Skin-to-skin contact and breastfeeding practices in Nigeria: a study of socioeconomic inequalities

International Breastfeeding Journal, Volume 17, No. 1, Year 2022

Interpretação

Background: The effects of breastfeeding practices on children’s health are undoubtedly of great interest. However, inequalities in breastfeeding practices and mother and newborn skin-to-skin contact (SSC) exist in many resource-constrained settings. This study examined the regional prevalence and socioeconomic inequalities in exclusive breastfeeding (EBF), early initiation of breastfeeding and SSC in Nigeria. Methods: Data on 2936 infants under six months were extracted from the 2018 Nigeria Demographic and Health Survey (NDHS) to determine EBF. In addition, data on 21,569 children were analysed for early initiation of breastfeeding and SSC. Concentration index and curves were used to measure socioeconomic inequalities in EBF, early initiation of breastfeeding and SSC. Results: The prevalence of EBF, early initiation of breastfeeding and SSC were 31.8, 44.2 and 12.1% respectively. Furthermore, Ogun state had the highest prevalence of EBF (71.4%); while Bayelsa state had the highest prevalence of SSC (67.8%) and early initiation of breastfeeding (96.2%) respectively. Urban dwellers had higher prevalence of EBF, SSC and early initiation of breastfeeding across household wealth quintile and by levels of mothers’ education in contrast to their rural counterparts. We quantified inequalities in early initiation of breastfeeding, EBF, and SSC according to household wealth and maternal education. The study outcomes had greater coverage in higher household wealth, in contrast to the lower household wealth groups; early initiation of breastfeeding (concentration index = 0.103; p = 0.002), EBF (concentration index = 0.118; p < 0.001), and SSC (concentration index = 0.152; p < 0.001) respectively. Furthermore, early initiation of breastfeeding (concentration index = 0.091; p < 0.001), EBF (concentration index = 0.157; p < 0.001) and SSC (concentration index = 0.156; p < 0.001) had greater coverage among mothers with higher educational attainment. Conclusion: Low prevalence and socioeconomic inequalities in early initiation of breastfeeding, EBF and SSC were identified. We recommend that health promotion programs targeted and co-designed with disadvantaged mothers are critical to meet global breastfeeding targets. Also, future researchers should conduct further studies especially clinical control trials and qualitative studies to unravel the possible reasons for differences in the indicators. We analysed a cross-sectional data extracted from Nigeria Demographic and Health Survey (NDHS) 2018. MEASURE DHS provided technical input in the process of data collection and is supported by the National Population Commission (NPC). NDHS is a vital source of data on EBF, early initiation of breastfeeding and SSC especially as it consists of a nationally representative sample of households. Demographic and Health Survey (DHS) data was collected through a stratified multistage cluster sampling technique. The procedure for stratification approach divides the population into groups by geographical region and commonly crossed by place of residence – urban versus rural. A multi-level stratification approach was used to divide the population into first-level strata and then subdivide the first-level strata into second-level strata, and so on. A two-level stratification in DHS is region and urban/rural stratification. DHS data is available in the public domain and accessed upon approval from DHS. The details of DHS data has been reported in a previous study [35]. Data on 2936 children under six months was extracted for the EBF analysis. In addition, data on 21,569 children was analysed for early initiation of breastfeeding and SSC respectively. NDHS 2018 selected a total of 41,668 households for the sample, of which 40,666 were occupied. Of the occupied households, 40,427 were successfully interviewed, yielding a response rate of 99%. In the households interviewed, 42,121 women aged 15–49 were identified for individual interviews. Interviews were completed with 41,821 women, yielding a response rate of 99% [36]. Outcomes Women’s educational attainment was categorised as: no formal education, primary school, secondary school, and higher education. Household wealth quintile was computed by DHS using principal components analysis (PCA) to assign the wealth indicator weights. In their computation, they assigned scores and standardised the wealth indicator variable using household assets including; wall, floor, roof and wall type; whether a household had improved versus unimproved sanitation amenities and water source; whether a household had essential assets such as electricity, radio, television, cooking fuel, refrigerator, furniture amongst others. Furthermore, the factor loadings and z-scores were calculated. For each household, they multiplied the indicator values by factor loadings and summed to produce the household’s wealth index value. The standardised z-score was disentangled to classify the overall scores to wealth quintiles; poorest, poorer, middle, richer and richest [37]. Household wealth quintiles and mothers’ educational attainment were used as measures of socioeconomic status similar to previous studies [38]. Residential status was classified as urban versus rural. Geographical region and states were measured as: This study was based on an analysis of population-based data that exist in public domain and available online with all identifier information removed. The authors were granted access to use the data by MEASURE DHS/ICF International. DHS Program is consistent with the standards for ensuring the protection of respondents’ privacy. ICF International ensures that the survey complies with the U.S. Department of Health and Human Services regulations for the respect of human subjects. The DHS project sought and obtained the required ethical approval from the National Health Research Ethics Committee (NHREC) in Nigeria before the surveys were conducted. No further consent was required for this study. Stata Version 14 (StataCorp., College Station, TX, USA) was used for data analysis. Stata survey module (‘svy’) was used with adjustment for the sample design. Percentage and Chi-square tests were used for summary statistics and bivariate analysis respectively. To determine socioeconomic inequalities in EBF, early initiation of breastfeeding and SSC, we used concentration index and present it graphically with the concentration curve. When the concentration index value is positive or the curve lies below the diagonal line (line of equality), it indicates that EBF, early initiation of breastfeeding and SSC coverage is greater among high socioeconomic groups. Conversely, when concentration index value is negative or the curve is above the line of equality, it indicates that EBF, early initiation of breastfeeding and SSC coverage is higher among low socioeconomic groups. The concentration index was used to decipher socioeconomic inequalities using Erreygers adjustment. The statistical significance was determined at p < 0.05.

