International Journal of Science and Research (IJSR)

ISSN (Online): 2319-7064

Index Copernicus Value (2013): 6.14 | Impact Factor (2013): 4.438

Factors Influencing Exclusive Breastfeeding among

Mother with Infant Age 0-6 Months
Shadia Mohamed Idris1 Amin Gordiano Okwahi Tafeng2, Arafa Elgorashi3

Abstract: Purpose: The health benefits of exclusive breastfeeding (EBF) on survival, growth and development of a child as well as
health and wellbeing of a mother are well documented. The purpose of this study to determine factors affect exclusive breastfeeding
practice. Objective:-The aimed of this study to identify the rate of exclusive breastfeeding and the factors influencing its practice among
infants aged 0-6 months. Material and Methods: 244 mothers with infant's 0-6monthsold were interview at Abu Said South
Administrative Unit Omdurman Locality Khartoum State-Sudan. Results: The rate of continuous exclusive breastfeeding since birth was
38.0% while the rate based on 24 hour recall was 56.7% .In univariate analyses, infant age and infant morbidity, maternal morbidity,
maternal breast health and maternal knowledge on breastfeeding issues had significant associations with exclusive breastfeeding.
Maternal knowledge aspects included; mothers correct knowledge on duration of exclusive breastfeeding ( P=0.005) and P<0.001); In
the logistic regression analyses, infant morbidity ( P=0.01) for continuous EBF since birth and ( P=<0.01) for EBF based on 24 hour
recall was retained as the strongest predictor of exclusive breastfeeding.. Exclusive breastfeeding rate in Abu Said South Administrative
unit Omdurman Locality Sudan was below the level recommended by WHO (90%) although higher than the Sudan national rate (41%).
Conclusions: The study findings indicated that infant morbidity and maternal breast health are important factors to consider in the
messages on the promotion of exclusive breastfeeding.

Keywords: Maternal, Infant health, Mortality, Breastfeeding, Exclusive, Sudan

1. Introduction mother to recuperate before she conceives again. In many

Sub-Saharan Africa societies, exclusive breastfeeding is
Breastfeeding is an unequalled way of providing ideal considered by far the best feeding option for women of
nutrition for the healthy growth and development of infants. unknown HIV status and for most HIV positive mothers,
The global public health recommendation is that infants although it is challenged by low acceptability and
should be exclusively breastfed for the first six months of feasibility(8).
life to achieve optimal growth, development and health (1).
However in all regions the percentage of infants under six
Exclusively breastfed (EBF) means giving only breast milk months receiving the benefits of exclusive breastfeeding is
to the infants, without mixing it with water, other liquids, less than 50% (9).
tea, herbal preparations or food in the first six months of life,
with the exception of vitamins, minerals or medicines (2 ). In the developing world, less than 40 % of infants under 6
months old receive the benefits of exclusive breastfeeding.
Exclusive Breastfeeding for the first six months of an The rate is particularly low in Africa, where less than one
infant’s life is a cost effective intervention in saving third of infants under 6 months old are exclusively breastfed
children’s lives and it is recommended by the WHO (2). (10).

(EBF) infants obtain most of the nutrients required to 1.1Regional Prevalence of EBF
support growth until six months. Vitamin D which is
insufficient in breast milk is supplemented by exposure to In Sudan mortality rates of infants and children younger than
sunlight for the skin to synthesize it while iron and zinc are five years are high (infant mortality rates 57.9 % per 1000
supplemented by prenatal stores (3).Exclusive breastfeeding live births and death rates of children younger than five
in the first six months of life stimulates babies’ immune years is 55.64 % per 1000 live births respectively) while the
systems and protects them from diarrhea and acute prevalence of EBF among infants below six months is low
respiratory infections, two of the major causes of infant (41%) Sudan (11).
mortality in the developing world and improves their
responses to vaccination (4).Exclusive breastfeeding during There has been a major increase in exclusive breast feeding
the initial months of life and continued breastfeeding in 19 African countries including Rwanda (88%), Tanzania
through at least the first year of life is associated with (41%), Ghana (63%), Benin( 70%),Bangladesh (64%),
substantial reduction in the burden of infections (5) (6) (7). Ethiopia (49%) , and Malawi (57%) among others.( 12)
Exclusive breastfed infants have been shown to have lower (13).Countries with low practice of exclusive breastfeeding
rates of acute respiratory infections and diarrhea to have rates include Chad (2%), Cote d’Ivoire (4%), Gabon (6%),
better neuro-developmental outcomes and have better Kenya (32%), and south Sudan (36%) among others (14).
physical growth compared to mixed or non-breastfed
infants.(7) Studies have identified various factors that influence
breastfeeding practices such as inadequate knowledge of the
Breastfeeding reduces the mother's risk of fatal postpartum health benefits of breastfeeding (15)(16); inadequate
hemorrhage, the risk of breast and ovarian cancer, and of antenatal counseling on breastfeeding (17) and belief that
anemia, and by spacing births, breastfeeding allows the breast milk is insufficient (18).A range of maternal and child
health attributes such as marital status, economical status
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 International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Index Copernicus Value (2013): 6.14 | Impact Factor (2013): 4.438
and child age also influence the practice of exclusive investigated.This study therefore obtained information
breastfeeding (19). which would lead to a better understanding of factors
influencing exclusive breastfeeding practice in Abu Said
In Sudan as well as in the targets population and in South Administrative Unit, Omdurman locality, Sudan.
developing countries children are suffered from high risk of
death due to poor infant feeding and malnutrition. Nearly all 1.2. Conceptual framework for the study
women can breastfeed if they are supported to be confident
and aware of good techniques and promotion of practices.In This study adopted WHO conceptual framework on factors
Sudan the determinants of exclusive breast feeding associated with exclusive breastfeeding practices.
especially in resource-poor settings have not been fully

