ORIGINAL

Niger J Paed 2015; 42 (2): 126 –131

Akpan UJ

Ibadin MO

Abiodun PO

Breastfeeding practices in early

infancy in Benin city, Nigeria

DOI:http://dx.doi.org/10.4314/njp.v42i2.11

Accepted: 29th February 2012

Abstract: Background: Adequate

early infant nutrition is essential

for subsequent optimum growth

and development of the child.

Exclusive breastfeeding is the

cornerstone of the best possible

nutrition in early infancy.

Objective: To assess current

breastfeeding practices in early

infancy in Benin City and further

progress ( if any) that may have

been made in the realisation of

optimal early infant feeding prac-

tices in the locale in the preceding

decade.

Most (98.4%) mothers had correct

information about exclusive

breastfeeding obtained mainly

from antenatal clinics and immuni-

zation centres. Factors signifi-

cantly associated with EBF w₂ ere

Akpan UJ⁽

)

Department of Paediatrics,

Federal Medical Centre,

Makurdi, Benue State, Nigeria.

high maternal education (X

=

Ibadin MO, Abiodun PO

Department of Paediatrics,

University of Benin Teaching Hospital,

Benin City, Nigeria.

9.718; p = 0.045), high socio-

2

economic status (X = 12.910; p =

0.012), increasing maternal age

2

(X = 14.777; p = 0.022), higher

2

parity (X = 15.212; p = 0.009),

2

delivery in hospital (X = 15.079; p

2

= 0.020) and infant’s age (X =

100.482; P = 0.0001).

Methods:

A

community-based

Conclusions/Recommendations:

Breastfeeding practices in Benin

City have not improved much

from what obtained a decade ear-

lier. Greater emphasis on female

education and socio-economic

empowerment are advocated as

tools for improvement. Reinvigo-

ration of the Baby-friendly Hospi-

tal Initiative is also recommended

to ensure continued health facility

interface that would ensure com-

munity mobilisation and support

for optimal breastfeeding.

household survey was carried out

in three representative wards in

Egor Local Government Area of

Benin City, from June to Septem-

ber, 2009. Infant feeding practices

were evaluated using pre-tested

questionnaires on 1068 mothers of

infants aged less than 12 months.

Result: Five hundred and forty-six

(

51.1%) infants were aged less

than 6 months. The Ever Breast-

fed Rate was 100.0% while the

Timely Suckling Rate was 35.5%.

The Exclusive and Predominant

Breastfeeding Rates were respec-

tively 40.7% and 30.4% while the

Bottle-feeding Rate was 32.2%.

Key Words: Breastfeeding, Prac-

tices, Early Infancy, Benin City

Introduction

alone could save the lives of up to 1.3 million children

8,9

annually, world-wide .

The provision of appropriate nutrition is of great impor-

tance during infancy and childhood if growth and devel-

opment are to be optimised. In the first 6 months of life

breast milk is the “perfect” blend of nutritional and non-

nutritional substances that ensure appropriate outcomes

in growth, cognition, immune response and long-term

Despite widespread knowledge of the current early in-

fant feeding recommendations and the benefits to the

child and the mother, indicators of early child nutrition

1

0

remain unacceptable in many parts of the globe . A

mother’s decision on how to feed her infant is a result of

a complex interplay of factors and it is believed that

mere knowledge of what is right is not sufficient to posi-

1

wellbeing . Beyond six months of age and well into the

second year of life, breast milk could still provide up to

2

11

5

0% of nutrient intake .

tively influence the behaviour of many .

Studies have established the adequacy of exclusive

breastfeeding in providing enough fluids and nutrients

Many mothers declare their intentions to breastfeed ex-

clusively and actually initiate the practice but could

abort same due to challenges that include need to return

to paid job, the feeling of insufficient m₃il_,₁k₁_,₁p₂roduction

3

-

for growth and development in the first half of infancy

5

2,5,6

.

Sub-optimal feeding practices lead to malnutrition,

which is a contributory factor to 60% of under-5 mortal-

and the tradition of water supplementation

.

