Nigerian Journal of Paediatrics

Breastfeeding pattern and nutritional status of children under two years in Oshogbo Local

Niger J Paediatr 2016; 43 (3):186 – 192

ORIGINAL

Oladoyinbo CA

Breastfeeding pattern and

Makanjuola OF

Sobo AA

nutritional status of children

under two years in Oshogbo

Local Government Area Osun

State Nigeria

DOI:http://dx.doi.org/10.4314/njp.v43i3.6

Accepted: 26th April 2016

Abstract : Background: This

1hr after birth and about 72% gave

study aims to assess breastfeeding

prelacteal meal. About 16.4%

Oladoyinbo CA (

)

pattern among mothers and nutri-

breastfed exclusively. Only 16.6%

Makanjuola OF, Sobo AA

tional status of children under two

express breast-milk and the me-

Department of Nutrition and Dietetics,

Federal University of Agriculture

years.

dian duration for continued breast-

Abeokuta, Nigeria.

Methodology: The cross sectional

feeding

this

study

was

Email: cathbadejo@yahoo.com

study was carried out in Oshogbo

18months. Complementary foods

Local Government Area, Osun

given to the children are mostly

State. A total of 350 nursing

home prepared cereals, solids and

mothers and their children under-

semi-solid foods. About 30.4% of

two years were randomly selected

the children were stunted, 25.4%

systematically. A structured ques-

were underweight and 15.3% were

tionnaire was used to obtain infor-

wasted. However 4.3% mothers

mation on the bio-data and socio-

were underweight, 29.1% were

economic characteristics of the

overweight and 2.6% were obese.

mothers. Breast feeding knowl-

Maternal age, family structure,

edge and pattern was assessed and

parity and monthly income were

anthropometric

measurements

significantly related

their

taken. Data was subjected to de-

knowledge of and the pattern of

scriptive and inferential statistics

breastfeeding.

using SPSS version 20.

Conclusion: The practice of exclu-

Results: One-third(32.6%) of the

sive breastfeeding and use of ex-

mothers were between 26-30years

pressed breast milk is poor among

of age and 40% of the children

the mothers. Stunting was also

were between 7-12 months old.

high among the children.

Only 2.6% of the mothers earned

>$400 per month. Most mothers

Key words: Breastfeeding, Under-

(85.7%) had adequate knowledge

two children, Nutritional Status,

about optimal breastfeeding, 72%

Prelacteal foods, Mothers

initiated breastfeeding more than

Introduction

mothers. This is particularly more pronounced in devel-

oping countries . It was also observed that despite all the

Breast-feeding is considered the most complete nutri-

recommendations by experts as regards infant breast-

tional source for infants because breast milk contains the

feeding for the first 6 months of life, a significant per-

essential fats, carbohydrates, proteins, and immunologi-

centage of mothers chose not to breastfeed. Going by

cal factors needed for infants to thrive and resist infec-

population studies in developing countries, it has been

tion in the formative first two years of life . In an analy-

shown that the greatest risk of nutritional deficiency and

sis of Child Survival Strategies, exclusive breastfeeding

growth retardation occurs in children between 3 and 15

(EBF) in the first 6 months of life and continued breast-

months of age, a period noted for suboptimal breastfeed-

ing .

feeding from 6 to 24 months was identified as the single

most effective preventive intervention in reducing child

mortality, with the potential of saving 1.3 million lives

Currently, increasing commitment to the Sustainable

annually .

Development Goals (SDG) offers a new drive to im-

prove breastfeeding practices. In addition to reducing

However, advocates of breastfeeding have noticed there

child mortality, improved breastfeeding practices con-

has been a global decline in the behavior among nursing

tribute to reduce poverty and malnutrition and improve

187

maternal health . Malnutrition has been responsible

measure the length (children that are not able to stand)

directly or indirectly, for 60% of the 10.9 million deaths

and heightometer to measure the height (children that

annually among under-five children. Well over two-

are able to stand) of the children and mothers. A sensi-

thirds of these deaths, which are often associated with

tive calibrated bathroom weighing scale was used to

inappropriate feeding practices, occur during the first

measure the weight of the mothers and the children able

year of life. It is further estimated that among children

to stand. The weight of children unable to stand was

living in the 42 countries with 90% of global child

taken by weighing the mothers carrying the child and

deaths, a package of effective nutrition interventions

subtracting the weight of the mother. The scale was

could save 25% of childhood deaths each year . Breast-

standardized using an object with a known weight.

