Abstract

Introduction: Breastfeeding is the optimal food for infants, best suited to their nutritional needs. Despite its benefits, it remains an uncommon practice worldwide and in Niger in particular. The objective of this study was to examine mothers’ knowledge, attitudes, and practices regarding breastfeeding. Materials and Methods: This was a cross-sectional study with descriptive and analytical aims. The study population consisted of mothers with a child aged 0 to 24 months, attending integrated health centers in the city of Niamey. The proportions were compared using Pearson’s Chi-square statistical test at the 5% significance level. Results: A total of 639 mothers were surveyed. 57.27% were under 25 years old, 29.58% were uneducated, and the majority were housewives (81.54%). Only 24.88% practiced exclusive breastfeeding, and advice from health professionals (92.17%) was the main source of motivation. Water was the main food associated with breastfeeding the infants younger than 6 months old (75.12%). The main factors associated with exclusive breastfeeding were the age, occupation, education of the mothers, and the time to first breastfeeding the child (P-value < 0.05). Conclusion: Exclusive breastfeeding was observed in only a quarter of mothers; improvement of applied practices could be incorporated in breastfeeding promotion strategies.

Keywords

Breastfeeding, Knowledge, Attitudes, Practices, Niamey

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1. Introduction

Breastfeeding is the suggested from world organizations as the best feeding practice. Breast milk is indeed considered the healthiest form of milk for babies. The World Health Organization (WHO) therefore recommends early breastfeeding within one hour of birth, exclusive breastfeeding for the first 6 months of life, and the introduction of healthy and complementary solid foods at 6 months of age, with continued breastfeeding up to 2 years of age and beyond [1]-[3].

Exclusive Breastfeeding is considered the best nutritional practice for the development of infants. Breastfeeding protects babies by providing antibodies against common pathogens. Moreover, it provides the essential nutrients in order to appropriately grow. Finally, it promotes mother-child attachment which is important for the development of communication and social skills [4] [5].

Many countries have successfully increased exclusive breastfeeding rates over the past 10 years. The prevalence of exclusive breastfeeding has increased dramatically by 10 percentage points to 48% globally. It is estimated that increasing breastfeeding rates could save the lives of 820,000 children each year, generating an additional $302 billion in revenue [4] [6].

In Niger, according to various surveys conducted by the National Institute of Statistics (NIS), only 14% of children under 6 months were exclusively breastfed in 2006, rising to 23% in 2012. However, despite the mobilization of various national and international institutions working for child survival, this rate is declining according to more recent studies, including the national nutrition survey carried out by the INS in 2019, which reports a practice of exclusive breastfeeding up to the age of 6 months of 21.10%. These rates are well below the global target of 70% by 2030 [4] [7] [8].

These relatively low rates prompted this study with the aim of investigating the knowledge, attitudes and practices of mothers of children aged 0 to 24 months on breastfeeding in health centers in the urban community of Niamey.

2. Materials and Methods

• Study setting: The health centers of the urban community of Niamey served as the setting for carrying out the study.

• Type and period of study: This was a cross-sectional study with a descriptive and analytical aim covering a period of 3 months from December 29, 2023 to March 29, 2024.

• Study population: It consisted of mother-child pairs aged 0 to 24 months attending health centers in the urban community of Niamey.

• Inclusion criteria: mother-child pairs whose mothers agreed to answer the questions were included in the study.

• Non-inclusion criteria: mothers whose infants were in poor clinical condition were not included.

• Sampling: We carried out a triple sampling of the choice of health districts, health centers and respondents.

• Choice of health districts: we exhaustively selected the 5 health districts that made up the urban community of Niamey.

• Choice of health centers: health centers in the various health districts with a population of women of childbearing age greater than or equal to 3000 were selected, i.e. 37 health centers out of the 68 in the urban community of Niamey.

• Selection of respondents: we exhaustively selected all mother-infant pairs who had attended the health centers selected during our visits and whose mothers had agreed to answer the questions.

• Variables studied: they were related to:

• Sociodemographic characteristics of mothers: age, education level and occupation.

• Sociodemographic characteristics and background of children: age, sex, sibling rank, birth date and place of delivery.

• Mothers’ knowledge about breastfeeding: source of information about breastfeeding, knowledge about weaning period, knowledge about the importance of colostrum, knowledge about the benefits of breastfeeding for mother and child, mothers’ knowledge about storing breast milk, mothers’ knowledge about the Lactational Amenorrhea Method (LAM) and mothers’ knowledge about breast cancer prevention through breastfeeding.

