Knowledge, attitude and support for exclusive breastfeeding among bankers in Mainland Local Government in Lagos State, Nigeria

Lagos State popularly known as the “Centre of excellence” was created in May 27 1967. It is located in the South Western part of the federation and shares boundaries with Ogun State both in the North and East and on the West by Republic of Benin. In the South, it stretches for 180 km along the coast of the Atlantic Ocean and occupies an area of 3,577sq km, 22% or 787sq km which consists of lagoons and creeks. It is a commercial nerve centre for all Nigerians and it is domiciled predominantly by Nigerians of different cultures and backgrounds [10]. The state is divided into administrative units called local government areas (LGAs). Mainland Local Government Area is one of twenty LGAs in Lagos state.

This study was carried out among mothers working in commercial banks within Mainland Local Government area of Lagos State. Female bankers were chosen for this study because of their inflexible and demanding work schedules, which makes them vulnerable to not practising breastfeeding. There are 44 medium scale banks in Mainland local government. From a fact-finding visit before the commencement of the study, it was discovered that an average of 10 mothers worked in each bank. Therefore, the study population was estimated to be 440 (44 × 10). Only women who were working in the banks and had given birth to at least one child were included in this study.

We estimated that 67% of the study population practised exclusive breastfeeding based on the response to a previous breastfeeding survey carried out in another region of Nigeria [11]. Using the 95% confidence level and a 5% margin of error the calculated sample size for our survey was estimated to be 190 respondents. We made a 10% allowance for non-response making our minimum sample size 210 (two hundred and ten).

The minimum sample size in this study (210) was estimated to be about half of the estimated population size (440) therefore by systematic sampling method every 2nd name on the list of names in the sampling frame of each bank was selected to participate in this study until the desired sample size was reached, the first respondent from the list was chosen by simple random sampling (balloting). Verbal invitations were made to potential participants and consent received before issuing questionnaires.

A structured, self-administered questionnaire adapted from several templates used in previous studies for mothers’ knowledge, attitude, practices and support systems for EBF was used to collect data [12‐15]. We are unaware of previous questionnaires specific to workplace support systems so we formulated questions based on a previous survey [16].

The questionnaire was divided into five parts which are Section A: sociodemographic data, Section B: data regarding the knowledge of exclusive breastfeeding, Section C: data on the attitude of respondents towards the practice of EBF, Section D: data on the practice of respondents towards EBF and Section E: data on support systems towards exclusive breastfeeding among respondents. A five-point Likert scale (1 = “Strongly Agree”, 2 = “Agree”, 3 = “Indifferent”, 4 = “Disagree”, 5 = “Strongly Disagree”) was used to collect data for Section C (attitude towards EBF).

To ensure data quality, the questionnaire was pretested among ten female bankers in another Local Government within Lagos state (Mushin) and necessary modifications were made. The data collection was carried out over a period of 5 weeks by the researcher, and questionnaires were collected a few hours after distribution.

Data was entered and analysed using Epi Info™ 7. Results were presented as frequency tables and charts as appropriate.

For Section B a correct answer to each question was given a score of one point while a wrong answer was given a score of zero. The total score for each respondent was calculated by summing up all the awarded marks and these were converted to percentages. A knowledge grade was assigned to each respondent based on his total percentage score. Knowledge score of 0–49% represented poor knowledge, 50–74% represented fair knowledge and a score of ≥75% represented good knowledge [4].

For Section C concerning attitude towards EBF, the responses on the Likert scale were given marks 1–5, respectively. The higher marks (4 & 5) represented a more positive attitude. The total attitude score for each respondent was calculated by adding all the awarded marks for all statements. This score was converted to a percentage (> 66% indicating a positive attitude and ≤ 66% indicating a negative attitude towards EBF).

Ethical approval was obtained from Health Research and Ethics Committee of the Lagos University Teaching Hospital in Lagos, Nigeria before collection of data. Informed verbal consent was obtained from participants, who were assured of strict anonymity and confidentiality during this survey.

Table 2 shows respondents’ knowledge of exclusive breastfeeding. All respondents had heard of EBF. More than three-quarters (77.5%) of the respondents knew that babies should be exclusively breastfed for the first 6 months of life while 3.5% were unsure. A large number (89–96%) of respondents were aware of the benefits of EBF to the infant. More than two-thirds (67%) of the respondents believe that breastfeeding should be on demand. The overall knowledge concerning EBF was good for 94% of respondents and fair for 6% of respondents. Additionally, most (95.5%) of the respondents had a positive view about expressing their breast milk with a breast pump or bare hands.

Table 3 shows the attitude of respondents towards exclusive breastfeeding. The majority of respondents (61–95%) either disagreed or strongly disagreed with all ten statements. Ninety-five percent of respondents disagreed with the statement that breastfeeding is old fashioned, embarrassing and should not be done in public, two-thirds of respondents disagreed with the statement that it is okay to stop breastfeeding before the baby is 6 months old if their work takes them away from their baby most of the time, 61.5% of respondents disagreed with the statement that it is not okay to store expressed breast milk for their baby when they are not available. Almost all respondents (94.5%) demonstrated a positive attitude towards exclusive breastfeeding.

Table 4 shows the respondents practice of exclusive breastfeeding. While about 56% of the respondents practiced EBF, only 28.5% practiced it for up to 6 months. A quarter of respondents exclusively breastfed because they were aware of its benefits while only 7% exclusively breastfed because they preferred it. Most of the respondents (58.8%) that did not practice EBF attributed it to a busy work schedule.

Table 5 shows the source of breastfeeding support and the preferred source for additional support. A large number of the respondents reported that their major source of breastfeeding support came from the baby’s father (44%) and from the hospital (35.5%) while the least support came from the workplace (1.5%). The majority (74%) of the respondents indicated that they needed more support from their workplace while only about 12% felt that they needed more support from breastfeeding peer groups. Table 6 shows the availability of workplace support for breastfeeding. Only a minority of respondents indicated that they had some sort of workplace support for breastfeeding. There were limited or no designated areas for breastfeeding and insufficient or no breaks provided for breastfeeding, limited flexibility with working hours and not much breastfeeding information provided at the workplace. The duration of maternity leave provided by the workplace was only 3 months for the majority (83.5%) of respondents.

Despite the favourable response rate, there are important limitations to this survey. Firstly, ten questionnaires were not returned. Although this is a small number it would have been useful to know the characteristics (e.g., age, socio-economic status, etc.) of the non-responders versus the responders so as to ascertain possible reasons for the non-response. Secondly, this was purely a quantitative study with no opportunity for participants to write down comments or express other concerns and not catered for by the questionnaire. Further surveys should include a qualitative assessment and possibly interviews so as to add more information to this field of study. Thirdly, the respondents had a few hours to complete the questionnaires before collection, as opposed to more time if it had been mailed to them or collected some days later. Fourthly, the sample was limited to one group of workers (bankers), therefore results may not be generalizable to all female workers in paid employment in Lagos, Nigeria. Fifthly, the study population would have had their children at different times such that recall when answering the questionnaire would have been variable.