NUTRITIONAL STATUS OF BREAST FEEDING MOTHERS AT UMAR SANDA

GENERAL HOSPITAL BIDA, NIGER STATE NIGERIAL.

BY

AISHA HASSAN
2021/144621AN

SUBMITTED TO
DEPARTMENT OF NUTRITION AND DIETETICS,
SCHOOL OF APPLIED AND NATURAL SCIENCES,
FEDERAL POLYTECHNIC,
P.M.B. 55, BIDA
NIGER STATE

IN PARTIAL FULFILLMENT OF REQUIREMENT FOR THE AWARD OF NATIONAL

DIPLOMA (ND) IN NUTRITION AND DIETETICS

JUNE, 2023

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 CHAPTER ONE

1.0 INTRODUCTION

Breast feeding has been reported as an unequalled way of providing ideal food for the heal

they growth and development of infants (Zareai et al., 2013). Breastfeeding (BF) is

associated with decreased risk for many early-life disease Condition In infants and health

benefits for Women. (MMWR,2013). Exclusive breastfeeding (EBT) is defined as an infant

receiving any breast milk and mother liquids or solid except for medicines (Sanusi, RA and

Falana, OA, 2013; MMWR 2013). Evidence has lintked adequate breastfeeding at childhood

with low risk of cancer (Sanusi 2009), obesity (sanusi and falana 2013) coupled with the

elimination of the risk of gastrointestinal illnesses associated with food and utensil

contamination as it needs no Preparation.

Breastfeeding is considered the most complete nutritional Source for Infants because breast

milk contains the essential fats, Carbohydrates, proteins, and immunological factors needed

for infants to thrive and resist infection in the formative. First Year of life Cadwell in Barry,

2004.(Jones et al., 2013) in an analysis of Child Survival strategies identified exclusive

breastfeeding (EBP), in the first 6 months of life and continue breast-feeding from 6 to

11months as the single most effective preventive intervention in reducing child mortality,

with the potential of Saving 1.3 million lives annually. Similarly, ((Leon - Cava et al., 2002)

have observed that improved breastfeeding practices are Crucial for child growth and

development. However advocate of breastfeeding have noticed there has been a global

decline in the behaviour among nursing mothers.

World Health Organization (WHO) has recommended breastfeeding for all mothers Until 24

month Breastfeeding provides optimal nutrition for the baby as well as strengthen the bond

between mother and their baby. Exclusive breast feeding is a practice recommended for

infants aged 0 to 6 months of birth in which the infant, only retrieves breast milk without any

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additional food or drinks, except for medications and Vitamins that are recommended by

doctors (WHO 2021). Exclusive breastfeeding has many benefits for babies, i.e to protect

from infections such as diarrhea (Lamberti et al., 2013) also for infant growth (Kuchenbecker

et al., 2013).

In addition, exclusive breastfeeding also provides other benefits for mothers. It acted as

natural Contraceptive during the 6months of exclusive breastfeeding. It also helps mothers to

lose. Weight because they dispenses Considerable amount of energy (Hatsu et al. 2013) while

the nutritional status of the mothers remains retained despite the weight loss (Tasnim et al,

2014). Apart from managing intakes, the mothers attempts to maintain their nutritional status

also influenced by other factors, such as food taboos in the local culture as well as their.

Socio-economic status (Sanusi and follana, 2013).

Research on the nutritional status of exclusive breast- feeding mothers in comparison to non-

exclusive or breastfeeding mothers in terms of their adequacy of nutrient intake and

anthropometric status has shown a significant difference in earlier study (okechukwu et al,

2013).

1.1 Statement of Problem

Data from randomized Studies in Nigeria has shown that maternity Care practices has a

substantial Impact on breastfeeding success and infant health outcome, infant's not being

breastfeed is associated with an increased menace of infectious morbidity as well as elevated

risks of childhood obesity, type I and type 2 diabetes, leukemia and Sudden Infant death

syndrome.For mothers, failure to breastfeed is associated with an increased. incidence of

premeno pausal breast cancer, Ovarian Cancer, retained gestational weight gain, type 2

diabetes, myocardial infarction and the metabolic syndrome (Alison stuebe, 2013) poor

Feeding and imbalance breast feeding mothers in Nigeria has been confirmed to cause of

some chronic diseases of the infants mentioned above.

