ORIGINAL

Niger J Paed 2014; 41 (1):43 – 47

Okafor IP

Olatona FA

Olufemi OA

Breastfeeding practices of mothers

of young children in Lagos, Nigeria

DOI:http://dx.doi.org/10.4314/njp.v41i1,8

Accepted: 23th June 2013

Abstract Objective: To deter-

mine the breastfeeding practices

initiation of breastfeeding. These

factors also significantly increased

practice of EBF for 6 months;

ANC- OR 2.54, 95%CI 1.49-4.35

and institutional delivery- OR

1.81, 95%CI 1.15-2.86. EBF for 6

months was significantly associ-

ated with lower parity (p=0.020)

and higher maternal educational

level. Those who had more than

secondary education were 8 times

more likely to practice EBF for 6

months than those with no formal

education (OR 7.65, 95%CI 2.58-

24.28).

Okafor IP⁽

)

(

prevalence, initiation and exclu-

Olatona FA, Olufemi OA

Department of Community Health &

Primary Care,

College of Medicine University of

Lagos, LUTH,

sivity) of mothers of young

children in Lagos.

Methods: This was a community-

based, cross-sectional study car-

ried out in 2010 in two Local

Government Areas of Lagos

State. Structured, interviewer-

administered questionnaires were

administered on 600 mothers

whom were selected by multistage

sampling technique. Data was

analyzed with Epi-info 2008.

Idi-Araba, Lagos, Nigeria.

Tel: +2348033272199

+2347043294609

Email: iphomaa@yahoo.com

Results: The majority, (91.8%) of

respondents breastfed their babies

and 59.2% of them initiated

breastfeeding within 1 hour of

delivery. Eighty-two percent prac-

ticed exclusive breastfeeding

Conclusion: Breastfeeding initia-

tion and exclusivity for 6 months

were inadequate. Promotion of

good health-seeking behavior, ma-

ternal education and family plan-

ning are recommended in order to

improve mothers’ breastfeeding

practices and infant nutrition.

(

EBF) and 52.9% did for

months. Formal antenatal care

ANC) (OR 3.27, 95%CI 2.03-

.29) and institutional delivery

OR 3.63, 95%CI 2.38-5.53)

significantly increased early

6

(

5

(

Key words: Breastfeeding, health-

seeking behavior, infant nutrition,

maternal education, Nigeria

Introduction

from six to 11 months has been identified as the single

most effective preventive intervention in reducing child

mortality, with the potential of saving 1.3 million lives

annually. In addition, during breastfeeding beneficial

hormones are released into the mo₂ther’s body and the

maternal bond can be strengthened. Furthermore, stud-

ies have shown that infants who are exclusively breast-

fed for 6 months and those with longer total breastfeed-

ing time have a lower risk of infections, cancers,

metabo₃l_,₄ic diseases such as obesity and diabetes in the

future.

Breastfeeding is one of the oldest practices known to

mankind. For almost all infants, breastfeeding remains

the simplest, healthiest and least expen-

sive feeding method that fulfils the infant’s needs. It is

considered as 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. Exclusive Breastfeeding is

recommended by WHO for each newborn up to six

months of age and the “Innocenti declaration” empha-

sizes that breastfeeding should be for at least two years.

Breastfeeding has many benefits both to mother and the

child. It confers both short-term and long-term benefits

to the child. It reduces infections and mortality among

infants, improves mental and motor development, and

protects against obesity and metabolic diseases later in

It has been estimated that exclusive breastfeeding

reduces infant mortality rate by up to 13% in low

5

income countries . Recent analysis showed that subopti-

mal breastfeeding, especially non-EBF in the first six

months results in about 1.4 million deaths and up to10%

of the disease burden in children younger than five years

6

in low income and middle income countries . A recent

study also confirmed that breastfeeding children for

more than 18 months are one of the factors associated

1

the life course . Frequent and exclusive breastfeeding

7

can delay the return of fertility through lactational

amenorrheoa method. Exclusive breastfeeding (EBF) in

the first six months of life and continued breastfeeding

with reduced risk of under -five mortality .

In spite of the enormous benefits of breastfeeding and

4

1

2

prevalence has remained low all over the world. Poor

breastfeeding practices have been widely documented in

the developing countries. Only about 39% of infants in

the developing countries (25% in Africa) are exclusively

breastfed for the first six months. Additionally, 6% of

infants in developing countries are never breastfed.

