Munyes www.iaajournals.

org
IAA Journal of Applied Sciences 10(1):60-75, 2023. ISSN: 2636-7246
©IAAJOURNALS
https://doi.org/10.59298/IAAJAS/2023/5.1.1000

Evaluating the Knowledge, Attitudes, and Practices Regarding Exclusive

Breastfeeding among Mothers at Maternal and Child Health Clinic, Moroto
Regional Referral Hospital, Moroto District

Munyes Susan

Faculty of Clinical Medicine and Dentistry Kampala International University Western

Campus Uganda.

ABSTRACT
This descriptive cross-sectional study aimed to assess the knowledge, attitudes, and
practices regarding exclusive breastfeeding (EBF) among mothers attending the Maternal and
Child Health Clinic at Moroto Regional Referral Hospital. The study was conducted between
November 2020 and April 2021, utilizing systematic random sampling and employing both
qualitative (focused group discussions) and quantitative (closed questionnaires) methods for
data collection. Data collected from 150 participants was analyzed using Microsoft Excel.
Results were summarized using frequency tables, charts, and narrative descriptions. The
majority (90%) of the mothers had prior awareness of EBF, with fellow breastfeeding mothers
(48%) and health workers (31%) being the primary sources of information. A small proportion
(4%) relied on the internet, primarily those educated to a tertiary level. Furthermore, 84%
correctly defined EBF, although 32% did not consider it sufficient for the first six months,
preferring to supplement with other foods. While 65% favored EBF over artificial feeding,
only 32% believed breast milk alone was adequate for the first six months. Mothers expressed
positive attitudes toward EBF, advocating for immediate breastfeeding initiation, on-demand
feeding, and continuation for about two years. However, due to perceived poor maternal
nutrition, some introduced supplementary feeds earlier, compromising the recommended
EBF duration. The study revealed a high level of awareness and positive attitudes toward EBF
among mothers in Moroto. However, despite knowledge about the benefits, some mothers
introduced supplementary feeds earlier than recommended due to concerns about
insufficient breast milk. Continuous outreach programs emphasizing the importance and
proper practices of EBF could help dispel misconceptions and ensure adherence to the
recommended breastfeeding practices.
Keywords: Exclusive breastfeeding, Infants, Mother, Milk, Family planning.

INTRODUCTION
Breastfeeding is an unequalled way of baby to get colostrum and thereafter,
providing ideal food for the healthy exclusive breastfeeding should last for six
growth and development of the infant [1] months of life, day and night for optimal
while exclusive breastfeeding implies a growth, development and health of the
method of feeding infants with only the newborn. Breastfeeding should then
breast milk of their mothers, be it directly continue for a minimum of two years with
from the breast or expressed except drops the introduction of a complementary diet
or syrups consisting of vitamins, mineral only after 6 months [3]. Exclusive
supplements or medicine. This means that breastfeeding has been found to reduce
the baby has no other food or drink but the risk of childhood illnesses such as
breast milk, not even a dummy [2]. The diarrhoea and other gastrointestinal and
World Health Organization recommends respiratory infections amongst other
that breastfeeding should start benefits both to mother and child [4] and
immediately following delivery for the breastfeeding is especially crucial in

