Sweet vs Unsweet Milk: An In-Depth Study of Infant and Young Child Feeding Knowledge Attitudes and Practices amongst Gambian Mothers Open Access
Gaye, MamHarr (Summer 2024)
Abstract
Appropriate infant and young child feeding practices (IYCF) are critical for the optimal growth and development of children, especially during the first two years of life. However, rates of key IYCF indicators such as exclusive breastfeeding, dietary diversity and minimum acceptable diet are sub-optimal across the world including in the West African nation of The Gambia. Mothers, being the primary care takers of young children, play a key role in their feeding, making it important that they have the appropriate knowledge and subsequent actions to ensure appropriate IYCF practices. The objective of the study was to gain an in-depth understanding of Gambian mothers’ knowledge, attitudes, and practices regarding infant and young child feeding. The qualitative research study consisted of 22 in-depth interviews with mothers of children under 24 months. Recruitment was hospital based in four sites: 2 urban sites in the West Coast region, one rural site in Central River Region and one rural site in the Lower River Region of The Gambia. 10 of the interviews were conducted in the urban area and the remaining 12 in the rural areas. Five of the interview transcripts were initially coded and a codebook was generated which was then applied to the remaining transcripts. A thematic analysis was conducted using MAXQDA. Key barriers and facilitators were identified and classified by knowledge, attitudes and practices. Mothers had high levels of knowledge on breastfeeding and the benefits of colostrum, but lower levels on complementary feeding requirements. Most mothers received their knowledge from key influencing groups such as grandmothers, and healthcare workers. Despite knowledge and intention to implement recommendations, IYCF practices were sub-optimal due to several reasons such as delays in the initiation of breastfeeding, introduction of pre-lacteal feeds or breastmilk alternatives before 6 months, perceptions of insufficient milk and a belief in sweet and unsweet breastmilk. Low levels of dietary diversity were due to low knowledge of complementary feeding requirements, limited access to diverse food groups and a heavy reliance on millet-based porridges as the complementary food of choice for young children. Consumption of animal-based proteins was low due to financial constraints and beliefs that very young children do not need meat. Access to nutrition interventions were identified as beneficial however, these were mainly available in the rural areas, with challenges in program implementation. Despite high knowledge and intention among Gambian mothers, IYCF practices remained suboptimal. Our study identified several key influencing factors that need to come into play to support families to reach feeding goals including consistent and accurate information being shared by all influencing groups, efforts to ensure early initiation and exclusive breastfeeding, knowledge of complementary feeding requirements and dietary diversity needs, increased access to a variety of food sources and lastly, well designed and monitored malnutrition programs. The government and key stakeholders can utilize the findings from this research to further refine existing programs to address key barriers and leverage existing facilitators, design new programs and produce contextualized recommendations and curricula to improve feeding practices.
Table of Contents
Chapter 1: Introduction 1
Chapter 2: Literature Review 5
Chapter 3: Methodology 11
Chapter 4: Results 14
Chapter 5: Discussion 31
Chapter 6: Recommendations 42
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