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Product Code: 00007929

No of Pages: 122

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The study was designed to assess the determinants of exclusive and non-exclusive breastfeeding practices among nursing mothers in Ekwusigo L.G.A of Anambra. A total of 239 respondents were selected using simple random sampling technique. A structured questionnaire was used to determine the respondents socio-economic characteristic and infant care practices.  Anthropometrics (weight for age, height for age and BMI for age indices) status of the infants were also assessed. World Health Organization (WHO) child growth standard charts were used to classify the anthropometric indices. Results on the socio-economic characteristics revealed that most(51.9%) of the nursing mothers were between 21-40 years (51.9%), some (40.6%) were between 21-30 and a few (6.7%) were between 41-50 years of age. Family size status of the respondent’s household revealed that some (46.4%) of them had only two children, while 27.3% of the respondents had three. More than half (70.3%) of the respondents had secondary education while the rest of them were either primary school leavers (15.6%) or graduates from tertiary institutions (5.4%) while 8.4% had no primary education.  Majority (47.3%) of the nursing mothers were civil servants and traders 32.6%. Only a few (7.5%) of them were just house wives. More than half (53.5%) of the respondents household earned monthly incomes above 40,000. Obstetric data revealed that the respondents had previously been pregnant once (9.2%), twice (34.4%), thrice (38.1 %) and four times (14.6%).  Only a few (1.7%) of the mothers had experienced child death. Results further showed that majority (60.2%) of the nursing mothers had fair knowledge of breastfeeding, some of them (22.2 %) had poor knowledge of exclusive breastfeeding, while only 17.6% had a good knowledge of exclusive breast feeding. The result on the attitude of nursing mothers towards exclusive breast feeding revealed that most (67.8%) of the nursing mothers had a good attitude towards breast feeding their children, while a good number (32.2%) of them had a fair attitude towards breastfeeding. Results further revealed that all (100%) of the respondents had discussions with their husbands on exclusive breastfeeding. Majority of them received adequate support from their husbands (93.3%) and inlaws (61.9%) on exclusive breastfeeding. Majority of the infants had normal length for age (95.0%), weight for age (82.4%), weight for length (90.4%) and MUAC for age (92.9%) status. However, wasting and underweight status of the infants were observed using weight for age (13.4%) and weight for length (9.2%) classifications. A significant difference (P < 0.05) was observed between maternal educational level and infant weight for age (X2 =17.40a; P-value = 0.03). Information on the determinants of exclusive and non-exclusive breastfeeding revealed that the following factors had a significant (P <0.05) effect on exclusive and non-exclusive breastfeeding practices: maternal educational status (X= 4.24; P=0.04), Parity (6.247a; 0.03), and level of support from husband (X2= 3.48; 0.04).