2

,7

ity in sub-Saharan Africa . Exclusive breastfeeding

1

27

The baby-friendly hospital initiative (BFHI) was de-

signed by WHO and UNICEF as a global effort to turn

health facilities, especi₃ally maternities, into centres of

Information on infant nutrition and family socio-

demographic parameters were obtained from respon-

dents using a pre tested questionnaire with open-ended

and close-ended questions. The questionnaires were

administered by one of the researchers and trained col-

leagues and the infant feeding practices were docu-

mente₁d₆_,₁u₇sing 24 hour recall data as recommended by

WHO . The socio-economic status of the family of

subjects was determined using the method described by

1

breastfeeding support. and promotion. Yet, well into

the second decade of its existence, the breastfeeding

indicat₀ors in many parts of the world fall short of

1

goals. The goal for the year 2000 was to achieve 80%

1

4

exclusive breastfeeding rate .

1

8

The United Nations urges member countries to make the

required efforts necessary to achieve the target of the

millennium development goal-four (MDG-4). These

efforts must include strategies to improve young child

nutrition in order to reduce under-five mortality. These

strategies should proceed from studies which attempt to

understand why some mothers in different communities

are less likely to adhere to early infant feeding recom-

mendations. The study therefore was undertaken to as-

sess the current early breastfeeding practices including

its determinants in Benin City. This is done against the

backdrop of what obtained in the locality a decade ear-

lier.

Olusanya et al .

Study subjects were mothers and their infant aged 0-364

days (just under 12 months). Information on the date of

birth of the infants was obtained from the mothers or

fathers and verified by birth records, where available.

Informed consent was obtained from every parent/

guardian.

Ethical clearance for the study was obtained from the

University of Benin Teaching Hospital Ethics Commit-

tee. Permission for the study was obtained from Edo

State Ministry of Health and Egor Local Government.

Data was entered directly into the Statistical Package for

Social Science (SPSS) spread sheet and checked for

accuracy. The data was then analysed using SPSS ver-

sion 15. Results were displayed in tables and figures

and chi square test was used to determine associations

between non-parametric variables. The student’s t test

was used to compare means. A p-value of < 0.05 was

considered significant.

Subjects and methods

The study, a cross-sectional, descriptive and community

based one was carried out in Egor Local Government

Area (LGA) of Edo State. Egor LGA is one of the three

LGAs that make up Benin City, the Capital of Edo State.

The City is urban and cosmopolitan in nature. It was

conducted between June and September, 2009.

Results

A multi-stage random sampling method was used.

Three of the 10 political wards in Egor (representing

Breastfeeding Practices

3

0%) were selected using a table of random numbers. It

Ever Breastfed Rate (EBR) among the 546 babies was

100%. All such infants were still receiving breast milk at

the time of the study. Of the 546 mothers (whose infants

were <6 months), 222 (40.7%) practiced exclusive

breastfeeding (EBF), 166 (30.4%) predominant breast-

feeding (PBF) and 158 (28.9%) mixed feeding (MF).

The proportion of infants exclusively breastfed declined

with increasing age (Table 1). About a third (28.9%) of

infants (<6 months) had complementary feeds intro-

duced rather early. Mixed feeding increased with

increasing age of infants.

was therefore assumed that the total population was

evenly distributed among the 10 wards. Thus, of the

total of 68,748 women of child bearing age in Egor,

each of the 10 wards would have approximately 6,875

women of child bearing age and any of these could have

an infant. On the basis of this assumption equal num-

bers of 356 mothers of infants were recruited from the

three selected wards to make up a sample size of 1068.

The method of subject identification was similar to that

used by the Expanded Programme on Immunization

1

5

(

EPI) . On arrival at a selected ward, central locations

Five hundred and thirty seven (98.4%) mothers had

heard about EBF yet less than half practised it. The

most frequent reason (58.3%) for its practice was “to

prevent illness.” Other responses included enhancing

babies’ intelligence (18.4%), ensuring fast growth

(6.8%) and fostering bonding between mother and child,

(5.8%). Mothers’ reasons for not practicing exclusive

breastfeeding are displayed in Table 2. The commonest

reason was the mother’s perception that the infant was

inadequately fed with breast milk.

were identified and these were mostly cross roads and T-

junctions. From such locations, a direction was ran-

domly selected from three or four available options,

through balloting. All households in the selected direc-

tions were visited sequentially and eligible respondents

identified and consecutively recruited until the end of

the road or ward boundary was reached. This procedure

was repeated from many central locations in the ward

until the required number of respondents was obtained.

