baseline survey - 特定非営利活動法人handsbaseline survey “project on promotion of...

Baseline Survey

“Project on Promotion of Maternal and Neonatal Care Focusing on Breastfeeding in Kericho District, Kenya”

December 2009

Yoshie, MIZOGAMI （HANDS）Health and Development Service

TABLE of CONTENTS Map Photographs

I. Summary of Baseline Survey -------------------------------------------------------- 1 II. Results of Qualitative Survey- Focus Group Discussion---------------------- 10 III. Results of Quantitative Survey ----------------------------------------------------- 23

Appendix

・ Focus Group Discussion: Discussion Guidelines ---------------------------- 53 ・ Qualitative Survey: Questionnaire------------------------------------------------- 56

Republic

of Kenya

Project Target Area (Kericho District)

Target Health Facilities

① Kabianga Health Centre

② Sosiot Health Centre

③ Chepkemel Health Centre

④ Kipsitet Dispensary

⑤ Kenegut Dispensary

⑥ Kiptere Dispensary

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Ｉ．Summary of Baseline Survey

Focus Group Discussion with fathers

保健省の一次医療施設（保健所）の分娩台 Interviewing mothers using questionnaire

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I. Summary of Baseline Survey

1. Purpose of the Baseline Survey

The baseline survey was conducted before the implementation of the “Project on Promotion of Maternal and Neonatal Care Focusing on Breastfeeding in Kericho District” in order to find out the health needs of mothers and children in Kericho District, Republic of Kenya.

2. Schedule

The field survey was conducted in September 2009 in Kericho District by Kericho District Ministry of Public Health and Sanitation (DMOH) staff, HANDS Kenya staff, and the student volunteers. All those field surveyors received training prior to the field survey.

3. Method

The survey consisted of a quantitative survey (structured interview with questionnaire) and a qualitative survey (focus group discussion). The survey design was done by HANDS and Kericho DMOH. The pretest of both questionnaire and discussion guidelines were done by Kericho DMOH.

【1】 Qualitative Survey

① Purpose of the Survey: To investigate the health needs of the mothers and children prior to the implementation of the project.

② Method: Focus Group Discussion (FGD) was conducted using a

semi-structured question guidelines. Question topics which were included in the question guidelines are shown below (table 1-2).

Table 1-2： Question Topics

No. Topics

1 Current situation of breastfeeding and its recognition 2 Information of child rearing 3 Family planning 4 Role of the father 5 Communication with the health facility 6 Occupation and community activities

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③ Target population of Focus Group Discussion: Mothers and fathers with small children living in the communities of the catchment area of health facilities targeted by the project, as well as those who do not live in the project’s target area (control group).

④ Sampling：

<Health Facilities> A total of six health facilities: 3 health centres （Kabianga Health Centre, Sosiot Health Centre, Chepkemel Health Centre）, 2 dispensaries （Kipsitet Dispensary, Kenegut Dispensary ） , and one health facility （ Kiptere Dispensary）were selected. Kiptere Dispensary was selected as a control site, in order to appropriately measure the effectiveness of the project. Upon selecting the control site, such conditions as community size and access to the health centre were taken into consideration. <Participants of Focus Group Discussion (FGD)> At each of the six health facilities selected, mothers and fathers who have small children were asked to gather to participate in the FGD. On the day of the FGD, approximately 12 mothers were randomly sampled by DMOH and HANDS Kenya staffs1. In a same way, approximately 12 fathers were also randomly sampled (table 1-3).

Table 1-3 Information of Participants of the Focus Group Discussion

Group Health Facility Date of

Interview

No. of

Interviewees2

Average

Age

Average No.

of Children

Mothers

Kabianga Health Centre 9th Sept 11 28.7 3.6 Kiptere Dispensary 10th Sept 12 28.8 3.7 Sosiot Health Centre 9th Sept 12 26.6 3.3 Kipsitet Dispensary 15th Sept 12 21.8 1.9 Kenegut Dispensary 16th Sept 12 22.8 2.3 Chepkemel Health Centre 29th Sept 14 24.4 2.8

Fathers

Kiptere Dispensary 27th Aug 11 40.4 3.0 Sosiot Health Centre 11th Sept 10 34.0 2.9 Chepkemel Health Centre 14th Sept 12 43.7 4.7 Kipsitet Dispensary 15th Sept 11 39.6 4.1 Kenegut Dispensary 16th Sept 12 39.1 3.6 Kabianga Health Centre 17th Sept 12 46.1 3.3

1 However, due to limited time of survey, in most cases fathers and mothers who visited the health facility were recruited as interviewees in the order they arrived. Therefore the method cannot be strictly called a random sampling. In addition, the survey team requested the health facility staff to select mothers and fathers who had children under 2 years old. However, in reality it was difficult to conduct a sampling by strictly following the children’s age. 2 FGD was conducted outside before noon, at a time when the mothers become busy. Therefore, some participants left during the discussion and others joined after the discussion began.

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⑤ Interviewers：

・ Facilitators: DMOH Officers (2 persons) ・ Recorder: HANDS Kenya staff

⑥ Training of Interviewers：

・ Prior to the interview, staffs conducting the survey (facilitator, recorder) were trained.

⑦ Method of Analysis: Recapitulative Context Analysis 【2】 Quantitative Survey

① Purpose of the Survey: To investigate the health needs of the mothers and children prior to the implementation of the project.

② Method: Structured interview using questionnaire3 was conducted. The topics

of the questionnaire are shown below (table 1-4.)

Table 1-4 Questionnare Topics

No. Topic

1 Colostrum: if it was given 2 Breastfeeding 3 Artificial Milk Feeding 4 Complementary Feeding

③ Targets of the survey:

Mothers who have children over 6 months old, and live in the catchment area of the health facility targeted by the project, as well as those who do not live in the catchment area (as a control group).

④ Sampling：

<Health Facilities> A total of six health facilities: 3 health centres （Kabianga Health Centre, Sosiot Health Centre, Chepkemel Health Centre）, 2 dispensaries （Kipsitet Dispensary, Kenegut Dispensary）, and one health facility（Kiptere Dispensary） were selected. Kiptere Dispensary was selected as a control site, in order to appropriately measure the effectiveness of the project. Upon selecting the control site, such conditions as community size and access to the health centre were taken into consideration.

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<Interviewees> At the health facilities mentioned above, HANDS Kenya staff and student volunteer staff randomly selected mothers who visited the facility on the day of survey. Over 50 samples were obtained at each health facility. The details are shown below.

Table1-5: Number of Interviews Conducted

Health Facility Interview

Date

Number of

Respondents

Kabianga Health Centre 9th Sept 17th Sept 28th Sept

50

Kiptere Dispensary 10th Sept 28th Sept 1st Oct

53

Sosiot Health Centre 11th Sept 14th Sept 54

Chepkemel Health Centre 14th Sept 29th Sept 5th Oct

52

Kipsitet Dispensary 15th Sept 1st Oct 6th Oct

51

Kenegut Dispensary 16th Sept 30th Sept 51

Total 311

⑤ Interviewers: ・ Interviewers: 3 Student Volunteers (health sciences majors) ・ Supervisor: HANDS Kenya staff

⑥ Training of the interviewers ：・ Prior to the filed survey, staffs conducting the survey (interviewers,

supervisors) were trained. ⑦ Method of Analysis: Statistical analysis using the SPSS

4. Findings

【1】 Results of Focus Group Discussion

As a result of the qualitative survey (FGD), mother and child health needs in the target areas of the project were identified. (For details, see Chapter II. Results of the Focus Group Discussion.)

3 Refer to appendix (p.5) for the questionnnare.

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Table 1-6 Needs of Mother and Child

No. Topic Met Needs Unmet Needs

1

Current Situation of Breastfeeding and

Recognition

・ Breast milk is fed to the child

・ It is perceived that breast milk is good from the veiw point of nutrision as well as prevention of deseases.

・ It is perceived that it’s better to feed breast milk for 6 months.

・ Food besides breastmilk is fed from relatively early stage.

・ When a mother cannot express enough breast milk or finds difficulty to do so, the proper way to deal with those problems is not known.

・ In many cases exclusive breastfeeding is given up when the mother start working.

・ In many cases the mother gives up exclusive breastfeeding when the baby cries soon after being breastfed, thinking that “the baby is not being fed enough”.

2

Information of Child Rearing

・ Mothers tend to receive information from their own mothers, women’s group and mothers-in-law

・ Radio programs play a role in coveying messages

・ Fathers know the mothers’ source of information.

・ Women must follow what is told by the mother-in-law.

・ Health facilities provide information, but it is not as common as the information provided through the community and media.

3

Family Planning

・ Some mothers and father think that the family planning is important from the view point of mother's health and the household economy.

・ Mothers consider it difficult to take care of many children. On the other hand, fathers want to have children until they have a son who can inherit properties.

・ Some believe that women become sick when they practice family planning.

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Role of the Father

・ To have responsibility for the shelter, food, and clothing for the family.

・ In recent years, in some cases men accompany their wife at the time of delivery.

・ Many women perfer to have men participate in child rearing and escort them to health facilities. However, due to socio-cultural factors participation of men is not common.

・ Men have limited time to spend with their children because of work, and some men can only see their children on the weekends.

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Relationship with the

Health Facility ・ Many women prefer to

give birth at a health facility if possible.

・ The importance of post natal care is understood among men and women.

・ Due to financial reasons, some women have to give up delivery at a health facility.

・ Some families find it dificult to go to the health facility as it is far from their houses.

・ Men do not know what kind of care women receive and women do not tell men about it.

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Work and Community

Activities

・ The merry-go-round is functioning and women in the community support women who have just delivered.

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【2】 Results of Quantitative Survey

As a result of the quantitative survey, the following facts regarding infant feeding situation were identified. Details of the findings are reported in “Chapter III. Results of the Quantitative Questionnaire Survey （p.23-52）”.

Table 1-7 Condition of Infant Feeding

No. Topics Results

1 Colostrum

・ Nearly 100% of mothers have ever fed breast milk to their children. ・ Among the mothers who have ever breastfed, 75% have fed colostrum within 3

hours after birth. ・ More than half of the mothers have fed food besides breast milk within 3 days

after birth. ・ Besides breast milk, most common foods (liquids) that were given within 3 days

after birth were water, milk diluted with water, sugar water, and glucose.

2 Breastfeeding

・ 5.1% of mothers have done 6 months exclusive breastfeeding. ・ Mothers, who are currently breastfeeding, are planning to continue breastfeeding

for an average of 27.24 months. ・ Mothers, who have stopped breastfeeding, continued breastfeeding for an

average of 22.67 months. ・ The most common answer for the reason to stop breastfeeding was “because

my child had grown old enough”, and other anwers were “I became pregnant”, “I am busy with work”.