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developing countries where many families there was a slight reduction in the
cannot afford alternative or percentages of EBF being at 52 and 56
supplementary nutrition for their children; respectively [10]. There is still much to be
hence saving household resources [5]. The done to protect the valuable function of
historical evolution of infant feeding breastfeeding, the most common method
included wet nursing, feeding bottles and of feeding, the emphasis must be put on
formula use and before the invention of mobilizing and educating mothers on the
bottle and formula feeding, wet nursing importance of exclusive breastfeeding.
was the safest and most common International guidelines recommend that
alternative to the natural mother’s breast women exclusively breastfeed their infants
milk. Society’s negative view of wet for the first six months of life and The
nursing combined with improvements of American Academy of Pediatrics (AAP)
the feeding bottle, availability of animal’s states that exclusive breastfeeding should
milk and advances in formula be the reference or normative module
development gradually led to the against which all alternative health,
substitution of artificial feeding for wet development and all other short- and long-
nursing [6] and thereby brought into term outcomes must be measured.
account the challenges that have been The World Health Assembly (WHA) set a
experienced with other forms of feeding global target to increase the rate of
other than breast feeding. Globally, there exclusive breastfeeding globally to 50% by
has been a decline in breast feeding in the 2025 [11] but globally, only 38% of infants
past decades with only 38 percent of the were found to be exclusively breastfed
infants worldwide being exclusively [12]. In an article published on 27 July
breastfed during the six months of life and 2019 on mapping exclusive breastfeeding
complementary feeding being in Africa between 2000 to 2017, it was
inappropriately introduced either too early shown that in previous national-level
or too late, with nutritionally inadequate or analysis, most countries were not in a
unsafe foods [7]. Additionally, the World position to meet the World Health
Health Organization recommends that Organization global nutrition target of 50%
breastfeeding should start immediately of EBF prevalence by 2025. [13] Even
following delivery for the baby to get though EBF rates have been optimal, in a
colostrum and that following this; report published on August 1 2017
exclusive breastfeeding should last for a breastfeeding scorecard, which evaluated
period of six months of life, day and night 194 nations, it was found that only 40% of
for optimal growth, development and children below six months were being EBF
health of the infant. Thereafter, with no country in the world meeting the
breastfeeding should continue for a recommended standard of EBF [3].
minimum of two years with introduction of Breastfeeding practices in Uganda are
complementary diet after 6 months [3]. contrary to the recommended practices by
Earlier studies conducted across the globe WHO with only 6 in 10 Ugandan children
showed that infants below 6 months who below 6 months being exclusively
were exclusively breast fed between 2000- breastfed [11] and with little
2007 were 38% worldwide ,23% in comprehensive knowledge of the
West/Central Africa, 39% in determinants of these breastfeeding
Eastern/southern Africa 44% in south Asia practices and attitudes of mothers towards
,26% in Middle East/North Africa and 43% breastfeeding. In Moroto district
in East Asia and in the United States, of the approximately 1000 women were noted to
79.2% of women who initiated give birth every year and only 20% of this
breastfeeding, 49.4% were still breast breast fed their babies exclusively,
feeding at 6 months and 27% continued therefore problems associated with lack of
breastfeeding to twelve months [8]; [9]. In exclusive breastfeeding such as
sub-Saharan Africa, more than 60% of EBF malnutrition, diarrhea, failure to thrive,
was being practiced in the countries of lack of mother to child bonding were found
Uganda, Kenya and Burundi. However, in common [11]. In spite of the factthat the
the counties of Tanzania and Rwanda, ministry of health in conjunction with