feeding, the age long practice of feeding the infants

Body Mass Index (BMI) of the mothers was calculated

seems not to be strictly adhered to, due to the demand of

as weight (kg) divided by the square of height in meters.

civilization. Some mothers do not actually believe in the

positive effect of breastfeeding, and there are social and

Data analysis

regional differences in breastfeeding practices regarded

as normal and acceptable in different social settings.

The WHO anthro software (2005) was used to analyze

Definitely many factors influence the pattern of breast-

the anthropometric data. Statistical Package for Social

feeding.

Sciences (SPSS) version 20 was used for data analysis.

Descriptive statistics chi square analysis were carried

Considering the importance of breastfeeding, this study

out.

therefore aims to assess breastfeeding pattern among

mothers, and the nutritional status of their children.

Results

Methodology

Table 1 shows the bio-data of the respondents. Forty –

Study design and location

three percent of the children were male while more than

half (56.6%) were female.

This study is descriptive and cross-sectional in design. It

was conducted in Oshogbo Local Government Area

Table 1: Bio-data of the Children

(LGA) Osun State.

Variable

Frequency

Percentage (%)

Gender

Sample selection

Male

152

43.4

Female

198

56.6

A multi-stage sampling technique was employed in se-

Total

350

100

lecting two communities from two wards out of the 15

Age of child

wards in Oshogbo. From the list of households in these

1-6 months

14.9

7-12 months

140

40.0

communities 350 households were selected using sys-

13-18 months

24.5

tematic random sampling. Household with a mother who

19-24 months

20.6

has a child under-two years were included and recruited

Total

350

100

for the study.

Data collection

Table 2 shows the bio-data of the mothers. Less than

one-tenth (6.3%) of the mothers were between the ages

A structured questionnaire was used to collect informa-

of 15 to 20 years. More than half (55.4%) of the mothers

tion on the bio-data and socio-economic characteristics

were Muslims and 95.4% of them were Yoruba.

of the respondents. The questionnaire was also designed

to obtain information on the knowledge of exclusive and

continued breastfeeding among mothers, and pattern of

breastfeeding. From a list of 15 questions to assess

knowledge of breastfeeding, an index was created to rate

the level of knowledge of the mothers, a score above

70% was rated as adequate knowledge, between 50%

and 69% as moderate knowledge and below 50% as

poor knowledge . Breastfeeding pattern was also as-

sessed. Anthropometric measurement of the children and

the mothers were taken. An infant meter was used to

188

Table 2: Bio-data of the Mothers

Breastfeeding Knowledge Assessment

Variables

Frequency

Percentage (%)

Most mothers (85.7%) had adequate knowledge about

Age of the mothers

breastfeeding, 14% had moderate knowledge and 0.3%

15-20

6.3

had poor knowledge. All the mothers interviewed in this

21-25

26.6

study were aware about Exclusive Breastfeeding (EBF).

26-30

114

32.6

About 70% of mothers got information about EBF from

31-35

21.7

the hospitals and clinic while about 30% of mothers got

35 and above

12.9

Total

350

100

information through the media. About 96.3% of the

Religion

mothers agreed that it is necessary to breastfeed exclu-

Christianity

154

44.0

sively for 6months and 91% stated that breastfeeding

Islam

194

55.4

should be continued after 6months. About 82% of the

Traditional

0.6

mothers believe that breast milk consumption by infants

Total

350

100

protects against infection.

Tribe

Yoruba

334

95.4

Breastfeeding initiation

Hausa

2.6

Igbo

0.6

Others specify

1.4

Figure 1 shows the pattern of breastfeeding initiation

Total

350

100

among the mothers. One-third (33.4%) of the mothers

Marital status

initiated breastfeeding 1hour after delivery.

