ORIGINAL

Niger J Paed 2015; 42 (3):218 –222

Akpan UJ

Ibadin MO

Abiodun PO

Feeding practices in late infancy in

Benin City, Edo State, Nigeria

DOI:http://dx.doi.org/10.4314/njp.v42i3.9

Accepted: 13th May 2015

2

.741; p=0.740) and family socio-

2

Abstract: Background: Whereas

considerable insight has been

gained and progress made in opti-

mum feeding in early infant feed-

ing same cannot be said with nu-

trition in late infancy. Tacking

challenges associated with nutri-

tion in late infancy demands that

extant practices and their short-

comings are exposed.

economic status (X =10.145;

p=0.930). Timely complimentary

feeding rate (TCFR) was very high

(

)

Ibadin MO

Department Paediatric, and Child

Health/University of Benin Teaching

Hospital, Benin City, Nigeria.

(

92.7%). Delayed introduction of

complimentary feeding was very

low (3.6%). Maize gruel (pap) was

the commonest (76.6%) comple-

mentary food utilized and com-

monly (99.5%) this was enriched

with a variety of other items with

milk as the commonest item used.

Fish was the commonest (41.0%)

animal product used as compli-

mentary food. Use of animal feeds

was however generally low and

their use was uninfluenced by fa₂m-

Email: mikobadin@yahoo.com

Akpan UJ

Department Paediatric,

Federal Medical Centre, Makurdi,

Benue State, Nigeria.

Objectives: To evaluate and docu-

ment practices regarding feeding

in late infancy in Benin City, Edo

State, Nigeria.

Abiodun PO

Department Paediatrician, and Child

Health, University of Benin Teaching

Hospital, Benin City, Nigeria.

Methods: Using a community-

based household survey involving

three representative political

wards in Egor Local Government

Area of Benin City, feeding prac-

tices in late infancy were evalu-

ated using a mix of structured and

non-structured, pre-tested ques-

tionnaires on 522 mothers of in-

fants aged >6months to 11

months. This was done between

June and September, 2009.

ily socio-economic status (X

.424, p=0.066).

=

5

Conclusions/Recommendations:

Bottle feeding rate remains unac-

ceptably high even into late in-

fancy.

Factors fostering this

should be exposed and tackled

because of the dangers inherent in

the practice. Timely complimen-

tary feeding practice is encourag-

ing and needs to be supported and

sustained for its benefits.

Results: The age range of mothers

was 17-48 years. Diverse ethnic

groups were represented with the

Binis constituting the largest

Key Words: Nutrition, Late, In-

fancy, Complimentary feeding,

Benin City.

(

48.6%). Bottle feeding rate

BOTFR) was 2.55% and Bottle

feeding practice was unassocia₂ted

with maternal occupation (X

=

Introduction

in inadequate amounts, not given at the right frequency,

low in nutrient₅d_-₇ensity, and prepared and delivered in

unsafe manners.

Sub-optimal feeding practices lead to malnutrition,

which is a contributory factor₆_,i₈n 60% of under-5 mor-

talities in sub-Saharan Africa. It has been estimated

Late infancy is a period of immense opportunity for the

consolidation on the gains accruing from rapid growth

and development occasioned by appropriate nutrition in

4

-6

1

early infancy. Whereas it is widely acknowledged that

exclusive breastfeeding provides enough fluids and nu-

trients_-₄for growth and development in first half of in-

that if breastfeeding and complementary feeding are

practiced as recom₉ mended, up to 19% of under-5 deaths

would be averted.

2

fancy investigators have also revealed that growth

faltering peaks when complementary feeds are intro-

duced₅as a result of poor complementary feeding prac-

tices.

Adequate attention has not been given to late infant

fee₅d_,₁i₂ng as compared to exclusive breastfeeding in Nige-

ria

If the target of the millennium development goal-

four (MDG-4) are to be met efforts must be made to

improve feeding in late infancy. These strategies should

proceed from studies that seek to document current feed-

ing practices during the critical transition period in

infant nutrition. This could form the basis of interven-

This implies that promoting optimal complementary

feeding is as important as promoting exclusive breast-

feeding. In many low-income countries of the world,

complementary feeds are often introduced too early, fed

2

19

tional measures designed to enthrone adequate nutrition

at this critical age group.

