Breakthrough RESEARCH/Nigeria, Plot 839 Idris Ibrahim Crescent, Jabi, Abuja, Nigeria.
Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA.
Int Breastfeed J. 2022 Sep 1;17(1):63. doi: 10.1186/s13006-022-00500-w.
Early initiation of breastfeeding within the first hour of birth and exclusive breastfeeding (EBF) for the first six months of life are beneficial for child survival and long-term health. Yet breastfeeding rates remain sub-optimal in Northwestern Nigeria, and such practices are often influenced by complex psychosocial factors at cognitive, social and emotional levels. To understand these influences, we developed a set of breastfeeding-related ideational factors and quantitatively examined their relationship with early initiation of breastfeeding and EBF practices.
A cross-sectional population-based survey was conducted in Kebbi, Sokoto, and Zamfara states from September-October 2019. A random sample of 3039 women with a child under-2 years was obtained. Respondents were asked about the two main outcomes, early initiation of breastfeeding and EBF, as well as breastfeeding-related ideations according to the Ideation Model of Strategic Communication and Behavior Change. Average marginal effects were estimated from mixed-effects logistic regression models adjusted for ideational and socio-demographic variables.
Among 3039 women with a child under 2 years of age, 42.1% (95% CI 35.1%, 49.4%) practiced early initiation of breastfeeding, while 37.5% (95% CI 29.8%, 46.0%) out of 721 infants aged 0-5 months were exclusively breastfed. Women who knew early initiation of breastfeeding was protective of newborn health had 7.9 percentage points (pp) [95% CI 3.9, 11.9] higher likelihood of early initiation of breastfeeding practice than those who did not know. Women who believed colostrum was harmful had 8.4 pp lower likelihood of early initiation of breastfeeding (95% CI -12.4, -4.3) and EBF (95% CI -15.7%, -1.0%) than those without that belief. We found higher likelihood of early initiation of breastfeeding (5.1 pp, 95% CI 0.8%, 9.4%) and EBF (13.3 pp, 95% CI 5.0%, 22.0%) among women who knew at least one benefit of breastfeeding compared to those who did not know. Knowing the timing for introducing complementary foods andself-efficacy to practice EBF were also significantly associated with EBF practices.
Ideational metrics provide significant insights for SBC programs aiming to change and improve health behaviors, including breastfeeding practices, Various cognitive, emotional and social domains played a significant role in women's breastfeeding decisions. Maternal knowledge about the benefits of breastfeeding to the mother (cognitive), knowledge of the appropriate time to introduce complementary foods (cognitive), beliefs on colostrum (cognitive), self-efficacy to breastfeed (emotional) and perceived social norms (social) are among the most important ideations for SBC programs to target to increase early initiation of breastfeeding and EBF rates in northwestern Nigeria.
在出生后第一小时内开始母乳喂养，并在生命的头六个月内进行纯母乳喂养，这对儿童的生存和长期健康都有益。然而，在尼日利亚西北部，母乳喂养率仍然不理想，这种做法通常受到认知、社会和情感层面复杂心理社会因素的影响。为了了解这些影响，我们制定了一系列与母乳喂养相关的观念因素，并对其与早期母乳喂养开始和纯母乳喂养实践的关系进行了定量研究。
本横断面人群调查于 2019 年 9 月至 10 月在凯比州、索科托州和赞法拉州进行。随机抽取了 3039 名 2 岁以下儿童的母亲作为研究对象。受访者根据战略沟通和行为改变的观念模型，被问及两个主要结果，即早期母乳喂养开始和纯母乳喂养，以及与母乳喂养相关的观念。混合效应逻辑回归模型调整了观念和社会人口统计学变量后，估计了平均边际效应。
在 3039 名 2 岁以下儿童的母亲中，42.1%（95%置信区间 35.1%，49.4%）实施了早期母乳喂养，而 721 名 0-5 个月大的婴儿中，有 37.5%（95%置信区间 29.8%，46.0%）纯母乳喂养。与不知道早期母乳喂养对新生儿健康有保护作用的妇女相比，知道早期母乳喂养具有保护作用的妇女实施早期母乳喂养的可能性高 7.9 个百分点（95%置信区间 3.9，11.9）。与没有这种信念的妇女相比，相信初乳有害的妇女进行早期母乳喂养的可能性低 8.4 个百分点（95%置信区间 -12.4，-4.3），纯母乳喂养的可能性低 8.4 个百分点（95%置信区间 -15.7%，-1.0%）。与不知道母乳喂养至少一个益处的妇女相比，知道母乳喂养益处的妇女进行早期母乳喂养（5.1 个百分点，95%置信区间 0.8%，9.4%）和纯母乳喂养（13.3 个百分点，95%置信区间 5.0%，22.0%）的可能性更高。知道何时引入补充食品以及实践纯母乳喂养的自我效能，也与纯母乳喂养实践显著相关。
观念指标为旨在改变和改善健康行为（包括母乳喂养实践）的 SBC 项目提供了重要的见解。认知、情感和社会等各种领域在妇女的母乳喂养决策中发挥了重要作用。母亲对母乳喂养对母亲（认知）的益处的了解、了解何时引入补充食品（认知）、对初乳的信念（认知）、母乳喂养的自我效能（情感）和感知的社会规范（社会）等观念是 SBC 项目的最重要目标，旨在提高尼日利亚西北部地区早期母乳喂养和纯母乳喂养率。
