Knowledge and Beliefs About Exclusive Breastfeeding Among Rural Nigerian Men in Enugu,Southeast Nigeria

Introduction

Exclusive breastfeeding has been defined as feeding an infant with breastmilk only without giving any other foods, not even water. The definition allows for prescribed medicines, immunizations, vitamins, and mineral supplements. ¹ The World Health Organization/United Nations Children's Fund recommends that children receive nothing but breastmilk for the first 6 months of life. ² Despite the benefits of exclusive breastfeeding, the rate in Nigeria is still low. According to the Nigeria Demographic Health Survey in 2003, ² only 26% of infants <2 months of age and 17% less than 6 months of age are exclusively breastfed. In a study among women in Enugu, Nigeria, it was observed that despite a high level of knowledge about exclusive breastfeeding, that level of practice was still low because of negative influences by mothers' in-laws and husbands. ³ This study aims to evaluate the knowledge, beliefs, and attitude of men in a rural community toward exclusive breastfeeding.

Materials and Methods

This study was carried out in a rural community in Enugu state, southeast Nigeria. A sample of 200 men was drawn from this community. Pretested, structured, interviewer-administered questionnaires were used to collect data from the selected men by medical students specially trained for the survey. Verbal informed consent was obtained from each participant before recruitment. Information collected from the men included their sociodemographic characteristics and their knowledge and beliefs about exclusive breastfeeding.

Data analysis was carried out with SPSS version 11 computer software (SPSS Inc., Chicago, IL). The χ² test was done for testing statistical significance. Statistical significance was considered present when the p value was less than 0.05.

Results

The age range of men studied was 19–90 years, with a mean of 47.2 ± 18.2 years. The majority (69.5%) were married, 64 (34.2%) had no formal education, 55 (29.4%) had primary education, and 31.6% and 4.8% had secondary and tertiary education, respectively.

One hundred fifty-four men (82.4%) had heard of exclusive breastfeeding, 81 (43.3%) correctly defined exclusive breastfeeding, and 56 (29.9%) knew that exclusive breastfeeding should be initiated within 30 minutes of the delivery of an infant. Their sources of information on exclusive breastfeeding were mainly medical personnel (39.0%) and news media (23%).

Only 30.5% of the men believed that breastmilk alone was ideal for an infant in the first 6 months of life; 53.5% of them believed that breastmilk and water should be given in the first 6 months of life. Seventy-two (38.5%) of the men studied accepted that colostrum should be given to the newborn child. The reasons for rejecting colostrum were because it was perceived as poisonous (45.5%), dirty (24.5%) milk, among other reasons.

One hundred six (56.7%) respondents accepted the practice of exclusive breastfeeding. Reasons for nonacceptance of exclusive breastfeeding were that it is inadequate (60.0%), time-consuming (19%), and negatively affects the health of the mother (15.5%). Knowledge of the advantages of breastfeeding revealed that nutritional adequacy and prevention of childhood illnesses were the commonest benefits acknowledged. Only one respondent knew the contraceptive benefit of breastmilk, and none mentioned prevention of some cancers as a benefit. Education had a significant impact on knowledge and acceptance of exclusive breastfeeding. Also, single men and those of younger age were more in favor of the practice of exclusive breastfeeding (Table 1).

Discussion

In this study 82.4% of the men had heard of exclusive breastfeeding, although only (43.3%) knew the correct meaning of exclusive breastfeeding. Jimoh ⁴ similarly demonstrated a high level of awareness of breastfeeding of 66.4% in his study in Equatorial Guinea. However, misconceptions and lack of in-depth knowledge on important aspects of exclusive breastfeeding still abound. Only 29.9% knew the correct time for initiation of breastfeeding, while 52.9% believed that a child must be given breastmilk and water. The high temperature in the tropics probably led to this opinion. Breastmilk contains sufficient water for the baby, and an exclusively breastfed baby does not suffer the risk of dehydration.

Men reportedly have hitherto not been traditionally involved in breastfeeding promotion campaigns, and this calls for intensive and sustained health education targeted at them to address these gaps in knowledge as well as the misconceptions. In such rural communities existing social structures like the men's village meetings and churches can be explored as possible avenues for further dissemination of vital information on exclusive breastfeeding to men.

Only 38.5% would support the statement that infants should be fed with colostrum because of misconceptions. Jimoh ⁴ similarly reported such misconceptions as the basis for low acceptance of feeding colostrum among men in Equatorial Guinea. The colostrum is rich in maternal antibodies, which when transferred to the baby during breastfeeding protect the newborn from some infantile diseases with subsequent reduction in neonatal mortality.^5,6 Not giving the child colostrum implies that these newborns starve during this period with possible delay in the establishment of lactation later. ⁷ There is a positive attitude by the men towards exclusive breastfeeding, which suggests that winning the confidence and support of men will improve the practice of exclusive breastfeeding of their spouse. Men need to understand the mutual benefit of exclusive breastfeeding to mother and child. This could go a long way in changing negative attitudes toward exclusive breastfeeding.

Conclusion

Nigerian rural men lack in-depth knowledge on some aspects of exclusive breastfeeding and should be targeted for intensive breastfeeding education.