Subjects were visited from 4.00 – 6.30p.m. on week

days and from 8.00a.m. on weekends and public holi-

days. Subjects who were absent were revisited at other

times that they were expected to be home.

Table 1 shows that 168 (45.4%) mothers who delivered

in hospital exclusively breastfed their infants while 29

(37.7%), 13(27.1%) and 12(23.5%) mothers who deliv-

ered in maternities, at home and at TBAs’ places and

1

28

church premises respectively, also breastfed exclusively.

The practice of EBF was significantly associated with

place of delivery (X = 15.079, p = 0.020). Mothers

delivering in orthodox health facilities were more likely

to practice exclusive breastfeeding than mothers who

delivered in other facilities or at home.

education and 85 (34.1%) with primary or no formal

education also breastfed exclusively. PBFR and MF

were most prevalent among mothers with primary or no

formal education. The mothers’ level of education sig-

nificantly influenced the choice of feeding practice. (X

= 9.718; p = 0.045).(Table 1)

2

Table 1: Infants’ age, place of delivery, maternal education,

family’s socio-economic status and breastfeeding practices.

Significantly, older mothers practiced exclusive breast-

feeding in comparison with younger ones (X = 12.521;

p=0.028) (Table 3). Family socio-economic class (SEC)

2

EBF

n(%)

PBF

n(%)

MF

n(%)

X

P value

significantly influenced choice of breastfeeding practice.

Age (in months)

2

(

X = 12.910; p = 0.012) as 42 (53.8%) mothers of high

0

2

– 1 (n=158)

– 3 (n=204)

94(59.5)

92(45.1)

52(32.9)

64(31.4)

12(7.6)

48(23.5)

SEC exclusively breastfed their infants in comparison

with 85 (45.5%) and 95 (33.8%) mothers belonging to

the middle and low SECs respectively, that did the

same. Maternal occupation was not significantly associ-

100.4

0.0001

82

4

- <6(n=184)

36(19.6)

50(27.2)

98(53.3)

Place of delivery

Hospital (n=370))

168(45.4)

29(37.7)

102

100(27.0)

25(32.5)

2

(27.6)

ated with EBF (X = 7.078; p = 0.215). (though more

Maternity (n=77)

23(29.9)

15.07

9

0.020

top civil servants and professionals (62.5%) practised

EBF than other occupational groups). EBF was most

practised by Etsako women and least practised by Urho-

bos. The differences observed in the practice among the

different tribes/ethnic groups were not statistically sig-

Home (n=48)

TBA/church

13(27.1)

12(23.5)

18(37.5)

23(45.1)

17(35.4)

16(31.4)

(

n=51)

Maternal education

Primary/Nil Educa-

tion. (n=249)

85(34.1)

87(34.9)

77(30.9)

2

nificant (X = 11.208; p = 0.082). Similarly paternal

Secondary (n=256)

Tertiary (n=41)

Family’s socio-economic status

High (n=78)

Middle (n=187)

115(44.9)

22(53.7)

69(27.0)

10(24.4)

72(28.1)

09(22.0)

9.718

0.045

0.012

education and infants’₂gender were not significan₂tly

associated with EBF(X = 2.147; p = 0.342) (X

0.817; p = 0.082) respectively.(Table 3)

=

42(53.8)

85(45.5)

18(23.1)

53(28.3)

18(23.1)

49(26.2)

12.91

0

Table 3 shows that the relationship between birth order

and exclusive breastfeeding was statistically significant

Low (n=281)

95(33.8)

91(32.4)

2

(

X = 15.212; p = 0.009). Babies in the birth orders be-

EBF: Exclusive breastfeeding; PBF: Predominant Breastfeeding; MF:

Mixed Feeding

yond fifth were significantly less likely to be exclusively

breastfed.

