'No sister, the breast alone is not enough for my baby' a qualitative assessment of potentials and barriers in the promotion of exclusive breastfeeding in southern Zambia

Eli Fjeld, Seter Siziya, Mary Katepa-Bwalya, Chipepo Kankasa, Karen Marie Moland, Thorkild Tylleskär, PROMISE-EBF Study Group, Thorkild Tylleskär, Philippe Van de Perre, Eva-Charlotte Ekström, Nicolas Meda, James K Tumwine, Chipepo Kankasa, Debra Jackson, Thorkild Tylleskär, Ingunn M S Engebretsen, Lars Thore Fadnes, Eli Fjeld, Knut Fylkesnes, Jorn Klungsoyr, Anne Nordrehaug-Astrom, Oystein Evjen Olsen, Bjarne Robberstad, Halvor Sommerfelt, Philippe Van de Perre, Eva-Charlotte Ekström, Nicolas Meda, Hama Diallo, Thomas Ouedrago, Jeremi Rouamba, Bernadette Traoré, Germain Traoré, Emmanuel Zabsonré, James K Tumwine, Caleb Bwengye, Charles Karamagi, Victoria Nankabirwa, Jolly Nankunda, Grace Ndeezi, Margaret Wandera, Chipepo Kankasa, Mary Katepa-Bwalya, Chafye Siuluta, Seter Siziya, Debra Jackson, Mickey Chopra, Mark Colvin, Tanya Doherty, Ameena E Googa, Lyness Matizirofa, Lungiswa Nkonki, David Sanders, Wanga Zembe, Eli Fjeld, Seter Siziya, Mary Katepa-Bwalya, Chipepo Kankasa, Karen Marie Moland, Thorkild Tylleskär, PROMISE-EBF Study Group, Thorkild Tylleskär, Philippe Van de Perre, Eva-Charlotte Ekström, Nicolas Meda, James K Tumwine, Chipepo Kankasa, Debra Jackson, Thorkild Tylleskär, Ingunn M S Engebretsen, Lars Thore Fadnes, Eli Fjeld, Knut Fylkesnes, Jorn Klungsoyr, Anne Nordrehaug-Astrom, Oystein Evjen Olsen, Bjarne Robberstad, Halvor Sommerfelt, Philippe Van de Perre, Eva-Charlotte Ekström, Nicolas Meda, Hama Diallo, Thomas Ouedrago, Jeremi Rouamba, Bernadette Traoré, Germain Traoré, Emmanuel Zabsonré, James K Tumwine, Caleb Bwengye, Charles Karamagi, Victoria Nankabirwa, Jolly Nankunda, Grace Ndeezi, Margaret Wandera, Chipepo Kankasa, Mary Katepa-Bwalya, Chafye Siuluta, Seter Siziya, Debra Jackson, Mickey Chopra, Mark Colvin, Tanya Doherty, Ameena E Googa, Lyness Matizirofa, Lungiswa Nkonki, David Sanders, Wanga Zembe

Abstract

Background: Appropriate feeding practices are of fundamental importance for the survival, growth, development and health of infants and young children. The aim of the present study was to collect baseline information on current infant and young child feeding practices, attitudes and knowledge in Mazabuka, Zambia, using a qualitative approach.

Methods: The study was conducted in Mazabuka, 130 km south of Lusaka in Zambia in January and February in 2005. Nine focus group discussions with mothers and a total of 18 in-depth interviews with fathers, grandmothers, health staff and traditional birth attendants were performed in both rural and urban areas.

Results: Breastfeeding was reported to be universal, the use of pre-lacteal feeds appeared to be low, colostrum was rarely discarded, and attitudes to and knowledge about exclusive breastfeeding were generally good. However, few practised exclusive breastfeeding. The barriers revealed were: (1) the perception of insufficient milk, (2) the fear of dying or becoming too sick to be able to breastfeed, (3) convention, (4) the perception of 'bad milk' and (5) lack of knowledge on the subject. The health staff and traditional birth attendants were the most important actors in transmitting knowledge about infant feeding to the mothers. Both categories appeared to have updated knowledge on child health and were well respected in the society. Fathers and grandmothers tended to be less knowledgeable on novel subjects such as exclusive breastfeeding and often showed a negative attitude towards it. At the same time they had considerable authority over mothers and children and infant feeding decisions. The rural population was in general less educated and more prone to conventional non-exclusive feeding practices.

Conclusion: The message that exclusive breastfeeding (EBF) is beneficial for child health had reached the health workers and was taught to mothers. However, conventions and expectations from family members in this Zambian community were important barriers in preventing the message of EBF from being translated into practice. The deep-rooted beliefs that prohibit EBF need to be addressed in projects and campaigns promoting EBF.