1.1 Statement of problem 3

1.2 Objectives of the study 4

1.2.1 General Objectives 4

1.2.2 Specific objectives 5

1.3 Significance of the study 5



2.1 Breastfeeding: A Public Health Issue 6

2.2 Definitions of Infant Feeding 9

2.2.1 Exclusive breastfeeding (EBF) 9

2.2.2 Prelacteal feeds (PF) 9

2.2.3 Complementary feeding (CF) 9

2.2.4 Predominantly feeding 9

2.2.5 Replacement feeding (RF) 10

2.2.6 Partial breastfeeding (PBF) 10

2.3 Breastfeeding Recommendations 10

2.4 Breastfeeding And The Link To Health 11

2.4.1 Tailor-made food 12

2.4.2 Prevention against infectious diseases 15

2.4.3 Infant mortality 17

2.4.3 Long-term benefits 18

2.4.4 Maternal health 22

2.5 Factors Which Influence Breastfeeding Pattern 24

2.5.1 Societal and cultural influences 25

2.5.2 Norms and attitudes 26

2.5.3 Cultural and traditional practices 28

2.5.4 The international code of marketing breast milk substitution and

baby-friendly hospital initiative (BFHI) 30

2.5.5 Human Immunodeficiency Virus 31

2.5.6 Maternal Age 34

2.5.7 Education 34

2.5.8 Occupation/Employment 35

2.5.9 Economic status 36

2.5.10 Marital status 37

2.5.11 Parity 37

2.5.12 Primiparity/Low Parity 38

2.5.13 Multiparity/High Parity 38

2.5.14 Antenatal Care 38

2.5.15 Multiple births 39

2.5.16 Type of delivery 39

2.5.17 Birth weight/infant size 40

2.5.18 Previous experiences with breastfeeding 40

2.5.19 Support from family and friends 41

2.5.20 Knowledge of individuals’ feeding as babies 42

2.5.21Maternal prenatal intention 42

2.6 Breastfeeding In Developing Countries 42



3.1 Study Design 50

3.2 Study Area 50

3.3 Population of The Study 50

3.4 Sampling and Sampling Techniques 51

3.4.1 Sample size 51

3.4.2 Sampling procedure 52

3.5 Preliminary Activities 52

3.5.1 Preliminary visits 52

3.5.2 Training of research assistants 53

3.5.3 Informed consent 53

3.6 Data Collection 53

3.6.1 Questionnaire administration 53

3.6.2 Anthropometric measurement 54 Date of measurement 54 Date of birth of the child 54 Weight measurement 55 Length measurement 55 Mid upper arm circumference                55

3.7 Statistical Analysis 56

3.8 Data Analysis 56




4.1 Socio-Economic Characteristics of Respondents 57

4.2 Pregnancy Characteristics of Nursing Mothers 60

4.3 Knowledge of Exclusive Breastfeeding 62

4.4 Attitude of Nursing Mothers Towards Exclusive Breastfeeding 63

4.5 Practice of Exclusive Breastfeeding 65

4.6 Factors Related to Breastfeeding 70

4.7 Determinants of Exclusive and Non-Exclusive Breastfeeding 72

4.7.1 Maternal education 72

4.7.2 Parity 73

4.7.3 Support from husband 73

4.8 Nutritional Status of Infants 77

4.9 Relationship Between Socio-Economic Characteristics of mothers and Nutritional Status of their children 80

4.10 Prevalence of exclusive breastfeeding in Ekwusigo LGA of Anambra State 84




5.1 Conclusion 85

5.2 Recommendations 86





Table                                      Page

4.1a Socio-economic characteristics of nursing mothers 59

4.2 Pregnancy characteristics of nursing mothers 61

4.3 Knowledge of exclusive breast feeding 63

4.4 Attitude of nursing mothers towards exclusive breast feeding 64

4.5a Practice of exclusive breastfeeding 68

4.5b Practice of exclusive breastfeeding 69

4.6 Factors related to breast feeding 71

4.7a Determinants of exclusive and non-exclusive breastfeeding 75

4.7b Determinants of exclusive and non-exclusive breastfeeding 76

4.8a Nutritional status of infants 78

4.8b Nutritional status of infants by sex 79

4.9a: Relationship between socio-economic characteristics and  

                  height for age 81

4.9b: Relationship between socio-economic characteristics and   

                  weight for age 82

4.9c: Relationship between socio-economic characteristics and weight for length 83

4.9d: Relationship between socio-economic characteristics and

      MUAC for age 84











Adequate nutrition during infancy is essential to ensure the growth, health and development of children to their full potential (World Health Organization (WHO), 2009a). Adequate diet is more critical in early infancy than at any other time in life. This is because of the infant’s high nutritional requirements in relation to body weight and the influence of poor or faulty nutrition during the first months of development. Moreover, the infant is more sensitive to abnormal nutritional situations and less adaptable than in later life to different types, forms, proportions and quantities of food. In view of this, the World Health Organization recommends that infants be exclusively breastfed for the first six months, followed by breastfeeding along with complementary foods for up to two years of age or beyond (Hanif, 2011).

Exclusive breastfeeding in the first six months of life stimulates infants’ immune systems and protects them from diarrhea and acute respiratory infections, two of the major causes of infant mortality in the developing world, and improves their responses to vaccination (United Nations International Children’s Fund (UNICEF), 2006). Exclusive breastfeeding can be defined as a practice whereby the infants receive only breast milk without mixing it with water or other liquids, tea, herbal preparations or food in the first six months of life, with the exception of vitamins, mineral supplements or medicines (Nkala and Msuya, 2011).

