FACTORS ASSOCIATED WITH EXCLUSIVE BREAST FEEDING PRACTICES AMONG MOTHERS OF INFANT AND YOUNG CHILDREN IN A PRIMARY HEALTH CARE CENTRE , KATHMANDU : A CROSS-SECTIONAL STUDY Affiliation

Introduc on Exclusive breast feeding up to first six months of life is the safest and healthiest prac ce for children all over the world. Various factors may affect to the exclusive breast-feeding though it is necessary for promo on of child's health. Objec ve The objec ve of this study was to iden fy the factors associated with exclusive breast feeding prac ces among mothers of infant and young children. Methodology A cross-sec onal study was carried out at Gokarna Primary Health Care Centre, Kathmandu. Total 137 mothers having at least one child 0-23 months of age, a ending to Maternal and Child Health Clinic were purposively selected for the study. Consecu ve sampling was done. All the mothers who meet the criteria during the period of data collec on (August to September, 2017) were included in the study. Ethical clearance was obtained from the Ins tu onal Review Commi ee of Kathmandu Medical College, Kathmandu. Wri en consent was taken from each respondent and face to face interview technique was used to collect the data using pre-designed structured ques onnaire. Data were analyzed using Sta s cal Package for Social Science 16.0 version. Both descrip ve and inferen al sta s cs were used for data analysis. Results Majority of the respondents (56.9%) had adequate knowledge on exclusive breast feeding, about 54% of the mothers had ini ated breast feeding within one hour of delivery and all in all mothers had ever breast fed their child. More than one third (36.5%) of babies were given pre-lacteal fed, around two thirds of babies were breast fed exclusively at least less than one month but only around 40% of the babies had received exclusive breast feeding for six months. Exclusive breast feeding was significantly associated with, normal vaginal delivery, pre-lacteal fed given and having adequate level of knowledge regarding exclusive breast feeding Conclusion On the basis of findings, mode of delivery, pre-lacteal feeding and level of knowledge on exclusive breast feeding were the factors significantly associated with exclusive breast feeding. The prac ce of exclusive breast feeding for six months of age was not up to the mark.


Results
Majority of the respondents (56.9%) had adequate knowledge on exclusive breast feeding, about 54% of the mothers had ini ated breast feeding within one hour of delivery and all in all mothers had ever breast fed their child.More than one third (36.5%) of babies were given pre-lacteal fed, around two thirds of babies were breast fed exclusively at least less than one month but only around 40% of the babies had received exclusive breast feeding for six months.Exclusive breast feeding was significantly associated with, normal vaginal delivery, pre-lacteal fed given and having adequate level of knowledge regarding exclusive breast feeding Conclusion On the basis of findings, mode of delivery, pre-lacteal feeding and level of knowledge on exclusive breast feeding were the factors significantly associated with exclusive breast feeding.The prac ce of exclusive breast feeding for six months of age was not up to the mark.

INTRODUCTION
Breast milk contains all the required nutrients for an infant up to first six months of life.It protects against common childhood diseases such as diarrhea and pneumonia, and may also have longer-term benefits such as lowering mean blood pressure and cholesterol, and reducing the 1 prevalence of obesity and type-2 diabetes mellitus.Exclusive breast feeding for 6 months has many benefits for the infant as well as mother.It protects against gastrointes nal infec ons which is evidenced not only in developing but also developed countries.Early ini a on of breast feeding within one hour of birth protects the neonate from many infec ons and reduces neonatal 2 mortality.
"Exclusive breast feeding (EBF) means that the infant receives only breast milk, no other liquids or solids are given -not even water -with the excep on of oral rehydra on solu on, or drops/syrups of vitamins, minerals 1 or medicines".For a child to be exclusively breast fed there should not be any pre-lacteal feeding of anything solid or liquid other than breast milk, medica ons or vitamins.Giving even a small amount water, gripe water, juice or porridge to infant is not considered "exclusive breast feeding."This recommenda on is worldwide irrespec ve of 3 development and socio-economic status of countries.To achieve op mal growth and development, WHO recommends infants should be exclusively breast fed for up to first six months of life.Therea er, infants should be given nutri onally adequate and safe complementary foods, 1 with con nuing breast feed for up to two years or more.Worldwide, about 40% of infants 0-6 months are 2 exclusively breast fed.
According to the findings of Nepal Demographic Health Survey 2016, Breast feeding is quite common in our country.Almost all (99%) of children have ever breast fed in Nepal and more than half (55%) of children are breast fed within the first hour of life.Though pre-lacteal is not recommended, about one third (30%) of children who were ever breast fed received a pre-lacteal feed.Two-thirds 4 (66%) of children under six months are exclusively breast fed.
A study on Breast feeding prac ces and associated factors was conducted in 2014 in Bhaktapur in which age of child, educa onal status, religion, occupa on and level of knowledge on breast feeding were found as the significant 5 factors associated with breast feeding.Though it is essen al in the promo on of child's health, various factors may affect to discon nue the exclusive breast feeding prac ces.In order to increase the rate of exclusive breast feeding, the factors hindering to this prac ce should be explored.Many studies have been done on breast feeding prac ces in Nepal however, we found very few studies related to exclusive breast feeding.Further specula on on this ma er is needed.Thus, this study was carried out to iden fy the factors associated with exclusive breast feeding prac ces among mothers of infants and young children in a Primary Health Care Centre of Kathmandu.

