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Suglo M, Kpekura S, Yiryuo L. Breastfeeding challenges among adolescent mothers: a phenomenological study at the Korle Bu Teaching Hospital in Ghana. BMJ Open 2024; 14:e077504. [PMID: 38950996 PMCID: PMC11218013 DOI: 10.1136/bmjopen-2023-077504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 05/30/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND The natural and best approach to give newborns the nutrients they need for healthy growth and development is through breast feeding. Breastfeeding rates fall more sharply with time for mothers under the age of 20 years. AIM This study sought to explore the challenges experienced by adolescent mothers who visit the department of obstetrics and gynaecology of Korle Bu Teaching Hospital in Ghana. METHOD This study employed a qualitative phenomenology design and collected data from adolescent mothers. Data were gathered with the aid of a semistructured in-depth interview guide from 13 breastfeeding adolescent mothers. Data for the study were analysed using content analysis. The study was conducted at the obstetrics and gynaecology department of Korle Bu Teaching Hospital, Ghana. FINDINGS Two major themes were generated from the study to be the challenges that confront adolescent breastfeeding mothers, and they are maternal factors of breastfeeding barriers and societal factors of breastfeeding barriers. Subcategories were generated for both themes during the process. CONCLUSION AND RECOMMENDATION Training of pregnant adolescents during antenatal care visits on how to manage the inability to lactate, breastfeeding stress, painful and sore nipple, engorged breast, stigma from society will lessen their burden. Furthermore, training close family members and friends on how to be kind and support adolescent mothers during breast feeding is important. In-service training should be organised for health workers to enhance their knowledge and practice of approaching and guiding adolescent mothers on effective breast feeding and the provision of cubicles in public places where adolescent mothers can comfortably breastfeed.
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Affiliation(s)
- Mavis Suglo
- Neonatal Intensive Care. P. O. Box 16, Tamale Teaching Hospital, Tamale, Ghana
| | - Stephen Kpekura
- Department of Nursing and Preventive, C. K. Tedam University of Technology and Applied Sciences, Navrongo, Ghana
| | - Lilian Yiryuo
- Department of Pediatrics, St. Joseph's Hospital, P. O. Box 3, Ghana Health Service, Jirapa, Ghana
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Holla P, Bhardwaj J, Tran TM. Mature beyond their years: young children who escape detection of parasitemia despite living in settings of intense malaria transmission. Biochem Soc Trans 2024; 52:1025-1034. [PMID: 38752830 PMCID: PMC11209762 DOI: 10.1042/bst20230401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024]
Abstract
Despite having the highest risk of progressing to severe disease due to lack of acquired immunity, the youngest children living in areas of highly intense malaria transmission have long been observed to be infected at lower rates than older children. Whether this observation is due to reduced exposure to infectious mosquito bites from behavioral and biological factors, maternally transferred immunity, genetic factors, or enhanced innate immunity in the young child has intrigued malaria researchers for over half a century. Recent evidence suggests that maternally transferred immunity may be limited to early infancy and that the young child's own immune system may contribute to control of malarial symptoms early in life and prior to the development of more effective adaptive immunity. Prospective studies of active and passive detection of Plasmodium falciparum blood-stage infections have identified young children (<5 years old) who remain uninfected through a defined surveillance period despite living in settings of highly intense malaria transmission. Yet, little is known about the potential immunological basis for this 'aparasitemic' phenotype. In this review, we summarize the observational evidence for this phenotype in field studies and examine potential reasons why these children escape detection of parasitemia, covering factors that are either extrinsic or intrinsic to their developing immune system. We discuss the challenges of distinguishing malaria protection from lack of malaria exposure in field studies. We also identify gaps in our knowledge regarding cellular immunity in the youngest age group and propose directions that researchers may take to address these gaps.