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Moroto district administration upheld maternal and child health clinics in Moroto
health Education emphasizing Exclusive district to establish the determinants of
Breastfeeding and encouraging maternal EBF in this region and thereby enhance the
co-operation and understanding on this benefits of this mode of feeding to both
matter, less than half of the target has yet mother and child. Therefore, this study
been achieved [14]. This study is therefore will assess knowledge, attitudes and
aimed at assessing the knowledge, practice of exclusive breastfeeding among
attitudes and practices of exclusive breast mothers attending the MCH clinic in the
feeding among mothers attending MRRH district.
METHODOLOGY
Study Design Where n = Estimated minimum sample size
A cross-sectional descriptive study design required
was used to collect qualitative and P= Proportion of a characteristic in a
quantitative data. This design was sample (50.0%]
preferred because it was relatively cheap [15].
and collected diverse data within a short Z=1.96 (for 95% Confidence Interval)
period required to analyze cause-effect e = Margin of error set at 8%
relationships in a representative subset of n = 1.962 x 0.50 (1 – 0.5)/ (0.08)2
a population. n= 3.84160 x 0.25/0.0064
Area of Study n=0.9604/0.0064
The study was conducted in Moroto n =150.0625
Regional Referral Hospital and its n approximately 150 breast feeding
catchment area. mothers.
Study Population Sampling Procedures
The target population was 150 mothers Groups of participants (breastfeeding
who visited the maternal clinic at MRRH women and those who had experience in
weekly. They include lactating women and breastfeeding) were chosen to represent
those with breastfeeding experience the entire population under study. The
between 15-49 years from Moroto district. participants were achieved through
The women were all from different Random selection whereby the researcher
backgrounds, marital status, religion, level visited the hospital in antenatal clinic and
of education but all were residents of whoever was present at time of visit was
Moroto district and its catchment area. interviewed and requested to fill out the
Inclusion criteria questionnaires.
Lactating women and all those who have Data Collection Methods and
had experience of breastfeeding between Management
and are attending MCH clinic at MRRH An introductory letter from the office of
district. the Head of the Department of Research
Exclusion criteria and Ethics Committee (IREC) of KIU was
lactating women and those who have used to assess and create rapport with the
experience of breastfeeding attending relevant offices and stakeholders. The
MCH clinic services at MRRH but refuse to cover letter explains the purpose of the
consent. study. The researcher sought permission
Sample Size Determination from the hospital administration before
Using Kish and Leslie's formula (1965), the accessing respondents. Informed consent
sample size for the general population was from respondents was also obtained.
150 respondents, with a fixed error of 8% Data for this study was collected by use of
and a Confidence Interval at 95%. Since researcher-administered questionnaires
there was no available literature on the and a focus group discussion guide. The
number of women attending the MCH questionnaires were administered to the
clinic, 50% was used to maximize the sampled participants
Sample size. Data Analysis and Presentation
Kish-Leslie (1965) formula: Data was analyzed with the help of
n = z²p (1-p) / E² Microsoft Excel. Percentages were used to
describe socioeconomic status,

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sociocultural practices, maternal with participants and the hospital staff,
characteristics and breastfeeding data capturing skill and developing
practices. interpersonal relationships among
Quality Control themselves and relating accurate
To ensure appropriate quality control and information to the researcher.
prevent missing or erroneous data, the Reliability of instrument
following was employed: Reliability of research instruments refers
Pre-test to the extent to which the results of the
Data collection instruments was pretested study can be reproduced when a similar
on 15 mothers at the nearby Clinics, in methodology is used. The instruments
Moroto district, prior to data collection. used in this study was developed from
The questionnaire was then adjusted and tools used in the assessment of
questions rephrased accordingly. The breastfeeding practices from various
focused group discussion guide was studies around the world.
administered to the same sample Research Ethics
participants that were used in the pretest To ensure acceptability of the student
to verify that the information given researcher to the community, a letter was
explained the quantitative findings. given by the school of medicine and
Training of data collection team dentistry addressed to the administrative
The team was trained on interpretation of authority of the area under study [16].
the questionnaires, social interaction skills
RESULTS
Socio-Demographic Factors. was a factor in terms of the ability of
The socio-demographic factors were; the mothers to afford alternative feeding
mother’s place of residence, the age of the methods for the child likewise the
mother, her religion, marital status, and husband’s education level and
level of education. Employment of mothers employment for the same reason.

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Table 1: Socio-Demographic Characteristics of Breastfeeding Mothers

From table 1 above, the MCH clinic was 27(15%) and then protestants 30(20%) with
attended to by both urban 72(48%) and a few Muslims 12(8%). most of the mothers

Participants’ Number of Percentage (%)

Responce participants
Village 78 52
Place of residence Trading Centre 72 48
15-20 12 8
Age group 21-30 66 44
31-40 72 48

41-45 0 0
Catholic 85 57
Anglican 23 15
Religion
Protestant 30 20
Muslim 12 8
Married 109 73
Divorced 0 0
Marital status Separated 26 17
Single mother 15 10
No formal education 88 59
Mother’s education Primary level 22 15
level Secondary 14 9
Tertiary level 26 17

Employment of father Employed 65 43

Not employed 85 57
No formal education 108 72
father’s education
level Primary 7 5
Secondary 12 8

Tertiary 23 15

Employed 21 14
Employment of mother
Unemployed 129 86

rural 78(52%) mothers in slightly different even though staying in the urban setting
numbers. While the child bearing age were not educated formally 88(59%) with
groups 21-30 66(44%) and 31-40 72(48%) only 26(17%) having reached tertiary level
constituted the majority of the attendees, while others 22(15%) had just reached
there were some young mothers 15-20 primary school as others stopped at
12(8%) but no elderly breast-feeding secondary school. These figures were not
mothers 41-50 0(0%). 109(73%) of the very different from their spouse’s
mothers were married non divorced and education levels. Of these, only 21(14%)
the Separated were 26 (17%) with some were employed and the rest 129(86%) were
Single mother 15(10%). Catholics who were unemployed, also not much of a difference
the majority 85(57%) followed by Anglicans with the husbands’ employment status.

