INTRODUCTION

World health and scientific organisations have endorsed breastfeeding as the best way of feeding infants. Breast milk lowers the incidence of gastrointestinal tract problems, infections, allergies and over­weight in the breastfed infants. There is also a decreased risk of death from sud­den infant syndrome. Besides that, mothers who breastfeed have a lower risk of ovarian, uterine and breast cancer, better child spacing and maternal at­tachment with their newborn (Malrides 1995) 

Malaysian culture traditionally accepted breastfeeding as the normal and healthy way of nourishing a newborn child. With the introduction of Western culture, how­ever, bottle-feeding was introduced and is now viewed as a “modern” mother’s way of providing nutrition to infants (Kang 1999). The National Health and Morbidity Study in 2006, reported a high proportion of Malaysian mothers initiating breast­feeding but the practice of exclusive breastfeeding for four to six months was low (14.5%) (Ministry of Health 2006). The prevalence of breastfeeding in Ma­laysia declined from 92% to 78% from 1950 to 1975 however it increased to 89% by 1996 (Ho et al. 1999). A study done in 1996 among Malay mothers in Kelantan found that almost all mothers (97.3%) breastfed their children, indicat­ing a high incidence of breastfeeding among rural Malay mothers (Zulkifli et al. 1996). The current study was designed to determine the practice of initiating breastfeeding among mothers in an urban community, its associ­ated factors, and evaluate the mothers’ knowledge regarding breastfeeding.

MATERIALS AND METHODS

This was a cross-sectional study con­ducted among mothers attending a Child Health Clinic in Cheras Baru, Kuala Lumpur between March and April 2008.  All mothers who attended the clinic dur­ing the study period who fit the selection criteria were included into the study. In­clusion criteria were mothers aged from 17 to 45 years old who gave consent to answer the questionnaire. Exclusion cri­teria were primigravida (no experience in breast feeding) and non-Malaysian.

Respondents were given a self-admin­is­tered questionnaire and were assisted by interviewers when necessary. Respon­dents’ data were collected via question­naire. The questionnaire consist-ed of two parts. The first part was on socio-demo­graphic data and the second part was on breastfeeding knowledge.

Successful initiation of breastfeeding was defined as mothers who breastfed their child for at least one week after deliv­ery (Khairani 1998). “Significant family members” was defined as respon­dent’s spouse and family members who stayed in or close by her residence.

All data were entered and analyzed using the Statistical Analysis for Social Science (SPSS) windows, version 14.0. A p value of less than 0.05 was taken to denote statistical significance.

RESULTS

A total of 162 mothers were included in the study. It was found that 152 mothers practiced breastfeeding at least one week after delivery giving a prevalence of 93.8%. The mother’s characteristics are summarized in Table 1.

Mothers who practise breastfeeding were predominantly Malay. Influence from significant family members was found to be an important factor towards encouragement of breastfeeding. In this study, mother’s age, education and em­ployment status, husband’s occupation and family income did not show any sig­nificant association with breastfeeding.

Figure 1 shows the source of knowl­edge about breastfeeding among the re­spondents. The top three important sources found in this study were health­care personnel (25.0%), mass media (books and magazines) (21.2%) and par­ents or relatives (18.5%).

Table 2 shows the relationship between antenatal class and breastfeeding prac­tice. More than half of the respondents (55.6%) attended antenatal education about breastfeeding when they were pregnant. In the breastfeeding group, 85 respondents (55.9%) had formal ante­natal education on breastfeeding. How­ever, attending antenatal classes did not significantly increase the practice of breastfeeding.

Table 3 illustrates the assessment of knowledge on breastfeeding among the mothers. Overall, the mothers’ know­ledge on breastfeeding was fairly good. However, more than half of the mothers thought that ‘they should stop breast­feeding if either or both of baby and mother is/are sick.’ More than 20% of the mothers were still ignorant regarding lactational amenorrhoea, breast milk protection against allergy and the preva­lence of sore nipples. Approximately 15% of the mothers did not know that breast milk is better than formula milk and about 9% were not knowledgeable regarding the benefits of colostrum.