・ At the age of 0 months, 3 months, and 6 months, the rate of exclusive breastfeeding and predominant breastfeeding drastically decreased.

3 Artificial Milk

Feeding

・ The most common answer for the reason to start articificial feeding was “I cannot express enough breat milk”, “I am busy working”.

・ The earliest age when artificial milk was first given was 0 month after birth, while 24 months was the latest. An average age was 3.98 months.

4 Complementary

Food Feeding

・ The most common answer for the reason to start complementary food feeding was “I cannot express enough breat milk”, “I am busy working”.

・ The earliest age when they started complementary food feeding was 0 month, while 36 months was the latest. An average age was 7.01 months.

Six months exclusive breastfeeding rate (6months EBR) is one of the indicators that measure the impact of project (project on Promotion of Maternal and Neonatal Care Focusing on Breastfeeding in Kericho District, Kenya). Through the questionnaire survey, project’s baseline date of 6month EBR was successfully obtained.

【3】 Suggestions for the project:

Based upon the results of the baseline survey, following suggestions were made for a better implementation of project.

1. Determining an appropriate target rate of first 6 month exclusive breastfeeding:

Upon setting a target rate of the first six months exclusive breastfeeding, the socio-cultural backgrounds of the communities as well as the situation of the mothers should be taken into consideration.

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2. Reaching group of people in need:

The survey revealed that underage (teenage group) pregnancy had been widely recognized as an emerging common problem in the communities. Some informants pointed out that the teenage groups tend to have less access to health facility. Some effective approaches should be examined to convey appropriate messages.

Through the survey, it is found out that housewives and women engaged in farming tend not to be given a sufficient maternity leave. The survey also revealed that this group of women tends to give up breastfeeding within the first 3 days after delivery. More family support and appropriate knowledge should be provided to those women.

3. Finding the right timing to intervene: 1) During the pregnancy and shortly after delivery

In order to curtail the tendency to start giving food other than breast milk within 3 days after delivery, the mother should be guided on proper breastfeeding skills including proper remedies when she experiences difficulty in producing enough milk. A support system established by the health facility staff with other resource persons should be available for the mother when needed. At the health facility, interventions should be integrated as part of post-natal care program.

2) One month and three months after delivery At around 1 month and 3 months after delivery, some babies tend to cry

after being breastfed. As a result, a good number of mothers start giving their babies foods other than breast milk, e.g. cow’s milk with sugar added and Uji, believing that: a. The amount of breast milk produced is not enough; b. The babies are simply dissatisfied with breast milk.

The mothers often observe that the baby given breast milk substitutes like cow’s milk and Uji sleeps better. This phenomenon further contributes to the discontinuation of exclusive breastfeeding. Furthermore, the demand from job, a pressure by their husband, mother, mother-in-laws, their friends and acquaintances with children of same age greatly influence the decision of continuation or discontinuation of breastfeeding.

Proper information and knowledge to all who possibly exercise influence on the mother should be provided. Emotional support should be made available to the mother. The family and community should also be heavily

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involved．The health facility staff should continue interventions to promote exclusive breastfeeding by utilizing every single opportunity like a visit for child immunization.

【4】 Limitation of the Survey

The quantitative survey was conducted mainly to obtain data regarding “6

months exclusive breastfeeding”. When an interviewed mother has more than two children over 6 months of age, interview was made on the child who is closer to 6 months old. The “6 months exclusive breastfeeding rate”4 was obtained through this survey, by asking the detailed feeding practice of mothers. However, there still remain some doubts regarding the accuracy of the data as the age of the interviewed children varied and much of the information relied on the mother’s memories. The qualitative survey mainly aimed to identify the general trend of the health needs of mothers and children in the catchment areas of the project within a short period of time. Therefore, there might be a limit in the accuracy of the result of this qualitative survey (focus group discussion).

5. Conclusion

HANDS（Health and Development Service） has been implementing mother

and child health project aiming for the improvement of maternal care in western Kenya, involving health facilities and the communities. The project which was launched in August 2009, “Project on Promotion of Maternal and Neonatal Care Focusing on Breastfeeding in Kericho District”, plans to promote breastfeeding to postpartum women and neonates from the standpoint of continuous care. During the course of the survey, much expectation towards the activities of HANDS was shown from the community.

HANDS hopes to promote the effective cooperation between the health service providers and the beneficiaries in the community in order to improve the nutrition status of neonates and infants

Finally, we would like to appreciate all the concerned people both in Kenya and in Japan who have contributed to execute this baseline survey.

4 In this survey, because the time period and sample size was restricted, it was not relevant to use the “exclusive breastfeeding rate” defined by WHO (The number of infants 0-5 months of age who received only breast milk during the previous day, divided by the number of infants 0-5 months of age). Such data could not be obtained due to the selection bias in the children’s months of age. According to Kenya DHS(2003), the exclusive breastfeeding rate was 2.7%.

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ＩＩ． Results of Focus Group Discussion- Situation of Breastfeeding and its Recognition-

II. Results of Qualitative Survey

-Focus Group Discussion

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II. Results of Focus Group Discussion

The analysis of the focus group discussion with mothers and fathers in Kericho district on breastfeeding and child rearing is shown below. Here, typical opinions and the results of recapitulative context analysis are described.

1. Breast feeding Situation and its Recognition

【1】 Mothers’ Opinion

① Infant Feeding “I breastfed for three months then I gave uji. It depends on how financially stable you are, if you have no financial problems, you can breast feed exclusively up to six months. “（46 years old, 4 children） “I am breastfeeding but when the baby cries I feed milk.” (28 years old, 3 children) “I breastfed exclusively for six months.” (30 years old, 6 children) “I gave cows milk with water the first day after birth before my breast milk started to flow. “ (26 years old, 3 children) “The baby feeds on breast milk but still cries. That means he is not satisfied with breast milk so I was forced to give uji 2 months after birth.” (No identification11） <Analysis> Regardless of the mother’s age, breastfeeding is done in general. ・ Besides the breast milk, UJI, UGALI, milk diluted with water, and

fruits etc. are given . ・ (UJI: A porridge which dissolve maize powder or cereals with

hot water and add milk and sugar. ・ UGALI: A most common staple food in Kenya which maize

powder cooked with hot water to a dumpling) ・ Many mothers described they had continued exclusive breast feeding for

six months. ・ Foods other than breast milk is begun at a relatively early stage, one

month or three months after birth, with the exception when breast milk is not produced immediately after birth.

・ Some reasons for giving foods besides breast milk were, “I have a job” and “My baby cries with only breast milk feeding”. When the baby cries, in many cases mothers judge the time to start giving foods besides breast milk thinking that the baby is not satisfied only with breast milk.

11 Participant who joined after the FGD began.

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② Breast feeding

“We are supposed to breastfeed for six months but due to work we are forced to give cow’s milk.” (33 years old, 5 children)

“It is good because it makes the child healthy and it prevents infection. If I have another child soon after, I will breast feed both of them like twins. “ (30 year old, 6 children) <Analysis> ・ Breastfeeding is regarded as a good substance in terms of infection

prevention. ・ There is a recognition that 6 months exclusive breastfeeding is necessary. ・ There are some cases where the mother cannot breastfeed due to work.

【2】 Fathers’ Opinion

① Infant Feeding “Mothers give cow’s milk then uji.” (48 years old, 5 children) “My wife breastfed for one month then she gave milk! The baby did not get full with only breast milk.” (53 years old, 4 children) “I advised my wife to give breastfeed for 6 months but my wife declined and started other foods.” (No identification) “I am not sure what my wife feeds the baby with. He is 1 1/2 years old but I don’t know since I leave home early in the morning.” (30 years old, 3 children) “In some tribes the mother (wife) and husband are not allowed to be together for over one month. So he only provides money.” (33 years old, 3 children)

<Analysis ・ Around half of the men interviewed knows general information about the

feeding practices of the mother.

② Breastfeeding “A breast fed child does not get sick easily.” (32 years old, 2 children) “Breast milk is necessary unless the mother goes to work or a teenager has to go back to school.” (42 years old, 3 children) “The child cannot be breastfed when the mother is not well fed.” (44 years old, 7 children) “It’s very important the baby gets a lot of attention and assurance. Then, the baby calms down.” (43 years old, 4 children)

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<Analysis> ・Breast milk is regarded as a good substance in terms of disease prevention and nutrition. ・It can be understood that mother’s work and nutrition status is holding preventing the mother from breastfeeding.

③ Food besides breast milk

“Natural food like fruits are good!” (42 years old, 5 children)

“We should not introduce packed or tinned foods because they have chemicals e.g preservatives which are not good for the child. Natural food is the best.” (No identification) “We like the child to be breastfed then start giving cow’s milk then uji made from millet. ” (75 years old, 4 children) <Analysis> ・ There is no resistance to feed other foods besides breast milk. ・ Cow’s milk, uji, fruits and other natural foods are preferred to processed

foods.

2. Information on Child Rearing 【1】 Mothers’ Opinion

“My mother-in-law will observe the baby, and if the baby’s weight is low she will tell me what to feed the child with.” (26 years old, 3 children)

“At the time of my first child my mother taught me how to give complementary foods, but the rest I taught myself.” (50 years old, 10 children) “I heard through the radio.”(25 years old, 2 children) “I learned from posters in hospital. (35 years old, 7 children) “I learned from my mother-in-law and at the church.” (30 years old, 4 children) “We have never been told at the clinic.”(16 years old, one child)

<Analysis>

・ In most cases, information on child nutrition was obtained from family members such as mothers, mothers-in-law, and grandmothers. Especially advice given from mothers-in-law need to be followed.

・ Other information sources were radio, church, community, and health facilities.

・ Regarding health facilities, the responses split: some said they have received information, others have never spoken about it. There is a possibility that the provided information is different at each health facility.

＾

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ＩＩ． Focus Group Discussion －Information on Child Rearing－

【2】 Father’s Opinion

“Old women teach the young women about breastfeeding.” (45 years old, 4 children) “I receive information on how to feed children from women’s groups!” (25 years old, 3 children) “I hear information at church meetings.” (48 years old, 6 children)

<Analysis>

・Information on infant feeding is received from older women, women groups, radio, health facilities, and church.

3. Family Planning 【1】 Mother’s Opinion

“Once you get married, it is a must to give birth!” (30 years old , 5 children) “I request for family planning so that I can take care of my children well. If I have too many children you can’t do anything!” ( 45 years old, 4 children) “If I only have girls, I will continue giving birth until I get a boy! If I refuse my husband will marry another woman.” (No identification) “They say if we go for family planning you become sick!” ( No identification) <Analysis> ・ Many women responded that the role of a married woman is to bear

children, especially sons. ・ Some women prefer family planning due to the burden of child rearing. ・ Some regard family planning as something harmful to the body.