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Mothers stay with their children others who are support staff who are not
When asked whether they stay with their allowed to come to work with their babies.
children all day and night, 78 (52%) of Those who left their children behind were
breastfeeding mothers answered yes and further asked whom they left the children
the rest 72 (48%) of them admitted to have with and for how long, the results were
times when they cannot avoid being away presented on the frequency table and pie
from their babies for example the working chart below.
group especially in private sector and the

Whom Mothers Leave their Children with

whom the babies are left with .

others

Sibling

Grand mother

Babysitter

0 10 20 30 40 50 60

Percentage(%) responders

Figure 1: Whom mothers leave their children with.

As presented above, breastfeeding work whether for short or longer hours.

mothers are comfortable with letting their This particular group is the most
mothers take care of the babies since they predisposed to using formula milk and
are assumed to know what to do from bottled breast milk for two reasons, one
experience and this can go on for several being they can afford and the other is that
hours that’s why grandmothers have the they are expected to work for longer hours
highest 41(577%), followed by siblings without interruptions especially in private
14(19.4%) who may have no choice but to sector so they would keep their babies off
take care of their young brothers or sisters. work premises. Others 6(8.3%) may be left
Babysitters 11(15.3%) are also employed with neighbors, in-laws or friends.
especially for mothers who have to go to

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Length of Time Babies are Left Without Mother

HOURS BABIES ARE LEFT WITHOUT

MOTHER

6%
13%
2
5
19%
62% 10
MORE THAN 10

Figure 2: length of time babies are left without mother.

The data presented on the pie-chart above crying time for the baby and a bother to
shows that these mothers were mostly the caretaker. Those who were away for
away from their babies for 2 hours 10hours 9(12.5%) or more than 10hours
45(62.5%) and in this time they may be out 4(5.6%) where in some sort employed and
fetching water and the baby is either would be expected to work without
sleeping or not necessarily wanting to feed interruptions case in point are the support
so other feeds can be avoided, whereas staff who are not allowed to bring children
14(19.4%) of the mothers would be away to work.
for 5hours that may entail some serious

Table 2: Knowledge of Bf Mothers On EBF

Variable Frequency(n) Percentage(%)
Have you Heard of EBF Yes 135 90
No 15 10

Source of information Fellow breastfeeding mother 65 48

Health worker 42 31

Internet 5 4
Seminar 23 17
Defination of EBF Correct 117 84
In correct 18 16

Time of initiation of Withijn 1 hour 135 100

EBF(HRS)
In 24 hrs 0 0

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I don’t know 0 0
Seen practice of EBF Yes 135 100
No 0 0

Thought of EBF goodness Yes 135 100

No 0 0

Is EBF a family planning Yes 72 53

method
No 38 32

I don’t know 20 15

As presented by the table above 135(90% ) answers were given by 18(16%) of them.
of the mothers had heard of EBF and only Also, of all these mothers 135(100%) who
15(10%) had no idea. Of those who had had heard about EBF knew that a baby
heard about it , Fellow breastfeeding could be initiated on breast milk within 1
mothers were the most providers of hour after birth. similarly, all had seen RBF
information 65(48%) followed by health being practised and thought it was very
workers 42(31%). Internet users were good practice however, some of them did
dotted 5(4%) mostly the educated to not know or think that EBF was a family
tertiary level and this very category had planning method with 38(32%) saying no
attended at least one seminar on the topic while 20(15%) had no idea,luckily majority
23(17%). 117(84%) of these mothers were 72(53%) knew it as a form of family
able to correctly define EBF as In correct planning.

