A Comparative Study of The Practice of Exclusive Breastfeeding as Related to the Type of Health Care Provider Assisting Delivery.

Abstract

This study is an investigation of one of the known factors that contribute to the high incidence of infant diarrhoea and malnutrition, the low level of the practice of 'exclusive breast-feeding'. Breast-feeding practice^ were studied in mothers who were assisted at delivery by different types of care provider in the Akwapim South District of the Eastern Region of Ghana. In the Akwapim South District, there is a high incidence of diarrhoea and malnutrition in infants (MOH. Annual Report, Akwapim South District 1997). The practice of exclusive breast-feeding is known to significantly reduce the incidence of diarrhoea and some of the other causes of high infant and under-five mortality and morbidity, and is one way of addressing this health problem (UNICEF, 1990). However health workers are only now seriously advocating this practice in an attempt to increase the presently unacceptable low level of the practice in Ghana. This objective is being achieved through training of health workers, which equips them with the ability to educate and help mothers to breast-feed exclusively. The different levels of training given different categories of health care providers in exclusive breast-feeding gives them varying degrees of capability to ensure that all babies are exclusively breast-fed from birth till they are at least six months old. The main objective of the study is to compare the influence of health care providers who assist mothers during delivery on the practice of exclusive breast-feeding with the view of investigating the ability of the health service to address the problem of poor infant feeding practices. The study was cross-sectional and comparative in that it considered prevalence of the practice of exclusive breast-feeding as related to the type of health care provider who gave assistance to the mother during delivery. A structured questionnaire and an interview guide were used as tools for data collection from mothers of children aged six to twelve months and service providers respectively. The major findings and (jonclusions of the study were: | ♦ Mothers who were assisted at delivery by orthodox medical practitioners were three times as likely to practise exclusive breast-feeding of their infants from birth till six months as those who were assisted by trained traditional birth attendants ♦ Mothers who were assisted at delivery by trained traditional birth attendants were three times as likely to practise exclusive breast-feeding of their infants from birth till six months as those who were assisted by untrained traditional birth attendants or other sources of assistance ♦ Trained traditional birth attendants still have inadequate or incorrect knowledge attitudes and practices in the promotion of exclusive breast-feeding despite their training ♦ Majority of the orthodox practitioners in the Akwapim South District have the right knowledge, attitudes and practices to promote exclusive breast-feeding. ♦ The communities in the Akwapim South District, particularly mothers and grandmothers need to have intensive health education on exclusive breast-feeding. The major recommendation made from the study were: ♦ The Ministry of Health needs to continue to train and update the TBA's in the country. They should be equipped with the required knowledge to enable them perform as well as the midwives in the district did. ♦ The district health administration needs to organise health education on exclusive breast-feeding not only for the mothers but also their husbands and the grandmothers of the infants for them fo have complete acceptance of exclusive breast-feeding. ♦ The midwives in the district need to use supervisory visits they make to TBA outfits to refresh their minds on the subject and also as a means for the TBA's to voice their problems including any misunderstandings they may have on the topic. ♦ The DHMT should draw up a program to retrain the TBA's t,j address their problems jf wrong knowledge, attitudes and practices. ♦ MCH staff should be fully involved in the program to ensure that their supervisory I 1 and monitory activities are effective ♦ The District Assembly and other institutions that are involved in development activities in the district should be involved in the activities to ensure thorough information dissemination to all community members. ♦ The untrained birth attendants should be included in the education campaigns as from the study, they had very little or no knowledge ♦ Health education at the antenatal clinics must be intensified such that even the mothers who attend limited number of clinics will be well informed.