EFFECTIVENESS OF EXCLUSIVE BREASTFEEDING IN THE DEVELOPMENT OF UNDER-5 CHILDREN

ABSTRACT

The purpose of this study was to examine the effectiveness of exclusive breastfeeding in the development of children under-five in Benue State, Nigeria. To achieve this purpose, 10 hospitals were randomly selected using multi-stage sampling technique (simple random, stratified, and purposive sampling techniques). The data was collected using a close-ended questionnaire. Five hundred (500) questionnaires were distributed to nursing mothers who visited antenatal clinics in the randomly selected hospitals, of which 455 were duly completed and returned. Frequencies of percentages and cross-tabulation statistics were used to answer research questions. Associations between demographic determinants and breastfeeding practices were analysed using Chi-square statistics at an alpha level of 0.05 to test the formulated hypotheses. The findings of the study indicated a high (99.8%) prevalence of breastfeeding among nursing mothers, of which 83.5% exclusively breastfed for up to 4–6 months, while only 16.5% supplemented breastfeeding. The findings further revealed that mother's age significantly influenced the practice of exclusive and non-exclusive breastfeeding, indicating high exclusive breastfeeding among mothers aged 25 years and above, and low exclusive breastfeeding among younger mothers aged 19 years and below. Results also showed that a mother's level of education significantly influenced breastfeeding practices, with literate mothers (those with at least secondary education) demonstrating higher exclusive breastfeeding rates. Based on these findings, it is recommended that special interventions be made for young mothers (15–19 years) with poor breastfeeding practices through education, nursing support, and health care counselling. Health care workers should intensify efforts to provide mothers with complete and current information on exclusive breastfeeding methods and child developmental benefits.

CHAPTER ONE

INTRODUCTION

1.1 Background of Study

Infant feeding practices are a major determinant of infant nutritional status, which in turn affects infant morbidity and mortality. Among feeding methods, breastfeeding is of particular importance because this practice is fundamental for the growth, development, health, and survival of infants. According to the World Health Organization (WHO, 2023), exclusive breastfeeding for the first six months of life remains a crucial public health recommendation, as breast milk provides all the energy and nutrients an infant requires during this period, supplying up to half or more of a child's nutritional needs during the second half of the first year, and approximately one-third during the second year of life. These nutritional and immunological properties of breast milk are well-established; it contains antibodies, immunoglobulins, antimicrobial peptides, growth factors, and human milk oligosaccharides, all of which play a pivotal role in the development of the infant's immune system (Nixarlidou et al., 2024).

The benefits of breastfeeding are numerous, ranging from providing infants with passive immunity against infectious diseases to supporting sensory, cognitive, and neurological development. Breastfeeding has been described as the gold standard in infant nutrition, providing the necessary nutrients for optimal growth and development (Çelik & Çelik, 2025). A growing body of evidence further confirms that breastfed children perform better on cognitive and intelligence tests, are less likely to be overweight or obese, and are less prone to developing diabetes later in life (Pan American Health Organization [PAHO]/WHO, 2023). Beyond benefits for the infant, breastfeeding also contributes to maternal health by reducing the risk of breast and ovarian cancers, facilitating postpartum weight loss, aiding birth spacing, and reducing the risk of cardiovascular disease (Obeagu & Obeagu, 2024; Tschiderer et al., 2022).

Despite the well-documented benefits, global exclusive breastfeeding rates remain suboptimal. A narrative review by Hossain and Mihrshahi (2022) covering studies from 2010 to 2022 confirmed the strong positive association between exclusive breastfeeding and reduced risk of gastrointestinal and respiratory infections in children under five, noting that optimal breastfeeding could potentially save approximately 800,000 children in low-income settings annually. Similarly, a 2025 meta-analysis by Obaka et al. found a significant protective effect of exclusive breastfeeding against diarrhoea morbidity in infants aged 0–6 months, further underscoring the public health imperative of promoting this practice.

In response to the overwhelming evidence supporting breastfeeding, the WHO and the United Nations Children's Fund (UNICEF) recommend that infants be exclusively breastfed for the first six months and thereafter receive nutritionally adequate complementary foods alongside continued breastfeeding up to 24 months or beyond (WHO, 2023). In Nigeria, the Baby-Friendly Hospital Initiative (BFHI), launched by WHO and UNICEF in 1991, has served as a key mechanism to protect, promote, and support breastfeeding. The BFHI has been implemented in six University Teaching Hospitals across Benin, Enugu, Maiduguri, Lagos, Jos, and Port Harcourt, with the objective of reducing infant malnutrition, morbidity, and mortality (Federal Ministry of Health and Social Welfare of Nigeria [FMoHSW], National Population Commission [NPC], & ICF, 2024). A recent systematic review and meta-analysis by Habte et al. (2025) confirmed that hospitals with complete BFHI implementation demonstrated significantly higher exclusive breastfeeding rates compared to those with partial or no implementation, highlighting the continued relevance of the initiative.

