Constraints of exclusive breastfeeding practice among breastfeeding mothers in alimosho general hospital

CONSTRAINTS OF EXCLUSIVE
BREASTFEEDING PRACTICE
AMONG BREASTFEEDING
MOTHERS IN ALIMOSHO GENERAL
HOSPITAL, IGANDO.
OBA ADEBOYE SOLOMON
2015/2401/17424N
LAGOS STATE SCHOOL OF
NURSING, IGANDO.
NOVEMBER, 2016.

CONSTRAINTS OF EXCLUSIVE
BREASTFEEDING PRACTICE AMONG
BREASTFEEDING MOTHERS IN
ALIMOSHO GENERAL HOSPITAL, IGANDO.
OBA ADEBOYE SOLOMON
2015/2401/17424N
LAGOS STATE SCHOOL OF NURSING,
IGANDO.
SUBMITTED IN PARTIAL FULFILLMENT OF
THE REQUIREMENT OF NURSING AND
MIDWIFERY COUNCIL OF NIGERIA FOR
THE AWARD OF “REGISTERED NURSE”
CERTIFICATE.
NOVEMBER 2016

CERTIFICATION PAGE
This is to certify that this research project titled: Constraints of exclusive breastfeeding
practice among breastfeeding mothers in Alimosho General Hospital, Igando. Was
carried out by Student Nurse Oba Adeboye Solomon with Index Number:
2015/2401/17424/N and examination number _______________ under my supervision.
_____________________
Itsuokor S.F. (Mrs) Qualifications:______________________
Supervisor
______________________
Aribisala P.B. (Mrs)
Principal

ABSTRACT
Breastfeeding provides a wide array of physical and psychological short-term and long-
term health benefits for mothers, infants, and young children. There is strong evidence
that infants receiving only breast milk with no other liquids or solids known as exclusive
breastfeeding, have many health benefits to mothers, babies, the environment, and
society. Exclusive breastfeeding is recommended for the first six months of life as the
best way of feeding an infant. The result of this study will increase the knowledge and
encourage mothers on exclusive breastfeeding in Alimosho General Hospital, Igando and
also show them the dangers of not practicing exclusive breastfeeding. It will also help
the Nurse to debunk myths about exclusive breastfeeding. Using a concurrent mixed
method approach, a structured questionnaire was administered to 100 breastfeeding
mothers. Breastfeeding was perceived as essential to baby's health. It strengthens the
physical and spiritual bond between mothers and their children. Exclusive breastfeeding
was considered essential but demanding. The research however reveals larger
percentage of the respondents are between 25-35 years in the study. The study showed
the major constraints to exclusive breastfeeding to be: lack of prior knowledge of
exclusive breastfeeding (81%); Nature of their job which does not allow them to practice
exclusive breastfeeding (58%); some are also of the opinion that they needed more time
to breastfeed their child exclusively (81%) and their health status (74%). In addition, the
qualitative findings showed that significant others played major roles on exclusive
breastfeeding practices. It is concluded from the study findings that exclusive
breastfeeding especially child growth plays an important role in child daily life. From
this study, it is concluded that working mothers find it extremely difficult to exclusively
breastfeed their babies according to the recommendation of World Health Organization.
Exclusive breastfeeding for up to six months requires the mother and her infant to be in
close proximity for this period and to use expressed breastmilk for separation of short
duration.

DEDICATION
I dedicate this research project to my Jewel of inestimable value, Mrs. Julianah Bolanle
Samuel-Oba who believes that hard work and prayers pays off. To the memory of my
late father, HRH Oba Samuel Folorunsho who believed so much that formal education
liberates a man.

ACKNOWLEDGEMENT
I give God almighty whole glory and adoration for his wonderful grace he has given me
all through my course of study in Lagos State School of Nursing, Igando. It is neither by
my power nor wisdom that I am able to scale through these three years, but just God
himself working in the life of his little child.
My special thanks to my intelligent and hardworking supervisor, Mrs. S.F. Itsuokor for
time spent correcting my write up despite her tight schedules. Ma, you are indeed a
mother! May your source of knowledge never run dry.
I heartily appreciate my dynamic head of school, Mrs. P.B. Aribisala for her motherly
love over the years. May God bless you beyond your expectations ma.
I owe a lot of gratitude to my amiable class coordinator, Mrs. Owolabi O.O. for her care,
love and supports. Also to her assistant, Mrs. Emmanuel O.T. May God also attend to
your personal needs in Jesus name.
I will never forget those that refined me from a novice in Nursing to what I am today. The
likes of Mr. Ogunbanjo, Mr. Mathew, Mrs. Odukoya, Mrs. Ojo (hostel Matron) Miss.
Olorunyomi, Mrs. Modupe, Mrs. Akande, Mrs. Oluwole, Mrs. Akolade, my very own big
brother Mr. Amisu and other staff of School of Nursing Complex. May God in his infinite
mercies add more colors to your lives.
I owe an unreserved gratitude to my mother, Mrs. Bola’ Samuel-Oba for her supports all
through my stay in school of Nursing. Also to my siblings “the unstoppable 7”, for their
financial supports, spiritual counselling and constructive criticism over the years,
starting from Oba John Kehinde, Oba Ezekiel Olaleye, Oba Johnson Ademola, Oba Joel
Adeoye, Oba Timothy Taiwo and Oba Jeremiah Kehinde. And also to wives turned
sisters’ Mrs. Eniola Oba, Dr. ‘Bukola Oba, Mrs. ‘Seun Oba and Mrs. Tosin’ Oba Without
you people in my life, what would have become of me? May God lift you all up above
your expectations.
I will not forget those that made my study period memorable. Sets 2013 and 2014
school of Nursing, you guys rocks! Also the entire Sets 2014 and 2015 School of
Midwifery. My roommates Ayodele Babatunde, Malick Akeem, Balogun Yusuf, Ojekunle
‘Bolu, I love you guys. My appreciation is not complete without mentioning the likes of
Raphael Anusa, Oyelakin Oluwatosin, Sanni Olamilekan, Oketeru Sijuanu, Adewole
Adebusola, Olukotun Itunu, Ogunlade Damilola, Olajide Taiwo, Ajayi Olamide, Ademoye
Blessing and Temitope Odufuwa. I appreciate you all.
My special thanks to Toluwalope Anise for her love, care and supports over the years
and Mr. Bakare Saheed who is always motivating me. May God continue to bless you
both real good.
My sincere prayer is that may we all reap the fruits of our labour and may God continue
to bless you all

Table of content
Certification Page ii
Abstract iii
Dedication iv
Acknowledgement v
Table of content vi-vii
List of tables viii-ix
List of Figures x
Chapter One
1.0 Introduction 1
1.1 Background of the study 2
1.2 Statement of Problem 3
1.3 Objective of Study 4
1.4 Significance of Study 4
1.5 Research hypothesis 4
1.6 Research questions 4
1.7 Limitation of study 5
1.8 Scope of study 5
1.9 Operational definition of terms 5
Chapter Two
Literature review
2.1 Concept of Exclusive breastfeeding 6
2.2 Benefits of exclusive breastfeeding to infants and mothers 7
2.3 Exclusive breastfeeding practices 8
2.4 Sources and knowledge of exclusive breastfeeding information 9
2.5 Attitude and knowledge of mothers on exclusive breastfeeding 10
2.6 Attitude solutions with exclusive breastfeeding practice 10
2.7 Conceptual framework 11
2.7.1 Discussion of conceptual framework 12

