EXCLUSIVE BREASTFEEDING PRACTICE AMONG MOTHERS ATTENDING ANTENATAL CLINIC IN IKENNE LOCAL GOVERNMENT OGUN STATE
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CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Nurse-led interventions, particularly breastfeeding-readiness education provided during antenatal visits, are essential in encouraging and promoting exclusive breastfeeding (EBF) among mothers. These interventions equip pregnant women with the necessary information, practical skills, and confidence required to initiate and maintain exclusive breastfeeding. They also help identify and address possible challenges that may interfere with successful breastfeeding. Previous research has demonstrated that nursing interventions play an important role in promoting positive breastfeeding practices through individualized counselling, emotional encouragement, and practical demonstrations (Tseng et al., 2020). Such interventions can improve maternal confidence and self-efficacy, which are important determinants of successful exclusive breastfeeding. For example, organized educational programmes conducted by nurses have been associated with improved early initiation of breastfeeding and increased continuation of breastfeeding during the first months after delivery (Edward et al., 2023).
Although breast milk offers numerous nutritional, economic, immunological, and psychological benefits, breastfeeding practices across different parts of the world remain below recommended standards. Breast milk is naturally designed to satisfy an infant's nutritional requirements while providing protection against infections and supporting healthy growth and development. It contains antibodies that strengthen the infant's immune system and help reduce the likelihood of common childhood illnesses, including diarrhoea and pneumonia (World Health Organization, 2021). From an economic perspective, breastfeeding is affordable because it reduces dependence on infant formula and may lower healthcare expenses associated with childhood illnesses. Its immunological benefits include the transfer of protective antibodies from mother to child, while its psychological benefits include the promotion of emotional attachment and bonding between mother and infant. Nevertheless, the availability and effectiveness of nursing interventions remain important factors in improving breastfeeding outcomes because they help address existing gaps in maternal knowledge and practical skills.
The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) recommend that infants should receive exclusive breastfeeding throughout the first six months of life. After this period, breastfeeding should continue alongside the introduction of suitable complementary foods until the child reaches two years of age or beyond (WHO, 2021). This recommendation is supported by substantial evidence demonstrating the short-term and long-term health advantages of breastfeeding for mothers and their children. Exclusive breastfeeding helps protect infants against common infections, contributes to reduced childhood mortality, and supports cognitive development, which may have positive effects on later intellectual performance. For mothers, breastfeeding supports recovery following childbirth, reduces the risk of breast and ovarian cancers, and may contribute to the natural spacing of pregnancies. Despite these established benefits, research indicates that exclusive breastfeeding rates remain below recommended levels in several parts of the world, particularly in low- and middle-income countries (Olasinde et al., 2021). Inadequate maternal education, traditional beliefs, and insufficient support systems are among the factors associated with these low rates.
The importance of exclusive breastfeeding as a global public health priority is further demonstrated by the World Health Organization's target of achieving an exclusive breastfeeding rate of at least 50% by 2025. This target was intended to contribute to the prevention of approximately 13–15% of deaths among children under five years in low- and middle-income countries, potentially saving millions of lives annually (Olufunlayo et al., 2019). Increasing exclusive breastfeeding coverage towards 90% could also substantially reduce childhood deaths associated with preventable conditions, including malnutrition and infectious diseases. However, local research in Nigeria, particularly studies conducted in Ile-Ife, has reported low exclusive breastfeeding rates, with only 19% of mothers practising exclusive breastfeeding (Amoo & Anjola, 2022). This situation demonstrates the need for more focused interventions to improve maternal breastfeeding practices. Continuous education during pregnancy and after childbirth can help mothers develop appropriate breastfeeding habits, overcome misconceptions, and resist social pressures that encourage the early introduction of other foods and liquids.
UNICEF identifies breast milk as the preferred standard for infant feeding because it is nutritious, readily available, and affordable, while providing the essential nutrients required for infant growth without some of the risks associated with artificial feeding (UNICEF, 2023). Nurses have important responsibilities in promoting breastfeeding because of their professional knowledge, clinical experience, and direct contact with pregnant and nursing mothers. Through health education, counselling, and continuous guidance, nurses can improve maternal awareness and provide practical assistance when breastfeeding difficulties arise. Nurse-led intervention programmes can also educate mothers about the economic advantages of exclusive breastfeeding, including reduced expenditure on infant formula and fewer healthcare costs resulting from preventable illnesses. Furthermore, involving husbands, experienced breastfeeding mothers, and other relevant support groups can create a more encouraging environment that helps mothers comply with recommended exclusive breastfeeding practices.
