STUDY OBJECTIVES.......................................................................................3 1.4.1 BROAD OBJECTIVE..................................................................................3 1.4.2 SPECIFIC OBJECTIVES..............................................................................3 1.5 RESEARCH QUESTION...................................................................................3 1.6 assumption of the study................................................................................3 CHAPTER TWO....................................................................................................... 4 2.0 LITERATURE REVIEW...................................................................................4 2.1 KNOWLEDGE..............................................................................................4

2.2 ATTITUDE ON EXLUSIVE BREASTFEEDING.....................................................6 2.3 PRACTICE...................................................................................................... 7 CHAPTER THREE...................................................................................................10 3.0 METHODOLOGY...........................................................................................10 3.1 STUDY AREA................................................................................................10 3.2 TARGET POPULATION..................................................................................10 3.3 study design...............................................................................................10 3.4 Inclusion Criteria.........................................................................................10 3.5 Exclusion Criteria........................................................................................10 3.6 Sampling Procedure....................................................................................11 vi

3.7 Data Collection Tools...................................................................................11 3.8 Data Analysis..............................................................................................11 CHAPTER FOUR.................................................................................................... 13 4.0 STUDY FINDINGS.........................................................................................13 4.1 INTRODUCTION...........................................................................................13 4.2 SOCIO-DEMOGRAPHIC INFORMATION..........................................................14 4.3 KNOWLEDGE...............................................................................................15 4.4 ATTITUDE ON EXCLUSIVE BREASTFEEDING.................................................16 4.5 PRACTICE ON EXCLUSIVE BREASTFEEDING.................................................16 CHAPTER FIVE...................................................................................................... 19 5.0 DISCUSSION................................................................................................19 5.1 INTRUDUCTION...........................................................................................19 5.2 SOCIO-DEMOGRAPHIC INFORMATION OF RESPONDENTS.............................19 5.3 KNOWLEDGE OF THE RESPONDENTS...........................................................20 5.4 ATTITUDES OF THE RESPONDENTS..............................................................21 5.5 PRACTICES OF RESPONDENTS.....................................................................22 CHAPTER SIX........................................................................................................23 6.0 CONCLUSION AND RECOMMENDATION........................................................23 6.1 CONCLUSION...............................................................................................23 6.2 RECOMMENDATIONS...................................................................................23 REFERENCES:.......................................................................................................24 APPENDIX I: QUESTIONNAIRE...............................................................................26

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CHAPTER ONE 1.0 INTRODUCTION 1.1 BACKGROUND TO THE STUDY

Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development. Virtually all mothers can breastfeed provided they have accurate information and the support of their family, the healthcare system and society at large. (Kramer et al 2001) Colostrums, the yellowish, sticky breast milk produced at the end of pregnancy, is recommended by WHO as the perfect food for the newborn and feeding should be initiated within the first hour after birth.(savage 1994) Exclusive breastfeeding is recommended up to six months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age and beyond. (WHO 2000) Unfortunately, not all infants/children are breastfed within this crucial development age, hence reason for this research.

1.2 PROBLEM STATEMENT

Globally, not more than 41.5% of infants are exclusively breastfed up to six months, complementary feeding frequently begins early in age leading to increased morbidity and mortality rates (WHO 2008).In 2009,8.1 million children across the world died before their fifth birthday, malnutrition and poor breastfeeding practices contributing to a third of this deaths.(WHO 2010) Though there is significant improvement of percentages of mothers practicing EBF in subSaharan Africa from 20% in 1996 to 30% in 2006,it is l evident that this rates are still low (UNICEF 2008).Diarrhea and gastrointestinal infections resulting from early weaning contributes to about 1.5 million under five deaths each year(WHO 2008) Kenya is ranked number 122 worldwide with 12.7% of mothers practicing EBF (WHO 2008).According to MOPHS (2010), 52 children die in every 1000 live births due to poor breastfeeding practices. In Kericho District, 5.1% of mothers practice EBF while in the study area only 2.1% of mothers practice it (MOH 2009).