Despite these measures, exclusive breastfeeding rates in Nigeria remain persistently low. Data from the 2023–2024 Nigeria Demographic and Health Survey (NDHS) showed that exclusive breastfeeding among infants aged 0–5 months stood at only 28.8%, and early initiation of breastfeeding declined from 42% in 2018 to 36% in 2023 (FMoHSW, NPC, & ICF, 2024). These figures are far below the WHO global target of at least 50% exclusive breastfeeding by 2025, and considerably lower than Sub-Saharan African averages of approximately 45–48% (Maduforo et al., 2025). A comparative analysis of the NDHS 2018 and 2023–2024 datasets noted only marginal improvements in exclusive breastfeeding (from 29% in 2018 to approximately 34% in 2023), reflecting persistent gaps in maternal and child nutrition practices (Mordecai et al., 2025). The situation is further compounded by a 32% stunting rate among children under five in Nigeria, signalling inadequate nutrition during early childhood (UNICEF Nigeria, 2024).

These dwindling attitudes regarding the practice of exclusive and non-exclusive breastfeeding have been attributed to several socio-economic, cultural, and socio-demographic factors as they affect the development of children. Research consistently identifies maternal age, educational attainment, and occupation as significant determinants of exclusive breastfeeding practices. A cross-sectional study by Zaman et al. (2025) in a tertiary hospital in Bangladesh found that mothers aged 26 years and below were significantly less likely to exclusively breastfeed compared to older mothers, while those with primary education demonstrated reduced odds of exclusive breastfeeding. These findings are consistent with earlier Nigerian-specific research and underscore the importance of targeted, evidence-based interventions. Thus, this research project aimed to examine the effectiveness of exclusive breastfeeding in the development of under-five children in Benue State, Nigeria.

1.2 Statement of Problem

Breastfeeding practices have undergone tremendous medical, cultural, and sometimes religious challenges and debate. In an attempt to achieve successful breastfeeding globally, the WHO and UNICEF launched the Baby-Friendly Hospital Initiative (BFHI) in 1991, which now spans more than 152 countries worldwide (WHO, 2024). This initiative is designed to support, protect, and promote the practice of exclusive breastfeeding for the first six months of life and continue thereafter until 24 months of age. Numerous medical and public health studies have established the superiority of breast milk over other types of infant feeding for the nourishment of human infants, offering superior immunological, nutritional, and developmental benefits (Nixarlidou et al., 2024; Alotiby, 2023).

Although breastfeeding is near-universal in Nigeria, the trend is towards the introduction of other feeds in addition to breast milk. Practices are characterised by late initiation of breastfeeding, the administration of pre-lacteal feeds, and the early introduction of complementary or weaning foods within the first month of life. According to the 2023–2024 NDHS (FMoHSW, NPC, & ICF, 2024), only 35.5% of children born in the two years preceding the survey were put to the breast within one hour of birth, and the exclusive breastfeeding rate among infants aged 0–5 months was 28.8% a figure that has stagnated over the past decade and remains far below the WHO target of at least 50% by 2025. Furthermore, a comparative scoping review of NDHS data (2018 vs 2023–2024) found that exclusive breastfeeding improved by only five percentage points over this five-year period, highlighting the slow pace of progress (Mordecai et al., 2025).

Considering the percentage of mothers practicing sub-optimal breastfeeding, it is not surprising that Nigeria continues to contend with high rates of child malnutrition and its associated under-five mortality. The 2023–2024 NDHS reported that under-five mortality has declined to 102 per 1,000 live births, though this remains far above the Sustainable Development Goal (SDG) target of 25 per 1,000 live births (FMoHSW, NPC, & ICF, 2024). The Nigerian Child Survival Action Plan (Federal Ministry of Health, 2025) has identified suboptimal breastfeeding as a critical driver of preventable child deaths and malnutrition.