Chapter Three
Research methodology
3.1 Introduction 13
3.2 Study design 13
3.3 Population of study/target population 14
3.4 Sample and sampling technique 14
3.5 Research instrument 14
3.6 Validity/reliability of instrument 14
3.7 Method of data collection 15
3.8 Method of data analysis 15
3.9 Ethical considerations 16
Chapter Four
Data presentation, analysis and interpretation
4.1 Introduction 18
4.2 Respondents characteristics and classification 18-34
4.3 Data presentation and analysis according to test of hypothesis 34-40
Chapter Five
Summary, Conclusion and Recommendations
5.1 Introduction 41
5.2 Discussion of findings 41
5.3 Implications for Nursing 42
5.4 Summary 42
5.5 Conclusion 43
5.6. Recommendations 44-45
References 46-47
Appendix Questionnaire 48-50

List of tables (Respondents Characteristics and Classification)
Table 1 Age of Respondents 18
Table 2 Occupation of Respondents 19
Table 3 Marital Status of Respondents 19
Table 4 Educational Status of Respondents 20
Table 5 Religion of Respondents 20
Table 6 Knowledge of exclusive breastfeeding 21
Table 7 Sources of knowledge of exclusive breastfeeding 21
Table 8 Duration of Exclusive breastfeeding 22
Table 9 Beneficial effect of exclusive breastfeeding 22
Table 10 Exclusive breastfeeding and Childs growth 23
Table 11 Exclusive breastfeeding is very difficult 23
Table 12 I find it difficult to breastfeed at night 24
Table 13 My child does not need breast milk after three months 24
Table 14 My relatives are not supportive when I am breastfeeding 25
Table 15 Breast milk alone satisfy my child 25
Table 16 I have not heard of exclusive breastfeeding before now 26
Table 17 I find breastfeeding painful 26
Table 18 My breast will become saggy when I breastfeed my child 27
Table 19 Nature of my job does not allow me to practice exclusive breastfeeding 27
Table 20 I need more time to breastfeed my child 28
Table 21 The quantity of breastmilk I produce does not satisfy my child 28
Table 22 Health status and exclusive breastfeeding 29
Table 23 Benefit of exclusive breastfeeding to mother and child 29
Table 24 When I breastfeed it helps prevent cancer 30
Table 25 Breastmilk helps protect my child from diseases 31
Table 26 Breastfeeding reduces the incidence of diarrhea 31
Table 27 Breastfeeding and child’s intelligence 32
Table 28 Breastfeeding will make my child develop fast 33
Table 29 Breastfeeding promotes bonding of mother and child 33
Table 30 Breastfeeding is economical 34

List of Tables (Data presentation and analysis according to test of hypothesis)
Table 1 Hypothesis One 36
Constraint to the practice of exclusive breastfeeding and breastfeeding
mothers in Alimosho General Hospital
Table 2 Hypothesis Two 37
Exclusive breastfeeding and the health of the baby
Table 3 Hypothesis Three 39
Benefit of exclusive breastfeeding and mothers in Alimosho General Hospital

List of Figures
Figure 1 Conceptual Framework 11

CHAPTER ONE
1.0 Introduction
Breastfeeding provides a wide array of physical and psychological short-term and
long-term health benefits for mothers, infants, and young children. According to the
American Academy of Pediatrics (AAP, 2005) and the World Health Organization (WHO,
2001), there is strong evidence that infants receiving only breast milk with no other liquids
or solids known as exclusive breastfeeding, have many health benefits to mothers, babies,
the environment, and society. Exclusive breastfeeding is recommended for the first six
months of life as the best way of feeding an infant (AAP, 2005; WHO, 2003).
Exclusive breastfeeding in the first six months of life and continued breastfeeding
from 6-11 months, has shown to be the single most effective preventive intervention for
reducing child mortality, with the potential of saving 1.3 million lives worldwide each year
(Bai, Wunderlich, & Fly, 2011). Development of appropriate breastfeeding promotion
interventions will help to achieve the Healthy People 2020 goals of increasing the
proportion of mothers who breastfeed their infants to 82% initiating in the early
postpartum period, with 61% breastfeeding their infants at six months and 34%
breastfeeding at one year of age (U.S. Department of Health and Human Services [DHHS],
2011).
Although breastfeeding initiation rates in the United States have increased overall
because of breastfeeding promotion efforts, the proportion of infants who are exclusively
breastfed at six months after birth has increased at a much slower rate compared to that
of infants who receive mixed feedings (Rojjanasrirat & Sousa, 2010). A report by the DHHS
(2011) stated that although there are many evidence-based documented breastfeeding
promotional activities, EBF rates are still far below the stated Healthy People 2020 goals.
The continuation of exclusive breastfeeding is positively associated with the value
of skilled support and advice a woman receives on breastfeeding from healthcare
professionals (Whelan, McEvoy, Eldin, & Kearney, 2011). Implementation of culturally
sensitive awareness programs and interventions directed at populations of specific
geographic areas are essential to improving the prevalence of breastfeeding (Gill, 2009).

1.1 Background of the Study
Breastfeeding is now an endangered practice around the world, in both rich and
poor countries. There is unanimous agreement on the need for and the route to, global
support for breastfeeding through various approaches and programmes. Baby friendly
hospital initiatives are one of the most important interventions towards that goal.
Infancy, especially the first six months of life is a period of exceptionally rapid
growth and high nutrient requirements relative to body weight. Human milk is ideal and
uniquely superior food for infants for the first six months (Robert M. etal 2006, pg 131).
These recommendations stem from the compelling advantages that breastfeeding offers
infants, mothers and society.
Robert M. etal opined that human milk feeding decreases the incidence of severity
of diarrhea, respiratory illness, otitis media, bacteremia, bacterial meningitis and
necrotizing enterocolitis. Colostrum, a high protein, low fat fluid is produced in small
amounts during the first few post-partum days. It has some nutritional value but
primarily has important immunologic and maturational properties.
World Health Organizations (WHO) recommends that “infants should be exclusively
breastfed for the first six months of life to achieve optimal growth, development and health.
Thereafter to meet their evolving nutritional requirements, infants should receive
nutritionally adequate and safe complementary foods, while continuing to breastfeed for
up to two years or beyond.
United Nations Children Emergency Funds (UNICEF) states that “every year, over
one million infants die and millions of others are impaired, because they are not
adequately/exclusively breastfed” (Parul Datta 2009). Every day between 3000 to 4000
infants die from diarrhea and acute respiratory infections because of the ability to feed
them adequately as a result of infants been taken away from their mothers and thousands
more succumb to other illness and malnutrition.
Mothers should be aware that breastfeeding is the safest, cheapest and best
protective food for infants, therefore, mothers should be encourage to practice
breastfeeding exclusively for adequate growth, development and healthy living. Superiority
of human milk is due to its nutritive and protective value.
Babies should be exclusively breastfed, meaning that they receive nothing but
breast milk not even water for about six months of life. Except in rarest cases, no

additional food or fluids are necessary and they can be harmful, introducing germs,
triggering allergies and filling the stomach so that infants take less breast milk. Breast
feeding should be sustained until the baby is at least two years old, but beginning at about
six months, breast milk should be complemented with appropriate solid foods.
1.2 Statement of Problem
Breastfeeding is acknowledged as the optimal way to feed infants, and it provides
health benefits to mothers and infants. Many national and international health
organizations recommend exclusive breastfeeding for at least six months and continued
breastfeeding for at least the first year of life or as long as desired by both mother and
child (AAP, 2005; United Nations Children’s Fund, 2006; WHO, 2003). Most mothers tend
not to feed their baby exclusively before the baby attains Six months of age, which has led
to different childhood illnesses such as diarrhea, malnutrition and this accounts for
frequent visits of both mother and child to the hospital corridors. This study is thus
carried out to determine the constraints to exclusive breastfeeding practices among
breastfeeding mothers in Alimosho General Hospital in Lagos-State, South-west Nigeria
as a sample population.
1.3 Objective of the Study
The purpose of the study is to:
1. Determine the constraints as faced by mothers in practice of exclusive
breastfeeding.
2. Update the knowledge of mothers on the need to practice exclusive breast feeding
in the first six months of life.
3. To create a background for future researches on constraints of practice of exclusive
breastfeeding.
1.4 Significance of the Study
The result of this study will increase the knowledge and encourage mothers on
exclusive breastfeeding in Alimosho General Hospital, Igando and also show them the
dangers of not practicing exclusive breastfeeding. It will also help the Nurse to debunk
myths about exclusive breastfeeding.

