CHAPTER ONE

INTRODUCTION

Background to the Study

Weaning is the introduction of supplementary food to a child’s diet after the first six months of

life. Infant weaning with supplementary feeds of breast milk substitutes, early introduction of

complementary feeding and incorrect weaning from breast milk are commonly found practices in

communities around the world (Inayati, Scherbaum, Purwestri, Hormann, Wirawan, Suryantan,

Hartono, Bloem, Pangaribuan, Biesalki, Hoffmann, & Bellows, 2022). The period of weaning

could involve a lot of problems and usually information gap exist in relation to how and when

weaning takes place. Adequate nutrition during infancy and early childhood is essential for

growth and development of children (Ashmika, Deerajen, Prity & Rajesh, 2023). It has been

recognized worldwide that weaning is beneficial for both the mother and child as breastmilk is

considered the best source of nutrition for an infant (Ku & Chow, 2020). The World Health

Organization (WHO) as said by Hanif recommends that infants should be exclusively breastfed

for the first six months after which complementary foods are introduced along with breastmilk

for up to two years of age or beyond. The first two years of life are critical stages for a child’s

growth and development. Any damage caused by nutritional deficiencies during this period

could lead to impaired cognitive development, compromised educational achievement and low

economic productivity (Kimani-Murage, Madise, Fotso, Kyobutungi, Mutau, Gitau & Yatich,

2021).

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Poor weaning and complementary feeding practices, together with high rates of morbidity from

infectious diseases are the prime proximate causes of malnutrition in the first two years of life.

Weaning confers both short-term and long-term benefits to a child. It reduces infections and

mortality among infants, improves mental and motor development, and protects against obesity

and metabolic diseases later in life (WHO, 2020). According to Kimani-Murage et al., (2021),

the WHO recommends exclusive weaning in the first six months, beginning from the first hour

of life, to meet the infant’s nutritional requirements and achieve optimal growth, development

and health. The mother is advised to continue weaning up to two years of age or more and begin

nutritionally adequate, safe, and appropriately-fed complementary foods at the age of six months

in order to meet the evolving needs of the growing infant. Since weaning is a process by which

food other than breast milk is introduced gradually into baby’s diet, first to complement the

breast milk and then to wean totally off breast milk involve selecting light nutritious food for

easy absorption. Then later replace light nutritious food with thicker feed using hygiene practices

when preparing them but majority of nutrition problems in rural areas are due to faulty weaning

food (Shadia & Bedor, 2023).

Predictors of weaning and weaning practices vary between and within countries. Factors that

influence the weaning process include infant feeding problems such as refusal to eat, colic,

diarrhea and vomiting (Ashmika et al., 2023). These factors represent challenges for mothers and

in turn may either directly or indirectly influence the feeding pattern. In view of the identified

factors, which are early introduction of complementary feeding and incorrect weaning from

breast milk, the researcher would carry out a study on infant weaning knowledge and practices

among mothers in Elele community, Rivers State.

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Statement of the Problem

Weaning has been one of the most wrongly practiced processes in the developmental stages of

the children. It was observed that mothers give their infant other food apart from breast milk

right from birth while some delayed supplementary diet till above Nine months with either case

having negative effect on the infant. WHO (Hanif, 2021) recommends a gradual weaning period

from 6 months to 2 years, this allows for the child to still receive the benefits from weaning,

while also consuming the necessary nutrients from the complementary foods. But almost half of

the mothers (52%) abruptly weaned their children while only 11.6% gradually weaned their

children as complementary food is being added to the children diet (Somiya, 2024). The time of

weaning is one of the most critical aspects of child's life. It is the transition period at which the

child whose main food used to be milk changes over to adult food. Usually if this period of

change in diet is well-planned and progresses smoothly, there will be no setbacks, but in a large

number of children, malnutrition usually takes place during this period. Ten million children

under the age of 5 years old die each year (Somiya, 2024). More than half of the deaths occur

because of poor weaning that leads to malnutrition. If adequate health systems were in place

nearly two-third of the deaths could be prevented. The most vulnerable period for developing

under-nutrition remains the transition from weaning to family foods. Malnourished children

often suffer the loss of precious mental capacities. They fall ill more often. If they survive, they

may grow up with lasting mental or physical disabilities (Dinesh & Sushilkumar, 2021).

3
Poor quality of weaning foods and improper weaning practices predispose infants to

malnutrition, growth retardation, infection, diseases and high mortality (Somiya, 2024). Food is

expected to be prepared adequately containing the required nutrients as well as appropriate with

a suitable texture and temperature. Without the knowledge of proper weaning practices as well as

a perception of the child’s hunger needs, malnutrition and illness may ensue. Thus, the weaning

period is therefore a vulnerable time when the child should be attentively cared for and observed

so as to maintain health (Somiya, 2024). Therefore, information gotten on weaning will improve

mother’s practice of weaning since the mother is the most important person in a baby’s life for

both its physical as well as its psychosocial care and growth. The mother-infant relationship is

the most vital formative relationship for the child. There arises a need to prevent wrong

assumption of mothers on weaning process and timing, there is need for sound education,

effective information and sufficient knowledge of weaning to be instilled in mothers. Nurses can

be agent of carrying out the educational needs for weaning infants in proper way. Therefore, the

need for a study on infant weaning knowledge and practices among mothers in Elele

Community, Rivers State.

Objective of the Study

The main objective of this study is to explore infant weaning knowledge and practices among

mothers in in Elele community, Rivers state. The specific objectives are to:

1. Determine the knowledge level on infant weaning among mothers attending in Elele

community, Rivers state

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2. Assess the practice level on infant weaning among mother sattending in Elele community,

Rivers state

3. Determine the relationship between mothers’ knowledge level and infant weaning

practices attending in Elele community, Rivers state.

Research Questions

The following research questions were answered:

1. What is the knowledge level on infant weaning among mothers attending in Elele community,

Rivers state.

2. What is the practice level on infant weaning among mothers attending in Elele community,

Rivers state.

3. What is the relationship between mothers’ knowledge level and infant weaning

practices attending in Elele community, Rivers state.

Significances of the Study

The study would help to establish inadequacy in infant weaning knowledge and practice among

mothers and also provide baseline data for subsequent studies on infant weaning knowledge and

practices among mothers.

This study would also help to provide recommendations for improving inadequacies in infant

weaning knowledge and practices among mothers.

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The study would also assist health institutions and the government at the federal, state and local

level to plan strategies to improve infant weaning knowledge and practices among mothers.

Scope of the Study

This study covered infant weaning knowledge and practices among mothers in Elele community,

Rivers state. The study is limited by recruitment of participants.

Scope of the Study

This study was conducted among mother residing in Elele community, Rivers state. The study

will be conducted between the periods of two weeks and will be delimited only to interested

mothers.

Operational Definition of Terms

Weaning: In this study, introduction of supplementary food to a child’s diet after the first six

months of life.

Mother: Women who has a child with age from birth to 24 months, in this study.

Knowledge: Mothers understanding regarding infant weaning as measured by knowledge score,

in this study.

Practice: Mothers activity regarding infant weaning as measured by practice score, in this study.

Infants: children aged from birth to 24 months of age in this study.

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 CHAPTER TWO

LITERATURE REVIEW

This chapter deals with the review of related literature. The review is divided into the following:

Conceptual review, Theoretical framework, Empirical review and Summary of literature review.