Multiple factors have been identified as influencing breastfeeding decisions beyond health considerations alone. A qualitative study by Falade et al. (2024) exploring breastfeeding practices in Jigawa State, Northern Nigeria, found that household members including husbands, mothers-in-law, and community elders play a significant role in shaping whether mothers exclusively breastfeed. A narrative review examining sociodemographic factors (Maysaroh et al., 2024) further identified maternal occupation, educational attainment, and socioeconomic status as key determinants of exclusive breastfeeding success across Sub-Saharan Africa. Specifically, a study from a Kaduna and Lagos States sample (Maduforo et al., 2025) confirmed that IYCF indicator prevalence, including exclusive breastfeeding, varied substantially by state and by demographic subgroup, calling for subnational, data-informed programme responses.

Despite this body of evidence, there remains a gap in the literature concerning the specific relationship between demographic factors and the effectiveness of exclusive breastfeeding in promoting child development among under-fives in Benue State. While several national-level surveys have tracked breastfeeding rates and mortality outcomes, fewer studies have focused on the synergistic influence of sociodemographic factors particularly mother's age, education, and occupation on both the practice and effectiveness of exclusive breastfeeding in the North Central geopolitical zone of Nigeria. This study therefore purposed to examine the effectiveness of exclusive breastfeeding in the development of under-fives in Benue State, contributing locally relevant evidence to guide targeted interventions.

1.3 Purpose of the Study

The main purpose of this research project was to examine the effectiveness of exclusive breastfeeding in the development of under-five children in Benue State, Nigeria. The specific purposes of the study are:

1. To assess whether a mother's age, level of education, and occupation influence the practice of exclusive breastfeeding.

2. To assess how effective exclusive breastfeeding is for children under-five.

3. To assess whether mothers have knowledge of the benefits and role that exclusive breastfeeding plays in child development (under-fives).

4. To determine if family views regarding breastfeeding influence a mother's decision to exclusively breastfeed.

1.4 Research Questions

This study sought to provide answers to the following specific research questions:

1. Does a mother's age, level of education, and occupation influence the practice of exclusive breastfeeding?

2. How effective is exclusive breastfeeding for children under-five?

3. Do mothers have knowledge of the benefits and role that exclusive breastfeeding plays in child development (under-fives)?

4. Do family views regarding breastfeeding influence a mother's decision to exclusively breastfeed?

1.5 Significance of Study

The findings of this study would provide insight into areas where health education campaigns are required to influence and promote the adoption of exclusive breastfeeding. Specifically:

The study would contribute to the generation of subnational demographic data on exclusive breastfeeding among nursing mothers attending antenatal clinics in Benue State. This evidence would be of value to nutritionists and health planners in designing policies and strategies that promote exclusive breastfeeding in specific groups and locations where it is poorly practiced.

The findings of the study would assist health workers in developing special intervention measures targeting specific age groups of mothers who demonstrate poor exclusive breastfeeding practices, in line with the WHO and UNICEF global breastfeeding strategy (WHO, 2023).

The findings of this study would help health educators, nurses, nutritionists, and curriculum planners to develop evidence-informed programmes for nursing mothers on the benefits of breastfeeding. In addition, the findings would inform the update of curricula in higher institutions of learning to prepare future parents in adopting effective and evidence-based breastfeeding methods for their babies.

1.6 Scope of Study

This research project focused on examining the effectiveness of exclusive breastfeeding in the development of under-five children in Benue State, Nigeria.

1.7 Operational Definition of Terms

Exclusive Breastfeeding: Exclusive breastfeeding means that the infant receives only breast milk. No other liquids or solids are given not even water with the exception of oral rehydration solution, or drops/syrups of vitamins, minerals, or medicines (WHO, 2023).

Under-fives: Children who are less than five years old, especially those who are not yet in full-time education (FMoHSW, NPC, & ICF, 2024).

1.8 Limitations of the Study

The researcher experienced the following limitations during the conduct of this study. First, the relationship between types of breastfeeding and infant morbidity and mortality was probably underestimated by some mothers, as many did not attend postnatal care for further assessment or advice from healthcare providers. Such nursing mothers were consequently not included in the study sample, which was restricted to mothers attending postnatal clinics.

Additionally, the study did not account for differences between infants raised by their biological mothers and those cared for by significant others, which may have introduced some bias in feeding decisions. To mitigate this, the researcher took care to encourage nursing mothers to provide accurate information about their feeding practices, clarifying that the study was purely academic in nature and not intended to pass judgment on individual choices. Time and financial constraints were further limiting factors; however, the researcher was able to successfully complete the work within the available resources.

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