EXCLUSIVE BREASTFEEDING PRACTICE AMONG MOTHERS ATTENDING ANTENATAL CLINIC IN IKENNE LOCAL GOVERNMENT OGUN STATE

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

The provision of nursing-based interventions, such as breastfeeding-readiness education during antenatal visits, plays a pivotal role in promoting exclusive breastfeeding (EBF) among mothers. This approach not only equips mothers with essential knowledge and skills but also addresses potential barriers to successful breastfeeding initiation and continuation. Research emphasizes that nurse-led interventions are instrumental in fostering positive breastfeeding behaviors by providing personalized guidance, emotional support, and practical demonstrations (Tseng et al., 2020). These interventions can significantly enhance maternal confidence and self-efficacy, which are critical for achieving breastfeeding exclusivity. For instance, structured educational programs delivered by nurses have been shown to improve early breastfeeding initiation rates and sustain breastfeeding for longer durations, particularly in the first few months postpartum (Edward et al., 2023).

Despite the well-documented nutritional, economic, immunological, and psychological benefits of breast milk, global and regional breastfeeding practices often fall short of recommended standards. Breast milk is uniquely tailored to meet an infant's needs, offering complete nutrition while protecting against infections and supporting optimal growth and development. It contains antibodies that bolster the infant's immune system, reducing the risk of common childhood illnesses such as diarrhea and pneumonia (World Health Organization, 2021). Economically, breastfeeding is cost-effective, eliminating the need for formula and reducing healthcare costs associated with infant illnesses. Immunologically, it provides passive immunity, and psychologically, it strengthens the mother-infant bond, promoting emotional well-being for both. However, one key factor influencing breastfeeding success is the availability and quality of nursing interventions, which can bridge gaps in knowledge and practice.

The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) recommend that all lactating mothers exclusively breastfeed their infants for the first six months of life, followed by continued breastfeeding alongside appropriate complementary foods up to two years or beyond (WHO, 2021). This recommendation is grounded in extensive evidence highlighting the short- and long-term health benefits for both mother and child. Exclusive breastfeeding reduces infant mortality by preventing common infections and supports cognitive development, potentially leading to higher intelligence scores later in life. For mothers, it aids in postpartum recovery, reduces the risk of ovarian and breast cancers, and helps in spacing pregnancies naturally. Nevertheless, studies indicate that EBF rates remain below these recommendations in many regions, including low- and middle-income countries (Olasinde et al., 2021). Factors such as inadequate maternal education, cultural beliefs, and lack of support systems contribute to these suboptimal rates.

To underscore the global importance, the WHO has set a target of at least 50% exclusive breastfeeding by 2025, aiming to prevent 13-15% of under-five deaths in low- and middle-income countries, which equates to saving millions of lives annually (Olufunlayo et al., 2019). Achieving 90% universal coverage for EBF could dramatically reduce child mortality from preventable causes like malnutrition and infectious diseases. Local studies in Nigeria, such as those conducted in Ile-Ife, reveal alarmingly low EBF rates, with only 19% of mothers practicing exclusivity, highlighting the urgent need for targeted interventions (Amoo & Anjola, 2022). Continuous prenatal and postnatal education can enhance mothers' breastfeeding practices, countering myths and building resilience against societal pressures to introduce supplementary feeds early.

UNICEF describes breast milk as the gold standard for infant feeding healthy, simple, and inexpensive, fulfilling all nutritional requirements without the risks associated with artificial feeding (UNICEF, 2023). Nurses' knowledge, expertise, and advisory roles are vital in raising awareness, providing education, and offering ongoing support to mothers and families. Nursing intervention strategies address breastfeeding challenges effectively, informing mothers about the cost-effective benefits of EBF, such as reduced medical expenses and improved family health outcomes. By integrating support groups, including husbands and experienced mothers, these interventions create a supportive ecosystem that encourages adherence to EBF guidelines.

Globally, the exclusive breastfeeding rate for infants under six months has improved to 48% as of 2023, marking a 10 percentage point increase over the past decade (UNICEF, 2023). However, regional disparities persist. In West and Central Africa, only 23% of infants are exclusively breastfed, while the Middle East and North Africa report 26%. Higher rates are observed in Eastern and Southern Africa (39%), East Asia and the Pacific (43%), and South Asia (44%) (UNICEF, 2023). In developed countries like England, EBF rates are low, with only 25% of infants breastfed until 6-8 weeks and 16% continuing to three to five months (Francis et al., 2021).

In Nigeria, EBF remains uncommon, with the 2018 Nigerian Demographic and Health Survey (NDHS) reporting only 29% of infants under six months exclusively breastfed (Nigerian Demographic and Health Survey, 2018). The 2023-24 NDHS indicates stagnation at 29%, with early initiation declining from 42% to 36% (Nigerian Demographic and Health Survey, 2023-24). Between 2000 and 2012, the rate was a mere 15.1% (UNICEF, 2023). Regional studies, such as in Plateau State, show even lower rates at 6% (Kayode, 2020). Despite training programs, mothers' knowledge and practice of EBF remain low (Nukpezah et al., 2021). Similar findings are echoed in other studies, indicating persistent gaps despite exposure to education (Amoo & Anjola, 2022; Olasinde et al., 2021). These challenges suggest underlying issues in program design and implementation, prompting this study on the effects of nursing-based interventions on EBF practices among pregnant women in two primary health care centers in Ikenne Local Government.