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Affiliation(s)
- Prasida Holla
- Ryan White Center for Global Health and Pediatric Infectious Diseases, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, U.S.A
| | - Jyoti Bhardwaj
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, U.S.A
| | - Tuan M. Tran
- Ryan White Center for Global Health and Pediatric Infectious Diseases, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, U.S.A
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, U.S.A
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN 46202, U.S.A
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Syahri IM, Laksono AD, Fitria M, Rohmah N, Masruroh M, Ipa M. Exclusive breastfeeding among Indonesian working mothers: does early initiation of breastfeeding matter? BMC Public Health 2024; 24:1225. [PMID: 38702668 PMCID: PMC11069251 DOI: 10.1186/s12889-024-18619-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 04/16/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Early initiation of breastfeeding (EIBF) is a starting point that lays the foundation for breastfeeding and bonding between mother and baby. Meanwhile, working mothers are one of the vulnerable groups for the success of exclusive breastfeeding (EBF). The study analyzed the role of EIBF on EBF among Indonesian working mothers. METHODS The cross-sectional study examined secondary data from the 2021 Indonesian National Nutritional Status Survey. The study analyzed 4,003 respondents. We examined EBF practice as an outcome variable and EIBF as an exposure variable. We included nine control variables (residence, maternal age, marital, education, prenatal classes, wealth, infant age, sex, and birth weight). All variables were assessed by questionnaire. The study employed a binary logistic regression test in the last stage. RESULTS The result showed that the proportion of EBF among working mothers in Indonesia in 2021 was 51.9%. Based on EIBF, Indonesian working mothers with EIBF were 2.053 times more likely than those without to perform EBF (p < 0.001; AOR 2.053; 95% CI 2.028-2.077). Moreover, the study also found control variables related to EBF in Indonesia: residence, maternal age, marital, education, prenatal classes, wealth, infant age, sex, and birth weight. CONCLUSION The study concluded that EIBF was related to EBF. Indonesian working mothers with EIBF were two times more likely than those without to perform EBF. The government needs to release policies that strengthen the occurrence of EIBF in working mothers to increase EBF coverage.
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Affiliation(s)
| | - Agung Dwi Laksono
- National Research and Innovation Agency Republic of Indonesia, Jakarta, Indonesia
| | - Maya Fitria
- Faculty of Public Health, Universitas Sumatera Utara, Medan, Indonesia
| | - Nikmatur Rohmah
- Faculty of Health Sciences, Muhammadiyah University of Jember, Jember, Indonesia
| | - Masruroh Masruroh
- Faculty of Health Science, Universitas Pesantren Tinggi Darul Ulum, Jombang, Indonesia
| | - Mara Ipa
- National Research and Innovation Agency Republic of Indonesia, Jakarta, Indonesia
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Ravichandran M, Parida SP, Singh AK, Mishra AK, Gopi K. Knowledge and practice of breastfeeding among lactating mothers in AIIMS, Bhubaneswar - A hospital-based cross-sectional study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:141. [PMID: 38784290 PMCID: PMC11114562 DOI: 10.4103/jehp.jehp_1003_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/03/2023] [Indexed: 05/25/2024]
Abstract
BACKGROUND 44% of infants under 6 months of age worldwide are only adequately breastfed. It is also found that only 41.6% of women breastfeed their child within one hour of birth and less than 50% of women continue breastfeeding up to 2 years. This study was conducted to assess the prevalence of early initiation of breastfeeding practice, to explore the knowledge and practices about breastfeeding among lactating mothers, and to find the effect of breastfeeding on the nutritional status of the child. MATERIALS AND METHODS A hospital-based study was conducted among 160 lactating mothers of infants below six months of age presenting to the immunization clinic at AIIMS Bhubaneswar. A semi-structured questionnaire based on the CDC breastfeeding questionnaire was administered to assess the knowledge and practice. The nutritional status of the infant was assessed by plotting the weight for age and length for age of the infant in the WHO growth charts. RESULTS 102 (75%) of mothers had initiated breastfeeding within the first hour of delivery. Adequate knowledge and practice of breastfeeding was present only in 4 (2.5%) and 3 (1.9%), respectively. It was found that 13.75% of women were using formula feed. The prevalence of underweight and less than normal length was 40% (n = 64) and 34.37% (n = 55) among infants, respectively. CONCLUSION This study emphasizes the importance of awareness among lactating mothers about the hindmilk, appropriate practice, and to find its effect on the nourishment of the children.