1.3 STUDY JUSTIFICATION

There has been a decline in breastfeeding in terms of prevalence and quality in Kenya with only 12.7%of mothers practicing EBF and 5.1% in Kericho. The resultant malnutrition, diarrhea episodes and other diseases have contributed to high under- five morbidity of 35 per 1000 live births and mortality of 100 per 1000 live births. It therefore necessary that this research is carried out to unveil the underlying knowledge, attitude and practices on EBF among mothers of reproductive age. The research findings will assist the government and partners to initiate campaigns to sensitize mothers on the benefits of breastfeeding to their children. It will serve as a partial fulfillment for the award of Diploma in Environmental Health sciences.
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1.4 STUDY OBJECTIVES

1.4.1 BROAD OBJECTIVE
To determine knowledge, attitude and practices on exclusive breastfeeding among mothers of reproductive age.

1.4.2 SPECIFIC OBJECTIVES

1. To assess knowledge on exclusive breastfeeding among mothers of reproductive age. 2. To establish the attitudes on exclusive breastfeeding among mothers of reproductive age. 3. To assess the practices on exclusive breastfeeding among mothers of reproductive age.

1.5 RESEARCH QUESTION

What is knowledge, attitude and practice on exclusive breastfeeding among mothers of reproductive age?

1.6 assumption of the study.

lack of finance and time to carry out the study effectively. Biased and inaccurate information is given as respondent tend to say what they dont practice. Insufficient equipment to carry out research. Unwilling and hostility of the subjects as most of them has a negative a negative attitude when questioned.

CHAPTER TWO
2.0 LITERATURE REVIEW 2.1 KNOWLEDGE

Breastfeeding is unequal way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. Exclusive breastfeeding for six months is the optimal way of feeding the infants and thereafter introducing complementary foods with continued breastfeeding up to two years of age and beyond (WHO 2000) To enable mothers to establish and sustain exclusive breastfeeding, WHO and UNCEF recommend initiation of breastfeeding during the first hour of life by providing the infant with breast milk without any additional food or drink not even water, breast feeding on demand that is as often as the child wants day and night. (WHO 2001) Breast milk is the natural first food for babies, it provides all the energy and the nutrients that the infants needs for the first months of and it continues to provide up to half or more of a childs nutritional needs during the second half of the first year and up to one third during the second half of the life. Breast milk promotes sensory and cognitive development and protects the infant against infections and chronic diseases. EBF reduces infant mortality due to common childhood illnesses such as diarrhea or pneumonia and helps for a quicker recovery during illness. These effects can be measured in resource poor and affluent societies (Kramer et al 2001) About two thirds of infants born to HIV infected mothers will not be infected even with no intervention such as Anti retroviral prophylaxis or caesarian section. Not all babies born to HIV infected mothers become infected with HIV.EBF for the first few months of life carries a lower risk of HIV transmission than mixed feeding. The transmission rate through breastfeeding is about 5-20%of the infants who are breastfed for several months by mothers who are HIV positive. As general principle in all populations, irrespective of HIV infection
4

rates, breastfeeding should continue to be protected, promoted and supported (UNAIDS, WHO and UNICEF, 1997). The extremely high risks of mortality and morbidity associated with infants who are not breastfed compared to those who are predominantly or exclusively breastfed need to be taken into account when informing HIV infected mothers of the risks and benefits of breastfeeding. The high risks of infant mortality ,associated with partial breastfeeding ,coupled with an earlier report of an increased risk of HIV transmission among children who are partially breastfed reinforces the need to discourage partial breastfeeding by both HIV infected and uninfected mothers (Rajiv Bahl et al 2005) According to Cohen et al (1994), breastfeeding provides sufficient nutrition for the infant in the first six months of life but addition of supplemental feeds within this period, displaces breast milk and does not increase the caloric intake of the infants even under optimal conditions i.e. (nutritious, microbiologically safe foods). According to Grossman (1990), many traditional society have recognized that a new mother is often vulnerable and sensitive and needs encouragement and support. The informal traditional support system that positively reinforce breastfeeding in the past may no longer be in place where modernization and bottle feeding have become the known; mother to mother support groups helps to fill this gap, as it is easier for mothers to share their concern with fellow mothers. Mother to mother support counters the dissemination of incorrect and misleading information thus enabling the mother to make informed choices about the feeding of a baby.

