Barriers to Optimal Maternal and Child Feeding Practices in Pastoralist Areas of Somali Region, Eastern Ethiopia: A Qualitative Study — Oak Academic Publishing
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Barriers to Optimal Maternal and Child Feeding Practices in Pastoralist Areas of Somali Region, Eastern Ethiopia: A Qualitative Study
Department of Public Health, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
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Department of Public Health, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
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Department of Public Health, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
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Department of Public Health, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
1 Department of Public Health, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
2 Department of Public Health, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
3 Department of Public Health, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
4 Department of Public Health, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
Maternal and child nutrition is critical for child health and survival. Appropriate feeding practices are of fundamental importance for health, nutrition, survival and development of infants and children. In pastoral areas of Ethiopia, barriers related to cultu re , knowledge, social norms, beliefs, behaviors, decision making in the household and burden of other responsibilities contribute to nutritional status of women and children to deteriorate. Policies and strategies are recommending assessment of barriers for designing programs and interventions to improve maternal and child nutrition practices. This study is aimed to assess barriers of optimal maternal and child feeding practices in Pastoralist areas of Somali region, Eastern Ethiopia . A q ualitative community based research method was used involving 17 focus group discussions and 20 in-depth interviews with mothers, grandmothers, health professionals and religious leaders from three districts. Data from FGDs and interviews were transcribed and coded. The agreed upon codes were synthe sized and grouped into exhaustive categories. The categories were then merged into themes representing the most common barriers on maternal and child feeding practice that emerged from the FGDs and interviews . We found that traditional beliefs, myths, culture custodian influence, low accessibility and availability of nutritional foods, pattern and burden of other responsibilities, poor knowledge and health seeking behavior, perceived milk insufficiency as main barriers for optimal maternal and child feeding practices . Barriers on optimal maternal and child feeding are very common in the study areas. More work needs to be done to strengthen community-based nutrition with strong social behavioral change communication with emphasis on age-specific counselling on maternal and child nutrition at health facilities, during antenatal and early postnatal visits in the study areas through different media channels, particularly, Somali Region TV and FMs to promote optimal nutrition in the region.
Bhutta, Z.A., Ahmed, T., Black, R.E., et al. (2013) What Works? Interventions for Maternal and Child Undernutrition and Survival. The Lancet, 371, 417-440. https://doi.org/10.1016/S0140-6736(07)61693-6
Barker, M., Dombrowski, S.U., Colbourn, T., Fall, C.H.D., Kriznik, N.M., Lawrence, W.T., et al. (2018) Intervention Strategies to Improve Nutrition and Health Behaviours before Conception. The Lancet, 391, 1853-1864. https://doi.org/10.1016/S0140-6736(18)30313-1
Shrimpton, R. (2012) Global Policy and Programme Guidance on Maternal Nutrition: What Exists, the Mechanisms for Providing It, and How to Improve Them. Paediatric and Perinatal Epidemiology, 26, 315-325. https://doi.org/10.1111/j.1365-3016.2012.01279.x
Haddad, L., Cameron, L. and Barnett, I. (2015) The Double Burden of Malnutrition in SE Asia and the Pacific Priorities, Policies and Politics. Health Policy and Planning, 30, 1193-1206. https://doi.org/10.1093/heapol/czu110
Black, R.E., Allen, L.H., Bhutta, Z.A., et al. (2008) Maternal and Child Undernutrition: Global and Regional Exposures and Health Consequences. The Lancet, 371, 243-260.
Lakshmi, G. (2013) Food Preferences and Taboos during Ante-Natal Period among the Tribal Women of North Coastal Andhra Pradesh. Journal of Community Nutrition & Health, 2, 32-37.
