1. 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.

2. Outline Introduction Problem statement Objectives Methodology Results
Conclusion

3. 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.

4. 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).

5. 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

6. Methodology
Study location
Jos north LGA of Plateau State Nigeria.

7. 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

8. 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

9. 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

10. 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.

11. Results

12. 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( )
1.322( )
Cesarean section
43(65.2)
23(34.8)
1.00
Place of delivery
Health facility
111(56.1)
87(43.9)
1.978( )
2.035( )
Home
61(76.3)
19(23.7)
Birth weight
<2.5kg
2(33.3)
4(66.7)
2.00( ) -
2.5kg-3.99kg
152(63.9)
86(36.1)
1.605( )
0.272( )
>4.0kg
18(50.0)
Availability of breastfeeding messages at health facilities
Yes
130(90.3)
14(9.7)
4.821( )
1.298( ) No
42(30.9)
94(69.1)
Social support
Have support
113(55.1)
92(44.9)
2.606( )
1.943( )
No support
74(70.5)
31(29.5)

13. 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( )
4.660 ( ) No
17(81.0)
4(19.0)
1.00
ANC visits
158(69.9)
68(30.1)
1.018( )
0.911( )
14(25.9)
40(74.1) -
No of ANC Visits
1-2 visits
43(81.1)
10(18.7)
0.128( )
0.272( )
3-4 visits
102(80.3)
25(19.7)
1.115( )
0.614( )
>4 visits
27(27.0)
73(73.0)
Parity
Primiparous
48(63.2)
28(36.8)
0.854( )
Multiparous
124(60.8)
80(39.2)
Birth order
1st born
0.807( )
2nd -4th born
95(57.9)
69(42.1)
0.625( )
5th born and above
29(72.5)
11(27.5)

14. 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)

15. 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.