• Mothers’ attitudes towards breastfeeding: time to first breastfeeding, administration of colostrum and frequency of feedings,

• Mothers’ breastfeeding practices: the practice of exclusive breastfeeding before the age of 6 months and associated foods.

• Operational definitions:

• Exclusive breastfeeding: An infant under 6 months of age receiving only breast milk and no other liquids (including water) or solid foods, except for drops and syrups (vitamins, minerals, and medications) [9].

• Lactational Amenorrhea Method (LAM): The lactational amenorrhea method is a natural, short-term method of contraception for breastfeeding mothers. A woman who feeds her baby exclusively with breast milk and has not resumed menstruation is temporarily infertile. This is because the hormones that produce breast milk also prevent the ovaries from releasing eggs for six months after delivery [10].

• Method and data collection: Data were collected by interviewing mothers and using the child’s health record after explaining the purpose of the survey and obtaining informed consent. A pre-established collection form was used as a support for data collection.

• Data entry and analysis: Data were entered and analyzed using SPSS version 26.0 software. Texts were processed using Microsoft Office Word 2016 software, and graphical representations and tables were created using Microsoft Office Excel 2016. Proportions were compared using Pearson’s Chi-square statistical test at the 5% significance level. The test was significant if the p-value was less than 0.05. Quantification of the risk factor was assessed by estimating the Odds Ratio (OR); the dependent variable was the practice of exclusive breastfeeding.

• Ethical aspects: the data was collected, entered and analyzed in strict compliance with professional confidentiality.

3. Results

At the end of the survey, 639 mother and child pairs aged less than 24 months were surveyed.

• Data relating to mothers

57.27% of them were under 25 years old; the average age was 26.89 years ± 6.23 years, ranging from 16 to 48 years. 42.57% of them were pauciparous; more than a quarter, or 29.58%, were uneducated and 81.37% were housewives.

• Children’s Data

The children were predominantly male with 53.21%; the average age was 6.23 months ± 4.42 ranging from less than one month to 24 months. They were full-term children at 95.15%; premature at 3.14% and post-term at 1.41%. The vaginal route was the most observed mode of delivery with 87.95% and in a health facility with 93.58%.

Table 1. Distribution of children according to sibling rank in health centers in the urban community of Niamey.

*8, 9, 10, 11, 12.

Children occupying the second place in the family were the most represented with 27.39% (Table 1).

• Mothers’ knowledge about breastfeeding

The majority of mothers, 87.17%, received advice on breastfeeding, mainly through health centers with 92.28%.

The child’s age 24 to 30 months was the main weaning period reported by 40.22% of mothers; while 36.46% of mothers had no idea (Table 2).

Table 2. Distribution of mothers according to knowledge of the child’s weaning period in health centers in the urban community of Niamey.

Table 3. Distribution of mothers according to knowledge of the benefits of breastfeeding in health centers in the urban community of Niamey.

Nutritional intake was the main known benefit of breastfeeding for the child with 72.61% and economic benefit for the mother with 74.33%. It also emerges from the knowledge assessment that only 10.33% of mothers knew that breast milk is preservable; 54.62% knew the importance of colostrum for the child; 98.12% were unaware of the Lactational Amenorrhea Method and a low rate of knowledge of breast cancer prevention through breastfeeding with 14.40% (Table 3).

• Mothers’ attitudes towards breastfeeding

Breastfeeding the child within 3 hours after birth was the most reported with 92.64%. Breastfeeding thereafter made at the request of the child in 54.15% of mothers (Table 4).

Table 4. Distribution of mothers according to the time taken to first breastfeed in the health centers of the urban community of Niamey.

• Mothers’ breastfeeding practices

Figure 1. Distribution of mothers according to the practice of exclusive breastfeeding before the age of 6 months in health centers in the urban community of Niamey.

All mothers reported breastfeeding their children, however the practice of exclusive breastfeeding before the age of 6 months was observed in 24.88% of mothers (Figure 1).

Figure 2. Distribution of mothers not exclusively breastfeeding before 6 months according to the associated food in the health centers of the urban community of Niamey.

Water was the main food associated with breastfeeding before the age of 6 months with 75.12% (Figure 2).

• Bivariate analysis

Table 5. Relationship between mothers’ age, occupation, time to first breastfeeding and exclusive breastfeeding practice in health centers in the urban community of Niamey.

The practice of exclusive breastfeeding was significantly linked to the mother’s age, profession, schooling and the time to first breastfeeding the child (p<0.05); the mother’s age over 25 years, the profession of housewife, schooling and early breastfeeding of the child were also factors significantly promoting the practice of breastfeeding (OR < 1) (Table 5).

