Determinants of suboptimal breastfeeding practices in Nigeria: evidence from the 2008 demographic and health survey

Background: In Nigeria, suboptimal breastfeeding practices are contributing to the burden of childhood diseases and mortality. This study identified the determinants of key suboptimal breastfeeding practices among children 0-23 months in Nigeria. Method: Data on 10,225 children under-24 months were obtained from the 2008 Nigeria Demographic and Health Survey (NDHS). Socio-economic, health service and individual factors associated with key breastfeeding indicators (early initiation of breastfeeding, exclusive breastfeeding, predominant breastfeeding and bottle feeding) were investigated using multiple logistic regression analyses. Results: Among infants 0-5 months of age, 14% [95% confidence Interval (CI): 13%, 15%] were exclusively breastfed and 48% [95% CI: 46, 50%] were predominantly breastfed. Among children aged 0-23 months, 38% [95% CI 36, 39%] were breastfed within the first hour of birth, and 15% [95% CI: 14, 17%] were bottle-fed. Early initiation of breastfeeding was associated with higher maternal education, frequent antenatal care (ANC) visits and birth interval but deliveries at a health facility with caesarean section was associated with delayed initiation of breastfeeding. Educated mothers, older mothers and mothers from wealthier households exclusively breastfeed their babies. The risk for bottle feeding was higher among educated mothers and fathers, and women from wealthier households including mothers who made frequent ANC visits. Conclusion: Socio-economic and health service factors were associated with suboptimal breastfeeding practices in Nigeria. To improve the current breastfeeding practices, breastfeeding initiatives should target all mothers - particularly low SES mothers - including, national and sub-national health policies that ensure improved access to maternal health services, and improvements to baby friendly hospital and community initiatives for mothers.