Most health centers and clinics recommend to new mothers that they practice EBF for at least the first six months of infants life in order to maximize the infants immune systems. Health providers are essential to helping mothers breastfeed their new born by utilizing all possible opportunities and forums to counsel women and their families on breastfeeding such as contacts during ANC visits, immunization sessions, village health and nutrition days. Mothers receive good education about breastfeeding and formula feeding from health care workers
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therefore increases their tendency to breastfeed exclusively for longer periods and avoid prelacteal feeds more, (Minnie 2006).

2.2 ATTITUDE ON EXLUSIVE BREASTFEEDING

Attitudes can determine the behavior and if women display a positive attitude towards breastfeeding, and it will help to support them in choosing breastfeeding as an early infant feeding method and the practice of exclusive breastfeeding for the first six months. New mothers have indicated that support is one of the most crucial aspects of initiating and confirming breastfeeding practices, (Shaker 2004). According to Ogbonna (2000), grandmothers play an important role in the mother and infants lives and are said to have a strong influence over what mothers feed their babies. In most cases grandmothers are reported to disapprove of breastfeeding. Since bottle feeding was the norm in the near past, often a older mothers and other relatives know very little about breastfeeding or even have negative experiences and cannot support her. Infant she might hear all kinds of undermining comments from ignorant people who dont understand breastfeeding process. Surveys have also revealed that, far too many women are uncomfortable at the thought of nursing their baby in public and that this discomfort is a woman cause of disruption of the breastfeeding relationship. This is because many men think that womans breasts are sexual organs, so they can become jealous over the nursing mothers breasts or start thinking that the baby is doing something indecent and pervert when it feeds. Breastfeeding is not a sexual Act but simply a feeding act. If can be pleasurable to the mother (through also painful) but if is not sensual pleasure, such a good feeling of being close to your baby, (Granju 1999). In United States, baring a breast to nourish and comfort a child is sometimes viewed as a taboo. When people see a woman using their breast for their most basic function, they maybe consciously or unconsciously confuse it with something thats sexual and that should be done in privacy (Pugliese, 2000). However, according to Dettwyler (1995), some cultures around the world, breast children.
6

holds no sexual connotations for either men or women. Sexual behavior

does not involve the breasts, which are perceived as existing for the sole purpose of feeding

Attitude of potential serious effect that of the prevailing opinion regarding colostrum. Colostrum is rich in unique immunologic properties important to the newborn but the failure to give colostrum may have more far reaching problems. The concern that coliseum is harmful and deleterious to the child often prevents the practice of breastfeeding, for the first several days of life, interfering with the mothers subsequent ability to quickly days of life, interfering with the mothers subsequent ability to quickly develop adequate mature breast milk. To replace colostrum does not promote normal sucking physiology for the child and desires the baby the important nutrients in colostrum, (Alena 2008) In some instances, some mothers stop breastfeeding thinking that they do not have enough milk. Almost all mothers can produce enough milk for one or even two babies. Usually, when a mother thinks that she does not have enough milk, her baby is in fact getting all she needs. Also, some husbands and friends think that, when a baby cries immediately after breastfeeding, it shows that she has not gotten enough and needs to be breastfed (Walter, 1998).

2.3 PRACTICE
Research shows that the teaching option globally is the initiation of breastfeeding within the first half an hour, exclusive breastfeeding for a full six months and continued breastfeeding through the second year or beyond. Breastfeeding improves short and long maternal and child health, thus contribute to the maintainance of the Millenium Development Goals (MDGs) 4, REDUCE CHILD MORTALITY and 5 IMPROVE MATERNAL HEALTH, by 2015 (WHO and UNICEF, 2007). UNICEF recently noted that the reduction of child deaths from 13 million globally in 1990 to 8.8 million in 2008 is partly due to the adoption of basic health interventions such as early and exclusive breastfeeding. More and more studies have shown that the implementation of ten steps with the continued post natal support contributes to increased breastfeeding initiation and EBF at the local, national and global levels (UNICEF, 2009). Today, an estimated 28% of all maternity facilities in the world have at some point implemented the ten steps which have contributed to an encouraging increased in breastfeeding
7

