Breastfeeding is the best way of feeding newborns and infants because of the cognitive benefits for the infant and health benefits for the infant and their mother   . Although the WHO has strong recommendations and despite the benefits of exclusive breastfeeding, many countries have been slow to address this topic. According to an analysis by the Global Breastfeeding Collective (GBC), only 40% of children less than 6 months of age are exclusively breastfed  . If for many people the concept of EBF until 6 months is a matter of course, it still faces many sociocultural barriers, especially in developing countries  . In West and Central Africa, the EBF ratio is lower than in any other area of the world; only 20% of children under 6 months of age are exclusively breastfed  . This study aims to identify the relationship between early breastfeeding, EBF and continuation of breastfeeding until 24 months of age.
2. Patients and Methods
This research work was carried out in the District of Parakou (Benin) in November 2016. The population targeted in this cross-sectional and analytical study consisted of all children aged 6 to 24 months and their mothers. More specifically, this study included all children aged 6 to 24 months living in the District of Parakou since at least 6 months of age and whose mothers volunteered to participate in the survey. The children of mothers who could not breastfeed for health reasons (according to their statement) were excluded. The minimum size of the child population to be investigated has been estimated at 406 statistical units using the Schwartz formula  . Cluster sampling was used in compliance with the WHO recommendations. Clusters were selected based on a probability proportional to the population size of the district areas. The data gathering technique used was a “face to face” interview by means of a structured questionnaire administered to the mothers of the included children. The main variables studied were related to early breastfeeding, EBF and continuation of breastfeeding until 24 months. The other variables studied were the sociodemographic characteristics of children and their mothers.
Early breastfeeding was defined as the fact that a newborn is fed with his or her mother’s breasts within the first hour after birth. EBF was defined as the nutrition of newborns and infants only with his or her mother’s breast milk during the first 6 months of life without adding water, other fluid or food except prescribed medicines. The duration adopted for the continuation of breastfeeding was 24 months   .
The data collected were entered and processed using the Epi-Info 7.2 software. The measures of central tendency of the quantitative variables were described by calculating the averages and their standard deviations. The ratios of qualitative variables were also determined. The Chi2 test was used to compare proportions, and differences were considered significant with a p-value < 0.05.
After completion of the survey, 420 infants born from 420 different mothers who met the selection criteria were included in the study.
3.1. Sociodemographic Characteristics of Children and Their Mothers
The children’s mean age was 9.04 ± 4.76 months, and the predominant age group (68.78%) was 6 to 12 months. The sex ratio was 1.03.
For the mothers, the mean age was 26.57 ± 6.93 years. The predominant age group consisted of mothers aged 15 to 30 years (71.90%). The mothers were uneducated in 50.23% of cases. The mothers had a primary school certificate, junior secondary school certificate or senior secondary school/high school certificate or more in 26.43%, 14.05% and 9.29% of cases, respectively.
3.2. Prevalence of Early Breastfeeding, EBF and Continuation of Breastfeeding until 24 Months
The prevalence of early breastfeeding was 32.62%, the prevalence of EBF was 26.67%, and the prevalence of continuation of breastfeeding until 24 months was 6.19%.
Table 1 shows the distribution of children aged 6 to 24 months investigated as respondents according to the prevalence of breastfeeding practices in Parakou in 2016.
3.3. Relationships between Early Breastfeeding, EBF and Continuation of Breastfeeding until 24 Months
Exclusive breastfeeding (EBF) was statistically associated with early breastfeeding with p = 0.014. Continuation of breastfeeding until 24 months of age was
Table 1. Distribution of children aged 6 to 24 according to early breastfeeding, EBF and continuation of breastfeeding until 24 months in Parakou in 2016 (n = 420).
also statistically associated with early breastfeeding (p = 0.0474). Continuation of breastfeeding until 24 months was not statistically associated with exclusive breastfeeding (EBF) (p = 0.6252).