Percieved importance of exclusive breast feeding

Figure 3: Perceived importance of exclusive breast feeding.

On the importance of EBF, mothers were took the day with 56(37%) followed by
asked to choose their best choice of how protection against infection and childhood
they perceived breastfeeding alone malnutrition with 30(22%) .others 25(19%)
without additives and the idea that breast said it strengthens mother-child bond as
milk Contains the right nutrients and water some chose that breastfeeding brings forth

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an intelligent and healthy baby 14(10%), Why won’t you BF a sick child
Protecting the baby against diarrhoea and Like stated above, under no circumstances
Protects against cancer were not popular at could a mother (as they said) not
5(7%) and 3(2%) respectively. breastfeed their child.
Cultural Practices Affecting EBF When a Child refuses to breastfeed?
The data on cultural practices are obtained Normally, children are eager to breastfeed
from 2 groups of 10 mothers engaged in and even when in mild pain breastfeeding
focused group discussions with the distracts them, when a child refuses to
researcher and the data obtained is as breastfeed, there is a serious reason and it
follows; All the randomized women in the could be sickness or traditionally
focused group discussions were bewitched if a suspected witch is in the
Karamojong’s vicinity. So, in most occasions they
Time of BF initiation culturally presume sickness and take to hospital or
There was a consensus in both groups shrine in case of bewitching respectively.
about the time of enrollment of a newborn Others however try giving milk or water in
to breast milk, it being within 1 hour an assumption that baby could get tired of
however variable the exact time in terms of breast milk alone,
minutes since some children may have How many times a day do you BF (day or
difficulties during birth but generally, the night)
timing was uniform. “I can’t count really, since the days are
How long does BF take? different, the child may disturb you today
Sometimes children enrolled to breast milk ay day then another day at night but
may have their mothers fall sick or due to ultimately you have to give the breast” one
domestic violence, and also pregnancy of the FGDs mothers
within same breast-feeding time, the This was in agreement with the rest of the
children may be left under the care of a mothers who said the baby determines
grandmother in most cases who has to find how many times you get to breast feed
other means of breast feeding the children. your baby.
however, without any impediments to the When to introduce other foods.
mother’s health or any of the above, Breastmilk alone is sufficient for the baby
children can breastfeed as far as 2 years. up to some month but some mothers are
Cultural views on breastfeeding challenged with low breast milk due to
Nothing peculiar to Karamojongs was poor feeding and sickly mothers as stated
reported about their culture towards above or even when family disputes occur
breastfeeding. Mothers are taught from and mother leaves her baby behind so the
childhood that they had to breast feed child is given other feeds other than breast
their children therefore breastfeeding was milk. also, by 4-6 month the mothers
a must with no better options. confess that breast milk alone is not
BF a sick child sufficient for the baby so they may need to
Yes, a sick child should be breast feed chip in some supplementary feeds.
except when it refuses, all mothers would What supplementary feeds do you give
not use that as an excuse to not breast feed the baby?
their child I can’t imagine not Many supplementary foods came up like
breastfeeding my child even in sickness, cow or goat milk, soupy Irish, meat and
that could lead to death if you don’t. bean soup, butter, nido, and one of the
only educated mothers there said formula
milk.

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Table 1: Attitude of mothers towards EBF.
Variable Frequency Percentage
What do you prefer to feed your Breastmilk only 48 32
baby for the first 6 months?
Breast milk and other 102 68
foods
Do you think that EBF is better than Yes 97 65
artificial feeding?
No 35 23

I don’t know 18 12

Do you ever believe that the first Yes 0 0

milk (colostrum) should be
discarded? No 150 100
Do you agree that only EBF is Agree 61 41
enough for child up to 6 months?
Disagree 89 59
Are you comfortable with extra Comfortable 104 69
feeding other than breast milk?
I don’t feel comfortable 46 31
Do you agree that child less than 6 Yes 70 47
month who is exclusively breastfed
is healthier than child who takes no 68 45
additional food?
don’t know 19 18