rates despite aggressive commercial promotion of infant formula and feeding bottles. However, this is a far outcry from the original goal of ALL maternity facilities practicing the ten steps by 1995 as stated in Innocenti Declaration 1990 on the protection, promotion and support of breastfeeding (UNICEF 2009). Charlotte (2009) stated that even though most health centers and clinics recommend to new mothers that they practice EBF for at least the first six months at infants life in order to maximize the infants immune systems, the social context in which these mothers live often denotes significantly from the clinical setting. The general up bringing of infants, including breastfeeding and other health concern are not issues simply and single handedly determined by mothers. Low levels of involvement of fathers and other community members including youth from the issue of caring for infants has been identified as a contributing factor to the low numbers of women who breastfeed. Mothers heed health care support too. The WHO describes breastfeeding as something that needs to be learnt. New mothers need proper instruction from healthcare workers as well as family encouragement, as they have to deal with nipple pain, tiredness and tears that they will not produce enough milk for the baby. If mothers do not feel that the way their infant is babies exclusively for six months or longer, (chudasama, 2009). According to Melissa (2009) also mothers should breastfeed their babies on demand as the baby wants. Breastfeeding on demand occurs when the child fells that she is hungry. Rooting, sucking on her hands and crying are all cues that the baby is ready to feed. During growths spurts, parents are often confused by babies who were nicely scheduled and have gone the way of feeding on demand. It is recommended that breastfed babies feed every two to three hours during the day. If a baby wakes himself to feed within that time period, he has set his own scheduled and he is essentially feeding on demand at the same time. If he is gaining weight well during the day (at least 8 to 12 feedings) he can feed on demand during the night time. In Kenya, despite the efforts by many medical and community health organizations, a significant proportion of mothers do not employ EBF. They often opt to provide inappropriate
8

early supplemental feeding or to substitute animal milk, starch preparations or commercial formula in lieu of human breast milk (MOH, 2006) According to Mbagaya (2009), supplementation of breast milk with water, fresh milk, tea, commercial juices, maize meal/millet porridge, mashed potatoes, bananas and fruits starts too early in Western Kenya thereby exposing the infants to diarrhea and other infections

CHAPTER THREE
3.0 METHODOLOGY 3.1 STUDY AREA
The study was undertaken in the rural community of Sosiot sub- location of Kericho district approximately 21 km west of Kericho town. It is one of the 17 sub-locations in Belgut Division having an area of 12.3km2 with a total population of 6228 persons and 1129 households.The district has a highland equatorial climate; receiving an average of annually. The areas main economic activities are dairy production and tea farming which is grown both in small scale and large scale. The district is served by 18 health facilities; one district hospital, one sub- district, eight health centers and eight dispensaries. Sosiot sub-location has one health centre and one dispensary. The average distance to a health facility is 15km.(KDBS 2009). 1700mm of rainfall

3.2 TARGET POPULATION

Mothers within the age bracket of 15-49 years

3.3 study design

Descriptive study of cross-sectional study was used.

3.4 Inclusion Criteria

Mothers of age bracket 15-49 years who consented to participate.

3.5 Exclusion Criteria

Mothers below 15 years and 49 years of age and did not consent to participate.

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3.6 Sampling Procedure

Purposive sampling, cluster sampling and simple random sampling methods will be employed Purposive sampling was used to select Sosiot sub location due to the low percentage of mothers practicing EBF according to Kericho District Baseline Survey (2009) Cluster sampling was used to cluster villages and Onyango P.(1995) method was used to allocate each village cluster its number of respondents i.e. Total number of household in cluster x convenient sample size Total number of households in the area of study Determination of number of respondents per cluster Cluster Household Number of respondents Sosiot 190 11 Siwot 170 11 Cheribo 208 12 Kiplalmat 204 10 Lelaitich 156 7 Kiptenden 201 9 Total 1,129 60 Simple random sampling was used to get respondents in each cluster by giving a number to each household. The number was put in a container and picked randomly. Papers written YES and NO was used incase a household has more than one mother of reproductive age and whoever picked YES was interviewed.

3.7 Data Collection Tools.

With the help of trained enumerators, face to face interview was employed where the interviewer read out the questions and the answers given by the respondent, compared with the options and the correct one ticked. Data was collected during the day in the month of January 2011.

