International Journal of Nutrition
ISSN: 2379-7835
Current Issue
Volume No: 4 Issue No: 2
share this page

Research Article | Open Access
  • Available online freely | Peer Reviewed
  • | Provisional

    Role of Religion on Knowledge, Attitude and Practices of Lactating Mothers on Infant Feeding

    Adepoju Oladejo T 1       Adesemoye Elizabeth T 2     Akinyele Isaac O 1    

    1Department of Human Nutrition, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria

    2Department of Microbiology, Federal University, Oye-Ekiti, Ekiti State; Nigeria

    Abstract

    Infant and young child feeding (IYCF) practices directly affect the nutritional status of children under two years of age, and ultimately, impact child survival. These practices are influenced by maternal knowledge and attitudes as well as socio-demographic and cultural factors; and an understanding of such factors is important to scaling up IYCF practices. This study was designed to assess the role of religion on knowledge, attitude and infant feeding practices among Christian and Muslim lactating mothers in Ibadan North Local Government Area (LGA), Oyo State.

    The descriptive cross-sectional study was conducted among 320 lactating mothers in the LGA. Eight focus group discussions were carried out among Christian and Muslim lactating mothers. An adapted pre-tested questionnaire was used to collect information on socio-demographic characteristics and IYCF knowledge, attitude and practices of the respondents. Knowledge on IYCF was assessed on 14-item scale, and the scores categorised as: ˂5.60 poor, 5.60–10.88 fair, and ˃10.88 good knowledge. Attitude was assessed on 13 statements from the IOWA Infant Feeding Attitude scale with lowest and highest obtainable score of 13 and 65 respectively. A score of ˂44 was ranked as poor, and ˃44 points good. Data were analysed using descriptive statistics and one-way ANOVA. Qualitative data was analysed thematically.

    Mean age of respondents was 30.0±4.9 years, 55.9% were Muslims, and 63.8% had fair knowledge. Good, Fair and Poor knowledge was higher in Muslim (55.2%, 56% and 57% respectively) compared with Christian respondents. Mothers with poor attitude constituted 56.0%. Muslim religion directly supports pre-lacteal feeding and duration of breastfeeding while the other indirectly supports breastfeeding.

    Religious practices directly and indirectly affect knowledge, attitude and practices of nursing mothers on infant feeding; hence, healthcare Professionals should pay more attention to nutrition education in religious houses using the infant and young child feeding module.

    Received 18 May 2019; Accepted 22 May 2019; Published

    Academic Editor:Tiziana Lavalle, PArma and Bologna University, Italy.

    Checked for plagiarism: Yes

    Review by: Single-blind

    Copyright©  2019 Adepoju Oladejo T

    License
    Creative Commons License    This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Competing interests

    The authors have declared that no competing interest exists.

    Citation:

    Adepoju Oladejo T, Adesemoye Elizabeth T, Akinyele Isaac O () Role of Religion on Knowledge, Attitude and Practices of Lactating Mothers on Infant Feeding. International Journal of Nutrition - 4(2):14-25.
    Download as RIS, BibTeX, Text (Include abstract )
    DOI10.14302/issn.2379-7835.ijn-19-2876

     Introduction

    A child’s growth is determined by the adequacy of dietary intake, which depends on infant and young child feeding and care practices and food security1. In accordance to Infant and Young Child Feeding (IYCF) guidelines, early initiation of breastfeeding immediately after birth (preferably within thirty minutes), exclusive breastfeeding for the first six months of life, timely introduction of complementary foods after the six months, continued breastfeeding for 2 years or beyond, age appropriate complementary feeding for children 6-23 months while continuing breastfeeding, active feeding for children during and after illness are recommended2. These practices are influenced by multiple interwoven factors which include health, psychosocial, cultural, political, and economic factors3.

    At about six months of age, an infant is developed and mentally ready for other foods. If complementary foods are not introduced, or are given inappropriately, an infant's growth may falter4. Culture, ethnic heritage, personal preference, habit, and other traditions are some of the factors that manipulate cultural diets. A diet that is culturally sensitive and takes into consideration all aforementioned factors is a must in promoting better nutrition in a community5.

