PREVALENCE AND PREDICTORS OF EXCLUSIVE BREASTFEEDING AMONG MOTHERS IN A SEMI-URBAN NIGERIAN COMMUNITY: A CROSS-SECTIONAL STUDY

A.M. Adebayo1,2, O.S. Ilesanmi1,2, D.T. Falana3 , S.O. Olaniyan3 , A.O. Kareem3 , I.F. Amenkhienan3 , F.O. Alele4 , A.A. Afolabi1 , B.A. Omotoso3 , and O.O. Ayodeji3 

  1. Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria. 
  2. Department of Community Medicine, University College Hospital, Ibadan, Oyo State, Nigeria. 
  3. Department of Community Health, Federal Medical Centre, Owo, Ondo State, Nigeria. 
  4. Anton Breinl Centre for Public Health & Tropical Medicine, James Cook University, Townsville, Australia.

Abstract

Background: The uptake of exclusive breastfeeding (EBF) is low globally including Nigeria despite its benefits and interventions. This study aimed to assess the prevalence and predictors of EBF among mothers in a semiurban Nigerian community. 

Methods: We conducted a cross-sectional study among nursing mothers attending the immunization clinic at the Federal Medical Centre, Owo, Ondo State. A semi-structured questionnaire containing the World Health Organization’s indicators for assessing breastfeeding practices was used for data collection. 

Results: A total of 386 mothers were recruited with a mean age of 30.8 ± 5.0 years. Among them, 149 (36.8%) were below 30 years, 345 (89.4%) have had ANC visit at least four times, and 259 (67.1%) had initiated breastfeeding immediately after delivery. The prevalence of EBF was 52.6%. Natural feeds were the common feeds introduced after 6 months among 159 (78.3%) mothers. One hundred and forty-four (62.1%) nursing mothers aged 30 years or older practiced EBF compared to 72 (48.3%) persons below 30 years (X2 = 6.290, p = 0.012). Also, 38 (70.3%) mothers who have delivered four or more children practiced EBF compared to 180 (54.2%) with fewer children (X2 = 5.437, p = 0.020). Nursing mothers aged 30 years or older had 36% higher odds of practicing EBF compared to younger persons (Adjusted Odds Ratio = 1.358, 95%CI = 0.886 – 2.081, p = 0.160). 

Conclusion: To achieve the WHO recommended target of ensuring that 90% of nursing mothers practice EBF, advocacy and health education must be intensified.

Keywords: Exclusive breastfeeding, Pregnancy, Immunization clinic, Exclusive breastfeeding practices, Nigeria.

Correspondence:

Dr. O.S. Ilesanmi 

Department of Community Medicine, 

University of Ibadan, 

Oyo State, 

Nigeria. 

Email: ileolasteve@yahoo.co.uk

Introduction

Exclusive breastfeeding (EBF) means an infant receives only breast milk from his/her mother or a wet nurse for the first six months of life without other solids or liquids.1 The World Health Organization (WHO) recommends EBF for the first six months of life. Complimentary foods can thereafter be added at six (6) months of age with the continuation of breastfeeding up to two years and beyond.1,2 It is evident from the literature that EBF offers both long and short-term benefits both to the mother and the infant.3 The benefits of EBF to the infant include a reduction in the vulnerability to infectious diseases, steady infant growth and cognitive development, as well as a reduced risk of childhood hypertension, obesity and diabetes mellitus.3 For the mother, the benefits of EBF include the strengthening of mother-child bond, and a reduction in post-partum blood loss, depression, type 2 diabetes, breast and ovarian cancer.4,5 Despite these benefits, global trends suggest that early cessation of breastfeeding, and poorly timed introduction of liquids, solid and semi solid foods is the norm in many communities across the globe.6

The United Nations Children’s Fund (UNICEF) reports that 40% of infants aged six (6) months and younger are exclusively breastfed globally.7 Of this estimate, only 23 countries across the globe have achieved the UNICEF and WHO recommendation of EBF for 60% of infants six (6) months and younger.8 According to the Global Burden of Diseases,Injuries, and Risk Factors Study, an estimated 47.5 million Disability Adjusted Life Years (DALYs) were lost in 2010 due to suboptimal breastfeeding.9 In addition, the low uptake of EBF has been reported as a factor that has contributed to 11.6% of Under-5 deaths in sub-Saharan Africa.9,10

In sub-Saharan Africa, there is a disparity in the uptake of EBF with the prevalence ranging from 23.7% in Central Africa to 32.6% in West Africa, 53.5% in East Africa and 56.6% in Southern Africa. The countries with the lowest prevalence in each region were Gabon – 6.0% (Central Africa), Cote d’Ivoire- 13.2% (West Africa), Comoros-13.5% (East Africa) and Namibia48.7% (Southern Africa). In Nigeria, the estimated prevalence of EBF was 17.5%, a proportion that is lower than the minimum 60% recommended by the World Health Organization and UNICEF. Despite the baby-friendly hospital initiative that was introduced in 1991 by UNICEF, Nigeria reports sub-optimal practice of EBF among nursing mothers.8,11 Evidence however suggest that the reported low uptake of EBF in Nigeria could be an outplay of some underlying factors.12 

Previous studies conducted in Edo, Osun, Imo, CrossRiver, and Anambra States have investigated the association between various factors and EBF.11,13,14,15,16 Findings from these studies suggest that maternal factors such as maternal age, maternal education, socioeconomic status, marital status, parity, and familial predisposition towards EBF were associated with EBF. In addition, infant-related factors such as infant age and proximity of the mother to the baby were also identified as factors that predict EBF.13,14,15 Other identified factors were health service-related factors such as the use of health facility based antenatal care, delivery at a government facility and breastfeeding education from a government health facility.13,14,15Most of these studies have however been conducted in few states and also just urban regions hence, there exists a dearth of literature on EBF in Ondo State and semiurban areas in Nigeria at large. A yearly breastfeeding program was instituted by the Federal Medical centre, Owo, Ondo State in 1994. The programme was geared towards improving the practice of EBF among nursing mothers, however, the effectiveness of the breastfeeding program has not been assessed since its commencement. The current prevalence and predictors of EBF in Owo several years after commencement of the annual breastfeeding week remains unknown. A study of this nature is needed to provide data required for nationwide comparison of the prevalence of EBF in Nigeria. Also, this study could provide statistics for subsequent evaluation of the annual breastfeeding program. This would subsequently inform on the strategies for improving EBF practice across Nigeria. Therefore, this study aimed to assess the prevalence and predictors of EBF in a semi-urban Nigerian community.