1.5 Research Hypotheses
 There is no constraint to the practice of exclusive breastfeeding among breastfeeding
mothers in Alimosho General Hospital, Igando.
 There is no significant relationship between exclusive breastfeeding and the health
of the baby
 There is no benefit of exclusive breastfeeding to mothers in Alimosho General
Hospital
1.6 Research Questions
I. Are there constraints to the practice of exclusive breastfeeding faced by
breastfeeding mothers in Alimosho General Hospital?
II. Do breastfeeding mothers in Alimosho General Hospital practice exclusive
breastfeeding?
III. Is exclusive breastfeeding beneficial to mothers in Alimosho General Hospital?
1.7 Limitations of study
This study is limited to Alimosho General Hospital, Igando.
1.8 Scope of study
This research will be conducted on breastfeeding mothers in Alimosho General
Hospital including those that have nursed a baby in the past two years.
1.9 Operational definition of terms
I. Breastfeeding: Breast milk (including milk expressed or from a wet nurse).
II. Constraints: A statement or action that shows hindrances why someone refused to
accept something.
III. Exclusive Breastfeeding: is defined as the “newborn receiving only breast milk and
no other liquids or solids except for drops or syrups consisting of vitamins, minerals,
or medicines” (Joint Commission, 2010, Set-05a).
IV. Solid or semi-solid foods: Any food or liquid including non-human milk and
formula

CHAPTER TWO
Literature Review
2.1 Concept of exclusive breastfeeding
According to World Health Organization exclusive breastfeeding means ‘that the
infant receives only breast milk. No other liquids or solids are given – not even water –
with the exception of oral rehydration solution, or drops/syrups of vitamins, minerals or
medicines’.
Breast milk is the natural and original first food for babies, it provides all the energy
and nutrients that the infant needs for the first months of life, and it continues to provide
up to half or more of a child’s nutritional needs during the second half of the first year,
and up to one-third during the second year of life.
WHO recommends ‘that infants should be exclusively breastfed for the first six
months of life to achieve optimal growth, development and health. Thereafter, infants
should receive nutritionally adequate and safe complementary foods, while continuing to
breastfeed for up to two years or more’.
Breast milk contains all the nutrients infant requirements in the first six months of life.
It protects against common and widespread childhood diseases such as diarrhea and
pneumonia, and may also have long term benefits such as lowering mean blood pressure
and cholesterol, and reducing the prevalence of obesity and type-2 diabetes.
To enable mothers to establish and sustain exclusive breastfeeding for 6 months, WHO
and UNICEF Recommend:
i. Initiation of breastfeeding within the first hour of life.
ii. Exclusive breastfeeding – that is the infant only receives breast milk without any
additional food or drink, not even water.
iii. Breastfeeding on demand – that is as often as the child wants, day and night.
iv. No use of bottles, teats or pacifiers.
2.2 Benefits of Exclusive Breastfeeding for Infants and Mothers
Breastfeeding is an unsurpassed method of providing ideal food for the healthy
growth and development of infants. It is also a fundamental part of the reproductive
process with imperative implications for the health of mothers. Breastfeeding served and

continues to serve as an appropriate method through which newborns are offered
essential nutrients necessary for optimal growth and intellectual development.
Breast milk is regarded as ideal, natural and protective food for newborns. Given
that prolonging people’s lives (by reducing mortality) and preventing disease (by reducing
morbidity) are some of the goals of public health (Brulde, 2011), breastfeeding or exclusive
breastfeeding has been recognized as an efficient advance to the achievement of these
goals.
In a study by Vennemann and colleagues (2009) breastfeeding was found to be
protective against sudden infant death syndrome by reducing the risk by 50% at all ages
during infancy; these benefits have been reported to exhibit those responses relationship,
that is, health gains increased with increase in duration and exclusivity.
Infants when exclusively breastfed for the optimal duration of six months are
considerably protected against the major childhood diseases conditions viz. diarrhea,
gastrointestinal tract infection, allergic diseases, diabetes, obesity, childhood leukemia
and lymphoma, inflammatory and bowel disease (WHO, 2012; American Academy of
Pediatrics,2012). In particular, the risk of hospitalization for lower respiratory tract
infections during the first year of life is reduced by 72% when infants are exclusively
breastfed for more than 4 months (American Academy of Pediatrics, 2012, p. 828). Duncan
et al (2009, p. 867) also found exclusive breastfeeding to be protective against single and
recurrent incidences of otitis media. Infants who were given supplementary foods prior to
4 months had 40% more episodes of otitis media than their counterparts.
Breast milk promotes sensory and cognitive development, and protects the infant
against infectious and chronic diseases. Exclusive breastfeeding 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). Breastfeeding contributes to the health and well-being of mothers; it helps to space
children, reduces the risk of ovarian cancer and breast cancer, increases family and
national resources, is a secure way of feeding and is safe for the environment (WHO, 2001).
Breastfeeding reduces the mother's risk of fatal postpartum hemorrhage and
premenopausal breast and ovarian cancer. Frequent and exclusive breastfeeding
contributes to a delay in the return of fertility and helps protect women against anemia

by conserving iron. Breastfeeding provides frequent interaction between mother and
infant, fostering emotional bonds, a sense of security, and stimulus to the baby’s
developing brain (WHO, 2001).
2.3 Exclusive breastfeeding practices
Despite high rates of initiation of breastfeeding, exclusive breastfeeding practices
are not common in developing countries. Only approximately one third of infants under
six months are exclusively breastfed. There are however variations in different regions
(UNICEF 2006b).
East Asia so far has the highest rates of exclusive breastfeeding at 43%, with
Eastern and Southern Africa at 41%. The region with the lowest reported exclusive
breastfeeding rates is Western and Central Africa at 20% (UNICEF 2006b). Despite the
low rates of exclusive breastfeeding in sub Saharan Africa, the available data indicate that
these rates improved between 1990 and 2004 gong from 15% to 32% (UNICEF 2006b).
This rise is attributed to Baby Friendly Hospital Initiatives practices and breastfeeding
promotion and support programmes that have been well established.
A study by Abrahams and Labbok (2009), examined the impact of Baby Friendly
Hospital Initiatives on exclusive breastfeeding trends. Data for this study were obtained
from demographic and health surveys of 72 developing countries. Results of this study
indicated annual significant increases in the rates of exclusive breastfeeding after the
introduction of Baby Friendly Hospital Initiatives compared to before its introduction.
2.4 Sources and Knowledge of Exclusive Breastfeeding Information
Formal breastfeeding policies in hospitals, staff and physician training in
breastfeeding management, and rooming-in have been shown to positively affect
breastfeeding promotion efforts (Kovach, 2002). Strategies such as the Baby-Friendly
Hospital Initiative (BFHI), peer counselling, paternal support, and education of the
mothers and health care professionals have been used to promote breastfeeding in the
U.S. (Martens, 2000; Philipp et al., 2001).
A study showed that a 1.5-hour mandated breastfeeding education intervention of
nursing staff significantly increased the compliance of the BFHI and breastfeeding beliefs
over a 7-month period at the intervention site compared to control site. The rates of EBF