Conceptual review

General issues about weaning

According to WHO’s Convention on the Rights of a Child (2016), every infant born into this

world has a right to food and nutrition, however, only few children meet their nutritional

requirements appropriate for their age. Poor nutrition is responsible for almost half of child

mortalities in the world. Per WHO fact sheets (2016) on infant and young child feeding,

malnutrition accounts for 2.7 million infant mortalities yearly and more than 800,000 infants are

likely to survive annually if all children aged 0-23 months are breastfed adequately.

Breast milk – Composition, nutritional value and storage

Breast milk is a natural food and nourishment for newborns; it forms the main source of

nutrients, energy and vitality for an infant. It is considered as the most convenient and safest

means of feeding an infant because it is ready made, at the right temperature and usually

available when needed (AAP 2012, UNICEF 2023). Additionally, breast milk contains

antibodies needed for protection of the newborn, hence a perfect food for babies (Munblit et al.

2017). The quantity, quality and production of breast milk varies to meet the nutritional and

fluid needs of an infant; it is evident that mother’s poor feeding habits, high intake of caffeine

and other products can affect the production and quality of breast milk (Ballard & Morrow

2023).

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A yellowish, sticky milk called colostrum produced during the latter part of pregnancy through

to delivery; is highly recommended by WHO to be given to babies within the initial hours

following delivery. Colostrum is very definite in volume, appearance and composition, it

contains an elevated level of immunologic components like secretory immunoglobulin A (IgA),

lactoferrin, leukocytes and epidermal growth factor for development. After the first days of

postpartum, this process of breast milk (colostrum) transformation continues into a transition

milk, which lasts for eight to twenty days until it transforms into a mature milk. Each stage of

breast milk composition contains nutrients, which are needed for the nourishment and growth of

a baby (Mondker et al.

2009, Ballard & Morrow 2023, Munblit et al. 2017).

Hormones within the human body enhance the growth of breast milk duct; progesterone,

estrogen, prolactin and others promote lactation before birth. However, the level of hormones

reduces to enable the flow of milk. Nutrients contained in human breast milk include water,

protein, fats, carbohydrates, minerals and vitamins (Ballard & Morrow 2023, Infant Nutrition

Council 2016). Each nutrient in breastmilk plays a role in nourishing the baby, a breastfed child

is protected against diseases through a chain of biomedical reactions which enable enzymes,

hormones and immunologic substances to protect the baby against diseases while enhancing the

survival of the newborn (Ballard & Morrow 2023, UNICEF 2015).

Breast milk has a unique and dynamic composition, which unlike formula milk with a constant

nutritional composition, is usually affected by the routine of feeding, and differs per mother and

even population (Ballard &Morrow 2023). Table 1 below illustrates the average composition of

nutrients in breast milk.

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Table 1. Composition of some key nutrients found in mature breast milk (NHMRC Dietary

Guidelines for children 2003, Infant Nutrition Council 2016).

Component Mean value for mature breastmilk (per 100 ml)

Energy (kj) 280

Energy (kcal) 67

Protein (g) 1.3

Fat (g) 4.2

Carbohydrate (g) 7.0

Sodium (mg) 15

Calcium (mg) 35

Phosphorus (mg) 15

Iron (mcg) 76

Vitamin A (mcg) 60

Vitamin C (mg) 3.8

Vitamin D (mcg) 0.01

Previously, breast milk when expressed was intended to feed preterm and sick babies who could

not breastfeed directly from their mothers’ breast. Of late, due to the trend of women in active

service, the act of expressing breast milk by lactating mothers for future use has become a

frequent practice (Stevens 2019). It is very vital that care is taken in how breastmilk is

expressed, handled and stored since it may get contaminated with viruses and bacteria or its

nutritional content may be reduced (Chang et al. 2020).

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For safety and preservation of nutrients in breastmilk, breast milk can be stored at a room

temperature (no more than 25-degree Celsius) for a maximum period of six hours, and for a

maximum of four hours at a hot temperature of 30 to 38 degrees Celsius. It can also be stored at

a temperature of 4 degrees in the refrigerator to be used within 72 hours or stored in a freezer at

-20 degrees to be used within a duration of up to six months (Canadian Agency for Drugs and

Technologies in Health 2016, Igumbor et al. 2000.). To ensure safety, refreezing or reheating of

expressed breast milk is not recommended. A study by Peters et al in 2016 reported that even

though freezing is a safe method of storing breast milk, it reduces the immunological

components in the expressed breast milk.

Weaning Recommendation

Weaning is an act of lactation whereby a baby is fed from a female breast; it can be done

directly by putting the baby to the mother’s breast or indirectly by expressing the milk using

breast pump and giving it to baby through bottle feed (WHO 2017). Health care agencies

advocate an early initiation of weaning during which infants should be fed on demand unless for

exceptional reasons (Fosu-Brefo & Arthur 2015). It is very necessary to feed directly from the

breast to avoid the transfer of contaminants to baby, however busy or working mothers can

express breast milk for use in future ensuring that breast milk is kept clean and stored depending

on the length of time intended for its use.

Exclusive weaning is defined by UNICEF (2015) as an act of feeding whereby “infant receives

only breast milk (includes breast milk which has been expressed or from a wet nurse) and

nothing else except for Oral Rehydration Salt (ORS), medicines, vitamins and minerals”.

UNICEF and WHO (2016) recommend that babies should be given only breast milk for the first

six months of their lives, after which weaning should be continued in addition to appropriate

10
complementary food until the baby is 24 months old. Although weaning for six months is a

desirable goal, weaning in general is a very important exercise.

HIV/AIDS is a prevalent issue in Nigeria. In 2015, the Joint United Nations Programme on

HIV/AIDS (UNAIDS) reported that 270,000 people were living with HIV/AIDS of which

19000 were children aged 0 to 14 years. Due to improved research about the effectiveness of

exclusive weaning; WHO recommends that with continuous intake of antiretroviral drugs during

pregnancy, after birth and during weaning, an HIV- infected mother can breastfeed her baby. In

such condition, the baby should be breastfed exclusively for six months after which there should

be a continual feed in addition to complementary food till twelve months (WHO 2020). This

practice is likely to reduce the risk of mother-child infection by 42% (Siegfried 2021, White et

al.

2024).

Benefits of Weaning

It is inarguably true that weaning has a positive impact in the lives of both baby and mother.

Breast milk is easy to digest, contains the right proportion of nutrient such as carbohydrates,

fatty acids, water and protein necessary for baby’s growth and development. Exclusive weaning

is a very necessary and important practice recommended to mother and child during the first six

months of the baby’s life due to its numerous benefits. This practice serves as a growth-

monitoring tool which not only support the growth and development of an infant but also

monitor the weight as well. During the first year of childhood development, breastfed babies are

leaner and healthier than formula fed babies (Ziegler 2006, Gale et al. 2022).

Global health departments advocate the practice of exclusively weaning at the initial stages of an

infant’s life since it helps stimulate and enhance the development of the mouth and jaws cells in

11
babies and ensures the growth of major organs in newborns. It aids in brain development and

enhances the intellectual capacity of the child. This feeding practice helps build the immune

system and protects the baby against diseases (Dieterich et al. 2023). There is a heightened proof

that exclusive weaning reduces the risk of gastrointestinal infections in children (Szajewska

2022). There is usually an elevated risk of diarrhea among children who are partially breastfed

or not giving breastmilk. Practicing exclusive weaning within an hour after birth protects new

babies from infection and death. Weaning a baby helps reduce fevers, which occur after child

immunization (AAP 2022, NHMRC 2022, WHO/UNICEF 2017.). Under 5 mortality rates per

every 1000 births in Nigeria as of 2015 was 61.6% (World Bank Group 2016). When exclusive

weaning is practiced effectively, it can prevent 13% of under 5 mortalities since it minimizes the

severity of infectious diseases (UNICEF 2016).