Bottle Feeding and Maternal Characteristics

Of the 522 infants aged >6-11 months, 133 (25.5%)

were bottle-fed giving a bottle-feeding rate (BOTFR) of

2

5.5%. Twenty or 30.7% of full time housewives, two

Subjects and methods

Study Design/Location

(28.6%) top civil servants/professionals, 42 (26.9%)

fashion designers/hairdressers, seven (25.9%) teachers

and 50(22.9%) traders bottle-fed their infants. There

was no significant association between maternal occupa-

The cross-sectional, descriptive and community based

study was carried out in Egor Local Government Area

2

tion and bottle-feeding (X =2.741; p=0.740). Sixteen

(

LGA) of Edo State, between June and September 2009,

(23.9%) mothers from high socio-economic class bottle-

fed whereas 51(25.2%) and 66 (26.1%) from the middle

and low social classes respectively also bottle-fed. The

practice of bottle feeding was not significantly associ-

using community based design consistent with the rec-

ommend₁a₃tions of the World Health Organization

(

WHO).

2

ated with family socio-economic status (X =10.145;

Sampling Method

p=0.930).

Applying a multi-stage random sampling method three

of the 10 political wards of the LGA were selected. It

was therefore assumed that the total population was

evenly distributed among the 10 existing wards. On the

basis of equal distribution of 68,748 women of child

bearing age among the wards, an equal number of 356

mothers were recruited from the three wards to make up

a sample size of 1068.

Timely Complementary Feeding

Of the 355 infants aged 6-9 months, 329 or 92.7% re-

ceived a combination of breast milk and complimentary

feeds. Thus, the timely complementary feeding rate

(TCFR) was 92.7%. Thus majority of infants who ought

to be on complementary feeding did so.

The method of subject identification was similar to that

used by the Expanded Programme on Immunization

Delayed Introduction of Complementary feeds

14

(

EPI). All households in the randomly selected direc-

Of the 522 infants only 19(3.6%) were not receiving

complementary feeds at the time of interview. Mothers’

reasons for this delay included “ample breast milk

flow”, infant’s refusal of complementary feeds and

several issues bothering on ignorance.

tions were visited and eligible respondents consecutively

recruited until ward boundaries were reached. This pro-

cedure was repeated from many central locations in the

ward until the required number of respondents was met.

Subjects were visited at times that were convenient to

them. Using researcher administered questionnaire in-

formation on nutrition in late infancy and family socio-

demographic parameters were obtained relying o₃n 24

Complementary Foods Utilized

The maize gruel popularly known as “pap” was con-

sumed by 400 (76.6%) of 522 infants aged 6-11 months.

Other food consumed included rice, fish, beans, fruits,

roots and tubers. Over a period of 24 hours (the dietary

recall period), infants consumed numerous food items

leading to overlap. Pap contributed 29.7%, fish, 16.0%;

rice, 15.5%; beans, 8.4%; fruits, 7.0%; Indomie noodles,

6.0%; Garri, 5.4%; egg, 3.7%; yam, 3.2%; fortified

commercial cereals, 3.3% and meat contributed the

least, 1.8%.

Pap was the commonest food item used for complemen-

tary feeding while fish was the commonest animal prod-

uct used. Out of the 522 infants only 24(4.6%) received

meat, 215(41.2%) received fish, 94(18%) received fruits

and 45(8.6%) were fed on fortified commercial comple-

mentary foods. The use of meat was low among study

population and majority made use of home-made com-

plementary food which was predominantly carbohy-

drates.

1

hour recall principle as recommended by WHO. The

socio-economic stratification of the families o₁f₅ subjects

was carried out as described by Olusanya et al.

