Infant feeding practices and determinants of poor breastfeeding behavior in Kinshasa, Democratic Republic of Congo: a descriptive study

Marcel Yotebieng, Jean Lambert Chalachala, Miriam Labbok, Frieda Behets, Marcel Yotebieng, Jean Lambert Chalachala, Miriam Labbok, Frieda Behets

Abstract

Background: Although breastfeeding is almost universally accepted in the Democratic Republic (DR) of Congo, by the age of 2 to 3 months 65% of children are receiving something other than human milk. We sought to describe the infant feeding practices and determinants of suboptimal breastfeeding behaviors in DR Congo.

Methods: Survey questionnaire administered to mothers of infants aged ≤ 6 months and healthcare providers who were recruited consecutively at six selected primary health care facilities in Kinshasa, the capital.

Results: All 66 mothers interviewed were breastfeeding. Before initiating breastfeeding, 23 gave their infants something other than their milk, including: sugar water (16) or water (2). During the twenty-four hours prior to interview, 26 (39%) infants were exclusively breastfed (EBF), whereas 18 (27%), 12 (18%), and 10 (15%) received water, tea, formula, or porridge, respectively, in addition to human milk. The main reasons for water supplementation included "heat" and cultural beliefs that water is needed for proper digestion of human milk. The main reason for formula supplementation was the impression that the baby was not getting enough milk; and for porridge supplementation, the belief that the child was old enough to start complementary food. Virtually all mothers reported that breastfeeding was discussed during antenatal clinic visit and half reported receiving help regarding breastfeeding from a health provider either after birth or during well-child clinic visit. Despite a median of at least 14 years of experience in these facilities, healthcare workers surveyed had little to no formal training on how to support breastfeeding and inadequate breastfeeding-related knowledge and skills. The facilities lacked any written policy about breastfeeding.

Conclusion: Addressing cultural beliefs, training healthcare providers adequately on breastfeeding support skills, and providing structured breastfeeding support after maternity discharge is needed to promote EBF in the DR Congo.