According to UNICEF (2023), the global rate of exclusive breastfeeding among infants below six months increased to 48% in 2023, representing a rise of approximately 10 percentage points over the preceding decade. However, considerable differences remain across geographical regions. Available estimates indicate that exclusive breastfeeding rates stand at approximately 23% in West and Central Africa and 26% in the Middle East and North Africa. Higher proportions have been reported in Eastern and Southern Africa (39%), East Asia and the Pacific (43%), and South Asia (44%) (UNICEF, 2023). Even in developed countries such as England, exclusive breastfeeding rates remain relatively low, with approximately 25% of infants receiving breast milk up to six to eight weeks and only 16% continuing to receive breast milk between three and five months (Francis et al., 2021).
In Nigeria, exclusive breastfeeding remains a major public health concern because a considerable proportion of infants do not receive breast milk exclusively during the first six months of life. The 2018 Nigerian Demographic and Health Survey reported that only 29% of infants below six months were exclusively breastfed (Nigerian Demographic and Health Survey, 2018). Similarly, the 2023–2024 Nigerian Demographic and Health Survey reportedly recorded an exclusive breastfeeding rate of 29%, while early initiation of breastfeeding declined from 42% to 36% (Nigerian Demographic and Health Survey, 2023–24). Historical data also indicate that the exclusive breastfeeding rate between 2000 and 2012 was approximately 15.1% (UNICEF, 2023). Findings from regional studies, including research conducted in Plateau State, have reported even lower rates, with exclusive breastfeeding estimated at 6% (Kayode, 2020). Despite the availability of maternal education and breastfeeding training programmes, gaps in mothers' knowledge and actual breastfeeding practices continue to persist (Nukpezah et al., 2021). Similar observations have been reported in other studies, suggesting that exposure to breastfeeding education does not always translate into appropriate breastfeeding practices (Amoo & Anjola, 2022; Olasinde et al., 2021). These persistent challenges raise questions about the adequacy, organization, and implementation of existing breastfeeding promotion programmes. It is against this background that the present study examines the effect of nursing-based interventions on exclusive breastfeeding practices among pregnant women attending antenatal clinics in two selected primary healthcare centres in Ikenne Local Government Area of Ogun State.
1.2 Statement of the Problem
Inadequate exclusive breastfeeding practices remain an important contributor to childhood illness and mortality across the world, particularly in communities with limited healthcare resources (Pérez-Escamilla et al., 2020). When infants are not exclusively breastfed, they may become more vulnerable to infectious diseases because they receive less of the protective antibodies and other immune-supporting components naturally present in breast milk. The early introduction of supplementary feeds may also increase exposure to contaminated food and water, thereby raising the risk of infections (Mantzorou et al., 2022). Among the health challenges associated with poor breastfeeding practices are diarrhoeal diseases and lower respiratory tract infections, which may be linked to inadequate maternal knowledge and inappropriate infant-feeding practices (Mulol & Coutsoudis, 2020). In Nigeria, limited knowledge and poor implementation of exclusive breastfeeding recommendations continue to contribute to this public health challenge (UNICEF, 2023).
Inadequate maternal knowledge and poor adherence to exclusive breastfeeding recommendations may expose children to several health risks, including infectious diseases, diarrhoea, upper respiratory tract infections, childhood obesity, reduced immune protection, sudden infant death syndrome, and malnutrition (Chipojola et al., 2020; Huda et al., 2022). Infants who are not exclusively breastfed may also experience increased susceptibility to digestive disturbances, allergic conditions, and infections, with possible consequences for their long-term health and development (World Health Organization, 2021). These concerns highlight the importance of strengthening maternal knowledge and encouraging appropriate breastfeeding practices during pregnancy and after childbirth.
The researcher's clinical observations have indicated the occurrence of health conditions such as malnutrition, obesity, infections, and diarrhoeal diseases among children, which may be associated with inadequate exclusive breastfeeding practices and weaknesses in existing breastfeeding education programmes. Although breastfeeding education is provided in some healthcare settings, the persistence of inappropriate infant-feeding practices suggests that existing approaches may not adequately prepare mothers to initiate and maintain exclusive breastfeeding. This situation creates a need for structured nursing interventions that go beyond the provision of general information by incorporating practical education, counselling, emotional support, and the involvement of relevant support groups.
Consequently, there is a need to evaluate whether a structured nurse-based intervention can improve pregnant women's knowledge and preparedness to practise exclusive breastfeeding. This study therefore focuses on assessing the effect of a nurse-based intervention on exclusive breastfeeding practices among pregnant women attending antenatal clinics in two selected primary healthcare centres in Ikenne Local Government Area of Ogun State. The study seeks to establish whether the intervention can improve maternal knowledge and anticipated breastfeeding practices, thereby providing useful evidence for strengthening breastfeeding promotion strategies.
1.3 Objectives of the Study
The main objective of this study is to evaluate the effect of a nurse-based intervention on exclusive breastfeeding practices among pregnant women attending antenatal clinics in Ikenne Local Government Area of Ogun State, Nigeria.