Table 2: Reasons for not practicing exclusive breastfeeding

Table 3: Maternal age, child’s birth order, child’ gender,

paternal education and practice of exclusive breastfeeding

Reasons

F

%

Infant not satisfied with breast milk

Babies need water

Insufficient breast milk

Infant formula is adequate

88

52

57

30

20

27.2

16.0

17.6

9.3

2

EBF n

No EBF n

(%)

X

P value

(%)

Maternal age (years)

Exclusive breastfeeding makes babies refuse other

6.2

1

2

3

>

B_si_trth order

6-20 (n=24)

1-25 (n=110)

6-30 (n=216)

1-35 (n=116)

6-40 (n=62)

05(20.8)

34(30.9)

92(42.6)

52(44.8)

32(51.6)

07(38.9)

19(79.2)

76(69.1)

124(57.4)

64(55.2)

30(48.4)

11(61.1)

foods

Mother not strong enough/Not enough food to eat

Work

Miscellaneous

Total

19

39

5.9

12.0

12.521

15.212

0.028

0.009

324 100.0

40 (n=18)

One hundred and ninety-one (42.7%) mothers who had

antenatal care (ANC) in hospitals breastfed exclusively,

1

2

3

4

5

>

(n=155)

(n=142)

(n=97

55(35.5)

50(35.2)

46(47.2)

29(44.6)

33(58.9)

09(29.0)

100(64.5)

92(64.8)

51(52.6)

36(55.4)

23(41.1)

22(71.0)

nd

rd

th

1

8 (34%) who had ANC in maternity homes did the

(n=65)

same but none who was cared for by a TBA breastfed

exclusively. Of mothers who had ANC in hospitals,

maternities and in TBAs’ place 134 (30.0%), 17 (32.1%)

and 3 (75.0%) respectively, practiced predominant

breastfeeding. One hundred and twenty-two (27.3%),

_t(_hn=56)

5

(n=31)

Infants’ gender

Male

Female

117(42.6)

105(38.8)

168(57.4)

166(61.2)

0.817

0.366

Paternal education

1

8 (34.0%) and one (25%) who had ANC in hospitals,

Tertiary

46(48.4)

49(51.6)

maternity homes and with TBAs’ place respectively

practiced mixed feeding. Place of ANC did not signifi-

Secondary

Primary/no

formal edu.

129(40.7)

47(35.1)

188(59.3)

2.147

0.342

2

cantly influence breast feeding practice (X = 5.991; p=

87(64.9)

0

.200).

EBF: Exclusive breastfeeding

The EBFR increased with increasing level of maternal

education while MF and PBFR increased with reducing

level of education. EBF was more rampant among

mothers with tertiary education. Table 1 shows that 22

Time of initiation of breastfeeding

Among the 546 infants 194 (35.5%) were put to the

breast within one hour of birth giving a Timely First

Suckling Rate (TFSR) of 35.5%. Seventy six (13.9%)

(

53.7%) mothers with tertiary education exclusively

breastfed their infants while 115 (44.9%) with secondary

1

29

infants began suckling within 30 minutes of life while

18 (21.6%) began after 30 minutes but within one hour

breastfeeding behaviour had been influenced by the in-

tensive breastfeeding promotions of the late 1990s. The

younger mothers perhaps began child bearing at the time

BFHI activities had waned. The relationship between

maternal age and EBF noted in this study is also sup-

ported by the_t_h finding_t_h that EBF was most prevalent

1

of birth. Two hundred and seventy five (51.2%)

achieved first suckling beyond one hour but within 24

hours of birth. Mothers who did not put their infants to

breast within one hour did so for the following reasons:

the need to rest after labour, surgical delivery, delayed

milk flow, maternal or infant illness.

rd

among 3 , 4 and 5 born infants. Such babies are

more likely to be born to older mothers. It is also prob-

able that mothers who have practised EBF previously

are the ones continuing with th₁e₁ practice.₂₃Nonetheless

Sixty three (17.0%) mothers, who delivered in the hospi-

tal put their babies to breast within 30 minutes of deliv-

ery while 5 (6.5%) who delivered in the maternity initi-

ated breastfeeding during the same period (Table 4).