1.2 Statement of the Problem

Poor exclusive breastfeeding practices contribute significantly to high rates of infant morbidity and mortality worldwide, particularly in low-resource settings (Pérez-Escamilla et al., 2020). Inadequate EBF exposes infants to increased risks of communicable diseases and infections, as breast milk's protective antibodies are absent when supplementary feeds are introduced early (Mantzorou et al., 2022). Common issues include higher incidences of diarrhea and lower respiratory tract infections due to suboptimal knowledge and practices among mothers (Mulol & Coutsoudis, 2020). In Nigeria, EBF knowledge and practice are notably low, exacerbating these problems (UNICEF, 2023).

Mothers' low knowledge and practice levels regarding EBF lead to a cascade of health issues, including infections, diarrhea, upper respiratory tract infections, childhood obesity, reduced immunity, sudden infant death syndrome, and malnutrition (Chipojola et al., 2020; Huda et al., 2022). Non-EBF infants face heightened risks of digestive problems, allergies, and weakened immune responses, leading to long-term health consequences (World Health Organization, 2021). The researcher's clinical observations note high incidences of malnutrition, obesity, infections, and diarrhea, potentially linked to poor EBF practices and gaps in training programs. This underscores the need for targeted nursing interventions to improve EBF in pregnant women attending primary health care centers in Ikenne Local Government.

Objective of the Study

The main objective of this study is to evaluate the effect of a nurse-based intervention on exclusive breastfeeding practice among pregnant mothers attending antenatal clinics in Ikenne Local Government Area of Ogun State, Nigeria.

The specific objectives are to:

1. Assess the level of knowledge of pregnant mothers on exclusive breastfeeding before the intervention.
2. Determine the baseline practice intention and anticipated breastfeeding behavior among pregnant mothers.
3. Determine the influence of the nurse-based intervention on the practice of exclusive breastfeeding among pregnant women after the intervention.
4. Determine the influence of the nurse-based intervention on the knowledge of exclusive breastfeeding among pregnant women after the intervention.

1.4 Research Questions

The following research questions guided the study:

1. What is the level of knowledge of pregnant women on exclusive breastfeeding before the intervention?
2. What is the baseline anticipated practice of exclusive breastfeeding among pregnant mothers attending antenatal clinics in Ikenne Local Government Area of Ogun State?

1.3 Hypotheses

The following null hypotheses were tested at 0.05 level of significance: HO₁: There is no significant difference in pregnant mothers’ knowledge level of exclusive breastfeeding practice before and after the intervention between the control and experimental groups. HO₂: There is no significant difference in pregnant mothers’ anticipated practice level of exclusive breastfeeding before and after the intervention between the control and experimental groups.

1.4 Scope of the Study

This study focused on evaluating the effect of a structured nurse-based educational intervention on the knowledge and anticipated practice of exclusive breastfeeding among multiparous pregnant women (≥36 weeks gestation) attending antenatal clinics in two selected primary health care centers in Ikenne Local Government Area, Ogun State, Nigeria.

1.6 Significance of the Study

1. The findings may provide empirical evidence on the effectiveness of nurse-led breastfeeding education interventions in improving maternal knowledge and future breastfeeding practices.
2. The results may inform the design of more effective, context-specific antenatal breastfeeding promotion strategies to improve maternal and child health outcomes.
3. Nurses and midwives may benefit from insights into how structured training programs can be integrated into routine antenatal care to enhance clinical decision-making and patient education.
4. The study may highlight the importance of allocating adequate time and resources for quality breastfeeding counseling, potentially influencing health policy and practice guidelines.
5. The data generated may serve as a foundation for future research on scalable, sustainable interventions to promote exclusive breastfeeding in similar settings.

1.8 Operational Definitions of Terms

• Effect: The measurable change in knowledge scores and anticipated breastfeeding practice scores attributable to the nurse-based intervention program.
• Nursing-Based Intervention: A structured, theory-informed educational and counseling program delivered by nurses, covering the definition, benefits, techniques, and challenges of exclusive breastfeeding, with active involvement of support groups (husbands, experienced breastfeeding mothers) to encourage EBF for the first six months and continued breastfeeding up to two years.
• Breastfeeding: The act of feeding an infant or young child with milk directly from a woman’s breast.
• Exclusive Breastfeeding: Feeding an infant with only breast milk (no other liquids or solids, except vitamins, minerals, or medicines when medically indicated) for the first six months of life.
• Pregnant Women: Multiparous women at 36 weeks of gestation or beyond attending antenatal care in the selected primary health centers in Ikenne Local Government Area.
• Practice (in this context): Intended early initiation of breastfeeding (within one hour of birth), planned frequency of breastfeeding (on demand), intention to breastfeed exclusively without prelacteal feeds or supplementary water/foods, and preparedness to express breast milk when temporarily separated from the infant.