The specific objectives are to:
1. Assess the level of knowledge of exclusive breastfeeding among pregnant women before the implementation of the intervention.
2. Determine the baseline intentions and anticipated breastfeeding practices of pregnant women before the intervention.
3. Examine the effect of the nurse-based intervention on exclusive breastfeeding practices among pregnant women after the intervention.
4. Evaluate the effect of the nurse-based intervention on pregnant women's knowledge of exclusive breastfeeding after the intervention.
1.4 Research Questions
The following research questions were formulated to guide the study:
1. What is the level of knowledge of exclusive breastfeeding among pregnant women before the implementation of the intervention?
2. What are the baseline intentions and anticipated exclusive breastfeeding practices of pregnant women attending antenatal clinics in Ikenne Local Government Area of Ogun State?
1.5 Research Hypotheses
The following null hypotheses were formulated and tested at the 0.05 level of significance:
Hypothesis One (H₀₁): There is no statistically significant difference in the level of knowledge of exclusive breastfeeding among pregnant women in the control and experimental groups before and after the intervention.
Hypothesis Two (H₀₂): There is no statistically significant difference in the anticipated practice of exclusive breastfeeding among pregnant women in the control and experimental groups before and after the intervention.
1.6 Scope of the Study
This study examines the effect of a structured nurse-based educational intervention on knowledge and anticipated exclusive breastfeeding practices among multiparous pregnant women who are at 36 weeks of gestation or beyond and attend antenatal clinics in two selected primary healthcare centres in Ikenne Local Government Area, Ogun State, Nigeria. The study specifically focuses on the participants' knowledge of exclusive breastfeeding, their intentions and preparedness to adopt recommended breastfeeding practices, and the changes associated with the implementation of the nursing intervention. The intervention incorporates structured education and counselling designed to improve maternal understanding and preparedness for exclusive breastfeeding.
1.7 Significance of the Study
The findings of this study are expected to provide empirical evidence regarding the effectiveness of nurse-led breastfeeding education programmes in improving maternal knowledge and preparedness to practise exclusive breastfeeding. By evaluating the changes associated with the intervention, the study may help establish the value of structured nursing education as an approach to promoting appropriate infant-feeding practices.
The findings may also contribute to the development of more effective and locally appropriate antenatal breastfeeding promotion strategies. Such strategies could be designed to address the specific educational, cultural, and practical needs of pregnant women in the study area. Improved breastfeeding education may contribute to better maternal and child health outcomes by encouraging early initiation and sustained exclusive breastfeeding.
Nurses and midwives may benefit from the findings because the study could provide useful information on how structured breastfeeding education and counselling can be incorporated into routine antenatal care. The results may help healthcare professionals strengthen their health education approaches, improve communication with pregnant women, and make better-informed clinical decisions when addressing breastfeeding-related concerns.
Furthermore, the study may demonstrate the importance of providing adequate time, materials, and institutional support for effective breastfeeding counselling during antenatal visits. This information could assist healthcare administrators and policymakers in making decisions concerning resource allocation, staff training, and the development of policies and guidelines that promote effective breastfeeding education.
Finally, the data generated from this research may serve as a useful reference for future investigations into breastfeeding promotion and nursing interventions. It may provide a foundation for developing and evaluating interventions that can be expanded and sustained in other primary healthcare settings with similar characteristics.
1.8 Operational Definitions of Terms
Effect: The measurable change in participants' knowledge scores and anticipated breastfeeding practice scores that can be attributed to the nurse-based intervention programme.
Nursing-Based Intervention: A structured educational and counselling programme delivered by nurses and guided by relevant theoretical principles. The programme addresses the meaning, benefits, techniques, and possible challenges of exclusive breastfeeding. It also encourages the participation of support groups, including husbands and experienced breastfeeding mothers, to promote exclusive breastfeeding during the first six months of life and continued breastfeeding alongside complementary feeding up to two years or beyond.
Breastfeeding: The process of feeding an infant or young child with milk produced by a woman's breasts, either directly through suckling or through expressed breast milk.
Exclusive Breastfeeding: The practice of feeding an infant with breast milk alone during the first six months of life, without giving other liquids or solid foods, including water, except for oral rehydration solution, vitamins, minerals, or medicines when medically indicated.
Pregnant Women: Multiparous women who are at 36 weeks of gestation or beyond and are receiving antenatal care at the selected primary healthcare centres in Ikenne Local Government Area.
Practice (in the Context of This Study): The intended breastfeeding behaviours of pregnant women, including the intention to initiate breastfeeding within one hour after delivery, breastfeed the infant on demand, maintain exclusive breastfeeding without introducing prelacteal feeds, supplementary water, or other foods, and express breast milk when temporarily separated from the infant.
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