    Nigerians are often very strict about their religious practice and beliefs, though the range of commitment, belief, and practice varies with each religion6. Religious belief globally influences specific eating practices and diets7. Despite interventions to reduce child mortality rate in Nigeria, child malnutrition is still a problem as the prevalence of stunting, wasting and underweight are 32%, 10.2% and 19.9% respectively8. Nigeria is often portrayed as a country where the religious demography is static; everybody belonging to one faith or the other and professing religion6.

    Oman and Thorensen9 stressed that religion can influence health through various psychological conditions such as character, will-power, focused attention or increased motivation beyond pathways such as social support. In agreement to this, a study carried out in Ethiopia by Basu-Zharku10, reported that religion seems to play a role in the use of contraceptives and women’s decisions to seek antenatal care. A study conducted in northern Ghana between two religious groups reported that religion plays a role in the practices of exclusive breastfeeding11. There is dearth of information on the role religions play on infant and young child feeding in Nigeria. This study was therefore designed to assess the role of religion on the knowledge, attitude and practices of mothers on infant and young child feeding.

    Methodology

    The study was descriptive cross–sectional in design. A three-stage sampling technique was used to select Ibadan North Local Government area (LGA) (being the most populous LGA in Ibadan) purposively out of eleven LGAs, twelve churches out of the list of churches with at least 500 worshippers and four mosques using simple random sampling technique. A total of 320 mothers with infant and children between 0-23 months were selected as respondents.

    Information was obtained from respondents using focus group discussions (FGDs) and adapted, pre-tested interviewer-administered questionnaire. Eight FGDs were conducted - six in the churches and two in the mosques. Each FGD session had 6-10 participants and was conducted within the church or mosque premises. Knowledge on infant feeding was assessed using 14-item questions derived from IYCF core indicators, and grouping of the score was based on mean of the score of the participants. Knowledge score was categorised as: ˂ 5.60 - poor knowledge, 5.60 – 10.88 fair knowledge, and score ˃10.88 was grouped as good knowledge. Attitude construct was assessed with 13 statements from the IOWA Infant Feeding Attitude scale12. These statements were scored using the 5-point Likert scale in which 1= strongly Agree, 2=Agree, 3=Neutral, 4=Disagree and 5=Strongly Disagree. Statements in favour of breastfeeding and complementary feeding were scored as 5=Strongly Agree, 4= Agree, 3=neutral, 2= Disagree and 1= strongly disagree. The lowest and highest scores obtainable from the attitude section were 13 and 65 respectively. Then based on the mean of the attitude score which was 43, the attitude score was grouped into two categories: score below 44 was grouped into fair attitude while participants with 44 point and above were categorized as good. The practice construct was measured using a 3-point Likert scale and some open-ended questions. Ethical approval was sought and obtained from the University of Ibadan/University College Hospital Ethical Review Board.

    Statistical Analysis

    Qualitative data obtained from the FGDs was transcribed, translated and analysed thematically, while quantitative data were analysed using descriptive statistics, Chi square test, one-way ANOVA and regression analysis through the use of Statistical Package for Social Sciences (SPSS) version 18.0, at p < 0.05.

    Results

    Focus Group Discussions

    All the participants in the FGDs consented to the fact that they had received health talks on different topics in their various churches and mosques but none had been on breastfeeding or complementary feeding. The health talk which varied according to the religious settings was organized either yearly, quarterly, bimonthly, monthly or fortnightly. It was organized for the congregation as a whole or just within the sub-groups in the religious setting. They reported that initiation of breastfeeding depends on the mother, the baby and circumstances.

    Most respondents voiced out a positive response to initiation of breastfeeding which should be immediately, some argued otherwise that the baby should be washed, and made to sleep while the mother rests for few hours. Few respondents in two of the FGDs did not agree to giving a baby colostrum as it is regarded as being unclean, and thus should be washed away while majority argued against it, stating the benefits. On the issue of exclusive breastfeeding (EBF), the respondents knew the meaning of EBF, as most of them mentioned that they got the information from the health workers, but some felt that breast milk and water means EBF. Only few of them got the information on EBF from friends and families.