Practicing exclusive weaning is not only beneficial to infants but nursing mothers too. Results

from a cohort study conducted by Saxton and colleagues in 2015 proved that the risk of

postpartum hemorrhage can be lowered through the practice of weaning. Continual weaning

postpones the menstrual cycle of a lactating mother hence reducing the risk of pregnancy

(Gebreselassie et al. 2018). It protects mother from the risk of type 2 diabetes, breast, uterine

and ovarian cancers. Weaning helps control post-natal depression in mothers (Swarna 2019).

In emergency situations, such as of food shortage or an outbreak of a water borne disease,

weaning serves as the most cost-effective means of meeting the nutritional requirement of

infants and a life-saver. Exclusive weaning is an effective means of minimizing child

malnutrition, it provides food security for infants in deprived and poor communities, hence

highly recommended in low and middle-income countries (UNICEF 2015, WHO 2016,

Nkrumah 2017).

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In addition, weaning increases the connection and love between mother and child. Skin to skin

contact create warmth, closure and help reduces neonatal deaths. Nevertheless, fathers are

encouraged to support mothers during the period of weaning. Supportive fathers also win a

stronger bond with their infants as well through bottle-feeding and spending quality time with

baby (Anderzén-Carlsson et al. 2024).

There are numerous advantages of breast milk over formula milk. Formula milk given to babies

as a breast milk alternative is expensive and poses a lot of risk to an infant’s life especially in

developing countries. This form of feeding is quite challenging since it needs to be measured

adequately, mixed well with clean water at the right temperature for the baby, while ensuring

that feeding bottles are kept clean; failure to perform this practice right can lead to

contamination and diarrhea. In the developing countries, the contamination risk during formula

feed is high and challenging (Mead 2018, UNICEF 2015.).

Maternal knowledge in exclusive weaning

Several studies conducted on exclusive weaning in the past years have shown progressive rates

in maternal knowledge in exclusive weaning among mothers (Oche et al. 2021, Mogre et

al.2016, Dun-Dery & Laar 2016). A study by Oche et al. in 2021 reported a rate of 54 % of

knowledge in exclusive weaning among mothers. In 2016, a study conducted by Mogre et al.

among rural lactating mothers in Nigeria reported that 74 % of mothers who took part in the

study had general knowledge in exclusive weaning. Also, a study conducted among professional

mothers in Nigeria by Dun-Dery & Laar in 2016 reported that almost all mothers (98 %) who

took part in the study had adequate knowledge about exclusive weaning. Information on

exclusive weaning according to mothers were gained through their healthcare providers during

prenatal and postnatal lessons (Mogre et al. 2016).

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Attitude

Society and individuals have a two-way relationship, while individuals make up a society,

society influences the lives of individuals. Society shapes up the attitudes and behaviors of the

individuals (Hossain & Ali 2024). Traditions, norms, lifestyles and shared values such as

culture, religion, education, economics and politics influence the quality of life and individual

choices (UNESCO 2010).

Cultural influence

The Nigerian society is highly imbedded with various culturally oriented perceptions. These are

among the leading factors, which influence a mother’s decision to breastfeed exclusively

(FosuBrefo & Arthur 2015). One paramount feature is a common myth that babies do not get

enough nutrients from breast milk hence the need to add other food substitutes such as porridge

and other soft food. This popular perception is likely to influence the attitude of most lactating

mothers in the choice to weaning exclusively. Due to the warm climatic conditions in Nigeria,

there is the believe that babies need water in addition to breast milk which tend to interfere with

the rationale behind the decision to exclusively breastfeed (Zhang et al. 2015, Mensah et al.

2017).

Contrary, results from another study conducted in Atwima Nwabiagya District of Nigeria

showed evidence of cultural approval of exclusive weaning (Ayawine & Ae-Ngibise 2015). This

shows the effect of cultural diversity and dynamism within a given society and how they impact

an individual’s behavior.

Religious influence

Religiosity is an important concept in the lives of people, it is well represented in the less

developed and developing countries hence the role played by religious leaders in harnessing a

14
behavior either positive or negative cannot go unnoticed (Pew Research Center 2018, Page et al.

2019, Aldashev & Platteau 2024). Religious leaders are usually accorded much respect within

the society, they mainly play the role of an advocate, educator, promotor, healer, counselor and

much more (Nicklas 2021, Lumpkins et al. 2023). Studies conducted in the role of religiosity in

health behavioral choices have shown an association between religion and health (Shaikh 2016,

Burdette 2022). A study conducted by Burdette in 2022 proved an association between church

attendance and the perception about weaning. The role played by church leaders in advocating

the importance of weaning was identified as the force behind the high prevalence in weaning

since it ignites a positive attitude towards weaning. Likewise, a study by Shaikh in 2016

reported that Islamic religion supports weaning and recognizes it as a natural and divine

responsibility of a mother to her child. This positive reinforcement influences mother’s attitude

towards weaning.

Personal motivation and confidence

According to the English Oxford Living Dictionary, “Self-motivation is one’s own enthusiasm

or willingness to achieve a goal without any external pressure”. It is the force that drives an

individual to embark on an activity aimed at reaching a goal. Self-motivation promotes

confidence in an individual’s action, confidence in one’s ability to perform a task and promotes

the inner will to do more (Benabou & Tirole 2021). Although majority of mothers breastfeed

their child during their infant life, the decision to attain an optimum weaning target is highly

influenced by an intrinsic desire to breastfeed. Having adequate knowledge about the importance

of breastmilk, making initial weaning plans, self-efficacy and anxiety heightens the confidence

of a lactating mother (O`Brien et al. 2018). Mothers who exhibited positive energy and attitude

15
towards weaning are most likely to decide to breastfeed their infants for a lengthy period and are

more likely to breastfeed exclusively (Glassman et al. 2015, Minas & Ganga-Limando 2016). A

study by Mogre et al. (2016) revealed that 92.6 % of mothers who participated in the study had a

positive attitude towards exclusive weaning.

Practice

The global exclusive weaning rate is 38 %, however the World Health Assembly in 2022 set a

target to increase the rate of exclusive weaning by at least 50 % by 2025 (WHO 2017b). Figure

1 illustrates the percentage of infants under six months who were breastfed exclusively around

the globe.

Percentage of children under 6 months of age who are exclusively breastfed by region (UNICEF

Global Database 2015 (modified).

60
51
50 47 46

40 38
32
30
30
25
Percentage
20

10

0
West and East Asia South Asia Latin Eastern and Least World
Central and Pacific America Southern Developed
Africa and African Countries
Caribbean

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Child feeding practices in Nigeria

The perception of breast milk as an ideal food for babies is farfetched within the Nigerian

society. It used to be a very common practice for mothers to breastfeed their babies from birth

until the child is two or more years, however due to barriers faced in weaning, the need to

perform other duties, coupled with advertisements airing on national television about infant

commercial food products, most mothers have given in to feeding baby with breast milk

substitutes (Fosu Brefo & Arthur 2015). Lack of knowledge about the right way to breastfeed a

child, the option of bottle feeding a child with expressed breast milk in the mother’s absence and

the lack of knowledge of the benefits of weaning especially during the first six months of an

infant’s life are also among the reasons for reduced rates in weaning (Gyampoh et al. 2014,

Arthur et al. 2015, Mogre et al. 2016).