Single

6.6

Married

318

90.9

Fig 1: Breastfeeding initiation

Widow

1.1

Divorced

1.4

Total

350

100

Family Structure

Monogamous

275

78.6

Polygamous

17.1

Single parent

4.3

Total

350

100

Parity

1 Child

23.7

2 Children

127

36.3

3 Children

25.4

4 Children

11.1

5 Children

2.9

6 and above

0.6

The use of Pre-lacteal meal

Total

350

100

WHO recommends that children should be exclusively

Table 3: Socio-economic characteristics of Mothers

breastfed for six months without giving water or any

Variable

Frequency

Percentage (%)

other liquid. A total 72.9% of the mothers gave their

babies pre-lacteal meal after birth. About 29.1%of moth-

Education Qualification of the mother

First School leaving

15.4

ers gave water, 15.4% mothers gave water, infant for-

SSCE

157

44.9

mula and herbal concoction, and 4.9% gave numerous

OND/ NCE

22.0

Higher education

13.4

other things like water, soft drink, juice, formula milk,

No formal education

4.3

cheese and herbal concoction. The main reason given by

Total

350

100

the respondents for introducing these pre-lacteal meals

Occupation of the mother

Student

6.0

to their babies was insufficient milk supply. About

Trading

181

51.7

21.2% of the mothers said that insufficient milk produc-

Farming

1.1

Civil Servant

15.1

tion was the main reason for introducing pre-lacteal

Artisan

23.5

meals, 18.4% had personal reasons such as baby was

Unemployed

0.6

Others

2.0

crying and baby was thirsty. Eleven percent of mothers

Total

350

100

who gave pre-lacteal meal (herbal concoction) did so in

Monthly income of the mother

order to prevent the children from infections. About 9%

#5000 - #14000

146

41.7

#15000 - #24000

111

31.7

of the mothers who gave pre-lacteal meal said this was

#25000 - #39000

13.1

done due to ill- health of the mother and their baby.

#40000 - #69,000

10.9

Above # 69,000

2.6

Total

350

100

Exclusive breastfeeding Pattern

Hours of working per day of mother

8 hours

132

37.7

10 hours

161

46.0

Figure 2 shows the pattern of exclusive breastfeeding

12 hours

13.1

among mothers. Eight percent of the mothers breastfed

Above 12hours

1.1

Less than 8hours

2.0

their child for two-three weeks and only 16.40% of the

Total

350

100

mothers practice exclusive breastfeeding.

189

Fig 2: Duration of exclusive breastfeeding among mothers

Table 5: Nutritional status of the mothers and children

Variable

Frequency

Percentage

Nutritional Status of Children

Height for age (stunting)

Adequate

244

69.7

Moderately stunted

11.4

Severely stunted

18.9

Total

350

100

Weight for age (underweight)

Adequate

261

74.6

Moderately underweight

11.1

Severely underweight

14.3

Total

350

100

Weight for height (wasting)

Adequate

296

84.6

Expression of breast milk

Moderately wasted

8.0

Severely wasted

7.4

Total

350

100

The result of this study shows that, only 16.6% of moth-

Body Mass Index of the mothers

ers use expressed breast milk to feed their children.

Underweight

4.3

About 69.0% of the mothers who expressed breast milk

Normal

224

64.0

Overweight

102

29.1

do so manually (hand pressing), 22.4% use pump and

Obese

2.6

8.6% use both methods. About 53.4% of mothers feed

Total

350

100

the expressed milk using feeding bottles and 46.6% use

spoon and cup as the method of feeding the babies with

Table 6: Relationship between nutritional status of the moth-

expressed milk.

ers and children

Underweight Normal overweight Obese

Total

Use of complementary foods

Variable

N (%)

N(%)

N (%)

P-value

Weight for height

About half (55.1%) of mothers introduced complemen-

Adequate

13(3.7)

194(55.4) 83(23.7)

6(1.7)

296(84.6)

tary food after 6 months, 12.9% after 5 months, and

Moderate

2(0.6)

13(3.7)

11(3.1)

2(0.6)

28(8)

Severe

0(0.0)

17(4.9)

8(2.3)

