6th International Public Health Conference 6th International Public Health Conference. TH Hotel & Convention Centre, Terengganu, Malaysia Early Initiation of Breastfeeding in Nigeria: Facilitators and Barriers By Itse Jacdonmi1, Muhamad.S.Suhainizam1, Ismail. B. Suriani1, Gbubemi. R. Jacdonmi2, Opara.O.Monica1 Address: 1 Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra, Malaysia, 2 School of Medicine and Public Health, International University, Bamenda, Cameroon.

Outline Introduction Problem statement Objectives Methodology Results Conclusion

Introduction Early initiation of breastfeeding (EIBF) is putting the baby to the mother’s breast within an hour after birth. The World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) recommend that breastfeeding be initiated within the first 1 h of birth. This is because early initiation significantly reduces neonatal mortality, stimulates breast milk production, increases uterine activity. It also fosters mother–child bonding and increases the duration of breastfeeding. It improves child survival, supports cognitive performance.

Problem Statement Each year approximately 4 million newborns die, most from preventable causes. Deaths in the neonatal period (the first 28 days of life) account for 41 percent of all deaths in children younger than 5 years (UNICEF, 2010). Nigeria is the 3rd worldwide with highest neonatal mortality rates of 7 % i.e 47 per 1000 live births (UNICEF, 2010). One-fifth of all neonatal deaths could be avoided if breastfeeding were initiated within the first hour of life for all newborns (Edmond et al., 2006; Mullany et al., 2008). Though, breastfeeding is almost universal in Nigeria, with 97.9 % of all children breastfed for a period of time, prevalence from national studies done in Nigeria report low figures for EIBF with just about 31.9 and 38.4 % of mothers initiating breastfeeding within 1 h of birth in 2008 and 2013 respectively (NDHS 2008 & 2013).

General Objective Specific objectives This study sought to identify facilitators and barriers to early initiation of breastfeeding among post-natal mothers in Nigeria. Specific objectives To describe the socio-demographic and economic characteristics of study respondents To determine the prevalence of early initiation of breastfeeding among post natal mothers To identify facilitators and barriers to early initiation of breastfeeding among post natal mothers

Methodology Study location Jos north LGA of Plateau State Nigeria.

Methodology Contd. Study design: Cross-sectional study Study population: Post-natal mothers who came for Bacilli Calmette Guerin (BCG) immunization at the health facility 280 mothers was the estimated sample size

Selection for eligibility Inclusion criteria Exclusion criteria Biological mother Mother/infant with diagnosed illnesses Registered at the PHCC/present at the time of data collection Consent to participate

Sampling technique 3 PHCCs were selected; Plateau State specialist PHCC, Township PHCC and Tudun wada PHCC Simple random sampling Simple random sampling with probability proportionate to size to calculate respondents from each PHCCs using average number of mothers attending ANC at HFs. Simple random sampling Table of random numbers used to select 280 respondents at the PHCC using the immunization register as the sampling frame. Based on Inclusion & Exclusion Criteria

Data collection/ Analysis Data collection instrument A validated structured questionnaire was administered to the post-natal mothers All data were analyzed using SPSS version 22. Descriptive statistics Inferential statistics- multivariate logistic regression A probability value (p-value) ≤ 0.05 was set for the assumption of statistical significance.

Results

Results Breastfeeding Initiation (N= 280) Within 1 h After 1 h   Breastfeeding Initiation (N= 280) Within 1 h After 1 h Variables N (%) COR (95% CI) AOR (95% CI) Type of delivery Normal vaginal 129(60.3) 85(39.7) 2.732(1.455-5.128) 1.322(1.202-3.446) Cesarean section 43(65.2) 23(34.8) 1.00 Place of delivery Health facility 111(56.1) 87(43.9) 1.978(0.980-3.989) 2.035(1.202-3.446) Home 61(76.3) 19(23.7) Birth weight <2.5kg 2(33.3) 4(66.7) 2.00(0.324-12.329) - 2.5kg-3.99kg 152(63.9) 86(36.1) 1.605(1.301-3.216) 0.272(0.311-2.361) >4.0kg 18(50.0) Availability of breastfeeding messages at health facilities Yes 130(90.3) 14(9.7) 4.821(2.476-9.387) 1.298(0.047-0.142) No 42(30.9) 94(69.1) Social support Have support 113(55.1) 92(44.9) 2.606(1.091-6.227) 1.943(1.177-3.209) No support 74(70.5) 31(29.5)

Results Contd. Breastfeeding Initiation (N= 280) Within 1 h After 1 h   Breastfeeding Initiation (N= 280) Within 1 h After 1 h Variables N (%) COR (95% CI) AOR (95% CI) Colostrum feeding Yes 155(59.8) 104(40.2) 10.697(4.578-24.993) 4.660 (2.824-7.691) No 17(81.0) 4(19.0) 1.00 ANC visits 158(69.9) 68(30.1) 1.018(1.460-2.255) 0.911(0.418-1.986) 14(25.9) 40(74.1) - No of ANC Visits 1-2 visits 43(81.1) 10(18.7) 0.128(0.063-0.261) 0.272(0.311-2.361) 3-4 visits 102(80.3) 25(19.7) 1.115(1.550-2.261) 0.614(0.212-1.780) >4 visits 27(27.0) 73(73.0) Parity Primiparous 48(63.2) 28(36.8) 0.854(0.379-1.717) Multiparous 124(60.8) 80(39.2) Birth order 1st born 0.807(0.379-1.717) 2nd -4th born 95(57.9) 69(42.1) 0.625(0.323-1.213) 5th born and above 29(72.5) 11(27.5)

Reasons for late initiation of breastfeeding (n=183) Frequency (N %) Bathing of mothers 15 (8.2) Bathing of babies 34 (18.6) Baby needed was asleep 56 (30.6) Mother tired and needed rest 11 (6.0) Baby didn’t cry for breast milk 24 (13.1) Physical sign of absent or insufficient breast milk Beliefs about colostrum being not good and dirty 21 (11.5)

Conclusion Only 34.6 % of postnatal mothers initiated breastfeeding within the first 1 hour after delivery. Facilitators of early initiation of breastfeeding included colostrum feeding, normal vaginal delivery, delivery at health facilities, availability of messages on breastfeeding at health facility and, social support. Major barriers included post birth activities performed such as bathing of babies, perception of mothers that baby’s needed rest and did not cry for breast milk, and also lack of breast milk produced after birth. It is therefore important to raise awareness and increase knowledge on early initiation of breastfeeding among mothers by health care providers during Antenatal Visits at health facilities.