Carmen Carrero Gonzalez1, Mariela Suarez-Villa2*, Sandra Milena Cano-Ibarra3, María Claudia Jordán M4, Marrugo Lopez Yennifer Edelia4, Enirys Judith Varela de la Hoz4 and Daina Katherin Ruiz Davila4
1Nutritionist - Dietitian, Clinical Nutrition Specialist, PhD Health Sciences, Research Professor in Nutrition, Universidad Simón Bolívar,Faculty of Health Sciences, Barranquilla, Colombia Associated Colciencias Category, Colombia
2Nurse Master’s in Education, Professor – Researcher, Universidad Simón Bolívar, Faculty of Health Sciences, Barranquilla, Colombia Senior Colciencias Category, Colombia
3Nurse PhD in Science, Master’s in Nursing, Professor – Researcher, Simón Bolívar University, Faculty of Health Sciences, Barranquilla, Colombia Junior Colciencias Category, Colombia
4Young Researcher, Faculty of Health Sciences, Simón Bolívar University, Barranquilla, Colombia
*Corresponding Author: Carmen Carrero Gonzalez, Nutritionist - Dietitian, Clinical Nutrition Specialist, PhD Health Sciences, Research Professor in Nutrition, Universidad Simón Bolívar, Faculty of Health Sciences, Barranquilla, Colombia Associated Colciencias Category, Colombia.
Received: January 03, 2020; Published: February 06, 2020
Citation: Carmen Carrero Gonzalez., et al. “Study of Attitudes, Knowledge and Practices in Breastfeeding in Managers and Non-Managers in Colombian Fertile Age”. Acta Scientific Paediatrics 3.3 (2020):03-08.
Background: Breastfeeding (LM) is the ideal food during the first months of life, LM strengthens the mother-child bond, prevents diseases and has beneficial effects with maturation and development.
Objective: It is based on applying a method to identify the knowledge and attitudes in the topic of Breastfeeding, in non-pregnant women and pregnant women and pregnant women in fertile age.
Material and Method: It was based on a qualitative, descriptive observational, prospective, cross-sectional research in the period from February to May 2019 in two health centers in the city of Barranquilla. The sample population was a total: pregnant women of childbearing age (30) and (30) non-pregnant women, first-time and multi-pregnant, voluntarily participated with prior informed consent, who met the inclusion criteria and who attended outpatient consultation Obstetrics Gynecology. The information was obtained directly, through the application of the validated questionnaire CAP instrument.
Results: The pregnant and multigent pregnant women predominated 18 to 23 years (46.60%), and the non-pregnant women, between 24 and 29 years (50%), 87% primigestas compared to 53% nulliparous, with a socioeconomic level I. In relation to the educational level, non-pregnant women between 24 and 29 years old showed that 100% finished higher education while pregnant women between 18 and 23 years finished high school in a (63.30%) Both groups showed knowledge in the subject.
Conclusion: We still need to promote the LM by health professionals, this requires us a greater commitment of the interdisciplinary team.
Keywords: Breastfeeding; Knowledge; Attitudes; Primitive; Multigesta
The importance of prenatal care during pregnancy is to monitor the evolution of the pregnancy, in order to obtain adequate preparation for childbirth, puerperium and newborn care, which includes the promotion of breastfeeding exclusive for the first six months. Attention to women during pregnancy has a comprehensive approach to education, guidance and counseling, given with quality, warmth and respect [1]. Breast milk is the only food that has nutritional and metabolic characteristics that make it ideal for feeding the newborn, as well as breast milk increases the defenses of the newborn helping to avoid infections [2]; It also provides a psychological exchange, emotional and emotional attachment between the mother and the newborn [3]. According to the World Health Organization (WHO), breastfeeding is feeding the mother's milk and this is the ideal way to provide young children with the nutrients they need for healthy growth and development and at the same time allows Strengthen the maternal bond. It is essential to know that breastfeeding is recommended to be exclusive until the first 6 months of the child's life, and then be part of their diet until 2 years of age [4]. The WHO says that in exclusively breastfed infants, the risk of Death is only 12% in low and middle income countries, compared to the risk of children who were not breastfed, which underlines the potent protective effect of exclusive breastfeeding. On average, infants under six months who are not breastfed are 3 to 4 times more likely to die than those who received breast milk [5]. In itself, the act of breastfeeding contributes to the prevention of infant mortality attributed to malnutrition; for this, it is necessary to promote and inform pregnant women about the benefits of breastfeeding for the mother and the child. One of the measures is the counseling of the health professional.