“Although we say family planning, when I only have girls I am not satisfied until we get a boy. We are not happy if we don’t get a boy.” (25 years old, 3 children) “Family planning is a must because the economy is too harsh. Long ago my parents got 15 children and they could manage but now life is difficult and we have to reduce the number.” (No identification) “Come and talk to us about family planning. Nowadays men leave home early in the morning and come back home late at night to sleep. This is why we make more children.” (71 years old, 8 children)

“When I got married that was my big issue! We planned to get three children but my parents wanted more.” (35 years old, 3 children)

＾

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ＩＩ． FGD 結果－家族計画－

“Space the children for two years so that they get everything they need and give the child time to grow.” (34 years old, 3 children)

<Analysis

・ For men, having sons is considered very important in order to have someone to inherit the property. Some men think it is important to bear many children.

・ Some men consider family planning is necessary when the financial situation of the household is not well.

・ There is not so much difference in thinking among generations. Some leaders in the community expressed anxiety about younger generations.

＾

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ＩＩ． Results of Focus Group Discussion －Role of Men－

4. Role of Men 【1】Mother’s Opinion

① Support at home “My husband will help sometimes such as holding the baby, but some tasks he will not help.” (23 years old, 2 children) “My husband helps in the morning by preparing the children to go to school.” (30 years old, 4 children) “My husband helps with only farming not cooking!” ( 26 years old, 4 children) “No way! My husband does not help. My sister helps me unless to fetch water from the bore hole.” (22 years old, 2 children) “Fathers don’t know how to hold babies.” (No identification) “My husband’s role is to go out to look for food.” (28 years old, 2 children) “My husband is just there but he does not even ask me anything about breast feeding.” (30 years old, 5 children)

<Analysis> ・ It is recognized that it is the men’s role to protect the family. ・ Most men do not take care of children and do not help with chores. ・ Men support school aged children and farming. ・ There is not difference among generations.

② Escort to health facilities

“I go alone, my husband cannot escort my child and I. Our culture does not allow it.” ( 28 years old, 4 children)

“He asks’ who is going for check-up is it me or you? Unless I am sick he will feel guilty to take me.” (27 years old, 4 children)

“I think it is good for the husband to accompany because it is not only my duty!” (33 years old, 5 children)

“I like to go alone.” (30 years old, 4 children) “When there is not much work, we come together.” (20 years old, 2 children) “My husband stays outside during delivery, he does not come in like other tribes do.” (45 years old, 4 children)

<Analysis> ・ Although there is some difference according to tribes and communitites,

it is not common for men to escort their wives and children to the health facility.

・ Some women prefer for their husbands to accompany, other women do not.

・ There is not much difference among generations.

＾

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① Role of men “I think there are four types of roles for husbands: security, food provision, parental care, and any other advice for the family.” (35 years old, one child) “When my wife is pregnant I ensure she goes to the clinic and then give birth in hospital then feed her, buy her clothes and ensure she has good health then educate the child and also do farming to help me cater for my family. I also ensure the child is breast fed.” (65 years old, 4 children) “Since I am the head of the family, I teach and pray for them.” (42 years old, 3 children) “I go out and find food and ensure the children are well fed, clothed, get education, and are healthy.” (35 years old, 4 children)

<Analysis> ・ Men have responsibilities as the head of the household to take care of the

food, shelter, and clothing for the family. It is uncommon for men to step into the area of women’s work such as housework.

② Relationship with children

“I spend time with my children during evenings, from seven to eight.” (26 years old, one child) “My small kids run to me and hug me when I am home. I talk to them after work and when eating.” (42 years old, 5 children) “I stayed with my firstborn all through but the secondborn I hardly had time for the child. I stayed with them over the weekend and from 6-8 P.M.” (No identification) “Nowadays life is difficult so we ask some of our children to go and sleep at our neighbors’ so I have no time to spend with them.” (31 years old, 3 children) “We don’t talk a lot with our women, unlike other cultures. I eat alongside my radio but the children eat with their mother.” (57 years old, 6 children) “We meet on Sundays because we go to church at 10 o’clock.” (No identification) “We never used to hold babies but now we do.” (43 years old, 4 children) <Analysis> ・ In general, many fathers are busy working and the only time they can

spend time with their children are during the evenings on weekdays and during weekends. It is the same among families with both grown children and infants.

＾

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・ Depending on culture, fathers cannot even hold their children, although it is changing slowly over generations.

③ Escort to the health facilities “I escort my wife, people have to know I have a wife!” (32 years old, 2 children) “No way, even when going to church my wife has to go alone but that was our culture at that time. A preacher from Europe said’ kipsigis people do not love their wives’ but we love our wives, we only do not show it openly.” (75 years old, 4 children) “Unless the doctor says I must, I do not accompany my wife.” (40 years old, 5 children) “I have escorted mine but I don’t like the child to be exposed to public because if the child is small those people with bigger babies will laugh at mine.” (57 years old, 6 children) “Most of us men are shy to go to the clinic.” (42 years old, 5 children) “It’s good that my wife and I both go so that we are taught what is good for the baby but when she goes alone she is taught and I might be against the ideas.” (65 years old, 4 children) “The culture has changed very much! For example when my wife gave birth I stayed with her in the same room unlike long ago. I even prepared uji for her.” (No identification)

<Analysis> ・ In some cultures, it is not common for men to accompany women. In all

generations, there are some resistance against men escorting their wives to the health facilities.

・ Mainly in younger generations men do not have resistance to escort their wives and children to the health facility.

＾

19

ＩＩ． Results of Focus Group Discussion －Relationship with Health Facilities－

5. Relationship with Health Facilities 【1】 Mother’s Opinion

① Birth Place “I delivered at Kericho District Hospital.” (40 years old, 5 children)

“Some of my children I gave birth at the hospital and some at home. When I gave birth at home, I was given an expected delivery date but labour came earlier.” (33 years old, 5 children) “It depends on where you go into labour. Like the time of this baby I delivered at home!” ( 30 years old, 6 children)

(In response to the question, “where would you like to deliver?”)

“I would like to deliver at hospital.” (All of participants) “(I don’t give birth in the hospital）due to our financial situation.” (30 years old, 4 children) <Analysis> ・ Although there was no major difference in the rate of deliveries at the

health facilities and those at home, most women prefer to give birth at health facilities.

・ Some reasons for home deliveries were “because I went into labour”, “because of financial issues”.

② Postnatal check-ups /Postnatal care

“It’s important because you may have a problem which you don’t know but the doctor might know.” (30 years old, 6 children) “If I am feeling okay, I take the baby for a check-up.” (33 years old, 5 children) “After one month I take my baby for a check-up. If I am not well I go earlier. But due to the long distance I cannot go easily.” (26 years old, 3 children)

“If I am fine, I can even go the next day after birth!” (30 years old, 4 children)

“I go to visit the clinic one week after birth.” (33 years old, 5 children) <Analysis> ・ It is recognized that it’s important to receive Postnatal check-ups

/Postnatal care at the health facility. ③ About Health facilities “I find it good to go to the clinic because I can prevent diseases.” (35 years old, 7 children) “When I visit the health facility, it helps me know my child’s health status, especially the weight.” (23 years old, 2 children)

＾

20

ＩＩ． Results of Focus Group Discussion －Relationship with Health Facilities－

“We are taught how to take care of our children.” (No identification)

<Analysis> Health facilities are considered to be an important place, in terms of health management and information source.


“Long time ago many children used to die but nowdays after we receive education at the clinic, children live longer.” (71 years old, 8 children) “I think it is very important for women and children to go to the clinic because they are taught how to stay well at home, what foods to avoid and also how to hold the baby and put them to sleep.” (56 years old, 6 children) “The problem is the access to the health facility. The distance from the house is about 20 km and no mode of transportation is available. Please provide mobile clinics.” (42 years old, 3 children) “I support the idea of health facilities. One time when my wife was pregnant she developed a complication and took her to hospital they asked me for her ANC card but she didn’t have it. Since my wife had never gone for check-ups it was difficult for the doctor to treat her and the doctor was very upset!” (56 years old, 7 children) “The child should be fully immunized but due to problems in storage facilities some drugs are missing and they postpone the immunization till the child is out grown.” (42 years old, 5 children)

<Analysis> ① Many men think it is important to receive check-ups and immunizations

at the health facilities, and would like for their wives and children to attend.

② Howeever, there is a problem of transportation and infrastructure.

＾

21

ＩＩ． Results of Focus Group Discussion －Others－

6. Work / Community activities 【1】 Mother’s Opinion

“We have an activity called merry-go-round and we take care of the mother who has just delivered by preparing food for her.” (28 years old, 4 children) “We have a merry-go-round activity where we contribute 50 shillings every month and help each other.” (26 years old, 3 children) “We buy the food for the mother, and also buy clothes and oil for the newly born.” (46 years old, 4 children) “We visit one another.” (22 years old, 3 children) “Whether or not we participate in the activity depends on what work you are involved in. In the case of the newly weds, they are free to join the activities until they settle and get children.” (35 years old, 7 children) “For my work, I pluck teas and do housework.” (30 years old, 5 children)

<Analysis> ③ Women are engaged in tea plucking, farming, and housework. ④ Women have a self-help activities called “merri-go-round” and “morik”.

Through these activities, post partum women are supported.


① Role as a wife “My wife is in charge of all home affairs. She is the home steward and to love

me in order to provide all they need.” (65 years old, 5 children) “The role of my wife is to raise children by feeding them and ensure they are healthy and advise them.” (42 years old, 3 children) “She supports me in my duties, like going to the shamba and helps me plan for the home duties and takeｓ care of the property and children.” (34 years old, 3 children)

“The role of the wife is to feed and take care of children and ensure they are healthy. Women are better at these tasks than men.” (57 years old, 6 children) “Wives need to ensure that she cooks for the kids because my role is to look for the food. But there are some things she is supposed to bring like vegetables. I would like for her to take care of me so that I would be happy and would work harder.” (44 years old, 7 children) “If she quarrels with me, I won’t bring the food so she has to make me happy.” (39 years old, 5 children)

<Analysis>

⑤ For men, wives are considered an important partner who supports them and manages the work inside the house.

