Knowledge and Practice of Exclusive Breastfeeding Among Mothers of Children Under One Years in Boudha


 Breast milk is the best nutrition for babies to achieve proper, growth and development and is said to be the first immunization, but in content of Nepal only one in two child less than age of six months is exclusively breastfed. So this study helped to find the knowledge and their practice regarding exclusive breastfeeding in women living Boudha area. Methodology: This is quantitative study, done by simple random sampling method. Data collection was done by interviewing 194 mothers in community by using structure questionnaire. The data was entered in SPSS v.22, after cleaning and coding, data were analyzed using chi-square statistical test as well as basic descriptive statistics. Results: This study was conducted among mothers of children under 1 year. Total responded were 194 with mean age and standard derivation of 26, 4.01. The minimum age of 16 years and maximum age of 36 years. Majority of the respondents are literate. Most of the respondents 48.5% are house wife, 44.3% monthly earning is below Rs 25000. All the respondents 100% do breast fed their babies. Good numbers of respondents 96.4% have high knowledge on breastfeeding. There is association between knowledge and practice (P value 0.06) and association between education and knowledge (P value 0.00) as well as there is association between occupation and knowledge (P value 0.047). Moreover, the current study found that there is no association between education and practice. Conclusion: Present study shows that knowledge of exclusive breastfeeding among mothers living in Boudha are good compare to practice. There should be awareness program needed to address to improve their practice also.


Introduction
Breastfeeding is the most paramount way of providing most ideal food for the normal growth and development of infant. Many studies have demonstrated that exclusive breastfeeding for a period six months is the essential way of feeding infants. Subsequently after the period of six months' baby can start complementary or supplementary food along with breastfeeding up to two years of age and beyond.
WHO and UNICEF recommend initiation of breastfeeding within the rst hour of life, exclusive breastfeeding (that is the infant only receives breast milk without any additional food or drink, not even water), and no use of bottles teats or paci ers. (1) Breast milk is the ideal food for a baby; it contains all the nutrients examples carbohydrates, protein, fat, water in their right proportion. Breast milk does not only provide essential feed for babies but it equally contains antibodies that help to ght infections. These antibodies are very important because they are necessary to strengthen the immune system.
Breast milk provides all the energy and nutrients that the infant needs for the rst month of life and it promotes sensory and cognitive development. Exclusive breast feeding lessens infant mortality due to common childhood illnesses such as diarrhea, pneumonia, and help for a quicker recovery during illness.
Breast feeding contributes to the health and well-being of mothers, it helps to space children, reduce risk of Ovarian cancer and breast cancer, increase family and national resources is a secure way of feeding and is safe for environment.

Study Design
The current study is a Quantitative Community based cross sectional which used Simple Random Sampling method.

Research Setting
Boudha is a small locality resided within the capital city of Kathmandu, Nepal. Located about 11 km from the center and northeastern outskirts of Kathmandu. The total population of Kathmandu in 2019 is roughly approximated to 985000. Boudha is ethnically culturally diverse, Hinduism and Buddhism are two primary religions in the city, and Nepali is the most commonly spoken language as well as Nepal Bhasa and English. (6)

Sample Selection
One ward of Boudha is selected using simple random sampling

Data Collection Tool
Interview with the community people by using structure questionnaire Sample Size: According to the National Health Survey Book of Nepal the prevalence of exclusive breast feeding is 66% so, the current study took 66% as the prevalence factor, 7% error with 95% confidence interval. Totally 194 mothers having children under one years were interviewed, with mean age and standard deviation of 26, 4.01. Minimum age was 15-19 years and maximum age was 25-29 years. 64.4% belongs to nuclear family whereas 35.6 %as joint family, 24.7% of the respondents have secondary level of education and only 9.3% have university degree. The majority of the respondents 49.5% were Hindu, 40.2% were Buddhist and rest 10.3% were Christian. Almost 48.5% of the women were housewife and only 1% supported her family by farming.44.3% had monthly income of below 25000 whereas only 7.7% had more than 75000. (68.6%) of the respondents reported that their annual income was su cient for less than three months and only 0.5% reported that their monthly income would be su cient for 6-12 months.  (66.5%) of the respondent's responses that they take permission from family for seeking health service during pregnancy and 33.5% does not. (47.5%) reported that their husband is decision maker for seeking health services whereas 17.5% said their father/mother in law and 35% reported self. During pregnancy 46.4% of women visited health services with their husband, 19.1% visited alone and 6.7% with others relatives of the family. (48.5%) of the respondents had reported that it will take more than 3-5 Km to reach a health facility, 36.6% said 1-3 Km and only 14.9% said more than 6-8 Km.        (67%) of the respondents reported that they are breast feed their child more than 10-12 times in a day while 14.4% breast feed more than ve times in a day. (56.7%) of the mother were reported that weaning ceremony will be conducted after completion of 6 months, 33% said when babies are ve months, 5.7% said 7 months followed by 4.6% said when babies are 8 months.
Based on Figure 1, 96.4% of the mothers have good knowledge towards breast feeding while 3.6% have poor knowledge toward breast feeding. And almost 51% of the respondents had poor practice of breast feeding while 49% have good practice of breast feeding.

Discussion
Through a face to face interview with 194 mothers, the study has found that a good number of respondents 96.4% have high knowledge on breastfeeding while almost 51% of the respondents had poor practice of breast feeding while 49% have good practice of breast feeding. There is association between knowledge and practice (P value 0.06) and association between education and knowledge (P value 0.00) as well as there is association between occupation and knowledge (P value 0.047). Moreover, the current study found that there is no association between education and practice.
While according to Ulka et al. International Breastfeeding Journal 2012 exclusive breastfeeding to children till 6 months is not done properly, but there is high percent of mother who gave colostrum and initiated breastfeeding within one hour of delivery. In contrast to the current study which shows despite the knowledge of mothers on breastfeeding are high but practice was poor but the study which was published in Nepal on 2015 describes about the level of knowledge and practices of exclusive breastfeeding among mothers. During this study knowledge and practices of EBF was quite well among mothers still there is various need to address.

Conclusion
The major conclusion was drawn on the basis of objectives and study ndings. Though many respondents knew advantages of breastfeeding to baby there were indications that certain key messages had not been addressed. The study showed that good knowledge was found in the area of expressing breast milk but still there is lack of good practice. Early introduction of other foods/drinks including semisolid foods was common. There is necessity to promote the knowledge and practice on exclusive breastfeeding among mothers through the provision of health information and supervision from the health personnel, which could be carried out within the existing healthcare system such as the antenatal and vaccination clinics.

Declarations
Ethics: Student Internal Ethical Committee SRM SPH has approved. Competing Interest: I declare no competing interest. Figure 1 The Overall Knowledge and Practice of Breastfeeding