As presented from the table above only EBF is enough for child up to 6 months as
48(32%) saw it sufficient to give breast milk the 61(41%) agreed. Almost similar
alone in the first 6 months while the perception on comfort with extra feeding
majority 102(68%) preferred to add some other than breast milk with 104 (69%)
other foods. When asked if they thought Comfortable and the I don’t feel
that EBF is better than artificial feeding? comfortable were 46(31%).70(47%) agreed
97(65%) answered yes and No was 35(23%) that child less than 6 month who is
while 18(12%) didn’t know. all 150(100%) exclusively breastfed is healthier than
believed that the first milk (colostrum) child who takes additional food while
should be not be discarded however 68(45%) dis not agree but also there were
89(59%) disagreed with the idea that only some who didn’t know 19(18%).

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Challenges of breast feeding

CHALLENGES OF BF
60
50
40
30
20
10
0
BF in public is BF is old Breast feeding No time No challenge
unconfortable fashioned makes one during day at all
loose shape due to work

Frequency Percentage(%)

Figure 4: Challenges of BF.

Mothers had this to say about how they time during the day due to work 36(24%)
feel about breastfeeding generally; while the rest had no challenge at all
Many said breastfeeding makes one lose 40(27%) in their breastfeeding schedule, a
shape 59(39%), others thought BF in public figure that should be encouraged to rise.
is uncomfortable 15(10%) and a few had no
DISCUSSION
The results presented above were breastfeeding mothers were the most
discussed according to the research providers of information 65(48%) followed
objectives; knowledge, attitudes and by health workers 42(31% who in this case
practices of mothers to exclusive together with NGOs with such projects are
breastfeeding. The results were further the primary source of data which gets to
compared to the research done by others the community .Internet users were dotted
on the same aspects. 5(4%) mostly the educated to tertiary level
Knowledge of Breastfeeding Mothers On and this very category had attended at
EBF least one seminar on the topic 23(17%).
As presented in the results on 117(84%) of these mothers where able to
knowledge,the idea of exclusive correctly define EBF as In correct answers
breastfeeding is taking shape in almost all were given by 18(16%) of them. Also,all
areas of the world icluding karamoja these mothers 135(100%) who had heard
especially moroto as per this study with about EBF knew that a baby should be
majority 135(90% ) of the mothers having initiated on breast milk within 1 hour after
heard of EBF compared to only 15(10%) birth. similarly, all had seen RBF being
who had no idea and mirrors the findings practised and thought is was a very good
of a systematic review done in East Africa practice still owing to the good
by [17]. This has been attributed the well dissemination of these empowered
dissemineted information on the subject mothers mostly by NGO programmes that
from the health centre and various groups are fighting malnutrition in Karamoja and
including NGO in the area on EBF giving a Moroto in particular however, some of
good coverage for those that maybe away them did not know or think that EBF was a
at the time to be told by fellow family planning method with 38(32%)
breastfeeding mothers as we see that of saying no while 20(15%) had no idea,
those that had heard about it ,Fellow luckily majority 72(53%) knew it as a form

