Factors influencing feeding practices of primary caregivers of infants (0-5.9 months) in Avian Park and Zwelethemba, Western Cape, South Africa

Goosen, Charlene (2013-03)

Thesis (MNutr)--Stellenbosch University, 2013.

Thesis

ENGLISH ABSTRACT: Introduction Breastfeeding is a key child survival strategy. Mixed feeding (predominant and partial breastfeeding as defined by the World Health Organisation) during the first six months of life is associated with childhood morbidity and mortality, especially in resource-limited settings, and carries the highest risk of HIV transmission through breastfeeding. When compared to exclusive breastfeeding, predominant, partial or no breastfeeding increases the risk for pneumonia and diarrhoea-related mortality. National exclusive breastfeeding rates are poor and have not improved significantly over the past fourteen years, supporting investigation into the contextual factors that influence infant feeding practices. Aim The study aimed to determine the feeding practices of primary caregivers of infants (0-5.9 months) and the influencing factors in Avian Park and Zwelethemba in Worcester, in the Western Cape Province of South Africa, in order to make recommendations, where appropriate. Methods The study was conducted from April to August 2011. A cross-sectional community-based survey was performed using a structured questionnaire. Focus group discussions were held with mothers, fathers and maternal and paternal grandmothers of infants younger than six months, and health care workers (formally trained professionals and counsellors) working in child health. Results One hundred and forty primary caregivers were interviewed. All caregivers were the biological mother of the infant. Seventy-seven percent (n=108) had initiated breastfeeding. At the time of the study, 6% (n=8) breastfed exclusively. Ninety-four percent (n=132) applied suboptimal breastfeeding practices: 36% (n=51) breastfed predominantly, 27% (n=38) breastfed partially, and 31% (n=43) did not breastfeed. Ninety percent (n=126) of the mothers had introduced water, of whom 83% (n=104) had done so before their infants were one month old. Forty-four percent (n=61) of the mothers had introduced food or formula milk, of whom 75% (n=46) had done so before their infants were three months old. Knowledge of the health and economic benefits of breastfeeding supported initiation but several barriers to exclusive breastfeeding remained. The main barriers were 1) the widely-held perception that infants needed water and nonprescription medicines, 2) the concern that milk alone does not satisfy the infant, 3) inadequate infant feeding education and support by the health system, 4) the lack of community-based postnatal support, 5) convention and family influence, 6) mothers separated from their infants and 7) local beliefs about maternal behaviour and breastfeeding. HIV infection exerted a significant influence on infant feeding choice (p<0.001) and none of the HIV-infected mothers breastfed (n=19). Forty-five percent (n=19) of the formula feeding mothers over-diluted the milk, and early supplementation of formula milk with food was common. Health care workers and maternal grandmothers were the key role-players in infant feeding information and support. Conclusion Exclusive breastfeeding during the first six months of life was a rare practice in these communities. Water, formula milk and/or food were introduced at an early age. HIV-infection discouraged breastfeeding and formula feeding practices proved to be poor. Comprehensive education and support at antenatal, intrapartum and postnatal level seemed lacking and community perceptions and convention contributed to mixed feeding practices. Mothers seemed ill equipped to negotiate infant feeding practices with roleplayers at home.

AFRIKAANSE OPSOMMING: Inleiding Borsvoeding is ‘n sleutelstrategie ter ondersteuning van kinderoorlewing. Gemengde voeding (hoofsaaklike en gedeeltelike borsvoeding, soos omskryf deur die Wêreldgesondheidsorganisasie) gedurende die eerste ses maande van lewe, sowel as geen borsvoeding, word geassosieer met kindersiektes and -sterftes, veral in gebiede met beperkte hulpbronne waar babas vatbaar is vir wanvoeding, gastroënteritis en longontsteking. Gemengde voeding dra ook die hoogste risiko vir MIV-oordrag deur borsvoeding. Nasionale eksklusiewe borsvoedingskoerse is swak en het nie oor die laaste veertien jaar verbeter nie. Dit dien as motivering vir die ondersoek na kontekstuele faktore wat babavoedingspraktyke beïnvloed. Doelwit Die doelwit van die navorsingsstudie is om voedingspraktyke van primêre versorgers van babas (0-5.9 maande) en die invloedryke faktore te bepaal in Avian Park en Zwelethemba in Worcester in die Wes-Kaap Provinsie van Suid-Afrika, om sodoende aanbevelings te kan maak waar gepas. Metodes Die studie is uitgevoer van April tot Augustus 2011. ‘n Gemeenskapsgebaseerde deursnee-opname is uitgevoer deur gebruik te maak van ‘n gestruktureerde vraelys. Fokusgroepbesprekings is uitgevoer met moeders, vaders, en oumas (aan moeders- en vaderskant) van babas jonger as ses maande, en gesondheidswerkers (formeel opgeleide werkers en beraders) wat in kindersorg werk. Resultate ‘n Onderhoud is met eenhonderd-en-veertig primêre versorgers gevoer. Al die versorgers was die biologiese moeder van die baba. Sewe-en-sewentig persent (n=108) het borsvoeding begin. Ten tye van die studie het 6% (n=8) eksklusief geborsvoed. Vier-en-negentig persent (n=132) het suboptimale borsvoedingspraktyke beoefen: 36% (n=51) het hoofsaaklik geborsvoed, 27% (n=38) het gedeeltelik geborsvoed en 31% (n=43) het nie geborsvoed nie. Negentig persent (n=126) van die moeders het water gegee, van wie 83% (n=104) dit gedoen het voordat hul babas een maand oud was. Vier-en-veertig persent (n=61) van die moeders het voedsel of formulemelk gegee, van wie 75% (n=46) dit gedoen het voordat hul babas drie maande oud was. Kennis van die gesondheids- en ekonomiese voordele van borvoeding het moeders ondersteun om te begin borsvoed, maar daar was steeds verskeie faktore wat eksklusiewe borsvoeding belemmer het. Die belangrikste hindernisse was 1) die algemene siening dat babas water en nie-voorskrif medisynes benodig, 2) die kommer dat alleenlik melk nie die baba bevredig nie, 3) ontoereikende babavoedingsonderrig en ondersteuning deur die gesondheidstelsel, 4) die gebrek aan gemeenskapsgebaseerde nageboorte-ondersteuning, 5) gebruike en die invloed van gesinslede, 6) moeders geskei van hul babas en 7) plaaslike sienings rakende moeders se gedrag en borsvoeding. MIV-infeksie het ‘n wesenlike invloed op voedingskeuse gehad (p<0.001) en geen van die MIV-positiewe moeders het geborsvoed nie (n=19). Vyf-en-veertig persent (n=19) van die formule voedende moeders het die melk oorverdun en vroeë supplementasie van formulemelk met kos was algemeen. Gesondheidswerkers en oumas was die kernrolspelers ten opsigte van baba-voedingsinligting en ondersteuning. Gevolgtrekking Eksklusiewe borsvoeding gedurende die eerste ses maande van lewe was ‘n seldsame praktyk in hierdie gemeenskappe. Water, formulemelk en/of voedsel is op ‘n vroeë ouderdom bekendgestel. MIV infeksie het borsvoeding ontmoedig en formulevoedingspraktyke was swak. Omvattende opvoeding en ondersteuning op voorgeboorte-, intrapartum- en nageboortevlak het ontbreek, en sienings en gebruike het bygedra tot gemengde voedingspraktyke. Dit het geblyk dat moeders nie toegerus was om oor babavoedingspraktyke met ander belanghebbendes by die huis te onderhandel nie.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/80071
This item appears in the following collections: