|Year : 2021 | Volume
| Issue : 1 | Page : 49-54
Breastfeeding knowledge, attitude, and practice among mothers in Al-Taif region, Saudi Arabia
Sultan Abdullah Al-Malki, Bayan Mansour Alnefaie, Morouj Mansor Aljoudi, Raghad Hasan Almosawei
Taif University, College of medicine, Pediatric Department, Taif, Saudi Arabia
|Date of Submission||08-Oct-2020|
|Date of Decision||01-Dec-2020|
|Date of Acceptance||09-Jan-2021|
|Date of Web Publication||02-Apr-2021|
Sultan Abdullah Al-Malki
Assistant Professor, Pediatric Department, College of Medicine, Taif University
Source of Support: None, Conflict of Interest: None
Background: The World Health Organization and other international health organizations have recommended exclusive breastfeeding (BF) for 6 months after birth. In Saudi Arabia, many studies reported that BF duration had regression over the past 30 years. Objectives: The aim of this study was to assess knowledge, attitude, and practice of BF among mothers in the population of Al-Taif region, Saudi Arabia. Materials and Methods: Samples of 300 mothers were called to participate in the study where a self-administrated online questionnaire was designed to collect data on knowledge, attitude, and practice of BF among participants' mothers. Results: The results showed that 98.7% of the participants thought that BF is important for their health, 98% thought that breast milk has immune stimuli for child protection, 91.3% saw that breast milk is a full nutrition child's food, 89% knew the benefits of colostrum, and 64% reported that the child should breastfeed only natural milk for 24 months. Most of the participants (62%) used breast and artificial feeding for their child, and 95.1% reported that they started BF after birth, but only 17% started in <2 h after delivery. There is no significant relationship between the type of infant feeding and educational level, occupation, and family income of the participant and her husband. Conclusion: The study revealed a good knowledge of mothers regarding breast feeding but demonstrated some challenges in their practice and attitude and calls for future studies to assess barriers to breast feeding and how to overcome it in Saudi Arabia.
Keywords: Exclusive breastfeeding, infant growth, mother care, nutritional requirements
|How to cite this article:|
Al-Malki SA, Alnefaie BM, Aljoudi MM, Almosawei RH. Breastfeeding knowledge, attitude, and practice among mothers in Al-Taif region, Saudi Arabia. Saudi J Health Sci 2021;10:49-54
|How to cite this URL:|
Al-Malki SA, Alnefaie BM, Aljoudi MM, Almosawei RH. Breastfeeding knowledge, attitude, and practice among mothers in Al-Taif region, Saudi Arabia. Saudi J Health Sci [serial online] 2021 [cited 2021 Jul 23];10:49-54. Available from: https://www.saudijhealthsci.org/text.asp?2021/10/1/49/312968
| Introduction|| |
Human milk is the best supplies for infants' survival, growth, and development, particularly in unsanitary circumstances. On the other hand, breast milk substitutes carry a high risk of infection and can be detrimental in infants.
Breastfeeding (BF) is associated with a decreased risk of infectious diseases such as otitis media, gastroenteritis, respiratory illness, and other diseases such as sudden infant death syndrome, necrotizing enterocolitis, obesity, and hypertension. Studies indicate that BF helps to improve mothers' health, as well as their children. Exclusive BF has been shown to have substantial health benefits for the mother. It is associated with lactation amenorrhea which is a great choice for contraceptive planning. In addition, mothers who breastfeed their babies are more likely to stay away from certain maternal diseases, for instance, postpartum depression, obesity, type 2 diabetes mellitus, breast cancer, and hypertension.
Breast milk consists of all the nutritional requirements that an infant need in the first 6 months of life. Exclusive BF is defined as providing only breast milk (including milk expressed or from a wet nurse) to the infant for the first 6 months of life, and without giving other food or drink, not even water, but the infant is permitted to receive oral replacement solution, drops, and syrups.
The American Academy of Pediatrics recommends exclusive BF for 6 months and continued BF for at least 12 months; thereafter, it can be continued for as long as the mother and the baby wish.
The World Health Organization (WHO) recommends continued BF up to 2 years of age or beyond, and it has been estimated that optimal BF of children younger than 2 years could annually save the lives of over 800,000 children under 5 years of age. BF has been considered as a crucial method for ensuring best growth and development of children and reducing infant mortality. In addition, BF is the most appropriate method meeting the physiological and psychological needs of an infant. Poor BF practices are common. It is anticipated that misconduct BF, particularly nonexclusive BF in the first 6 months of life, results in more than million deaths and 10% of the health problems burden in children younger than 5 years of age.