    Although most of the respondents had adequate knowledge of EBF, their attitude towards it differed, as some argued that breast milk only is enough for a baby less than six months, while some argued otherwise. Some also argued that EBF practice depends on the gender of the baby, as it is generally believed that baby boys eat more than baby girls, therefore breast only cannot be enough for a baby boy for six months.

    Most of the lactating mothers were aware of the duration of breastfeeding and its benefits as they stated that they were told at the clinic to breastfeed for 24 months. However, their level of practice differed, as most of them whose children were above one year had stopped breastfeeding. Few of them argued that duration of breastfeeding depends on the gender of the baby as they felt a boy should breastfeed longer than a baby girl, while majority of the mothers stated that breastfeeding should be stopped once the child starts walking.

    There was a consensus in two groups of FGDs on the preference of their religious leaders’ advice to that of health workers because they believe there could be some spiritual implication for disobeying a religious leader, and that the health worker who is a stranger could advise them against their religion especially if she’s not practicing their religion; while other groups disagreed with the reasons and stated that they will rather listen to a health worker’s advice on their baby’s health than their religious leaders, stating that both are professionals in different fields and the health worker will be more knowledgeable than their religious leaders in the area of child care practices.

    Most of the lactating mothers mentioned that they were aware that water should not be given to a child less than six months, but only very few of them practiced it due to some reasons such as feeling that the child will be thirsty if not given water, pressure from the grandmothers, emulating the health worker’s practices, feeling that the child’s tongue will stick to the throat, and the mother feeling bad. Other reasons stated for giving water was to ensure the baby get used to plain water taste.Some of the mothers stated that water should be given the very first day after delivery to welcome the baby to the world, while some argued that water should not be given to the baby until after 2-4 weeks, some argued three months and some 2 months. Only few of the women agreed with, and practiced the health worker’s advice on not to give water to a baby less than 6 months of age.

    The foods used to initiate complementary feeding as stated by the mothers were semi-solid foods like pap mixed with crayfish or groundnut, Amala (yam flour pudding) with ewedu soup, milk, Indomie and egg, tea, golden morn, infant formula, moinmoin(bean cake). Some respondents stated that they were taught at the clinic how to mix several ingredients with pap for their infants. Time of initiation of complementary feeding differs among the participants, as some of them stated that any food or liquid should not be given to a child less than six months, and some argued that liquids and semi-solid food can be given to an infant after 3 months. Some of the respondents argued that the gender of the baby determines when to initiate complementary feeding as it is believed that boys eat more than girls, therefore boys should start complementary food earlier than girls. Most of the mothers stated that proteinous food must always be included in the food given to young children.

    Socio demographic Characteristics of the Respondents

    In Table 1, the mean age of mothers was 30±4.9 years, with 56.6% and 40.9% being between 19 – 30 and 31 – 40 years respectively; while the mean age of the infants and young children was 11.54±6.5 months, with 28.1% being less than 7 months. More than half (55.9%) of the respondents were Muslims, 44.1% were Christians, 89.1% were married, 6.9% were cohabiting, 2.5% were single, while 1.5% were widows. The highest level of education attained by the respondents were: tertiary 54.1%, secondary 27.2%, primary 5.9%, no formal education 1.3%, and Quranic 0.9% education.