According to reports from the 2024 Nigeria Demographic and health survey, exclusive weaning

rate among children less than 6 months was 52 % with 4 months mean duration. This portrays

the country’s slow growth in reaching the target of achieving a total national coverage as set by

WHO/UNICEF. The demographic and health survey indicated a high rate of child malnutrition

which accounted for 66 % anemic rate among children under 5 years which could very well be

prevented through proper child feeding practices including weaning. Reports from a study

conducted by Dun-Dery and Laar in 2016 showed that 99 % of Nigerian children who are under

6 months were breastfed. However, 63 % of these children were given only breastmilk within

this period. For those who give supplementary food to their babies before their sixth month, the

distribution of complementary food added to breast milk were, 7 % of other milk, 18 % water, 4

% other liquids and 19 % of mashed meals (GDHS 2024). This early introduction of breast milk

substitutes, water and food usually increases the baby’s risk of infections leading to high

17
incidences of diarrhea and child mortality (Popokin et al. 2020, Arifeen et al. 2021, Aidam et al.

2015). Poor nutrition has been identified as one of the leading causes of under five deaths in the

country. Insufficient food nutrients and poor feeding habits reduce the body’s immunity to

diseases, causing impaired physical and mental development (Arthur et al. 2015).

A study by Gyampoh et al. (2024) reported that 13 % of children less than 5 years are

underweight in Nigeria. The country recorded a slow decrease in neonatal deaths compared to

under five mortalities over the past years (Nigeria Health Service 2016). A study conducted in

Northern Nigeria proved that children who are introduced to complementary foods after their

sixth month of life are protected from chronic malnutrition (Saaka et al. 2015). A study by Dun-

Dery and Laar in 2016 also reviewed that professional mothers are very much aware of the

concept of exclusive weaning and its recommendations; however, its practice was low (10.3 %).

Notwithstanding these current trends, the Nigeria Child Health Policy regarding

recommendations by WHO and UNICEF encourages lactating mothers to breastfeed exclusively

for the first six months of their babies’ life (GHS 2015).

The effect of maternal age on the practice of exclusive weaning

Maternal age reportedly has a link with infant feeding choices and practices (Kitano et al. 2016,

Fosu- Brefo 2015). A study by Mensah et al. in 2017 found a relationship between the age of a

mother and the practice of exclusive weaning, however, the study identified that other factors

come to play in the choice of practicing exclusive weaning. The work by Mangrio et al. in 2017

reported a similar assertion but found a low level of evidence in the connection between

maternal age and the practice of exclusive weaning. A study conducted in Nigeria reported that

mothers aged between 25 years to 49 years were more likely to breastfeed their babies for longer

periods than younger mothers (Owusuaa 2015).

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The effect of maternal education

It is evident that the higher the level of education of a nursing mother the higher, the chances of

her weaning her child for a longer duration (Thu et al. 2022). Several studies conducted within

Nigeria have reported that mothers’ level of education is a major determinant to the practice of

exclusive weaning (Aidam et al. 2015, Gyampoh et al. 2024, Arthur et al. 2015, Mogre et al.

2016). It is noted that women with secondary and tertiary education are more likely to be

educated on exclusive weaning, they are aware of its benefits to both babies and mothers, hence

they are well motivated to breastfeed exclusively. In dealing with the effect of lack of education

on exclusive weaning, health care personnel, facilitators and counselors are encouraged to pay

much attention to the uneducated or less educated mothers and child care givers when providing

education on weaning (Mogre et al. 2016).

Maternal employment status and duration of maternity leave

According to a study conducted by Dun-Dery & Laar in 2016, the rate of exclusive weaning

among working mothers at six months is 10.3 % although early initiation and practice of

exclusive weaning soon after delivery was 91 %. The study results prove that the length of

maternity leave granted to a working mother affects her choice of infant feeding and the rate of

practicing exclusive weaning. The longer the period of maternity leave offered to a working

mother the longer the practice of exclusive weaning and vice versa (Februhartarty et al. 2022,

DunDery& Laar 2016, Mangrio et al. 2017). Longer leave period gives the mother an

opportunity to spend more time with her baby, hence the higher the chance of practicing

exclusive weaning.

Maternity leave period varies in Nigeria, depending on one’s occupational status, however, the

official maternity leave period is twelve weeks (84 days) with full pay including two weeks

19
extension for mothers who go through caesarian section or an abnormal delivery (Dun-Dery

&Laar 2016).

The study by Mensah et al. in 2017 revealed much disparities between self-employed mothers

and mothers who are employed by a private or public organization in terms of the duration and

practice of exclusive weaning. Reasons for this assertion is because independent mothers work

according to their schedule and therefore determine when to resume work and when to take

breaks at work to feed their babies; babies are usually taken to the workplace and a place is

apportioned for feeding the baby. Whereas mothers employed by others choose baby feeding

options according their work schedule. Exclusive weaning rates among public-private sector

working mothers is usually low (Mensah et al. 2017). Due to short duration of maternity leave,

nursing mothers are faced with the challenge of weaning their children at the work place which

is usually not baby friendly hence it discourages the practice of exclusive weaning while

promoting the use of breast milk substitutes. These challenges require legislation, which will

encourage and support working mothers to breastfeed for a longer period.

Place of giving birth

Place of delivery and the number of antenatal and postnatal attendance during and after

pregnancy are high predictors of the knowledge and practice of exclusive weaning. Women who

live in the urban centers, with available and accessible health care centers and health personnel

are more likely to initiate weaning early and are willing to practice exclusive weaning than

women who deliver at home and assisted by unskilled traditional birth attendance, family or

friends (Tawiah-Agyemang et al. 2018).

According to Nigeria Demographic and Health Survey (GDHS 2018), 57 % of deliveries took

place in health facilities with 48 % in government own facilities. Out of the 42 % births, which

20
took place at home, 58 % of these cases occurred in the rural settings while 17 % took place in

the urban centers. More than half of delivery cases were attended to by health personnel, with 30

% assisted by traditional birth attendant and 8 % by close relatives. A study conducted in

Kintampo in the Brong Ahafo Region of Nigeria on Early-Initiation of Weaning reported that

mothers who breastfeed their babies within an hour to 12 hours of having their baby are more

likely to breastfeed exclusively than mothers who breastfeed later after 12 hours of birth

(Tawiah-Agyemang et al. 2018). It is also noted that women who attend prenatal classes and

deliver at a health care center are more likely to breastfeed their newborns early enough through

health education and assistance from health care providers (USDHHS 2021).

Mode of delivery

Reports from earlier studies have shown that the mode of delivery and the weight of baby are

closely linked with the practice of exclusive weaning. Women who go through normal delivery

with normal baby weight are more likely to practice exclusive weaning than women who give

birth through a caesarian section with preterm babies (Tampah-Naah & Kumi-Kyereme 2023,

Andy 2015, Dun-Dery & Laar 2016). Tampah-Naah & Kumi-Kyereme (2023) in their work on

the determinants of exclusive weaning acknowledged the high tendency of a mother to

breastfeed her average size baby exclusively than overweight or preterm baby due to

complacency or anxiety.

Support

Assistance received by lactating mothers during the period of weaning is vital in achieving the

recommended period of exclusive weaning (Flacking et al. 2020, Rempel& Rempel 2021,

Mithani et al. 2015). This assistance can range from emotional support through encouragement

and positive enforcement, support through education or informative programmes on weaning,

21
instrumental support such as creating an environment of comfort to facilitate weaning among

busy or working mothers (Ratnasari et al. 2017).