Breast feeding initiation within the first 30 minutes was

3

experiences from Chile , Enugu and Jos on EBF do

not support the assertion, as EBF was more common

amongst first babies. Okparaocha et al found no asso-

2

21

significantly associated with place of delivery (X =

ciation with birth order .

1

8.88; p = 0.026). Mothers who delivered in the hospi-

tal were more likely to initiate early breastfeeding than

those who delivered in other locations.

Though more (62.5%) top civil servants and profession-

als than others practiced EBF, maternal occupation did

not significantly influence EBF. Okparaocha et al made

21

same observation 10 years earlier in Benin City.

Table 4: Relationship between place of delivery and time of

initiation of breast feeding

Against expectations that full time housewives would

readily engage in EBF since they have their babies wit₁h₁

them almost all the time, this was not the case. Aghaji

from Eastern Nigeria had made similar observation. A

plausible explanation for the trend is that many of such

women are less likely to be well educated and belonging

to lower social strata – a strata unlikely to breastfeed

exclusively.

Place of

Delivery

0-30

mins

n(%)

>30mins-

1hr n (%)

>1hr-24hrs

n(%)

>24 hrs

n(%)

Total

n(%)

TBA/Church

Home

MH

Hospital

Total

5(9.8)

3(6.3)

5(6.5)

63(17)

76(13.9)

10(19.6)

8(16.7)

18(23.4)

82(22.2)

118(31.6)

28(54.9)

30(62.5)

49(63.6)

168(45.4)

275(50.4)

8(15.7)

7(14.6)

5(6.5)

57(15.4)

77(14.1)

51(100.0)

48(100.0)

77(100.0)

370(100.0)

546(100.0)

2

X = 18.88; df=9; p=0.026. MH=Maternity Home; TBA=Traditional

Birth Attendants; Hr= Hour; Mins = Minutes

Mothers with secondary and tertiary education were

more likely to initiate breastfeeding early than others. A

plausible reason for this is that educated mothers are

more likely to imbibe the tenets of breastfeeding classes

during ANC and also have improved access to docu-

ments on “Successful Breastfeeding.”

Thirteen (17.6%) mothers with tertiary education initi-

ated breastfeeding within 30 minutes of infant’s birth,

1

4

02 (19.7%) with secondary education did the same and

8 (10.2%) with primary or no formal education also

Maternal education was also positively associated with

the practice of EBF. More mothers with tertiary educa-

tion exclusively breastfed their babies. Si₁m₁ ilar findings

initiated breastfeeding within the first 30 minutes. Ini-

tiation beyond 30 minutes but within one hour was com-

parable among all levels of education. Maternal educa-

tion beyond primary level was significantly associated

2

1

24

had been reported in Benin City , Enugu and Kano .

1

2

In Enugu , paternal education also significantly influ-

enced EBF but in the current study as with that carried

out in Uganda, such was not the case. Educated parents

are more likely to acc₁ept new health initiatives, tech-

with early initiation of breastfeeding (X = 21.141; p =

0

.001).

1

nologies and strategies than the less educated who tend

to cling to tradition.

Discussion

Half of mothers in the study belonged to low socio-

economic classes. This was not surprising since Nigeria

is a developing country with low female literacy rate and

high level of unemployment. In 2007, the World Bank

reported that more t₅han 70% of Nigerians lived on less

In the study, older mothers (36-40 years) adhered more

to optimal breast feeding practices. In tand₉em with thi₂s₀

1

observation are the findings from canada and Isreal

where older women were noted to breastfeed than

3

younger one₁s. In contradistinction, studies in Chile and

2

than US $1 a day and more recently, in 2009, the

Benin City found the practice commoner in younger

2

5

2

“State of the World’s Children” reported 43% preva-

lence of poverty in urban centres in Nigeria. A positive

association was found between socio-economic status

and EBF in the pre₁sent study.

mothers (about the age of 20 years). Eregie in 1996

found no association between maternal age and EBF in

Benin C₁ity- a finding that was corroborated in 1998 by

1

Aghaji in Enugu. Nonetheless the present study and

2

Okparaocha et al reported similar association in Benin

that of Okparaocha et al were community-based while

Eregie’s and Aghaji’s were hospital-based.