also increased by 23% (31% vs.54%), and fewer nurses offered supplementation (45% vs.
87%) after the intervention (Martens, 2000).
Although breastfeeding promotion or intervention programs have focused on
educating the mothers, family members, and employers about the benefits of supporting
breastfeeding, not much attention has been paid to the health professionals influencing
these target groups. Surveys evaluating health care professionals’ knowledge and
attitudes about breastfeeding revealed that these professionals do strongly advocate to
their clients that breastfeeding is the optimum method of infant feeding (Pascoe et al.,
2002).
Support from governmental programmes, health professionals, and education in
schools is very significant for the promotion of exclusive breastfeeding and for bringing
about changes in person’s behavior. Valuable educational efforts require knowledgeable
health professionals to compel these efforts; consequently, students majoring in health
sciences such as public health, nutrition and home economics should be comprehensively
educated and trained to support and advocate breastfeeding.
2.5. Attitude and knowledge of Mothers on Exclusive Breastfeeding Practice
Research showed that a large number of mothers are not practicing Exclusive
breastfeeding as a result of poor knowledge which result in poor attitude towards it. For
instance, Chetley (2003) identified negative perception of lack of sufficient milk, fear of
weight gain, breast sagging, pain, sleep deprivation, exhaustion or maternal employment
as the problems highlighted by poor attitude of mothers who are not positive towards
exclusive breastfeeding.
In the same vain inadequate knowledge or inappropriate practice of breastfeeding
were identified as those factors which can lead to undesirable consequences which also
affect mother's attitude. Nevertheless, Mennela (2001) realized from his study that women
who continued breastfeeding exclusively were more determined to success and overcome
any barrier, relying mostly on family support and proper time management.
2.6. Attitude Solutions with Exclusive Breastfeeding Practice
Although exclusive breastfeeding is an important behavior that has seen identified
as related to improved health of mothers, infants and children as well as lower health care

cost. Exclusive breastfeeding based on available evidence, achievements of these goals are
still far from the desired progress. Exclusive breastfeeding practices including initiation
and duration are influenced by multiple inter woven factors which include health,
psychosocial, cultural, political and economic factors. Among these factors, decision
regarding exclusive breastfeeding in low-income countries are influenced by education,
employment place of delivery, family pressure, cultural values, and spouse support within
the home.
To further explain, much research which looks at exclusive breastfeeding behavior
shows that there are complex relationships to it which involves not only incentive, but
disincentives as well. Often the disincentives outweigh the advantages for many women.
These disincentives form any barriers to compliance with the breastfeeding
recommendations. These common factors which affect exclusive breastfeeding practice
are the mother returning to work outside of the home, the support of the other within the
home and mother psychological health (Chudasama, Patal and Kavishwar, 2009).
Gundelman et al, (2009) identified lacking job flexibility and psychosocial stress as the
barriers to exclusive breastfeeding practice by working; mothers.
Further explanation puts in that one of the problems continually encountered by
working mothers which tends to reduce the rate of exclusive breastfeeding is sex-specific,
and therefore, cannot be viewed as gender neutral in child bearing. The act of
breastfeeding becomes even more difficult because many do not consider exclusive
breastfeeding to be critical for baby survival. Thus specific legislation on breastfeeding of
the right to pump milk, lactation at work, extra package to boost breastfeeding working
mothers still remain a mirage.

Socioeconomic characteristics
Occupation
Education level
Income sources
Access to health care
Ownership of selected items
Maternal characteristics
Child spacing
Marital status: spousal support
Mode and place of delivery
Breast feeding policies
WHO
Exclusive breastfeeding
Breast milk only
Other feeding methods
Mixed feeding
Replacement feeding
Socio-cultural factors
Traditions
Cultural practices
Maternal perception
2.7 Conceptual framework
The study will be guided by the following conceptual framework
Figure 1
Independent variables
Moderating variables
Dependent Variable
Intervening variables
2.7.1 Discussion of conceptual framework
The conceptual framework illustrates the association of exclusive breastfeeding and
social economic characteristics, social-cultural factors and maternal characteristics as
factors that influence it practice. The practice or non-practice of exclusive breastfeeding
is further influenced by breast feeding policies such as World Health Organizations policy
on Infant and Young Child Feeding and the strategies adopted at the national level to
promote its implementation. However, those not adhering to the exclusive breastfeeding
recommendation may practice mixed feeding; giving the child other foods alongside the
breast milk or may practice replacement feeding especially in the context of HIV/AIDS

whereby the child is never breast fed but rather is given formula milk or other type of
breast milk substitute.

CHAPTER THREE
RESEARCH METHODOLOGY
3.1 INTRODUCTION
This chapter describes the procedures and methods that was used in this research
study which include the description of research design, the study population, sample and
sampling technique, instrument and data collection and method of data analysis.
Research methodology is the application of steps, strategies and procedures for
gathering and analysing data in a research investigation in a logical and systematic way
(Burns and Grove 2010).
3.2 STUDY DESIGN
According to Burns and Grove (2010) a research design is a blueprint for conducting
the study that maximizes control over factors that could interfere with the validity of the
findings.
The design guides the researcher to plan, implement the study so as to achieve the set
goals and is referred to by Polit and Beck (2006) as “a general plan for addressing research
questions, including specifications for enhancing the studies’ integrity”.
For the purpose of this study since it is determining what is happening in the
present, a cross-sectional survey based study was adopted with a self-administered
questionnaire. Cross-sectional studies entail the collection of data from the cross-section
of the population at a given time.
The study setting is Alimosho General Hospital. This hospital is owned by Lagos
State Government and was established in the year 2012. It is located along LASU/ Isheri
Road, Igando.
It comprises of various units such as Emergency unit, the wards (Male and Female),
the Outpatient department (Medical and surgical), Pharmacy unit, laboratory unit, etc. It
also consists of several clinics such as Eye clinic, Dental clinic, Physiotherapy clinic.

A Maternal and child complex which was opened in the year 2012 comprises of
emergency unit, pre and post-natal ward, a theatre, paediatric unit etc, and clinics like
Antenatal clinic, Child Welfare clinic.
3.3 POPULATION OF STUDY/TARGET POPULATION
The women of reproductive age were chosen in which every woman was given equal
opportunity including their health workers.
3.4 SAMPLE AND SAMPLING TECHNIQUE
The sampling technique that was used in this study was a convenient method in which
women who attended Post Natal clinic were selected, especially those that can read and
write, including their health providers.
3.5 RESEARCH INSTRUMENT
The instrument used for data collection was detailed questionnaire to gather information
from women of reproductive age.
The questionnaire made up of 4 sections, section A deals with demographic data, (age,
occupation, level of education, marital status) section B deals with the knowledge of
women about Exclusive breastfeeding, section C deals with constraints of exclusive
breastfeeding, while section D deals with benefits of exclusive breastfeeding to mother
and child.
3.6 VALIDITY AND RELIABILITY OF INSTRUMENT
The research instrument was subjected to content validity before administered on the
respondents. This allows the researcher to evaluate the content validity. Reliability to
regards the consistency of the results obtained from the instrument used in this research.
Reliability is achieved when the same research process is repeated and reproduces results
within stated confidence limits. Bells (1993) cited in (Eriksson, 2002) states that the
reliability of an investigation is satisfying if another researcher can conduct the same
research and draw the same conclusions. This has to do with the ability of a research
finding to replicate itself if a parallel study is conducted. For the purpose of this study,
Cronbach’s Alpha was used to test the reliability of research item employed in this study.