References

    1. Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? Lancet. 2003;361:2226–34. doi: 10.1016/S0140-6736(03)13779-8.
    1. United Nations Statistics Division Progress towards the Millennium Development Goals, 1990–2005. 2005.
    1. Central Board of Health Zambia Central Board of Health Annual Health Statistical Bulletin, 2003. 2003.
    1. Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS. How many child deaths can we prevent this year? Lancet. 2003;362:65–71. doi: 10.1016/S0140-6736(03)13811-1.
    1. Coutsoudis A, Goga AE, Rollins N, Coovadia HM. Free formula milk for infants of HIV-infected women: blessing or curse? Health Policy Plan. 2002;17:154–60. doi: 10.1093/heapol/17.2.154.
    1. Coovadia HM, Rollins NC, Bland RM, Little K, Coutsoudis A, Bennish ML, Newell ML. Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study. Lancet. 2007;369:1107–16. doi: 10.1016/S0140-6736(07)60283-9.
    1. Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera J. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008;371:243–60. doi: 10.1016/S0140-6736(07)61690-0.
    1. Bhandari N, Bahl R, Mazumdar S, Martines J, Black RE, Bhan MK. Effect of community-based promotion of exclusive breastfeeding on diarrhoeal illness and growth: a cluster randomised controlled trial. Lancet. 2003;361:1418–23. doi: 10.1016/S0140-6736(03)13134-0.
    1. Morrow AL, Guerrero ML, Shults J, Calva JJ, Lutter C, Bravo J, Ruiz-Palacios G, Morrow RC, Butterfoss FD. Efficacy of home-based peer counselling to promote exclusive breastfeeding: a randomised controlled trial. Lancet. 1999;353:1226–31. doi: 10.1016/S0140-6736(98)08037-4.
    1. Haider R, Ashworth A, Kabir I, Huttly SR. Effect of community-based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomised controlled trial [see comments] Lancet. 2000;356:1643–7. doi: 10.1016/S0140-6736(00)03159-7.
    1. Aidam BA, Perez-Escamilla R, Lartey A. Lactation counseling increases exclusive breast-feeding rates in Ghana. J Nutr. 2005;135:1691–5.
    1. Central Statistical Office Zambia census of population and housing 2000 (Summary) 2003.
    1. Kitzinger J. Qualitative research. Introducing focus groups. BMJ. 1995;311:299–302.
    1. Malterud K. Qualitative research: standards, challenges, and guidelines. Lancet. 2001;358:483–8. doi: 10.1016/S0140-6736(01)05627-6.
    1. Kvale S. Interviews. An Introduction to Qualitative Research Interviewing: Sage Publications; 1996.
    1. Krueger RA. Analysing and Reporting Focus Group Results. London: SAGE Publications; 1998.
    1. Crabtree B, Miller W. Doing Qualitative Research. Newbury Park: Sage; 1999.
    1. Omari AA, Luo C, Kankasa C, Bhat GJ, Bunn J. Infant-feeding practices of mothers of known HIV status in Lusaka, Zambia. Health Policy Plan. 2003;18:156–62. doi: 10.1093/heapol/czg020.
    1. Kakute PN, Ngum J, Mitchell P, Kroll KA, Forgwei GW, Ngwang LK, Meyer DJ. Cultural barriers to exclusive breastfeeding by mothers in a rural area of Cameroon, Africa. J Midwifery Womens Health. 2005;50:324–8. doi: 10.1016/j.jmwh.2005.01.005.
    1. Davies-Adetugbo AA. Sociocultural factors and the promotion of exclusive breastfeeding in rural Yoruba communities of Osun State, Nigeria. Soc Sci Med. 1997;45:113–25. doi: 10.1016/S0277-9536(96)00320-6.
    1. McCann MF, Bender DE. Perceived insufficient milk as a barrier to optimal infant feeding: examples from Bolivia. J Biosoc Sci. 2006;38:341–364. doi: 10.1017/S0021932005007170.
    1. Bond G, Ndubani P. Formative Research on Mother to Child Transmission of HIV/AIDS in Zambia: a Working Report of Focus Group Discussions Held in Keemba, Monze, Zambia Lusaka. 1999.
    1. National Food and Nutrition Commission (Zambia) Report on the Assessment of the Baby Friendly Hospital Initiative. 2001.
    1. Arifeen S, Black RE, Antelman G, Baqui A, Caulfield L, Becker S. Exclusive breastfeeding reduces acute respiratory infection and diarrhea deaths among infants in Dhaka slums. Pediatrics. 2001;108:E67. doi: 10.1542/peds.108.4.e67.
    1. Kruger R, Gericke GJ. A qualitative exploration of rural feeding and weaning practices, knowledge and attitudes on nutrition. Public Health Nutr. 2003;6:217–23.
    1. Coutsoudis A, Pillay K, Kuhn L, Spooner E, Tsai WY, Coovadia HM. Method of feeding and transmission of HIV-1 from mothers to children by 15 months of age: prospective cohort study from Durban, South Africa. AIDS. 2001;15:379–87. doi: 10.1097/00002030-200102160-00011.
    1. Iliff PJ, Piwoz EG, Tavengwa NV, Zunguza CD, Marinda ET, Nathoo KJ, Moulton LH, Ward BJ, Humphrey JH. Early exclusive breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival. AIDS. 2005;19:699–708. doi: 10.1097/01.aids.0000166093.16446.c9.
    1. Coutsoudis A. Influence of infant feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa. Ann N Y Acad Sci. 2000;918:136–44.
    1. Kalibala S. Empowering Communities to Respond to HIV/AIDS: Ndola Demonstration Project on Maternal and Child Health: Operations Research Final Report Washington, DC. 2003.
    1. Coutinho SB, de Lira PI, de Carvalho Lima M, Ashworth A. Comparison of the effect of two systems for the promotion of exclusive breastfeeding. Lancet. 2005;366:1094–100. doi: 10.1016/S0140-6736(05)67421-1.

Source: PubMed

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