    Table 1. Demographic characteristics of the Respondents
    Variable Frequency Percentage
    Mother’s age at last birthday    
    19-30 years 181 56.6
    31-40years 131 40.9
    41-50years 6 2.5
    Age of last child (in months)    
    0-6 months 90 28.1
    7-12 months 92 28.8
    13-18 months 84 26.2
    19-23 months 54 16.9
    Religion    
    Christian 141 44.1
    Muslim 179 55.9
    Marital Status    
    Single 8 2.5
    Married 285 89.1
    Cohabiting 22 6.9
    Widow 5 1.6
    Highest level of education    
    None 4 1.3
    Primary education 19 5.9
    Secondary Education 87 27.2
    Ordinary National Diploma certificate 72 22.5
    Higher National Diploma certificate / Bachelor’s degree 101 31.6
    Post graduate degree 34 10.6
    Quranic education 3 0.9
    Respondent employment status    
    Civil/Public servant 55 17.2
    Private employment 78 24.3
    Artisan 29 9
    Trader 115 36.1
    Unemployed/housewife 43 13.4
    Estimated monthly income    
    Less than ₦20,000 78 24.4
    ₦20,001 - ₦50,000 115 35.9
    ₦50,001 – ₦70,000 61 19.1
    ₦70,001 – ₦99,000 29 9.1
    More than ₦100,000 37 11.6
    Total 320 100

    More than one-third (36.1%) of respondents were traders, 24.3% were in private employment, 17.2% were Civil servants, 13.4% were unemployed while 9.0% were artisans, with 24.4% earning less than ₦20,000, 35.9% earned between ₦20,001 – ₦50,000, 19.1% earned between ₦50,001 – ₦70,000, and 11.8% earned above ₦100,000/month.

    Knowledge of Respondents on Infant Feeding

    In Table 2(a), majority (85.0%) of the respondents were aware that initiation of breastfeeding should be within 60 minutes after birth, 83.4% believed that a baby should be exclusively breastfed for six months and beyond, while 16.6% suggested less than 6 months exclusive breastfeeding. Majority (68.8%) of respondents were aware that colostrum should be fed to the baby, 11.9% did not agree while 19.4% did not know whether it should be fed to the baby or not. More than two-third (68.7%) mothers believed that infants should not be given water earlier than 6 months and beyond, 91.6% agreed that sick children should still be breastfed, 59.7% believed sick mothers can breastfeed their babies, while 50.0% were aware that there is danger in bottle feeding.

    Table 2(a). Respondents’ knowledge on infant feeding
    Variable Frequency Percentage
    When should breast feeding be initiated?    
    Less than 30 minutes 177 55.3
    31-60 minutes 95 29.7
    61mins – 6 hours 21 6.5
    6 – 24 hours 25 7.8
    More than 24 hours 2 0.6
    Should Colostrum be given to an infant?    
    Yes 220 68.8
    No 38 11.9
    Don’t Know 62 19.4
    How long should a baby be given breast milk only?    
    Less than 6 months 53 16.6
    ≥6 months 267 83.4
    When should a baby start taking water    
    Less than 3months 73 22.8
    4months 21 6.6
    5months 6 1.9
    ≥6months 220 68.7
    When should a baby start taking herb and other liquids?    
    Less than 3months 81 25.3
    4months 23 7.2
    5months 7 2.2
    ≥6months 209 65.3
    Mothers to breastfeed when the child is sick    
    Yes 293 91.6
    No 3 0.9
    Don’t Know 24 7.5
    Mother to breastfeed when the mother is sick    
    Yes 191 59.7
    No 57 17.8
    Don’t Know 72 22.5
    Glucose water can be given to a baby if breast milk is delayed    
    Yes 217 67.8
    No 43 13.4
    Don’t Know 60 18.8
    Dangers associated with bottle feeding    
    Yes 160 50
    No 86 26.9
    Don’t Know 74 23.1
    Total 320 100

    Only 20.9% of respondents had good knowledge, 63.8% had fair knowledge, while 15.3% had poor knowledge (Table 2b). Categorising respondents’ knowledge on basis of religion, 21.3% of the Christian respondents had good knowledge, 63.8% had fair knowledge, and 14.9% had poor knowledge compared with 20.7%, 63.7% and 15.6% of Muslim respondents respectively (Table 2 (c)), with no significant difference (p>0.05) between the two religions.