3.8 Data Analysis

Primary data collected from the field was analyzed and presented in tables.

11

12

CHAPTER FOUR
4.0 STUDY FINDINGS 4.1 INTRODUCTION
This chapter presents the results obtained from the collection of data in Sosiot sub location where a total of 60 respondents were interviewed on knowledge, attitude and practice on exclusive breastfeeding among mothers of reproductive age. The findings were computed, analyzed and presented in form of tables and figures for easy interpretation of the data obtained from the questionnaire.

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4.2 SOCIO-DEMOGRAPHIC INFORMATION

Table 4.1 .

Age of respondent 15 21 22 28 29 35 36 42 43 49 Totals Marital status Single Married Divorced Separated Widowed Totals Level of education None Primary Secondary Post-secondary Totals Occupation Housewife Business woman Employed Others Totals

Number of respondent 7 27 19 4 3 60 11 45 0 3 1 60 3 30 20 7 60 38 13 4 5 60

Percentage 12 45 31 7 5 100 18 75 0 5 2 100 3 60 30 7 100 75 13 4 5 100

Majority of the respondent were between age of 22 28 years (27 45%).marital status shows that majority of respondent were married (45 75%). Level of education shows that majority of the respondent (60%) had barely gone beyond primary education level. Occupations of the respondent show above three quarter (78%) of respondents interviewed were housewife.
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4.3 KNOWLEDGE
Table 4.3 Age of the youngest child Age Less than one month 1 6 months 7 -12 months 1 2 years Above 2 years Total Number of respondents 3 12 10 12 23 60 Percentage 5 20 17 20 38 100

A considerate (38%) of the respondents had their last born above 2 years.

Fig. 4.3 Had heard of EBF An overwhelming percentage (80%) of the respondents had heard of EBF

Table 4.4 Definition of exclusive breastfeeding

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Definition Breastfeeding the baby at least 4 times Feeding the baby with breast milk only for the first six months Feeding the baby with breast milk and

Number of respondents 3 45 5

Percentage 5 75 8

artificial feeds like cows milk Dont know 7 12 Total 60 100 An impressive percentage (75%) of the respondents were able to explain correctly what exclusive breastfeeding means.

4.4 ATTITUDE ON EXCLUSIVE BREASTFEEDING

Table 4.5 Reasons for women avoiding EBF Reasons Breastfeeding changes the shape of breasts Is time consuming The baby will not get enough milk Dont know Total Number of respondents 3 10 41 6 60 Percentage 5 17 68 10 100

An astounding percentage (68%) of the respondents said they avoided breastfeeding their babies exclusively for six months since they did not get enough milk.

4.5 PRACTICE ON EXCLUSIVE BREASTFEEDING

Table 4.6 Initiation of breastfeeding after birth. Time During the first half an hour of life After an hour After two hours
16

Number of respondents 22 8 11

Percentage 37 13 18

After one day Total

19 60

32 100

Initial breastfeeding started during the first half an hour of life as shown by a sizeable percentage (37%) of the respondents.

Table 4.7 Time for breastfeeding. When As long as the child demands by crying After every contact with the baby After a specified time Total 20 15 60 33 25 100 Number of Respondents 25 Percentages 42

Most (42%) of the respondents breastfed their babies as they demanded by crying.

Fig. 4.14 Practice of exclusive breastfeeding incase of work. A hefty percentage (85%) of the respondents said that it was not possible for the working mothers to practice exclusive breastfeeding.

17

15% YES NO 85%

Table 4.8 Feeding the baby incase of work. Method Expressing milk Maternity leave Carrying the baby to work Use of formula feeds Total Number of respondents 6 2 2 50 60 Percentage 10 4 4 82 100

An evidential percentage (82%) of the respondents opted to use formula feeding incase of work.

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CHAPTER FIVE
5.0 DISCUSSION 5.1 INTRUDUCTION
This chapter presents the discussion on the findings after data collection analysis and presentation in the determination of the knowledge, attitude and practices on exclusive breastfeeding among mothers of reproductive age.