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1.2 JUSTIFICATION OF THE STUDY

Malnutrition remains an existing problem among Nigeria especially women and children,

which could be due to lack of food or Socio - cultural factors of the people during

breastfeeding. This study will review the feeding habit of breastfeeding mothers on their

infants, diet intake of the mothers to know the actual cause of malnutrition related diseases

among breastfeeding mothers and their infants, for proper development of the child and

healthy state of the mothers.

1.3. Aims and objectives of the study

General Objectives

To access the nutritional status and food consumption of breastfeeding mothers at umar

Sanda General Hospital Bida, Niger state Nigeria.

1.4 specific objectives

(i) To determine the Socio economic and demographic characteristics of the respondents

(ii) To investigate the food consumption pattern of the respondents

(iii) To access the food habit of the respondents.

1.5 Scope of Study

This research is limited to the nutritional status and food consumption of breastfeeding

mothers at Umar Sanda General Hospital Bida, Niger State, Nigeria.

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 CHAPTER TWO

2.0 LITERATURE REVIEW

2.1 NUTRITIONAL STATUS

Nutritional status has been defined as an individual’s health condition as it is influenced by

the intake and utilization of nutrients (Todhunter, 2015) in theory, optimal nutritional status

should be attained by consuming sufficient, but not excessive, sources of energy; essential

nutrients and other food components (such as dietary fiber) not Containing toxins or

contaminant.

Nutritional status is a measure of the health condition of an individuals as affected primarily

by the intake of food a utilization of nutrients. According to the world health organization

(WHO, 2015) health is not only the absence of disease but a state of complete mental and

physical in reaction to the productivity and performance of an individual good nutritional

status which can only be realized in communities that are found secure.

2.1.1 IMPORTANT OF MUTRITIONAL STATUS ASSESSMENT

Nutritional status is assessed to identify people at risk of malnutrition for early intervention or

referral before they become malnourished to identify individuals for treatment as they tend to

have longer hospital stays shower recovery form infection and Complication and higher

mobility and mortality of not treated early. To track child growth, to identify medical

complication that affect the body's ability to digest food and Utilized nutrients which can

increase the risks of malnutrition and infection to inform nutrient education and Counseling

to establish appropriate nutrition Care Plan (District Health Barometer, 2016).

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2.2 DEFINITION of EXCLUSIVE BREASTFEEDING

WHO (2016) stated that exclusive breastfeeding means 'that the infant receives only breast

milk; no other liquids or solid are given - not even water. -with the exception of oral

rehydration solution, or drops/Syrup of vitamins, minerals or medicines. Breast milk contains

all the nutrients that the baby needs. That means breast milk is the natural and Original food

for babies, which Provides all the energy and nutrients that infant needs for the first months

of life.

It also recommend that breastfeeding protect against many illnesses like diarrhea, and

Common childhood illness such as pneumonia and has long- -term health benefit for mother

and child like reducing risks of overweight and obesity in childhood and adolescence. It also

associated with intelligence quotient (IQ) in children WHO (2016)

2.3 BENEFITS OF BREASTFEEDING:

Review of different literature indicates that breast milk has remarkable health benefit for

infants and young children especially under, 2-years of age. It has also benefit for the mothers

as well as the Society WHO (2016)

2.3.1 THE VALUE OF BREASTFEEDING TO THE MOTHER

Wanyonyi (2010) indicated that Breastfeeding has different benefits for the mother if it is

based on the demand. This includes; it helps protect against another pregnancy Ovulation by

producing prolactin that prevent the formation of ovulation Steroid, Prevents. Prolactin has an

inhibiting influence On the Synthesis of ovarian steroids, delaying ovulation cycle. It helps to

produce oxytocin that help uterus Contract after birth and prevent bleeding. It also helps

reduce uterine, disorder, ovarian and breast cancer if babies breast longer periods in same

study, it indicated that breastfeeding after the birth helps to swiftly allow mother's weight loss

after pregnancy. This is because the reserve fat accumulated during pregnancy help to

produce milk and these enable her to loss at least 500 kcal per day Wanyonyi (2010)

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2.3.2 BREASTFEEDING BENEFITS FOR COMMUNITY.