Through which the primitive mother is guided and accompanied during the onset of breastfeeding and exclusivity until six months of age of the child [6].
Worldwide, only 35% of infants are breastfed during their first four months of life. The literature shows that there are still mothers who do not know its importance. Mothers require more information support from the professional health team, and family support, since they still remain uninformed about certain aspects related to exclusive breastfeeding and breastfeeding techniques, for the proper growth and development of their children. To address this problem, WHO, UNICEF and the Pan American Health Organization (PAHO) have made a series of efforts to promote breastfeeding, among which the creation of the Amigos del Niño y de la Madre Hospitals stands out, training on breastfeeding counseling, the celebration of the world day of LM [7].
While it is true that in some countries breastfeeding has increased, this does not happen worldwide because the time in which babies are breastfed is less and less. Internationally, less than 40% of children under the sixth month of life receive maternal breast as the only food. Adequate guidance and support by health personnel on this issue is essential for mothers and family members to initiate and maintain optimal breastfeeding practices [4]. 38% of children under six months of age in the world receive LM exclusively and 39% of children from 20 to 23 months of extrauterine life benefit from the practice of breastfeeding. “Worldwide, 830,000 deaths of newborns could be avoided every year if all newborns were fed breast milk in the first hour of life. Children who are not breastfed in their first hour of life are 86.5% more likely to die during the neonatal period” [8].
On the other hand in Spain multiple national and international scientific-health institutions recommend the LM during the first six months of life exclusively and keep it until the second year if both the mother and the child want it, together with an adequate establishment of the complementary feeding the final decision regarding the way of feeding the child corresponds to the mother, but health workers must provide parents with adequate information about breastfeeding and its advantages, and provide the necessary support to make breastfeeding a successful experience [9].
Latin America has the best rate of children starting the LM, within the first hour of life. When comparing the rate with other continents, Latin America has 58% compared to 50% in Africa, 50% in Asia and 36% in Eastern Europe. But only in 5 of the 21 Latin American countries for which data are available; this applies to half or more of infants. In addition, none of the countries cover the two years that it is recommended to prolong breastfeeding except for Peru, which has the highest rate in the region with 68.3%, in breastfeeding practices [9]. Peru occupies the first place in LME in Latin America and the Caribbean. The LME, in the first six months of the infant's life, shows national averages that maintain figures towards greater growth: from 68% in 2012, it increased to 72% [10].
In relation to the programs in promotion to the LM, studies are evidenced where the benefits of an educational program in LM are mentioned. For example, in Peru, health workers responsible for comprehensive care of the mother-child binomial play a key role in maintaining breastfeeding. Hence, there is a need for them to be endowed with knowledge and skills to support and protect the LM. In this sense, the Ministry of Health, has taken as a basis the 20hour course of the Initiative Hospital Friend of Children of WHO/ UNICEF, which has been translated and adapted considering the current international and national regulatory framework referred to the subject has developed in coordination with UNICEF –Perú the Workshop Course: “Promotion and support to the LM, in health facilities friendly to the mother and the child” - facilitator's manual, which constitutes an instrument for the training of health personnel in the national level [11].
There are many actions that Peru has implemented to preserve the LME. In 2002, the National Plan of Action for Children and Adolescents 2002 - 2010 is proposed as the first strategic objective: Ensure a healthy life for children aged 0 to 5 years and, within that objective, that all children and girls under 2 years access to breastfeeding and optimal complementary feeding. in 2006, a new Infant Feeding Regulation is promulgated. That same year, the extension of the hour of breastfeeding for working mothers in case of multiple births and the obligation of the Public Sector Institutions to implement lactaries where they work 20 or more women of childbearing age [12].