    Table 2(b). Respondents categorisation of knowledge on infant feeding
    Knowledge Frequency Percentage
    Poor 49 15.3
    Fair 204 63.8
    Good 67 20.9
    Total 320 100

    Table 2(c). Respondents’ categorization of knowledge based on religion
      Christians Muslims
    Knowledge Frequency Percentage Frequency Percentage
    Poor 21 14.9 28 15.6
    Fair 90 63.8 114 63.7
    Good 30 21.3 37 20.7
    Total 141 100 179 100

    Attitude of Respondents on Infant Feeding

    In Table 3, two-third (40.6%) of the respondents felt embarrassed breastfeeding their babies in public places, 50% reportedly were not embarrassed doing so, 39.1% believed that formula feeding was a better choice, 41.9% disagreed, while 15.9% were neutral. One-tenth (10.6%) of the respondents were of the opinion that there is no difference between breastfed and formula-fed babies, while 73.4 disagreed. Also, 22.2% respondents believed breastfed babies can be overfed compared to formula-fed babies, while 46.0% respondents disagreed with this notion.

    Table 3(a). Respondents’ attitude to Infant feeding
    Variables Strongly agree (%) Agree (%) Neutral (%) Disagree (%) Strongly disagree(%)
    Breast milk only is not enough for my baby who is less than 6months 15.6 26.3 6.3 35.3 16.6
    My baby who is less than 6months should be given water 11.3 35.9 5.9 32.8 14.1
    I feel embarrassed breastfeeding in public places like banks, school, cafeteria, market etc. 10.0 30.6 9.4 31.9 18.1
    Formula feeding is the better choice because am working. 7.2 31.9 19.1 32.2 9.7
    There’s no difference between a breastfed baby and formula feed baby 2.2 8.4 15.9 50.6 22.8
    Breast-fed babies are likely to be overfed than formula-fed babies. 7.5 14.7 28.8 32.6 13.4
    I can start giving my baby semi-solid foods before 6months. 4.7 30.9 9.7 40.3 14.4
    I can’t breastfeed my child more than one year. 5.0 10.6 9.7 56.9 17.8
    Semi solid food should be used to initiate complementary feeding. 12.5 53.4 17.5 12.2 4.4
    I’ll rather listen to my religious leader’s advice on my baby’s feeding than a health worker. 9.7 27.5 13.4 30.9 18.4
    I can’t give my baby any food not supported by my religion. 15.3 45.0 9.4 15.6 14.7
    I feel ashamed breastfeeding in the church or mosque during service. 3.4 19.4 12.5 45.3 19.4
    I force my baby to eat if he/she refuses to eat 10.6 31.6 13.4 31.9 12.5

    About half (49.3%) of the respondents disagreed with the idea of rather listening to their religious leader’s advice on their baby’s health than health workers while 37.2% agreed with the idea. About half (51.9%) of the respondents disagreed that breast milk only is enough for a baby less than 6 months while 41.9% agreed with the statement. Generally, 55.9% of respondents had poor attitude to infant feeding; and on religion basis, 58.2% and 54.2% had poor attitude among the Christian and Muslim respondents respectively (Table 3 (b) and (c)).

    Table 3(b). Respondents’ categorisation of attitude
    Attitude Frequency Percentage
    Poor 179 55.9
    Good 141 44.1
    Total 320 100

    Table 3 (c). Respondents’ categorisation of attitude based on religion
      Christians Muslims
    Attitude Frequency Percentage Frequency Percentage
    Poor 82 58.2 97 54.2
    Good 59 41.8 82 45.8
    Total 141 100 179 100

    Respondents’ Practices of Infant Feeding

    Almost half (49.4%) of respondents reportedly initiated breastfeeding under one hour of delivery of their babies while 41.6% did so between 1 and 24 hours (Table 4). Majority (74.1%) were still breastfeeding their children, 20.6% breastfed for 12 – 18 months, while 2.2% breastfed for less than 12 months. About forty-nine percent (48.7%) of respondents introduced water to their children at less than 6 months, while 30.6% did so at 6 months. Only 10.6% of mothers introduced semi-solid foods to their children in less than 6 months, 30.3% at 6 months, and 33.1% did so after 6 months. Majority (67.8%) of respondents were still breastfeeding their baby while 32.2% had stopped breastfeeding. Amongst the lactating mothers who were still breastfeeding their infants, 77.9% had children that were between 1 and 12 months, while 18.4% had children between 13 and 18 months. Only 3.7% of the mothers had children between 19 and 23 months (Table 4).

