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.

Deficiencies in the Intentions, Attitudes, and Knowledge of Future Healthcare Professionals Regarding Breastfeeding

The aim of this study was to determine the level of knowledge, positive intentions, and attitudes regarding breastfeeding among university students. A validated questionnaire collected data from 236 students of the Faculty of Dental Medicine and Health Osijek about breastfeeding intentions, attitudes, and knowledge. Descriptive methods were used to present the students' results in terms of their intentions, attitudes, and knowledge. For each question included in the questionnaire, the maximum possible and maximum achieved numbers of points were calculated, as well as the percentage of points achieved in relation to the maximum possible number. Correlations between the results on individual scales of the questionnaire and the total results of the questionnaire are shown by Spearman's correlation coefficient. Questionnaire answers that were least in line with professional recommendations were selected and analyzed. We found that the areas that should be given special attention in the education of students are: the intention of breastfeeding for more than a year; the use of breaks for breastfeeding in the workplace; attitudes and knowledge about the quality of breast milk in relation to substitutes; attitudes about breastfeeding in public places and breastfeeding for more than two years; and the feeling of maternity and breastfeeding (compared to bottle feeding). The relationship between the results was considered in terms of intentions, attitudes, and knowledge in relation to the overall results of the questionnaire, and the authors' thoughts on the reasons behind the poorer results achieved for certain questions were presented.

A Survey of Breastfeeding Attitudes and Health Locus of Control in the Nigerian Population

OBJECTIVES

Breastfeeding is important to infant health and survival in sub-Saharan Africa. To promote breastfeeding effectively, understanding of psychological factors associated with infant feeding choices is required. This study investigated breastfeeding attitudes and health locus of control (HLoC) in a Nigerian community sample.

METHODS

Men and women (N = 400) (71% female; mean age 34.2 years/ range 18-86 years) were recruited through community groups in Nigeria. Self-report survey by questionnaire measured breastfeeding attitudes using the Iowa Infant Feeding Attitude Scale (IIFAS) and health locus of control using the Multidimensional Health Locus of Control Scale (MHLoCs).

RESULTS MEAN

IIFAS scores (mean = 57.7; sd = 7.8) became less favourable with increasing age (p = 0.02). Men had higher IIFAS scores (mean = 58.6; sd = 7.6) than women (mean = 56.6; sd = 8.0) indicating more favourable attitudes toward breastfeeding (p = 0.02). Women scored higher than men on external chance HLoC (ECHLoC) (p = 0.003) and external powerful others HLoC (EPHLoC) (p = 0.02). Increasing age was associated with higher scores on ECHLoC (p < 0.01) and EPHLoC (p < 0.01). Multiple linear regression analysis was significant (p < 0.001) and explained 7.8% of variance in breastfeeding attitude. Lower IIFAS scores, reflecting more negative attitudes to breastfeeding, were associated with higher ECHLoC (p < 0.01) and EPOHLoC (p < 0.05). Higher IIFAS scores, reflecting more positive attitudes to breastfeeding, were associated with greater IHLoC (p < 0.01). Neither age nor gender were associated with IIFAS scores in the final model.

CONCLUSIONS

This implies a need to explore health locus of control when promoting positive attitudes to breastfeeding and supporting families in breastfeeding advocacy.

Levels and Determinants of Prenatal Breastfeeding Knowledge, Attitude, and Intention Among Pregnant Women: A Cross-Sectional Study in Northwest Ethiopia

Background

Pregnant women are a critical part of the community to assess various determinants of their future breastfeeding practice. This study aimed to assess the levels and determinants of breastfeeding knowledge, attitude, and intention among pregnant women.

Methods

A hospital-based cross-sectional study was conducted among 422 pregnant women from January 18 to February 27, 2022, at Debre Tabor Comprehensive Specialized Hospital (DTCSH) in Northwest Ethiopia. Data were collected via face-to-face interviews from participants selected by convenience sampling technique. Data analysis was made using Stata version 16.0. Multiple logistic regression analysis was used to assess the determinants of the knowledge, attitude, and intention of pregnant women, with a p-value < 0.05 considered statistically significant.