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Affiliation(s)
- Mythry Ravichandran
- Department of Community Medicine and Family Medicine, AIIMS, Bhubaneswar, Odisha, India
| | - Swayam P. Parida
- Department of Community Medicine and Family Medicine, AIIMS, Bhubaneswar, Odisha, India
| | - Arvind K. Singh
- Department of Community Medicine and Family Medicine, AIIMS, Bhubaneswar, Odisha, India
| | - Abhisek K. Mishra
- Department of Community Medicine and Family Medicine, AIIMS, Bhubaneswar, Odisha, India
| | - Kumbha Gopi
- Department of Epidemiology, South East Asia Field Epidemiology and Technology Network, NCDC, MOHFW, Delhi, India
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Tende FK, Nwameme AU, Tabong PTN. Acceptability of breast milk donor banking: A qualitative study among health workers in Greater Accra Regional Hospital, Ghana. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001870. [PMID: 37585414 PMCID: PMC10431602 DOI: 10.1371/journal.pgph.0001870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023]
Abstract
Despite the compelling evidence demonstrating the immediate and long-term health advantages of prompt breastfeeding from birth, not all newborns are breastfed exclusively for a variety of reasons. As a result, the World Health Organization has made new recommendations for the adoption of breastmilk donor banks to make sure that children receive breastmilk when mothers are unable to produce it. In order to better understand how health professionals at the Greater Accra Regional Hospital, who would be leading the charge in putting this policy into practice, perceive and accept the practice of storing breastmilk, this study was conducted. At the Greater Accra Regional Hospital, 18 healthcare professionals were chosen using maximum variation purposive sampling procedures. They were made up of eleven midwives, a medical officer, six nurses, and two nutritionists and all participants were interviewed face to face using a semi structured interview guide. Data was transcribed verbatim and was analyzed using thematic analysis. Participants in the study admitted that they would be open to using or contributing to a bank of breastmilk. Participants also said that if safety precautions are taken, they would urge their customers to give breastmilk and recommend breastmilk from a breastmilk bank to them when the situation calls for it. Health professionals recommended that education be provided prior to the installation of breast milk donor banking to lessen or eliminate any misconceptions people may have about it. The concept of breastmilk donor banking was fairly accepted among health workers. Misconceptions about the safety of breast milk was the main concern. The results emphasize the necessity of greater stakeholder engagement and education prior to the implementation of this policy in order to boost acceptance and uptake.
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Affiliation(s)
- Fred Kafui Tende
- Department of Social and Behavioural Sciences, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Adanna Uloaku Nwameme
- Department of Social and Behavioural Sciences, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Philip Teg-Nefaah Tabong
- Department of Social and Behavioural Sciences, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
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Mohammed S, Yakubu I, Fuseini AG, Abdulai AM, Yakubu YH. Systematic review and meta-analysis of the prevalence and determinants of exclusive breastfeeding in the first six months of life in Ghana. BMC Public Health 2023; 23:920. [PMID: 37208682 PMCID: PMC10199593 DOI: 10.1186/s12889-023-15758-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 04/26/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Exclusive breastfeeding is a public health priority in sub-Saharan Africa. However, systematic reviews on its determinants in Ghana remain scarce. Therefore, we systematically reviewed the prevalence and determinants of exclusive breastfeeding in children 0-6 months in Ghana. METHODS We conducted systematic searches in Embase, Medline, and Africa-Wide Information from the databases' inception until February 2021 for studies that assessed the prevalence and determinants of exclusive breastfeeding in children 0-6 months in Ghana. Random-effects meta-analysis was used to estimate the pooled prevalence of exclusive breastfeeding and narrative synthesis to summarise the determinants. We calculated the proportion of total variability that was due to between study heterogeneity using I² statistics, and Egger's test assessed publication bias. The review is registered with PROSPERO, CRD42021278019. RESULTS Out of the 258 articles identified, 24 met the inclusion criteria. Most of the included studies were cross-sectional and were published between 2005 and 2021. The pooled prevalence of exclusive breastfeeding (EBF) among children 0-6 months in Ghana was 50% (95%CI 41.0-60.0%). The prevalence was higher in rural areas (54%) than in urban areas (44%). Several factors were identified as facilitators of EBF, including older maternal age, self-employment, unemployment, living in a large house, being a house owner, giving birth in a health facility, non-caesarean delivery, adequate antenatal attendance, counselling services, participation in support groups, adequate knowledge about EBF, positive attitude towards EBF, and higher maternal education among rural dwellers. Additionally, having an average birthweight facilitated EBF. Barriers to EBF were also identified, including higher maternal education among urban dwellers, less than three months of maternity leave, maternal HIV-positive status, the experience of partner violence, lack of access to radio, inadequate breastmilk production, lack of family support, having a partner who wants more children, counselling on complementary feeding, healthcare worker recommendation of complementary feed, single marital status, and infant admission to neonatal intensive care units. CONCLUSION In Ghana, EBF rates are low, with only about half of all children aged 0-6 months breastfed exclusively. A multi-dimensional approach is required to tackle the diverse sociodemographic, obstetric, and infant-related issues that hinder EBF practice in Ghana.
