Abstract
Exclusive Breastfeeding (EBF) refers to the practice of feeding breast milk only, (including expressed breast milk) to infants; and excluding water, other liquids, breast milk substitutes, and solid foods. Inadequately breastfed infants are likely to be undernourished and have childhood infections. EBF knowledge and infant feeding practices have not been studied sufficiently in Sokoto State, Nigeria. We describe the results of a randomized community trial to promote Exclusive Breastfeeding (EBF) in two local government areas Kware and Bodinga selected as intervention and control groups respectively. During advocacy meetings with community leaders, a Committee was formed. Members of the Committee were consulted for informed consent and selection of ten female volunteers who would educate mothers about breastfeeding during home visits. Participants comprised mothers of infants who were breastfeeding at the time of the study. A total of 179 mothers were recruited through systematic random sampling from each community. Volunteers conducted in-person interviews using a structured questionnaire and counseled mothers in the intervention group only. At baseline, intervention and control groups differed significantly regarding maternal occupation (P=0.07), and age of the index child (P=0.07). 42% of infants in the intervention group were up to 6 months old and about 30% of them were exclusively breastfed. Intention to EBF was significantly associated with maternal age (P=0.01), education (P=0.00) and women who were exclusively breastfeeding (P=0.00). After counseling, all infants up to 6 months of age were exclusively breastfed. The proportion of mothers with intention to EBF increased significantly with maternal age (P=0.00), occupation (P=0.00) and women who were exclusively breastfeeding (P=0.01). Post-intervention surveys showed that source of information and late initiation of breastfeeding was not significantly associated with intention to EBF. Mothers who reported practicing EBF for 6 months, were older (P=0.00) multi-parous (P=0.05) and more educated (P=0.00) compared to those who did not practice EBF. Among them, significantly increased proportion of women agreed that EBF should be continued during the night (P=0.03), infant should be fed on demand (P=0.05), sick child could be given medication (P=0.02), EBF offered protection against childhood diarrhea (P=0.01), and helped mothers with birth spacing (P=0.00). This study shows that there is a need for reaching women with reliable information about infant nutrition in Sokoto State. The results show decreased EBF practice among working mothers, young women, mothers with poor education and fewer than five children. Counseling is a useful strategy for promoting the duration of EBF for six months and for developing support systems for nursing mothers. Working mothers may need additional resources in this setting to enable them to practice EBF.
Highlights
Exclusive Breastfeeding (EBF) refers to the practice of feeding breast milk only, to infants; and excluding water, other liquids, breast milk substitutes, and solid foods
We describe the results of a randomized community trial to promote Exclusive Breastfeeding (EBF) in two local government areas Kware and Bodinga selected as intervention and control groups respectively
Educational attainment was low in both communities; 34% of women in Kware compared to 43% of women from Bodinga had completed formal education
Summary
Under-five mortality rate (U5MR) is a sensitive indicator of national development and is being used to monitor MDG 4: to reduce by two-thirds, between 1990 and 2015, the mortality rate of children under five. Even in the poorest countries, Exclusive Breastfeeding (EBF) is well-known as an affordable and feasible intervention that improves newborn survival It fulfills the nutritional requirements of infants and protects them from childhood infections including diarrhea, and pneumonia [6,7]. Women who deliver in these health facilities are less likely to practice traditional prelacteal feeding and more likely to initiate exclusive breastfeeding within the first hour after birth, compared to women who deliver at home [18] (Table 2). The following definitions are taken from WHO [19]: Exclusive Breastfeeding (EBF) is defined as the practice of feeding breast milk only, including expressed breast milk, to infants and excluding water, other liquids, breast milk substitutes, and solid foods. In Kware, maternal and child health services are provided by a Primary Health Centre as well as a Comprehensive Health Centre operated by Usmanu Danfodiyo University Teaching Hospital, Sokoto
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