＾

22

ＩＩ． Results of Focus Group Discussion －Others－

7. Others （Opinion on Child Health, Suggestions for the Project）

【1】 Fathers’ Opinion “Babies should be well fed and should be kept clean. I am concerned because it’s my own baby.” (32 years old, 2 children) “The sight of a dirty child is not good and we should not wait for the mother to bathe them. We should do it!” (43 years old, 4children) “Women go out to work and we could be left with the children. That is why we should ensure they are clean by changing their diapers now that there are disposable ones.” (40 years old, 2 children) “It is good to support our wives by bringing up the children and doing everything expected as a father.” (52 years old, 2 children) “Please find a way of talking to our teenagers who have children because they do not accept themselves as mothers. They think going to the clinic is for the married women only!” (42 years old, 3 children) “Thanks for having this opportunity to talk to us. My wife delivered in the house and did not attend the clinic. I have learned something and if you could bring us such teachings every month I would appreciate it.” (No identification)

<Analysis> ⑥ Although fathers recognize their cultural role in the society, they have a

positive mind to take part in child rearing in the community. ⑦ Under such situation, there are expectations for HANDS to involve the

fathers in the new project.

23

ＩＩI． Results of Questionnare－Basic Data of Respondents－

III．Results of Quantitative Survey

24


III. Results of Quantitative Survey

The data of the quantitative survey on breastfeeding patterns of mothers living in Kericho district who had children over six months old was analized and the results are shown below.

1. Basic data of respondents

The following information is the basic data from 312 respondents.

【1】 Age

The age ranged from 17 years to 47 years old.（Average age; 26.28 years）13.

Figure 3-1 The age of questionnaire respondents

13 Note: The results were obtained through oral interviews.

17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 43 45 46 47

年齢

0

10

20

30

40

人数

2

7

12

27

20

34

24

16

2220

8

21

8

30

68

3

8

15

24

32

4

12

1 1

Age

No. of

Resp

onde

nts

25


Figure 3-2 The age of respondents (per health facility）

【2】 Ethnic Group

292 mothers were Kipsigis (93.9％), followed by 12 Luos（3.9％）. (Number of valid responses：310 people）.

Table 3-1 Ethnic Group

Frequency Percentage

Kipsigis 292 94.2

Luo 12 3.9

Luhya 3 1.0

Meru 1 .3

Gikuyu 1 .3

Nandi 1 .3

Total 310 100.0

Distribution by each health facility is shown below.

Table 3-2 Ethnic Group （per health facility）

Health Facility

Total Kabianga Kipsitet Sosiot Chepkemel Kenegut Kiptere

Ethnic

group

Kipsigis 47 43 53 46 51 52 292

Luo 3 5 1 3 0 0 12

Luhya 0 1 0 2 0 0 3

Meru 0 0 0 1 0 0 1

Gikuyu 0 1 0 0 0 0 1

Nandi 0 1 0 0 0 0 1

Total 50 51 54 52 51 52 310

Kabianga Kipsitet Sosiot Chepkemel Kenegut Kiptere

保健医療施設

0

5

10

15

20

25

30

平均年齢

27.06 26.39225.148 25.558

26.961 26.66

Health Facility

Ave

rage

Age

26


【3】 Occupation

Mothers were asked how they spent most of their time working（number of valid response: 308）. Most respondents were housewives（125）, followed by farmers（110）, and business（36）.

Table 3-3 Occupation


Housewife 125 40.6

Farming （tea

plucking） 117 38.0

Business 36 11.7

Teacher 11 3.6

others 19 6.2

Total 308 100.0

Table 3-4 Occupation （per health facility）

Health Facility


Main Work Housewife 14 23 25 25 26 12 125

Farming（tea

plucking） 25 8 23 16 15 30 117

Business 4 10 4 5 7 6 36

Teacher 4 2 2 1 1 1 11

others 3 7 0 4 1 4 19

Total 50 50 54 51 50 53 308

【4】 Age at First Birth

Most mothers first give birth at 18 years of age（57 respondents）. The average age at first birth was 18.86 years.

Figures 3-3 Age at First Birth

11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 31 32 34

年齢

0

10

20

30

40

50

60

人数

2 13

7

20

34 34

57

33

53

16

23

64

75

1 2 1 1 1

Age

No. of

Resp

onde

nts

27


Generally, the age at first birth of women living in developing countries is said to be 18 to 19 years old. The results of this survey revealed the same situation.

Teenage pregnancy is one of the factors for maternal and infant mortality. Also, school drop out of young pregnant girls is a social problem. The distribution of the frequency of first age at birth is grouped in the following table. 21.5％ of women are under 16 years old, 56.9％ are between 17 to 20 years old, which means that just under 80% of women first give birth before they reach 20 years old.

Table 3-5 Age at First Birth （per age group）

frequency percentage

～16 years 67 21.5

17～20years 177 56.9

21～24years 49 15.8

～25years 18 5.8

Total 311 100.0

Data per health facility is shown in Table 3-6.

Table 3-6 Distribution of age at first birth （per health facility）

Health Facility


Age at

first birth

～16 years 14 8 4 8 15 18 67

17～20years 27 32 34 32 31 21 177

21～24years 5 6 11 11 5 11 49

～25years 4 5 5 1 0 3 18

Total 50 51 54 52 51 53 311

【5】 Number of Children

The number of children delivered and those living are shown in table 3-7 and 3-8.

Table 3-7 Number of Children Delivered


1 61 19.6

2 89 28.6

3 54 17.4

4 43 13.8

5 31 10.0

6 15 4.8

7 11 3.5

8 3 1.0

9 2 .6

10 2 .6

Total 311 100.0

28


Table 3-8 Number of Living Children


1 62 19.9

2 88 28.3

3 57 18.3

4 44 14.1

5 27 8.7

6 17 5.5

7 9 2.9

8 3 1.0

9 2 .6

10 2 .6

Total 311 100.0

The average number of living children was 3.05, and most respondents answered 2 children (88 respondents). Data per each health facility is shown below.

Figure 3-4 Number of Living Children （per health facility）

【6】 Targeted Child

The questionnaire survey investigated the breastfeeding patterns of the youngest child who is over 6 months old. The following information is the basic data of the interviewed child.

① Age in month／Age

The average age of the interviewed child was 31.21 months, and the median at 24.00 months. The distribution of the age group is shown in table 3-7.


保健医療施設

0

1

2

3

4

平均数

3.163

2.537

3.038

3.529

3.038

Health Facility

Ave

rage

No. of

Child

ren

29


Table 3-7 The age of the interviewed child


Age Under 1 49 15.8

1 years 59 19.0

2 years 71 22.8

3 years 61 19.6

4 years 28 9.0

5 years 32 10.3

Over 6 11 3.5

Total 311 100.0

② Firstborn child or not

The targeted child being the firstborn was 30.2% (94 cases), and the targeted child being a secondborn or those born later was 69.8％ (217 cases).

③ Sex 48.9％ (152 cases) were girls, 51.1% (159 cases) were boys.

【7】 Household Members

Family members besides the child is shown in table 3-8.（valid response: 302 cases, multiple answers allowed）. Besides husbands, the most common case was mother-in-law (66 respondents) and father-in-law (34 respondents).

Table 3-8 Household Members

Respondents Cases

frequency ％％

Husband 262 55.0 86.8

Mother-in-law 66 13.9 21.9

Father-in-law 46 9.7 15.2

Mother 34 7.1 11.3

Father 23 4.8 7.6

Other 45 9.5 14.9

Total 476 100.0 157.6

Other answers included brothers and sisters, brothers and sisters in law, housemaid, and in the case where polygamy exists, other wives.

【8】 Child Rearing

In the case where the respondent cannot look after their child, when asked whether or not there is someone who can take care of the child, 32.5% (101 respondents) answered “yes”, 67.5% (210 respondents) answered “no”. Those who help with child bearing are mother-in-law, mothers, sisters, husbands, sisters-in-law, and housemaids.

＾

30

ＩＩI． Results of Questionnaire Survey －Situation of Colostrum Feeding－

2. Situation of Colostrum Feeding

【1】 Experience of Breastfeeding

99.7%, or 310 mothers responded that they had ever breastfed their child. With the exception of one mother who was sick, all respondents had breastfeeding experience.

【2】 The Timing of Feeding Colostrum

Regarding the first time when colostrum was given to the child after delivery, most mothers answered “within 0 hour” (108 respondents), followed by “one hour” (102 respondents). 77.4% mothers (240 respondents) gave colostrum within 3 hours after birth.

Figure 3-5 Timing of Colostrum

【3】 Feeding within 3 Days after Birth

More than half of the mothers (55.9%, 174 respondents), fed their child something besides breast milk within three days after delivery, which is generally considered to be the time when it is difficult to produce breast milk. Most mothers fed water (72 respondents), sugar and glucose water, cow’s milk

diluted with water, and sugar added to cow’s milk and other artificial milk. When compared, 66 respondents (37.9%) gave artificial milk (including those with sugar and water added) which are considered to be substitutes for breast milk, while 108 respondents (62.1%) gave water and other liquids.

0 1 2 3 4 5 6 7 8 12 24 48 72 96 168

出産後初乳までの時間

0

20

40

60

80

100

120

人数

108102

21

94 4

92 1

6

21

10 92 2

No. of

Resp

onde

nts

Hours after Birth

＾

31


Data per health facility is shown in Figure 3-6. Figure 3-6 Feeding within 3 Days after Birth （per health facility）

The following data shows the relation between mother’s occupation and their feeding practice 3 days after birth.

Table 3-9 Cross Tabulation Table : Relation Between Mother’s Occupation and

Feeding Practice 3 Days after Birth

Did they feed foods

other than breast milk

within 3 days after

birth? Total

Yes No

Occupation Housewife

Frequency 76 49 125

Expected Frequency 70.0 55.0 125.0

Farming（tea

plucking）

Frequency 76 40 116


Business

Frequency 12 24 36


Teacher Frequency 2 9 11


others Frequency 6 13 19


Total Frequency 172 135 307



保健医療施設

0

10

20

30

40

人数

26

29

27

23

37

32

24

22

26

29

14

21

母乳以外を与えた

母乳しか与えていない

Breast milk and other liquids

Only breast milk

No. of

Resp

onde

nts

Health Facility

＾

32


Chi-Square Tests

Value df Asymp, Sig (2-sided)

Pearson Chi-Square 23.926(a) 4 .000

Likelihood Ratio 24.304 4 .000

Linear-by-Linear

Association 14.267 1 .000

Number of Valid Cases 307

a 1 cell (10.0%) has expected count less than 5. The minimum expected count is 4.84

It can be assumed that more housewives and farmers were feeding foods besides breast milk 3 days after birth, compared to so-called white collars such as business persons and teachers.