The result from the reliability test shows Cronbach Alpha to be 0.943. This is an
acceptable level according to Sekeran, (2003) who set a minimum benchmark of 0.70.
Therefore, the instrument developed for measuring constraints of exclusive breastfeeding
practice among breastfeeding mothers in Alimosho General Hospital, Igando, Lagos.
Constructs was judged to be sufficiently reliable.
3.7 METHOD OF DATA COLLECTION
The researcher will take permission from the principal of the school to administer
her questionnaire; the research will have to distribute the questionnaires randomly among
the patients. Details of the study will be explained to the respondents and their consent
will be sought before they participate.
3.8 METHOD OF DATA ANALYSIS
Analysis of the data collected was done manually through coding and tabulation of the
responses derived from each questionnaire according to the variables involved. The
analysis was done through the conversion of the raw scores into percentages for easy
interpretation of the demographic characteristics of respondents with respect to age, sex,
marital status, level of education among others.
The coding was to facilitate easy cross tabulation and was presented in the form of tables
showing broad distribution of the items in order to further enhance our data analysis.
Finally, in the test of hypotheses, However, Pearson Moment Correlation Coefficient
(PPMC) were used to test the formulated hypotheses because correlation analysis is
completely concerned with the strength of the relationship between two variables. (i.e the
degrees of closeness of relationship between two variables). Some relationships among
variables are much stronger than others while some may be rather weak.
The statistical formula for the correlation is given below:
Σxy - ΣxΣy
n
Σx2 - (Σx)2 (Σy2 -( Σy)2
n n

Where:
n= the total no of the data
(Σx) = sum of independent variable (population)
(Σy) = sum of the dependent variable
(Σxy)= sum of the product of x and y
(Σx2) = sum of the squares of x
(Σx)2 = square of the sum of x
(Σy2) = sum of the squares of y
3.9 ETHICAL CONSIDERATIONS
The following ethical issues will be observed during the process of conducting this study;
 In accordance with ethical principles guiding research involving human subjects.
This study will be conducted after obtaining approval from the management of
Alimosho General Hospital, Igando and Lagos State School of Nursing.
 The respondents will be fully informed about benefits to be derived from this study,
this will enable them to give voluntarily informed consent.
 All the respondents will be given choices devoid of preferential treatment.
 The researcher will not influence or impose his opinion on the respondents.
 Anonymity and confidentiality will be endured by using questionnaire that does not
require respondents to divulge their identity.
 All information given will not be used against the respondents.

CHAPTER FOUR
DATA PRESENTATION, ANALYSIS AND INTERPRETATION
4.1 INTRODUCTION
In this chapter attempt is made to present the empirical findings resulting from the
analysis of the data gathered in order to address the research questions and hypotheses.
A total of 100 copies of questionnaires which was retrieved from the respondents were
found usable out of the 150 copies of questionnaires administered. The questionnaires
and the research hypotheses were analyzed using Chi-square.
4.2 RESPONDENTS CHARACTERISTICS AND CLASSIFICATION
This section is concerned with thoughtful, charming and incredibly helped the
demographic characteristics of respondents. It covers variables such as respondents’ Age,
Occupation, Marital Status, Educational Status and Religion of Respondents in the study.
The key findings of this research are presented in tables below:
TABLE 1: AGE OF RESPONDENTS
Frequency Percent
15-25 YEARS 39 39.0
25-35 YEARS 57 57.0
35-50 YEARS 4 4.0
Total 100 100.0
Source: Field work, 2016
From table 1, 39% of the respondents were between the ages 15-25 years, 57% were
between the ages 25-35 years and 4% were between the ages 35-50 years. The research
however reveals larger percentage of the respondents are between 25-35 years in the
study.

TABLE 2: OCCUPATION OF RESPONDENTS
Frequency Percent
Civil Servant 10 10.0
Trading 4 4.0
Schooling 3 3.0
Others 83 83.0
Total 100 100.0
The table presented above reveal the occupation of the respondents, it however reveals
that 10% are Civil servant, 4% are trader, 3% are student while 83% involve in other
activities respectively in the study.
Table 3: MARITAL STATUS OF RESPONDENTS
Frequency Percent
Single Mothers 57 57.0
Married 39 39.0
Divorced 4 4.0
Total 100 100.0
The table presented above reveals the marital status of the respondent, 57% are single
mothers, 39% are married while 4% are divorced, and it thus reveals that single mothers
dominate the sampled population in the study.

TABLE: 4 EDUCATIONAL STATUS OF RESPONDENTS
Frequency Percent
Primary 14 14.0
Secondary 57 57.0
Tertiary 29 29.0
Total 100 100.0
Educational background of the respondents as represented on the table 4 obviously,
shows that 14% possess primary school leaving certificate, 57% of the respondents are
WAEC/GCE certificate holder while 29% possess B.SC/HND certificate. This purely
means that majority of the respondents are WAEC/GCE certificate holder. Thus, the
results gathered could be used to draw reasonable conclusions.
Table 5: RELIGION OF RESPONDENTS
Frequency Percent
Valid
Christian 39 39.0
Islam 57 57.0
Traditional 4 4.0
Total 100 100.0
The table presented above reveals the religion of the respondents, it reveals that 39% are
Christians, 57% are Islam and while 4% are traditional worshiper, it thus reveals that
majority of the respondents are Islam in the study.

KNOWLEDGE OF EXCLUSIVE BREASTFEEDING
Table 6: Have you heard of exclusive breastfeeding
Frequency Percent
Valid
Yes 90 90.0
No 10 10.0
Total 100 100.0
The table presented above is aimed at knowing if the respondents have heard of exclusive
breastfeeding, 90% have heard, while 10% do not aware, it thus revealed majority of the
respondents aware of exclusive breastfeeding as revealed in this study.
Table 7: If yes, from which source did you get your information from?
Frequency Percent
Antenatal Clinic 60 60.0
Postnatal Clinic 26 26.0
Print Journal 3 3.0
Electronic Media 4 4.0
Church/Mosque 7 7.0
Seminar Nil Nil
Total 100 100.0
The table presented above is aimed at knowing the source of respondents’ information,
60% source information from antenatal clinic, 26% from postnatal clinic, 3% from print
journal, 4% from Electronic media, 7% from church/mosque while none source
information from seminar, it thus revealed majority of the respondents use the antenatal
clinic as source of information in this study.

Table 8: How long do you think a child should be breastfed before introduction of
other foods?
Frequency Percent
Valid
6 months 86 86.0
9 months 11 11.0
12 months
Others
2
1
2.0
1.0
Total 100 100.0
From the above table 86% of the respondents confirmed that a child should be breastfed
exclusively for six months before introduction of other foods, 11% confirmed nine months,
2% confirmed twelve months while 1% of the respondents confirmed by others. This
implies that majority of the respondents confirmed that a child should be breastfed
exclusively for six months before introduction of other foods in this study.
Table 9: Do you think exclusive breastfeeding is beneficial to
the mother
Frequency Percent
Valid
Yes 88 88.0
No 12 12.0
Total 100 100.0
From the above table, 88% of the respondents asserted that exclusive breastfeeding is
beneficial to the mother and 12% did not agree to this statement in this study.

Table 10: Do you think exclusive breastfeeding is essential for your
child’s growth?
Frequency Percent
Valid
Yes 76 76.0
No 24 24.0
Total 100 100.0
From the above table, 76% of the respondents agreed that exclusive breastfeeding is
essential for child’s growth and 24% did not agree to this statement. This implies that
majority of the respondents believes that exclusive breastfeeding is essential for child’s
growth that would prevent them from diseases in this study.
CONSTRAINTS OF EXCLUSIVE BREASTFEEDING PRACTICES
Table 11: Exclusive breastfeeding is very difficult
Frequency Percent
Valid
Yes 36 36.0
No 62 62.0
Not sure 2 2.0
Total 100 100.0
From the above table, 36% of the respondents confirmed that exclusive breastfeeding is
very difficult, 62% confirmed that exclusive breastfeeding is not difficult to practice while
2% of the respondents are not sure. This implies that exclusive breastfeeding is not
difficult to practice in this study.

