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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 19  |  Issue : 2  |  Page : 139-144

Prevalence and factors influencing exclusive breastfeeding practice among nursing mothers: A prospective study in North-Western Nigeria


1 Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
2 Department of Pharmacology and Therapeutics, Usmanu Danfodio University Sokoto, Sokoto, Nigeria
3 Department of Community Health, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Date of Submission07-Apr-2022
Date of Decision29-May-2022
Date of Acceptance01-Sep-2022
Date of Web Publication23-Nov-2022

Correspondence Address:
A Adamu
Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, PMB: 2370, Sokoto
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njbcs.njbcs_23_22

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  Abstract 


Context: Exclusive breastfeeding (EBF) is a key to achieving sustainable development goals (SDGs), but its practice has remained low in Nigeria, despite the strong evidences in support of EBF for the first six months of life. Setting and Design: This was a nine months descriptive cross-sectional study carried out among nursing mothers with children 6–24 months attending pediatric follow-up clinic and family health clinic of Usmanu Danfodiyo University Teaching Hospital, Sokoto. Materials and Methods: Interviewer administered questionnaire was used to obtain information on the sociodemographic characteristics and EBF practices of mothers. Statistical Analysis Used: Data were analyzed using SPSS version 20. Results: A total of 240 mothers were interviewed. The mean age of the mothers was 29.7 ± 6 years. All the respondents breastfed their children, 82 (34.2%) practiced EBF for six months. Higher level of maternal education (P = 0.001), ANC attendance (P = 0.001), maternal occupation (P = 0.007), hospital delivery (P = 0.007) significantly influence the practice of EBF for six months. Conclusion: EBF practice was sub optimal. Thus, improving utilization of antenatal care, female education, and hospital delivery are crucial interventions to increase EBF practice toward achieving SDG-2 and 3 in Sokoto.

Keywords: Exclusive breastfeeding, factors, mothers, practices, Sokoto


How to cite this article:
Adamu A, Isezuo K O, Ali M, Abubakar F I, Jiya F B, Ango U M, Yunusa E U, Bello M M. Prevalence and factors influencing exclusive breastfeeding practice among nursing mothers: A prospective study in North-Western Nigeria. Niger J Basic Clin Sci 2022;19:139-44

How to cite this URL:
Adamu A, Isezuo K O, Ali M, Abubakar F I, Jiya F B, Ango U M, Yunusa E U, Bello M M. Prevalence and factors influencing exclusive breastfeeding practice among nursing mothers: A prospective study in North-Western Nigeria. Niger J Basic Clin Sci [serial online] 2022 [cited 2022 Nov 29];19:139-44. Available from: https://www.njbcs.net/text.asp?2022/19/2/139/361891




  Introduction Top


Exclusive breast feeding (EBF) is a key to achieving sustainable development goals (SDG) and is one of the cost-effective ways in ending preventable under five mortality and morbidity.[1] While breast milk enhances neurological development and protects the child from diseases, such as diarrhea, pneumonia, and malnutrition, breastfeeding also promotes the health of the mother by improving child birth spacing and reducing the risk of diseases, such type 2 diabetes, ovarian cancer, and breast cancer; breastfeeding plays an important role in increasing the household income and improving food security.[2]

Globally, in 2018, about 41% of infants less than six months of age are exclusively breastfed, far short of the 2030 global target of 70%, while over two-thirds of mothers continue breastfeeding for at least one year, and by two years of age, breastfeeding rates drop to 45%.[3] To achieve optimal growth and overall wellbeing of the child, the World Health Organization (WHO) as a consequence of evidenced-based findings has recommended that infants within 1 h of life should initiate breastfeeding, exclusively breastfed for six months after which, complementary foods should be introduced as breastfeeding continues for up to two or more years.[4]