＾

33

ＩＩI． Results of Questionnare Survey –Situation of Artificial Milk Feeding

3. Situation of Breastfeeding

【1】 Situation at the Time of Survey

At the time of survey, 105 mothers (33.8%) were breastfeeding their children, and 206 mothers (66.2%) were not breastfeeding.

The age-specific data of the targeted child is shown below. Of the 49 mothers who had children over six months old and under one-year of age responded that they were currently breastfeeding. The breastfeeding pattern was relevant to the children’s age.

Table 3-10 Breastfeeding Statistics (age-specific)

Now breastfeeding Total

Yes No

Age of the targeted child

Under 1 year 49 0 49

1 year 44 15 59

2 years 11 60 71

3years and older 1 131 132

Total 105 206 311

Mothers who were breastfeeding planned to breastfeed for an average of 27.24 months after birth, and the most common response was until the child was 2 years of age. On the other hand, mothers who were not breastfeeding stopped breastfeeding at an average of 22.67 months after birth, and the most common response was 2 years of age. From these facts, there is a tendency for mothers to breastfeed until the child is 2 years of age.

Figure 3-7 Duration of Breastfeeding (per health facility)


保健医療施設

0

5

10

15

20

25

授乳期間平均

23.4

20.16

21.55

24.823.71

22.47

Health Facility

No. of

month

s

＾

34


The average point of time for mothers to stop breastfeeding is shown below, as data per health facility.

【2】 Reasons for not Breastfeeding

When mothers were asked why they chose not to breastfeed, the following response was obtained. (Number of valid response: 203, multiple choice possible)

Table 3-11 Reasons for not Breastfeeding

Number of Response Cases

Frequency ％％

The baby grew enough to stop breastfeeding 185 77.7 91.1

I became pregnant 15 6.3 7.4

I am busy with my job 13 5.5 6.4

I am busy taking care of other children 6 2.5 3.0

My health is not in a good condition 5 2.1 2.5

I do not express enough breast milk 4 1.7 2.0

The baby does not suckle well 4 1.7 2.0

The baby’ health is not in a good condition 2 0.8 1.0

Others 4 1.7 2.0

Total 238 100.0 117.2

Others responses were “the baby can eat other foods”, “the baby dislikes breast

milk”, “I went back to school”.

＾

35


4. Situation of Artificial Milk Feeding

【1】 Definition

In this survey, “artificial milk” is defined as something which is close to breast milk, with view to the culture and custom in the community, such as “milk”, “uji”, “infant formula (NAN)”. It is considered as something which can be given in place of breast milk at an early age.

【2】 Situation at the Time of Survey

At the time of survey, 308 mothers (99.0%) were feeding artificial milk to their child, and only 3 mothers (1.0%) were not feeding artificial milk at all.

Of the 3 cases where artificial milk feeding did not occur, 2 cases were of small children who were 6 months of age.

Table 3-12 Situation of Artificial Milk Feeding (age-specific)

Artificial Milk

Feeding Now

Total

Yes No

Age of the

targeted child

Under 1 year 47 2 49

1 year 59 0 59

2 years 71 0 71

3years and older 61 0 61

4 years 28 0 28

5 years 32 0 32

6 years and older 10 1 11

Total 308 3 311

＾

36


【3】 Initiation of Artificial Milk Feeding

The earliest time artificial milk was first given was 0 months after birth, while 24 months was the latest, according to mothers who responded that they were feeding artificial milk at the time of survey. (Average 3.98 months, Median: 3.00 months, most common response: 6 months, number of valid responses: 309.)

It can be seen that “0 months”, “3 months”, and “6 months” is the time of initiation for artificial milk feeding. At the time of 6 months after birth, 87.4%, or 270 mothers had begun artificial milk feeding.

Figure 3-8 Initiation Stage of Artificial Milk Feeding

Targeted child was grouped by their age in months and the initiation of artificial milk feeding was observed per health facility.

Table 3-13 Initiation of Artificial Milk Feeding (per health facility)

Health Facility


Initiation Age

(in months)

of artificial

milk feeding

Under 3

months 17 19 20 17 25 24 122

3 months to

6 months of

age

26 25 23 30 19 25 148

Over 6

months 6 7 11 5 7 3 39

Total 49 51 54 52 51 52 309

0 1 2 3 4 5 6 7 8 9 12 14 17 20 21 24

子どもの月齢

0

10

20

30

40

50

60

人数

35

49

38

51

24

18

55

11

4 3

15

1 1 1 1 2

Age in Months

No. of

Resp

onde

nts

＾

37


The following responses were given when mothers were asked why they fed artificial milk. (Valid responses: 308, Multiple choice answers possible)

Table 3-14 Reasons for Feeding Artificial Milk

Number of Responses Cases

Frequency ％％

The baby grew enough to stop breastfeeding 274 72.5 89.0

I do not express enough breast milk 28 7.4 9.1

I am busy with my job 25 6.6 8.1


I am busy taking care of other children My

health is not in a good condition

10 2.6 3.2

The baby’ health is not in a good condition 4 1.1 1.3

I was told by others to do so 3 0.8 1.0

My health is not in a good condition 3 0.8 1.0

The baby does not suckle well 3 0.8 1.0

I have problems positioning my baby 1 0.3 0.3

Others 14 3.7 4.5

Total 378 100.0 122.7

When observing the distribution of the most common response “ I felt that my baby was old enough to feed artificial milk” against the initiation period of artificial milk feeding, the initiation period of 131 respondents placed between 3 months to 6 months, and 109 respondents below 3 months.

Table 3-15 Initiation Stage of Artificial Milk Feeding (grouped by reason)

Reason for Feeding Artificial Milk

Initiation Age

(in months)

of artificial milk

feeding

My baby was

old enough to

start artificial

feeding

I cannot

express enough

breastmilk

I am busy with

my job

Under 3 months 109 14 8

3 months to 6

months of age 131 13 14

Over 6 months 34 1 3

Total 274 28 25

＾

38


No significant difference was seen among the order of birth among the children. However, it is shown that the firstborn tends to be initiated to artificial milk feeding at a later stage than children born later.

Table 3-16 Cross Tabulation Table of Initiation Stage of Artificial Milk Feeding and

Order of Birth

The Order of Birth

Total

Firstborn

Second-born

and children

born after

Initiation Age

(in months)

of

artificial milk

feeding

Below 6

Months

Frequency 77 193 270


Column Percent 82.8% 89.4% 87.4%

Over 6

Months

Frequency 16 23 39





Column Percent 100.0% 100.0% 100.0%

Chi-Square Tests

Value df

Asymp. Sig.

(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)

Pearson Chi-Square 2.534(b) 1 .111

Continuity Connection (a) 1.974 1 .160


Fisher’s Exact Test .135 .082

Linear-by-Linear


No. of Valid Cases 309

a Computed only for a 2x2 table

b 0 cells (.0%) have expected count less than 5. The minimum expected count is 11.74.

＾

39

ＩＩI． Results of Questionnare Survey- Situation of Artificial Feeding－

5. Situation of Complementary Feeding

【1】 Definition

In this survey, any food besides artificial milk and breast milk that is consumed by an infant is defined as complementary foods (artificial supplements, other foods or liquids).

【2】 The Situation at the Time of Survey

At the time of the survey, there were 297 mothers (95.5%) who were feeding complementary foods to their children, while 14 mothers (4.5%) were not feeding complementary foods.

The data of targeted children by age group is shown in the following table.

Table 3-17 The Situation at the Time of Complementary Feeding

Now Feeding

Complemenary Food Total

Yes No

Age of the

targeted child

Under 1

year 39 10 49

1 year 56 3 59

2 year 70 1 71

3 year 61 0 61

4 year 28 0 28

5 year 32 0 32

6 years and

older 11 0 11

Total 297 14 311

Of the 296 mothers who responded specific foods that they fed as

complementary foods, 289 mothers (92.9%) responded that they fed ugali, the staple food in Kenya. Other responses were rice, vegetables, meat, and fruits.

＾

40


【3】 Starting of Complementary Feeding

The earliest time complementary feeding was begun by mothers who replied that they were now feeding complementary food was 0 month, while 36 months was latest. (Average: 7.01 months, Median: 6.00 months, most Common Response: 6 months, valid responses:297). 60.6% or 180 mothers had begun artificial feeding within 6 months after birth, and therefore 6 months can be seen as a significant time for starting complementary feeding.

Figure 3-9 Starting Period for Complementary Feeding

Starting period of complementary feeding per health facility is shown in the table below.

Table 3-18 Starting Period of Complementary Feeding (per health facility)

Health Facility


Age in

months

when

starting

artificial

feeding

Under 3

months 5 6 7 2 8 3 31

3 months to

6 months of

age

26 10 29 26 20 38 149

Over 6

months 16 31 13 24 22 11 117

Total 47 47 49 52 50 52 297

0 1 2 3 4 5 6 7 8 9 12 16 17 18 19 20 24 36

子どもの月齢

0

20

40

60

80

100

人数

5

13 13

19 19

27

84

24 23

16

40

1 15

1 14

1

Age in Months

No. of

Resp

onde

nts

＾

41


The reasons why mothers fed complementary foods are shown below. (Number of valid responses: 294, Multiple choice answers possible).

Table 3-19 Reasons for Feeding Complementary Foods

Number of

Responses

Cases

Frequency ％％

My baby is old enough to start artificial feeding 286 84.9 97.3

I cannot express enough breast milk 14 4.2 4.8

I am busy with my work 13 3.9 4.4

I am busy taking care of other children 11 3.3 3.7


My baby is not well 2 0.6 0.7

I was told by other people to do so 2 0.6 0.7

My health was not in a good condition 2 0.6 0.7

Others 3 0.9 1.0

Total 337 100.0 114.6

Distribution of the starting period of complementary feeding against the most common response “My child is old enough to start complementary feeding” is shown below. It can be observed that the “time when the child is old enough to be fed complementary food” comes later than the “time when the child is old enough to be fed artificial milk”. More than half of the mothers regard 6 months as the time to start complementary feeding.

Table 3-19 Starting Period of Complementary Feeding

Reasons for Feeding Complementaryl Food

Age in months

when starting

artificial

feeding

My baby is old

enough to start

artificial feeding

I cannot

express

enough

breast milk

I am busy with

my work

Under 3

months 31 1 2

3 months to 6

months of age 141 6

8

Over 6 months 114 7 3

Total 286 14 13

＾

42


As seen below, the second child and those born after tend to be fed complementary foods within 6 months after birth, when compared to the firstborn child.