Table 12: I find it difficult to breastfeed my child at night
Frequency Percent
Valid
Yes 66 66.0
No 31 31.0
Not sure 3 3.0
Total 100 100.0
From the above table, 66% of the respondents confirmed that child breastfeeding is very
difficult at night, 31% confirmed that child breastfeeding is not difficult at night while 3%
of the respondents are not sure. This implies that exclusive breastfeeding is difficult to
practice at the night in this study.
Table 13: My child does not need breast milk after three months
Frequency Percent
Valid
Yes 25 25.0
No 73 73.0
Not sure 2 2.0
Total 100 100.0
From the above table, 25% of the respondents confirmed that child does not need
breastmilk after three months, 73% confirmed that child needs breast milk after three
month while 2% of the respondents are not sure. This implies that child’s needs
breastmilk after three months in this study.

Table 14: My relatives are not supportive when I am breastfeeding
Frequency Percent
Valid
Yes 17 17.0
No 79 79.0
Not sure 4 4.0
Total 100 100.0
From the above table, 17% of the respondents confirmed that some of relatives are not
supportive whenever I am breastfeeding, 79% confirmed that some relatives are supportive
whenever I am breastfeeding while 4% of the respondents are not sure. This implies that
majority of relatives are supportive whenever I am breastfeeding in this study.
Table 15: Breastmilk alone satisfy my baby
Frequency Percent
Valid
Yes 61 61.0
No 37 37.0
Not sure 2 2.0
Total 100 100.0
From the above table, 61% of the respondents confirmed that breastmilk alone satisfy
their baby, 37% confirmed that breast alone did not satisfy their baby while 2% of the
respondents are not sure. This implies that only breastmilk is satisfies respondents’
babies in this study.

Table 16: I have not heard of exclusive breastfeeding before now
Frequency Percent
Valid
Yes 81 81.0
No 16 16.0
Not sure 3 3.0
Total 100 100.0
From the above table, 81% of the respondents confirmed the unawareness of exclusive
breastfeeding before now, 16% confirmed the unawareness of exclusive breastfeeding
before now while 3% of the respondents are not sure. This implies that majority of the
respondents are not aware of exclusive breastfeeding before now in this study.
Table 17: I find breastfeeding painful
Frequency Percent
Valid
Yes 18 18.0
No 80 80.0
Not sure 2 2.0
Total 100 100.0
From the above table, 18% of the respondents confirmed that breastfeeding is very painful,
80% confirmed that breastfeeding is not painful while 2% of the respondents are not sure.
This implies that majority of the respondents confirmed that breastfeeding is not painful
in this study.

Table 18: My breast will become saggy when I breast feed my child
Frequency Percent
Valid
Yes 26 26.0
No 69 69.0
Not sure 5 5.0
Total 100 100.0
From the above table, 26% of the respondents confirmed that breast becomes saggy when
breastfeeding child, 69% confirmed that breast does not saggy when breastfeeding child
while 5% of the respondents are not sure. This implies that breast would not saggy when
I breastfeed my child in this study.
Table 19: Nature of my job does not allow me to practice exclusive
breastfeeding
Frequency Percent
Valid
Yes 58 58.0
No 40 40.0
Not sure 2 2.0
Total 100 100.0
From the above table, 58% of the respondents confirmed that the nature of my job does
not allow me to practice exclusive breastfeeding, 40% confirmed that the nature of my job
does not allow me to practice exclusive breastfeeding while 2% of the respondents are not
sure. This implies that majority of the respondents confirmed that the nature of their job
does not allow to practice exclusive breastfeeding in this study.

Table 20: I need more time to breastfeed my child
Frequency Percent
Valid
Yes 81 81.0
No 17 17.0
Not sure 2 2.0
Total 100 100.0
From the above table, 81% of the respondents confirmed that they need more time to
breastfeed their child 17% of the respondents need no time to breastfeed their child while
2% of the respondents are not sure. This implies that majority of the respondents need
more time to breastfeed their child in this study.
Table 21: The quantity of breastmilk I produce does not satisfy my child
Frequency Percent
Valid
Yes 26 26.0
No 64 64.0
Not sure 10 10.0
Total 100 100.0
From the above table, 26% of the respondents confirmed that the quantity of breastmilk I
produce does not satisfy my child, 64% confirmed that the quantity of breastmilk I
produce satisfies my child while 10% of the respondents are not sure. This implies that
the quantity of breast produces by majority of respondents satisfies their child in this
study.
Table 22: The state of my health will not allow me to breastfeed my
child exclusively

Frequency Percent
Valid
Yes 74 74.0
No 24 24.0
Not sure 2 2.0
Total 100 100.0
From the above table, 74% of the respondents confirmed that the state of their health does
not allow to breastfeed their child exclusively, 24% confirmed that that the state of their
health does not allow to breastfeed their child exclusively while 2% of the respondents are
not sure. This implies that majority of the respondents does not breastfeed their child
exclusively in this study.
BENEFIT OF EXCLUSIVE BREASTFEEDING TO MOTHER AND CHILD
The table presented above is aimed at ascertaining that breastfeeding allows my uterus
fall back in place, 44 percent strongly disagreed, 39 percent agreed, 1 percent undecided,
7 percent disagreed while 9 percent strongly disagreed with the statement. It is pertinent
Table 23: Breastfeeding allows my
uterus fall back in place
Frequency Percent
Strongly Agree 44 44.0
Agree 39 39.0
Undecided 1 1.0
Disagree 7 7.0
Strongly Disagree 9 9.0
Total 100 100.0

to know through the opinion of the respondents that breastfeeding allows my uterus fall
back in place in this study.
Table 24: When I breast feed, it helps prevent cancer
Frequency Percent
Agree 39 39.0
Undecided 3 3.0
Disagree 8 8.0
Total 100 100.0
The table presented above is aimed at ascertaining that when I breast feed, it helps prevent
cancer, 37 percent strongly disagreed, 39 percent agreed, 3 percent undecided, 8 percent
disagreed while 13 percent strongly disagreed with the statement. It is pertinent to know
through the opinion of the respondents that when breastfeed, it helps prevent cancer in
this study.
Table 25: Breast milk helps protect my child from diseases
Frequency Percent
Agree 40 40.0
Undecided 2 2.0
Disagree 12 12.0
Total 100 100.0

The table presented above is aimed at ascertaining that breast milk helps protect my child
from diseases, 35 percent strongly disagreed, 40 percent agreed, 2 percent undecided, 12
percent disagreed while 11 percent strongly disagreed with the statement. It is pertinent
to know through the opinion of the respondents that breast milk helps protect child from
diseases in this study.
Table 26: When a child is well breastfed, it reduces the incidence of diarrhoea
Frequency Percent
Agree 30 30.0
Undecided 4 4.0
Disagree 15 15.0
Total 100 100.0
The table presented above is aimed at ascertaining that when a child is well breastfed, it
reduces the incidence of diarrhoea, 44 percent strongly disagreed, 30 percent agreed, 4
percent undecided, 15 percent disagreed while 7 percent strongly agreed, it is pertinent
to know through the opinion of the respondents that when a child is well breastfed, it
reduces the incidence of diarrhoea in this study.