Ethical Clearance

The University of Benin Teaching Hospital’s Ethics

Committee, Edo State Ministry of Health and Egor Lo-

cal Government Council gave their approval for the

study.

Data Analysis

Data was entered directly into the Statistical Package for

Social Science (SPSS) spread sheet and checked for

accuracy. They were subsequently analysed using ver-

sion 15. The students’ t-test was used to compare means

generated from continuous variable and p-value of <

0

.05 was considered significant.

Socio-Economic Status and Use of Animal Products as

Complementary Foods

Results

Thirty-five (51.5%) mothers from high social class, 79

(

40.1%) from the middle class and 101(39.3%) from the

Of the 1068 mothers interviewed 522 or 48.9% had

babies that were aged> 6-11 months.

low social class gave their infants fish. However, social

class was not significantly associated with the use of

2

20

2

fish (X =3.442; p=0.179). Seven (10.3%) mothers from

It is important to educate mothers on the need to intro-

duce complementary foods at six months despite

mother’s ample milk flow and infant’s ostensible satis-

faction with breast milk. It is also important to educate

mothers on the art of timely introduction of complemen-

tary feeds to improve acceptance among babies. Maize

gruel differently known as pap, Ogi or Akamu, was the

commonest complementary food utilised. Fish was the

commonest animal product used as complementary

food. Some authors had reported the use of animal

product as being com₁moner among high income fami-

high socio-economic class offered their infants egg

whereas 20 (10.2%) and 22(8.5%) from the middle and

low socio-economic classes respectively, offered their

infants the same food item. There was no significant

relationship between social class and use of egg

X =0.444; p=0.801).

From the high, middle and low socio-economic classes

five (7.4%), 12(6.1%) and six (2.3%) mothers respec-

tively offered their infants meat. Although mothers

from the low socio class were less likely to offer meat to

their infants there was no significant association be-

2

(

8

lies because of cost. In this study however there was

2

tween use of meat and socio-economic class (X =5.424;

p=0.066).

no significant association between socio-economic class

and use of animal products as complementary feeds.

This is possibly due to the fact that fish, the commonest

animal item for complementary feeding is less expensive

in the study locale, particularly the frozen type, thus cost

may not have been an issue. The use of meat was not

popular in the study. Perhaps this may have to do with

cultural norms that discourage the early introduction of

meat to the staples of growing children. Meat is a rich

source of protein, iron and zinc. Mothers should be en-

couraged to puree meat and offer it to their infants.

Even in Northern Nigeria where the rearing of cattle is

prevalent, the use of meat as compleme₈ntary food is

Table 1: Social-economic status and consumption of fish

among infants aged 6-11 months

Use of fish

Social Class

Yes

n(%)

No

n (%)

Total

n (%)

High (Classes I & II)

Middle (Social Class III) 79(40.1)

Low (Classes IV & V) 101(39.3)

35(51.5)

33(48.5) 68(100.0)

118(59.9) 197(100.0)

156(60.7) 257(100.0)

307(58.8) 522(100.0)

Total

215(41.2)

2

X =3.442; df : 2; p = 0.179.

1

Items Used For Pap Enrichment

acknowledged to be low. Iliyasu et al in 2005 re-

ported that only 4.2% of their study population from

Kano did.

Table 2 shows the food items used for pap enrichment.

Of the 400 infants who received pap, 398 (99.5%) had

some items added unto it in a bid to enrich it. Some

mothers used two or more items. Milk was the com-

monest item used. The use of sugar as an enriching item

was low. Of the 398 mothers who enriched pap, 351

Many authors have noted pap as the commonest comple-

mentary food₅_,₁n₇o_,₁t₉_,j₂u₀st in Nigeria but also in most parts of

West Africa.