DISCUSSION

The prevalence of breastfeeding in this study was 93.8%. The prevalence was comparatively similar to previous studies done in Malaysia (Ho et al. 1999; Zulkifli et al. 1996). The high prevalence of breastfeeding is viewed as a result of greater awareness of the benefits to health and nutrition for breast fed infants.  However, this study did not assess if the mothers continued breast­feeding beyond a week. It had been re­ported that a high proportion of Malay­sian mothers initiated breastfeeding but the practice of exclu-sive breastfeeding for four to six months was low (Ministry of Health 2006).

In this study, Malay mothers were more likely to breastfeed than non-Malay. The result is supported by The National Health and Morbidity study done in Ma­laysia (Ministry of Health 2006). In the Malay culture and Islamic religion, moth­ers are encouraged to breastfeed their children and this could explain the high breastfeeding prevalence in this ethnic group (Counsilman & Viegas 1985).

The findings in this study showed that a woman’s partner and family play an im­portant role in her decision to breast­feed. This finding is supported by west­ern studies which reported positive as­socia­tion between partner’s support for breastfeeding with initiation as well as duration of breastfeeding (Scott et al. 2001). Thus, significant family encour­agement is a positive pre­dictor for breastfeeding practice.

Previous studies showed that educated women were more likely to breastfeed their children (Simard et al. 2005; Lin et al. 2004). The father’s education level, too, has an enhancing effect on breast­feeding (Newton 2004). However some studies found the oppo­site (Mohammad et al. 2006; Li et al. 2002). Likewise our finding did not support these relation­ships. The prevalence of initiating breastfeeding had no significant associa­tion with mothers’ employment status, husband’s occupation or family income.

Antenatal class is the medium for pro­viding information which includes promo­tion of breastfeeding. Systematic reviews conclude that educational programs are more effective at improving breastfeeding initiation (Dyson et al. 2005; Guise et al. 2003) than literature alone (Fairbank et al. 2000).  However, previous studies had reported that participation in antenatal class had no significant association with prevalence of initiating breastfeeding (Citra et al. 2007; Foo et al. 2005). A possible explanation for this could be that those who did not attend received sup­port and knowledge from other sources.

With regard to knowledge on breast­feeding, the majority of respondents knew that breastfeeding should be initi­ated immediately after birth and exclusive breastfeeding should be practised for the first six months. This could be due to the successful breastfeeding promotion practiced in many government and pri­vate hospitals. However it is a concern that approximately 15% of the mothers did not know that breast milk is better than formula milk and about 9% were not knowledgeable regarding the benefits of colostrums. Almost half of the mothers thought that breastfeeding should be dis­continued when either mother or child is sick.  This misconception should be cor­rected by health providers during the breastfeeding educational programmes.  In addition, more than 20% of mothers were still ignorant regarding lactational amenorrhoea, protection against allergy and that sore nipple is a common prob­lem when breastfeeding. These are some areas of breastfeeding that need to be addressed and given more emphasis to mothers to improve their knowledge of breastfeeding.

Overall, the mothers’ knowledge on breastfeeding was fairly good except for certain areas mentioned above.  This may reflect successful antenatal pro­grammes initiated by our society. It could also be explained by the great effort from health personnel in delivering talks on the benefits of breastfeeding. This is shown by the findings in this study, where the top three sources of knowl­edge about breast feeding indicated by the mothers were healthcare personnel, mass media (books and magazines) and parents. These main sources of know­ledge can be used as a channel to cor­rect   mis­conceptions and improve moth­ers’ knowledge on breastfeeding.

CONCLUSION

The prevalence of initiating breastfeeding among mothers attending the Maternal and Child Health clinic was high. Majority of the mothers had adequate knowledge regarding breastfeeding, however certain areas such as ‘continuing breastfeeding when either mother or child is sick’, lac­tational amenorrhoea, protection against allergy and ‘sore nipple is a common problem when breastfeeding’ need more emphasis during future educational pro­grammes. Influence from close family members was significantly associated with breastfeeding practice. Thus, it would be beneficial to include close fam­ily members during health education pro­grammes to promote breastfeeding.

ACKNOWLEDGEMENT

We would like to express our sincere ap­preciation to Mr. Nik Muhammad Shahid Nik Jaffar, Mr. Mohd Khalid Al Walid Abas, Miss Nurul Azreen Yusof, Miss Nur Hairi Nahar, Miss Rohayu Abdul Halim for their assistance.