The traditional role played by husbands especially in developing countries during decision

making within a family, as well as the contributions of close relatives play a key role in

influencing a behavior (United Nations 2021). When fathers are aware of the essence of weaning

and have positive attitude towards it, they are more likely to influence their spouses to

breastfeed exclusively and for longer duration of time. The significant other and close relative

most often represent the support system to a nursing mother, they provide emotional and

material support as well as assistance in performing chores at home and other duties pertaining

to child care to make time for the mother to breastfeed (Flacking et al. 2020, Rempel& Rempel

2021, Mithani et al. 2015).

Just as an approval from the significant others increases the practice of exclusive weaning,

studies have reviewed that disapproval from close relatives and friends can as well hinder the

practice of exclusive weaning (Zhang et al. 2015, Ratnasari 2017, Mensah et al. 2017).

Support received from the workplace can also influence mother’s child feeding choices as well

as the duration of exclusive weaning. Exclusive weaning when practiced effectively promotes

organizational growth, productivity and efficiency since when workers have healthy children,

they take less frequent sick leaves, hence there is the need for employers to provide

opportunities which will facilitate weaning (UNICEF 2010).

Weaning campaigns and support groups in Nigeria

Early and substantial knowledge about weaning, building confidence to breastfeed and the

support during weaning immensely contribute to the practice of exclusive weaning (Idris et al.

2022). Intervention programmes and campaigns are avenues for providing education, assistance

22
in answering questions about challenges faced during weaning. These programs usually involve

the joint effort of a body of health workers, mothers at various community levels and other

health advocates performing the key role of awareness creation about the health benefits of

weaning.

There are a lot of health programs which are on-going in Nigeria geared towards promoting

child health and survival. For instance, Baby Friendly Hospital Initiatives (BFHI) was

introduced in Nigeria in 1995 as an approach to help minimize the rate of infant deaths in

Nigeria. This initiative supported by WHO and UNICEF was to promote the level of

understanding concerning weaning practices and to create awareness about the ten-steps to

successful weaning (Tampah-Naah & Kumi-Kyereme 2023, Kakrani et al. 2015, Mogre et al.

2016). This initiative supports and train health workers, equipping them with resources needed

for education on weaning. With the adoption of this initiative, the Nigeria Health Service took

an active role in overseeing the development, implementation and the promotion of exclusive

weaning during the first six months of life.

Every Newborn Action Plan (ENAP) led by WHO and UNICEF, is a policy set to address the

problem of high neonatal mortality rates which has been hindering the achievement of the

Millennium Development Goals (MDG) 4 and 5 in reducing maternal and infant death rates in

Nigeria. It is a roadmap for change to end preventable child deaths. Focus areas included

reproductive care, maternal, newborn and child health (ENAP 2015-2020).

As a means of regulating the sale of inappropriate breast milk substitutes, International Code of

Marketing of Breast Milk Substitutes was implemented in 1981 by World Health Assembly

(WHO 2017). The trend in the sale of excessive milk substitutes has caused a decline in weaning

worldwide, coupled with infant malnutrition and increased mortality (UNICEF 2017) hence the

23
need to abolish it. Similar to this initiative is the Nigeria Weaning Promotion Regulation also

known as the Legislative Instrument was enacted in 2000 by the government of Nigeria to

prevent excessive sale of breast milk substitutes, this aimed at promoting exclusive weaning in

the country (Tampah-Naah & Kumi-Kyereme 2023, Mogre et al. 2016).

Another policy, which seeks to support the legislations above in collaboration with the Nigeria

Food and drugs board is Nigeria Child Health Policy. It promotes exclusive weaning from birth

to 180 days of life (GHS 2015). Education, communication and informative materials designed

to promote the campaign on exclusive weaning has been instituted nationwide, available to be

used by both health workers and public (Tampah-Naah & Kumi-Kyereme 2023). High Impact

Rapid Delivery (HIRD) approach is a national initiative to minimize infant and maternal deaths.

It includes mainly of health and nutritional interventive education at the community levels by

informing mothers about ways to minimize childhood diseases, the use of ORS during diarrhea,

vaccination, vitamin A supplementation, advocates the need for first six months exclusive

weaning, appropriate complementary feed after six months, proper care for new born, regular

deworming, family planning among others (Fosu-Brefo & Arthur 2015, MOH 2017).

Community based infant and young child feeding is a UNICEF incorporated programme,

adopted in Nigeria, which aims at promoting child growth, wellbeing and development through

community level education to mothers, caregivers providing counselling, practical assistance

and improving baby feeding practices. This programme ensures ground level access to health

care, making healthcare accessible to vulnerable groups. This package also includes training

tools for health personnel involved in community work (UNICEF 2016).

As a comprehensive child healthcare programme, the GHS`s Child Welfare Clinic (CWC)

provides child care services to promote the health of infants in the country. Among the

24
numerous services provided include immunization against infectious diseases, growth

monitoring, health promotion and nutrient supplementation. Much of its activities are directed

towards the education on weaning and proper care for newborns (Gyampoh et al. 2024). This

clinic teaches mothers especially the young ones the act of weaning a baby.

As a branch in the CWC, the Growth Monitoring and Promotion (GMP) is a programme

embarked on to empower mothers to take proper care of their children, it provides educational

campaigns on childcare, feeding and healthcare. It promotes a cordial relationship between

public health workers and mothers (Gyampoh et al. 2024). With the help of qualified health

personnel, mothers are enlightened about the activities that come to play in caring for a baby and

proper ways of feeding a baby. Project Share Nigeria, a non-governmental organization located

in the Northern part of the country is an example of weaning support groups which provide

initial weaning training to young mothers in various communities within the region. In addition

to its focus areas of primary health care, education and agriculture, facilitators encourage

mothers on the importance of weaning and train working mothers on how to effectively

incorporate weaning into the corporate life (PSG 2018).

Promoting weaning among traders and market women in Nigeria (in Nigerian society, market

women is a term commonly and casually used for all the women who work in several aspects of

a market setting), the Nigeria Infant Nutrition Action Network (GINAN), an organization which

focuses on infant feeding and nutrition issues provide peer counseling to market women whilst

promoting a baby-friendly market environment. Market women are often unable to attend

postnatal health services, and because of high illiteracy rate, most of these women lack adequate

education about the enormous benefits of weaning a baby. GINAN focuses on empowering

them.

25
Logical Framework of the study

Figure 2 gives an overview of the main themes in this study; Knowledge, Attitude and Practice

of exclusive weaning. Knowledge, attitude, practice of Exclusive Weaning.

Recommendation

Concept Benefits
Knowledge

EXCLUSIVE
WEANING
Cultural
Influence Attitude Practice

Personal
Religious motivatio Demographic Support
Influence n& factors
Confiden
ce

Theoretical framework

The theoretical framework used for this study is Health Belief Model (HBM) and Social

Learning Theory (SLT).

Health Belief Model (HBM)

The Health Belief Model (HBM) was first developed in the early 1950s by social psychologists

Hoch Baum, Rosenstock, and Kegels, working in the U.S. Public Health Service. The model was

created to understand why people fail to participate in programs that prevent or detect diseases.

26
Later, Rosenstock expanded it to include individual beliefs and perceptions that predict health-

related behaviours.

The Health Belief Model assumes that a person’s readiness to take a health-related action

depends primarily on their perception of the threat posed by a health problem and the value

associated with taking preventive action. In the context of infant weaning, this model helps to

explain why some mothers adhere strictly to recommended weaning practices while others

engage in inappropriate feeding despite receiving the same health information.