4. Discussion

The average age of the mothers was 26.89 years ± 6.23 years ranging from 16 to 43 years. Doumbia A. [11] in 2024 in Mali, Mato N. [12] in 2021 in Niger and Ismael H. [13] in 2022 in Niger had respectively found average ages of 25.84 years, 24.80 years and 27.84 years. The young age of mothers could be explained by the precocity of procreation in our regions.

More than a quarter of mothers, or 29.58%, were not in school. Takassi OE et al. [14] in 2023 in Togo reported a non-schooling rate of 22.09% and Ismael H. [13] a rate of 33.60%. These relatively high rates of non-enrollment once again reflect the difficulties of access to education in our regions and in particular among the female junta.

Mothers with a “housewife” profession were the most represented with 81.37%. Safiatou M. [15] in 2021 in Mali and Ouattara A. [16] in 2023 in Mali had found respective rates of 52.03% and 55.6%.

The children were predominantly male with 53.21% with an average age of 6.23 months ± 4.42. Kangay S. et al. [17] in 2018 in Niger found a male predominance of 57%; a survey carried out in Niger in 2012 by the National Institute of Statistics reported a male predominance of 50.54% [7].

Pauciparous mothers were the most represented with 42.57%. This result is similar to that of Ouattara A. [16] and Diao O. [18] in 2024 in Mali who had respectively reported 45% and 46.90%. These results are consistent with the young age of mothers and the precocity of procreation observed in our survey.

The majority of mothers, 87.17%, received advice on breastfeeding, mainly through health centers with 92.28%. Mato N. [12] and Ismael H. [14] reported 85.60% and 73.20% respectively, including 80.40% and 71.29% from health personnel. These results reflect the particular interest that health personnel have in breastfeeding.

Nutritional intake and protection against infections with 72.62% and 74.33% respectively were the main known benefits of breastfeeding for the child, while the economic benefit was the main benefit for the mother with 73.33%. Diadié OH et al. [19] in 2020 in Niger found protection against diseases as an advantage of breastfeeding with 46.9% of the respondents. Boubacar M. [20] in 2016 in Niger reported the health and good growth of the infant as the main advantages of breastfeeding with 49.5% and 20.7% respectively. These results reflect the under-information of mothers regarding the advantages that breastfeeding offers for both the mother and the child.

Only 10.33% of mothers knew that breast milk is preservable; 54.62% knew the importance of colostrum for the child; 98.12% were unaware of the Lactational Amenorrhea Method and a low rate of knowledge of breast cancer prevention through breastfeeding with 14.40%. These results once again reflect the weakness of communication in favor of breastfeeding.

Breastfeeding the child within 3 hours after birth was the most reported with 92.64%of cases. Mato N. [10], Elkamel N. [21] in 2018 in Morocco and Takassi OE et al. [14] had respectively reported 81.60%; 75.79% and 53.5%. These results could be explained by the increase in deliveries in health facilities and the breastfeeding advice that health personnel could provide after delivery.

The frequency of breastfeeding the child was on demand in 54.15% of mothers. May Wake S. [22] in 2022 in Niger and Faycal [23] in 2012 in Cameroon had respectively reported that 62.67% and 87.10% of mothers breastfed on demand of the child. The WHO in fact recommends breastfeeding on demand of the child marked by crying.

All mothers reported breastfeeding their children, however the practice of exclusive breastfeeding before the age of 6 months was observed in 24.88% of mothers. Dieynaba B. [24] in 2021 in Senegal in 2021 and Léon G. et al. [25] in 2028 in Burkina Faso had respectively reported 51.80% and 40% of exclusive breastfeeding. Our bivariate analysis objectified that the practice of exclusive breastfeeding was significantly associated with the age, profession, education of the mother and the time to first breastfeeding the child (p < 0.05); the age of the mother over 25 years, the profession of housewife, the education of the mother and the early breastfeeding of the child had also been factors significantly favoring the practice of breastfeeding (OR < 1).

Water and decoctions were the main foods associated with breastfeeding before the age of 6 months with 75.12% and 26.29% respectively. These results could be explained by the hot climate of Niger with the feeling that the child was thirsty and the weight of the Muslim religion which recommends giving zamzam water to newborns.

5. Conclusion

Mothers had relatively low levels of knowledge about breastfeeding. Exclusive breastfeeding was observed in only a quarter of mothers, with water being the main association. Exclusive breastfeeding was significantly associated with factors such as the mother’s age, occupation, education, and time to first breastfeeding. Improving mothers’ knowledge, attitudes, and practices in this area requires appropriate communication and consideration of the identified factors.

Conflicts of Interest

The authors declare no conflicts of interest regarding the publication of this paper.

References