Result

About 57.8% of participants had adequate breastfeeding knowledge and only 46.9% had a positive attitude. Almost two-thirds (65.4%) of them had good intentions to breastfeed. Pregnant women attaining secondary education (AOR = 2.0; 95% CI: 1.31, 3.19), achieving college or university education (AOR = 3.13; 95% CI: 1.63, 7.41), being multiparous (AOR = 2.11; 95% CI: 1.33, 3.43), having four or more ANC visits (AOR:1.45; 95% CI: 1.21, 4.31), and having prior breastfeeding experience (AOR: 3.53; 95% CI: 2.22, 5.65) were significant predictors of adequate knowledge. Attending college or university education (AOR = 2.71;95% CI: 2.33, 5.13), being multiparous (AOR = 1.56; 95% CI: 1.32, 8.25), and having adequate knowledge (AOR = 2.02; 95% CI: 1.88,7.14) were determinants of a positive breastfeeding attitude. Whereas, advanced age (AOR = 1.44; 95% CI: 1.12, 5.59), adequate knowledge (AOR: 5.21; 95% CI: 1.51,8.04), and positive attitude (AOR = 2.41;95% CI:1.50, 4.27) were independent predictors of good breastfeeding intention.

Conclusion

The breastfeeding knowledge and attitude of pregnant women were generally suboptimal. Their overall breastfeeding intention was also unsatisfactory. This highlights the need to develop culture-specific interventions aimed at improving breastfeeding knowledge, attitudes, and intention to enhance the appropriate breastfeeding practice of their future children.

Effectiveness of a smartphone-based educational intervention to improve breastfeeding

Background

Exclusive breastfeeding (EBF) is essential during the first six months of life and confers countless benefits to mothers and infants. This study aimed to assess the effectiveness of a smartphone-based educational intervention to improve new mothers’ breastfeeding for infants younger than six months of age in Urmia, Iran.

Methods

A randomized controlled trial study was conducted from January to December 2019 with 40 new mothers and their first child aged < 3 months, assigned to the intervention (mobile app education + routine care) and control groups (routine care). The mean age of infants was 1.25 and 0.98 months for each group consequently. The designed app content categorized according to seven sections (the importance of breastfeeding, behavioral methods, complementary feeding and EBF, pumping and manual expression, managing common breast-related and breastfeeding problems, breastfeeding tips in special situations, and common queries) for educating the required knowledge to nursing mothers.

Results

Forty mothers were assessed for primary outcomes in each group. At three months, the mothers’ knowledge, attitude, and practice (KAP) had meaningful differences in the intervention group compared to the control group. In the intervention group, the degree of changes in knowledge and attitude were 5.67 ± 0.94 and 8.75 ± 1.37 respectively more than the control group (p < 0.001, p < 0.001). However, this amount for the practice score was 0.8 ± 0.49 which is considered to be marginally significant (p = 0.063). During the study, the mothers’ breastfeeding self-efficacy showed significant progress in favor of the intervention group. The score enhancement was 26.85 ± 7.13 for the intervention group and only 0.40 ± 5.17 for the control group that was confirmed to be significant (p < 0.001).

Conclusion

The smartphone-based app for educating new mothers on breastfeeding had a significantly positive effect on breastfeeding self-efficacy and maternal KAP. In future studies, the intervention can be tested in both prenatal and postpartum periods.

Determinants of Knowledge and Attitude towards Breastfeeding in Rural Pregnant Women Using Validated Instruments in Ethiopia