1(0.3)

26(7.4)

0.9% introduced it at one month. The kind of comple-

Total

15(4.3)

224(64.0) 102(29.1) 9(2.6)

350(100)

0.171

mentary food given to babies includes pap (maize gruel),

Height for age

Adequate

12(3.4)

166(47.4) 64(18.2)

2(0.6)

244(69.7)

milk and home prepared meals. Five percent of the

Moderate

0(0.0)

25(7.1)

13(3.7)

2(0.6)

40(11.4)

mothers gave cereals foods like pap alone, 24.6% gave

Severe

3(0.9)

33(9.4)

25(7.1)

5(1.4)

66(18.8)

pap and formula milk as complementary food, 3.4%

Total

15(4.3)

224(64.0) 102(29.1) 9(2.6)

350(100) 0.019

Weight for age

gave pap fortified with fish and crayfish and 14.3% gave

Adequate

10(2.9)

173(49.4) 75(21.4)

3(0.9)

261(74.5)

legumes (cooked cowpea) and animal foods.

Moderate

1(0.3)

24(6.9)

11(3.1)

3(0.9)

39(11.1)

Severe

4(1.1)

27(7.7)

16(4.6)

3(0.9)

50(14.2)

Total

15(4.3)

224(64.0) 102(29.1) 9(2.6)

350(100) 0.224

Continued Breastfeeding duration

P<0.05 is considered significant

the findings shows that among the mothers that have

Factors Associated with Knowledge and Practice of

stopped breastfeeding 0.7% of the mothers stopped

Breastfeeding

breastfeeding at 24 months, 15.4% at 18 months, 4.0%

at 15 months, 12% at 12 months, and 0.3% at 9months.

Table 7 shows that maternal age, family structure, num-

Majority (15.4%) of the mothers stopped breastfeeding

ber of parity, occupation and monthly income of the

at 18 month. About 28.3% of the mothers terminated

mothers are factors found to be significantly associated

breastfeeding due to insufficiency of breast milk or per-

with the knowledge of breastfeeding. Although educa-

ception that breast milk was not enough,8% due to work

tional level of the mothers was not significantly associ-

activities, 14.9% were due to the perception that the

ated with the knowledge of breastfeeding, the findings

baby was old enough and 21% was based on personal

shows that the older the women, the more knowledge-

decision.

able they are about breastfeeding. Also, the higher the

parity among the women the higher the level of knowl-

Relationship Between Nutritional status of the Children

edge of breastfeeding

and the Mothers

Age of the mothers, marital status, religion, family

Table 5 shows that the prevalence of stunting, under-

structure, number of parity, educational qualification,

weight and wasting in this study is 30.3%, 25.4% and

occupation and monthly income of the mothers were not

15% respectively. About 29.1% of the mothers were

significantly associated with practice of exclusive

overweight, 2.6% were obese. It was also observed that

breastfeeding among the mothers.

there is co-existence of a dual form of malnutrition

(42.1%) in the form of stunted child and Overweight

mothers’ pairs in this study.

190

Table 7: Factors Associated with Knowledge and Practice of

adherences were observed. A study in Malawi, reported

Exclusive Breastfeeding

that 58% of mothers started practicing mixed feeding,

Variable

P-value

including introduction of water, traditional medicine and

formula milk to their babies before six months .

Knowledge of exclusive breastfeeding

Age of the mothers

2.08

0.003

The 2013 Nigeria Demographic and Health Survey re-

Religion

1.57

0.054

ported that 17% of mothers in Nigeria practiced exclu-

sive breastfeeding . The finding of this study shows that

Marital status

1.97

0.781

Family Structure

1.26

0.005

16.4% of mothers practice exclusive breastfeeding. A

Number of parity

2.35

0.030

Education Qualification of the mother 2.46

0.280

prevalence of 82% has however been reported in Lagos

and 31% in Sokoto, Nigeria, . In East Asia

Nigeria

Occupation of the mother

3.08

0.685

Monthly income of the mother

2.01

0.001

Pacific, it was found that 43% mothers practiced exclu-

Practice of exclusive breastfeeding

sive breastfeeding and 41% in East/South Africa . This

Age of the mothers

3.08

0.819

Religion

1.57

0.262

implies that practice varies widely across the globe with

Marital status

1.97

0.243

different culture.

