Prevalence and factors associated with exclusive breastfeeding among children aged 0 to 6 months attending the immunization unit at Benadir Hospital in Mogadishu, Somalia

Abstract

Background: Exclusive breastfeeding (EBF) refers to the most favorable way of receiving only breast milk directly from the breast or expressed. World Health Organization (WHO) recommends the practice of exclusive breastfeeding for up to 6 months of age. The health benefits of exclusive breastfeeding on growth, development, survival, and well-being of the mothers are well recognized. Despite global efforts to increase exclusive breastfeeding practices, various studies in developing countries still report sub-optimal exclusive breastfeeding practices. However, data on exclusive breastfeeding practices is limited in Somalia. Objectives: This study aimed to determine the prevalence and factors associated with exclusive breastfeeding for children aged 0 to 6 months attending the immunization unit at Benadir hospital in Somalia. Methodology: This was a cross-sectional study with both qualitative and quantitative components carried out in Benadir hospital, Mogadishu, Somalia. Data was collected over a period of two consecutive months. A semi-structured questionnaire was used for collecting information on demographics and socio-economic characteristics and breastfeeding practices among 334 mothers. Additionally, Focus Group Discussions (FGDs) of breastfeeding mothers and key Informant interviews with health workers were conducted. Consent was obtained from all study participants before conducting discussions and interviews. Quantitative data was entered using EPIDATA 3.1 and analyzed using STATA 14.0 while the content thematic approach was used for analysis of qualitative data. The prevalence of EBF was reported as a proportion while factors independently associated with EBF were determined using regression analysis. Results: The prevalence of exclusive breastfeeding was 38.3% (95% CI 31.9%-45.6%) among children aged 0-6 months in Mogadishu, Somalia. Exclusive breastfeeding rates decreased with the age of the infant. The younger infants were more likely to be exclusively breastfed (AOR, 5.1; 95% CI,1.65-15.80). Mothers with formal education and housewives were more likely to exclusively breastfeed their babies with AOR, 2.48; 95% CI, 1.54-4.01 and AOR, 4.01; 95% CI, 1.10-14.58, respectively. Infants who were not sick in the past two weeks were more likely to be exclusively breastfed (AOR, 2.26; 95% CI,1.40-3.67). All the participants acknowledged that exclusive breastfeeding was good and recognized the benefits of breastfeeding. Despite the positive perceptions, few mothers exclusively breastfed for the first six months. Insufficient breast milk, lack of awareness, negative cultural beliefs, low socio-economic status, mothers resuming work and pregnancy were among important factors for early cessation of exclusive breastfeeding. Conclusions: The prevalence of exclusive breastfeeding was found to be low in Mogadishu, Somalia. The factors associated with exclusive breastfeeding were younger age of the infant, mothers with formal education, being a housewife and infant not being ill in the past two weeks. Negative community perceptions like insufficiency of breast milk, colostrum considered not good for the baby and a belief that water was necessary to reduce heat of the baby’s body hindered exclusive breastfeeding. Recommendations: In order to increase the rate of exclusive breastfeeding, a multi-pronged approach should be used. The heath workers and immunization teams should address the negative perceptions held by the mothers to promote exclusive breastfeeding. In addition, efforts should be made to operationalize the Infant and Young Child Feeding (IYCF) policy which was endorsed by the Somali government but is not yet fully implemented.