Information, education, and communication strategies aimed at behavior change are solutions for successful BF. For such an encouraging campaign to be effective, health givers must improve their health education skills.
In the United States, it has been reported that BF increased from 60% among infants born during 1993–1994 to 77% among infants born during the period between 2005 and 2006.
In Saudi Arabia, the rate of continuation of BF for up to 2 years has declined from 32% in 1987 to 3.2% in 2000, and it was reported, in the same study, that a dropping in trend of exclusive BF from 90% to 50% at the age of 3 months.
Only 0.2% of mothers in Saudi Arabia exclusively breastfeed their infants at 2 years of age.
In our study, we aimed to assess the knowledge, attitude, and practice of BF among mothers in the population of Al-TaifCity, Saudi Arabia.
| Materials and Methods|| |
This was a cross-sectional online survey.
The study duration was 5 months from June 5, 2019, to November 5, 2019.
Al-Taif is a city in Mecca province of Saudi Arabia, at an elevation of 1879 m (6165 ft) on the slopes of the Sarawat Mountain. It has a population of 1,200,000 people and the fifth largest city in Saudi Arabia.
A sample of 300 mothers were called to participate in the online questionnaire study from different primary health-care centers in Taif city where the inclusion criteria were all mothers who have child younger than 2.5 years, and the exclusion criteria were women who do not have children or have their children older than 2.5 years.
Tools and data collection procedure
A self-administrated online pretested questionnaire was designed to collect data on knowledge, attitude, and practice of BF among participants' mothers.
Online consent from mothers was obtained.
The collected data were analyzed using IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Qualitative data were expressed as numbers and percentages, and the Chi-square test was used to test the relationship between variables. Moreover, quantitative data were expressed as mean ± standard deviation, and Kruskal–Wallis test was used to test the relationships between variables. P < 0.05 was considered as statistically significant.
Ethical approval was obtained from the institutional review board (IRB) of the College of Medicine at Taif University. The consent form was attached to the IRB application. We assured the participants that all answers given would be strictly confidential and used for research purposes only. No competing financial interests exist.
| Results|| |
[Table 1] shows that the mean age of the participants was 36.43 ± 9.4 years, and the age of birth of the first baby ranged from 21 to 25 in 46.36% of mothers, and the age of birth for second and third baby ranged from 26 to 30 years in 28.7% and 28.2% of mothers, respectively. In the same time, most of the participants reported not having a fourth baby (50.3%).
|Table 1: Mean age of the participant mothers and age of birth of their babies|
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[Table 2] shows that 68.3% of the participants had university education and 51% of them had work. For their husbands, 49% had university education and 91% had jobs. Most of the participants had a family income that ranged from 7000 to <15,000 rupees.
|Table 2: Distribution of educational level and occupation of the participants and their husbands and their family income|
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According to the knowledge of the participants regarding BF, 98.7% thought that BF is important for their health, 98% thought that breast milk has immune stimuli for child protection, 91.3% saw that breast milk is a full nutrition child's food, 89% knew the benefits of colostrum, and 64% reported that the child should breastfeed only natural milk for 24 months. Seventy percent of the participants said that the number of lactation times in the first month must be 8 times or more, 88.7% thought BF is better than artificial, and 94.7% recommend their friends and relatives to breastfeed [Table 3].
|Table 3: Distribution of knowledge of the participants regarding breastfeeding, and whether they recommend their friends and relatives to breastfeed (n=300)|
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According to the practice of the participants regarding BF, [Table 4] shows that most of the participants (62%) used breast and artificial feeding for their child and 11.7% used the artificial feeding only. For breastfeed mothers, 83% reported that the baby position when BF was the lying position, 89.8% reported that the baby burp after BF, 95.1% reported that they started BF after birth, 17.4% initiated BF within 2 h after delivery, and 68.3% reported that they had some difficulties with BF. For those giving only artificial feeding for their babies, their main reason was being a working mother (48%).
|Table 4: Distribution of breastfeeding mothers according to their practice regarding breastfeeding, and the cause of giving artificial milk according to artificial feeding mothers|
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As regards the participants' attitude toward the duration of BF babies, 51.3%, 36.6%, and 29.4% reported that the duration BF of first, second, and third baby, respectively, should range from 0 to 24 months [Table 5].
|Table 5: Participant's attitude toward the duration of breastfeeding babies (n=265)|
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[Table 6] shows that there was no significant relationship between type of child feeding and the educational level, occupation, and family income of the participant and her husband (P ≥ 0.05).