Understanding the underlying determinants of maternal knowledge and attitude towards breastfeeding guides the development of context-specific interventions to improve breastfeeding practices. This study aimed to assess the level and determinants of breastfeeding knowledge and attitude using validated instruments in pregnant women in rural Ethiopia. In total, 468 pregnant women were interviewed using the Afan Oromo versions of the Breastfeeding Knowledge Questionnaire (BFKQ-AO) and the Iowa Infant Feeding Attitude Scale (IIFAS-AO). We standardized the breastfeeding knowledge and attitude scores and fitted multiple linear regression models to identify the determinants of knowledge and attitude. 52.4% of the women had adequate knowledge, while 60.9% of the women had a neutral attitude towards breastfeeding. In a multiple linear regression model, maternal occupation was the only predictor of the BFKQ-AO score (0.56SD; 95%CI, 1.28, 4.59SD; p = 0.009). Age (0.57SD; 95%CI, 0.24, 0.90SD; p = 0.001), parity (-0.24SD; 95%CI, -0.47, -0.02SD; p = 0.034), antenatal care visits (0.41SD; 95%CI, 0.07, 0.74SD; p = 0.017) and the BFKQ-AO score (0.08SD; 95% CI, 0.06, 0.09SD; p < 0.000) were predictors of the IIFAS-AO score. Nearly half of the respondents had inadequate knowledge and most women had a neutral attitude towards breastfeeding. Policymakers and managers could address these factors when planning educational interventions to improve breastfeeding practices.

Literacy is power: structural drivers of child malnutrition in rural Liberia

BACKGROUND

In Liberia, an estimated 32% of children under 5 are stunted. Malnutrition and hunger worsened during the country's civil war and were further exacerbated by the 2014-2016 outbreak of Ebola virus disease. Studies examining adherence to recommended infant and young child feeding practices frequently do so with an emphasis on the knowledge, attitudes and beliefs of mothers and caregivers. Often overlooked are the structural factors that enable or constrain their agency to practise evidence-based recommendations.

METHODS

Between July and December 2017, we surveyed 100 Liberian mothers to assess the sociodemographic factors associated with the risk of severe acute malnutrition in children in Maryland County, Liberia. We also conducted 50 in-depth interviews at two government health facilities to qualitatively explore mothers' experiences, as well as health workers' understandings of the determinants of malnutrition in the region. We applied logistic regression to analyse quantitative data and inductive content analysis to thematically interpret qualitative data.

RESULTS

Mothers were less likely to have a child with severe acute malnutrition if they had an income greater than US$50 per month (adjusted OR (aOR)=0.14, p<0.001), were literate (aOR=0.21, p=0.009) or exclusively breast fed during the first 6 months of life (aOR=0.18, p=0.049); they were more likely to have a child with severe acute malnutrition if they were married or in domestic partnerships (aOR=8.41, p<0.001). In-depth interviews elucidated several social, economic and programmatic factors that shaped suboptimal feeding practices, as well as decisions for and against seeking formal care for malnutrition.

DISCUSSION

The lived experiences of Liberian mothers and health workers illustrate that child malnutrition is a direct consequence of abject poverty, food insecurity, illiteracy, the precarious nature of formal and informal work, and the lack of robust social protection. Behaviour change and health education interventions that do not seek to alleviate structural barriers to compliance are unlikely to be effective.

Maternal knowledge on infant feeding in São Luís, Maranhão, Brazil

Abtract Objectives: to describe the knowledge of infant feeding on breastfeeding and the introduction of complementary feeding among mothers of children under one-year-old in São Luís, MA. Methods: a cross-sectional descriptive study using a single questionnaire, standardized by trained interviewers, who visited all the residents in 20 communities chosen by convenience. This questionnaire searched for socioeconomic, demographic information, care received during pregnancy, and the knowledge about infant feeding. The analysis was performed through the creation of knowledge scores, frequency listing, central tendency and dispersion measurements. Results: among the 709 interviewees, 53.5% presented satisfactory knowledge. The score on the percentage mean of knowledge on infant feeding was 66.7%. The specific score on the introduction of complementary feeding was 60.7% and breastfeeding was71.4%. The benefits of breastfeeding for the babies were better known than the advantages it confers on mothers. The worst result was related to porridge preparation,(13.5%). Conclusion: the proportion of mothers who did not know about the basic teachings of infant feeding is high. This can lead to reduce exclusive breastfeeding time, increase rates of improper introduction of food and drink, and in favor early weaning.

Breastfeeding knowledge, attitudes, intentions, and perception of support from educational institutions among nursing students and students from other faculties: A descriptive cross-sectional study

BACKGROUND

Nursing education aims to promote positive health practices among the general population as well as among nurses themselves. Breastfeeding is one of these important health practices. However, to date there is little evidence regarding the extent to which nursing education affects nursing students' attitudes, knowledge, intentions, and their perception of institutional support regarding breastfeeding.