For Colombia, according to the National Survey of the Food and Nutrition Situation (ENSIN 2010), the total duration of lm was 14.9 months; in which Medellín showed a duration of 10.1 months, so it is considered one of the cities with less duration; on the other hand, the duration of the practice of exclusive breastfeeding is very short and decreases during the first 6 months, from 63% in the first two months of life to 24% at five months. The median duration of exclusive breastfeeding in the country was 1.8 months. In three of the four major cities (Cali, Medellín and Barranquilla) and in the Caribbean region, a duration of exclusive breastfeeding is observed for less than 1 month. According to the mothers, the reasons for the definitive suspension of breastfeeding for children under two years, was mainly because they ran out of milk or because of the child's rejection; and, after 2 years, consider that the child was the age for weaning, followed by the woman's employment [13].
Breastfeeding is a natural act and as a learned behavior, which provides an ideal food for the healthy growth and development of infants; it is also part of the reproductive process with important and beneficial effects on the health of the mother [14]. Some benefits of breastfeeding: develops the emotional bond between the mother and her daughter or son, protects the mother against breast cancer and ovary, and helps you regain the weight before pregnancy, prevents you from spending on other foods for the girl or boy, breast milk is 100% natural and has no risk of contamination, improves the development of the brain, lungs and teeth of the girl or boy, helps functions such as chewing and breathing, feeding with breast milk, your daughter or son grows healthy and strong, with many defenses and without anemia”. The objective of our research was based on to analyze the attitudes, knowledge and practices in breastfeeding in a group of pregnant and non-pregnant women who are primigent and multigests in Colombian fertile age.
A qualitative, descriptive observational, prospective, crosssectional research was carried out in the period from February to May 2019 in two health centers in the city of Barranquilla. The sample population consisted of a total of 60 women (30 pregnant women and 30 non-pregnant primigestas and multigests), who attended an outpatient clinic at the Gynecology-Obstetrics. The sample was taken randomly and at will with prior informed consent, who met the inclusion criteria: women of childbearing age between 18 and 35 years, with a minimum level of study: primary who knew how to read and write to answer the questionnaires of the method of knowledge, attitudes and practice (CAP) [15]. Validated, whose exclusion criteria: under 18 and over 35, women who were selected for the study, but who decide to retire during the investigation, women with postpartum complications. The surveys were conducted by a specialist in clinical nutrition and nursing students in the seventh and eighth semester of the nursing program of the Simón Bolívar University, in the city of Barranquilla, during the morning, two days a week (Tuesday and Thursday) in the programmed health centers. The study is considered a minimum risk, with the ethics committee of the research department of the university institution with the provisions of the scientific, technical and administrative standards that govern the internal standards for research studies No. 00002 of 03/15/2011 Simón Bolívar University [16] Classification of research when it involves human beings as a subject of study, in accordance with the provisions of Article 11 of Resolution 8430 of 1993 of the Ministry of Health [17]. A database was developed in a spreadsheet in SPSS Program [18] Excel. The technique of participatory observation and interview of study subjects was used.
The study was carried out with pregnant women and non-pregnant primigestant and multi-pregnant women of childbearing age, predominantly the group of pregnant women between 18 and 23 years old (46.60%) and the group of non-pregnant women represented (50%) between 24 and 29 years the rest for both groups was occupied by the group of women between 30 and 35 years, with prior informed consent, their participation was voluntary, they were interviewed in two maternal and child health centers in the city of Barranquilla Atlántico. In relation to the educational level, the group of non-pregnant women between 30 and 35 years of age 100% finished their studies of higher education, while younger pregnant women between 24 and 29 years only The study was carried out with pregnant women and non-pregnant primigestant and multi-pregnant women of childbearing age, predominantly the group of pregnant women between 18 and 23 years old (46.60%) and the group of non-pregnant women represented (50%) between 24 and 29 years the rest for both groups was occupied by the group of women between 30 and 35 years, with prior finished high school in a (63.30%). As for the socioeconomic level with the highest percentage in both pregnant and non-pregnant women, it is the socioeconomic stratum I. A questionnaire or CAP survey knowledge, attitudes and practices in relation to the subject of Breastfeeding 15, regarding the level of knowledge attitudes and practice on breastfeeding it was evident that women between 24 - 29 in both groups studied turned out to have a greater degree of knowledge with the highest number of correct answers (60%). Regarding the item: What is colostrum? the option, the type of milk that leaves the breast during the first days (after delivery) with more defenses, it was evident that a high number of the total number of women studied (81%), are aware of the importance of colostrum for your child. Regarding the item: benefits of breastfeeding for you, 34% of women surveyed have knowledge of the benefits of breastfeeding for your health.