|Table 6: Relationship between the type of child feeding and the educational level, occupation, and family income of the participant and her husband|
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| Discussion|| |
The present study aimed at assessing knowledge, attitude, and practice of BF among mothers in Al-Taif Saudi Arabia. In our study, we found that the mean age of the participants was 36.43 ± 9.4 years; in the other study which was done in 2017 in Northwest Ethiopia, the mean age was 27.65. The age of birth of the first baby ranged from 21 to 25 years, and the age of birth for second and third baby ranged from 26 to 30 years compared with other studies where the range was for first baby from 14 to 31 years and second baby from 18 to 36 years.
In our study, we found that 89% knew the benefits of colostrum, percentage is higher than what in a study that was done in a tertiary care center in Rajasthan where the percentage of participants who knew the benefits was 75.8%.
In the current study, the benefits of BF were largely accepted by majority of lactating mothers, as 98% felt that it improved immunity. This result concurs with the results of a study that was done among lactating women which revealed that 78% of participants said it improved immunity for child protection.
In the present study, 94.7% of the participants said that they would recommend exclusive BF to their friends and relatives, comparable results were reported by a study done in Rajasthan who found that 86.1% would recommend their relatives. According to which age the child should breastfeed only natural milk, we found the greater part of participants (64%) said until 24 months and around 20% said until 6 months, our result is different from the other study which was done in Rajasthan where the majority said until 6 months (33.9%). Fifty-seven percent of our study mothers have started BF as early as four hours after birth.
In a previous study done in Taif City, Kingdom of Saudi Arabia, 2013, timely initiation BF rate was low 22%, and the prevalence of exclusive BF was 19%, whereas in our study, the initiation of BF immediately after birth (less the first 2 h of life) also found low (only 17% of mothers) and 26% of baby feeding were exclusive BF. Furthermore, we found that the number of mothers who initiated BF in 1st day after birth was 252 of 300, 95.1%, and 13 of 300 (4.9%) of the mothers did not initiate BF after birth.
Herein, this study showed that 68.3% reported having difficulty with BF. Moreover, the most common reason for stopping BF was mother's work (106 of 300, 48%). The study done in Hail district found that the most important factor for early cessation of BF was that 72 of 300 (32.6%) of mothers thought that stopping BF and use of artificial milk is healthier. The other two reasons were the refusal of the baby (34 of 300, 5.4%) and mother's disease (9 of 300, 4.1%) which were the least common factors.
The present work showed that a nonsignificant relationship was found between the type of child feeding and the educational level of the participants despite the high percentage of those who reported using the BF only among those with postgraduate education. Similar results were present in the previous study where more exclusive BF found in university educated mothers as compared with secondary school educated mothers.
In a study done in Malaysia to evaluate the relationship between mothers' educational level and feeding practices among children in Selangor, mothers with high education level did not exclusively breastfeed their infant according to the recommendation (that as at 6 months), the study attributed this to some reasons as that the mother was working, mothers preferred infant formula milk, and the child may be taken care by other people such as maid or grandmother. In our study, there was no significant relationship between the type of child feeding and educational level and occupation.
According to Niger et al., uneducated mothers breastfed their children for a longer duration compared to educated mothers. Our result also well demonstrated that housewife mother and those who worked in governmental occupation had higher percent in BF only than those who are working (29% vs. 21%).
A study was done to find the association between household socioeconomic status (SES), BF, and infants' anthropometric indices. This study showed that duration of BF was significantly higher in the middle SES than the low and the high SES groups. In addition, those with associated degree, bachelors' degree, and university students were less likely to not having 6-month exclusive BF.
Although a nonsignificant relationship was found between the type of child feeding and the family income of the participants, a higher percentage of those who were breastfed exclusively were among mothers of low socioeconomic standard which can be attributed to the free access to BF.
One of the limitations was being a cross-sectional study that showed the relation between variables without concluding a cause–effect relationship.
| Conclusion|| |
The study revealed a good knowledge of mothers regarding BF; however, it showed that only 26% of mothers exclusively breastfed their babies, 17% of them initiated immediate BF, 68% had difficulties with BF. Nearly half of mothers are workers and the work of mothers was found the main reason of giving artificial milk. Furthermore, our study demonstrated no significant relationship between type of child feeding and the educational level, occupation, and family income of the participant and her husband. Therefore, it is imperative to call for future studies to assess challenges and barriers to BF and how to overcome them in Taif City and in Saudi Arabia.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]