Table 3-21 Cross Tabulation Table of Starting Period of Artificial Feeding and the

Order of Birth of Targeted Child

The Order of Birth

Total

Firstborn

Second born

and children

born after

Age in months

when starting

complementar

y feeding

Below 6

months


Expected frequency 52.7 127.3 180.0


Over 6

months

Frequency 42 75 117

Expected frequency 34.3 82.7 117.0



Expected frequencyp0 87.0 210.0 297.0

Column Percent 100.0% 100.0% 100.0%

Chi-Square Test

Value df

Asymp. Sig.

(2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)

Pearson Chi-Square 4.066(b) 1 .044

Continuity Connection (a) 3.556 1 .059


Fisher’s Exact Test .051 .030

Linear-by-Linear



a Computed only for a 2x2 table.

b 0 cells (.0%) have expected count less than 5. The minimum expected count is 34.27。

＾

43

6. 6 Months Exclusive Breastfeeding

【1】 Definition

To reduce the risk of interviewee mothers relying on their memories and their risk of overestimating as much as possible, “6 Months Exclusive Breastfeeding” is defined in the following way.14

14 This method also relies on the memory of mothers and the accuracy of the data needs further discussion.

“Have experience breastfeeding, and did not feed any food besides breast milk within 3 days after birth.” AND “Now breastfeeding and that period is over 6 months” OR “Now not breastfeeding, but stopped breast feeding at later than 6 months after birth” AND “Now not feeding artificial milk (cow’s milk, infant formula, uji) and have never fed” OR “Now feeding artificial milk, but started at later than 6 months after birth”. AND “Now not feeding complementary food (any food besides breast milk and artificial milk, and have never fed) OR “Now feeding complementary food, but started at later than 6 months after birth”.

＾

44

【2】 Analysis of Breastfeeding Patterns

According to the definition above, 6 months exclusive breastfeeding rate was 5.1%. (16 out of 311 respondents)

Data per health facility is shown below. According to the questionnare survey at

Kabianga Health Centre and Sociot Health Centre, the rate of mothers who continued exclusive breastfeeding for 6 months exceeded 10%, while at Kiptere Dispensary no one was found to exclusively breastfeed.

Figure 3-10 Practice of 6 Months Exclusive Breastfeeding (per health facility)

The 6 months exclusive breastfeeding rate was extremely low. However, in order to investigate the conditions which enable 6 months exclusive breastfeeding, the data was grouped in the following way and data of mothers whose child rearing

was close to 6 months exclusive breastfeeding was analized. (1) 6 months exclusive breastfeeding (EBF) (2) 6 months predominant breastfeeding (PRBF)15 (3) 4 months exclusive breastfeeding (EBF)16 (4) Others

15 In this survey, the definition of predominant breastfeeding is based on that of WHO. Cases in which mothers “fed food other than artificial milk or breast milk within 3 days after birth and continued exclusive breastfeeding for 6 months after birth” were grouped as mothers who “fed mostly breast milk only for 6 months”. The WHO defines as follows: "Predominant breastfeeding" means that the infant's predominant source of nourishment has been breast milk (including milk expressed or from a wet nurse as the predominant source of nourishment). However, the infant may also have received liquids (water and water-based drinks, fruit juice) ritual fluids and ORS, drops or syrups (vitamins, minerals and medicines). （http://www.who.int/nutrition/topics/infantfeeding_recommendation/en/index.html） 16 Based on the fact that before the promotion of 6 months exclusive breastfeeding, more than 4 months of exclusive breastfeeding had been promoted by WHO.


保健医療施設

0

10

20

30

40

50

60

人数

52

6

2 1

4549 48

50 5053

実施した

実施しなかった

No. of

Resp

onde

nts

Health Facility

6 Months EBF Practiced

6 Months EBF not Practiced

6 Months EBF NOT Practiced

6 Months EBF Practiced

＾

45

Table 3-22 Breastfeeding Patterns


6 Months EBF 16 5.1

6 Months PRBF 12 3.9

4 Months EBF 44 14.1

Others 239 76.8

Total 311 100.0

6 Months PRBF and 4 months EBF can be regarded as a close condition to 6 months EBF. Data per health facility is shown below.

Table 3-23 Breastfeeding Pattern (per health facility)

Health Facility


Breastfee

ding

Pattern

6 Months

EBF 5 2 6 2 1 0 16

6 Months

PRBF 0 5 3 3 1 0 12

4 Months

EBF 9 2 8 10 7 8 44

Others 36 42 37 37 42 45 239

Total 50 51 54 52 51 53 311

Factors which were thought to influence the breastfeeding patterns were

analized, but no statistical significant difference was found. The following results are shown in order to comprehend the breastfeeding patterns.

＾

46

① Relationship with the occupation of mothers The following points were indicated as the relation between the mother’s occupation and breastfeeding patterns. ・ Breastfeeding practice of housewives were satisfactory. In many cases mothers

fed their children water within 3 days after birth, the percentage of 6 months PRBF was high. It can be said that 6 months EBF, 6 months PRBF, and 4 months EBF cases were relatively high. Therefore, there is a possibility that 6 months EBF can be achieved when conditions are ready, such as knowledge of mothers and support from surrounding people.

・ On the other hand, regarding the situation of farmers, the percentage of those whose child rearing was “other”(see Table 3-24) practices was high. It is assumed that the burden of work is the bottleneck for breastfeeding.

Table 3-24 Cross Tabulation Table of Breastfeeding Patterns and Mother’s Occupation

Occupation

Total Housewife

Farming (tea

plucking) Business Teacher Others

Breast-

feeding

Pattern

6 months

EBF

Frequency 6 6 3 0 1 16

Expected Frequency 6.5 6.1 1.9 .6 1.0 16.0

Column Percent 4.8% 5.1% 8.3% .0% 5.3% 5.2%

6 months

PRBF

Frequency 10 2 0 0 0 12

Expected Frequency 4.9 4.6 1.4 .4 .7 12.0

Column Percent 8.0% 1.7% .0% .0% .0% 3.9%

4months

EBF

Frequency 17 11 7 3 6 44

Expected Frequency 17.9 16.7 5.1 1.6 2.7 44.0

Column Percent 13.6% 9.4% 19.4% 27.3% 31.6% 14.3%

Others

Frequency 92 98 26 8 12 236


Column Percent 73.6% 83.8% 72.2% 72.7% 63.2% 76.6%

Total Frequency 125 117 36 11 19 308


Column Percent 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Chi-Square Test

Value df

Asymp.Sig.

(2-sided)



Linear-by-Linear

Association .021 1 .884


a 10 cells (50.0%) have expected count less than 5. The minimum expected count is .43.

＾

47

② Time of Feeding Colostrum Regarding the relation between the breastfeeding pattern and whether or not

colostrum was fed within 3 hours after birth, mothers who fed colostrum within 3 house after birth practiced 6 months EBF, 6 months PRBF, 4 months EBF at a higher rate than mothers who first fed colostrum at a later time.

Table 3-25 Cross Tabulation Table of the Breastfeeding Pattern and the Time of Feeding Colostrum

Time of Feeding

Colostrum after Birth

Total

Within 3

hours

After 4

hours

Breastfeed

ing

Pattern

6 months EBF

Frequency 14 2 16



6 months

PRBF

Frequency 9 3 12



4months EBF

Frequency 40 4 44



Others






Column Percent 100.0% 100.0% 100.0%

Chi-Square Test

Value df

Asymp.Sig.

(2-sided)



Linear-by-Linear



a 2 cells (25.0%) have expected count less than 5. The minimum expected count is 2.71.

＾

48

③ The Order of the Child When the child is a firstborn, it is indicated that the rate of 6 months EBF, 6 months

PRBF, and 4 months EBF is higher compared to the case when the child is a second-born or born later. Many factors influence the rate such as the age of the mother at the time breastfeeding, economic status of the household, burden and the experience of child rearing, and birth spacing. Through acquirement of knowledge and child rearing support from surrounding people, is seems possible that the breastfeeding situation of the second-born and those born after can be improved.

Table 3-26 Cross Tabulation Table of Breastfeeding Pattern and the Order of the Child

The Order of the Child

Total

First

born

Second born

and children

born after

Breastfee

ding

Pattern

6 months EBF

Frequency 7 9 16



6 months

PRBF

Frequency 6 6 12



4months EBF

Frequency 14 30 44



Others






Column Percent 100.0% 100.0% 100.0%

Chi-Square Test

Value df

Asymp.Sig.

(2-sided)



Linear-by-Linear



a 2 cells (25.0%) have expected count less than 5. The minimum expected count is 3.63。

＾

49

【3】 Case Study

Cases of “mothers who exclusively breastfed for 6 months” are shown below, to be used as a role model for mothers who practice breastfeeding.

① The Case of A

A is a 27-year-old housewife and has 4 children, 2 girls who are 12 years and 8 years old, and 2 boys who are 5 years and 5 months old. The age at first birth was 15 years. Now, she is living with her husband, and does not have anyone who is helping her with child bearing.

The targeted child was the 5 year old boy of A, and his feeding was described as the following. The boy was fed colostrum 1 hour after birth, and breastfeeding was continued until he was 2 and a half years old. A stopped breastfeeding because she thought the boy had grown old enough. Artificial milk feeding and complementary food feeding was begun at the age of one. Now she is feeding the boy only ugali and vegetables.

② The Case of B

B is a 20 year old housewife. She first gave birth at the age of 18, and now is a mother of 2 sons. She is living with her husband and mother-in-law, however she is looking after the children herself.

B fed colostrums within 1 hour after birth. She feels her son had grown enough at the age of 2 and stopped breastfeeding. She began to feed artificial milk and complementary food when the child reached 9 months of age. She is now only feeding uji, ugali, vegetables, and tea.

③ The Case of C

C is 23 years old and has business work. She first gave birth at the age of 20 and is a mother of a 3 year old boy. She is a single mother and now living with her sisters.

C fed colostrums within 1 hour after giving birth. When the child was 1 year old, she felt that her son had grown old enough and stopped breastfeeding. She started artificial milk feeding at the age of 7 months and complementary food feeding at 9 months. Now the boy is only fed uji, ugali, meat, and vegetables.

④ The Case of D

D first gave birth at 18 years of age and is now 19 year old. She is a

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50

housewife, and her daughter is 1 year old. She is living with her husband and she takes care of the child herself. D is still breastfeeding and plans to continue until the child is 2 years old. Artificial milk and complementary food was fed at the time of 7 months. She is now feeding her daughter ugali, rice, and green vegetables.

⑤ The Case of E

E is a 30 year old housewife. After giving birth to a boy who is now 13 years old at 17 years of age, she had 5 children since then. Now the children are 10 years , 8 years, 7 years (girl), 5 years (boy), and 4 months old (girl). She lives with her husband and takes care of the children herself.