Graph 1: Attitude of pregnant and non-pregnant women of childbearing age between 18-35 years of age attending health centers in the city of Barranquilla 2019. Source: Survey
95% of the total number of women surveyed considered that it is important to breastfeed within the first hour of life.
Graph 2: Practice of pregnant and non-pregnant women of childbearing age between 18-35 years of age attending health centers in the city of Barranquilla 2019. Source: Survey.
84% of the women studied said they started breastfeeding within the first hour of life compared to 16% who started after the first hour.
Graph 3 Source: Survey.
79% of women surveyed said they had provided breastfeeding until 6 months of age without including any other type of food.
Graph 4 Source: Survey.
Despite the proven knowledge about the benefits and importance of breastfeeding, mothers do not provide breast milk until 2 years of age with a percentage of 41.6%.
WHO recommends exclusive breastfeeding for six months, and thereafter the introduction of complementary foods, in addition to maintaining breastfeeding up to 2 years? Breastfeeding is one of the most effective ways to ensure the health and survival of children. If this breastfeeding regime is followed up to two years of age, each year around 800,000 child lives would be saved [18]. The level of knowledge about breastfeeding and a correct practice by the mother allows the benefits of the same to be greater compared to those mothers who do not. In the present study it was found that the group of pregnant women and pregnant multigests predominated 18 to 23 years (46.60%), the group of non-pregnant women, between 24 and 29 years (50%), in general 87% in primeval condition, and 53% of nulliparous women, with a socioeconomic level grade I. In relation to the educational level, the group of nonpregnant women between 24 and 29 years old 100% finished their studies of higher education while young pregnant women 18 to 23 years finished secondary school (63.30%); These results were lower than those found by Barakoti., et al. where he obtained that 66% pregnant women studied were educated above the 10th grade year, we also found that 80% of the group of pregnant women were engaged in household chores compared to a 100% of the group of non-pregnant women workers, these results differ from those obtained by Barakoti., et al. 2012 where only 27% were employed [19].
According to UNICEF [20,21] everything a baby needs to grow and develop healthily is in breast milk, so it is considered the perfect food for the first months of his life, within the socio-demographic characteristics that describe the sample, women are presented as a majority within the age group of 20 to 24 years, with 41.9%. 48.4% have high school studies and 38.7% high school, 77.4% [22], in our study we found a relationship at the educational level the group of non-pregnant women between 24 and 29 years 100% finished their higher education studies while that young pregnant women 18 to 23 years finished high school in a (63.30%).
Arizmendi Jaime., et al. 51 women, 17 to 41 years old, participated in their study. Primigestas 23% and multigestas 77%. Basic level of studies 82%, upper middle 18% 23 In our study 66.7% of the women surveyed finished the higher educational level which showed a high knowledge of breastfeeding, That same study revealed that the primigest and multigest women these revealed, strongly agree to give exclusive breastfeeding during the first 6 months: 50%, 3 months 20.9%, 2 months 21.4%, only the first month 18.3% and not breastfeeding 36% [23]. These figures were lower than those found in our study where it was observed that 79% did provide breastfeeding until 6 months of age without including any other type of food. The LM remains the best cost-effective intervention on the health of the individual, so it should be considered a priority objective of public health and not a parenting style, where every effort will be necessary to support mothers in their achievement [24].
