Knowledge Attitudes and Future Intentions of Nigerian High School Students Towards Infant and Young Child Nutrition & Feeding Kelebogile T. Setiloane Phd (Tufts) Associate Professor, Nutrition Department of Behavioral Health & Nutrition University of Delaware

Background Breastfeeding is widely practiced in Nigeria, but only 17% of children are exclusively breastfed for first 6mths1 Also, 59% newborns are given something other than breastmilk during the first 3 days of life – water most common1 Changing infant feeding behavior requires knowledge and addressing deep rooted attitudes Education to begin even before conception – during childhood and adolescence Nigeria Demographic and Health Survey 2013. Rockville, Maryland, USA: National Population Commission and ICF International. In Nigeria, breastfeeding is widely practiced among women 6 but only 17% of children are exclusively breastfed for the recommended first 6 months of life and 59% of newborns were given something other than breast milk (pre-lacteal feed) during the first three days of life.6 Water is reported to be the most common pre lacteal feed in this setting.7 high concern because limits the frequency of suckling by the infant and exposes the baby to the risk of infection. This pattern of infant feeding undermines child growth and development Changing infant feeding behavior requires not only improving knowledge in this area but also confronting the deep rooted perceptions about infant feeding so that attitudes are changed. To achieve this it has been suggested that education in this area begins early, not only prior to labour and birth but even before conception, during childhood and adolescent, a time when thought processes are more flexible and open to new ideas.8,9

Why Adolescence? Transition between childhood and adulthood They will become parents of the future Many play significant role in upbringing and care of younger siblings Important group to target for nutrition interventions Curious and open to new ideas Large numbers and demographic weight Make up 43% of Nigeria population vs 14% of US population Adolescence is the period of age from 10 to 19 years is the transition between childhood and adulthood. This important group to target for nutrition interventions not only because of their curiosity and openness to new ideas, but also because of their large numbers and demographic weight, particularly in the developing world.9 Adolescents make up about 20% of the world total population;10 in developing countries they have an even higher demographic weight, for instance, 43% In Nigeria compared to 14% in the USA.10 The large size of the global youth population has led to an increased focus on preparing this population group for their future biological, social and economic roles in the community.9,11 Young peoples perceptions about the care and feeding of children is important as most will become parents in the future and many in developing countries play a significant role in the upbringing and care giving of younger siblings.12 More attention should be given to understanding what youth think

Objectives Assess adolescent girl’s knowledge and attitude about IYCF practices against current international nutrition guidelines Examine degree to which there were gender differences in knowledge and attitudes The objectives of this study were to: (1) assess the adolescent girls knowledge and attitude regarding IYCF practices against current international nutrition guidelines (2) examine the degree to which there were gender differences in knowledge and attitude regarding IYCF. While this investigation focused primarily on adolescents girls’ attitudes, their responses were compared against boys’ responses because there is plenty of evidence suggesting that mens support of IYCF practices is an important determinant of actual practice.13,14

Methods Cross sectional study set in high school in Abeokuta, south west Nigeria Questionnaire distributed in 3 classrooms after permission from Headmaster and teacher Major Questions asked: Provision of water to infants prior to initiating breastfeeding after birth Timing of breastfeeding initiation Whether infant can survive on breastmilk alone at 3 and 5 months of age Timely introduction of appropriate complementary foods How long planned to breastfeed their child Boys asked how long expected future spouse would breast feed To assess knowledge attitudes and future intentions toward infant and child feeding behaviors, respondents were asked whether they agreed or disagreed with a series of statements about child feeding behaviors. Statistical analysis of the data was completed using the Statistical Package for Social Sciences (SPSS Version 20) including descriptive statistics and bivariate analyses (chi-square) which was used to test the statistical significance of difference in attitudes by gender. The criterion for statistical significance was set at 0.05.

Characteristics of Students N = 136, 74males 62 female Males 54% ; Females 45.6% Age – Range 14yrs – 18yrs Mean 15.4 87% fathers and 89% Mothers had schooled beyond high school 71% had at least one sibling younger The demographic characteristics of the participants are shown in Table 1. There were more males (54.4%) than females (45.6%) in the sample. The age of students ranged from 14 to 18 years, with a mean of 15.4.0 ± 0.74 years. The mean age of male and female students was 15.61 ± .79 years and 15.26 ± .0.62 years, respectively. Most parents of the participants (87% fathers and 89% mother) had attended school beyond the high school level, and 32% 30% and 9% of the participants had one, two and 3 siblings respectively, younger than themselves, this in contrast to 22% who had no siblings younger than themselves.

Results – Girls attitudes on exclusive BF(n=62) Agree Disagree Don’t know Best to give newborn water 29.5% 57.4% 13.1% Best to BF after birth 65% 31.7% 3.3% 3mo can survive on BM alone 88.5% 9.8% 1.6% 5mo can survive on BM alone 40.0% 53.3% 6.7% Table 2. shows how attitudes of adolescent girls toward early child feeding behaviors deviate noticeably from the current international recommendation that infants be exclusively breastfed for the first six months of birth. About one third of adolescent girls agreed that water should be given to infants immediately following birth while 13.1% reported that they did not know whether this was a good idea or not. A little more than two thirds of the girls agreed that it is best to breastfeed the baby within one hour of birth while 70.5% reported that it is healthy for infants to be given water to drink at 1 month. A large majority of participants agreed that an infant of 3 months can survive on breast milk alone, while 40% agreed an infant of 5 months can survive on breast milk alone. Results of this study show that for the most part adolescents report their expectations about IYCF practices clearly as the prevalence of ‘don’t know’ responses was relatively low.

Results cont. All girls and boys reported intention to breastfeed any future child 41% of girls expect BF duration of 12-24 vs 6.6% duration of 24mths No significant difference between boys and girls towards giving water to infant immediately after birth Girls significantly more likely than boys to report ‘it is best to start BF within one hour of birth’ – 66.7% vs 54.5%; p<.002

Discussion/Conclusion Findings support literature – exclusive BF to 6mths not dominant cultural model of infant feeding in this population Children internalize cultural models of IYCF practices and use these to form expectations about how they will feed their children May likely lead to reproduction of suboptimal child feeding practices Women’s prenatal intentions predictive of their postnatal infant feeding behavior Studies have shown that women’s prenatal intentions are predictive of their postnatal infant feeding behavior 19-21

Conclusion Targeting adolescent girls and boys supplying them with correct IYCF information may be an effective way to improve not only norms regarding child feeding behaviors but also nutrition and development of future generations of children that will be born from the present population of adolescents.

Kelebogile Setiloane, Phd University of Delaware Thank-you! Kelebogile Setiloane, Phd University of Delaware ksetil@udel.edu