NJERI (2012) indicated that breastfeeding has main benefits for the Community including:

1. Breast milk contains no waste or pollution

2. It helps breastfeeding mothers to have healthy babies that have less absence from work,

because they do not have to say home as frequently because their children are healthier.

3. It helps food support programs, to reduce costs while that is encouraging breastfeeding and

decreasing formula use. It also indicated that it could save about 4 million dollars from the

Cost of the formula use for e.g.in USA American and that was if 50% of infants were

exclusively breast fed for the first three months of life.

2.4 BARRIERS AFFECTING EXCLUSIVE BREAST FEEDING (EBF)

Debra J Hector (2013) developed a systematic approach in selecting factors for examination

of determinants' or barriers influencing EBF. The main objective of developing that was to be

used as a Common factors for affecting breast feeding and been adapted to solve the

problems in affecting effective implementation of EBF

The Socio-demographic characteristics of the mother are actually risk markers, those factors

that signal where a problem is occurring, but may not directly contribute to it.

Several studies identified lists of possible factors affecting breastfeeding practices, and/or

have grouped or categorized these factors.

The took they developed, in their study of influences on mothers feeding decisions, propose

an adaptation of an ecological model, in which influences are seen as emanating from

relationships between people and groups, and their environments. They extended more focus

on environments and the wider social context of people and groups. According to them the

factors affecting the practice of exclusive breastfeeding (EBF) were referred to as predictors,

determinants, barriers, influences and contributing Factors.

Table 2.1: Conceptual framework of factors affecting breastfeeding.

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Categories of factors affecting exclusive Breastfeeding practices socio-demographic /

characteristic of the mother and family structural and social support

Health and risk status of mothers and infants mothers knowledge, attitudes, and skills.

Aspects of the feeding regime/ practices

Health Services (including hospital and health facilities) Organization, policies and practices,

Socio - cultural, economic and environmental factors.

The following diagram depicts the Conceptual frameworks of factors affecting exclusive

breastfeeding practices as adopted by (Debra J Hector, 2013) Figure that Individual 1 to ten

and address mother.

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 A CONCEPTUAL FRAMEWORKS OF FACTOR AFFECTING BREASTFEEDING PRACTICES

Breastfeeding practice

Individual Attributes of the mother/infant

Attributes of the infant Attributes of the mother
level factors dyad

Features of the environment

Group level
factors
Hospital and Home/family World Community
health services environment environment environment

Society level
Figure 2.1: Conceptual framework of factors affecting
Public EBF (Debra J Hector, 2005).
policy environment
factors

 Attributes of society, culture and economy

 Cultural norms breastfeeding, child feeding
 Role of women and men in the society
 Cultural norms re-sexuality
 Food system

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The above Conceptual framework proposes three levels of factors that influence

breastfeeding practices: individual, group, and society. The frame work can the used to

generate hypotheses about factors affecting breastfeeding and the type of interventions that

might be used to address them.

Individual level factors: relate directly to the mother, infant, and the mother-infant dyad.

They include the mother's intention to breast feed; her knowledge, skills, and parenting

experience, the birth experience; the birth experience, health and risks status of mothers and

infants and the nature of early interaction between mother and infants.

2.5 BREASTFEEDING FOR INFANT HEALTH AND NUTRITION

Breastfeeding Birth spacing

The benefits of breastfeeding are constantly becoming better understood. Breastfeeding

reduces exposure to pathogens in the environment, gives protection by immunization

provides anti-bacterial and antiviral substances, and supplies the correct mix and density of
Infant
Infant survival Mother
nutrients; It also has very little direct Cost. Bottle feeding, which is the usual alternative in
Nutrition
Health
early life, tends to be contaminated non-Ideal in terms of nutrients, and not affordable to

many families in poor Societies.

The new born infant's needs and the mother's ability to provide for them, not only to nourish

but to protect, are closely linked.

