Four in every ten infants in Northwest Ethiopia exposed to sub-optimal breastfeeding practice

Determinants of early cessation of exclusive breastfeeding practices among rural mothers from Jaffna District of Sri Lanka

BACKGROUND

Sri Lanka is an upper-middle-income country with excellent health statistics. However, 2016 Demographic and Health Survey data have shown 82% and 64% of mothers exclusively breastfed infants aged 0-6 months and 4-5 months, respectively. The short duration of exclusive breastfeeding (EBF) has an impact on the growth and development of babies. Since no studies have been reported on EBF practices of the rural mothers in Jaffna District, an administrative district among 25 districts of Sri Lanka, this study aimed to assess the factors influencing the early cessation of EBF.

METHODS

For this community-based cross-sectional study, 338 mother-child pairs were selected from 2013-14. EBF was defined as children not receiving any food or drink, including complementary foods, formula milk or milk products except for medicines and vitamins or mineral drops, other than breast milk since birth. Socio-economic and demographic factors, the influence of the mode of delivery, and knowledge on EBF were obtained using an interviewer-administered questionnaire. The details of EBF and reasons for the cessation of breastfeeding before six months were obtained from a subgroup of mothers (n = 208). Multivariate analysis was performed to explore the correlates of breastfeeding.

RESULTS

In this study, 71.2% (95% CI 64.5, 77.2) had practiced EBF for six months. Early discontinuation of EBF was practiced by employed mothers (AOR 4.3; 95% CI 1.3, 13.9), mothers of low birth weight babies (AOR 3.6; 95% CI 1.6, 8.2) and those who experienced Cesarean section birth (AOR 2.9; 95% CI 1.2, 6.9). The EBF practiced by mothers of rural Jaffna was not associated with the gender of the babies, type of family, number of children in a family, religion of the household, knowledge on EBF, or family income.

CONCLUSION

The prevalence of EBF up to six months was low in rural Jaffna, and it was influenced by employment, birthweight of the babies, and the mode of delivery. To enhance EBF, the Regional Directorate of Health Service, Jaffna, should take necessary action with policymakers to increase maternity leave for at least six months, reduce the Cesarean section rate, and provide nutritional support to pregnant mothers.

Development and validation of the Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa

BACKGROUND

In Sub-Saharan Africa, the nutritional status of children born to teenage mothers deserves critical attention. Maternal knowledge and attitudes concerning infant and young child feeding (IYCF) may predict actual practices and child nutritional status. This study created and validated the Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa.

METHODS

A literature search on IYCF knowledge and attitude gaps in teenage mothers generated scale items. Ten nutrition experts and six teenage mothers assessed content validity and comprehensibility, respectively. Construct validation was conducted by item response theory (IRT) and confirmatory factor analysis (CFA), in 150 teenage mothers in rural communities of Abuja, Nigeria. Model fit parameters were estimated by standardized chi-square tests. Internal consistency reliability was determined by marginal reliability and Cronbach's alpha. In a sub-sample of 40 women who completed the questionnaire two weeks later, test-retest reliability was assessed via intraclass correlations.

RESULTS

The IRT analysis retained 23 knowledge items on infant food type, breastfeeding and complementary feeding, with acceptable discrimination and difficulty. CFA produced a six-factor solution (exclusive breastfeeding, breast milk expression, meal frequency, responsive feeding, dietary diversity, and barriers) with 17 attitude items. Confirmatory fit and Tucker Lewis indices > 0.9; Root Mean Square Errors of Approximation and Standardized Root Mean Square Residuals < 0.08, showed good model fit. Overall Cronbach's alpha of the attitude scale (0.843), subscales (≥ 0.6) and high intraclass correlation coefficients (> 0.75) indicated reliability.

CONCLUSION

The Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa is a valid assessment tool for IYCF knowledge and attitudes of teenage mothers.

Breastfeeding knowledge, attitude, and self-efficacy among mothers with infant and young child in rural Ethiopia

BACKGROUND

Breastfeeding has several benefits for both mothers and their children. Despite strong evidence in support of the practice, its prevalence has remained low worldwide, particularly in Ethiopia. Therefore, this study is aimed to assess breastfeeding knowledge, attitude, and self-efficacy among mothers with index infants and young children in the rural community of Southwest Ethiopia.