Family Structure

1.26

0.720

Number of parity

2.35

0.178

Poor practice of the use of expressed breast milk is ob-

Education Qualification of the mother 2.46

0.997

Occupation of the mother

3.08

0.711

served in this study. In a study conducted in Jos, Nigeria

Monthly income of the mother

2.01

0.812

it was reported that, mothers would not use expressed

breast milk, because they believed that expressed milk

P<0.05 is considered significant

was unsafe . Abosede and Esanbodo noted in their

study that the practice of feeding infant with expressed

breast milk was culturally unacceptable among Yoruba

mothers, because they perceived that breast milk could

Discussions

easily be contaminated, poisoned or bewitched . Again,

storage conditions may often not be optimal especially

The initiation of baby friendly hospital initiative (BFHI)

in a developing country like Nigeria where there is con-

is one of the interventions to improve the knowledge

tinuous fluctuations in electricity supply. Milk stored for

and practice of breastfeeding among mothers. More than

long periods is at greater risk of deterioration and bacte-

two- third (85.7%) of the mothers had adequate knowl-

rial contamination. It has been reported that though hu-

edge about breastfeeding. Previous study had also

man milk has immune protective properties which pro-

shown that Nigeria mothers have adequate knowledge

tects it from contamination, these properties are stable

about breastfeeding .However a study carried out in a

when milk is stored at room temperature for 8hrs, refrig-

military barracks in South-Western Nigeria reported that

erated at 0-4 C or frozen at -20 C for 12months .

only 19.6 % of mothers have good knowledge on breast-

feeding . Previous studies have also confirmed that

Complementary feeding is the introduction of other

women are aware of EBF and that hospitals are impor-

foods and liquid alongside breast milk when breast milk

tant channels for disseminating of EBF information .

alone is no more sufficient to meet the nutritional re-

More than half (70%) of the mothers in this study got

quirement of the infants . The introduction of comple-

information on EBF from hospitals and clinics. This

mentary food at the right time during infancy is neces-

shows that the hospital is the primary source of informa-

sary for nutritional and developmental reasons and aids

tion on EBF.

the ease of transition from milk feeding to family

foods . More than half (55.1%) of mothers introduced

Infants and young child feeding guidelines recom-

complementary food after 6 months. Studies have shown

mended that all newborn should start breastfeeding im-

that when complementary foods are introduced early and

mediately, within the first hour after delivery . Only a

too frequently, it displaces breast milk as the major

quarter (28.6%) of the mothers in this study initiated

source of nutrition . This can lead to diarrhea, growth

breastfeeding within the first hour of delivery while 33%

faltering and mortality in the infant since some of these

initiated breastfeeding after an hour. In Taiwan, it was

complementary foods given are not nutritionally ade-

found out that the rate of breastfeeding initiation within

quate and are mostly given in in-sufficient amount.

1hr was l5% . Another study in Lagos Nigeria, found

that 59.2% of mothers initiated breastfeeding within one

WHO recommends that from age 6 months nutritional

hour after birth . Early breastfeeding initiation has been

needs (especially energy) of infant cannot be met by

found to increase mother to child bonding, regulate in-

breast milk alone and complementary feeding needs to

fant temperature, breathing and enhance breastfeeding

fill the energy and nutrients gap . Dewey and Brown

longevity .

stated the importance of using locally available food

items for complementary feeding guided by the princi-

Adequate nutrition during infancy is important for nor-

ples of acceptability, low price and accessibility of raw

mal growth and development. WHO defined exclusive

materials . It has been stated that feeding infant with

breastfeeding as the period when an infant receives only

pap alone (maize or sorghum gruel) will not meet the

breast milk from its mother or a wet nurse or expressed

energy requirement due to high moisture content of

breast milk and no other liquid or solids with the excep-

pap . It is important that nutrient dense food from dif-

tion of drops of syrups consisting of vitamins, mineral

ferent food groups (like legumes, nuts and animal pro-

supplements or medicines . About 72.9 % non-

191

tein) should be combined with cereals for infants to

As economic development and urbanization precede

meet their requirement.