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Affiliation(s)
- Shamsudeen Mohammed
- MedicineDepartment of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ibrahim Yakubu
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand.
- Department of Nursing, Nursing and Midwifery Training College, Gushegu, Ghana.
| | | | - Abdul-Malik Abdulai
- Department of Nursing, Nurses' and Midwives' Training College, Tamale, Ghana
| | - Yakubu H Yakubu
- School of Clinical Sciences, Department of Nursing, Auckland University of Technology, Auckland, New Zealand
- Department of Intensive Care Unit, Tamale Teaching Hospital, Tamale, Ghana
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Terefe B, Shitu K. Exploring the determinants of exclusive breastfeeding among infants under six months in the Gambia using gambian demographic and health survey data of 2019-20. BMC Pregnancy Childbirth 2023; 23:220. [PMID: 37005575 PMCID: PMC10067212 DOI: 10.1186/s12884-023-05544-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 03/24/2023] [Indexed: 04/04/2023] Open
Abstract
INTRODUCTION For infants, no one is as nutritious as breastmilk for the rest of their lives. It is a great guarantee for their future health, especially if they can exclusively breastfeed for the next few months, from the moment they are born until the end of the fifth month. Although breastfeeding rates are very low, there is no data record about it in the Gambia. OBJECTIVE This study aimed to assess the status of exclusive breastfeeding and its determinants among infants under six months of age in the Gambia. METHODS It is a secondary data analysis using the 2019-20 Gambia demographic and health survey data. A total of 897 weighted mother-infant paired samples were included in the study. A logistic regression analysis method was employed to declare factors significantly associated with exclusive breastfeeding among infants under six months of age in Gambia. Variables with a p-value of 0.2 were entered into multiple logistic regression analysis, and after controlling other confounding factors, an adjusted odds ratio of 95% CI was applied to identify associated variables. RESULTS Exclusive breastfeeding was found in 53.63% only among infants under six months of age. Being a rural resident (AOR = 2.14, 95% CI: 1.33, 3.41), reading a newspaper (AOR = 5.62, 95% CI: 1.32, 24.09), and being counseled on breastfeeding by a health professional (AOR = 1.36, 95% CI: 1.01, 1.82) are times more likely to practice exclusive breastfeeding, respectively. On the other hand, a child with a fever (AOR = 0.56, 95% CI: 0.37, 0.84), a child whose age is 2-3 months (AOR = 0.41, 95 CI: 0.28, 0.59), and a child whose age is 4-5 months (AOR = 0.11, 95% CI: 0.07, 0.16) is less likely to be fed exclusively than a 0-1-month-old child. CONCLUSION Exclusive breastfeeding remains among the public health challenges in the Gambia. Strengthening health professionals' counseling techniques on breastfeeding and infant illnesses, promoting the pros of breastfeeding, and designing timely policies and interventions are urgently needed in the country.
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Affiliation(s)
- Bewuketu Terefe
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Po. Box: 196, Gondar, Ethiopia.
| | - Kegnie Shitu
- Department of Health Education and Behavioral Science, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Obeng C, Jackson F, Nsiah-Asamoah C, Amissah-Essel S, Obeng-Gyasi B, Perry CA, Gonzalez Casanova I. Human Milk for Vulnerable Infants: Breastfeeding and Milk Sharing Practice among Ghanaian Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416560. [PMID: 36554441 PMCID: PMC9779609 DOI: 10.3390/ijerph192416560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 06/13/2023]
Abstract
Human milk has the best impact on childhood survival. In Ghana, it is estimated that 43% of women exclusively breastfeed for 0-5 months and only 42% of breastfeeding mothers continue through 20-23 months. Although the Ghanaian government has implemented policies to facilitate exclusive breastfeeding, substantial gaps to achieve optimal newborn health and wellbeing remain. The purpose of this study was to evaluate breastfeeding prevalence and human milk sharing practices among Ghanaian women. Qualitative responses were received from Ghanaian females (n = 1050). In our sample, 81% indicated they breastfed their children and 8% reported ever sharing breastmilk with another mother. Reasons for sharing milk included (i) insufficient breastmilk production of the recipient mother, and (ii) mother's unavailability prompting women to offer their milk to a crying baby. About 60% of our sample reported that they were not concerned about sharing their milk. Findings present a strong indicator for milk donation towards the establishment of a human milk bank in Ghana. Health promotion efforts should aim at increasing education about the risks involved in milk sharing as well as the benefits of human milk donation through formal and safer channels such as a Human Milk Bank.