Key Constructs of the Health Belief Model

1. Perceived Susceptibility:

This refers to a mother’s belief about the likelihood that her infant could develop health

problems (such as malnutrition or infection) if proper weaning practices are not followed. A

mother who perceives her child as vulnerable is more likely to adopt appropriate feeding habits.

2. Perceived Severity:

This is the belief about the seriousness of the consequences of poor weaning, such as diarrhoea,

stunted growth, anaemia, or undernutrition. The greater the perceived severity, the stronger the

motivation to engage in healthy feeding practices.

3. Perceived Benefits:

This refers to the mother’s belief in the effectiveness of proper weaning practices to reduce risks

and promote healthy growth. Mothers who believe that introducing nutritious complementary

foods at six months will strengthen their infants’ immunity are more likely to follow

recommended practices.

4. Perceived Barriers:

27
These are factors that hinder a mother from performing the desired health action. Barriers to

proper weaning may include cultural taboos, lack of resources, limited knowledge, or influence

from elderly relatives who advocate traditional feeding practices.

5. Cues to Action:

These are external or internal factors that trigger decision-making. Examples include health talks

from nurses, posters at immunization clinics, community campaigns, or observing another

mother’s healthy child who was properly weaned.

6. Self-Efficacy:

Added later by Bandura, this refers to the confidence a mother has in her ability to successfully

carry out the required action. A mother who feels capable of preparing nutritious complementary

meals and feeding her child safely is more likely to practice effective weaning.

Assumptions of the Health Belief Model

The model assumes that:

Health-related behaviour is influenced by personal beliefs or perceptions.

1. Individuals weigh the perceived benefits of an action against the perceived barriers.

2. Behaviour change occurs when perceived threat and benefits outweigh perceived barriers.

3. External influences, such as health messages or social cues, can trigger positive actions.

Relevance of the HBM to Infant Weaning

The HBM is highly relevant to this study because it explains the psychological factors

influencing a mother’s decision to initiate and maintain good weaning practices. Even when

28
health information is available, a mother’s perception of her child’s susceptibility and the

benefits of action determine whether she will act on that information.

For instance, a mother who believes that exclusive breastfeeding for six months followed by

gradual weaning prevents malnutrition will likely adhere to this recommendation. The model

also provides a framework for health workers to design interventions that address

misconceptions, reduce barriers, and build mothers’ confidence in adopting proper weaning

behaviours.

Social Learning Theory (SLT)

The Social Learning Theory (SLT), developed by Albert Bandura in 1977, emphasizes the

importance of social influence and observational learning in shaping human behaviour.

According to this theory, behaviour is learned through watching others (models) and observing

the consequences of their actions. Bandura’s famous “Bobo Doll Experiment” demonstrated that

people, especially children, imitate behaviours they see rewarded or accepted in their social

environment. The theory proposes that learning is a cognitive process that takes place in a social

context and can occur purely through observation, even without direct reinforcement. This means

that mothers may learn infant feeding and weaning practices by watching their peers, mothers-in-

law, or health workers, without necessarily experiencing the behaviour’s outcomes themselves.

Key Components of the Social Learning Theory

1. Attention:

Before a behaviour can be learned, an individual must pay attention to it. Mothers must notice

how others feed their infants—such as observing a friend preparing soft pap or mashed

vegetables.

2. Retention:

29
This involves remembering the observed behaviour. Mothers recall details of feeding times, food

preparation methods, or hygiene practices for later use.

3. Reproduction:

The individual must have the ability to replicate the observed behaviour. A mother who has

observed proper food hygiene during weaning may apply the same techniques at home.

4. Motivation:

Behaviour is more likely to be repeated if it leads to positive outcomes (e.g., seeing another

mother’s child healthy and well-fed). Motivation can also stem from encouragement by health

workers or community approval.

Relevance of SLT to Infant Weaning

In many societies, mothers learn infant feeding behaviours from their family members, especially

older women or traditional caregivers. When grandmothers or friends advocate early introduction

of solid foods, young mothers may adopt the same pattern. Similarly, observing health workers

demonstrating correct weaning techniques can influence positive change.

The Social Learning Theory therefore explains how cultural beliefs, social interactions, and peer

influence shape mothers’ weaning behaviours. It underscores the need for modelling desirable

behaviours through health education sessions, media campaigns, and community role models

who practice proper weaning.

Empirical review

Adeyemi and colleagues (2020) carried out a descriptive cross-sectional study in Ibadan, Nigeria,

to assess mothers’ knowledge and practice of infant weaning. The study revealed that although

78% of the mothers had heard about weaning, only 46% correctly defined it as the gradual

30
introduction of complementary foods alongside breast milk. The findings further indicated that

cultural beliefs and maternal education level significantly influenced weaning practices. The

study concluded that health education programs should emphasize the importance of timely and

appropriate weaning practices.

In a study conducted in Kumasi, Ghana, Mensah and Boateng (2019) examined the knowledge,

attitude, and practices of mothers on infant weaning. Using a structured questionnaire among 250

mothers, the study found that 61% initiated complementary feeding at six months, while 39%

introduced solid foods earlier. Mothers with tertiary education demonstrated better understanding

of food diversity and hygiene practices during weaning. The researchers recommended

intensified community health education through antenatal and postnatal clinics.

Eze and Okafor (2021) investigated weaning practices among rural mothers in Enugu State.

Results showed that most mothers (68%) commenced weaning before six months, mainly due to

the perception that breast milk alone was insufficient. The study highlighted poor knowledge of

food combinations and feeding frequency, leading to malnutrition in infants. The authors

advocated for continuous health worker engagement with rural mothers to improve

complementary feeding practices.

Sharma et al. (2018) conducted a hospital-based survey among 300 mothers in Delhi to evaluate

knowledge and practices regarding infant weaning. Findings revealed that 55% of mothers had

average knowledge, while only 25% practiced appropriate weaning. A significant association

was found between mothers’ occupation, income, and their weaning practices. The study

recommended regular counselling sessions during antenatal and postnatal visits to enhance

maternal knowledge.

31
Oduro and colleagues (2020) studied infant weaning practices in Nairobi. Using a cross-sectional

design, they found that although 80% of respondents were aware of the recommended six-month

exclusive breastfeeding, 48% weaned their infants earlier due to return to work. Knowledge gaps

were identified in the areas of balanced diet composition and hygienic food preparation. The

authors suggested policy interventions to support working mothers with maternity leave

extensions and workplace lactation support.

Bello and Musa (2021) examined weaning practices among mothers attending immunization

clinics in Kano State. Out of 200 respondents, 70% had good knowledge of weaning, but only

40% adhered to proper weaning timing and feeding frequency. The study observed that cultural

influences and advice from grandmothers shaped many mothers’ decisions. The authors

emphasized the need for culturally sensitive health education campaigns targeting both mothers

and family members.

Nwosu et al. (2019) carried out a study in Anambra State to assess the relationship between

maternal education and weaning practices. The study revealed that mothers with higher

education levels demonstrated better understanding of complementary feeding guidelines.

However, a notable proportion of uneducated mothers practiced early or late weaning, resulting

in increased risk of undernutrition. The study recommended that primary health care centres

should incorporate nutrition talks in maternal and child health services.

Ali and Ahmed (2018) conducted a cross-sectional study in Karachi, Pakistan, involving 400

mothers. Findings indicated that only 30% of mothers could correctly identify the age to start

weaning, and 45% practiced poor food hygiene during infant feeding. The authors attributed this

to inadequate exposure to nutrition education and low literacy levels. They concluded that

community-based nutrition programs should be strengthened to improve mothers’ practices.