AI Digest

Study Justification:

– The study aimed to examine the prevalence and socioeconomic inequalities in exclusive breastfeeding (EBF), early initiation of breastfeeding, and skin-to-skin contact (SSC) in Nigeria.
– Breastfeeding practices have a significant impact on children’s health, making it an important area of study.
– Inequalities in breastfeeding practices and SSC exist in resource-constrained settings, highlighting the need for research in this area.

Study Highlights:

– The prevalence of EBF, early initiation of breastfeeding, and SSC in Nigeria were found to be 31.8%, 44.2%, and 12.1% respectively.
– Ogun state had the highest prevalence of EBF (71.4%), while Bayelsa state had the highest prevalence of SSC (67.8%) and early initiation of breastfeeding (96.2%).
– Urban dwellers had higher prevalence of EBF, SSC, and early initiation of breastfeeding compared to rural dwellers across different socioeconomic groups and levels of maternal education.
– Socioeconomic inequalities were identified, with higher coverage of EBF, early initiation of breastfeeding, and SSC among higher socioeconomic groups and mothers with higher educational attainment.

Recommendations for Lay Reader and Policy Maker:

– Health promotion programs targeted at and co-designed with disadvantaged mothers are recommended to address the low prevalence and socioeconomic inequalities in early initiation of breastfeeding, EBF, and SSC.
– Future research should include clinical control trials and qualitative studies to further understand the reasons for differences in breastfeeding indicators.

Key Role Players:

– Health promotion organizations and agencies
– Community health workers
– Maternal and child health clinics
– Non-governmental organizations (NGOs) working in maternal and child health

Cost Items for Planning Recommendations:

– Development and implementation of health promotion programs
– Training and capacity building for health workers and community volunteers
– Outreach and awareness campaigns
– Provision of breastfeeding support materials and resources
– Monitoring and evaluation of program effectiveness
Please note that the cost items provided are general suggestions and may vary depending on the specific context and resources available.