METHODOLOGY
A cross-sec onal study was conducted at Gokarna Primary Health Care Centre (PHCC), Kathmandu, Nepal.Mothers from various demographical characteris cs and backgrounds visit here for maternal and child health (MCH) services.A variety of informa on can be collected regarding the research topic.So the researchers had purposefully selected this area as the study se ng.All the mothers having at least one child 0-23 months, and a ending to MCH clinic and willing to par cipate were the study popula on.We excluded the mothers a ending to MCH clinic but do not have child or have child more than 2 years.We had taken socio-demographic and obstetrical characteris cs of the respondents as independent variables and prac ce of exclusive breast feeding as outcome variable.Total 137 mothers who met the inclusion criteria during one month data collec on period were selected for the study by using consecu ve sampling technique.Forty one women had less than six months child and 96 women had 6-23 months child.Structured ques onnaire was designed in order to collect the necessary data.Ques onnaire was divided into three parts: part I consis ng of socio-demographic variables, part II consis ng of awareness regarding Exclusive Breast feeding and part III consis ng of prac ces of Exclusive Breast feeding.Face to face interview technique was used to collect the data.Data collec on was done from August to September, 2017.For the ethical considera on, approval for the study was obtained from ins tu onal review commi ee of Kathmandu Medical College, permission for data collec on was taken from the concerned authority of Gokarna PHCC and wri en consent was obtained from each respondents of the study.All the collected data were entered in Epidata version3.1 and were analyzed using Sta s cal Package for Social Science (SPSS) 16.0 version.Both descrip ve and inferen al sta s cs were used for data analysis.Socio-demographic and obstetrical informa on of the respondents were presented in frequency and percentage.For knowledge regarding exclusive breast feeding, one score for each correct response was given, and more than 50% of total score was considered as adequate level of knowledge and less than 50% was considered as inadequate knowledge.Chi-square test was used for analysis of associa on between the demographic variables with the prac ce of exclusive breast feeding.P-value of <0.05 was considered as sta s cally significant.

RESULTS
Socio-demographic profile of the respondents is illustrated in table 1. Majority of the respondents (62%) were between age group of 20 to 30 years with the Mean ± S.D= 25.09 ± 5.55 years.According to ethnicity of the respondents, majority (68.6%) were Janja followed by Brahmin and Chhetri (21.9%).Among the Janja most of the respondents were Tamang.Likewise, majority (62.2%) of the respondents were Hindus and 29.2% were Buddhists.Regarding educa onal status of the respondents, 38.6% had primary level and 36.6% had secondary level educa on.Similarly, 26.3% of the respondents had never been to school.By occupa on, majority of the respondents (54.7%) were homemaker followed by 25.5% daily laborer.On the basis of type of family, more than two thirds (71.5%) of the respondents belonged to nuclear family.Around 60% of the respondents had one child.Among them 70% had child of age 6 to 23 months.Majority (76.6%) of the respondents had ins tu onal delivery among which 85.4% had normal vaginal delivery.Most (88.3%) of the respondents had gone for antenatal check up and majority (76.9%) had received advise on exclusive breas eeding during the visit.(Table 2) Majority of the respondents (56.9%) had adequate knowledge on exclusive breas eeding (Table 3).Prac ce regarding breas eeding and exclusive breas eeding is presented in table 4. Majority (54%) of the mothers had ini ated breas eeding within one hour of delivery.More than one third (36.5%) of babies were given pre-lacteal fed and most (86%) of them were given formula feed (Lactogen) as pre-lacteal feed.Around two third (64.9%) of the babies   were breast fed exclusively for at least less than one month but only around 40% of the babies had received exclusive breast feeding for six months.More than 90% of the mothers were breast feeding their child con nuously up to 23 months of age.
Chi-square test was applied to iden fy the factors associated with exclusive breast feeding prac ces.There was no sta s cally significant associa on between exclusive breast feeding and the age, ethnicity, religion, educa on, occupa on, antenatal visits, advice on exclusive breast feeding during ANC, number of children and age of current child.Exclusive breast feeding was significantly associated with normal vaginal delivery, pre-lacteal fed given and having adequate knowledge regarding exclusive breast feeding.(Table 5)