Choudhury, N., Moran, A.C., Alam, M.A., Ahsan, K.Z., Rashid, S.F. and Streatfield, P.K. (2012) Beliefs and Practices during Pregnancy and Childbirth in Urban Slums of Dhaka, Bangladesh. BMC Public Health, 12, Article No.: 791. https://doi.org/10.1186/1471-2458-12-791
Girard, A.W., Dzingina, C., Akogun, O., Mason, J.B. and McFarland, D.A. (2012) Public Health Interventions, Barriers, and Opportunities for Improving Maternal Nutrition in Northeast Nigeria. Food and Nutrition Bulletin, 33, S51-S70. https://doi.org/10.1177/15648265120332S104
Saldanha, L.S., Buback, L., White, J.M., Mulugeta, A., Mariam, S.G., et al. (2012) Policies and Program Implementation Experience to Improve Maternal Nutrition in Ethiopia. Food and Nutrition Bulletin, 33, S27-S50. https://doi.org/10.1177/15648265120332S103
Huybregts, L.F., Roberfroid, D.A., Kolsteren, P.W. and Van Camp, J.H. (2009) Dietary Behaviour, Food and Nutrient Intake of Pregnant Women in a Rural Community in Burkina Faso. Maternal & Child Nutrition, 5, 211-222. https://doi.org/10.1111/j.1740-8709.2008.00180.x
Oni, O.A. and Tukur, J. (2012) Identifying Pregnant Women Who Would Adhere to Food Taboos in a Rural Community: A Community-Based Study. African Journal of Reproductive Health, 16, 68-76.
Young, A.G. and Pike, I.L. (2012) A Biocultural Framework for Examining Maternal Cravings and Aversions among Pastoral Women in East Africa. Ecology of Food and Nutrition, 51, 444-462. https://doi.org/10.1080/03670244.2012.696013
PAHO/WHO (2003) Guiding Principles for Complementary Feeding of the Breastfed Child. PAHO/WHO, Washington DC.
LANCET (2013) Maternal and Child Nutrition. Building Momentum for Impact. LANCET, 4, 15-39.
Organization for Economic Co-operation and Development (OECD) World Health Organization (2018) Health at a Glance: Asia/Pacific. WHO, OECD Publishing, Tokyo.
WHO (2009) Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals. WHO, Geneva, 41.
Victora, C.G., Adair, L., Fall, C., Hallal, P.C., Martorell, R., Richter, L.M., et al. (2008) Maternal and Child Undernutrition: Consequences for Adult Health and Human Capital. The Lancet, 371, 340-357. https://doi.org/10.1016/S0140-6736(07)61692-4
Ethiopia, Ministry of Health (2014) Health Policy and Practice, Information for Action. Quarterly Health Bull., Addis Ababa, 26-34.
Alive & Thrive (2011) An Advocate’s Guide for Helping Advance Infant and Young Child Nutrition in Ethiopia. Alive & Thrive, Washington DC.
UNICEF (2015) State of the World’s Children 2015 Country Statistical Information. UNICEF, New York, 42-47.
Skeel, L.S. and Good, M.E. (1988) Mexican Cultural Beliefs and Breastfeediing: A Model for Assessment and Intervention. Journal of Human Lactation, 4, 160-163. https://doi.org/10.1177/089033448800400409
Shirima, R., Greiner, T., Kylberg, E. and Gebre-Medhin, M. (2001) Exclusive Breast-Feeding Is Rarely Practised in Rural and Urban. Public Health Nutrition, 4, 147-154. https://doi.org/10.1079/PHN200057
Hizel, S., Ceyhun, G., Tanzer, F. and Sanli, C. (2006) Traditional Beliefs as Forgotten Influencing Factors on Breast-Feeding Performance in Turkey. Saudi Medical Journal, 27, 511-518.
Wanjohi, M., Griffiths, P., Wekesah, F., et al. (2016) Sociocultural Factors Influencing Breastfeeding Practices in Two Slums in Nairobi. International Breastfeeding Journal, 12, Article No.: 5. https://doi.org/10.1186/s13006-016-0092-7
Diji, A.K.-A., Bam, V., Asante, E., Lomotey, A.Y., Yeboah, S. and Owusu, H.A. (2017) Challenges and Predictors of Exclusive Breastfeeding among Mothers Attending the Child Welfare Clinic at a Regional Hospital in Ghana: A Descriptive Cross-Sectional Study. International Breastfeeding Journal, 12, Article No.: 13. https://doi.org/10.1186/s13006-017-0104-2
Daglas, M. and Antoniou, E. (2012) Cultural Views and Practices Related to Breastfeeding. Health Science Journal, 6, 353-361.