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of family planning. This is attributed to the formula feeding [21]. When asked if they
fact that some of them get pregnant earlier thought that EBF is better than artificial
than some who are breastfeeding. The idea feeding, 97(65%) answered yes and No was
of family planning using EBF does not stick 35(23%) while 18(12%) didn’t know
because of this discrepancy in preventing somewhat contradicting with the idea of
pregnancy. This is comparable to research them knowing what it entails and
done in India on the same subject with importance. this was attributed to
similar numbers [18]. On the importance of ideologies that since the quality of feeding
EBF, all knew that EBF protects the child by mothers in poverty-stricken areas as
from illness and strengthens him so we seen in the socio-demographics where the
were asked to choose their best choice of majority had no formal education and were
how they perceived breastfeeding alone unemployed, breastmilk alone is
without additives and the idea that breast inadequate, breastmilk, in turn, does not
milk Contains right nutrients and water contain all the nutrients it should
took the day with 56(37%) followed by otherwise contain. This study is in line
protection against infection and childhood with a study carried out in Aminu Kano
malnutrition with 30(22%) .others 25(19%) Teaching Hospital to assess Knowledge,
said it strengthens mother-child bond as Attitude and practices of Exclusive
some chose that breastfeeding brings forth Breastfeeding whereby the majority
an intelligent and healthy baby 14(10%), acknowledged that EBF is better than
Protecting the baby against diarrhoea and artificial breastfeeding [22]. However, in
Protects against cancer was not popular at contrast to the current study, another
5(7%) and 3(2%) respectively. study carried out to assess the Prevalence
This researchs findings on knowledge are of EBF and the associated factors in the
comparable with research done in rural areas of Chad found that most of the
southern ethopia were all the respondents majority did not know whether EBF had
351(100%) knew about what EBF means any advantages over Artificial
from those respondent 295(89.1%) knew breastfeeding [23]. All 150(100%) believed
the duration of EBF is the first 6month and that the first milk (colostrum) should not
23(6.9%) less than 6month. Among the be discarded however 89(59%) disagreed
respondents concerning the importance of with the idea that only EBF is enough for a
EBF 351(100%) knew that breast milk is child up to 6 months and 61(41%) agreed.
important and all knew BF can prevent the Almost similar perceptions on comfort
baby from infection and strengthen the with extra feeding other than breast milk
baby, also 193(55%) of them had with 104 (69%) Comfortable and
knowledge about contraceptive benefit of uncomfortable were 46(31%).70(47%)
exclusive breast feeding [19]. agreed that child less than 6 months who
Attitudes are exclusively breastfed is healthier than
Much as the mothers had knowledge on the a child who takes additional food while
duration, benefits and importance of 68(45%) did not agree but also some didn’t
exclusive breastfeeding only 48(32%) saw know 19(18%). This study is in line with a
it sufficient to give breast milk alone in the study conducted in Ethiopia on Factors
first 6 months while the majority 102(68%) Associated with Early Initiation and
preferred to add some other foods. This is Exclusive Breastfeeding Practices among
in line with a study carried out in Nigeria Mothers of Infant Age Less Than 6 Months
to asses Knowledge and attitude towards whereby the majority of the mother
EBF which found out that majority of the believed that giving extra feeds besides
mothers did not believe that breast milk breast milk was better than breast milk
alone was enough for a baby up to the age alone and child who are given extra feeds
of 6 months [20]. This study is in contrast grow faster and are healthier.
to a study of knowledge, attitude, and The majority of the mothers thought that
practices of exclusive breastfeeding breastfeeding makes one lose shape
carried out in Addis Ababa which found 59(39%), others thought BF in public is
out that most of the mother have positive uncomfortable 15(10%) especially the
attitude on breastfeeding and not accept educated and single mothers and a few had

