Exclusive breastfeeding among infants in Jigawa State, Nigeria: a cross-sectional analysis

Initiation of breastfeeding within 1 hour of birth, exclusive breastfeeding (EBF) up to 6-months, and complementary feeding with continued breastfeeding up to two years of age are World Health Organization recommended practices. However, infant feeding patterns vary widely, influenced by cultural, social, economic and environmental factors. This study aims to evaluate EBF in Jigawa state, proving context-specific data to guide locally relevant public health interventions. We conducted a cross-sectional analysis of household survey data collected between January to June 2021 in Kiyawa Local Government Area, Jigawa. These data formed the baseline survey from the ‘Integrated Sustainable Childhood Pneumonia and Infectious Disease Reduction in Nigeria’ (INSPIRING) Jigawa cluster randomized controlled trial (ISRCTN3921355). We analysed a sub-set of the data, for women with children under two years of age, to determine the prevalence of early initiation of breastfeeding, EBF up to 6-months, and timing of complimentary feeding initiation, and associations with socio-economic indicators. Multivariable modified Poisson regression was used to explore associations with EBF amongst 0–5-month-olds (i.e. current EBF), and with retrospectively reported EBF up to 6 months amongst 6–24-month-olds. A total of 4836 eligible women with a child under two years were surveyed across 3800 compounds. Among mothers of children aged 0–5 months, 98.1% were breastfeeding and 71.3% reported EBF at the time of the survey. Only 20.0% initiated breastfeeding within 1 hour of birth. The likelihood of EBF was lower among women in manual (aRR: 0.85; 95%CI: 0.77, 0.94) and non-manual work (aRR: 0.87; 95%CI: 0.78, 0.97) compared to those not working, and higher in those from higher compound wealth quintiles, and who had suffered recent pregnancy or child loss (aRR: 1.25; 95%CI: 1.01, 1.56). Among 6–24-month-olds, older maternal age reduced the likelihood of completing 6-months of EBF. EBF was associated with socio-economic factors in this rural, low-income setting, but the self-reported prevalence of EBF was much higher than expected, compared to nationally representative surveys. Targeted support for older mothers, mothers of twins, and household-centered education involving key family members will be essential to improve EBF practices in this high mortality setting.