This study was performed in children aged 6 to 24 months. This age group might be a source of information bias for the determination of EBF prevalence due to forgetfulness and neglect. The farther we move away from the age of six months, the more mothers there may be who might have difficulty remembering information related to the practice of EBF. However, the cluster sampling technique helped to limit selection bias and ensure the representativeness of our sample. The study had the merit of addressing a health problem that continues to expand within the communities.
4.1. Prevalence of Early Breastfeeding, EBF and Continuation of Breastfeeding until 6 Months
The prevalence of early breastfeeding estimated at 32.62% is higher than that reported by Boinémé I. et al. in 2010 in Tunisia (12%) and that of the 4th Population
Table 2. Relationship between early breastfeeding, EBF and continuation of breastfeeding until 24 months among children aged 6 to 24 months in Parakou in 2016.
Table 3. Relationship between EBF and continuation of breastfeeding until 24 months among children aged 6 to 24 months in Parakou in 2016.
and Health Survey in Benin (EDSB-MICS 2011) (19.60%)   . Our reported result is lower than the rate (53.5%) reported by Djadou et al. in Togo in 2018  . Compared to Togo, our low prevalence might be due to the deficit of knowledge and practices of health professionals in early breastfeeding because the birth rate in health facilities is estimated at 84%  .
The prevalence of exclusive breastfeeding (EBF) was 26.67%. This prevalence is higher than the prevalence reported by Adédémy et al. in 2013 in Benin (14.71%) and similar to that reported by Chiabi et al. in 2012 in Cameroon and Niguse et al. in 2015 in Ethiopia (26.40%)    . However, our prevalence is lower than the rate of 72.2% noted by Djadou et al. in Togo in 2018  . This prevalence is low because, in view of free provision, easy accessibility and the benefits of breastfeeding in a poverty situation, the practice of EBF should be feasible at 100%.
This poor practice of EBF might be because mothers incorrectly think a child who is EBF is not full. Moreover, the negative influence of mothers-in-law and other senior women taken as people holding good practices in childcare is also a factor that is likely to explain the low rate.
The prevalence of continuation of breastfeeding until 24 months was 6.19%. This prevalence is lower than the prevalence reported in the EDSB-MICS 2014 (45.50%) and EDS-MICS-IV (52.60%)   . This difference existing between these rates might be due to the questionnaire formulation during interview and to the belief according to which breastfeeding is incompatible with pregnancy due to poor quality of milk. In addition, some ethnic groups believe that breastfeeding is an obstacle to sexual intercourse.
4.2. Relationships between Early Breastfeeding, EBF and Continuation of Breastfeeding until 24 Months
Early breastfeeding has a positive impact on exclusive breastfeeding (EBF) and continuation of breastfeeding until 24 months with p = 0.014 and p = 0.0474, respectively. In contrast, EBF does not influence the continuation of breastfeeding (p = 0.6252). These results explain the critical role that early breastfeeding plays in breastfeeding. The early breastfeeding process and communication of the benefits of breastfeeding have a positive impact on mothers’ engagement in the practice of breastfeeding. Improving performances in the practice of breastfeeding should be possible by considering cultural and anthropological considerations specific to the community and by promoting early breastfeeding. Although this study has been randomized to population in Parakou’s District alone, the results cannot be inferred for all children aged 0 - 24 months in Benin. Only multicenter studies can help to understand the reality of breastfeeding in our country.
Both the continuation of breastfeeding until 24 months and the practice of exclusive breastfeeding (EBF) are influenced by early breastfeeding of the child. As a result, early breastfeeding might be considered an important strategy for promoting breastfeeding and thereby child health.
Ethical and Professional Considerations
Recruitment was anonymous. The women included in the study were recruited only after their prior consent. The authors were granted an authorization by the relevant authorities of the District before starting this work. The ethics committee of the Faculty of Medicine of the University of Parakou has approved it.