    Table 4. Respondents’ practices on infant feeding
    Variable Frequency Percentage
    Initiation of plain water    
    Less than 6 months 156 48.7
    6 months 98 30.6
    More than 6 months 6 1.9
    Not yet initiated 60 18.8
    Initiation of teas, juices, sweetened water    
    Less than 6months 57 17.8
    6months 147 45.9
    More than 6 months 21 6.6
    Not yet initiated 95 29.7
    Initiation of animal and plant milk    
    Less than 6months 64 20
    6months 121 37.8
    More than 6 months 32 10
    Not yet initiated 103 32.2
    Initiation of semi-solid foods    
    Less than 6months 34 10.6
    6months 119 37.2
    More than 6 months 70 21.9
    Not yet initiated 97 30.3
    Initiation of solid foods    
    Less than 6months 11 3.4
    6months 97 30.3
    More than 6 months 106 33.1
    Not yet initiated 106 33.1
    Initiation of breast milk    
    Less than 1hr 158 49.4
    1-24hrs 133 41.6
    More than 24hrs 19 5.9
    Don’t Know 10 3.1
    Duration of breastfeeding    
    Less than 12months 7 2.2
    12-18months 66 20.6
    19-24months 10 3.1
    Still breastfeeding 237 74.1
    Infants still breastfeeding    
    Yes 217 67.8
    No 103 32.2
    Received breast milk in the last 24hrs    
    Yes 229 71.6
    No 91 28.4
    Received vitamins/minerals in the last 24hrs    
    Yes 169 52.8
    No 151 47.2
    Total 320 100

    Discussion

    The age range of the respondents is within the women reproductive age (WRA), with almost all being less than 41 years (Table 1). This is beieved to be due to the fact that the reproductive stage of most woman before menopause is within this range, and most women prefer completing child bearing before the age of forty years due to the fear of reduction in level of fertility at ages higher than forty years. However, there was no significant difference (p> 0.05) between the age and infant feeding knowledge of the respondents. This is in line with the finding in a study conducted in North India13. The mean age of the children (11.54±6.5 months) was indicative that majority of them were already being fed complementary foods. The higher percentage of Muslim respondents compared to the Christian counterpart might be due to the fact that there were limited but very big Nasfat centres where the Muslims gathered for worship on Sundays, unlike in the Christian settings where there are several churches, though big, but with less congregation than the Nasfat centres. The literacy level of respondents was quite high, and the type of employment they were involved in might have contributed to their knowledge about infant and young child feeding. Similar finding was reported by Adnan and Muniandy14.

    Pre-lacteal feeding practices among the respondents in this study was lesser than the 43% reported in a study in Uganda by Wamani et al.15 The foods commonly used as pre-lacteal feeds are glucose water, gripe water, salt-sugar solution, plain water, fruit juice, infant milk and honey. This report is in line with a study carried out in India and Ghana on infant feeding practices11,13.

    Of all the respondents who used honey as prelactal feed, 89.3% were Muslims. This was reported to be so by religious leaders who highlighted that their religion supports pre-lacteal feeding, especially the use of honey, water and tamaru seed to perform a ritual before the child starts taking breastmilk. It is believed that this ritual performed for the child whereby the first thing he/she tastes is sweetness, will make life enjoyable for the baby. According to Shaikh and Ahmed16, the ritual which is known as ‘Tahneek’ is performed based on the practice of the Holy Prophet. The Hadith have indicated that Prophet Muhammad softened dates in his mouth and rubbed them over the soft palates of newborns. The taste of the sweetness is what is sought and not the ingestion. According to WHO17, using honey as pre-lacteal feeding is putting the baby at risk of botulism.