Figure 1: Factors associated with exclusive breastfeeding practices (1).

Breastfeeding is a complex process governed by 2. Result and Discussion

Psychological and Physiological factors which are in turn
conditioned by a wide spectrum of environmental, socio- Table 1: Socio demographic characteristics of Mothers.
economic and cultural factors (20). These factors affect N=244
breastfeeding and exclusive breastfeeding rates in different Characteristics Category n %
directions and to varying degrees depending on culture (21). Less than 18 10 4.1 %
18-24 25 10.2%
While there is a large body of published material on the Mothers Age in 25-34 176 72.1%
factors affecting breastfeeding, there are few studies Years 35-44 29 12%
documenting factors influencing exclusive breastfeeding. A Total 244 100%
fundamental limitation of research in this area is lack of a Married 200 82%
conceptual or theoretical base to guide researchers in Single 31 12.7%
planning their studies or to assist readers to interpret results Marital Status Separated 13 5.3%
in a broad context (22). Total 244 100%
Less than 3 42 17%
4-6 individuals 178 73%
Furthermore there are limited studies especially in Sudan Family size More than 6 25 10%
that have investigated the factors associated with exclusive
Total 244 100%
breast feeding. Single 228 93.4%
State of Child on Twins 16 6.6%
In this study, the framework was used as a guide to birth Total 244 100%
investigate the maternal demographic characteristics Illiterate 3 1.2%
(education, age and marital status), knowledge on Mother’s kalwa 5 2.1%
breastfeeding, maternal morbidity, socio-economic factors Educational level Primary 14 5.7%
(occupation, education
income source and item ownership) and contextual factors Secondary edu. 175 72%
(place of delivery, type of delivery, breastfeeding support University 47 19%
(breastfeeding counseling and sources of information) and Total 244 100%
attitudes and beliefs about breastfeeding practices. Table 1.Shows the Socio demographic characteristics of
Mothers. Majority of mothers age 72.1% were 25-34yrs, (82
%) of the mothers were married, (72%) had secondary
school education.
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Table 2: Illustrate the infant’s Characteristics. N=244 facility, the delivery occurred too fast or because they had
Characteristics Category n % done it with other children.
Male 88 36%
Gender Female 156 64%
Total 244 100%
0-1 month 61 25%
1-2 month 44 18%
Infant age 3-4 month 54 22%
5-6 month 85 35%
Total 244 100%
First 96 40%
Second 40 16%
Infant birth Third 59 24%
Order Fourth and above 48 20%
Total 244 100%
Table .2 represents infant characteristics. 35% were children Figure 1 Represents the Breastfeeding status based on 24
age between 5-6 months, 64% were female’s infants. 40% hours recalls’ definition, the prevalence of exclusive
were first born. breastfeeding was 56.7% (95% CI; 49.3-64.2)

