1. Introduction

Breastfeeding is the act of feeding a child with breast milk directly from the breast and a physiological process by which all mammals feed their infants. It is a cultural practice beneficial to health ^[1]. Many documents establish the benefits associated with exclusive breastfeeding ^{[2, 3]} asserted that exclusive breastfeeding of babies for six months as recommended by Baby Friendly Hospital Initiative (BFHI) remains a well recognized childhood survival strategy of great benefit in reducing infant and under-five mortality rates.

The unique composition of human milk makes it the best for human babies ^[4]. Moreover, formula feeding raises risk of illness and death by depriving infants of the protection offered by the many essential infection-fighting components of human milk and the nutrients tailored by the mother’s biology to meet the precise needs of her infant. Infants and mothers who practice breastfeeding and more especially, exclusive breastfeeding enjoy some benefits from the act. The society at large equally benefits from the practice of exclusive breastfeeding as increased breast feeding would save health care costs in any country ^[5]. Breastfeeding therefore is the best source of infant nutrition and the safest method of infant feeding.

Various government and non-governmental organizations have been involved in the promotion of exclusive breastfeeding. For instance, the Baby Friendly Hospital Initiative (BFHI) is a joint programme by World Alliance for Breastfeeding Action (WABA) and United Nations Children Funds (UNICEF) to protect, support and promote the practice of exclusive breastfeeding at different times ^[6]. WABA also organizes the World Breastfeeding Week which is being celebrated every first to seventh of August or November (depending on location) is dedicated to breastfeeding in more than 170 countries to encourage breastfeeding and improve the health of babies and mothers around the world ^[7]. In Nigeria, the government of Lagos State has increased maternity leave from three months to six months and also introduced paternity leave ^[8].

Despite the involvement of government and non governmental organizations in creating awareness about breastfeeding and encouraging mothers to practice exclusive breast feeding, advocates of exclusive breastfeeding have observed that there is a global decline in the behaviour of breastfeeding among nursing mothers and is particularly pronounced in developing countries ^[9]. For examples; Exclusive breastfeeding rates was put at 17 percent according to the National Demographic Health Survey 2003 and the rate dropped from 17 percent to 13 percent in the 2008 NDHS. Only 10 percent of children ages 6-23 months are fed appropriately based on recommended infant and young child feeding (IYCF) practices, NDHS ^[10]. A study ^[11] showed that exclusive breastfeeding rate is very low in and fall short of the recommendation of 90 percent coverage by the World Health Organization. Nursing mothers and other members of the society still have some difficulty which prevent them from breastfeeding their infants especially when it comes to breastfeeding exclusively. It is against this background that the perceptions of nursing mothers regarding exclusive breastfeeding are sought through this study.

The following research questions were drawn to guide the study:

1. Are nursing mothers aware of exclusive breastfeeding?

2. Do nursing mothers know the benefits of exclusive breastfeeding?

3. Do nursing mothers practice exclusive breastfeeding?

The objectives of this descriptive survey were as follows:

1. To examine the awareness of exclusive breastfeeding among nursing mothers in Anyigba, North Central, Nigeria.

2. To investigate the knowledge of the benefits of exclusive breastfeeding among nursing mothers in Anyigba, North Central, Nigeria.

3. To find out if nursing mothers in Anyigba, North Central Nigeria practice exclusive breastfeeding.

The following hypotheses were formulated to guide the study:

1. H_o: Awareness of exclusive breastfeeding is not significantly related to its practice.

2. H_o: Knowing that exclusive breastfeeding is beneficial to babies is not significantly related to its practice.

2. Materials and Methods

The research design was a cross-sectional descriptive survey type. The study plan involved the use of both qualitative and quantitative method of data collection in order to test hypotheses and answer research questions raised in the study.

The target population consisted of all nursing mothers currently nursing a child of 0-9months of age in Anyigba, Dekina Local Government Area of Kogi State, North Central Nigeria and attending child welfare and immunization unit of the hospital of study. The study population consisted of 432 nursing mothers who brought their children to the hospitals of study for immunization as at the time of study.

The sample consisted of 286 (66.7% of the study population) nursing mothers using the hospitals of study for child immunization as at the time of the study and the two head of immunization units in the hospitals of study, bringing the total sample size to 288. The sampling techniques included accidental, purposive and cluster sampling techniques; which aimed at selecting the appropriate place of study and responses from current nursing mothers relevant to the study.

Research instruments included questionnaire, In-depth interview and Focus group discussion. A total number of 234 copies of the questionnaire were adequately filled and returned by the participating nursing mothers. 28 nursing mothers were interviewed (14 from each of the hospital of study), while 22 nursing mothers and the two heads of units participated in the sessions of the focus group discussion (11 nursing mothers and the head of unit in each session).

Data were run with the Statistical Package for Social Sciences (SPSS) version 17.0. Qualitative data was analyzed using content analysis, while quantitative data was analyzed with frequency and percentage and hypotheses were tested using chi-square.

3. Results

Majority of respondents were aged 25-34 (46.6%), 91.1% were married and 47.4 has secondary education. Majority were traders (35.6%); (60.3%) earned less than N10.000 per month. Respondent were predominantly Christian (65.8%) and had 1-3 children (70.9%).

Table 1. Socio-demographic Characteristics of Respondents

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Section B: Validation of Research Questions

Research Question 1: Are nursing mothers aware of exclusive breastfeeding?

Table 2. Respondent’s Awareness of Exclusive Breastfeeding

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Table 2 indicated that majority of the participants 223 (95.3%) were aware of exclusive breastfeeding and majority 186 (79.5%) equally got their first information about exclusive breastfeeding from health workers. Similarly, 27 out of 28 participants of the in-depth interview were fully aware of exclusive breastfeeding and their major informants were health workers during ante-natal and post-natal visits.