Regarding the 5 year old boy who was targeted, she fed him colostrums within 1 hour after birth and continued breastfeeding until 2 years old. She stopped because she felt that the boy has grown old enough. She fed artificial milk at 7 months and complementary food at 1 years of age. Now, she feed her son ugali, maize, and vegetables.

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51

【4】 Transition of Breastfeeding Patterns

Finally, the breastfeeding patterns according to the age in months of the targeted children are shown below.

Figure 3-11 Breastfeeding Patterns (per age in months)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0ヶ月 1ヶ月 2ヶ月 3ヶ月 4ヶ月 5ヶ月 6ヶ月

パーセント

子どもの月齢

母乳なし

部分的に母乳

ほぼ母乳（PRBF）

完全母乳（EBF）

The EBF rate at 0 months was 43.7%, because many mothers were feeding their children foods other than breast milk within 3 days after birth. As the figure shows, EBF rate and PRBF rate drastically decreases as the months increases, from 1 month, 3 months, and 6 months. Appropriate information communication and child rearing support given at these periods can contribute to the increase in the EBF rate.

Perc

enta

ge

Age in Months

No Breastfeeding

Partially Breastfeeding

PRBF

EBF

0 1 2 3 4 5 6

＾

52

Appendix

‐ Focus Group Discussion: Discussion Guideline

‐ Qualitative Survey:

Questionnare

＾

53

FGD Questionnaire Guideline

１． For Mothers

１） Introduction to the Focus Group Discussion

Hello everyone. Thank you very much for coming today. My name is ______from HANDS Kenya. I will be the facilitator today. Let me introduce the record keeper for today. Her name is _____________.We belong to an NGO called Health and Development Service, it is an organization which is provides health services to people around the world. Our headquarter is located in Tokyo, Japan, and in Kenya, we have a branch office in Kericho. We conducted a maternal and child health project in Kisii and Kericho together with the health center staffs from the year 2005 to 2008. We aimed to improve the maternal health service at the health centers. On this occasion, we have come back to Kericho to begin a project which aims to improve maternal and child health services through the promotion of breastfeeding. The purpose of our discussion today is to hear your comments regarding breastfeeding, from a mother’s perspective. Your comments will be very important in planning our activities to improve the health of mothers and children. Please speak freely about how you feel. Your comments will be recorded by _______but we will assure you that your privacy (what you speak out) will be protected.

２） Beginning of the Discussion

＊When the participant gives a comment, always ask “why they feel this way”, and try to deepen the discussion.＊ (1) How many children do you have now and how old are they? “From here on, we would like to ask those of you who have children 2 or 3 years old. If you do not have a child who is 2 or 3 years old, please answer referring to the youngest child.” (2) I would like to ask you what kind of food and drinks you have given (or is now giving) your baby.

① To mothers who have given only breast milk when the baby was born, and to mothers who are now feeding only breast milk: 1. How many times a day did you breastfeed/ are you breastfeeding? About how many minutes did

you breastfeed every time/are you breastfeeding every time? Why did you, do you do that? 2. How long did you continue breastfeeding after the baby was born? (How many months old is

the baby now, and how long do you plan to continue breastfeeding them?) Why? ② To mothers who have given/now giving infant formula to their babies：

1. Why have you gicen (or are you giving) infant formula？ 2. When did you start giving infant formula after the baby was born? Why did you choose this

time? 3. How long did you continue infant formula after the baby was born? (How many months old is

the baby now, and how long do you plan to continue infant formula them?) Why？ 4. Have you ever given breast milk? For how many months after the baby was born did you

breastfeed? Why did you stop breastfeeding? ③ To mothers who fed/feed their babies other food (for example ____) and liquids (for example _____)

besides breast milk and infant formula.： 1. What do you/ did you feed besides breast milk and infant formula? Why did you choose to feed

your baby this food? 2. When did you begin giving food besides breast milk and infant formula, such as _______and

_______ to your baby? Why did you decide to do so? 3. How long are you planning to feed breast milk and infant formula? Why? 4. Why are you giving breast milk, infant formula, and other food and liquids together?

(3) Generally, from who or where do you receive information regarding child bearing?

（Have the mothers speak freely. If there is no comments, ask questions such as “How about your mother?”, “How about your husband?”, How about your relatives?”, “How about your friends and neighbors?”, “How about the health center?”, “How about the MOH booklet, magazines or books?”, “How about the radio?” “How do you/did you feel about these people?”）

(4) What are your feelings and ideas about breastfeeding as part of your child bearing? Why is this so? （Have the mothers speak freely. If there is no comment, ask questions such as “Do you think it is better to breastfeed?” “Is there any problems to breastfeeding?”, “Is there anything you feel uncomfortable about breastfeeding? (for example, they feel that breast milk is not enough to provide enough nutrition for the babies” , “How do you feel about giving only breast milk to the babies until 6 months after birth?” In

＾

54

order to deepen the discussion, ask “Why do you feel/think this way?”)

(5) Did/Do you have any problems when you breastfed/breastfeed? For example, ・ Could not produce any breast milk /enough breast milk ・ The baby cannot suck properly, it cries often ・ Do not know how to hold the baby (how to position the baby) ・ Not in a good health condition ・ It is difficult to breastfeed during working hours ・ There are other older children to take care of so it is difficult to breastfeed

When you had a problem, have you ever consulted someone? What kind of advice did you receive from them? How did you feel about that? What made you feel that way?

(6) Where did you deliver your baby? Why did you choose that place?

(7) Did you have a medical staff or a TBA examine you and your baby within one week after the delivery?

What did you have examined? Do you feel it is necessary for postpartum women and babies to be examined? Why do you think so?

(8) When and for what kind of purpose do you go to a health center? Why do you choose a health center?

(9) Have you ever received a service regarding breastfeeding and childbearing at a health center or have consulted someone at the health center? When was that? How did you feel about the service? What made you feel that way?

(10) Do you have any work or volunteer activities besides housework and childbearing? How many days a week do you participate in such activities? Why do you participate in such activities? （Have everyone talk freely. If there are no comments, ask questions such as “How about the Safe Motherhood Group?” “How about farming?” In order to deepen the conversation, ask “why do you say so?”）

(11) Finally, please comment if you have any concerns regarding the nutrition and the health of your baby or child bearing, or if you have any requests to improve the current situation. Why do you comment this way?

３） Closing of the discussion

Appreciate the participants for their time and close the discussion.

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55

２． For Fathers １） Introduction to the Focus Group Discussion

Hello everyone. Thank you very much for coming today. My name is ______from HANDS Kenya. I will be the facilitator today. Let me introduce the record keeper for today. Her name is _____________.We belong to an NGO called Health and Development Service, it is an organization which is provides health services to people around the world. Our headquarter is located in Tokyo, Japan, and in Kenya, we have a branch office in Kericho. We conducted a maternal and child health project in Kisii and Kericho together with the health center staffs from the year 2005 to 2008. We aimed to improve the maternal health service at the health centers. On this occasion, we have come back to Kericho to begin a project which aims to improve maternal and child health services through the promotion of breastfeeding. The purpose of our discussion today is to hear your comments regarding breastfeeding, from a father’s perspective. Your comments will be very important in planning our activities to improve the health of your wife and children. Please speak freely about how you feel. Your comments will be recorded by _______but we will assure you that you privacy (what you speak out) will be protected.

２） Beginning of the Discussion

＊When the participant gives a comment, always ask “why they feel this way”, and try to deepen the discussion.＊

(1) How many children do you have now and how old are they?

“From here on, we would like to ask those of you who have children 2 or 3 years old. If you do not have a child who is 2or 3 years old, please answer according to the age of your youngest baby.”

(2) What is your role inside your family? What kind of chores do you have? When do you do those tasks?

Why?

(3) What is your wife’s role inside your family? What kind of chores does she have? When does she do those tasks? Why?

(4) How long do you spend with your children? When do you have that time? Why do you choose that time?

(5) In your daily life, do you speak to your wife about child bearing? What kind of things do you talk about? Why?

(6) Where or from whom does your wife receive information about child bearing? （Have the fathers speak freely. If there is no comments, ask questions such as “How about your mother?”, “How about your wife’s mother?”, How about your relatives?”, “How about your friends and neighbors?”, “How about the health center?”, “How about the MOH booklet, magazines or books?”, “How about the radio?” “How do you/did you feel about these people?”）

(7) Have you ever escorted your pregnant wife or children to the health center or the hospital for their regular check-up? When did you escort them? Why?

(8) What do you think about your wife attending the health center and receiving a check up, and your small

children receiving infant check up? Why do you think so?

(9) What kind of food and liquid does your wife regularly feed the children? What do you think about that? Why?

(10) What do you think about women breastfeeding their babies? Why do you think so?

(11) What do you think about women giving their babies other food and liquid besides breast milk? Why? (12) Finally, please comment if you have any concerns regarding the nutrition and the health of your baby or

child bearing, or if you have any requests to improve the current situation. Why do you comment this way?

３） Closing of the discussion Appreciate the participants for their coming and close the discussion.

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56

Questionnaire on Breastfeeding

1. Number 1. | | | |

2. Name of HC (where survey is conducted) 2. | |

3. Name of investigator 3. | |

4. Name of supervisor 4. | |

5. Name of person responsible for coding 5. | |

6. Classification □ 1) Valid □ 99) Invalid 6. | |

<Survey starts> Please allow me to ask you questions on how you raise your children. This survey will only be used to make clear the situation of breastfeeding in Kericho district. I assure your privacy will be perfectly protected. <Part I: Basic information>

7. Please tell me your name.

_________________/________________ (First Name) / (Last Name) 7. | | | |

8. What is the name of the location and sub-location you live in?

1) Location 2) Sub-location

8-1 | | | | 8-2 | | | |

9. What is your ethnic group? 9. | | | |

10. How old are you? years old 10. | | | |

11. What kind of activity do you spend your time most in a day?

11. | | | |

12. How old were you when you had your first baby? years old 12. | | | |

13. Children’s Information

13.1 How many children did you give birth to? children 13.1 | | | |

13.2 How many children are living? children 13.2 | | | |

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57

13.3 How old are they and what are their names? Please tell me one by one. *If possible, ask them to show ‘Child Health Cards’

*Choose and circle the target child following the answer (the youngest over 6 months old).

