Breastfeeding: knowledge and practice among mothers attending an immunization clinic in a federal tertiary institution, in South Eastern Nigeria

Abstract Background Breastfeeding, particularly exclusive breastfeeding (EBF) for the first 6 months, is a cost-effective strategy for reduction of infant morbidity and mortality. Despite World Health Organization (WHO) recommendations, EBF rates remain suboptimal in Nigeria, a low-income country. Maternal knowledge and attitudes are critical determinants of EBF practice. This study assessed breastfeeding knowledge and practices among mothers to identify factors associated with the suboptimal rate and suggest interventions for improving EBF rate in Nigeria. Methods A descriptive cross-sectional study was conducted using a structured questionnaire administered to mothers attending the immunization clinic of Federal Tertiary Institution, in South Eastern Nigeria. Knowledge and practices regarding breastfeeding were evaluated. Simple and multiple logistic regression analyses were performed to identify factors associated with EBF practice. Results Among 297 participating mothers, with a mean age of 29.3 ± 5.3 years, 212 (71.4%) had tertiary level of education. Knowledge levels appeared relatively high: 275 (92.6%) had heard of EBF, 255 (85.9%) recognized its benefits for the mother-baby dyad, and 239 (80.5%) correctly identified the 6-month duration. However, only 155 (50.5%) reported practicing EBF with their current infant. In contrast, 179 (60.3%) reported practicing EBF for 6 months with previous children. While 194 (65.3%) recognized the importance of initiating breastfeeding within 1 h of birth, 16 (5.4%) believed initiation should wait until baby and mother are “ready” and 16 (5.4%) endorsed discarding colostrum. Only 125 (42.0%) preferred feeding breast milk alone for the first 6 months. Mothers with tertiary education were significantly more likely to have practiced EBF compared to those with secondary education (69.5% vs. 38.5%; Adjusted OR = 0.38, 95% CI 0.19 to 0.73, p = 0.004). Maternal age, socioeconomic class, tribe, and religion were not significantly associated with EBF practice. Conclusion Despite generally high awareness of EBF recommendations/practice, actual practice among these mothers was an average (50.5%), revealing a significant knowledge-practice gap. Maternal education level was a strong predictor of EBF practice. These findings underscore the urgent need for enhanced, targeted health education interventions focusing on translating knowledge into practice, particularly during antenatal and early postpartum care, to improve EBF rates.