32
Johnson et al. (2022) investigated the determinants of appropriate infant weaning practices

among mothers in Pretoria. Results revealed that mothers’ employment status, access to health

information, and social support influenced weaning behavior. The study found that 65% of

mothers practiced timely weaning, while the rest either introduced foods too early or too late.

The researchers highlighted the importance of integrating nutrition education into primary health

services to promote optimal infant feeding.

Uche and Nwachukwu (2023) explored mothers’ knowledge and practice of infant weaning in

Abia State. The study employed a descriptive survey of 250 mothers attending postnatal clinics.

Results showed that 72% had moderate knowledge, but only 52% demonstrated good weaning

practice. The major barriers identified were cultural taboos, lack of nutritional awareness, and

influence of elderly relatives. The researchers recommended community-based interventions that

incorporate traditional leaders and local caregivers in promoting appropriate infant weaning.

Summary of Literature Review

The review of related literature highlighted that infant weaning is an essential phase in child

nutrition and growth, requiring both adequate knowledge and proper practice from mothers.

Breast milk was identified as the ideal and most complete source of nourishment for infants,

offering nutrients, antibodies, and protection against diseases. Health organizations such as WHO

and UNICEF recommend exclusive breastfeeding for the first six months, followed by gradual

introduction of complementary foods up to two years or beyond. Despite these guidelines, poor

weaning practices persist due to factors such as cultural beliefs, low literacy levels, economic

challenges, and maternal workload. Theoretical frameworks like the Health Belief Model and

Social Learning Theory explain how mothers’ perceptions of health risks, benefits, motivation,

and social influence determine their feeding behaviours. Empirical studies reviewed across

33
different countries, including Nigeria, revealed that maternal education, occupation, and family

or community support significantly affect mothers’ adherence to proper weaning practices. The

literature concludes that while awareness of proper weaning has improved, gaps still exist

between knowledge and actual practice. Therefore, continuous health education, community

sensitization, and supportive policies are essential to enhance mothers’ knowledge and promote

effective infant weaning for improved child health outcomes.

CHAPTER THREE

RESEARCH METHODOLOGY

The chapter was organized under the following heading; research design, research setting, target

population, sample size, sampling techniques, instrument for data collection, validity and

reliability of instrument, method of data collection, method of data analysis and ethical

consideration.

Research design

The study adopted a descriptive method to explore infant weaning knowledge and practice

among mothers in Elele community River’s state.

Research setting

This study was conducted in Elele community in Rivers state, Port Harcourt. It is one of the big

towns in Ikwerre Local Government Area of Rivers State, Nigeria. Madonna University is

located in Elele in Ikwerre local government area. Elele, one of the major cities in Rivers State,

is a medium-sized town in the Niger Delta Region. It has a population of about 20,620. The

distance between Elele and Port Harcourt, the capital of Rivers, is roughly about 42 kilometers

(26 miles) distant. It takes 445 kilometers (276 mi) to get from Elele to Abuja, the capital of

Nigeria.

34
Target population

The population of the study was 150 mothers that are living within Elele community, Rivers

state.

Sample size

Sample size was determined using Leslie Kish formula. to select 100 participants proportionally

from Elele community, Rivers state for the study.

Sampling Technique. Simple random sampling technique was adopted. Respondents who were

willing to give information were recruited for the study.

Inclusion criteria: Mothers with a child whose age is within 6-24months.

Exclusion criteria: Mothers with a child having abnormalities which affect feeding.

Instrument for data collection

A developed questionnaire consisting of three subscales and 30 items was utilized for the study.

The subscales included socio-demographic data, infant weaning knowledge and practice

regarding infant weaning. There were 8 questions on demographic data, 15questions on infant

weaning knowledge and 7 questions on infant weaning practice

Validity of the instrument

Validity referred here is the degree or extent to which an instrument actually measures what is

intended to measure. Face validity of the research instrument was established by the researcher.

In order to validate the instrument, the researcher gave the developed tool to the supervisor for

modification of items, assessment and approval of the instrument. Corrections were affected

before finial production of the instrument.

Reliability of the instrument

35
The reliability of the research instrument will be determined. The Pearson Correlation

Coefficient was used to determine the reliability of the instrument. Recruited participants were

asked to complete the developed and structured questionnaire after they have been informed

about the study and consent has been obtained to collect data on knowledge and practice

regarding infant weaning in the Elele community. 10 copies of the questionnaire were

distributed to pregnant women in Elele community, 2 weeks later it was redistributed to same set

of persons. The result of the co-efficient was 0.85.

Method of data collection

The questionnaires were administered to the subject’s face to face with the help of a research

assistant. 100 questionnaires were administered. Application letter from the researcher seeking

for permission to collect data from the mothers is written to the chairman of Elele community.

Also informed consent is obtained from the participates before proceeding to administer the

questionnaire. Following the permission, participates were briefed about the study purpose and

the procedure of the data collection process. Participates are assured confidentially of

information been supplied. A total of 98 (98.8%) questionnaires will be returned.

Method of data analysis

The data was analyzed using descriptive statistics such as mean, standard deviation, frequency

and percentage. The results were presented in tables

Ethical consideration

The questionnaires were administered to the subject’s face to face with the help of a research

assistant. 100 questionnaires were administered. Also informed consent is obtained from the

participates before proceeding to administer the questionnaire. Following the permission,

participates were briefed about the study purpose and the procedure of the data collection

36
process. Participates are assured confidentially of information been supplied. Information

obtained from the participants was kept confidential and the right to withdraw from the study at

any point by participants was respected.

Agunbiade MO, Ogunleye VO. Constraints to exclusive weaning practise among breastfeeding

mothers in SouthWest Nigeria: Implication for scaling up. International Weaning Journal.

2022; 9(7):5-7.

Ashmika M, Deerajen R, Prity P, Rajesh J. An assessment of the weaning practises and infant

feeding pattern among mothers in Mauritius. Journal of Nutrition and Metabolism. 2023;

8(5):8-12.

Bewket Zeleke L, Gebremihael MW, Adinew YM et al. (2017): Appropriate weaning practice

and associated factors among infants and young children in Northwest Ethiopia. Journal

of Nutrition and Metabolism, 8: 1-7.

Brown A, Lee M. A descriptive study investigating the use and nature of baby-led weaning in a

UK sample of mothers. Maternal and Child Nutrition Journal. 2020; 7(1):34-47.

Dhanasekaran N (2015): Knowledge on practice of weaning among the mothers with infant

below six months of age in Salem, Tamilnadu. Journal of College of Medical

SciencesNepal, 11(1): 12-16.

37
Dinesh B, Sushilkumar C. A community based study of feeding & weaning practises in under

five children in semi urban community of Gujarat. National Journal of Community

Medicine. 2021; 2(2):5-8.

Fahmy SI, Nofal LM, Shehata SF et al. (2015): Updating indicators for scaling the

socioeconomic level of families for health research. Journal of the Egyptian Public

Health Association, 90(1): 1-7. Released I (2023)

Folasade A, Emmanuel TO, Ogunfowokan O et al. (2017): Infant weaning knowledge and

practice among mothers attending infant welfare clinic in three primary healthcare

centres in Ikenne local government area, Ogun state, Nigeria. IJAR., 3(12): 227-230.

Guled RA, Mamat NM, Azdie W et al. (2016): Knowledge, Attitude and Practice of

Mothers/caregivers on Infant and Young Child Feeding in Shabelle Zone, Somali Region,

Eastern Ethiopia: A Cross-Sectional Study. Revelation and Science, 6(2): 133-9.