City a decade earlier which corroborated similar find-

2

6

ings in studies carried out in United States of America

2

7

and the United Ki₃ngdom . In contradist₂i₈nction, how-

Okparaocha et al averred that younger mothers were

more amenable to change while older ones were more

likely to stick to tradition. In this study, it is likely that

the older mothers being encountered are the same whose

2

ever, Okechukwu in Jos and Wamani in Uganda

found no association between socio-economic status and

EBF. The urge to give the best to their children would

1

30

be stronger in high socio-economic class families. If it is

an acknowledged fact that EBF is superior to other

forms of feeding the high SEC families are more wont to

comply than others. In this study as well as that con-

ducted in Kano , ethnicity was not significantly associ-

ated with exclusive breastfeeding.

EBFR of only 21% in a baby-friendly hospital in Ilesa; a

value that was comparable to the then national average

of 17%. This could imply that the impact of BFHI is

more in Benin City, though the practice of EBF has

stagnated in Benin City in the last decade. This could be

due to the fact that younger mothers have not been ade-

quately mobilized to significantly add to the proportion

of mothers who are breastfeeding exclusively.

2

4

The place of antenatal care did not significantly influ-

ence breast feeding practices in the study. However, it

2

1

did 10 years earlier . Over 90% of mothers in the study

had heard of EBF because of the promotional activities

in ANCs that had gone on for nearly two decades. It

was therefore not surprising that the place of recent

ANC did not influence the choice of breastfeeding prac-

tice for the index infant.

EBF declined with increasing age. It was most preva-

lent among infants 0-1 month. Similar p₂a₉ttern had₂₈been

2

1

noted earlier in Benin City , Ibadan Uganda and

3

Chile . This trend could depict mothers’ perception that

infants need other foods beside breast milk as they grow

older.

Unlike the place of ANC, the place of delivery was sig-

nificantly associated with breastfeeding practices. This

was probably because mothers who delivered in hospi-

tals had hospital staff support for BF just before delivery

as could occur in orthodox health facilities. It is also

plausible that the higher prevalence of EBF among

mothers delivering in hospitals is influenced by the cali-

bre of mothers than by hospital practices.

The commonest (27.7%) reason why mothers failed to

breastfeed exclusively was the perception that babies

were no longer satisfied with breast milk as they re-

mained fretful after being breastfed and the fretfulness

ceased when they were offered additional feeds. The

impact of this challenge may be less if mothers have

easy access to lactation managers. A help-line might be

appropriate.

Delivery in hospital was significantly associated with

initiation of breastfeeding within 30 minutes of infant’s

birth. It is expected that labour room staff who work in

hospitals would be better trained than those who work in

other health facilities and would assist mothers to initi-

ate breastfeeding on time.

The PBFR of 30.4% was comparable to the 33.8% re-

2

1

ported earlier in Benin City . Breastfeeding education

that discourages water supplementation must reach not

just the expectant mothers but also key family members

if the practice must stop.

The EBR in the study was 100%. This supports the

claim that breastfeeding is the norm in many developing

countries. Other Nigerian researcher₉s had equally docu-

Conclusion

2

mented high EBR. Lawoyin et al reported 99.9% in

In conclusion, breastfeeding indices in the preceding

decade in Benin City have remained relatively static. If

no deliberate efforts are made to enshrine exclusive

breastfeeding the initial gains of the past may be eroded.

Reinvigoration of the BFHI is recommended. This will

ensure continued health facility interface that would

ensure community mobilisation and support for optimal

breastfeeding.

3

0

Ibadan in 1998 and Ogunlesi et al reported 98% in

2

8

Ilesa, in 2005. In rural Uganda , in 2002, 99% of moth-

ers studied had breastfed their babies and in Northern

Nigeria all 310 mothers studied breastfed their infants

and young children. These are in contrast to what ob-

tains in developed countries like the U.S. where 74% of

mothers ever breastfed and Ever Breastfeeding Rate at

3

1

six months was abysmally 43% . In the United King-

dom the Millennium Cohort study conducted between

Limitations of study/Further studies

2

000 and 2002, 70% of U.K. mothers ever breastfed but

only 38% still breastfed at four months of infant’s age.