About a decade earlier, Okparaocha

19

et al had reported 83.8% use of pap. In the present

study 99.5% of infants who received pap had it enriched

with one, two or three items but in Okparaocha’s study,

only 49% of infants receiving pap had it enriched. Ok-

paraocha’s finding was comparable to findings from a

study conducted in Kano in 2005 where 41.8% of in-

fants on c₁o₈ mplementary feeds received pap that was not

enriched. The scope of items for enrichment however,

have remained the same in Benin City over the preced-

ing 10 years. These include protein rich items as milk in

powdered form, soya bean, and ground crayfish. Energy

dense item such as sugar was also used and in few in-

stances mothers utilised salt. Most (88%) infants re-

ceived pap enriched with only one item and this could

be inadequate.

(

88.2%) consistently added only one item, 42(10.6%)

added two while five (1.3%) added three items.

Table 2: Food items used for enriching pap

Food Item

Protein rich items

Milk

Soya bean

Ground crayfish

Energy dense items

Sugar

frequency

%

365

66

17

77.8%

14.1

3.6

10

07

04

2.1

1.5

0.9

Beverages

Others

Total

469

100.0

Nutrient and calorie density of maize gruel is improved

when up to three items are added especially items

sourced from legumes or animal products. Soya bean

was the only legume used in the present study. The use

of sugar was low and no mother used palm oil. The use

of sugar is believed by mothers to cause diarrhoea and

diabetes later in life. Palm oil is in abundant supply in

Benin City and its environ and it is a rich source of vita-

min A. Failure to use it as an enriching item possibly

stems from ignorance or aversion. Palm oil permanently

stains the container when feeding bottles or plastic

bowls are used. This may cause mothers to reject the

product. This problem may be solved by encouraging

mothers to use stainless steel bowls and spoons while

Discussion

The timely complementary feeding rate observed in the

present study was 92.7%. Th₆is was much higher than

1

the national average of 64%. Earlier studies in Benin

City however did not estimate timely complementary

feeding rate. The high rate noted in Benin City was not

surprising as the prevalent challenge had more to do

with early or premature introduction than late introduc-

tion of complementary feeds. This notwithstanding,

3

.6% infants who ought to have been on complementary

feeding were not. Reasons given for this delay included

ample breast milk supply and issues bothering on igno-

rance on the part of the parents.

2

21

carrying out complementary feeding.

breastfeeding introduce semi-solids. Early introduction

of complementa₂₄ry feeds is associated with the use of

feeding bottles. The increased incidence in the use of

feeding bottles in Benin City in the last decade may be

indicative of the fact that some aspects of the “Ten Steps

to Successful Breastfeeding” no longer receive adequate

attention or support.

Sugar makes the maize gruel more palatable and easily

acceptable. However, excessive use of the product may

cause dental caries. Those who added salt claimed it

was for the prevention of abdominal pain and that at-

tempts earlier made to add other items had resulted in

food rejection or diarrhoea. The addition of salt to pap

is unwarranted as it adds no special value to the feeds at

that age. It may in fact co₅n_,₂t₁ribute to the development of

hypertension in later life.

Milk was the commonest

item used. This probably stemmed from the ready avail-

ability of pre-packaged powdered milk which is cheap.

The increased proportion of mothers who served en-

riched pap to their babies in the present study in com-

parison to what obtained a decade earlier may be a re-

flection of effects of the heightened promotion of appro-

priate complementary feeding in antenatal clinics and

immunization centres.

Conclusion

In conclusion, maize gruel has remained the commonest

complementary food utilized but more mothers now

enrich it even though the quality of enrichment remains

inadequate and questionable. We recommend that fe-

male education should continue to receive support from

government and parents as most studies have demon-

strated that higher maternal education is significantly

associated with optimal infant feeding practices.

The bottle feeding rate among infants aged 6- <12

months was 25.5 %. This figu₂re is lower than the 30%

2

reported by Ogunlesi in Ilesa in 2005 but higher than

Conflict of interest: None

Funding: None

19

the 19.4% noted by Okparaocha et al earlier in Benin

City. However the two earlier studies were carried out

among children aged 0-12 months. In Saudi Arabia, the

bottle₃feeding rate by three months of infancy was

Acknowledgement

2

7

6%. The differences noted in the BFR may have to do

with the level of affluence in the different societies stud-

ied. In the present study bottle-feeding was rampant

even at the onset of late infancy. This is the age group in

which most mothers who do not practice exclusive

We wish to thank all mothers who willingly participated

in the study. The supports of the leadership of Egor

Local Government Council and of the various communi-

ties used are deeply appreciated.

