Adherence to WHO Exclusive Breastfeeding Guidelines and Perceived Barriers: A Comparative Study of Rural, Suburban, and Urban Communities in Enugu State, Nigeria.
1
College of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla Enugu, Nigeria
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Exclusive breastfeeding (EBF) for the first six months, as recommended by the World Health Organization (WHO), is a key public health strategy for improving infant survival and development. Adherence to WHO EBF guidelines remains suboptimal, influenced by sociocultural, maternal, and systemic factors. Evidence suggests adherence may differ across rural, suburban, and urban communities, yet these contextual variations are underexplored. Understanding these differences is critical for designing targeted interventions. This study assessed adherence to WHO EBF guidelines and identified perceived barriers among mothers in Enugu State, Nigeria.
METHODS:
A descriptive comparative cross-sectional study was conducted in three settings: a rural community, a suburban community, and Enugu metropolis. Using multistage and systematic sampling, 250 mothers with at least one previous childbirth were recruited. Structured questionnaires collected data on breastfeeding practices relative to WHO EBF guidelines and perceived barriers. Descriptive statistics summarized adherence, while Pearson’s chi-square test identified significant predictors of adherence (p < 0.05). Written informed consent was obtained from all participants.
RESULTS:
Breastfeeding was initiated by most mothers (rural 94.7%, urban 98.7%, suburban 100%), with early initiation within one hour ranging from 44.9% (urban) to 67.4% (suburban). Colostrum feeding was high (87.2–93.0%). Introduction of water or other liquids before six months was common, particularly in rural communities (75.8%), indicating suboptimal adherence. Reported barriers included maternal fatigue, infant refusal, cultural pressure, breast pain, return to work, and lack of partner support (~50–60%). Significant predictors of adherence were maternal age (p=0.002), community type (rural, suburban, urban) (p=0.002), father’s education (p=0.016), father’s occupation (p=0.035), and number of children (p=0.008).
CONCLUSIONS:
Adherence to WHO exclusive breastfeeding guidelines is suboptimal, especially regarding early introduction of liquids, with marked differences across community types. Community-specific, culturally sensitive interventions targeting maternal, familial, and systemic barriers are essential to improve EBF adherence and infant health outcomes
Exclusive breastfeeding (EBF) for the first six months, as recommended by the World Health Organization (WHO), is a key public health strategy for improving infant survival and development. Adherence to WHO EBF guidelines remains suboptimal, influenced by sociocultural, maternal, and systemic factors. Evidence suggests adherence may differ across rural, suburban, and urban communities, yet these contextual variations are underexplored. Understanding these differences is critical for designing targeted interventions. This study assessed adherence to WHO EBF guidelines and identified perceived barriers among mothers in Enugu State, Nigeria.
METHODS:
A descriptive comparative cross-sectional study was conducted in three settings: a rural community, a suburban community, and Enugu metropolis. Using multistage and systematic sampling, 250 mothers with at least one previous childbirth were recruited. Structured questionnaires collected data on breastfeeding practices relative to WHO EBF guidelines and perceived barriers. Descriptive statistics summarized adherence, while Pearson’s chi-square test identified significant predictors of adherence (p < 0.05). Written informed consent was obtained from all participants.
RESULTS:
Breastfeeding was initiated by most mothers (rural 94.7%, urban 98.7%, suburban 100%), with early initiation within one hour ranging from 44.9% (urban) to 67.4% (suburban). Colostrum feeding was high (87.2–93.0%). Introduction of water or other liquids before six months was common, particularly in rural communities (75.8%), indicating suboptimal adherence. Reported barriers included maternal fatigue, infant refusal, cultural pressure, breast pain, return to work, and lack of partner support (~50–60%). Significant predictors of adherence were maternal age (p=0.002), community type (rural, suburban, urban) (p=0.002), father’s education (p=0.016), father’s occupation (p=0.035), and number of children (p=0.008).
CONCLUSIONS:
Adherence to WHO exclusive breastfeeding guidelines is suboptimal, especially regarding early introduction of liquids, with marked differences across community types. Community-specific, culturally sensitive interventions targeting maternal, familial, and systemic barriers are essential to improve EBF adherence and infant health outcomes
| eISSN: | 2654-1459 |
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