Mothers’ adherence to optimal infant and young child feeding practices in Uganda: a cross-sectional study

Introduction

Optimal Infant and Young Child Feeding (IYCF) is crucial for survival across the entire childhood continuum. The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) have recommended initiation of exclusive breastfeeding from the time of birth up to 24 months of age¹. Optimal feeding of infants from 0 to 5 months has been associated with significantly lower risk of all-cause and related mortality compared to partial or not breastfeeding at all^1,2.

Estimates suggest that optimal IYCF practices could prevent approximately 12% of mortality in the under 5’s annually. This accounts for about 800,000 lives in Low and Middle-Income Countries (LMICs)³.

Early initiation of optimal IYCF within the first hour following birth in the form of exclusive breastfeeding up to 6 months followed by continued breastfeeding for up to 2 years and beyond with appropriate complementary foods after completion of 6 months is the gold standard for optimal IYCF^1,4.

Sub-Saharan African countries have one of the highest prevalence of breastfeeding at one year, however only 37% of infants less than 6 months are exclusively breastfed^3,5. Various factors have been cited for the low optimal IYCF practices, including; socio-economic status^6,7, home births, culture and poorly implemented and monitored strategies of regulating the marketing of breast-milk substitutes, feeding bottles and teats^6–10. Other cited factors to non-adherence to optimal IYCF include; education levels, health providers’ practices and market pressures to use breast milk substitutes and other nutritional supplements^3,11.

The Uganda demographic and health survey¹² noted that only 63% of infants younger than six months are exclusively breast fed and complementary foods are not introduced in a timely fashion for all children; 33% of children under five are stunted, with only 6% of children aged 6–23 months being appropriately fed¹².

This study sought to establish the factors influencing mothers’ adherence to optimal infant feeding practices for infants below the age of two years in Mpigi town council health facilities, Mpigi District, Uganda. Findings from this study provide country specific data on the extent of adherence to optimal IYCF practices. Such evidence is seminal to policy makers to sustain IYCF policies and programmes.

Methods

Results

264 participants were invited to participate in the study, 100% of these fully completed the survey.

Discussion

In this study, majority of the participants were adherent (79.6%) to IYCF practices while 20.4% were non-adherent to IYCF practices. This could be attributed to well-established strategies facilitating optimal IYCF in Uganda. Indeed, numerous campaigns and policies are in place in support of optimal IYCF in Uganda. These include, but are not limited to, activities involving frontline healthcare providers such as nurses and midwives and ANC services. Optimal IYCF was reflected by assessing practices reflecting IYCF practices such as: breastfed within the first hour after delivery, ability to exclusively breastfeed upto 6 months, continue to breastfeed after introducing others foods to baby and recommended duration of breastfeeding post introduction of complementary feeding¹⁴. This is also in line with the WHO published set of population-level IYCF indicators of appropriate feeding practices in children ages 6–23 months¹.

Infant feeding practices in this study were appropriate with regards to the WHO criteria for optimal IYCF practices. This finding is contrary to that reported in a study in Kenya in Urban informal settlements in Nairobi that reported inappropriate IYCF practices¹¹. Optimal IYCF practices such as breast feeding have been reported to be high in Uganda compared to other Sub-Saharan African Countries like Nigeria and Niger⁹. This finding supports the findings of this study of a good estimate of optimal IYCF practices. There were significantly more mothers who reported to have initiated BF within an hour compared to less than half reported in a similar study in India¹⁵.

In context of characteristics of the sample, socio-demographic and economic characteristics of the participants in this study were similar to those reported form the recent population census in Uganda¹². This makes our findings generalizable to the entire population with minimal limitations. The majority of the mothers were aged 20 to 34 years, this is attributed to the fact that majority of the reproductive population in Uganda lies within this age group. Most of the mothers had at least 1 to 3 children. This finding is in line with the fertility rate reported in Uganda, owing to the fact that on average, each mother in Uganda has on average up to 7 children. There were comparatively more female babies compared to male ones, this is in line to the female to male ratios reported in the recent population of Uganda. The most common level of education attained by the mothers was primary education. Indeed, it has been estimated that at least majority of the Ugandan population has attained primary education¹². With regards to occupation and average monthly income; most mothers were housewives and earned an average monthly income of 100,000 to 300,000 Uganda Shillings. This is in line with the economic characteristics of majority of the Ugandan population revealed in the recent census.

