Breastfeeding profile and practice of Nigerian mothers: a cross-sectional survey
Keywords:
Exclusive breastfeeding, Baby-friendly, Practice, NigeriaAbstract
Background: Breastfeeding patterns in the developing world are still below the recommended levels and the potential to improve child survival remains untapped. This study investigated the breastfeeding profile and practices of Nigerian nursing mothers.
Methods: This cross-sectional survey involved women at attending selected baby-friendly facilities in Ile-Ife, South-West, Nigeria who had breastfed their most recent baby for a minimum of six months. A self-administered questionnaire was used to obtain data on demographics, infant-maternal characteristics and breastfeeding practices. 383 mothers volunteered for this study, yielding a response rate of 95.7%. Data were analyzed using descriptive and inferential statistics at 0.05 alpha level.
Results: The mean age of the respondent was 29.0 ± 4.96 years. Exclusive breastfeeding (EBF) rate was 86.2%. Breastfeeding initiation time of less than 1 hour after delivery and 24 hours rooming-in practice rate was 78.3% and 79.1% respectively. Daily breastfeeding time and total breastfeeding duration was 8.06 ± 2.33 hours and 18.3 ± 4.82 months respectively. The mean onset time for water supplementation was 4.74 ± 1.77 months with a rate of 30.3% within 1-3 months. Weaning initiation time was mostly (43.9%) within 12 to 18 month of infant’s age. There was significant association between EBF practice and each of maternal education (X2 = 6.554; P = 0.038) and Socio-Economic Status (SES) (X2 = 19.32; P = 0.031) with most of the respondents in the lower SES (56.1%) subscribing to EBF.
Conclusions: Exclusive breastfeeding (EBF) rate for the first six months among Nigerian mothers attending baby-friendly clinics was high. Breastfeeding initiation time after delivery was early, water supplementation to breastfeeding was before 5 months of the infant’s life and weaning practice was late. Maternal educational level and socio-economic status significantly influenced EBF practice.
References
Chantry CJ, Eglash A, Labbok M, the Academy of Breastfeeding Medicine Board of Directors. ABM statements: position on breastfeeding. Breastfeed Med. 2008;3(4):267-70.
Uvnäs-Moberg K, Eriksson M. Breastfeeding: physiological, endocrine and behavioural adaptations caused by oxytocin and local neurogenic activity in the nipple and mammary gland. Acta Paediatr. 1996;85(5):525-30.
Singh B. Knowledge, attitude and practice of breast feeding: a case study. Eur J Sci Res. 2010;40(3):404-22.
World Health Organization (WHO). Global strategy for infant and young child feeding, 2003. Available at: http://whqlibdoc.who.int/publications/2003/9241562218.pdf. Accessed 12 September 2011.
World Health Organization (WHO). Indicators for assessing breast-feeding practices. In: WHO, eds. WHO Reference (WHO/CDD/SER/91.14). Geneva, Switzerland: World Health Organization; 1991:1-14.
Engebretsen IM, Wamani H, Karamagi C, Semiyaga N, Tumwine J, Tylleskar T. Low adherence to exclusive breastfeeding in Eastern Uganda: a community-based cross-sectional study comparing dietary recall since birth with 24-hour recall. BMC Paediatr. 2007;7:10.
UNICEF. UNICEF rings alarm bells as breastfeeding rates plummet in East Asia, 2012. Available at: http://www.unicef.org. Assessed 4 March 2013.
Vega López MG, González Pérez GJ. Maternal factors relating to breast-feeding duration in areas around Guadalajara, Mexico. Bull Pan Am Health Organ. 1993;27(4):350-9.
Khassawneh M, Khader Y, Amarin Z, Alkafajei A. Knowledge, attitude and practice of breastfeeding in the north of Jordan: a cross-sectional study. Int Breastfeed J. 2006;23(1):17.
Sguassero Y. Optimal duration of exclusive breastfeeding: RHL commentary. In: Sguassero Y, eds. The WHO Reproductive Health Library. Geneva: World Health Organization; 2008.
UNICEF. Overview of breastfeeding patterns, 2009. Available at: http://www.childinfo.org/breastfeeding_overview.html. Accessed 12 August 2011.
UNICEF. Tracking progress on child and maternal nutrition: a survival and development priority, 2009. Available at: http://www.unicef.org. Assessed 11 June 2012.
Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS. Bellagio child survival study group: how many child deaths can prevent this year? Lancet. 2003;362:65-71.
MDGS. Nigeria millennium development goals report (NMDG), 2001. Available at: http://www.Mdgs.gov.ng. Accessed 04 March 2012.
World Health Organization (WHO). Data bank on infant and young child feeding on Nigeria, 2010. http://www.who.int/nutrition/databases/infantfeeding/countries/nga.pdf. Accessed 24 November 2012.
Awoyinka BS, Ayinde OA, Omigbodun AO. Acceptability of caesarean delivery to antenatal patients in a tertiary health facility in south-west Nigeria. J Obstet Gynaecol. 2006;26(3):208-10.
Örün E, Yalçın SS, Madenda Y, Üstünyurt-Eras Z, Kutluk S, Yurdakök K. Factors associated with breastfeeding initiation time in a baby-friendly hospital. Turkish J Paediatr. 2010;52:10-6.
Baker EJ, Sanei LC, Franklin N. Early initiation of and exclusive breastfeeding in large-scale community-based programmes in Bolivia and Madagascar. J Health Popul Nutr. 2006;24(4):530-9.
Mullany LC, Katz J, Li YM, Khatry SK, LeClerg SC, Darmstadt GL, et al. Breast-feeding patterns, time to initiation, and mortality risk among newborns in Southern Nepal. J Nutr. 2008;138(3):599-603.
Amir LH, Donath S. A systematic review of maternal obesity and breastfeeding intention, initiation and duration. BMC Pregn Childbirth. 2007;7:9.
Chapman DJ, Perez-Escamilla R. Identification of risk factors for delayed onset of lactation. J Am Diet Assoc. 1999;99:450-4.
Cotton CW, Garcia Fragoso L. Rooming-in improves breastfeeding initiation rates in a community hospital in Puerto Rico. Bol Asoc Med P R. 2010;102(1):30-2.
Cho MJ, Cheon CM, Seo JK, Shin SM. A Survey on the factors of breast feeding failure related to the role of medical personnels. J Korean Pediatr Soc. 2001;44:389-96.
Yoo ML, Kang HS, Young MK, Jin SK, Ji YC, Hyun JS, et al. Complete rooming-in care of newborn infants. Korean J Paediatr. 2010;53(5):634-8.
Smith PB, Moore K, Peters L. Implementing baby-friendly practices: strategies for success. Am J Matern/Child Nurs. 2012;37(4):228-33.
WHO/UNICEF. Protecting promoting, and supporting breastfeeding; the special role of maternal services. A joint WHO/UNICEF statement, 1993. Available at: whqlibdoc.who.int/publications/9241561300.pdf. Accessed 24 February 2012.
Bystrova K, Widströn A, Matthiesen A, Ransjö-Arvidson A, Welles-Nyström B, Vorontsov I, et al. Early lactation performance in primiparous and multiparous women in relation to different maternity home practices. A randomised trial in St. Petersburg. Int Breastfeed J. 2007;2:9.
Widstrom AM, Ransjo-Arvidson AB, Christensson K, Matthiesen AS, Winberg J, Uvnas-Moberg K. Gastric suction in healthy newborn infants. Effects on circulation and developing feeding behaviour. Acta Paediatr Scand. 1987;76:566-72.
Fairbank L, O'Meara S, Renfrew M, Woolridge M, Sowden A, Lister-Sharp D. A systematic review to evaluate the effectiveness of interventions to promote the initiation of breastfeeding. Health Technol Assess. 2000;4(25):1-171.
Pérez-Escamilla R, Pollitt E, Lönnerdal B, Dewey KG. Infant feeding policies in maternity wards and their effect on breastfeeding success: an analytical overview. Am J Public Health. 1994;84(1):89-97.
Christensson K, Siles C, Moreno L, Belaustequi A, de la Fuente P, Lagercrantz H, et al. Temperature, metabolic adaptation and crying in healthy, full-term newborns cared for skin-to-skin or in a cot. Acta Paediatr Scand. 1992;81:488-93.
Bystrova K, Widstrom AM, Matthiesen AS, Ransjo-Arvidson AB, Welles-Nyström B, Wassberg C, et al. Skin-to-skin contact may reduce negative consequences of “the stress of being born”: a study on temperature in newborn infants, subjected to different ward routines in St. Petersburg. Acta Paediatr. 2003;92:320-6.