Table 27: A child that is exclusively breastfed demonstrates high intelligence later
in life
Frequency Percent
Agree 31 31.0
Undecided 2 2.0
Disagree 8 8.0
Total 100 100.0
The table presented above is aimed at ascertaining that A child that is exclusively
breastfed demonstrates high intelligence later in life, 49 percent strongly disagreed,
31percent agreed, 2 percent undecided, 8 percent disagreed while 10 percent strongly
agreed, it is pertinent to know through the opinion of the respondents that a child that is
exclusively breastfed demonstrates high intelligence later in life in this study.
Source:
Field
work,
2016
The
table
presented above is aimed at ascertaining that breastfeeding will make my child develop
fast, 44 percent strongly disagreed, 39 percent agreed, 1 percent undecided, 7 percent
disagreed while 9 percent strongly disagreed with the statement. It is pertinent to know
Table 28: Breastfeeding will make my child develop fast
Frequency Percent
Agree 39 39.0
Undecided 1 1.0
Disagree 7 7.0
Total 100 100.0

through the opinion of the respondents that breastfeeding will make my child develop fast
in this study.
Table 29: Breastfeeding promotes bonding of mother and child
Frequency Percent
Agree 39 39.0
Undecided 3 3.0
Disagree 8 8.0
Total 100 100.0
The table presented above is aimed at ascertaining that breastfeeding promotes bonding
of mother and child, 37 percent strongly disagreed, 39 percent agreed, 3 percent
undecided, 8 percent disagreed while 13 percent strongly disagreed with the statement. It
is pertinent to know through the opinion of the respondents that breastfeeding promotes
bonding of mother and child in this study.
Table 30: Breast feed helps me save money as I don’t need to buy breastmilk.
Frequency Percent
Agree 40 40.0
Undecided 2 2.0
Disagree 12 12.0
Total 100 100.0

The table presented above is aimed at ascertaining that breast feed helps me save money
as I don’t need to buy breastmilk, 35 percent strongly disagreed, 40 percent agreed, 2
percent undecided, 12 percent disagreed while 11 percent strongly disagreed with the
statement. It is pertinent to know through the opinion of the respondents that breast feed
helps me save money as I don’t need to buy breastmilk in this study.
4.3 DATA PRESENTATION AND ANALYSIS ACCORDING TO TEST OF HYPOTHESES
The Pearson's correlation is used to find a relationship between at least two continuous
variables. The value for a Pearson's can fall between 0.00 (no correlation) and 1.00 (perfect
correlation). Other factors such as group size will determine if the correlation is significant.
Generally, correlations above 0.80 are considered pretty high, as presented on the table
below:
The Range of r Interpretation
r = 1 Perfect negative correlation
1< r 0.8 Strong negative correlation
0.8 < r 0.5 Fair negative correlation
0.5 < r < 0 Weak negative correlation
r = 0 No correlation
0 < r < 0.5 Weak positive correlation

In this sub-section, the research hypotheses geared towards achieving the stated
objectives of the study were tested using Pearson Product Moment Correlation (PPMC)
analysis statistical tool at 0.05 level of significance.
HYPOTHESIS ONE
 Ho: There is no constraint to the practice of exclusive breastfeeding among
breastfeeding mothers in Alimosho General Hospital, Igando.
N X Y XY X2 Y2
1 32 38 1216 1024 1444
2 28 35 980 784 1225
3 21 10 210 441 100
4 19 17 323 361 289
TOTAL 100 100 2729 2610 3058
Table 1: constraint to the practice of exclusive breastfeeding and breastfeeding mothers
in Alimosho General Hospital
0.5 r < 0.8 Fair positive correlation
0.8 r < 1 Strong positive correlation
r = 1 Perfect positive correlation

Variable N SUM r-cal P-value Df r-task
value
Decision
Constraint to the
practice of
exclusive
breastfeeding (X)
4 X:100
X2:2610
XY:2729
0.9243 0.05 3 0.878
Breastfeeding
mothers in
Alimosho
General Hospital
(Y)
4 Y:100
Y2:3058
Rejected
Result
Ho is rejected. This implies that there is practice of exclusive breastfeeding among
breastfeeding mothers in Alimosho General Hospital, Igando.
Decision
From the above hypothesis tested, this implies that there is high positive practice of
exclusive breastfeeding among breastfeeding mothers in Alimosho General Hospital,
Igando.

HYPOTHESIS TWO
Ho: There is no significant relationship between exclusive breastfeeding and the health of
the baby
N X Y XY X2 Y2
1 39 15 585 1521 225
2 33 8 264 1089 64
3 12 36 432 144 1296
4 16 41 656 256 1681
TOTAL 100 100 1937 3010 3266
Table 2: Exclusive breastfeeding and the health of the baby
Variable N SUM r-cal P-value Df r-task value Decision
Exclusive
breastfeedin
g (X)
4 X:100
X2:3010
XY:1937
0.9008 0.05 3 0.878
Health of the
baby (Y)
4 Y:100
Y2:3266
Rejected

Result
Ho is rejected. This implies that exclusive breastfeeding guarantee good and sound health
of a baby
Decision
From the above hypothesis tested, this implies that there is high positive relationship
between exclusive breastfeeding and the health of a baby.
HYPOTHESIS THREE
Ho: There is no benefit of exclusive breastfeeding to mothers in Alimosho General Hospital
N X Y XY X2 Y2
1 20 42 840 400 1764
2 15 36 540 225 1296
3 35 10 350 1225 100
4 30 12 360 900 144
TOTAL 100 100 2090 2750 3304

Table 3: Benefit of exclusive breastfeeding and mothers in Alimosho General Hospital
Variable N SUM r-cal P-
value
Df r-task
value
Decision
Benefit of
exclusive
breastfeedin
g (X)
4 X:100
X2:2750
XY:2090
0.9145 0.05 3 0.878
Mothers in
Alimosho
General
Hospital
4 Y:100
Y2:3304
Rejected
Result
Ho is rejected. This denotes that the benefit of exclusive breastfeeding and mothers in
Alimosho General Hospital.
Decision
From the above hypothesis tested, this implies that there is high positive relationship
between benefit of exclusive breastfeeding and mothers in Alimosho General Hospital.

CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.1 INTRODUCTION
This chapter presents a summary of the major findings of the study. It also examines the
constraints of exclusive breastfeeding mothers in Alimosho General Hospital, Igando,
Lagos State. The Chapter one covers the general introduction to the study; also
description of the problem, objective of the study, research questions, significance of the
study, scope and definition of terms used in the study. Chapter two elucidate on literature
review as well as theoretical framework. Chapter three describes the research
methodology. It contains explanation of the research design, population of study,
sampling technique, and sample size, instrument of data collection and method of data
analysis. Chapter four covers data analysis and interpretation while chapter five present
the discussion of findings, Nursing implications, summary, conclusion and
recommendations.
5.2 DISCUSSION OF FINDINGS
The result is in line with Chetley (2003) who believed that, few women or mothers
are constraint by negative perception of lack of sufficient milk, fear of weight gain, breast
sagging, pain, sleep deprivation, exhaustion or maternal employment as the problems
highlighted by poor attitude of mothers who are not positive towards exclusive
breastfeeding. This has often been attributed exclusive breastfeeding as the major problem
which had hindered effective and successful practicing exclusive breastfeeding. The extant
research showed that a large number of mothers are not practicing exclusive breastfeeding
as a result of poor knowledge which result in poor attitude towards it.
Besides, in the same vain inadequate knowledge or inappropriate practice of
breastfeeding were identified as those factors which can lead to undesirable consequences
which also affect mother's attitude. UNICEF (2006b) opined that exclusive breastfeeding
practices are not common in developing countries especially Nigeria, only approximately
one third of infants under six months are exclusively breastfed. There are however
variations in different regions. There is benefit of exclusive breastfeeding to mothers in
Alimosho General Hospital.