1) 1st daughter /Name 2) 2nd daughter /Name 3) 3rd daughter /Name 4) 4th daughter /Name 5) 5th daughter /Name 6) 1st son /Name 7) 2nd son /Name 8) 3rd son /Name 9) 4th son /Name 10) 5th son /Name

13.3-1 | | | 13.3-2 | | | 13.3-3 | | | 13.3-4 | | | 13.3-5 | | | 13.3-6 | | | 13.3-7 | | | 13.3-8 | | | 13.3-9 | | | 13.3-10 | | |

14. Whom do you live with (excluding your children)? Please enumerate every member. Tick as many as possible

□ 1) Husband □ 2) Father □ 3) Mother □ 4) Father-in-law □ 5) Mother-in-law □ 6) Others

14-1. | | 14-2. | | 14-3. | | 14-4. | | 14-5. | | 14-6. | |

15. Do you have anyone helping to look after your children when you have difficulties to do so? (family, friends, etc.)

□ 1) Yes Who? □ 2) No

15. | |

<Part II: Breastfeeding> In the part II, please give me information referring to [NAME] (=name of the target child). 16. First exposure to breastfeeding

16.1 Have you ever breastfed [NAME]?

□ 1) Yes □ 2) No -> SKIP TO Q.16.3 16.1 | |

I. 16.2

II. (If ever breastf

ed) *marked YES

16.2.1 After giving birth when did you first put [NAME] to the breast? III.

Hours / Days / Months (Circle) IV. *If less than 1 hour, write ‘00’ hours.

16.2.1 | | | |

16.2.2 In the first three days after delivery, before your milk began flowing regularly, was [NAME] given anything to drink besides breast milk?

□ 1) Yes What? □ 2) No

-> SKIP TO Q.17

16.2.2 | |

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58

V. 16.3

VI. (If never

breastf

ed) *marked NO

Why didn’t you feed breast milk? Tick as many as possible

Because □ 1) I couldn’t produce enough breast

milk □ 2) my baby couldn’t suckle breast milk

well □ 3) I couldn’t position my baby properly

when I tried □ 4) my physical condition wasn’t good

enough □ 5) my baby’s physical condition wasn’t

good enough □ 6) I was busy with my job □ 7) I was busy to look after other

children □ 8) I became pregnant □ 9) Others (Specify)

16.3-1. | | 16.3-2. | | 16.3-3. | | 16.3-4. | | 16.3-5. | | 16.3-6. | | 16.3-7. | | 16.3-8. | | 16.3-9. | |

17. Feeding Patterns

17.1 Do you feed [NAME] your breast milk now?

□ 1) Yes □ 2) No -> SKIP TO Q.17.1.2 17.1 | |

＾

59

VII. 17.1.1

(If breastfeed now) *marked YES

17.1.1.2 For how many months have you breastfeed [NAME]?

Months 17.1.1.2 | | | |

17.1.1.3 For how many months have you ONLY breastfeed [NAME]?

Months 17.1.1.3 | | | |

17.1.1.4 Up to how many months are you going to breastfeed?

months old

-> SKIP TO Q.17.2

17.1.1.4 | | | |

VIII. 17.1.2 (If not breastfeed now) *marked NO

17.1.2.1 How old was [NAME] when you stopped breastfeeding?

months old *If she’s never breastfed, write ‘00’ months *If less than 1 month, write days after ‘D’ (‘D3’ means 3 days).

17.1.2.1 | | | |

17.1.2.2 Why don’t you breastfeed [NAME]?

Because □ 1) I can’t produce enough breast milk □ 2) my baby can’t suckle breast milk well □ 3) I can’t position my baby properly when I

try □ 4) my physical condition isn’t good enough □ 5) my baby’s physical condition isn’t good

enough □ 6) I am busy with my job □ 7) I am busy to look after other children □ 8) I am pregnant □ 9) my baby is old enough to stop

breastfeeding □ 10) Others (Specify)

17.1.2.2-1. | | 17.1.2.2-2. | | 17.1.2.2-3. | | 17.1.2.2-4. | | 17.1.2.2-5. | | 17.1.2.2-6. | | 17.1.2.2-7. | | 17.1.2.2-8. | | 17.1.2.2-9. | |

17.2 Do you feed [NAME] artificial milk (means cow’s milk, uji, or NAN (infant formula)) now?

□ 1) Yes □ 2) No -> SKIP TO Q.17.2.2 17.2 | |

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60

IX. 17.2.1 (If feed artificial milk now) *marked YES

17.2.1.1 Why do you feed artificial milk to [NAME]? Tick as many as possible



enough □ 6) I am busy with my job □ 7) I am busy to look after other children □ 8) I am pregnant □ 9) my baby is old enough to start artificial

milk □ 10) someone advised feed artificial milk □ 11) Others (Specify)

17.2.1.1-1. | | 17.2.1.1-2. | | 17.2.1.1-3. | | 17.2.1.1-4. | | 17.2.1.1-5. | | 17.2.1.1-6. | | 17.2.1.1-7. | | 17.2.1.1-8. | | 17.2.1.1-9. | | 17.2.1.1-10. | | 17.2.1.1-11. | |

17.2.1.2 How old was [NAME] when you started to feed artificial milk?

months old *If less than 1 month, write days after ‘D’ (‘D3’ means 3 days).

17.2.1.2 | | | |

17.2.1.3 Until how many months are you going to feed artificial milk?

months old

-> SKIP TO Q.17.3

17.2.1.3 | | | |

X. 17.2.2

(If not feed artificial milk now) *marked NO

17.2.2.1 Have you ever fed artificial milk to [NAME]?

□ 1) Yes □ 2) No -> SKIP TO Q.17.3

17.2.2.1 | |

17.2.2.2 Why did you feed artificial milk to [NAME]? Tick as many as possible

Because □ 1) I couldn’t produce enough breast milk □ 2) my baby couldn’t suckle breast milk well □ 3) I couldn’t position my baby properly

when I tried □ 4) my physical condition wasn’t good


good enough □ 6) I was busy with my job □ 7) I was busy to look after other children □ 8) I was pregnant □ 9) my baby was old enough to start

artificial milk □ 10) someone advised feed artificial milk □ 11) Others (Specify)

17.2.2.2-1. | | 17.2.2.2-2. | | 17.2.2.2-3. | | 17.2.2.2-4. | | 17.2.2.2-5. | | 17.2.2.2-6. | | 17.2.2.2-7. | | 17.2.2.2-8. | | 17.2.2.2-9. | | 17.2.2.2-10. | | 17.2.2.2-11. | |

17.2.2.3 How old was [NAME] when you fed artificial milk for the first time?

Months old 17.2.2.3 | | | |

17.3 Do you feed [NAME] artificial supplements, other foods or liquids now?

□ 1) Yes □ 2) No -> SKIP TO Q.17.3.2 17.3 | |

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61

XI. 1

7.3.1

XII. Weaning

XIII. (If feed artificial

supplements

now) *marked YES

17.3.1.1 What kind of artificial supplements, other foods or liquids do you feed [NAME]?

17.3.1.1 | | | |

17.3.1.2 Why do you feed artificial supplements, other foods or liquids to [NAME]? Tick as many as possible



enough □ 6) I am busy with my job □ 7) I am busy to look after other children □ 8) I am pregnant □ 9) my baby is old enough to start weaning □ 10) someone advised to feed artificial

supplements, other foods or liquids □ 11) Others (Specify)

17.3.1.2-1. | | 17.3.1.2-2. | | 17.3.1.2-3. | | 17.3.1.2-4. | | 17.3.1.2-5. | | 17.3.1.2-6. | | 17.3.1.2-7. | | 17.3.1.2-8. | | 17.3.1.2-9. | | 17.3.1.2-10 | | 17.3.1.2-11 | |

17.3.1.3 How old was [NAME] when you started weaning? .

months old *If less than 1 month, write days after ‘D’ (‘D3’ means 3 days)

17.3.1.3 | | | |

17.3.1.4 How old will be [NAME] when you start to feed the same food as adults?

months old

-> SKIP TO Q.18

17.3.1.4 | | | |

XIV. 17.3.2

(If not feed artificial supplements now) *marked NO

17.3.2.1 Have you ever fed artificial supplements, other foods or liquids to [NAME]?

□ 1) Yes □ 2) No -> SKIP TO Q.18

17.3.2.1 | |

17.3.2.2 Why did you feed artificial supplements, other foods or liquids to [NAME]? Tick as many as possible

Because □ 1) I couldn’t produce enough breast milk □ 2) my baby couldn’t suckle breast milk well □ 3) I couldn’t position my baby properly

when I try □ 4) my physical condition wasn’t good


good enough □ 6) I was busy with my job □ 7) I was busy to look after other children □ 8) I was pregnant □ 9) my baby was old enough to start

weaning □ 10) someone advised to feed artificial

supplements, other foods or liquids □ 11) Others (Specify)

17.3.2.2-1. | | 17.3.2.2-2. | | 17.3.2.2-3. | | 17.3.2.2-4. | | 17.3.2.2-5. | | 17.3.2.2-6. | | 17.3.2.2-7. | | 17.3.2.2-8. | | 17.3.2.2-9. | | 17.3.2.2-10 | | 17.3.2.2-11 | |

17.3.2.3 How old was [NAME] when you feed artificial supplements, other

months old 17.3.2.3 | | | |

＾

62

foods or liquids for the first time?

18. Feeding in yesterday 18.1 What kind of foods or liquids did you feed (NAME) yesterday (during the day and in the nighttime)? Tick as many as possible

□ 1) Breast milk □ 2) artificial milk -> SKIP TO Q.18.3 □ 3) others (specify) -> SKIP TO Q.18.3

18.1-1. | | 18.1-2. | | 18.1-3. | |

XV. 8.2

XVI. (If

breastfed

yesterday) XVII. *marked

18.1-1

18.2.1 How many times did you breastfeed yesterday (during the day and in the nighttime)?

times 18.2.1 | | | |

18.2.2 How many times did you breastfeed in the nighttime (between sunset and sunrise)?

Times

-> SKIP TO Q.18.4 18.2.2 | | | |

XVIII. 8.3

XIX. (If fed

other

foods

or

liquids

) XX. *marked

18.1-2 or

18.1-3

18.3.1 How many times did you feed artificial milk or other foods or liquids yesterday (during the day and in the nighttime)?

times 18.3.1 | | | |

XXI. 18.4

XXII. (common

questio

ns)

18.4.1 Did [NAME] drink anything from a bottle with a nipple yesterday (during the day and in the nighttime)?

□ 1) Yes What? □ 2) No

18.4.1 | |

18.4.2 Was sugar added to any of the foods or liquids your baby ate yesterday (during the day and in the nighttime)?

□ 1) Yes □ 2) No 18.4.2 | |

<Survey ends> I really appreciate your kind cooperation.

19. Date / / 2009

19. | | | | |

baseline survey - 特定非営利活動法人handsbaseline survey “project on promotion of...

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