Christensson K, Cabrera T, Christensson E, Uvnas-Moberg K, Winberg J. Separation distress call in the human neonate in the absence of maternal body contact. Acta Paediatr. 1995;84(5):468-73.
Tan KL. Knowledge, attitude and practice of breastfeeding in Klang, Malaysia. Int Med J 2009;8:17-21.
Hajian-Tilaki KO. Factors associated with the pattern of breastfeeding in the north of Iran. Ann Hum Biol. 2005;32:702-13.
Agho KE, Dibley MJ, Odiase JI, Ogbonmwan SM. Determinants of exclusive breastfeeding in Nigeria. BMC Pregn Childbirth. 2011;11:2.
Federal Office of Statistics (FOS) (Nigeria) and IRD/Macro International Inc. Nigeria demographic and health survey 2003. In: FOS, eds. FOS Survey. Columbia, Maryland: Federal Office of Statistics and IRD/Macro International Inc; 2004.
Parkinson KN, Drewett, RF. Feeding behaviour in the weaning period. J Child Psycho Psychiatry. 2001;42:971-8.
Bolling K, Grant C, Hamlyn B, Thornton A. UK infant feeding survey 2005, 2007. Available at: http://www.ic.nhs.uk/pubs/ifs Accessed 5 March 2012.
Hornell A, Hofvander Y, Kylberg E. Introduction of solids and formula to breastfed infants: a longitudinal prospective study in Uppsala, Sweden. Acta Paediatr. 2001;90:477-82.
Wright CM, Parkinson KN, Drewett RF. Why are babies weaned early? Data from a prospective population based cohort study. Arch Dis Child. 2004;89:813-6.
Schiess S, Grote V, Scaglioni S, Luque V, Martin F, Stolarczyk A, et al. European childhood obesity project. Introduction of complementary feeding in 5 European countries. J Paediatr Gastroenterol Nutr. 2009;49:1-8.
Armentia A, Banuelos C, Arranz ML, Del Villar V, Martín-Santos JM, Gil FJ, et al. Early introduction of cereals into children’s diets as a risk-factor for grass pollen asthma. Clin Exp Allergy. 2001;31:1250-5.
Fergusson DM, Horwood LJ, Shannon FT. Early solid feeding and recurrent childhood eczema: a 10-year longitudinal study. Pediatrics. 1990;86:541-6.
Kajosaari M. Atopy prophylaxis in high-risk infants. Adv Exp Med Biol. 1991;310:453-8.
Forsyth JS, Ogston SA, Clark A, Florey CD, Howie PW. Relation between early introduction of solid food to infants and their weight and illnesses during the first two years of life. BMJ. 1993;306:1572-6.
Popkin BM, Adair L, Akin JS, Black R, Briscoe J, Flieger W. Breastfeeding and diarrheal morbidity. Pediatrics. 1990;86:874-82.
Wilson AC, Forsyth JS, Greene SA, Irvine L, Hau C, Howie PW. Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. BMJ. 1998;316:21-5.
Perez-Escamilla R. Update on the breastfeeding situation in Africa. Nutr Res. 1993;13:597-609.
World Health Organization (WHO). Infant and young child nutrition. In: WHO, ed. Fifty-fourth World Health Assembly no. 54•2. Geneva: WHO; 2001: 1-4.
Ross L. Weaning practices. J Nurse-Midwif. 1981;26:9-14.
Khakoo, GA, Lack G. Introduction of solids to the infant diet. Arch Dis Child. 2004;89:295.
Ward Platt MP. Demand weaning: infants’ answer to professionals’ dilemmas. Arch Dis Child. 2009;94:79-80.
Condon L, Ingram J, Hamid N, Hussein A. Cultural influences on breastfeeding and weaning. Community Practition. 2003;76(9):344-9.
Lee H. Racial/ethnic differences in breastfeeding initiation and duration among low-income inner-city mothers. Soc Sci Quarter. 2009;90(5):1251-71.
Flacking R, Nyqvist KH, Ewald U. Effects of socioeconomic status on breastfeeding duration in mothers of preterm and term infants. Eur J Public Health. 2007;17(6):579-84.
Avery M, Duckett L, Dodgson J, Savik K, Henly SJ. Factors associated with very early weaning among primiparas intending to breastfeed. Matern Child Health J. 1998;2(3):167-79.