Moreover, the prevalence of no breastfeeding is 5.6%;

the prevalence of continued feeding is 86% and 68% for

infants and children a₈ged 6-11 months and 12-23

months respectively. Poor breastfeeding practices,

together with high rate of morbidity from infectious dis-

eases are the prime proxim₉ ate causes of malnutrition in

the first two years of life.

million inhabitants. The study was done in two of the

20 Local Government Areas (LGAs) in the State. The

LGAs are further divided administratively into wards.

These two LGAs were served by one tertiary, two

secondary and 19 Primary Health Care Centres (PHCs),

including seven health posts. There were also numerous

private health facilities and alternative health

practitioners.

The study population was females in the reproductive

age group aged 15-45 years in the two selected LGAs.

Only those residing in the study area and whose last

confinement was not more than two years prior to

interview, were included in the study. Appropriate

sample size was determined using the formula for

descriptive studies at a precision of 5%. Multi-stage

sampling approach was used to select the 600

respondents who participated in the study (300 from

each LGA). At each stage, simple random sampling

technique was employed. First, two of the 20 LGAs

were selected, followed by the selection of five wards

each from the selected LGAs and the selection of one

street from each ward. Next was the houses; the starting

point was determined by simple random sampling, and

then moved in consecutively higher numbers. The final

stage was the selection of eligible respondents from the

houses.

The first two years of life are critical stages for a child's

growth and development. Any damage caused by nutri-

tional deficiencies during this period could lead to fal-

tered growth, disease, impaired cognitive development,

compromised education₀al achievement, low economic

1

productivity and death. A quarter (25%) of children

under five years of age in Sub-Saharan Africa are under-

1

weight, 43% are stunted , 11.4 % of them are wasted.

In Nigeria, Neonatal Mortality Rate is 40/1000 live

births, Infant Mortality Rate is 75/1,000 live births w₁h₂ile

the under -five Mortality rate is 157/1000 live births.

In Nigeria breastfeeding practices continue to fall well

below the WHO/UNICEF recommendations for devel-

oping countries. Report of Kenyan Demographic and

Health Survey 2008-2009 revealed that 32% of children

under the age of six months are exclusively breastfed,

improving from only 13% in 2003 whereas in Nigeria,

proportion of children less than 6 months who are exclu-

sively breastfed decreased from 17% in 2003 to 13% in

As the interview of respondents went on, more streets

were selected and the process continued until the desired

sample size was met. Only one respondent in each house

was interviewed and if there was more than one, simple

random sampling was done to select only one. The

mother was questioned on her youngest child and an

equal proportion of women were interviewed in each

ward.

Data collection was done with a semi-structured,

interviewer-administered questionnaire which was pre-

tested in another LGA among 20 of a similar group of

women.

2

008. The proportion of children less than six months

who received complementary foods increased from 18%

to 35%. Various factors associated with sub-optimal

breastfeeding practices have been identified in various

settings. These include maternal characteristics such as

age, marital status, occupation, and education level; an-

tenatal and maternity health care. Others are health edu-

cation and media exposure, socio-economic status and

area of residence; and the child's characteristics includ-

ing birth weight₁,₃m_,₁₄ethod of delivery, birth order, and the

use of pacifiers.

Results

This study therefore, examines breast-feeding practices

among mothers in Lagos state Nigeria, specifically

breastfeeding prevalence, initiation and exclusivity. The

result will be useful to health educators, policy makers

and other stakeholders in detecting possible areas for

intervention in order to improve the breastfeeding

practices among mothers in Lagos State and reduce

child morbidity and mortality.

Three hundred and fifty-two (58.7%) of the respondents

were between 26 and 35 years and majority were mar-

ried, 470(78.3%). One-third of them had two children

while one-tenth had at least five children. Only 37

(6.2%) had no formal education while the rest had at

least primary education. Almost one quarter (23.5%) of

them was unemployed.

The majority, (91.8%) of respondents breastfed their

babies and 59.2% of them commenced within one hour

postpartum. Eighty-two percent of the women practiced

exclusive breastfeeding (EBF). As much as 43.1% of

them practiced EBF for less than six months, 52.9% for

six months and 4% for more than six months. The mean

duration for EBF was 5.2 ± 1.8 months. Two hundred

and eighty-eight (64.4%) of respondents who had ANC

at formal health institutions as against 38 (35.6 %) of

Materials and methods

This was a cross-sectional study carried out in January,

2

010 in Lagos, Nigeria. Lagos is a heavily populated

megacity where women of child-bearing age and

under-fives constitute about two-fifths of the over 10

4

5

them who did not, initiated breastfeeding within one

hour of delivery. Mothers who had ANC at a health

facility were three times more likely to initiate breast-

feeding within one hour than those who did not

Institutional delivery was also a significant determinant

in the initiation of breastfeeding within an hour of child

birth. Women who delivered at the health facility were

three times more likely to initiate breastfeeding within

one hour than women who did not (p<0.001, OR 3.63,

(

p<0.001, OR 3.27, 95%CI 2.03-5.29).