The reported breast feeding rate in this study is higher than that reported in World Breastfeeding Initiative: Uganda Assessment Report that showed that 40% of the children under 6 months of age have not been exclusively breastfed and only 52.5% were breastfed within an hour of birth.

Reasons reported to enable those who embraced initiation of BF with the first hour included; had plenty of breast milk production, enough time with the baby and encouragement from HCWs. Indeed, strong individual champions such as HCWs who encourage IYCF such as initiating BF in the first hour have been reported elsewhere as catalysts to optimal IYCF practices^14,16. Engagement of the mother by providing enough time with the baby would in turn stimulate milk production. This could in part solve the problem of lack of breast milk production which was one of the barriers to initiating BF in the first hour. In addition, controlling for pain after delivery could go a long way in giving mothers more comfort post-delivery so that they could start enjoying happy times with the new born.

In context of initiating complementary feeding, few mothers in this study were aware of the right timing. Emphasis on the right timing and preparation of complementary feeds during ANC and PNC visits needs to be hastened in facility and community based programmes. Awareness of the benefits of BF was significant in this study.

Attendance of ANC was overwhelmingly high in this study. This could be attributed to programmes such as the Baby Friendly Hospital Initiative (See World Breastfeeding Trends Initiative, Uganda Report 2015). However; practical demonstrations need to be incorporated in the ANC visits. The majority of the mothers reported that they did not received practical demonstration during ANC visits. These could improve feeding behaviors of mothers and in turn sustain optimal IYCF practices upto a recommended time.

Correlates to adherence to optimal IYCF included socio-demographic factors such as; age of the mother, level of education and average monthly income of the family. A similar study that assessed the impact of Socio-demographic and health service factors on breastfeeding in SSA using demographic health survey data reported that educational attainment was a significant predictor of IYCF practices such as exclusive breast feeding⁸. Health condition of the mother during pregnancy, awareness of the right age to introduce complementary food and having received information on IYCF during ANC visits were independent predictors of adherence to optimal IYCF practices. We argue that to promote and sustain IYCF practices, it is imperative to create public awareness about appropriate complementary feeding, its timing and providing IYCF counseling support systems for mothers.

Limitations of the study

While as this study presents important information on the extent of adherence to IYCF practices in Uganda, the data was obtained using self-report from the mothers. Such information gained from self-report is liable to bias as we cannot ascertain the truthfulness of information provided. In addition, the findings of this study are obtained from a semi-urban setting, as such these finding could not be generalizable to mothers in urban settings who could have different socio-demographic and economic characteristics.

Conclusion

A significantly good adherence to optimal IYCF practices was revealed in this study. Promotion and sustaining well-established policies to support IYCF programmes is recommended to maintain optimal IYCF practices. In addition, practical demonstrations need to be incorporated in the ANC visits.

Ethical approval and consent

The study proposal was approved by the Institute of Public Health and Health Management of Clarke International University. Permission to collect data from health facilities was granted by the District Health Officer (DHO) and the administrator in-charge of the health facilities. It was strictly voluntary to participate in the study and written informed consent was obtained from participants at all times.

Data availability

The data underlying this study is available from figshare. Dataset 1: A study on Factors influencing mothers’ adherence to optimal and young child feeding practices for babies below two years in Mpigi town council, Mpigi district, Uganda. https://doi.org/10.6084/m9.figshare.6470705.v1¹⁷

This dataset is available under a CC by 4.0 license

Data points containing ‘999’ or ‘99’ denote missing variables. Additionally where respondents have answered yes or no, their answer in some cases prevents them from answering the next question and their for the subsequent analysis. ‘999/99’ was used in case also.

Author endorsement

Masoomeh Imanipour confirms that the author has an appropriate level of expertise to conduct this research, and confirms that the submission is of an acceptable scientific standard. Masoomeh Imanipour declares they have no competing interests. Affiliation: Faculty of Nursing and Midwifery, Tehran University of Medical Sciences (TUMS), Tehran, Iran.