Regional prevalence and socioeconomic inequalities in infant care practices: evidence from 2018 Nigeria Demographic and Health Survey

Abstract Background: The effects of breastfeeding practices on children’s health are undoubtedly of great interest worldwide. However, there is inequalities in the coverage of exclusive breastfeeding (EBF), early initiation of breastfeeding (EIBF) and mother and newborn skin-to-skin contact (SSC) in many resource-constrained settings. The aim of this study was to explore regional prevalence and examine the socioeconomic inequalities in EBF, EIBF and SSC in Nigeria.Methods: Data on 2,936 infants under six months old were extracted from the 2018 Nigeria Demographic and Health Survey (NDHS) to determine EBF. In addition, data from 21,569 children were analyzed for EIBF and SSC. Concentration index (CI) and concentration curve were used to measure socioeconomic inequalities in EBF, EIBF and SSC.Results: The prevalence of EBF, EIBF and SSC were 31.8%, 44.2% and 12.1% respectively. Furthermore, Ogun State had the highest prevalence of EBF (71.4%); while Bayelsa State had the highest prevalence of SSC (67.8%) and EIBF (96.2%) respectively. Urban dwellers had higher prevalence of EBF, SSC and EIBF across household wealth quintile and by levels of mothers’ education in contrast to their rural counterparts. We quantified the degree of wealth-related and mothers education inequalities in EBF, SSC and EIBF. There were pro-rich EBF (CI = 0.118; p< 0.001), EIBF (CI = 0.103; p=0.002) and SSC (CI = 0.152; p< 0.001) respectively. Also, EBF (CI = 0.157; p< 0.001), EIBF (CI = 0.091; p< 0.001) and SSC (CI = 0.156; p< 0.001) were significantly more concentrated among mothers with higher educational attainment. The test for differences between urban versus rural was significant in EBF, SSC and EIBF by mothers educational attainment. But this was only significant in EIBF by household wealth respectively.Conclusion: Socioeconomic status determined breastfeeding practices and SSC in Nigeria. Breastfeeding practices interventions should target all mothers, especially those of low socioeconomic status and to ensure improvements in baby friendly initiatives.