9

5%CI 2.38-5.53) (Table 1).

Table 1: Associations between place of antenatal care, place of delivery and initiating breastfeeding within one hour

2

Variable

Initiated BF within 1 hour (%)

χ

p

OR (95% CI)

Yes

No

Total

Had formal ANC

326

249

Yes

288 (64.4) 159 (35.6) 447

23.93

<0.001*

3.27* (2.03-5.29)

1

No

31 (35.6)

319

56 (64.4)

215

87

Total

534

Had institutional delivery

Yes

No

283 (66.1) 145 (33.9) 428

37.12

<0.001*

3.63* (2.38-5.53)

1

43 (35.0)

326

80 (65.0)

225

123

551

Total

*Significant

practicing EBF for six months increased with a signifi-

cant difference. Using ‘no formal education’ as a refer-

ence point, mothers who had secondary education as

their highest educational level were six times more

likely to practice EBF for six months (OR 5.69, 95%CI

2.03-17.9) Those who had more than secondary educa-

tion were eight times more likely to practice EBF for six

months (OR 7.65, 95%CI 2.58-24.28) (Table 2)

The youngest group of mothers (16-25 years) practiced

EBF for six months more than their older counterparts

(

62.2%) with no significant difference. Parity was

significantly associated with EBF for six months. From

parity of two, as the number of children increased, prac-

tice of EBF for six months decreased (p=0.020) As the

educational level increased, the likelihood of a woman

Table 2: Associations between socio-demographic variables and practice of exclusive breastfeeding for six months

2

Variable

Practiced EBF for 6 months (%)

χ

p

OR (95% CI)

Yes

No

Total

Age (year)

1

2

3

6 – 25

6 – 35

6 – 45

46 (62.2)

149 (54.0)

62 (60.8)

28 (37.8)

127 (46.0)

40 (39.2)

74

276

102

2.42

0.300

1

0.79 (0.49-1.28)

0.81( 0.46-1.40)

Number of children

1

2

3

4

30 (49.2)

96 (62.3)

64 (60.4)

53 (58.2)

14 (35.0)

31 (50.8)

58 (37.7)

42 (39.6)

38 (41.8)

26 (65.0)

61

11.75

24.11

0.020*

1

154

106

91

1.62 (0.92-2.86)

1.66 (0.90-3.06)

1.60 (0.86-3.10)

0.56 (0.25-1.24

≥

5

40

Education

No formal

Primary

Secondary

Post secondary

5 (17.9)

23 (82.1)

45 (51.1)

93 (39.1)

34 (34.7)

28

88

238

98

<0.001*

1

43 (48.9)

145 (60.9)

64 (65.3)

3.63*(1.23-11.52)

5.69*(2.03-17.19)

7.65*(2.58-24.28)

*Significant

(

p=0.001, OR 2.54, 95%CI 1.49-4.35). Place of delivery

More than half (60.2%) of the women who had ANC at

the health facility practiced EBF for six months as

against 37.3% of those who did not. Mothers who had

ANC at a health facility were three times more likely to

practice EBF for six months than those who did not

was also significantly associated with the practice of

EBF for six months. Mothers who had institutional de-

livery were two times more likely to practice EBF for

six months than women who did not (p=0.01, OR 1.81,

9

5%CI 1.15-2.86) (Table 3).

Table 3: Associations between place of antenatal care, place of delivery and practice of exclusive breastfeeding for

six months

2

Variable

Practiced EBF for 6 months (%)

χ

p

OR (95% CI)

Yes

No

Total

Had formal ANC

Yes

No

Total

224 (60.2)

25 (37.3)

249

148 (39.8)

42 (62.7)

190

372

67

439

11.22

0.001*

2.54* (1.49-4.35)

1

Had institutional delivery

Yes

No

Total

214 (59.9)

43 (45.3)

257

143 (40.1)

52 (54.7)

195

357

95

452

6.01

0.010*

1.85* (1.15-2.86)

1

*Significant

4

6

Discussion

though with no significant differences. In China,

younger age of mother was shown to be positively asso-

ciated with EBF and in Northern (Jos), and eastern

Nigeria (Anambra), the practice of exclu-

sive bre₂₄a_,s₂₆tf_,₂e₇eding increased with increasing age of

Parity was found to be significantly asso-

ciated with EBF. From parity of 2 and more, the practice

of EBF decreased with the lowest proportion among

grand multiparous women. It is possible that smaller

family size afforded them more time, dedicated to the

care and nurture of their babies. But the primiparous

women also had lower prevalence of EBF. Undue pres-

sure from their mothers-₂i₃n-law to give other feeds

maybe responsible for this.