Research Question 2: Do nursing mothers know the benefits of exclusive breastfeeding?

Results shown on Table 3 indicated that majority of nursing mothers have adequate knowledge of the benefits of exclusive breastfeeding for both mother and child. Result from the focus group discussion and in-depth interview sessions equally affirmed that nursing mothers had knowledge of the benefits of breastfeeding exclusively for six months before introducing supplement and water.

Table 3. Respondent’s Knowledge of the Benefits of Exclusive Breastfeeding (EBF)

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Research Question 3: Do nursing mothers practice exclusive breastfeeding?

Majority of respondents had practiced or were practicing exclusive breastfeeding. Although, 177 (75.6) claimed to have practiced or to be practicing exclusive breastfeeding, only 156 (66.7%) did it or were doing it correctly.

Table 4. Practice of Exclusive Breastfeeding

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The section deals with the testing of the hypotheses generated for the study using chi-square.

Decision Rule: The decision rule is to reject the Null hypothesis when the calculated chi-square value is greater than the table/critical value; if otherwise, then the null hypothesis is accepted while alternative hypothesis is rejected.

Significance Level: The level of significance for testing each hypothesis is 0.05

Degree of Freedom (DF): N-1

Hypothesis 1:

H_o: Awareness of exclusive breastfeeding is not significantly related to its practice.

H₁: Awareness of exclusive breastfeeding is significantly related to its practice.

Table 5. Awareness and practice of exclusive breastfeeding (X² Table)

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Hypothesis 2:

H_o: Knowing that exclusive breastfeeding is beneficial to babies is not significantly related to its practice

H₁: Knowing that exclusive breastfeeding is beneficial to babies is significantly related to its practice

Table 6. Knowledge of Benefits of exclusive breastfeeding to Child and Practice (X² Table)

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4. Discussion

The study shed some light on the awareness of exclusive breastfeeding among nursing mothers in Anyigba, Kogi State, North Central Nigeria. The study found a high level of awareness of breastfeeding exclusively among respondents, and their major informants are the health workers. These findings are similar to findings in ^[12], where majority of nursing mothers were equally aware of exclusive breastfeeding and received information from health workers.

The high level of awareness may be due to the fact that the study was carried out in an emerging university town in Kogi State, where majority of the respondents had a reasonable level of education.

The study revealed that majority of respondents has the knowledge of some benefits of exclusive breastfeeding for both mother and child. For instance, 89.3% knew that exclusively breastfed babies have some advantages over others who are no; 88% knew that exclusive breastfeeding enhances physical, mental and social growth and developments of infants and 65.4% knew that early initiation of breastfeeding could prevent some infants and mother’s death.. This may be as a result of respondent’s level of education, as well as adequate information from health workers. These benefits have been established by some documents such as ^[13], who found that exclusively breastfed babies were three-times less likely to fall sick than artificially-fed babies; ^[13], found that infants who received partial or no breastfeeding were more than twice likely to die before age one than infants who were exclusively breastfed for the first four months and ^{[14, 15]} found that breastfeeding reduces suffering in children and their mothers by reducing the risk of pneumonia, diabetes, under and over-nutrition, high blood pressure and cholesterol, cancers and lowered intelligence.

A high rate of exclusive breastfeeding (66.7%) was obtained in this study and is similar to what was obtained in a study carried out at Jos University Teaching Hospital, Jos, Nigeria, ^[16] where 67 percent of nursing mother practiced or were practicing exclusive breastfeeding.

On the contrary, it is higher than 32-40 percent global exclusive breastfeeding rate reported by World Health Organization in 1995 and 2011 respectively. ^[17]. It is also higher than 37.3 % that was found among nursing mothers in in 20011 (^[18], despite the fact that both studies were carried out in modern health facilities where information on exclusive breastfeeding and its benefits were high. The difference in these findings could be attributed to some other factors other than awareness and knowledge of benefits of exclusive breastfeeding.

Results of hypotheses tested revealed that awareness of exclusive breastfeeding and knowledge of benefits of exclusive breastfeeding among nursing mothers are significantly related to its practice; affirming some tenets of Health Belief Model that when people are aware of a health condition, they will likely take necessary action to prevent the adverse effect of the condition and or take action to promote a positive health condition, and that a person is likely to adopt health behaviour when he or she perceived some benefits from taking such action. In addition, people are most likely to adopt the desired preventive behaviours when they have skills needed to make low-risk choices among others ^[19].

5. Conclusion

This study has demonstrated high level of awareness, knowledge of benefits, positive perception and practice of exclusive breastfeeding among the sample population studied. The practice of exclusive breastfeeding can help promote the health of both babies and mothers. In conclusion, awareness of the benefits of exclusive breastfeeding is a motivating factor for its practice.

6. Recommendations

Following the findings from this study, the following recommendations are therefore made:

Government and non government organizations involve in the promotion of exclusive breastfeeding should organize more training programme for health workers in the ante- natal and post-natal/child welfare unit and staff should be encouraged to participate in such programmes, where they can update their knowledge with latest information on exclusive breastfeeding, since they constitute the greatest means of information dissemination on exclusive breastfeeding.

Promotion of exclusive breastfeeding should involve programmes that will capture not only nursing mothers and health workers, but other members in the communities most especially husbands and older women who are involved in child care. Younger generations such as adolescents need to have a reasonable knowledge of exclusive breastfeeding and its many benefits even before child bearing age.

Facilities such as crèche should be provided by various governments and private organization at work place and in higher institution of learning, to enable nursing mothers who are working or studying continue breastfeeding without jeopardizing their work or study. Employers should also be encouraged to give nursing mothers extra break time to be able to perform this very important act of breastfeeding.

Competing Interest

The authors have no competing interests.

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