References

1

2

.

Koletzko B. Preface. In: Koletzko

B, editor. Pediatric Nutrition in

Practice. S Karger AG; Basel,

Switzerland: 2008.

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

population. Am J Clin Nutr 1995;

6. Federal Ministry of Health. Infant

13. 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.

14. World Health Organisation Immu-

nisation Coverage Cluster Survey –

Reference Manual 2005.

and Young Child Feeding in Nige-

ria: Guidelines Abuja, Nigeria;

2005.

7. UNICEF. Complementary Foods

and Feeding: Nutritional Compan-

ion to Breastfeeding after 6

months. http://www.unicef.org/

programme/ breastfeeding/

food.htm. (accessed 23/10/2008).

8. Ezeife C, Nwosu N. Government

policy on complementary feeding.

J Int Child Hlth, 2007; 1: 45 – 84.

9. Jones G, Steketee RW, Black RE,

Bhutta ZA, Morris SS. How many

child deaths can we prevent this

year? Lancet 2003; 362: 65 – 71.

10. The Baby-Friendly Hospital Initia-

tive: A Global Effort to Give Ba-

bies the Best Possible Start in Life.

UNICEF/WHO; 1997.

11. Fallot ME, Boyd JL, Oski FA.

Breastfeeding reduces incidences

of hospital admissions for infec-

tions in infants. Pediatrics 1980;

55: 1121-4.

6

2: 371 – 6.

www.who.int/vaccines-documents/

(accessed 20/8/08).

3

4

.

Eregie C. O. Exclusive breastfeed-

ing and infant growth studies:

15. 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.

16. UNICEF. State of the Worlds Chil-

dren 2009. New York: United

Nation Children’s Fund; 2008.

17. Onofiok NO, Nnanyelugo DO.

Weaning Foods in West Africa:

Nutritional Problems and Possible

Solutions. www.unu.edu/

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, editors. Opportunities

for Africa’s Newborns: Practical

Data, Policy and Programmatic

Support for Newborn Care in Af-

rica. PMNCH, Cape Town. 2006:

unupress/food/v191e/ch06.htm

(accessed 6/11/09).

12. Ibe BC. Overview of complemen-

tary feeding. J Int Child Hlth,

2007; 1: 23-40.

18. 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. Niger Med Pract 2005;48: 50-5

1

01-12.

5

.

Okeahialam T. Complementary

feeding: the foundation of child

nutrition. J Int Child Hlth, 2007;

1

: 1 – 22.

2

22

1

2

9. Okparaocha HU, Ibadin MO,

Muogbo DC. Current practices in

infant nutrition in Benin City,

22. 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/

23. Infant Feeding in Saudi Arabia:

Mothers Attitudes and Practices;

December 2005. www.findhealth-

articles.com/rec-pub_17037217-

infant-feeding-saudi-arabia-

mothers-attitudes-practices.htm.

24. 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.

Nigeria. Niger J Clin Pract 2002;

5

: 139-42.

0. Tagbo BN, Ugbasoro MD. Com-

plimentary feeding pattern of in-

fants attending the University of

Nigeria Teaching Hospital

the_internet_journal_of_nutrition_

and_wellness/

volume_1_number_2_45/article/

infant_and_toddler_feeding_ prac-

tices_in_the_baby_friendly_initiati

ve_bfi_era_in_ilesa_nigeria.html.

(accessed 22/10/07).

(UNTH) Ituku Ozalla, Enugu.

Niger J Paediatr 2009; 36: 51-59.

1. Ibeziako SN. Impediments to

complementary feeding. J Int

Child Hlth 2007; 1: 85-95.

2