Despite strong evidences in support of EBF for the first six months of life,[5] its practice has remained low in Nigeria. Breastfeeding rates in Nigeria reduced with age, 83% of the children are breastfed up to one year, while 28% were breastfed up to two years.[6] It was shown that the proportion of the children who are not breastfeeding increases with age.[6] The 2018 Nigeria Demographic and Health Survey reported an EBF rate of 29% for the first six months of life.[7] This remains significantly below the target of 50% set by the World Health Assembly to be achieved in 2025 and the SDG target for 2030.[8] It has been estimated that EBF reduces infant mortality rates by up to 13% in low-income countries.[9]

Due to the tremendous benefits of breastfeeding, the United Nations human rights expert advocated that countries need to stop the inappropriate marketing of breast milk substitutes and at the same time emphasize and promote breastfeeding as a human right with the intention of protecting and supporting both the mother and child.[10] However, there appears to be a current increase in the number of infants zero to six months being exclusively breastfed globally (46%) when compared with the period from 2007 to 2014, where only about 36% were reported to be exclusively breastfed.[11] In 2012, WHO member states endorsed and committed to support implementation and monitoring of the “comprehensive implementation plan on maternal, infant and young child nutrition” with one of the six targets been, to increase to at least 50% the rate of exclusive breastfeeding for the first six months by 2025.[11] To achieve this target for the beneficial interest of both mother and child, breastfeeding practices have to be supported by addressing the multifactorial determinants not only through law and policy but also through interventions that take into cognisance the sociodemographic factors that may influence the practice of breastfeeding; because when appropriate and effective interventions are adequately delivered, breastfeeding practices rapidly increases.[12]

The benefits of EBF are well established especially in poor communities where early introduction of foods other than breast milk is of particular concern because of the risk of pathogen contamination and inadequate preparation of breast milk substitutes leading to increased risk of morbidity and malnutrition.[13] Breastfeeding practices have been shown to be influenced by demographic, biophysical, social, cultural, and psychological factors.[14] Ekanem et al.[15] reported an EBF rate of 24% among working mothers in Calabar, some factors associated with practice of EBF in their study were high maternal level of education, maternal antenatal clinic attendance and lesser number of children.[15] Similarly, another report from Enugu, Nigeria, showed only 24.3% of the mothers practice EBF and over 60% of the mothers were discouraged by the respondent's mothers and mother in-laws against EBF practice.[16] It is in line with this, that this study aimed to determine the prevalence and factors influencing EBF practice among nursing mothers attending UDUTH, Sokoto.


  Methodology Top


Study area

UDUTH, Sokoto is a tertiary health facility located in Sokoto, the Sokoto State capital, North-Western Nigeria. It serves as a referral center for more than 10 million people from Sokoto, Zamfara, Niger, Katsina, and Kebbi states of Nigeria and the neighboring Niger and Benin republics in the West African sub-region.[17]

Study design/study population

This was a descriptive cross-sectional study carried out from January 01, 2016 – September 30, 2016, among nursing mothers with children 6–24 months attending pediatric follow-up clinic and family health clinic of UDUTH, Sokoto.

Sample size determination

The minimum sample size was estimated at 240 using the Cochran formula for calculating the sample size for cross-sectional studies.[18] About 20% prevalence of EBF reported by Salami in Edo state was used.[19] A precision level of 5%, and an anticipated 95% response rate were used.

Data collection and analysis

Data were collected using a pretested structured interviewer administered questionnaire and the study subjects were recruited consecutively until the required sample size was obtained. The questionnaire comprised of two sections; section one: the sociodemographic characteristics and section two: EBF practices of the mothers. About six staffs of Health Information Management Departments assisted the researcher in questionnaire administration after pre-training on conduct of survey research, the study objectives and questionnaire administration. Data were analyzed using Statistical Software Package for Social Sciences (IBM-SPSS) version 20. Descriptive statistics (frequency tables and summary indices) were generated. Chi square was used to test association between EBF practice and sociodemographic characteristics influencing the practice. P value was set at <0.05 significant level.