Kimani-Murage, E.W., Wekesah, F., Wanjohi, M., et al. (2015) Factors Affecting Actualisation of the WHO Breastfeeding Recommendation in Urban Poor Settings in Kenya. Maternal & Child Nutrition, 11, 314-332. https://doi.org/10.1111/mcn.12161
Vyas, S., Kandpal, S.D., Semwal, J., Chauhan, S. and Nautiyal, V. (2010) Trends in Weaning Practices among Infants and Toddlers in a Hilly Terrain of a Newly Formed State of India. International Journal of Preventive Medicine, 5, 741-748.
Malhotra, N. (2013) Inadequate Feeding of Infant and Young Children in India: Lack of Nutritional Information or Food Affordability? Public Health Nutrition, 16, 1723-1731. https://doi.org/10.1017/S1368980012004065
Chaturvedi, S., Ramji, S., Arora, N.K., Rewal, S., Dasgupta, R. and Deshmukh, V. (2016) Time-Constrained Mother and Expanding Market: Emerging Model of Under-Nutrition in India. BMC Public Health, 16, Article No.: 632. https://doi.org/10.1186/s12889-016-3189-4
Maxwell, M., Mukora-Mutseyekwa, F.N.N., Zvinavashe, M. and Haruzivishe, C. (2015) Perceptions and Barriers to Exclusive Breastfeeding in Manicaland, Zimbabwe. Journal of Public Health Medicine, 21, 30.
Nankumbi, J. and Muliira, J.K. (2015) Barriers to Infant and Child-Feeding Practices: A Qualitative Study of Primary Caregivers in Rural Uganda. Journal of Health, Population and Nutrition, 33, 106-116.
Nduna, T., Marais, D. and van Wyk, B. (2015) An Explorative Qualitative Study of Experiences and Challenges to Exclusive Breastfeeding among Mothers in Rural Zimbabwe. Childhood Obesity and Nutrition, 7, 69-76. https://doi.org/10.1177/1941406414568562
Hackett, K.M., Mukta, U.S., Jalal, C.S.B. and Sellen, D.W. (2015) A Qualitative Study Exploring Perceived Barriers to Infant Feeding and Caregiving among Adolescent Girls and Young Women in Rural Bangladesh. BMC Public Health, 15, Article No.: 771. https://doi.org/10.1186/s12889-015-2115-5
Geethalakshmi, R.G. and Smitha Yadav, J.S. (2017) Qualitative Exploration of Infant and Young Child Feeding Practices in Rural Field Practice Area of SSIMS and RC: A Focus Group Discussion Study. International Journal of Community Medicine and Public Health, 4, 2787-2792. https://doi.org/10.18203/2394-6040.ijcmph20173324
Burns, J., Emerson, J.A., Amundson, K., Doocy, S., Caulfield, L.E. and Klemm, R.D.W. (2016) A Qualitative Analysis of Barriers and Facilitators to Optimal Breastfeeding and Complementary Feeding Practices in South Kivu, Democratic Republic of Congo. Food and Nutrition Bulletin, 37, 119-131. https://doi.org/10.1177/0379572116637947
Mekonnen, N., Asfaw, S., Mamo, A., Mulu, Y. and Fentahun, N. (2018) Barriers and Facilitators of Child-Feeding Practice in a Small Sample of Individuals from Gozamin District, Northwest of Ethiopia: A Qualitative Study. BMC Nutrition, 4, Article No.: 25. https://doi.org/10.1186/s40795-018-0233-z
Otoo, G.E., Lartey, A.A. and Pérez-Escamilla, R. (2009) Perceived Incentives and Barriers to Exclusive Breastfeeding among Periurban Ghanaian Women. Journal of Human Lactation, 25, 34-41. https://doi.org/10.1177/0890334408325072
Mgongo, M., Hussein, T.H., Stray-Pedersen, B., Vangen, S., Msuya, S.E. and Wandel, M. (2019) Facilitators and Barriers to Breastfeeding and Exclusive Breastfeeding in Kilimanjaro Region, Tanzania: A Qualitative Study. International Journal of Pediatrics, 10, Article ID: 8651010. https://doi.org/10.1155/2019/8651010
Central Statistical Agency (2016) Ethiopian Demographic and Health Survey (EDHS). CSA, Addis Ababa, 5.
