This study described breastfeeding policy and practices in addition to breastfeeding rates and duration amongst a group of mothers who attended a BFHI accredited paediatric clinic in Lagos, Nigeria. Ninety seven percent of mothers initiated breastfeeding and 91% were continuing to breastfeed twelve months later. Although breastfeeding rates and duration amongst these study participants are commendable, the suboptimal duration of exclusive breastfeeding in the first six months is of concern. The 36% exclusive breastfeeding rate at six months observed in our study was similar to the 33% reported in a Baby Friendly Hospital in Enugu, Nigeria . The rate was also similar to the 37% reported among the nursing mothers attending a comprehensive health centre in Nnewi, Nigeria  and the 30% reported in a community in Sokoto state, Nigeria . However, the rate was higher than the 19% reported in an urban comprehensive health centre in Ile-Ife, Southwest Nigeria  and the 13% obtained from a national demographic health survey in Nigeria . Although, there are discrepancies in the exclusive breastfeeding rates reported in the various regions in Nigeria, the reported rates are too low compared to the set target for 2015 of 90% recommended by the WHO . These results suggest a need for education to raise community, health professional and maternal awareness about the importance of breastfeeding, particularly exclusive breastfeeding in the first six months.
The low rate of exclusive breastfeeding observed in our study, as well as the low rates previously reported in Nigeria, was in contrast to the situation reported in the neighboring West African countries. For instance, in Ghana, exclusive breastfeeding rate was 63%, while in Togo, exclusive breastfeeding rate increased from 48% in 2011 to 63% in 2012 . The low rates of exclusive breastfeeding practices in Nigeria may have contributed to the high burden of under-nutrition and high mortality rate among Nigerian children when compared to Ghana  and Togo .
This is the first documented description of BFHI activities in LASUTH and it is therefore difficult to make an assertion on the trends of breastfeeding practices, rates and policy in this hospital. Evaluation of BFHI accreditation in many regions of the world has demonstrated the intervention as an important strategy for promoting, protecting and supporting breastfeeding. Ojofeitimi and colleagues in Ile-Ife, Nigeria  demonstrated an increase in the breastfeeding rates among mothers attending a BFHI accredited centre compared to those attending another non-accredited one. Our findings reveal that current BFHI activities in our hospital would benefit from attention to breastfeeding promotional campaigns that have been successful in other facilities.
Every breastfeeding mother who visits our hospital presents an opportunity for health education. The prevalence of Predominant rather than Exclusive breastfeeding and the introduction of formula feeding identified in our study presents a challenge. Alerting our staff, mothers and the wider community to the risks of gastroenteritis, nutritional deficit and their consequences is imperative. The establishment of an active breastfeeding support group to provide education and support for breastfeeding is one BFHI strategy deserving attention at our clinic. Prominent signage of our breastfeeding policy is another. Previous studies have shown an improvement in the practice of exclusive breastfeeding after reinforced education of the mothers . Providing breastfeeding information when mothers visit our outpatient clinic may reinforce information given in hospital.
We found higher exclusive breastfeeding amongst women with a Christian background and those who had their antenatal care at private hospitals. These findings are similar to other studies which reported that Christian religion was associated with a number of healthy behaviors [21–23].
In contrast to our findings, a study in Ibadan, southwest Nigeria found that mothers who delivered at a tertiary or secondary health facilities were more likely to breastfeed exclusively for six month compared to the mothers who delivered in private hospitals . This difference may be due to a decline in the promotion of breastfeeding activities in government secondary and tertiary hospitals .
The duration of breastfeeding has an influence on a child’s nutritional status, morbidity and mortality . WHO recommends breastfeeding up to and beyond 2 years . In our study, most mothers breastfeed up to the age of 12 months, thereafter, breastfeeding rates gradually decline. Many of the reasons given for earlier cessation of breastfeeding highlight areas where we need to support mothers. These reasons need to be addressed during promotional campaigns aimed at encouraging breastfeeding. Similar to other studies [28, 29], we found an association between a higher level of education and earlier cessation of breastfeeding. This may be due to the fact that mothers with high level of education are career women who have to return back to work due to a short maternity leave, lack of electricity to preserve expressed breast milk, and lack of company policies that allow the establishment of a crèche within the company where mothers can take a break to breastfeed their children. Our findings contrast those from a similar study in Nairobi, Kenya  which demonstrated that mothers with higher education levels breastfed for longer duration than those with a lower level of education. This difference was ascribed to relatively higher prevalence of HIV infection among those with lower education in the Kenyan subjects which may be associated with early cessation of breastfeeding.
Our study findings demonstrate a need to provide better breastfeeding education and support at every opportunity. This is especially important in a country like Nigeria where poverty, malnutrition and diarrheal diseases remain prevalent among infants.
Our findings also suggest that focus should be on exclusive breastfeeding for the first six months of life and increasing duration of breastfeeding by mothers. Thus, the goal of interventions should include increasing knowledge on long-term benefits of breastfeeding and the provision of long term breastfeeding support for mothers.
The limitation of this study is that it is cross sectional and therefore caution must be exercised in making causal influence of the identified determinants on exclusive breastfeeding for six months of life and total duration of breastfeeding. Another limitation is the small sample size of mothers which may have resulted in many important independent variables that were not significant. We proposed that future research studies with a larger sample size compare breastfeeding practice at the GOPC with like services to identify effective strategies to promote, protect and support breastfeeding.