Ethical considerations

Ethical approval was obtained from the Ethics Committee of UDUTH, Sokoto (UDUTH/DCS/HERC/2015/013). Written Informed consent was obtained from the study participants.


  Results Top


Sociodemographic characteristics of the study respondents

A total of 240 mothers were interviewed, over one-third 82 (34.%) of the respondents were of Hausa ethnicity. The mean age of the mothers was 29.7 ± 6 years (range 17–45 years) and majority 66 (27.5%) were within the age range 25–29 years. Most 77 (32.1%) of the respondents had secondary level of education, while 57 (23.8%) had no formal education, 99 (41.3%) of the mothers were unemployed. [Table 1]. One hundred and six (44.1%) of the respondents had 1–2 number of children. [Table 1].
Table 1: Social-demographic characteristics of the study respondents

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The mean age of the respondent's children was 10.5 ± 4.5 months, there were slightly more 133 (55.4%) females than 107 (44.6%) male children. Largest proportion 196 (81.6%) of the respondent's children were in the age range 6.1–12 months [Table 2].
Table 2: Age and sex distribution of the respondents' children

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Prevalence of exclusive breastfeeding practice

All the respondents breastfed their children but only 82 (34.2%) practiced EBF for 6 months [Figure 1].
Figure 1: Prevalence of Exclusive Breastfeeding Practice for six months

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Reasons for not practicing exclusive breastfeeding

In the majority 158 (65.8%) of the respondents that did not practice EBF, the reason given by most 44 (27.8%) was not knowing the importance of EBF practice, followed by the believe that child need more water in 39 (24.7%), short maternity leaves in 28 (17.7%) of the respondents and also the feeling that breast milk is insufficient 19 (12.0%) for a baby. [Table 3].
Table 3: Reasons for not practicing exclusive breastfeeding

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Type of feeds giving to the infants along with breastmilk for the first six months of life

In the present study, non-EBF was predominant with the majority 115 (72.8%) of the mothers that did not practice EBF gave water in addition to breast milk to their infants for the first six months of life, while 28 (25%) gave milk formula and breastmilk for the first six months [Table 4].
Table 4: Feeds given to children along with breast milk before six months of age

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Factors influencing respondents practice of exclusive breastfeeding

The sociodemographic characteristics of the respondents that significantly influence the respondents practice of EBF for six months were maternal level of education (P = 0.001), maternal occupation (P = 0.007), ANC attendance (P = 0.0001), place of delivery (P = 0.004), prenatal feeding advice (P = 0.0001) and postnatal feeding advice (P = 0.0001) [Table 5].
Table 5: Factors associated with exclusive breastfeeding practice for six months

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  Discussion Top


This study aimed to determine the prevalence and factors influencing EBF practice among nursing mothers attending UDUTH, Sokoto. In the present study, all the mothers breastfed their infants,[20] this is inconsistent with the findings of previous studies.[21],[22],[23],[24] Only 34.2% of the mothers practiced EBF for the first six months. The EBF practice rate obtained in this study was however higher than 31% reported by Oche and Umar[20] in Kware, Nigeria. A higher EBF rate was observed in this study when compared to 26.9% reported by Oliemen et al.[13] in Gbarantoru Community, Bayelsa State, Nigeria, and 24.3% reported Sanusi et al.[16] in a community-based study in Enugu. The EBF practice rates of 24% reported in Calabar[15] and 6% in Imo states of Nigeria[24] were lower than 34.2% reported in this study. In contrast to the EBF practice rate for the first six month obtained in this study, higher rates were reported by previous studies, 52.6% by Okafor et al.[25] in Lagos, 58.8% in Southwest Nigeria,[22] 41.4% among mothers of children under 2 years of age living in a military barrack in Southwest Nigeria.[21] These differences in the prevalence rates could be due to existing risk factors such as socio-demographics, customs, attitudes, beliefs and women's work conditions.[24] This study shows a wide gap between desired and actual EBF practice.