Sadler, K., Kerven, C., Calo, M., Manske, M. and Catley, A. (2009) Milk Matters: A Literature Review of Pastoralist Nutrition and Programming Responses. Feinstein International Center, Tufts University and Save the Children, Addis Ababa.
Central Statistical Agency (2011) Ethiopian Demography and Health Survey (EDHS). CSA, Addis Ababa, 32.
Braun, V. and Clarke, V. (2006) Using Thematic Analysis in Psychology. Qualitative Research in Psychology, 3, 77-101. https://doi.org/10.1191/1478088706qp063oa
Kavle, J., Mehanna, S., Khan, G., Hassan, M., Saleh, G. and Galloway, R. (2014) Cultural Beliefs and Perceptions of Maternal Diet and Weight Gain during Pregnancy and Postpartum Family Planning in Egypt. USAID, Maternal and Child Health Integrated Program, 9.
Kavle, J.A. and Landry, M. (2017) Addressing Barriers to Maternal Nutrition in Low- and Middle-Income Countries: A Review of the Evidence and Programme Implications. Maternal & Child Nutrition, 14, e12508. https://doi.org/10.1111/mcn.12508
Beglay, A. (2002) Barrier to Good Nutrients Intake during Pregnancy: Qualitative Analysis. Nutrition & Dietetics, 59, 175-180.
Radwan, H. and Sapsford, R. (2016) Maternal Perceptions and Views about Breastfeeding Practices among Emirati Mothers. Food and Nutrition Bulletin, 37, 73-84. https://doi.org/10.1177/0379572115624289
Lundberg, P.C. and Trieu, T.N. (2011) Vietnamese Women’s Cultural Beliefs and Practices Related to the Postpartum Period. Midwifery, 27, 731-736. https://doi.org/10.1016/j.midw.2010.02.006
Sa, J., Bouttasing, N., Sampson, L., Perks, C., Osrin, D. and Prost, A. (2013) Identifying Priorities to Improve Maternal and Child Nutrition among the Khmu Ethnic group: Formative Research. Maternal and Child Nutrition, 9, 452-466. https://doi.org/10.1111/j.1740-8709.2012.00406.x
Kavle, J.A., Mehanna, S., Saleh, G., Fouad, M.A., Ramzy, M., Hamed, D., et al. (2014) Exploring Why Junk Foods Are “Essential” Foods and How Culturally Tailored Recommendations Improved Feeding in Egyptian Children. Maternal & Child Nutrition, 11, 346-370. https://doi.org/10.1111/mcn.12165
Ministry of Health (2010) Qualitative Assessment of Maternal Nutrition Practices in Zambia. The Infant & Young Child Nutrition (IYCN) Project, Lusaka.
Thepha, T., Marais, D., Bell, J. and Muangpin, S. (2017) Facilitators and Barriers to Exclusive Breastfeeding in Thailand: A Narrative Review. Journal of Community and Public Health Nursing, 3, 160. https://doi.org/10.4172/2471-9846.1000160
Leurer, M.D., Petrucka, P. and Msafiri, M. (2019) Maternal Perceptions of Breastfeeding and Infant Nutrition among a Select Group of Maasai Women. BMC Pregnancy and Childbirth, 19, Article No.: 8. https://doi.org/10.1186/s12884-018-2165-7
Webb-Girard, A., Charobon, A., Mbugua, S., Kamau-Mbuthia, E., Amin, A. and Sellen, D.W. (2010) Food Insecurity Is Associated with Attitudes towards Exclusive Breastfeeding among Women in Kenya. Maternal & Child Nutrition, 8, 199-214. https://doi.org/10.1111/j.1740-8709.2010.00272.x