Força da prova

N/A

Resumo

We analysed a cross-sectional data extracted from Nigeria Demographic and Health Survey (NDHS) 2018. MEASURE DHS provided technical input in the process of data collection and is supported by the National Population Commission (NPC). NDHS is a vital source of data on EBF, early initiation of breastfeeding and SSC especially as it consists of a nationally representative sample of households. Demographic and Health Survey (DHS) data was collected through a stratified multistage cluster sampling technique. The procedure for stratification approach divides the population into groups by geographical region and commonly crossed by place of residence – urban versus rural. A multi-level stratification approach was used to divide the population into first-level strata and then subdivide the first-level strata into second-level strata, and so on. A two-level stratification in DHS is region and urban/rural stratification. DHS data is available in the public domain and accessed upon approval from DHS. The details of DHS data has been reported in a previous study [35]. Data on 2936 children under six months was extracted for the EBF analysis. In addition, data on 21,569 children was analysed for early initiation of breastfeeding and SSC respectively. NDHS 2018 selected a total of 41,668 households for the sample, of which 40,666 were occupied. Of the occupied households, 40,427 were successfully interviewed, yielding a response rate of 99%. In the households interviewed, 42,121 women aged 15–49 were identified for individual interviews. Interviews were completed with 41,821 women, yielding a response rate of 99% [36]. Outcomes Women’s educational attainment was categorised as: no formal education, primary school, secondary school, and higher education. Household wealth quintile was computed by DHS using principal components analysis (PCA) to assign the wealth indicator weights. In their computation, they assigned scores and standardised the wealth indicator variable using household assets including; wall, floor, roof and wall type; whether a household had improved versus unimproved sanitation amenities and water source; whether a household had essential assets such as electricity, radio, television, cooking fuel, refrigerator, furniture amongst others. Furthermore, the factor loadings and z-scores were calculated. For each household, they multiplied the indicator values by factor loadings and summed to produce the household’s wealth index value. The standardised z-score was disentangled to classify the overall scores to wealth quintiles; poorest, poorer, middle, richer and richest [37]. Household wealth quintiles and mothers’ educational attainment were used as measures of socioeconomic status similar to previous studies [38]. Residential status was classified as urban versus rural. Geographical region and states were measured as: This study was based on an analysis of population-based data that exist in public domain and available online with all identifier information removed. The authors were granted access to use the data by MEASURE DHS/ICF International. DHS Program is consistent with the standards for ensuring the protection of respondents’ privacy. ICF International ensures that the survey complies with the U.S. Department of Health and Human Services regulations for the respect of human subjects. The DHS project sought and obtained the required ethical approval from the National Health Research Ethics Committee (NHREC) in Nigeria before the surveys were conducted. No further consent was required for this study. Stata Version 14 (StataCorp., College Station, TX, USA) was used for data analysis. Stata survey module (‘svy’) was used with adjustment for the sample design. Percentage and Chi-square tests were used for summary statistics and bivariate analysis respectively. To determine socioeconomic inequalities in EBF, early initiation of breastfeeding and SSC, we used concentration index and present it graphically with the concentration curve. When the concentration index value is positive or the curve lies below the diagonal line (line of equality), it indicates that EBF, early initiation of breastfeeding and SSC coverage is greater among high socioeconomic groups. Conversely, when concentration index value is negative or the curve is above the line of equality, it indicates that EBF, early initiation of breastfeeding and SSC coverage is higher among low socioeconomic groups. The concentration index was used to decipher socioeconomic inequalities using Erreygers adjustment. The statistical significance was determined at p < 0.05.

Materiais

N/A

Inovações

Based on the provided information, here are some potential innovations that could improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop mobile applications that provide information and support to pregnant women and new mothers. These apps can offer guidance on breastfeeding practices, skin-to-skin contact, and other maternal health topics. They can also provide reminders for important milestones and appointments.

2. Telemedicine Services: Implement telemedicine services that allow pregnant women and new mothers to consult with healthcare professionals remotely. This can help overcome geographical barriers and provide access to expert advice and support, especially in rural areas where healthcare facilities may be limited.

3. Community Health Workers: Train and deploy community health workers who can provide education and support to pregnant women and new mothers in their communities. These workers can conduct home visits, offer counseling on breastfeeding and skin-to-skin contact, and connect women to appropriate healthcare services.

4. Maternal Health Hotlines: Establish toll-free hotlines staffed by trained healthcare professionals who can provide guidance and answer questions related to maternal health. This can be particularly helpful for women who may not have easy access to healthcare facilities or who prefer to seek advice over the phone.

5. Public Awareness Campaigns: Launch public awareness campaigns to promote the importance of breastfeeding practices and skin-to-skin contact. These campaigns can target both expectant mothers and the general public, aiming to increase knowledge and understanding of the benefits of these practices.

6. Financial Support Programs: Implement financial support programs that provide incentives or subsidies for breastfeeding supplies, such as breast pumps or lactation consultants. This can help reduce the financial barriers that some women may face when trying to establish and maintain breastfeeding.

7. Maternity Leave Policies: Advocate for improved maternity leave policies that allow women to take sufficient time off work to establish breastfeeding and provide adequate care for their newborns. Longer maternity leave periods can support breastfeeding initiation and continuation.

It is important to note that these recommendations are based on the information provided and may need to be tailored to the specific context and needs of Nigeria.