globally, the coexistence of under-nutrition and over-

nutrition within the same household which is often de-

WHO Global and National Infants and Young Child

scribed as the dual burden of malnutrition is increasingly

Feeding Guidelines recommends that breastfeeding on

being reported both in low and middle income countri-

es . Nutrition transition which brought about the major

demand should continue with adequate complementary

feeding up to 2 years or beyond . The result of this

change in the nutritional profile of human populations

study shows that only 0.7% of the mothers stopped

resulted from a shift from traditional diet to the western-

ized diet . The co-existence of over and under-nutrition

breastfeeding at 24 months and 15.4% of the mothers

stopped breastfeeding at 18 months. The NDHS report

has important public health consequences as child under

shows that the median duration of continued breastfeed-

-nutrition severely limits human potential and life ex-

ing is 18 months in Nigeria . Breastfeeding remains a

pectancy, while obesity is a risk factor for diabetes and

heart diseases .

critical source of nutrients for the young infant and child

even after introducing complementary foods. It provides

about half (½) of an infant’s energy needs up to the age

Maternal age, family structure, number of parity and

of one year, and up to one third (1/3) during the second

monthly income of the mothers were found to be signifi-

year of life. Breast milk continues to supply higher qual-

cantly associated with knowledge of the mothers on

ity nutrients than complementary foods, and also has

breastfeeding. Though educational level of the mothers

protective factors .

was not significantly associated with knowledge of

breastfeeding, the high level of knowledge of breast-

In another study it was asserted that an attempt to im-

feeding among this group of women may be due to the

prove maternal and child health care is often frustrated

experienced gained from previous birth. It has however

because normative practices differ quite markedly from

been reported that education was significantly related to

recommendations, due to different reasons. For example,

duration of breastfeeding and that mothers with higher

perceived milk insufficiency, work activities and lack of

educational level are likely to continue breastfeeding

than mothers with low or no formal education in USA .

social support, often determine maternal intention to

initiate and maintain breastfeeding .

A study in Sagamu, South-West Nigeria reported that

educational level, age, occupation, marital status and

The prevalence of stunting in South-Asia was reported

ethnicity were not significantly related to knowledge of

to be 38%, underweight 32% and wasting 16% . In

breastfeeding among mothers. It was also reported in

Nigeria, the NDHS reported that the prevalence of stunt-

the same study that there was no significant association

ing is 37%. Underweight is 29% and wasting 18% .

between maternal education, age, ethnicity, marital

The finding of this study is similar to the NDHS report.

status and practice of exclusive breastfeeding among

mothers .

The aetiology of stunting has been shown to be com-

plex; inadequate nutrition and infection are among fac-

tors that play major role leading to stunting . Similarly,

some infant feeding practices are inappropriate and this

Conclusion

may be a contributing factor to the increase in preva-

lence of stunting during the first 18 months of life. This

Mothers in this study had adequate knowledge of breast-

implies that inadequate breastfeeding practices observed

feeding which can be attributed to information from

in this study may be one reason for the high prevalence

hospital. However, despite the adequate knowledge of

of stunting, wasting and underweight among this group.

breastfeeding few mothers breastfed exclusively. About

a quarter of mothers initiated breastfeeding within 1hr

The prevalence of stunting was high among the children

after delivery, while expression of breast milk among

and overweight was also high among mothers. Double

mothers in this study seems not to be culturally accept-

burden of malnutrition in form of Stunted Child and

able. Most mothers terminated breastfeeding completely

Overweight Mothers (SCOWT) pairs exist in this study

at 18months. The prevalence of stunting was high

area and the prevalence is found to be notable and may

among the children and overweight was high among

require intervention. Epidemiological evidence suggest

mothers. The hospitals and health officials should not

a link between maternal and child nutrition as early as

relent to encourage and support mothers on good breast-

gestation, and that maternal nutrition can influence the

feeding practices.

risk of child stunting and subsequent obesity in adult-

hood .

Conflict of Interest: None

Funding: None

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