Majority of the respondent's reason for not practicing EBF, was because of not knowing the importance of EBF, this is in support of an earlier study.[14],[15],[23] In this study, 19% of the women never practiced EBF believing that their breast milk was insufficient for their babies, similar finding was reported by other studies.[14],[15],[21],[23] Furthermore, 39% of mothers did not practice EBF due to the believe that a baby require more water, this is consistent with the findings of previous studies[14],[26] and some of the mothers reason for not practicing EBF is that it is demanding, similar finding was reported by peterside et al.[13] Casmir Ebirim et al.[24] and Agunbiade and Ogunleye[27] while some of the mothers reasons for not practicing EBF included short maternity leave.[23],[24] The issue of work as a constraint to practicing EBF and also the feeling that breast milk is insufficient has been reported in a number of other Nigerian studies.[24],[27] some of the mothers in this study did not practice EBF, because of the belief that breastfeeding causes breast to sag. The perception that EBF lead to sagging of the breast has been reported as a challenge to EBF in other settings.[24],[27],[28]

Several demographic factors have been reported to influence mothers practice of EBF.[29] In this study maternal age has no association with the practice of EBF. This is consistent with the findings of studies done in Sokoto[20] and Ogun state, Nigeria.[22] On the other hand, a report by Ekanem et al.[15] showed association between maternal age and practice of EBF, as older mothers practiced EBF more than the young mothers in their study, they speculated that young mothers may be inexperience and are also more easily influenced by family pressure not to practice EBF.[15] Although mothers from the Hausa and Yoruba tribes practiced EBF more than mothers belonging to other tribes in this study, the difference was not however significant, this agrees with the finding of previous study.[15] There is also no significant association in this study between practice of EBF and family size. On the contrary the finding of a study conducted in Cross Rivers state, Nigeria,[15] and Lagos state, Nigeria[25] reported association between the practice of EBF with family size, in their study mothers with small family size practiced EBF more than the mothers with large family size.

A higher maternal educational level was observed to have association with EBF practice when compared to mothers with no formal education. This finding corroborates the findings of earlier studies.[24],[27],[28] This may be informed by their understanding of the health implications of EBF on child's health. However, there are conflicting reports on the influence of maternal educational status on EBF practice, an inverse relationship between maternal educational attainment and breastfeeding practice was reported by some researchers.[15],[20] These researchers argued that women with high educational attainment usually engage in formal employments with busy schedules which negatively impacts on their ability to breastfeed. Mothers that are unemployed exclusive breastfed their infants in this study more than mothers who are civil servants, the difference was significant. This agrees with the finding of a previous studies.[24],[30] This may be because mothers who are unemployed spent more time with their infants.

Maternal antenatal clinic attendance was associated significantly with EBF practice, this is consistent with the findings of other studies.[15],[22],[30] Health institutions are good sources of information about breastfeeding and other appropriate feeding practices for mothers, this has also been established in Nigeria[24],[31] and outside Nigeria.[32] But this is inconsistent with the finding of a study carried out in North-Western Nigeria[31] that showed that even though most of the mothers in their study received counseling on EBF, majority did not practice it and that awareness of optimal breastfeeding messages does not necessarily translate into practice by the mothers. Delivering in the hospital was significantly associated with the practice of EBF when compared to the mothers that gave birth at home. This finding concurs with the findings of previous studies.[25],[29] This could be due to the fact that mothers who give birth in the hospitals are more opportune to obtain immediate obstetric and postnatal care, such as nutritional education and counseling on the benefit of breastfeeding, correct positioning and attachment and breast care.[32]


  Conclusion and Recommendations Top


EBF practice in the study area is suboptimal. Maternal educational status, occupation, antenatal care attendance and hospital delivery were factors associated with EBF practice. Most of the mothers' reason for not practicing EBF, is not knowing the importance of EBF. Thus, improving utilization of antenatal care, female education and hospital delivery are crucial interventions to increase EBF practice and achieving SDG-2 and 3 in Sokoto.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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