Breastfeeding an infant exclusively for the first six months of life carries numerous benefits, such as lowered risk of gastrointestinal infection, pneumonia, otitis media and urinary tract infection in the infant, while mothers return to their pre-pregnancy weight very rapidly and have reduced risk of developing type 2 diabetes (Kramer and Kakumer, 2009; WHO, 2011). However, studies have shown that many mothers find it difficult to meet personal goals and to adhere to the expert recommendation for 6 months of exclusive breastfeeding before continued breastfeeding for 2 years despite increased rate of initiation (Whalen and Cramton, 2010). Some of the major factors that affect exclusivity and duration of breastfeeding include breast problems, such as sore nipples or mothers’ perceptions of producing inadequate milk (Thurman and Allen, 2008; Cherop et al., 2009; Nkala and Msuya, 2011) and societal barriers such as employment, length of maternity leave (Thurman and Allen, 2008) inadequate breastfeeding knowledge (Cherop et al., 2009), lack of guidance and encouragement from health care professionals (Ku and Chow, 2010; Thurman and Allen, 2008).

Another factor that leads to early cessation of breastfeeding is the advertisement of infant formulas which encourages mothers to opt for the use of pacifiers and bottle-feeding (Hanif, 2011; Thurman and Allen, 2008). Additionally, many mothers opt for breast milk substitutes because they need to resume work, while others claim that they produce insufficient milk (Sloan et al., 2006).

Exclusive breastfeeding plays a pivotal role in determining the optimal health and development of infants, and is associated with a decreased risk for many early-life disease conditions, including respiratory tract infection and diarrhea (Chuang et al., 2007). It has been estimated that EBF reduces infant mortality rates by up to 13% in low-income countries (Jones et al., 2003). A large cohort study undertaken in rural Ghana concluded that 22% of neonatal deaths could be prevented if all infants were put to breast within the first hour of birth (Edmond et al., 2006).


The major problem on the aspect of infant feeding in Nigeria, like in other developing countries of Sub-Saharan Africa, has been the practice of exclusive breastfeeding (Ukegbu, 2007). Malnutrition contributes to Nigeria’s current health problems (morbidity and mortality) in several ways. Undernutrition remains a devastating problem in many developing countries, affecting over 815 million people, causing more than one-half of child deaths (Ruel, 2003; Ukegbu, 2007). Although WHO, UNICEF and Nigeria’s National Breastfeeding Policy (NNBP) recommended that infants be exclusively breastfed from birth to six months and continued breastfeeding to 24 months and beyond for optimal survival, growth and development. Unfortunately, only 17% of infants under six month of age are exclusively breastfed in Nigeria (Federal Ministry of Health (FMH), 2007).

Black et al. (2008) reported that suboptimum breastfeeding especially non-EBF in the first 6 months of life results 1.4 million deaths and 10% of the disease burden in children younger than 5years in low income and middle-income countries (Black et al., 2008). Also, 37% of children under 5years are stunted (moderate or severe), infant mortality rate is 69/1000 live births and under-five mortality is 128/1000 live births (Demographic and health survey, 2013). Therefore, due to the problems identified, the study was aimed at investigating determinants of exclusive breastfeeding of nursing mothers in Ekwusigo Local Government Area of Anambra State.


1.2.1 General Objectives

The general objective of the study was to assess the determinants of exclusive breastfeeding among nursing mothers in Ekwusigo Local Government Area of Anambra State.

1.2.2 Specific objectives

The specific objectives were to:

i) determine the socio-economic and demographic characteristics of mothers with exclusively breastfed and non-exclusively breastfed infants.

ii) assess the knowledge, attitude and practice of infant feeding of the nursing mothers.

iii) assess the nutritional status of the infants, using anthropometric indicators (weight for age, length for age, weight for length and mid-upper arm circumference for age)

iv) determine the effect of socio-economic and demographic characteristics of the nursing mothers on the nutritional status of infants.


The findings of this study will:

i) facilitate efforts by agencies, ministries, organizations, individuals or groups as regards developing programs or strategies to improving the nutritional status of infants in the region, thereby reducing the rate of infant mortality.

ii) help health educators, nurses and nutritionists to develop informed programs for nursing mothers on the benefits of exclusive breastfeeding.

iii) give an insight into areas where health education campaigns are required to influence and promote the adoption of exclusive breastfeeding.

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