Rice S, Coombs D, Fish L, Leeper J. Breast feeding and contraception in Peru. J Health Popul Nutr. 2002;20(1):51-8.
Huffman SL, Chowdhury AKMA, Chakraborty J, Simpson NK. Breast feeding patterns in rural Bangladesh. Am J Clin Nutr. 1980;33:144-54.
Jakobsen MS, Sodemann M, Molbak K, Aaby P. Reason for terminating breastfeeding and the length of breastfeeding. Int J Epidemiol. 1996;25:115-21.
Simondon KB, Costes R, Delaunay V, Diallo A, Simondon F. Children’s height, health and appetite influence mothers’ weaning decisions in rural Senegal. Int J Epidemiol. 2001;30:476-81.
Scott JA, Binns CW. Factors associated with the initiation and duration of breastfeeding: a review of the literature. Breastfeed Rev. 1999;7(1):5-16.
Williams PL, Innis SM, Vogel AMP, Stephen LJ. Factors influencing infant feeding practices of mothers in Vancouver. Can J Public Health. 1999;117(90):114-9.
Northstone K, Emmett P, Nethersole F. ALSPAC study team. Avon longitudinal study of pregnancy and childhood. The effect of age of introduction to lumpy solids on foods eaten and reported feeding difficulties at 6 and 15 months. J Hum Nutr Diet. 2001;14:43-54.
Tarrant R, Younger K, Sheridan-Pereira M, White M, Kearney J. Factors associated with weaning practices in term infants: a prospective observational study in Ireland. Br J Nutr. 2010;104(10):1544-54.
Wright C, Birks E. Risk factors for failure to thrive: a population-based survey. Child Care Health Dev. 2000;26:5-16.
Eregie CO. Observations on water supplementation in breastfed infants. West Afr J Med. 2001;20(4):210-2.
Kakute PN, Ngum J, Mitchell P, Kroll KA, Forgwei GW, Ngwang LK, et al. Cultural barriers to exclusive breastfeeding by mothers in a rural area of Cameroon, Africa. J Midwif Womens Health. 2005;50(4):324-8.
Davies-Adetugbo AA. Sociocultural factors and the promotion of exclusive breastfeeding in rural Yoruba communities of Osun State, Nigeria. Soc Sci Med. 1997;45(1):113-25.
Abiona TC, Onayade AA, Ijadunola KT, Obiajunwa PO, Aina OI, Thairu LN. Acceptability, feasibility and affordability of infant feeding options for HIV-infected women: a qualitative study in south-west Nigeria. Matern Child Nutr. 2006;2:135-44.
Scariati PD, Grummer-Strawn LM, Fein SB. Water supplementation of infants in the first month of life. Arch Paediatr Adolesc Med. 1997;151(8):830-2.
Nath DC, Goswami G. Determinants of breastfeeding patterns in an urban society of India. Hum Biol. 1997;69:557-73.
Dubois L, Girard M. Social inequalities in infant feeding during the first year of life. The longitudinal study of child development in Quebec (LSCDQ 1998-2002). Public Health Nutr. 2003;6:773-83.
Di Napoli A, Di Lallo D, Pezzotti P, Forastiere F, Porta D. Effects of parental smoking and level of education on initiation and duration of breastfeeding. Acta Paediatr. 2006;95:678-85.
Ong G, Yap M, Foo LL, Tai BC. Impact of working status on breastfeeding in Singapore: evidence from the national breastfeeding survey 2001. Eur J Public Health. 2005;15(4):424-30.
Aslam S, Sultan M, Akram F. Exclusive breast feeding; duration at Northern areas of Pakistan a hospital based study. Professional Med J. 2010;17(2):286-90.
Giashuddin MS, Kabir M. Breastfeeding duration in Bangladesh and factors associated with it. Indian J Community Med. 2003;28:34-8.
Bautista LE. Factors associated with the initiation of breast feeding by women in the Dominican Republic. Revista Panamericana de Salud Publica. 1997;1:200-7.
Scott JA, Binns CW, Oddy WH, Graham KI. Predictors of breastfeeding duration: evidence from a cohort study. Pediatrics. 2006;117:e646-55.
Giashuddin MS, Kabir M. Duration of breastfeeding in Bangladesh. Indian J Med Res. 2004;119:267-72.