Table 3: Socio-economic Status. N= 244

Factors Category n %
Maternal occupation Housewife 108 44.4%
Casual worker 53 21.6%
Self employed 34 14%
Office worker 46 18%
Total 244 100%
Employed 16 8%
Vocational worker 24 12%
Husband Occupation Casual worker 112 56%
Laborers 48 24%
Total 200 100%
450-749 SDG 55 22.5%
750-949 SDG 117 48%
Maternal Monthly 950-1149 44 18%
income 1150 and above 28 11.5% Figure 2 Shows that continuous exclusive breastfeeding
Total 244 100% since birth rate was 38.0% (95% CI; 30.7-45.3) The
prevalence of continuous exclusive breastfeeding since birth
Table .3 shows Socio-economic Status of the study was 66.7% (95% CI; 59.6-73.8) at 0-1 month, 42.3% (95%
population. (44.4%) were housewives, 21.6% were casual CI; 34.9-49.7) at 1 month, 43.3% (95% CI; 35.9-50.7) at 2
workers and the rest (18%) had regular jobs (employed) and months, 38.9% (95% CI; 31.6-46.2) at 3 months, 21.7%
self-employed (14.0%). (56.0%) of the married women (95% CI; 15.2-27.9) at 4 months and 17.1% (95% CI; 11.5-
reported their husbands were casual workers while those in 22.7) at 5 months.
self-employment were 24.8%, those vocational workers
were 12%. and those employed were 8%. While the monthly
income of the family/ Sudanese Pounds (SDG): most of the
families (48%) had the family income of 750-949
SDG/Month

Table 4: Delivery History of the Mothers:N = (244)

Variable Category n %
Place of delivery Hospital 168 69%
Home 76 31%
Total 244 100%
No. child Delivered Single 225 92%
Twins 19 8%
Total 244 100%
Mother type of delivery Normal 228 93.4% Figure 3 Show the prevalence of exclusive breastfeeding
caesarean 16 6.6% was 84.8% (95% CI; 79.4-90.2) at 0-1 month, 73.1% (95%
Total 244 100% CI; 66.5-79.8), at 1 month, 70.0% (95% CI; 63.1-76.9), at 2
Table. 4 represents delivery history of the mothers. 69% months, 55.6% (95% CI; 48.2-63.1), at 3 months, 30.4%
deliver at hospital. 92% single child and 93.4% have normal (95% CI; 23.5-37.3) at 4 months and 29.3% (95% CI; 22.5-
delivery. Findings from focus group discussions revealed 36.1) at 5 months
that most mothers who gave birth at home did so because
they could not afford to pay for the cost charged at the health

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Table 6: Summary of the main findings on attitudes/perceptions and beliefs on exclusive breastfeeding and common
agreements among the study groups
Main areas of Focus for FGDs Main and common findings on attitudes/perceptions and beliefs among the study groups
Sources of breastfeeding information  Health facility mainly public; Family, friends and peers; Media and Traditional birth attendants
 Exclusively breastfeed for six months
Messages regarding breastfeeding  Initiate breastfeeding within 1 hour after birth
 Clean the breasts before breastfeeding
 Breastfeed the baby on demand
 Breastfeed a baby for 30 minutes
 Breastfeeding mothers should eat a healthy diet
 Breast milk is natural food for babies that contains all nutrients
 Breastfeeding protects babies from illnesses and promotes quick recovery from illnesses
 Breast milk is safe, hygienic and always available
 Exclusively breastfed infants grow healthy and strong
Benefits of exclusive breastfeeding  Breastfeeding enables mother and child to bond
 Breast feeding delays pregnancy in some women
Exclusive breastfeeding practices in  EBF not commonly practiced
Abu said south .
 Supportive husband, parents and friends
 Having breastfed exclusively another child
Factors encouraging mothers to  Having adequate breast milk
practice exclusive breastfeeding for  Attending counseling sessions at the hospital
six months  Mother being available always
 Economically stable mothers have enough to eat and are able to breastfeed exclusively
 Benefits especially to the baby
 Belief that some mothers have inadequate milk
 High levels of poverty in Abu said south
 Unsupportive husbands who drink a lot
 Lack of knowledge on exclusive breastfeeding benefits
Factors discouraging mothers from  Employers do not allow casual workers to carry their babies to work
practicing exclusive breastfeeding for  Exclusive breastfeeding is time consuming and a mother has many tasks to perform
six months  Conceiving within six months after giving birth
 Mothers give in to pressure from family and peers to introduce fluids and food.
 Many infants need water to sooth stomach pain
 Educate mothers and the whole community on benefits of exclusive breastfeeding
 Bring breastfeeding counseling to the community level
Suggestions on how exclusive  Encourage employers to allow casual workers to carry their babies to the place of work
breastfeeding can be improved in Abu  Government to initiate employment opportunities for the community so that mothers can settle
said south down and breastfeed
 Inappropriate to express human milk
Expressing and handling of expressed  Mothers may not get enough milk to express
breast milk  Hygiene standards low in Abu said south to handle expressed breast milk

Table No.6 Emerged from the focus group discussions, hiccups. It was also a common belief that when infants cry a
negative attitudes and beliefs negatively influenced lot even after breastfeeding the child is either hungry or has
exclusive breastfeeding and other infant feeding practices. stomach pains and once given something else they calm
Viewing expressing of breast milk as a taboo denied the down. Some mothers believed that breastfeeding would
mothers the opportunity to express and leave breast milk for cause their so breast to sag or lose shape while others
their infants as they left their homes to go to work. Another believed if they conceived while the child was still
common belief was that mothers do not have adequate breast breastfeeding they had to stop breastfeeding
milk to sustain their infants for six months and also the
belief that the child must take water to quench thirst and stop