5.2 SOCIO-DEMOGRAPHIC INFORMATION OF RESPONDENTS

All the respondents were within the reproductive age bracket with a sizeable percentage (45%) falling between the age of 29-35 years. This is the age that is perceived to be mature and physiologically prepared for parenthood and are therefore more likely to breastfed exclusively. Majority (75%) of the respondents were married women. These are mothers who are expected to breastfed for longer durations since they rely on their spouse to supply household needs, at this crucial age of their childs development and thereafter. Most of the respondents had acquired primary education only. This shows that they had meagre knowledge on the advantages of breast milk and the breastfeeding techniques which might have led to their prior practice of exclusive breastfeeding. This agrees with Grossman (1990) who stated that low level of education leads to poor practice of exclusive breastfeeding. From the study findings it was found out that most (78%) of the respondents were housewives and engaged in farming. This is the group of mothers who do not get enough maternity leave therefore would give up breastfeeding exclusively at the first three months after delivery.

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5.3 KNOWLEDGE OF THE RESPONDENTS

The study findings demonstrated abundance of knowledge on EBF as majority (80%) respondents had heard of the recommendation to exclusively breastfeed for six months. Mothers support groups provide proper information and knowledge to pregnant and nursing mothers on childcare and feeding of their infants. Experienced breastfeeding mothers model optimal breastfeeding practices, share information and experiments and offer support to other women in an atmosphere of trust and respect. This agrees with Horta (2007) who said that peer counseling and merry-go-round have been effective in supporting breastfeeding mothers and provision of the right information on breastfeeding. Health workers are in the frontline in educating mothers and promoting breastfeeding practices. Many (60%) of the respondents reported that health workers were their preferred source of information. This shows that health workers utilized all possible opportunities and forums to counsel women and their families on breastfeeding such as contact during ANC checkups, pregnant and lactating mothers meetings, immunization sessions, village health and nutrition days. Health workers therefore are essential to helping mothers breastfeed their newborns and infants. They watch women closely during their pregnancy as well as during and after delivery and are called for expert advice, and mothers. This agrees with Minie (2006) who said that mothers receive good education about breastfeeding and formula feeding from healthcare workers therefore increases their tendency to breastfeed exclusively for longer periods and avoid prelacteal feeds more. Old women have practically borne the burden of looking after nursing mothers and therefore have become useful babysitters for their grandchildren. An overwhelming majority (85%) of the respondents had received support and information on how to breastfeed from their mothers and mothers-in-law. They play and important role in the mothers and infants lives as they have strong influence over what mothers feed their babies. Some of them encouraged mothers to mix-feed their infants with most of them giving water thinking that child would be thirsty. This concurs with Dorothy (2005) who stated that old women encouraged. Young mothers to mix feed their infants with most women introducing water and feed supplementation prior to six months of age and others as early as three months
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5.4 ATTITUDES OF THE RESPONDENTS.

Almost all mothers can produce enough breast milk for one or even two babies. However, according to the study findings, majority (72%) of the respondents thought that breast milk alone was not enough for the baby. They said that their babies would cry soon after being breastfed showing dissatisfaction with breast milk and that their babies would sleep better after being given breast milk substitutes like cows milk. This contradicts WHO (2000) which stated that the quantity of nutrients present in the volume of milk produced by healthy lactating mothers has been found to be adequate in meeting the babys nutrient and energy requirement upto the age of six months of life. Breastfeeding only require the mother to bare her breasts and feed the baby. It costs nothing but only a few minutes but from the study findings, it is the contrary where majority (78%) the respondents said that practice of exclusive breastfeeding was impracticable, time consuming and stenuous, requiring the mother to be close to her baby at all times which in the real sense is not possible due to commitments. This concurs with Shaker (2004) who said that the most prevalent attitudes potentially leading to failure of exclusive breastfeeding are those surrounding the adequacy of breast milk, impracticability due to changing roles and responsibilities of women and the feeding that breastfeeding is too time consuming, competing for mothers time especially time she needs to earn income for the family. Baring a breast to nourish and comfort a child is neither a taboo, a crime nor a sexual act but simply a feeding act. Most (58%) of the respondents would therefore breastfeed comfortably in the public since the breast hold no sexual connotation for either men or women. This supports Dettwyler (1995) who said that, sexual behavior does not involve the breasts, which are perceived as existing for sole purpose of feeding children.