METHODS

A community-based cross-sectional study was conducted between March and April 2022 as baseline data for a cluster of randomized control trials. Multistage sample techniques followed by systematic random sampling techniques were employed. The Chi-square and Fisher's exact probability tests were used to assess the baseline differences in the socio-demographic characteristics of the two groups. An independent sample t-test was used to determine the mean differences. Multivariate logistic regression analysis was used to evaluate the association. All tests were two-tailed, and a statistically significant association was declared at a p-value ≤ 0.05.

RESULTS

A total of 516 mothers (258 from the intervention and 258 from the control group) were interviewed. A total of 516 mothers (258 from the intervention group and 258 from the control group) were interviewed. Except for the child's sex and age, no significant difference was observed between the intervention and control groups in terms of socio-demographic variables (p > 0.05). Independent t-tests found no significant difference between the two groups (p > 0.05) in terms of the mean score of maternal breastfeeding knowledge, attitude and self-efficacy at baseline. After adjusting for other covariates, maternal age (AOR = 1.44, 95% CI: 0.69, 3.07), educational status (AOR = 1.87, 95% CI: 0.56,2.33), occupation (AOR = 1.79, 95% CI, 1.04, 3.69), ANC (antenatal care) (AOR = 1.88, 95% CI, 1.11, 4.09), received breastfeeding information (AOR = 1.69, 95% CI, 1.33, 5.04), postnatal care (PNC) (AOR = 3.85, 95% CI, 2.01, 5.77) and parity (AOR = 2.49, 95% CI, 1.08, 4.19) were significantly associated high level breastfeeding knowledge. The positive attitude was associated with maternal age (AOR = 2.41, 95% CI, 1.18, 5.67), education status (AOR = 1.79, 95% CI, 0.99,4.03), ANC (AOR = 2.07, 95% CI, 1.44,5.13), last child breastfeeding history (AOR = 1.77, 95% CI, 1.21,4.88) and high level of breastfeeding knowledge (AOR = 2.02, 95% CI, 1.56,4.04). Finally, high breastfeeding self-efficacy was associated with ANC (AOR = 1.88, 95% CI 1.04,3.83), parity (AOR = 4.05, 95% CI, 1.49, 5.03) and high knowledge level (AOR = 1.69, 95% CI, 0.89,2.85).

CONCLUSIONS

The study concluded that mothers in both the intervention and control groups have a low level of breastfeeding knowledge, a neutral attitude, and medium self-efficacy. Therefore, nutrition education interventions using tailored messages appropriate to the sociocultural context in the rural setting should be developed and evaluated continuously.

Breastfeeding performance index and associated factors among children aged 0-6 months in Ethiopia: Analysis of the 2019 Ethiopia Mini Demographic and Health Survey

Background

Infants under the age of 6 months are commonly affected by malnutrition globally. The higher the breastfeeding performance index (BPI), the greater the advantage of breastfeeding will be. However, there is a lack of literature in the context of Ethiopia. Therefore, this study is aimed at investigating the magnitude and determinants of the breastfeeding performance index score among mothers of children under the age of 6 months in Ethiopia.

Methods

This study was conducted using the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS) dataset. A stratified, two-stage cluster sampling technique was used in the study. The survey data were weighted using the “svy” function in STATA version 16. Descriptive statistics, bivariable and multivariable logistic regression were employed in the analysis. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) was reported. The results were considered statistically significant if the p-value was < 0.05. The goodness of fit of the model was checked using the Hosmer–Lemeshow test.

Results

A total of 4,273 mothers with children under the age of 6 months were included in the analysis. Our analysis revealed that the prevalence of low breastfeeding performance index was 79.05% (95% CI: 78.01, 81.59). A unit increase in child age (AOR = 11.56; 95% CI: 6.97, 19.17), the richest wealth quintile (AOR = 2.76; 95% CI: 1.18, 6.5), a higher level of education (AOR = 5.41; 95% CI: 2.08, 14.05), being married or living with partner (AOR = 2.73; 95% CI: 1.18, 6.27), being women from Somali (AOR = 5.11; 95% CI: 2.08, 12.56), Afar (AOR = 3.03; 95% CI: 1.16, 7.91), Oromia (AOR = 1.88; 95% CI: 1.03, 3.41), Diredawa city administration (AOR = 2.89; 95% CI: 1.04, 8.07), and antenatal care (ANC) visit (AOR = 2.05; 95% CI: 1.31, 3.19) were positively associated with the low breastfeeding performance index.

Conclusion

The prevalence of the low breastfeeding performance index was found to be high. Hence, the findings of the study suggest the need to target interventions aimed at improving breastfeeding performance toward mothers with higher socioeconomic and demographic status and educational status. Antenatal care clients are among the targets of the intervention.