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Affiliation(s)
- Cecilia Obeng
- Department of Applied Health Science, School of Public Heath, Indiana University, Bloomington, IN 47405, USA
| | - Frederica Jackson
- Department of Applied Health Science, School of Public Heath, Indiana University, Bloomington, IN 47405, USA
| | - Christiana Nsiah-Asamoah
- Department of Clinical Nutrition and Dietetics, University of Cape Coast, Cape Coast TF0494, Ghana
| | - Salome Amissah-Essel
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast TF0494, Ghana
| | - Barnabas Obeng-Gyasi
- Department of Applied Health Science, School of Public Heath, Indiana University, Bloomington, IN 47405, USA
| | - Cydne A. Perry
- Department of Applied Health Science, School of Public Heath, Indiana University, Bloomington, IN 47405, USA
| | - Ines Gonzalez Casanova
- Department of Applied Health Science, School of Public Heath, Indiana University, Bloomington, IN 47405, USA
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Al-Gashanin MA, Ghazwani EY. Knowledge, Attitude, and Practice of Weaning among Mothers in Najran Region, Saudi Arabia, 2021. J Nutr Metab 2022; 2022:6073878. [PMID: 35284142 PMCID: PMC8906984 DOI: 10.1155/2022/6073878] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/08/2022] [Indexed: 11/24/2022] Open
Abstract
Background Weaning is a complex process of a gradual introduction of complementary foods to the infant's diet. It is recommended that solid food is introduced between 6 and 12 months of age. Weaning is difficult and potentially dangerous time for infants' growth and mother's education is an established determinant of its success. Little is known about weaning attitudes or practice among mothers in Najran Region of Saudi Arabia. Method The study is a cross-sectional questionnaire-based observational investigation using random sampling scheme. We utilized ordinal logistic regression modelling to evaluate the relationship between demographic variables and knowledge level among mothers. Results The total number included was n = 385 mothers who agreed to take part in the study. Good satisfactory knowledge rate was n = 135, 35.1%. Knowledge was mostly sought from other mothers (n = 102, 26.5%), followed by reliance on their own experience (n = 82, 21.3%). Seeking doctors' advice was associated with better knowledge levels. Worse adjusted knowledge scores were associated with bottle feeding (OR = 0.5383, p=0.0137), using cerelac preparations (OR = 0.0316, p=0.0092), development of weaning symptoms (OR = 0.5869, p=0.0260), seeking other mothers' advice (OR = 0.4750, p=0.0226), and feeding babies under 4 times daily (OR = 0.2742, p=0.0008). Mother education did not have significant impact on knowledge scores. Discussion. We confirmed, in this work, that knowledge levels were alarmingly unsatisfactory about weaning among our participants. Women were likely following local customs in terms of their choice of weaning methods even among the well-educated. The association between seeking doctors' advice and better knowledge should be utilized in future educational interventions. Underfeeding babies of below 4 times daily was correlated substantially with poorer knowledge score. This could be viewed as reverse causality, as clearly more knowledgeable mothers are expected to stick to optimum feeding frequency. Recommendations. Communication channels between physicians and mothers need to be opened and widened through focused educational programmes. Poor knowledge is clearly associated with infant underfeeding and difficulties in recognizing weaning symptoms. Such points need to be emphasized in design of health education packages to nursing mothers. Research on knowledge about weaning should focus on its association with traditional weaning methods and bottle feeding.
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Affiliation(s)
| | - Eisa Yazeed Ghazwani
- Family and Community Medicine Department, Faculty of Medicine, Najran University, Najran, Saudi Arabia
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