    Early initiation of breastfeeding within one hour after birth is one of the core indicators of practicing infant feeding, as this reduces infant mortality rate4. In a study conducted in Ghana, religion was found to plays a role in initiation of breastfeeding as reported by Aborigo et al.11

    The percentage of respondents that reportedly initiated breastfeeding within one hour of birth in this study was greater than that reported in a study from in India on infant and young child feeding practices by Sinhababu et al.18, and lesser than the 53% obtained from a study in Sokoto by Oche et al.19 Nigeria, and 62.6% obtained in Southwest Ethiopia by Tamiru et al.20. This percentage can be increased if pregnant women are well trained on infant feeding.

    Majority of the respondents who agreed to rather listen to their religious leader’s advice on their baby’s health than health workers were Muslims while 42% were Christians. In line with the finding from FGDs, the reason for the preference of religious leader’s advice rather than that of health workers by respondents was because it was believed that there will be spiritual implication for disobedience to whatever the spiritual leader says, while some of them stated that they don’t trust the health workers unlike their women coordinator who they can run to at any time due to the fact that she has the experience; and that the health worker may advise them against their religion. The implication of this finding may be severe if the religious leader and women coordinator’s knowledge is not in line with the WHO recommended infant practices.

    From the findings in this study, Muslim mothers breastfeed longer than Christian mothers. This could be due to the fact that the Islamic religion does not permit married women to work outside of their home, as the husband is solely responsible for earning income and providing for the family, thus giving enough time for the lactating mother to breastfeed the children for a longer period of time.

    As regards initiation of complementary feeding, a larger proportion of the respondents disagreed that an infant can start eating semi-solid foods before six months. Also, majority of the mothers agreed that semi-solid food should be used to initiate complementary feeding. This is in contrast with the result obtained from the focus group discussions, as most of the respondents were of the opinion that complementary feeding can be initiated three to four months after the birth of the child.

    Reasons given for why early complementary foods should be introduced earlier were: insufficient breast milk, gender of the baby (as it is believed that a baby boy should eat more than a baby girl), and the baby getting used to the taste of the family food, and lack of time (for working mothers). All these reasons were believed to be due to inadequate knowledge of the respondents on infant feeding, as this is not usually being taught despite the several health talks that are usually being given under religious settings.

    The respondents acknowledged that trainings on preparation of nutritious complementary foods were conducted by health workers at the clinic, however, not all of them practice optimal complementary feeding due to cost of food, preparation time and availability. This was similar to the finding of a study carried out in Ebonyi State by Ugwu and Obi21.

    Strength and Limitation

    The strength of this study is in the use of both quantitative and qualitative methods in data collection, while the limitation of the study is the potential for recall bias because mothers had to remember time of initiation of breastfeeding and how the child was fed from birth and in the preceding day for those with children more than 6 months.

    Conclusion

    Even though majority of the respondents were knowledgeable about good infant and young child feeding practices, their attitude and practice was sub-optimal. Religion affected the attitude and practice of good IYCF, as the respondents claimed to rather listen to their religious leaders than the health workers. It is therefore recommended that religious leaders should be taken into consideration and educated on good infant feeding practices as they are capable of influencing the attitudes of their followers positively or negatively. Also, since all the religious gatherings do have health talks or seminars, nutrition education using a module on infant and young child feeding can be incorporated into the health talks which will be a benefit for all, especially the pregnant and lactating mothers.