OBJECTIVES

To compare breastfeeding attitudes and knowledge among nursing students and students from other faculties, as well as their perception of their academic institution's support for breastfeeding, and to explore the association between these factors and students' intention to breastfeed during the course of their studies.

DESIGN

This study was a descriptive cross-sectional study.

SETTINGS

The study was conducted at a large university in central Israel.

PARTICIPANTS

One hundred female students from the faculty of nursing and 100 female students from other faculties, of childbearing age, who were either pregnant or mothers.

METHODS

The students completed a questionnaire regarding their breastfeeding knowledge, intentions, attitudes, and their perception of their academic institution's support for breastfeeding.

RESULTS

Nursing students' level of breastfeeding knowledge was very high, and higher than that among students from other faculties. However, both groups had similar moderately positive overall scores for attitudes towards breastfeeding. In addition, both groups expressed similar moderate intentions to breastfeed during the course of their studies. Students' perception of their academic faculty as supportive of breastfeeding, their breastfeeding attitudes, and breastfeeding knowledge, were found to predict their intention to breastfeed during the course of their studies.

CONCLUSIONS

Nursing programs should place more emphasis on improving nursing students' attitudes towards breastfeeding. In order to promote breastfeeding among students during their studies, it is important to ensure a pro-breastfeeding environment on campus.

Knowledge and practice of exclusive breastfeeding among mothers in the tamale metropolis of Ghana

Background

The prevalence of exclusive breastfeeding (EBF) for the first six months of life has remained low worldwide and in Ghana, despite strong evidence in support of its practice. This study was aimed at assessing the knowledge and practice of exclusive breastfeeding among mothers in the Tamale metropolis of Ghana.

Methods

In a descriptive cross-sectional study, 393 mother-infant pairs attending child welfare clinics from three health facilities in the Tamale Metropolis were surveyed. A structured item questionnaire was used to collect data on the socio-demographic Characteristics of the participants, their knowledge regarding breastfeeding and level of practice of exclusive breastfeeding (EBF). The results were presented in frequency counts, percentages and inferences were made using a contingency table and chi-square values were computed to check for the relationship between participants demographic characteristics, the Knowledge and the practice of EBF and P value was set at 0.05.

Results

The Analysis of the data was done with SPSS version 20. The study surveyed a total of 393 mothers from Tamale metropolis, of whom 27.7% reported having exclusively breastfed their infant for the first 6 months of life. The socio-demographic of the participants showed that they all had some level of education. The study revealed that 39.4% initiated breastfeeding within one hour after birth. Majority of participants had heard of EBF 277 (70.5%), about 344 (87.5%) of participants believed that EBF should be practised for 5 months in their locality. Pearson Chi-square test of the association between sociodemographic characteristics associated and EBF showed a significant association between EBF and the sex of the child, X² = 4.177, P = .041. Whiles, EBF and the Knowledge on child spacing was X² = 17.769, P < .001 and EBF and knowledge on Breast cancer reduction was also significant X² = 4.384, P = .036.

Conclusions

Although all the participants had some level of education background, a majority did not have adequate knowledge on EBF and EBF practice was low in the study community. Thus, we suggest improved education at the child welfare clinics and the media should be used as a platform to educate women adequately about importance of EBF.

Factors Associated with Exclusive Breastfeeding Practice among Nursing Mothers in rural areas of Enugu State and its Implications for Social Work Practice in Nigeria

This study investigates factors that influence exclusive breastfeeding practice. Focus group discussions involving 60 nursing mothers from selected rural areas of Enugu State, Nigeria, was adopted. Thematic analysis was adopted in analyzing data collected. Findings show that nursing mothers in the study area are yet to fully accept the 6 months' practice of exclusive breastfeeding. Issues relating to culture, economic hardship, and support networks were revealed to exercise gross influence on practice of exclusive breastfeeding. The study concluded that professional support from social workers is very vital to achieving conformity to the practice. This can be done through awareness creation that would accommodate support networks, while adopting exclusive breastfeeding campaign models that have proven successful in other African nations.