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. 2018 Feb 13;18(1):247.
doi: 10.1186/s12889-018-5145-y.

Population attributable risk of key modifiable risk factors associated with non-exclusive breastfeeding in Nigeria

Felix Akpojene Ogbo  1   2 , Andrew Page  3 , John Idoko  4 , Kingsley E Agho  3   5
Affiliations

Population attributable risk of key modifiable risk factors associated with non-exclusive breastfeeding in Nigeria

Felix Akpojene Ogbo et al. BMC Public Health. .

Abstract

Background: Non-exclusive breastfeeding (non-EBF) is a risk factor for many of the 2300 under-five deaths occurring daily in Nigeria - a developing country with approximately 40 million children. This study aimed to quantify and compare the attributable burden of key modifiable risk factors associated with non-EBF in Nigeria to inform strategic policy responses and initiatives.

Methods: Relative risk and exposure prevalence for selected modifiable risk factors were used to calculate population attributable fractions based on Nigeria Demographic and Health Surveys data for the period (1999-2013). Scenarios based on feasible impact of community-based interventions in reducing exposure prevalence were also considered to calculate comparative potential impact fractions.

Results: In Nigeria, an estimated 22.8% (95% Confidence Interval, CI: 9.2-37.0%) of non-EBF was attributable to primary and no maternal education; 24.7% (95% CI: 9.5-39.5%) to middle and poor household wealth, 9.7% (1.7-18.1%) to lower number (1-3) and no antenatal care visits; 18.8% (95% CI: 6.9-30.8%) to home delivery and 16.6% (95% CI: 3.0-31.3%) to delivery assisted by a non-health professional. In combination, more than half of all cases of non-EBF (64.5%; 95% CI: 50.0-76.4%) could be attributed to those modifiable risk factors. Scenarios based on feasible impacts of community-based approaches to improve health service access and human capacity suggest that an avoidable burden of non-EBF practice of approximately 11% (95% CI: -5.4; 24.7) is achievable.

Conclusion: Key modifiable risk factors contribute significantly to non-EBF in Nigerian women. Community-based initiatives and appropriate socio-economic government policies that specifically consider those modifiable risk factors could substantially reduce non-EBF practice in Nigeria.

Keywords: Infant; Nigeria; Non-exclusive breastfeeding; Population attributable risk.

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Conflict of interest statement

Ethics approval and consent to participate

The DHS project obtained the required ethical approvals from the National Health Research Ethic Committee (NHREC) in Nigeria before the surveys were conducted (Assigned Number NHREC/01/01/2007). Participants were informed of the rationale for the surveys, confidentiality of their responses, and that they don’t have to answer the questions if they do not feel comfortable doing so. Participants provided written informed consent before they were allowed to participate in the surveys. The data used in this study were anonymous and are publicly available to apply for online. Approval was sought from MEASURE DHS/ICF International and permission was granted for this use.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

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