Hanif HM (2021): Trends in breastfeeding and complementary feeding practices in Pakistan,

1990-2007. International Breastfeeding Journal, 6(1): 15-18.

Hanif HM. Trends in weaning and complementary feeding practises in Pakistan, 1990–

[Link] Weaning Journal. 2021; 6(15):20-25.

Kimani-Murage EW, Madise NJ, Fotso JC et al. (2021): Patterns and determinants of

breastfeeding and complementary feeding practices in urban informal

settlements, Nairobi Kenya. BMC Public Health, 11(1): 39699.

Kimani-Murage EW, Madise NJ, Fotso JC, Kyobutungi C, Yatich N. Patterns and determinants

of weaning and complementary feeding practises in urban informal settlements, Nairobi,

Kenya. BMC Public Health. 2021; 11(6):396-400.

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Kotb S, Mohamed AG, Mohamed EM et al. (2022): Knowledge and practices of working mother

about breastfeeding and weaning in Assiut city, Egypt. Life Science Journal, 9(1): 803-8.

Memon S, Shaikh M, Kousar T et al. (2020): Assessment of infant feeding practices at a tertiary

care hospital. JPMA-Journal of the Pakistan Medical Association, 60(12): 1010-5.

Motee A, Ramasawmy D, Pugo-Gunsam P et al. (2023): An assessment of the breastfeeding

practices and infant feeding pattern among mothers in Mauritius. J Nutr Metab.,

2013:243852.

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Semukasa EL, Kearney J. Complementary feeding practises in Wakiso district of Uganda.

African Journal of Food, Agriculture, Nutrition and Development. 2024; 14(4):15-20.

Shadia M, Bedor MA. Infant feeding and weaning practice of mothers in hail. International

Journal of Science and Research. 2023; 2(4):23-30.

Somiya GSM. Infants feeding and weaning practises among mothers in northern Kordofan State,

Sudan. European Scientific Journal. 2024; 10(24):1857-1861.

Tatone-Tokuda F, Dubois L, Girard M (2017): Psychosocial Determinants of the Early

Introduction of Complementary Foods. Health Education & Behavior, 36(2): 302-320.

39
 APPENDIX A

MADONNA UNIVERSITY, NIGERIA

FACULTY OF SCIENCES

DEPARTMENT OF NURSING SCIENCE

P.M.B 05, Elele, Rivers State

Our Ref……………………………… Office of: Dean of Faculty

C/O DR. CHUWKWU CHINEYE

Your Ref …………………………… Tel: +234 9159814309

Email: c3nedu@[Link]

TO WHOM IT MAY CONCERN

The bearer Name (Reg No) is a bona-fide student of this University. She is carrying out a
Research on INFANT WEANING KNOWLEDGE AND PRACTICES AMONG

40
MOTHERS IN ELELE COMMUNITY, RIVERS STATE as part of the requirements for
the award of ‘Registered Midwife’ certificate.

She is asking for permission to obtain data from your community. Kindly accord her the
necessary assistance, please. All information / data shall be treated as strictly confidential. At
the end of the study the finding shall be communicated to you.

Yours faithfully,

Dr. Chukwu Chinenye

APPENDIX B

INFORMED CONSENT

Madonna University Teaching Hospital,

Nursing Science Department,
Elele Campus,
Rivers State.

Dear respondents,

I am a midwifery student of the above-named institution carrying out a research study on

“INFANT WEANING KNOWLEDGE AND PRACTICES AMONG MOTHERS IN ELELE
COMMUNITY, RIVERS STATE” The questionnaire is strictly for collection of data for
academic purposes. Please supply the information as frankly as possible to make this study a
success.

Rest assured that all the information given by you will be treated with strict confidentiality. Your
names and personal identifiers are not required.
Thank you for your acceptance and co-operation.

41
 Yours faithfully,

Nwaneri Stephanie Chinaza

APPENDIX C

QUESTIONNAIRE

RESEARCH QUESTIONNAIRE ON THE INFANT WEANING KNOWLEDGE AND

PRACTICES AMONG MOTHERS IN ELELE COMMUNITY, IKWERRE LOCAL

GOVERMNENT AREA, RIVERS STATE.

INSTRUCTIONS

Do not write your names on the questionnaire

They are in sections A and B

Tick (√) the correct response(s) as appropriate and give necessary comments.

SECTION A: DEMOGRAPHIC DATA

INSTRUCTION: Please endeavor to complete the questionnaire by ticking the correct answer

(s) from the options or supply the information where necessary.

42
1. Age range

a. 20-24

b. 25-29

c. 30-34

d. 35-39

e. 40-44

2. Marital Status

a. Single

b. Married

3. Ethnicity

a. Yoruba

b. Hausa

c. Igbo

4. Occupation

a. Civil servant

b. Self employed

c. Unemployed

5. Religion

a. Islam

b. Christianity

6. Educational qualification

a. Primary

b. Secondary

43
 c. Tertiary

d. No formal education

SECTION B

QUESTIONS ON INFANT WEANING KNOWLEDGE AND PRACTICES AMONG

MOTHERS IN IKWERRE LOCAL GOVERNMENT AREA, RIVERS STATE.

7. How is your knowledge regarding infant weaning.

a. Low

b. Moderate

c. High

8. There is a correlation concerning occupation and infant weaning practice among mothers.

a. Positive

b. Negative

9. There is a correlation regarding educational level and infant weaning practice.

a. Positive

b. Negative

10. There is a correlation regarding ethnicity and infant weaning practice.

a. Positive

b. Negative

11. There is a correlation concerning knowledge level and infant weaning practice.

a. Positive

b. Negative

44
 APPENDIX D
LETTER OF ATTESTATION

45
 APPENDIX E
TEST FOR RELIABILITY

Reliability test is done using Spearman Rank Correlational co-efficient. The calculation is from
ten (10) respondents on two sets of questionnaires administered during the test- retest technique.

S/N X Y RX RY di= RX-RY di2

1 24 25 3rd 2nd 1 1

2 19 21 8th 6th 2 4

3 25 26 2nd 1st 1 1

4 18 16 9th 10th -1 1

5 23 24 4th 3rd 1 1

6 26 23 1st 4th -3 9

46
 7 20 19 7th 8th -1 1

8 22 20 5th 7th -2 4

9 16 18 10th 9th 1 1

10 21 22 6th 5th 1 1

Rs = 1 – 6
n (n2 – 1)
Where
di is the difference between ranks of corresponding values of X and Y
n= number of pairs observation.
X = Result of the first test
Y = Result of the second test
Rs = 1 – 6 (24)
10 (102 -1)
Rs = 1 - 144
100 (100-1)
Rs = 1 – 144
1000-10
Rs = 1 – 144

47
 990
Rs = 990 – 144
99
Rs = 846
990

Rs= 0.8545 0.85.

APPENDIX F
APPROVAL
To the Research Committee
Department of Nursing
Madonna University

Student’s Name: Nwaneri Stephanie Chinaza

Index No: NSC/20/1693
The Research Project entitled:
INFANT WEANING KNOWLEDGE AND PRACTICES AMONG MOTHERS IN ELELE
COMMUNITY, RIVERS STATE.
Of which I have mentored has been reviewed, corrections has been made and is recommended
for submission/ presentation , in particular ( please check) for :
Research Proposal (Chap 1-3) for pre-council exams
Complete Research Project (Chap1-5) for council exam
Others (Internal or External Defense) for BNSc degree
Remarks (if any) _________________________________________

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 _______________________________________________________

Name of Supervisor:

(Signature over printed name)

Date: _________________________

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