Data collected during the 1970s by the world Fertility Survey show an overall historical

decline in breastfeeding both in terms of it initiation and durations. In fact the steady decrease

had been observed by the early twentieth Century. In Sweden, reduction in the rate of babies

being exclusively breastfeed at 2 months from 85% in 1944 to only 35% by 1970 was one

example of this continued downward trend. Similar statistics are available for other

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developed and Some Urban areas of developing countries through the WHO Collaborative

study (contemporary, patterns of breastfeeding, WHO, 2013). This changing pattern of infant

feeding has been attributed to "the demands of modern "life" and industrialization, as

alternative means of Feeding became available to public.

2.6 Benefits of Exclusive Breastfeeding (EBF) for the Baby:

Many researchers have identified that Exclusive Breastfeeding (EBF) has enormous benefits

for infants, for instance, (Fatoumata Binta Diallo 8, 2009) in Conakry, Guinea, indicated that

the risks of morbidity was reduced. I Closer to 70%, when the child exclusive breastfed. This

radiated that exclusive breastfeeding protected against serious morbidities (diarrhea,

respiratory infections, and low growth) in the first six months of life.

it was stated that infants who exclusively breastfed from 0-6 months had a significantly lower

prevalence of diarrhea and acute respiratory infection that those infants who are not

exclusively breastfed. Exclusive breastfeeding remains the most appropriate option for many

Hiv-infected mothers in Sub-Saharan Africa including Ethiopia. However, to increase the

acceptability and feasibility for Exclusive Breastfeeding (EBF) for the HIV-infected infants,

there should be good promotion of Exclusive Breastfeeding (EBF) as the best option for all.

infants (NJERI, 2012).

The study further indicated that mixed breastfeeding quadrupled. mother-to-infant HIV

transmission and was associated with a three times greater risk of transmission and death by

age 6 months when compared to exclusive breast feeding. In the same study, predominant

breastfeeding was associated with a 2.6 fold increase in HIV transmission as compared to

exclusive breast feeding. It was also shown that expressed breast milk from a HIV positive

mother can be utilized. for replacement feeding, as it is free from active HIV, Safe, nutritious

affordable, available, and protective. In addition to this, breast milk is a natural gift that

fulfills a baby's entire nutritional as well as fluid requirement of the baby in the first six

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months of life. Therefore, there is no need to give water or other liquid for infants to maintain

lost moisture in hot climate. It also provides Colostrum, which is the baby's immunication,

that has antibodies Vitamin A, and other that prevent them from neonatal death.

The same study showed that first milk, Colostrum gradually Changes its composition from

birth and this helped them as a main Source of nutrient and this is one of the major benefits of

breast milk. Breastfeeding is also associated with decreasing acute illnesses such as

gastrointestinal infections, lower respiratory tract diseases, and acute otitis media. It also

showed that Children not breastfeed are 10times higher at risk of dying due to any Case and

3-fold higher risk of not being hospitalized for any cause (NJERI, 2012)

2.7. Mother's personal characteristics (e.g. Mothers Knowledge & Attitude).

According to (NJERI 2012), maternal chacteristics such as education, influence breastfeeding

practices. The study also indicated that duration of exclusive breastfeeding of mainly

associated with information and knowledge about breastfeeding. Mother's level of education

been reported to be positively associated with initiation, exclusiveness and duration of

breastfeeding.

2.7.1 Socio-demographic Characteristic

According to the study, exclusive breastfeeding was associated significantly with current

marital status, economical status, etc. and that evidenced there is a Significant association

between breastfeeding rates and Socio-demographic characteristics of mothers including

maternal age, maternal education level, and family income.

On top of that, the study found that breastfeeding rates increase with an increasing maternal

age for all race-ethnicity groups, and hence, older mothers breastfeed more probably than

Younger. However, low level of breastfeeding was recorded with lower level of maternal

education whereas higher rates of breastfeeding were linked with higher family incomes

higher income than for mothers with lower family incomes (NJERI, 2012)

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2.7.2 Cultural Factors

NJERI (2012), also stated that different cultural factors such as different beliefs or myths

have an influence on breastfeeding. For instance, Indian people belief that mothers milk is not

ready until 2-3 days and post-partum delays initiation of breastfeeding while colostrum

generally discarded. He also identified that different cultural beliefs among Lebanse women

has caused that the mother could potentially harm her infant through breastfeeding and some

of the Cultural beliefs include an inherited inability to produce milk, having "bad milk", and

transmission of abdominal Cramps to infants through breast milk. It was further witnessed

that obstacles to exclusive breastfeeding include the perception of insufficient breast milk,

fear of dying or becoming sick to breastfeed. Moreover, breast milk insufficiency was

perceived to be a reason for discontinuing exclusive breastfeeding from most of the studies,

Cultural Practices do not agree with exclusive breast feeding for 6 months.