References

    1. Estimates of under-five mortality rates by country, the 2011 release. [ ]
    1. Building a future for women and children. The 2012 Report [ ]
    1. Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, Rudan I, Campbell H, Cibulskis R, Li M. et al.Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. The Lancet. 2012;379(9832):2151–2161. doi: 10.1016/S0140-6736(12)60560-1.
    1. Mosley WH, Chen LC. An analytical framework for the study of child survival in developing countries. Bull World Health Organ. 2003;81(2):140–145.
    1. Ministère du Plan avec la collaboration du Ministère de la Santé Kinshasa RDdCaMIIC. Maryland, USA: Congo Democratic Republic: DHS, 2007 - Final Report (French); 2008.
    1. Resultat Preliminaires [ ]
    1. WHO/UNICEF. Progress on sanitation and drinking-water 2010 update. World Health Organization; 2010.
    1. WHO. Global strategy for infant and young child feeding, the optimal duration of exclusive breastfeeding. 2001. (Provisional agenda item 13.1). [ ]
    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(9608):243–260. doi: 10.1016/S0140-6736(07)61690-0.
    1. Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS. How many child deaths can we prevent this year? Lancet. 2003;362(9377):65–71. doi: 10.1016/S0140-6736(03)13811-1.
    1. Edmond KM, Zandoh C, Quigley MA, Amenga-Etego S, Owusu-Agyei S, Kirkwood BR. Delayed breastfeeding initiation increases risk of neonatal mortality. Pediatrics. 2006;117(3):e380–e386. doi: 10.1542/peds.2005-1496.
    1. Bhutta ZA, Chopra M, Axelson H, Berman P, Boerma T, Bryce J, Bustreo F, Cavagnero E, Cometto G, Daelmans B. et al.Countdown to 2015 decade report (2000–10): taking stock of maternal, newborn, and child survival. Lancet. 2010;375(9730):2032–2044. doi: 10.1016/S0140-6736(10)60678-2.
    1. WHO/UNICEF. Baby-friendly hospital initiative: revised, updated and expanded for integrated care. 2009. [ ]
    1. Abrahams SW, Labbok MH. Exploring the impact of the Baby-Friendly Hospital Initiative on trends in exclusive breastfeeding. Int Breastfeed J. 2009;4:11. doi: 10.1186/1746-4358-4-11.
    1. Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, Haider BA, Kirkwood B, Morris SS, Sachdev HP. et al.What works? Interventions for maternal and child undernutrition and survival. Lancet. 2008;371(9610):417–440. doi: 10.1016/S0140-6736(07)61693-6.
    1. Coutinho SB, de Lira PI, de Carvalho LM, Ashworth A. Comparison of the effect of two systems for the promotion of exclusive breastfeeding. Lancet. 2005;366(9491):1094–1100. doi: 10.1016/S0140-6736(05)67421-1.
    1. Coghlan B, Brennan RJ, Ngoy P, Dofara D, Otto B, Clements M, Stewart T. Mortality in the Democratic Republic of Congo: a nationwide survey. Lancet. 2006;367(9504):44–51. doi: 10.1016/S0140-6736(06)67923-3.
    1. Coghlan B, Ngoy P, Mulumba F, Hardy C, Bemo VN, Stewart T, Lewis J, Brennan RJ. Update on mortality in the Democratic Republic of Congo: results from a third nationwide survey. Disaster Med Public Health Prep. 2009;3(2):88–96. doi: 10.1097/DMP.0b013e3181a6e952.
    1. Monitoring the Status of Women and Children. Area Graph, DRC [ ]
    1. Labbok MH, Pérez-Escamilla R, Peterson A, Coly S. Breastfeeding and Child Spacing - Country Profiles. Washington DC: Institute of Reproductive Health. Georgetown University; 1997.
    1. Infant Feeding Practices Study II. The Questionnaires [ ]
    1. DHS Model Questionnaires. [ ]
    1. McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q. 1988;15(4):351–377. doi: 10.1177/109019818801500401.
    1. Labbok MH. Community interventions to promote optimal breastfeeding: Review of studies on early initiation, any breastfeeding, exclusive breastfeeding, and continued breastfeeding. Washington, DC: The Infant & Young Child Nutrition Project (IYCN); 2012.
    1. Salhab WA, Wyckoff MH, Laptook AR, Perlman JM. Initial hypoglycemia and neonatal brain injury in term infants with severe fetal acidemia. Pediatrics. 2004;114(2):361–366. doi: 10.1542/peds.114.2.361.
    1. Cornblath M, Hawdon JM, Williams AF, Aynsley-Green A, Ward-Platt MP, Schwartz R, Kalhan SC. Controversies regarding definition of neonatal hypoglycemia: suggested operational thresholds. Pediatrics. 2000;105(5):1141–1145. doi: 10.1542/peds.105.5.1141.
    1. de Rooy L, Hawdon J. Nutritional factors that affect the postnatal metabolic adaptation of full-term small- and large-for-gestational-age infants. Pediatrics. 2002;109(3):E42. doi: 10.1542/peds.109.3.e42.
    1. Hoseth E, Joergensen A, Ebbesen F, Moeller M. Blood glucose levels in a population of healthy, breast fed, term infants of appropriate size for gestational age. Arch Dis Child Fetal Neonatal Ed. 2000;83(2):F117–F119. doi: 10.1136/fn.83.2.F117.
    1. Li R, Fein SB, Chen J, Grummer-Strawn LM. Why mothers stop breastfeeding: mothers' self-reported reasons for stopping during the first year. Pediatrics. 2008;122(Suppl 2):S69–S76.
    1. Gatti L. Maternal perceptions of insufficient milk supply in breastfeeding. J Nurs Scholarsh. 2008;40(4):355–363. doi: 10.1111/j.1547-5069.2008.00234.x.
    1. Britton C, McCormick FM, Renfrew MJ, Wade A, King SE. Support for breastfeeding mothers. Cochrane Database Syst Rev. 2007;1 CD001141.
    1. Chung M, Ip S, Yu W, Raman G, Trikalinos T, DeVine D, Lau J. In: Interventions in primary care to promote breastfeeding: a systematic review. Agency for Healthcare Research and Quality, editor. Rockville (MD), USA; 2008. (vol. Evidence Syntheses, No. 66).

Source: PubMed

3
Sottoscrivi