Table 7: Maternal morbidity and breastfeeding complications and the relationship with exclusive breastfeeding
Independent variable Continuous EBF EBF 24hrs recall
O.R 95%CI P-value O.R 95%CI P-value
Maternal illness 3.12 1.28-7.62 0.012 2.17 1.03-4.57 0.043
Breastfeeding problem 3.82 1.65-8.86 0.002 4.27 2.06-8.88 < 0.001

Table No7 Agree withIslam et al. (2011), in a study educated on how to overcome problems faced during
involving two study groups, identified mothers sickness breastfeeding so that they can be able to achieve the six
(pain at the operated site), cracked nipples and mastitis, months exclusive breastfeeding as recommended by World
breast abscess and inverted nipples as some of the causative Health Organization.
factors involved in avoidance of breastfeeding. As it
emerges from this and other studies, mothers need to be
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Index Copernicus Value (2013): 6.14 | Impact Factor (2013): 4.438
Table 8: Infant characteristics and their relationship with Table8 shows that the rate is far from reaching the
exclusive breastfeeding recommended level of 90% by WHO/UNICEF for exclusive
Characteristic EBF History EBF 24 hrs. recall breastfeeding of all infants less than six months. There is a
Infant age n % X2 test P-v n % X2 test P-value wide variation in the exclusive breastfeeding rates as
(months) determined by the two definitions in this study. This is
0-1 month 34 55.9 18.391 <0.001 48 79.7 32.910 < 0.001 because the 24 hour recall does not account for feeding
2-3 months 18 41.7 28 64.6 practices beyond the previous 24 hours and therefore giving
4-5 months 10 18.8 16.105 <0.001 16 29.7 30.459 <0.001 an exaggerated rate of exclusive breastfeeding (WHO,
6 months 52 49.5 76 72.9
2008).
group
Table 9: Maternal knowledge score on breastfeeding issues
Characteristic N= 244 Table No 9 .As revealed by the findings of this study
adequate knowledge on exclusive breastfeeding is critical
Continuous EBF since birth n Mean Std T – test p-
for its practice. It is therefore important to improve on
score Deviation value
Yes 151 5.25 1.48 0.012 strategies, education and training on information concerning
No 93 5.80 1.20 0.001 exclusive breastfeeding in order to be able to reach mothers
Non–EBF (24 hrs. Re-call) 105 5.04 1.42 with low knowledge on the benefits and optimal duration of
group exclusive breastfeeding.
EBF based on 24 hrs. recall 139 5.77 1.31 0.001

Table 10: Maternal knowledge on breastfeeding and relationship with exclusive breastfeeding
Independent variable Continuous EBF EBF 24hrs recall
O.R 95%CI P-value O.R 95%CI P-value
Maternal correct knowledge on duration of EBF 2.661 1.345-5.069 0.005 3.418 1.807-6.465 0.001
Maternal knowledge that Breastfeeding protects against pregnancy 1.445 0.755-2.767 0.266 2.092 1.072-4.082 0.030
Maternal knowledge that semi solid/ solid food should be introduced 2.683 1.142-6.306 0.024 3.102 1.450-6.634 0.004
at six months

As presented in table 10. Correct knowledge on duration of knowledge on duration of exclusive breastfeeding were
exclusive breastfeeding was only significantly associated more likely to breastfeed their infants exclusively.
with exclusive breastfeeding as defined using 24 hour recall
(P=0.01).(** Adjusted Odd Ratio (AOR), * significant 4. Recommendations
association)
1) Breastfeeding promotion messages for mothers offered
3. Conclusions should emphasize the importance of prompt health
seeking behavior as maternal and child morbidity
The exclusive breastfeeding rate in Abu said South influenced the practice of EBF; correct knowledge on
Administrative unit Omdurman locality falls way below the breastfeeding issues particularly the health benefits of
level recommended by W.H.O. The highest rates of exclusive breastfeeding.
exclusive breastfeeding are observed up to 3 months then 2) Negative attitudes and beliefs regarding exclusive
they decline to very low rates at 5 months. For the majority breastfeeding should be addressed during counseling by
of the infants, exclusive breastfeeding stops at around 3 the nutritionists, health and community health workers.
months. From the findings of this study, factors that 3) Additional research is required to establish ways of
influenced exclusive breast feeding in the study community improving breastfeeding counseling at the health facility
included; Infant age; Infant health; maternal morbidity; level in order to make it more effective.
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Index Copernicus Value (2013): 6.14 | Impact Factor (2013): 4.438
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