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no time during the day due to work 36(24%) rich were unlikely to sustain exclusive
while the rest had no challenge at all breastfeeding up to six months; 58% of
40(27%) in their breastfeeding schedule, a women in the poorest quintile practiced
figure that should be encouraged to rise exclusive breastfeeding compared to only
since a positive mentality of mothers 42% in the richest quintile [26]. [4] also
towards breastfeeding as a whole would found wealth status to be importantly
enhance to 100% the subject of exclusive associated with breastfeeding behavior. In
breastfeeding for the standard first six line with the above, all the group
months of life. This study is in agreement discussants agreed to breastfeeding child
with another study carried out in the even in sickness, that not breast feeding
suburbs of Indonesia to assess the attitude could be contributing to a child’s death.
of mothers towards EBF which found that Normally, children are eager to breastfeed
most mothers had mixed feelings and a and even when in mild pain breastfeeding
negative attitude towards EBF [24]. distracts them, when a child refuses to
Practices of Exclusive Breastfeeding breastfeed, there is a serious reason and it
The data on cultural practices as obtained could be sickness or traditionally
from 2 groups of 10 mothers engaged in bewitched if a suspected witch is in the
focused group discussions with the vicinity and this belief is held across the
researcher sited a consensus in both region so they take the child to hospital or
groups about the time of enrollment of a shrine in case of bewitching respectively.
new born to breast milk (1 hour) with Others however try giving milk or water in
variations in minutes depending on the an assumption that baby could get tired of
ease or difficulty of delivery process with breast milk alone.
all children enrolled to breast milk for as “I can’t count really, since the days are
far as 2 years except for those who may different, the child may disturb you
have their mothers fall sick or due to today ay day then another day at night
domestic violence leaving children behind, but ultimately you have to give the
and also pregnancy within same breast- breast”
feeding time, the children may be left One of the FGDs mothers was quoted
under the care of a grandmother in most saying that baby determines how many
cases who has to find other means of times to be breast fed in other words
breast feeding the children say cow milk or stating that breastfeeding is done on
goat milk and sometimes a good Samaritan demand. However, this contradicts
fellow breastfeeding mother. This is in research done by Singh J and friends on the
agreement with research by [25], in 2015 same matter which found out that only 42%
that found out that a woman’s personal of the mothers breastfed on demand
experiences and psychosocial support will possibly because of the alternative feeding
also influence her decision to breast feed. methods available in India that are scares
For example women with supportive if any in Moroto or Karamoja [18].
partners and families are more likely not Breastmilk alone is sufficient for the baby
only to choose to breastfeed but also to up to some months but some mothers are
succeed [25]. Nothing peculiar to challenged with low breast milk due to
Karamojongs was reported about their poor feeding and sickly mothers as stated
culture towards breastfeeding. Mothers above or even when family disputes occur
knew by default from childhood that and mother leaves her baby behind so the
breastfeeding was a must with no better child is given other supplementary feeds
options therefore do not defer much from like cow or goat milk, soupy Irish, meat
the WHO guidelines. These findings agree and bean soup, butter, nido, and formula
with a study conducted in Uganda which milk (as put up by one of the only educated
showed that Mothers in the above the mothers) other than breast milk [27]-[32].
poorest quintile are less likely to practice Also, by 4-6 month the mothers confess
exclusive breastfeeding compared to that breast milk alone is not sufficient for
counterparts in the poorest wealth the baby so they may need to chip in some
quintile. Despite the early initiation, the supplementary feeds [33].

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CONCLUSION
The aspects of knowledge on EBF in Moroto educated counterpart who can afford
and catchment areas are remarkable with formula milk which is not as popular in the
majority of the mothers attending the region,
clinic having the ideas promoted in the Cultural Practices Towards EBF
exclusive breastfeeding campaign The Karamojong culture does not differ
worldwide, however, some of those with from the standard EBF protocol as put up
this knowledge do not follow to the dot by WHO except for the nutritional
and deliberately introduce supplementary inequalities that are widespread in the
feeds earlier for fear that the breast milk is region as a whole.
not sufficient enough due to poor diet in Recommendations
poverty-stricken areas, these skeptics too The health centres in Moroto especially the
need more continued education to regional referral and the many NGOs with
convince them. The knowledge on the such projects on EBF and malnutrition
importance of EBF and breastfeeding as a should be encouraged to continue
whole is universal and therefore puts the impacting mothers with the right
subject area at per with the rest of the information about EBF so that the locals
world. may be convinced further to practice it
Attitudes of Mothers to EBF without doubts of quality of nutrition for
As stated earlier above, the attitude of the baby.
mothers toward EBF is strictly determined Cultural Practices Towards EBF
by their knowledge and social status as Since no cultural gap hindering EBF was
seen in the number that obtained formal found, the community should be
education and those that have encouraged to trust and practice EBF for
employment, they do not have problems the time scheduled without second
breastfeeding their babies but rather with thoughts.
what quality of nutrients the child gets Attitudes of Mothers Towards EBF
given their nature and quality of what they Emphasis on importance of EBF to both the
eat. Even those who fear loss of body shape mother and child should be proclaimed
still breastfeeding as they do not have during outreaches to these mothers or
alternatives as the majority are even when they come to the hospital
uneducated and unemployed unlike their especially MHC.
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CITE AS: Munyes Susan (2023). Evaluating the Knowledge, Attitudes, and Practices
Regarding Exclusive Breastfeeding among Mothers at Maternal and Child Health Clinic,
Moroto Regional Referral Hospital, Moroto District. IAA Journal of Applied Sciences
10(1):60-75. https://doi.org/10.59298/IAAJAS/2023/5.1.1000

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