Breastfeeding is widespread in many developing coun-

tries like Nigeria but the challenges are sub-optimal

breastfeeding practices.

Data from respondents relied on 24 hour recall with its

attendant drawbacks. To what extent this has affected

the results is difficult to decipher. A multi centre study

might be required for comparison.

The TFSR in the₀ study is comparable to the national

1

average of 32% and the 37% reported from Ilesa in

Conflict of interest: None

Funding: None

30 21

005 by Ogunesi . In 1998, Okparaocha documented

2

a much higher rate of 52%. It would appear that labour

room practices that ensure that mothers make early con-

tact with their newborn infants and are assisted in initiat-

ing early feeding have waned.

Acknowledgement

The EBFR in this study was 40.7% while the PBFR was

We wish to acknowledge with thanks the contributions

of the leadership of Egor Local Council and the various

communities utilised for the study. Members of house-

holds that participated in the study made invaluable con-

tributions to the realisation of the objectives of the

study. To them we remain grateful.

3

0.4%. The 40₂.7% noted in this study differs greatly

2

from the 27% recorded for Benin City in the mid

990s. It is however comparab₁ le to the 38% observed in

1

2

Okparaocha’s study in 1998. In a recent study in an-

3

0

other part of Nigeria, Ogunlesi in 2005, reported an

1

31

References

1

2

3

.

Koletzko B. Preface. In: Koletzko

B, ed. Pediatric Nutrition in Prac-

tice. S Karger AG, Basel, Swit-

zerland; 2008.

Federal Ministry of Health. Infant

and Young Child Feeding in Nige-

ria: Guidelines Abuja, Nigeria;

13. UNICEF. The Baby-Friendly

Hospital Initiative: http://

www.unicef.org/ programme/

breastfeeding/baby.htm (accessed

23/10/2008).

14. Okeke TA. Knowledge, attitude

and practice of exclusive breast-

feeding among mothers in Enugu,

Nigeria. J Coll Med 1998; 3: 13-6.

15. World Health Organisation Immu-

nisation Coverage Cluster Survey

– Reference Manual 2005.

24. Iliyasu Z, Kabir M, Abubakar IS,

Galadanci NA. Current knowledge

and practice of exclusive breast-

feeding among mothers in Gwale

Local Government Area of Kano

State. Nig Med Pract 2005; 48: 50

-5.

2

005.

25. UNICEF. State of the Worlds Chil-

dren 2009. New York: United

Nation Children’s Fund; 2008.

26. Galson SK. Surgeon General’s

Diaz S, Herreros C, Aravena R,

Casado ME, Reyes MV, Schiap-

pacasse V. Breastfeeding duration

and growth of fully breastfed in-

fants in a poor urban Chilean

th

Perspective. The 25 anniversary

www.who.int/vaccines-documents/

accessed 20/8/08).

of the surgeon general’s workshop

on breastfeeding and human lacta-

tion: the status of breastfeeding

today. Pub Hlth Rep 2009; 124:

356-8.

27. Griffiths LJ, Tate RA, Dezateux C

and the Millennium Cohort Study

Child Health Group. Do early

infant feeding practices vary by

maternal ethnic group? Pub Hlth

Nutr 2007;10: 957-64.

28. Wamani H, Astrom AN, Peterson

S, Tylleskar T, Tumwine JK. In-

fant and young child feeding in

Western Uganda: knowledge, prac-

tices and socioeconomic correlates.

J Trop Pediatr 2005; 51: 356-61.

29. Lawoyin TO, Atwood S, Olawuyi

JF. A rapid assessment of breast-

feeding status using current status

data Afr J Med med Sci 2001;

30:23-5.

30. Ogunlesi T, Dedeke O, Okeniyi J,

Oyedeji G. Infant and toddler

feeding practices in the baby-

friendly (BFI) era in Ilesa, Nigeria.