AI Innovations Description

Based on the description provided, the recommendation to improve access to maternal health, specifically in relation to breastfeeding practices and skin-to-skin contact (SSC) in Nigeria, is as follows:

1. Targeted Health Promotion Programs: Implement health promotion programs that are specifically designed and targeted towards disadvantaged mothers. These programs should focus on educating and empowering mothers about the importance of breastfeeding practices and SSC for the health and well-being of both the mother and the newborn.

2. Co-Design with Disadvantaged Mothers: Involve disadvantaged mothers in the design and development of health promotion programs. This will ensure that the programs are culturally sensitive, relevant, and address the specific needs and challenges faced by these mothers. By including their input and perspectives, the programs can be tailored to better meet their needs and increase their engagement and participation.

3. Address Socioeconomic Inequalities: Recognize and address the socioeconomic inequalities that exist in early initiation of breastfeeding, exclusive breastfeeding (EBF), and SSC. These inequalities were identified in the study, with higher prevalence of these practices observed among urban dwellers and mothers with higher educational attainment. Efforts should be made to provide equal access and support for all mothers, regardless of their socioeconomic status, to ensure that no one is left behind.

4. Conduct Further Research: Conduct further studies, including clinical control trials and qualitative studies, to gain a deeper understanding of the reasons for the differences in breastfeeding practices and SSC indicators. This research can help identify barriers and facilitators to these practices and inform the development of targeted interventions and strategies to improve access and uptake.

By implementing these recommendations, it is hoped that access to maternal health, specifically in relation to breastfeeding practices and SSC, can be improved in Nigeria, leading to better health outcomes for both mothers and newborns.

AI Innovations Methodology

Based on the provided information, here are some potential recommendations to improve access to maternal health, specifically related to breastfeeding practices and skin-to-skin contact in Nigeria:

1. Implement targeted health promotion programs: Develop and implement health promotion programs specifically targeted at disadvantaged mothers, with a focus on educating them about the importance of breastfeeding practices and skin-to-skin contact. These programs should be co-designed with the involvement of the target population to ensure cultural sensitivity and relevance.

2. Strengthen healthcare infrastructure: Improve the availability and accessibility of healthcare facilities, particularly in rural areas, to provide support and guidance to mothers regarding breastfeeding practices and skin-to-skin contact. This includes training healthcare providers on the benefits and techniques of breastfeeding and promoting skin-to-skin contact.

3. Enhance community support: Engage community leaders, traditional birth attendants, and community health workers to raise awareness about the importance of breastfeeding and skin-to-skin contact. Encourage community support groups and peer networks to provide guidance and support to mothers.

4. Address socioeconomic inequalities: Develop strategies to address socioeconomic inequalities that contribute to disparities in breastfeeding practices and skin-to-skin contact. This may involve providing financial assistance or incentives to disadvantaged mothers, improving access to education and employment opportunities, and addressing cultural and social barriers.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define indicators: Identify specific indicators to measure the impact of the recommendations, such as the percentage of mothers practicing exclusive breastfeeding, the percentage of mothers initiating breastfeeding early, and the percentage of mothers practicing skin-to-skin contact.

2. Data collection: Collect baseline data on the selected indicators from a representative sample of mothers in different regions of Nigeria. This can be done through surveys or interviews conducted by trained researchers.

3. Intervention implementation: Implement the recommended interventions, such as targeted health promotion programs, strengthening healthcare infrastructure, and enhancing community support. Ensure that the interventions are implemented consistently across the selected regions.

4. Post-intervention data collection: After a specified period of time, collect data on the same indicators from the same sample of mothers. This will allow for a comparison between the baseline and post-intervention data.

5. Data analysis: Analyze the data using appropriate statistical methods to determine the impact of the interventions. Calculate the changes in the selected indicators and assess whether the recommendations have led to improvements in access to maternal health, specifically related to breastfeeding practices and skin-to-skin contact.

6. Interpretation and reporting: Interpret the findings of the data analysis and report the results, highlighting the impact of the recommendations on improving access to maternal health. Provide recommendations for further improvements or modifications to the interventions based on the results.

It is important to note that this methodology is a general framework and may need to be adapted based on the specific context and resources available for the simulation study.

Autores & Coautores

Statistics:

Citations: 3

Authors: 3

Identifiers:

DOI: 10.1186/s13006-021-00444-7

Research Areas:

Community Interventions, Disparities, Environmental, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants

Study Countries:

Nigeria

Study Design:

Cross Sectional Study, Grounded Theory

Study Approach:

Mixed-methods, Qualitative, Quantitative

Participants Gender:

Female

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