2.7.3 Environmental Factors

Environmental factors can influence breast-feeding and these include commercial incentives

for formula feeding, Supplementing newborns with formula, and using bottles before

discharge, has greater influence on Exclusive Breast (EB). His evidence, in developing

Countries show that initial breastfeeding has enormous benefit and can reduces deaths due to

diarrheal disorders and lower respiratory tract infections in Children which is otherwise,

influenced by the environmental factors (NJERI, 2012).

2.7.4 Medical Condition

It was also indicated that different medical Condition Such as mother and child's health

condition could affect breastfeeding. The medical condition includes the case when mothers

with HIV, permanently avoid breastfeeding and other mother who have, herpes simplex virus

type 1 (HSV-1), temporarily, avoid breastfeeding, and an illness that prevent mother from

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taking care of their babies such as sepsis, and maternal medication that affect the infants

health (NJERI, 2012).

The other health conditions provide disease such as breast abscess, hepatitis B, Hepatits C,

mastitis, tuberculosis, etc Even though mother with such Condition Can Continue

breastfeeding, they will Consider bottle-feeding and this influences breastfeeding. Other are

in case of child's birth weight is under (very low), born at less than 32 weeks of gestational

period, and newborn who are at risk of hypoglycemia, may need other food than breast milk

and which will affect breastfeeding.

2.7.5 Lack Access to services (like Health, water, Nutrition etc)

According to studies by (Nabeela Ahmed, 2015), inadequate breastfeeding Practices can be

attributed to food insecurity, income - poverty and lack of access to education and health

services, Infant feeding practices pose risks if poor in terms of portion size, feeding frequency

and diversity. Meaning diet and illness are immediate factors closely bound up with maternal

health and nutritional status as well as Care-giving practices and for instance, Diarrheal and

acute respiratory infections are the cause of two thirds of all deaths of Children Under one

year.

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 CHAPTER THREE

3.0 METHODOLOGY

The study was carried out at Umaru Sanda General Hospital Bida, Niger State, Nigeria. There

were children who still on exclusive breastfeeding from 0-6 months. It was Chosen as the

location of study, because it was observed that most of the children undergo the effect of

breastfeeding.

3.1 STUDYDESIGN

The study will be descriptive cross-section study design that will be carried out using a well-

structured questionnaire to collect data from Umar Sanda General Hospital Bida, Niger state.

3.2 STUDY LOCATION

The study will be carried out among breastfeeding Children 0-6 month in Umar Sonda

General Hospital Bida, Niger State.

3.3 STUDYPOPULATION

The study will be comprised of breastfeeding a children 0-6 month.

3.4 SAMPLE SIZE

The Sample size will be 50, Comprising both male and female children, who are 0-6 on

exclusive breastfeeding.

3.5 SAMPLING TECHNIQUES

Anthropometric measurement will be use to determine the number of prevalence of

malnutrition cases amoung the infants.

3.6 METHOD OF DATA COLLECTION

A well-structured questionnaire will be used for Collection. The total numbers of the

questionnaires will be administered by hand, duly completed and returned.

3.7 DATA ANALYSIS

Data will be collected and analyzed using percentage and frequencies.