According to the study by García Carrion LA [25], he identified in the mothers studied the level of knowledge about breastfeeding in the participants was high in 6.7% and half in 51.7%. These results differ from our study, observing a low level of knowledge about breastfeeding at a younger age, because young women between 18-23 years had a higher number of erroneous answers (30%), in relation to adult women between 24-29 years who demonstrated extensive knowledge about breastfeeding with 55% correct answers.
Ordoñez 2015, in his study where he applied a questionnaire with a sample of 73 mothers, to clarify the knowledge about breastfeeding found that 48% breastfeed with exclusive breast milk until 6 months and those who abandoned it was due to lack of breast milk [26] While Our study revealed that 79% did provide breastfeeding until 6 months of age without including any other type of food.
For his part Guerrero 2016, in his study he applied a questionnaire consisting of 26 questions to a sample of 100 teenage mothers, to specify the knowledge about breastfeeding were the following: Level 1 (bad) corresponds to 55% of the sample, the Level 2 (regular) at 19%, Level 3 (good) at 21% and Level 4 (excellent) at 5% of the sample. Therefore, it is concluded that of the surveyed mothers the highest percentage indicates that they do not have knowledge about Breastfeeding [27]. In our study 66.7% of the women surveyed finished the higher education level which showed a high knowledge of breastfeeding, in addition the group of young women between 18-23 years had a higher number of erroneous answers (30%), in relation to adult women between 2429 years who demonstrated ample knowledge about breastfeeding with 55% correct answers.
On the other hand, Coronado in his study describes that of the total of 107 adolescent mother mothers surveyed, 25% have a high level of knowledge and 20.6% have a low level [28]. Remigio Rafael Gorrita Pérez., et al. [29] study group 1: 67 mothers in whom investigated during the third trimester of pregnancy knowledge about LM, and received education in relation to the topic of breastfeeding and another group that did not receive training in the subject. The time that children in both groups received SCI. In group 1, 33 mothers breastfed their children from 4 to 5 months (49.25%), followed by 19 who breastfed for 6 months (28.36%). In group 2, 28 mothers (41.79%) breastfed for 1 to 3 months, followed by 21 who did it for 4 to 5 months (31.34%), and only 11, for 6 months (16.42%). Our study revealed that women surveyed without prior training revealed that 79% did provide breastfeeding until 6 months of age without including any other type of food.
That same author [29] in another study demonstrated with pregnant women in the third trimester of pregnancy although all the groups showed insufficient knowledge about LM, those that showed worse results were the adolescents (94%), and those that showed a better performance were those older than 35 years, results these that They differ from ours where the group of adult women between 24-29 years of age showed a broad knowledge of breastfeeding with 55% correct answers.
81.7% in our study stated that colostrum is the type of milk that leaves the chest during the first days (after delivery) with more defenses. A study by Barakoti., et al. observed that 69% of pregnant women knew about the role and importance of colostrum for newborns in the health of the child, that same study reveals that 41% stated that it helps the adequate growth of the child and the fight against infection, while 27% felt that it added to good health, but could not specify, 31% did not know [19]. Another study [30] showed similar results, where 83.7% of participants knew that colostrum increases the baby's immunity and 30.2% of mothers reported that it is the first protection against infection.
Study conducted by Bautista-Hu alpa Y., et al. observed that 99% of mothers breastfeed their baby; however, only 28% of mothers provide their child with exclusive breastfeeding and 72% do not provide their child with LME [31]. On the other hand our research revealed that 79% did provide breastfeeding until 6 months of age, not including Other type of food.
The results of the study show that there is still a need to promote breastfeeding by health professionals. Our study concluded that the group of young women 18 to 23 years finished high school in a (63.30%), despite this 79% said they provided Breastfeeding without including another type of food however it is note that it is still necessary implement education programs in Promotion to the benefits of Breastfeeding for both the child and the mother.
The authors declare that they have no conflict of interest in the writing of this article and no patient data appears.
Copyright: © 2020 Carmen Carrero Gonzalez., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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