    References

    1.SahaKK FrongilloEA, AlamDS AriffenSE, Persson L A, Rasmussen K M. (2008) Appropriate infant feeding practices result in better growth of infants and young childrenin rural Bangladesh. , Am J Clin Nutr.87: 1852-9.
    2.Garg M, MarriyahH DeekshaK. (2015) Infant and Young Child Feeding (IYCF) practices in Udupi district. , Karnataka.” Journal of Nutrition Research1 38-44.
    3.CripeET.(2008).Supporting breastfeeding: nursing mothers' resistance to and accommodation of medical and social discourses. InEmerging Perspective in HealthCommunication:Meaning, Culture and Power. Edited by Zoller HM, Dutta MJ. New York: RoutledgeTaylor and Francis Group,63-84.
    4.IYCF. (2011) Infant and Young Child Feeding. Programming Guide. Nutrition section,programmesUNICEF. , New York
    5.BawadiH Al-SahawnehS. (2008) Developing a meal-planning exchange list for traditional dishes in Jordan. , Journal of the American Dietetic Association.108 5, 840-846.
    6.IgweL.(2011).Leaving religion and living without religion in Nigeria [online] Summer,The Australian Humanist,Availability,ISSN:. 0004-9328.
    7.Jesse R L. (2010) article: god is not the lunch-lady: accommodation of religious dietary practices in public schools Cardozo Law Review de novo,Cardozo L. Rev. De Novo.430.
    8.NNHS National Nutrition, Survey Health.Report on the nutrition and health situation of Nigeria.(2018).
    9.Oman D, ThorensenCE. (2003) Does religion cause health? Differing interpretation and diverse meanings.Journal of. , Health Psychology 7, 365-380.
    10.Basu-ZharkuIO. (2011) The Influence of Religion on Health."Student Pulse. pg.1/3. Retrieved from: Accessed on 21st of march,2013,3(01): 3-01.
    11.AborigoRA Moyer, RominskiS C A, Adongo P, Williams J, LogoniaG AffarG.Hodgson A,EngmannC (2012). Infant nutrition in the first seven days of life. in rural Northern Ghana,BMC Pregnancy and Childbirth,12: 76.doi: 10-1186.
    12.A De La Mora, Russell D W, Dungy C I, LoschM DusdiekerL. (1999) The Iowa Infant Feeding Attitude Scale: Analysis of reliability and validity. , J Appl Soc Psychol 29(11), 2362-2380.
    13.MahmoodSE SrivastavaA, ShrotriyaVP MishraP. (2012) Infant feeding practices in the rural population of north India. J Family Community Med.2012,May-Aug, PMCID: PMC3410177 19(2), 130-135.
    14.Adnan N, MuniandyND. (2012) The Relationship between Mothers’ Educational Level and Feeding Practices among Children in Selected Kindergartens in Selangor, Malaysia: A Cross- sectional Study. , Asian Journal of Clinical Nutrition 4(2), 39-52.
    15.WamaniH AstromAN.Peterson S,TylleskarT,TumwineJK (2005). Infant andYoung Child Feeding in Western Uganda: Knowledge, Practices and Socio-economic Correlates. , Journal of Tropical 51(6), 356-361.
    16.Shaikh U.AhmedO.(2006).Islam and Infant Feeding, Breastfeeding Medicine,1: 3,©. , Mary Ann Liebert, Inc
    17.WHO. (2010) World Health Organization. Infant and young child feeding practices Fact sheet N°342.www.who.int/mediacenter/factsheets/fs342/en. Accessed on 25th August,2013.
    18.Sinhababu A, Mukhopadhyay D K, Panja T K, Saren A B, Mandal N K et al. (2010) Infant and Young Child-feeding Practices in Bankura District. , West Bengal, India. J Health Popul Nutr. June; 28(3), 294-299.
    19.OcheMO UmarAS, AhmedH. (2011) Knowledge and practice of exclusive breastfeeding in Kware. , Nigeria Afr Health Sci.2011,September 11(3), 518-523.
    20.TamiruD BelachewT, Mohammed S LohaE. (2012) Sub-optimal breastfeeding of infants during the first six months and associated factors in rural communities of Jimma Arjo Woreda, Southwest Ethiopia. , BMC Public Health; 12, 363.
    21.Ugwu F, Obi C. (2010) Complimentary Feeding Practices and Nutrient Intake of Children Aged. 6–18 Months in Ebonyi State, South East Nigeria. “World Food System-A Contribution from Europe” Tropentag, September,14-16,2010 , Zurich .