Comparison of knowledge, attitudes and practices on exclusive breastfeeding between primiparous and multiparous mothers attending Wajir District hospital, Wajir County, Kenya: a cross-sectional analytical study

Mohamed et al. International Breastfeeding Journal (2018) 13:11 https://doi.org/10.1186/s13006-018-0151-3 RESEARCH Open Access Comparison of knowledge, attitudes and practices on exclusive breastfeeding between primiparous and multiparous mothers attending Wajir District hospital, Wajir County, Kenya: a cross-sectional analytical study Mahat Jimale Mohamed1*, Sophie Ochola1 and Victor O. Owino2 Abstract Background: Exclusive breastfeeding (EBF) is recommended for 6 months of age, with continued breastfeeding for 2 years of age or beyond. There is paucity of information on the disparity in Knowledge, Attitudes and Practices (KAP) on EBF between primiparous and multiparous mothers. This study compared the KAP on EBF between primiparous and multiparous mothers attending Wajir County Hospital, Wajir County, Kenya and investigated the association between maternal knowledge and attitudes and EBF. Methods: Information on maternal KAP on EBF was collected through structured researcher administered questionnaires for a total of 281 mothers, recruited from a maternal and child health centre in 2014; primiparous (n = 137) and multiparous (n = 144) with infants 0–5 months of age. Maternal knowledge and attitudes on various aspects of breastfeeding were determined. The knowledge and attitude scores were also calculated. The practice of EBF was determined based on a 24-h recall. Results: The prevalence of EBF among infants 0–5 months old was 45.5%. The rate of EBF among primiparous mothers was 39.4% and multiparous mothers 49.3%. The knowledge score on breastfeeding (out of a total of 10) for the primiparous mothers was 7.93 ± 2.10 and 7.49 ± 2.20 for the multiparous mothers. The mean attitude score (out of a total score of 40) for the primiparous mothers was 29.46 ± 5.65 and 28.65 ± 6.40 for the multiparous mothers. The prevalence of EBF and maternal knowledge and attitudes towards breastfeeding was similar among the two groups of mothers. Those mothers with positive attitudes towards breastfeeding were more likely to EBF (Fisher’s exact test; p = 0.00) compared with those with lower scores. Conclusions: Interventions to promote exclusive breastfeeding should be tailored to the needs of each population by identifying the factors that influence the practice in a given context. The findings of this study will be useful particularly for behavior change communication interventions by those organizations working in similar circumstances to the study area. Keywords: Knowledge, Attitude and practices (KAP), Primiparous mothers, Multiparous mothers, Exclusive breastfeeding, Kenya * Correspondence: 1 Department of Food, Nutrition and Dietetics, Kenyatta University, P.O BOX 438433, Nairobi 00100, Kenya Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Mohamed et al. International Breastfeeding Journal (2018) 13:11 Background The WHO and UNICEF recommend exclusive breastfeeding (EBF) for the first 6 months of life [1]. Exclusive breastfeeding is defined as giving no other food or drink to the infant, not even water, except breast milk (including milk expressed or from a wet nurse) for the first 6 months of life, but allows the infant to receive ORS (oral replacement solution), drops and syrups (vitamins, minerals and medicines) [2]. The World Health Assembly (WHA) has set a global target to increase the rate of exclusive breastfeeding globally to 50% by 2025 [3]. Exclusive breastfeeding is regarded as one of the most powerful tools policy-makers have at their disposal to improve the health of their population and economies [4]. Globally, only 38% of infants are exclusively breastfed [5]. In East Africa, the EBF rates are quite impressive with Rwanda (84.9%), Burundi (69.3%), Uganda (63.2%), Kenya (61.4%) and Tanzania (50%) all having more than half of the infants 0–5 months old exclusively breastfed [5]. Despite the recent increase in EBF to 61.4% [6] from 32% [7], Kenya has the second lowest rate among the East African countries. Exclusive breastfeeding rates in Wajir County Kenya, the study site is 43.6% which is way below the national rate and the WHO target of 90% [8]. In Kenya, the Ministry of Health targets an annual increase of 3% for the country translating to a rate of 56% by the years 2016/2017 [9]. The Kenya National Nutrition Action Plan 2012–2017 has mainstreamed promotion of exclusive breastfeeding as one of the priority nutrition interventions in the country [9]. Currently, Infant and Young Child Feeding (IYCF) counselling is conducted at government health facilities during growth monitoring and promotion of children less than 5 years of age to mothers and/or caregivers of children already at risk of malnutrition. Counselling on IYCF has also been included in the roles of Community Health Volunteers (CHVs) under the umbrella of the “Community Health Strategy”. Other community based initiatives include the Baby Friendly Community Initiative and Mother-to-Mother Support groups [9]. Primigravidas are regarded as a vulnerable group in which insufficient messages may lead to decreased chances to achieve EBF [10]. Primigravidas are more accepting of non-scientific health promotion messages received through various sources [11]. Primiparous mothers, compared to multiparous mothers, have been observed to have more challenges in practicing EBF being their first experience. Primiparous mothers are less likely to practice exclusive breastfeeding through to 6 months and less likely to breastfeed for 2 years and more [12]. They may have difficulties in adjusting to the new role and less breastfeeding skills [13]. Among the primiparous mothers, factors shown to influence or predict EBF are breastfeeding self-efficacy, breastfeeding outcome expectancy, sociocultural factors and early initiation of breastfeeding [14]. Page 2 of 10 Many studies have demonstrated that multiparity is associated with longer exclusive breastfeeding [15–19]. Studies have shown that breastfeeding duration increases with increasing parity and this may be because of previous breastfeeding experiences [20–22]. In contrast, some studies have shown that parity has no significant influence on duration of breastfeeding [23]. No studies have been conducted in Kenya comparing the Knowledge, Attitudes and Practice (KAP) of EBF among primiparous and multiparous mothers. This study therefore compare (...truncated)