DISCUSSION
Exclusive breas eeding prac ce during the first six months of life is considered as the most effec ve interven on for 6 preven ng childhood morbidity and mortality.The World Health Organiza on (WHO) es mates that a lack of exclusive breas eeding for the first six months of life contributes to about 800,000 preventable child deaths 7 worldwide each year.
A na onal infant and young child feeding /breas eeding policy of Nepal has recommended that infants should be exclusive breas ed for the first six months and complementary feeding to be started a er six months with 8 con nued breas eeding up to 2 years and more.Strategy for Infant and Young Child Feeding: Nepal 2014 has set targets to increase early ini a on of breas eeding rate, within one hour birth from 45% to 65%, increase exclusive breas eeding rate (<6 months) from 70% to 80%, and maintain the rate of con nued breas eeding up to 2 years 9 at above 93% by 2020.
The findings of the study revealed that majority of the respondents (62%) were between age group of 20 to 30 years with the Mean ± S.D= 25.09 ± 5.55 years, majority (68.6%) were Janja likewise, majority (62.2%) of the respondents were Hindu and majority of the respondents (54.7%) were homemaker.Around 70% of the respondents had child of age 6 to 23 months.Majority (76.6%) of the respondents had ins tu onal delivery among which 85.4% had normal vaginal delivery.Majority of the respondents ( 5 6 .9 % ) h a d a d e q u ate k n o w l e d ge o n exc l u s i ve breas eeding, about 54% of the mothers had ini ated breas eeding within one hour of delivery and all in all mothers had ever breas ed their child.More than one third (36.5%) of babies were given pre-lacteal fed and around 40% of the babies had received exclusive breas eeding for six months.
Socio-demographic findings of the present study showed that majority of the respondents (62%) were between age group of 20 to 30 years, 62.2% were Hindus, 26.3% were never been to school and majority of the respondents (54.7%) were homemaker by occupa on.The findings was consistent with the findings of a study conducted in Bhaktapur, Nepal where majority (76.6%) of the respondents were from age group 20-30 years, around 83.0% were Hindus, 25.8% could not read and write, and 5 62.8% respondents were house-wives.
The findings of this study related to prac ce on breas eeding showed that majority (54%) of the mothers had ini ated breas eeding within one hour of delivery, more than one third (36.5%) of babies were given pre-lacteal feed, around two thirds (64.9%) of the babies were breas ed exclusively at least less than one month but only around 40% of the babies had received exclusive breas eeding for up to first six months of life and more than 90% of the mothers had breas ed their child con nuously up to 23 months of age.Most of these findings were comparable with the findings of In this study, there was no significant associa on of exclusive breas eeding with educa onal status of mother, occupa on of mother, and advice on EBF during ANC.In contrast, a study on exclusive breas eeding and associated factors among mothers showed that educa onal status of the mother and her husband, employment status of mother, counseling on breas eeding during ANC, infant feeding counseling during PNC, were significantly associated with 10 EBF.In the present study exclusive breas eeding was significantly associated with normal vaginal mode of delivery, pre-lacteal feeding and knowledge regarding exclusive breas eeding.The result was comparable with the

CONCLUSION
On the basis of findings, it can be concluded that exclusive breas eeding was significantly associated with normal vaginal delivery, pre-lacteal fed given and knowledge regarding exclusive breas eeding.Sta s cally significant associa on of exclusive breas eeding prac ce was not found with other socio-demographic variables.Though breas eeding prac ce was found to be good, rate of absolute exclusive breas eeding for six months of age is quite low.Many mothers are s ll unaware about exclusive breas eeding and its importance.Awareness programmes on importance of exclusive breas eeding are essen al in the community to increase the rate of exclusive breas eeding and to reduce the avoidable risk of morbidi es and mortali es among infants and young children.

LIMITATION OF THE STUDY
This study was carried out in a very small sample size.Study unit was selected by using purposive sampling technique.
So, the findings of the study may not represent the whole popula on.

RECOMMENDATIONS
Similar studies can be conducted using larger sample size.
Hospital based prospec ve study can also be done regarding the topic.Awareness programmes on importance of exclusive breas eeding are essen al in the community to increase the rate of exclusive breas eeding.

breast feeding for six months (n=96*)
*Dura on of EBF was analyzed among mothers of 6-23 months children only

Table 5 :
Associa on of exclusive breas eeding up to six months with selected variables Similarly, the finding was consistent with a study done in central Nepal which showed that caesarean delivery was significantly associated with exclusive breas eeding 11cessa on.