Application of child survival strategies such as breast

feeding is a major way of bringing down the high Infant

Mortality Rate in Nigeria in order to achieve the 4 Mil-

th

lenium Development Goal. A vast majority of our re-

spondents breastfed their babies but their practices re-

garding breastfeeding were poor. These poor practices

may compromise the nutritional status of their children.

This is quite similar to the proportion of women who

breastfed in another study among those who delivered in

Hospitals in Australia (96%) and in a semi-urban com-

munity in Lagos (100%). In other studies conducted in

other st₁a₅t_,₁e₆s_,₁₇in_,₁₈Nigeria, all the respondents breastfed their

women.

babies.

This is not surprising since initiation of

breastfeeding is almost universal in Nigeria.

Despite the high prevalence of EBF, only about half of

the mothers practiced it for the recommended 6 months.

The practice of EBF for 6 months was commonest

among the youngest age group and least common among

the oldest age group but the difference was not signifi-

cant. They were probably no longer strong enough to

cope with this very demanding practice unlike the

younger mothers. The younger mothers were probably at

the optimum age for best maternal health outcomes and

so more likely to have good practices. Other Nigerian

studies showed that maternal age and parity d₁₇id_,₁₈not con-

fer any advantage in breast feeding practices.

More than half of the women (54.3%) initiated breast-

feeding within one hour of delivery. Although this may

not be considered adequate, it is higher than both our

national₉and regional average (44% and 30% respec-

1

tively). It may be due to the relatively high educational

level of our respondents. In another southwest town in

Nigeria (Ilesha) and northern town, Sokoto only₈_,₂8₀%

1

initiated breast feeding within one hour of delivery.

The positive influence of good health-seeking behavior

is also evident in this study. Our results indicate that

ANC and delivery at a formal health institution were

factors which can significantly influence initiation of

breastfeeding immediately after birth and the practice of

EBF for 6 months. This is not surprising since many of

the Primary Health Care Centers and hospitals have

adopted Baby Friendly Hospital Initiative (BFHI).

Moreover, research has shown that antenatal guidance

and education concerning advantages of breastfeeding is

significantly associated w₂₁it_,₂h₂initiation of breastfeeding

The benefits of maternal education are buttressed by the

findings from this study. As the educational level in-

creased, the likelihood of a woman breastfeeding her

baby exclusively for 6 months increased. This is similar

to the result obtained from the study in Jos where better

educational status of the women was associated with

increased practice of EBF. However, in rural Sokoto and

Ilesha, educational attainment did not have significant

2

0 18

effect on EBF for 6 months. , Being rural areas, it is

likely that the women may have low educational

attainments.

within 1 hour of delivery.

In a facility-based study in

Port-Harcourt, southsouth region of Nigeria, it was

found that the presence of more than one delivery assis-

tant as well as the presence of a breastfeeding-trained

delivery assistant in health facility enhanced the m₃oth-

Conclusion

2

ers’ practice of early initiation of breastfeeding. In

Though there is high prevalence of breastfeeding,

breastfeeding practices are still suboptimal in this region

despite evidence of numerous benefits to both mother

and child. Community-based breast-feeding promotion

programs should remain a priority, with renewed em-

phasis on early initiation in addition to exclusiveness

and duration of breast-feeding. Programmes to improve

female education, family planning and health-seeking

behavior for maternal healthcare are also key to good

practice.

other clinic-based Nigerian studies, significantly higher

proportions of mothers who had₁₇_,A₂₄NC and delivery in

health facilities practiced EBF.

The women would

have been repeatedly educated on good breastfeeding

practices during their ANC visits and eventually, they

put them into practice. These health workers are a posi-

tive influence in the adoption of best practices.

Most of our respondents practiced EBF. The prevalence

is higher than the figure o₄btained in Anambra State,

2

southeast Nigeria (37.3%). It is also higher than the

Conflict of interest: None

Funding: None

prevalence among another group of Yoruba mothers of

South W₁e₈s_,₂t,₀ Nigeria (71.6%) and rural area of Sokoto

Reports form Ile-Ife, another southwest

(

78.7%).

town showed that only a small proportion (19%) of the

nursing mothers practiced EBF. This means that the

practice varies widely₂₅across Nigeria even among

women of the same tribe.

In this study, the younger mothers practiced EBF more,

4

7

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