According to Vennemann and colleagues (2009) breastfeeding was found to be protective
against sudden infant death syndrome by reducing the risk by 50% at all ages during
infancy; these benefits have been reported to exhibit those responses relationship, that is,
health gains increased with increase in duration and exclusivity.
Infants when exclusively breastfed for the optimal duration of six months are
considerably protected against the major childhood diseases conditions viz. diarrhea,
gastrointestinal tract infection, allergic diseases, diabetes, obesity, childhood leukemia
and lymphoma, inflammatory and bowel disease (WHO, 2012).
5.3 IMPLICATIONS FOR NURSING
Nurses should endeavor to imbibe the habit of health educating pregnant women
appropriately during each antenatal visit. This will help them practice exclusive
breastfeeding after delivery.
There should be re-training of Nurses on appropriate professional conduct
towards women who are breastfeeding. Nurses should be at the forefront of campaign for
exclusive breastfeeding since this is going to help reduce infant mortality.
5.4 SUMMARY
The goal of this study was to examine constraints of exclusive breastfeeding mothers
in Alimosho General Hospital, Igando, Lagos-State. The findings showed that mothers
don’t have adequate knowledge of exclusive breastfeeding. This has often been attributed
exclusive breastfeeding as the major problem which had hindered effective and successful
practicing exclusive breastfeeding. The extant research showed that a large number of
mothers are not practicing exclusive breastfeeding as a result of poor knowledge which
result in poor attitude towards it.
Besides, in the same vain inadequate knowledge or inappropriate practice of
breastfeeding were identified as those factors which can lead to undesirable consequences
which also affect mother's attitude. UNICEF (2006b) opined that exclusive breastfeeding
practices are not common in developing countries especially Nigeria, only approximately
one third of infants under six months are exclusively breastfed. There are however
variations in different regions. There is benefits of exclusive breastfeeding to mothers in
Alimosho General Hospital. The findings from the all hypotheses are related to Brulde,

(2011) in the literature that breastfeeding is an incomparable system of providing ideal
food for the healthy growth and development of infants. It is also an essential part of the
reproductive process with imperative implications for the health of mothers. Breastfeeding
also serves as continues method through which newborns are given essential nutrients
indispensable for optimal growth and intellectual development.
5.5 CONCLUSION
Based on the researcher findings in the study, conclusion was drawn on the constraints
of exclusive breastfeeding mothers in Alimosho local government area of Lagos State. It is
concluded from the study findings that exclusive breastfeeding especially child growth
plays an important role in child daily life.
Research finding support the fact that in order for mothers to exclusively breastfeed their
babies, mothers require to appreciate the reasons that exclusive breastfeeding is best and
they require to get positive messages about exclusive breastfeeding from friends and family
members.
The popular proverb says that knowledge is power, lack of correct exclusive breastfeeding
knowledge and the inability to apply the knowledge in breastfeeding children is a very
serious threat to the practice of exclusive and adequate breastfeeding.
The fact remains that exclusive breastfeeding is practiced by a minority of women may be
attributed to a number of factors like social, economic, cultural, political factors. Cultural
factors may be crucial when promoting exclusive breastfeeding everywhere, but are
particularly crucial in traditional rural communities. Local perceptions of what constitutes
optimal infant feeding practices may differ greatly from international recommendations.
From this study, it is concluded that working mothers find it extremely difficult to
exclusively breastfeed their babies according to the recommendation of World Health
Organization. Exclusive breastfeeding for up to six months requires the mother and her
infant to be in close proximity for this period and to use expressed breastmilk for
separation of short duration. However, practicing exclusive breastfeeding may be
perceived as being non compatible with working outside of the home, thus creating an
economical barrier.

5.6 RECOMMENDATIONS
Based on the above findings and conclusion, the following recommendations were made;
That the inadequate social support systems at the household and community levels has
seen as a barrier to optimum breastfeeding. It is believed that mothers needs an enabling
environment if they are to practice optimal breastfeeding and this can only be possible
with full support at both the household and the community levels. The workload of the
pregnant and lactating woman should be addressed. Besides, government should promise
that workplace is free of harassment and discrimination against women who prefer to
breastfeed their babies through appropriate mechanisms.
That National policies on breastfeeding are important for the promotion and support of
breastfeeding at all levels. The lack of political commitment to breastfeeding promotion
and support may probably be due to ignorance of its many benefits for the individual
(mother and infant), household, community and the nation. Governments have still to
understand the health, social and economic benefits of breastfeeding.
That Nurses should be encouraged to serve as role model to other women generally to
practice exclusive breastfeeding. They should not be mere educators of this thus
promoting optimal growth in others at the detriment of their own offspring. Government
health institutions should provide crèches at places of work to encourage health personnel
to practice exclusive breastfeeding.
Healthcare providers should persistently go on board on educating general populace
regarding the importance of exclusive breastfeeding to remove family negative influence
especially women in their prenatal period.
In light of all the barriers stated above, the baby friendly initiative is the best answer to
mother practice optimal breastfeeding including exclusive breastfeeding.

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World Health Organization, Infant and Young Child Feeding, World Health Organization,
Lyon, France, 2009.

LAGOS STATE SCHOOL OF NURSING, IGANDO
QUESTIONNAIRE
Dear Respondents,
My name is Oba Adeboye Solomon, a final year student of the above named institution. I
am currently carrying out a research study on “Constraints of exclusive breastfeeding
practice among breastfeeding mothers in Alimosho General Hospital.”.
This questionnaire is designed to collect information about “Constraints of exclusive
breastfeeding practice among breastfeeding mothers in Alimosho General Hospital,
Igando, Lagos-State”. You are therefore expected to answer the following questions. All
answers to the questionnaire will be treated confidential. So, please provide honest and
accurate response to these questions by ticking the appropriate box.
Oba Adeboye Solomon
Student Nurse
SECTION A (Please tick ( ) the appropriate column in the space provided)
DEMOGRAPHIC DATA
1. Age: 15-25 years 25-35 years 35- 50 years
2. Occupation : Civil servant Trading Schooling Others__________
3. Marital status : Single Married Divorced
4. Educational status : Primary Secondary , Tertiary
5. Religion : Christian , Islam Traditional
SECTION B
Please tick ( ) the appropriate column in the space provided
KNOWLEDGE OF EXCLUSIVE BREASTFEEDING
6. Have you heard of exclusive breastfeeding? Yes No
7. If yes, from which source did you get your information from? Antenatal Clinic
Postnatal Clinic Print Journal Electronic Media Church/Mosque
Seminar
8. How long do you think a child should be breastfed before introduction of other
foods? 6 months 9 months 12 months others _______
9. Do you think exclusive breastfeeding is beneficial to the mother? Yes No
10. Do you think exclusive breastfeeding is essential for your child’s growth? Yes
No

SECTION C (Please tick ( ) the appropriate column in the space provided)
SECTION D (Please tick ( ) the appropriate column in the space provided)
BENEFIT OF EXCLUSIVE BREASTFEEDING TO MOTHER AND CHILD
SA= STRONGLY AGREE A= AGREE UD= UNDECIDED D= DISAGREE SD= STRONGLY
DISAGREE
S/NO QUESTION SA A UD D SD
23. Breastfeeding allows my uterus fall back in place
24. When I breast feed, it helps prevent cancer
25. Breast milk helps protect my child from diseases
26. When a child is well breastfed, it reduces the incidence of
diarrhoea
CONSTRAINTS OF EXCLUSIVE BREASTFEEDING PRACTICES
S/NO Questions Yes No Not
sure
11. Exclusive breastfeeding is very difficult
12. I find it difficult to breastfeed my child at night
13. My Child does not need breast milk after 3 months
14. My relatives are not supportive when I am breastfeeding
15. Breastmilk alone satisfy my baby
16. I have not heard of exclusive breastfeeding before now
17. I find breastfeeding painful
18. My breast will become saggy when I breast feed my child
exclusively
19. Nature of my job does not allow me to practice exclusive
breastfeeding
20. I need more time to breastfeed my child
21. The quantity of breastmilk I produce does not satisfy my child
22. The state of my health will not allow me to breastfeed my child
exclusively

27. A child that is exclusively breastfed demonstrates high
intelligence later in life
28. Breastfeeding will make my child develop fast
29. Breastfeeding promotes bonding of mother and child
30. Breast feed helps me save money as I don’t need to buy
breastmilk

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