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 REFERENCES

Alison Stvebe, (2013). The Risks of not breast feeding mothers and infants. National library
of medicine. National Center for biotechnology information. Rev. Obstat Gynecol 2
(4): 222-231.
Debra, J. Hector, L.K Karen, L. Webb, Peter Heywood, (2013). Factors affecting
breastfeeding practices. Applying a Conceptual framework, 16, 5.
Dina Rahayuning Pangestuti, (2018). Nutritional status of Exclusive Compared to Non-
exclusive Breastfeeding Mother. J. Gizi pangan, Volume 13, Number 1.
District Health Barometer, (2016). Available - omhttp://wwiw.Cabsa.Org.za [Accessed May
620171.
Fatoumata Binta Diallo &, L.B., Jean-Marie Moutquin, Marie-Pierre Garant, (2013). The
effects of exclusive Versus non-exclusive breastfeeding on specific infant morbidities
in Conakry (Guinea). Pan African Medical Journal, 2(2), 9.
Hatsu IE, McDougald, DM, Anderson, A.K., (2013). Effect or of infant feeding, on maternal
body Composition. International Breastfeeding Journal 3(18) Tasnim S, Akhtar 5N,
Haque FA- (2014). Nutritional status and breast feeding practice among mothers
attendding lactation management Centre. Pediatrics Research international Journal.
DOI: 10 (2014. 790373)
Jones, G.R.W. Steketee, R.E. Black, A.Z. Bhutta and S.S. Morris, (2013). The Bellegio child
Survival study group. How many child deaths can we prevent this year Lancet,
262:65-71.
Kuchenbecker, J. Jordan I, Reinbott A, Hermann, J., Jeremias T, Kennedy, G., Muehlhoff, E.,
Mtimuni, B., Krawind, M.B., (2015). Exclusive breast feeding and its effect on
growth of Malawian infants: results from a cross-sectional study. Pediatrics and
International Child Health 35(1) 14-32.
Lamberti, L.M., Walker CLF, Norman A, Victora C, Black RE (2011). Breastfeeding and the
risks for diarrhea morbidity and mortality. Brac public thealth 11 (suppl +_ 3) 515
http://doisong/oH36/47-2458-S3 I SIS.
Leon-Cana, N., C. Lutter, J. Ross and L. Martin, (2013). Quantifying the benefits of
breastfeeding: A Summary of the evidence. Published by PAHO and by the
LINKAGES Project for USAID, Washington, DC.

16
MMKR, (2013). Breastfeeding trend and Updated national health objectives for exclusive
breastfeeding - United States, birth years 2000-2004. Morb Mort Wkly Rep (2013)
Aug 3, 56 (30): 8760-3.
Njeri, M. L. (2012). Factors influencing exclusive breastfeeding among infants less than 6
months in Kasarani Informal Settlement, Molo District, Kenya, nutrition and health.
Njeri, M.L. (2012). Factors influencing exclusive breastfeeding among infants. Less than 6
months. In Kasarani informal settlement, Molo District, Kenya. (nuutrition and
Health), Kenya.
Okechutin, A.A., Okpe, E.C., Okolo, AA. (2013). Exclusive, breastfeeding and post-natal
Changes in maternal anthropometry. Nigerian journal of practice 12 (4): 383-3884.
Sanusi, R.A. and Falana, O.A, (2013). The Nutritional Status of mother's Practicing
breastfeeding Ibadan in Nigeria: Africa Journal of Biomed Res 12 No 2.
Sanusi, R.A., Falana, O.A., (2013). The nutritional status of mothers practicing breast feeding
in Ibadan, Nigeria. Africa Journal of Biomed Res 12(2): 108-112.
Tella Adeyinka; Falaye Ajibola2, Arema Oyesoji 2
and Tella, Adedeji3, (2013). A Hospital-
Based Assessment of Breast-Feeding Bethanion, and practices among nursing
mothers in Nigeria and Ghana. Pakistan journal of nutrition 7(1):165-171.
Todhunter, E.M. (2015). Guide to Nutrition Terminology for indexing and Retrieval.
National institutes of Health, Public Health service, 11. S. Department of Health,
Education, and Welfare, Bethesda, Md. 270 pp.
Wanyonyi, M.N. (2010). Barriers to exclusive breastfeeding and nutritional status of non-
exclusive breastfed infants in eldoret municipality, isenya 83
WHO (World Health Organization 2013), obesity: Preventing and managing the global
epidemic. Report of a WHO Consultation. Geneva WHO: WHO Technical Report
Series, 894).
WHO / UNICEF, (2021). Infant and young child Feeding, Current Issues, WHO, Geneva.
World Health Organization (2015), Children Feeding Practices and Nutritional.
Zarea, M.O. Brien, M.L., Fallon, A.B. (2013). Creating a breastfeeding Culture: a
Comparison of breastfeeding Practices in Australia and Iran. Breastfeeding Rev 15(2):
15-20.

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