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5.5 PRACTICES OF RESPONDENTS

The study finding shows that majority (95%) of the respondents breastfed their babies at birth. This is necessary as it ensures that colostrums which is rich in immunologic properties to the newborn is taken by the baby, hence increasing cases of hypoglyceamia, hypothermia and acidosis which is common among low birth weight infants. It also reinforces the prevalence and duration of breast feeding This correlates positively with Popkin (1995) who stated that initiation and establishment of breastfeeding following birth are crucial to increasing and reinforcing the prevalence and duration of breastfeeding and the utilization of the most essential and nutritious first milk (colostrum) Most (53%) of the respondents had introduced early supplements to their babies as early as three months. This is the time when many women return to work or school and need additional support in order to continue with breastfeeding. As a result a good number of mothers start giving their babies foods other than breast milk e.g. cows milk with sugar added and porridge. This accedes WHO and UNICEF (2003) that a number of women change to a artificial feeding after a few weeks, or give bottle feeds, or some other supplements, in addition to breastfeeding, from too early in age. Incase of a working mother, the practice of exclusive breastfeeding is a challenge as evidenced by majority (85%) of the respondents. They are given short maternity leaves of three months leaving formula feeding as the only option at an early age which expose their babies to diarrhoeal and respiratory infections. This coincides with Jakobsen (1996) who said that working shortly after delivery reduces the duration and proximity of mothers to their children hence making breastfeeding inaccessible leading to early termination of exclusive breastfeeding before six months.

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CHAPTER SIX
6.0 CONCLUSION AND RECOMMENDATION 6.1 CONCLUSION
Even though majority of the respondents had abundant knowledge on exclusive breastfeeding, it was regrettable that they could not translate to attitude change and ultimately to its practice. This therefore shows that mothers of Sosiot sub location were not achieving the recommended six months of exclusive breastfeeding since they gave their infants alternative feeds at an early age.

6.2 RECOMMENDATIONS
The ministry of Health in conjunction with Ministry of Education should initiate a special educational programme on exclusive breastfeeding which should be incorporate into the existing framework and systems of adolescent education to create awareness of breastfeeding to these future mothers. The health workers should promote exclusive breastfeeding by utilizing every single opportunity like a visit for child immunizations and organize outreach activities to educate mothers on safe motherhood. A support system should be established by health facility staff with other resource persons to guide mothers during pregnancy and shortly after delivery on proper breastfeeding skills including proper remedies when a breastfeeding mother experiences difficulty in producing enough milk. Proper information and knowledge to all who possibly exercise influence on the mother especially spouses and mother-in-laws should be provided for the success of exclusive breastfeeding. Government policies regarding longer leave for new mothers and child care centers inside large institutions should be considered. Location rooms at places of work should be provided.
23

REFERENCES:
CohenR.J, Brown, K.H, canahuati,J,Rivera,L.L, and Dewey,K.G,Effects of age on introduction of complementary foods on infant breast milk intake and Growth: a randomized intervention study in Honduras. East African Medical Journal 1998; 75:441-442. Dewey K,G,perez Escamilla, Pollit, E; Lonnerdal, B. Infant Feeding Policies in maternity wards and their Effects on Breastfeeding success: and Analytical overview. American Journal Public Health.1994; 84:89. Dorothy Meyer,Pat Mitchell, Kathryn A Kroll cultural barriers to exclusive breastfeeding by mothers in a rural area of Cameroon area of Cameroon, Africa Journal of midwifery and womens health July 2005(vol.50, (4),324-328) Gay L.R. 1981.Educational Research: competencies for analysis and Application. charcles E. Marill publishing company A. Bell and Howell company.collumbus, Toronto, London. Kramer et al promotion of breastfeeding Initiative Trial In the Republic of Belarus, Journal f the American Medical Association,2001,285(4) 413-420 Mbagaya G. Child feeding practices in rural western Kenya community. African Journal prm healthcare family medicine 2009;1(1)Art 15;DOI:10.4102/phctm.v1 1-15 Onyango P. (1995) Sample Size determination. Nairobi, Africa centre for Technology Studies press. Rajiv B. Chris F, Betty R; Infant Feeding Pattern and Risks of Death and Hospitalization in The First Half of Infancy: Multicentre cohort study, Bulletin of the world Health Organization; June 2005; 83(6):418-426 Savage K.F (1994) Helping Mothers to Breastfeed.Nairobi, AMREF
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UNICEF