The Internet J Nutr Wellness 2005.

www.ispub.com/journal/the_ inter-

net_journal_of_nutrition_and_well

ness/volume_1_number_2_45/

article/infant_and_toddler_feeding

_practices_in_the_baby_friendly_i

nitiative_bfi_era_in_ilesa_nigeria.

html. (accessed 22/10/07).

population. Am J Clin Nutr 1995;

6

2:371 – 6.

16. WHO/UNICEF/USAID. Indica-

tors for Assessing Infant and

Young Child Feeding Practices:

Part I, Definitions. Conclusion of

a Consensus Meeting held 6-8

November 2007. Washington DC:

WHO; 2007.

17. World Health Organization. Indi-

cators for Assessing Breastfeeding

Practices. WHO/CHD/SER 1997;

10: 1-2

18. Olusanya O, Okpere E, Ezimokhai

M. The importance of social class

in voluntary fertility control in a

developing country. W Afr Med J

1985; 4: 205-11.

19. History of Breastfeeding – Wikipe-

dia. www.wikipedia.org/wik/

History-of_breastfeeding (accessed

23/4/09).

20. Ever-Hadani P, Seidman DS,

Manor O, Harlap S. Breastfeeding

in Isreal: maternal factor associ-

ated with choice and duration. J

Epidemiol Comm Hlth 1994;48:

281-5.

21. Okparaocha HU, Ibadin MO,

Muogbo DC. Current practices in

infant nutrition in Benin City, Ni-

geria. Niger J Clin Pract 2002; 5:

139-42.

22. Eregie CO. Studies on exclusive

breastfeeding: a report on associ-

ated factors in an African Popula-

tion. J Trop Pediatr 1998; 44: 172

-3.

23. Okechukwu AA. Infant feeding

practices among mothers delivered

at the Jos University Teaching

Hospital intending to breastfeed

exclusively for six months. Niger

J Clin Pract 2007; 10: 194-9.

4

5

.

Eregie C. O. Exclusive breastfeed-

ing and infant growth studies:

reference standards for head cir-

cumference, length and mid-arm

circumference/head circumference

ratio for the first 6 months of life.

J Trop Pediatr 2001; 47: 329 – 34.

Quinn V, Guyon A, Martin L,

Neka-Tebeb H, Martines J, Sagoe-

Moses C. Nutrition and Breast-

feeding Promotion. In: Lawn J,

Kerber K, eds. Opportunities for

Africa’s Newborns: Practical Data,

Policy and Programmatic Support

for Newborn Care in Africa.

PMNCH, Cape Town; 2006; 101-

1

2.

6

.

Okeahialam T. Complementary

feeding: the foundation of child

nutrition. J Int Child Hlth, 2007;

1

:1 – 22.

7

8

.

Ezeife C, Nwosu N. Government

policy on complementary feeding.

J Int Child Hlth, 2007; 1: 45 – 84.

Jones G, Steketee RW, Black RE,

Bhutta ZA, Morris SS. How many

child deaths can we prevent this

year? Lancet 2003; 362: 65 – 71.

Edmond KM, Bahl R, Taiwah-

Agyemang, Lawn JE, Kirkwood

BR. Breast is still Best: New Evi-

dence of the Potential to Save at

least 1.4 million lives. Common

Wealth Health Ministers Refer-

ence Book 2006; 2006.

9

.

31. Campbell O. Breastfeeding Boosts

the National Economy, April 2009.

www.mothering.com/articles/

new_baby/breastfeeding/nursing-

by-numbers.html (accessed

1

0. UNICEF. State of the Worlds

Children 2006. New York: United

Nation Children’s Fund; 2005.

1. Aghaji MN. Exclusive breastfeed-

ing practice and associated factors

in Enugu, Nigeria. West Afr. J

Med. 2002; 21: 66-9.

6/11/09).

1

2. Haider R, Kabir I, Hamadani JD,

Habte D. Reasons for failure of

breastfeeding counselling: moth-

ers’ perspective in Bangladesh.

Bull WHO 1997; 75: 191-6.