report

of

current

status

of

Baby

Friendly

Hospital

Initiative:

http//www.unicef.org/programme /breastfeeding/assets/status phf.org WHO and UNICEF (2007) Breastfeeding is the Best Feeding. Nairobi, Oxford University press. WHO and UNICEF(2001) Facts for Life. United Kingdom, Oxford Shire.

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APPENDICES

APPENDIX I: QUESTIONNAIRE
ELDORET POLYTECHNIC
TOPIC: KNOWLEDGE, ATTITUDE AND PRACTICE ON EXCLUSIVE BREASTFEEDING AMONG MOTHERS AGED BETWEEN 15 49 YEARS OF

REPRODUCTIVE AGE IN SOSIOT SUB - LOCATION KERICHO DISTRICT. I am a student from Eldoret polytechnic carrying out on knowledge, attitude and practice on exclusive breastfeeding among mothers aged between 15 49 years of reproductive age in Sosiot sub - location Kericho district. I kindly request your assistance consent to participate in this study. I assure you of privacy and confidentiality of all the information that you give. Thank you. Interviewer Schedule No Name of the village. Date of interview Respondent no. . INSTRUCTIONS a)The information given will be purely for learning purposes. b)The information given will be treated with utmost confidentiality. c)Tick the appropriate answers in the space provided ( ) 1.0 SOCIO-DEMOGRAPHIC INFORMATION 1) Age of the respondent
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a)15-24 b) 25-34 c) 35-44 d) 45-54 2) Marital status a) Single b) Married c) Divorced d) Separated ( e) Widowed )

( ( ( (

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( ( ( (

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3) Educational level a) Primary b) Secondary c) Tertiary d) None 4) Occupation a) Housewife b) Businesswoman c) Employed 2.0 KNOWLEDGE 5) What is exclusive breastfeeding? a) Is breastfeeding a baby at least 4 times a day. b) Is feeding the baby with breast milk only, for the first 6 months c) Is feeding the baby with breast milk and artificial feeds like cows milk 6) Where did you get the information from?
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( ( ( (

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a) Health workers b) Media c) Fellow mothers

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7) Which is the right duration for exclusive breastfeeding? a)1 - 2 months b) 2 4 months c) 0 6 months ( ( ( ) ) )

8) Is exclusive breastfeeding good for the baby? a) YES b) NO ( ( ) )

9) Do old women teach young women how to breastfeed? a) YES b) NO 2.1 ATITUDE 10) Do you think breast milk alone is enough for the baby? a) YES b) NO ( ( ) ) ( ( ) )

11) Is it easy to practice? a) YES b) NO ( ( ) )

12) Do you feel comfortable breastfeeding in the public? a) YES b) NO ( ( ) )

13) Why do some women avoid breastfeeding their babies exclusively for the first six months?
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a) Breastfeeding changes the shape of breasts b) Is time consuming c) The baby will not get enough milk 2.2 PRACTICES 14) Did you breastfeed at birth? a) YES b) NO ( ( ) )

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15) If YES after how long? a) During the first half an hour of life b) After half an hour c) After two hours d) After one day e) Never breastfed ( ( ( ( ( ) ) ) ) )

16) How do/did you determine when to breastfeed? a) As long as the child demands by crying b) After every contact with the baby c) After a specified time 17) How often do/did you breastfeed in a day? a) 5 times b) 8 times c) As long as the child demands 18) At what age do/did you intend to wean the child? a) 2 months ( )
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( ( (

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b) 3 months c) 4 months d) 6 months

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19) Incase of work, do you practice exclusive breastfeeding? a) YES b) NO ( ( ) )

20) If YES, how do you manage? a) Expressing milk b) Maternity leave c) Carrying the baby to work ( ( ( ) ) )

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