BackgroundChildhood malnutrition, an important risk factor for child mortality, has been a major health problem with no improvement over the last eight years in Malawi. One of the direct causes to child malnutrition is inadequate dietary intake, more often a result of inappropriate feeding practices. However, breast milk has unique nutritional characteristics hence optimum breastfeeding can avert the risk of malnutrition. For developing countries where HIV is prevalent, such as Malawi, exclusive breastfeeding is the better option which is safe, feasible, and acceptable in preventing of mother-to-child-transmission. However studies looking at infant feeding practices in Malawi have not focused on maternal perceptions; or rural and urban differences, although these factors have been known to influence breastfeeding.
ObjectivesThe aim was to study breast feeding practices and perceptions in an urban and rural setting and investigate which socio-demographic factors are associated with optimum breastfeeding practices and infant’s nutritional status
MethodologyA cross-sectional survey was conducted where 349 mothers of infants below 12 months of age were interviewed. The survey was conducted in two communities in Mangochi district; Mangochi Township, an urban area and Lungwena, a rural area. In addition weight and length of the infants were taken.
ResultsBreastfeeding was initiated within the first hour of giving birth for 65.3% of the mothers. 98% of the interviewed mothers initiated breastfeeding without giving any pre-lacteal feeds. Only 5% of the mothers had discarded colostrum before initiating breastfeeding. Exclusive breastfeeding rates at 2, 4, 6 months were significantly different between the rural and urban area. The rates were 8.9%, 3.2%, 0.6% in the rural area and 51%, 29.2%, 5.7% in the urban area respectively. However, a higher proportion of the mothers both in the rural (17.8%) and the urban area (58.3%) perceived that infants should be breastfed exclusively until 6 months. 76% of both urban and rural mothers had the opinion that infant’s crying inferred as hunger by the mother was the main reason why mothers do not breastfeed. 96% of the mothers thought that there were benefits associated with breastfeeding.
Another person had decided for nearly half of the mothers to start giving complementary feeds. Elderly family or community members were reported by 25% of the mothers as having been the person who made the decision. Health workers were reported by 60% of the mothers to be the persons who had influenced their perceptions. Almost all infants were breastfed when sick. 42.7 % of the rural and 25.3% of the urban mothers breastfed less often when sick. 88% of the mothers were aware about mother-to-child-transmission. But 30.3% of them were not aware of prevention of mother-to-child-transmission. 35.7% of the rural mothers and 22.9% of the urban mothers would still prefer to breastfeed if they were found HIV positive.
12.6% of the infants were stunted and underweight while 6.6% were wasted. The rates of stunting, being underweight or wasting were significantly higher in the rural than the urban area; and among infants not breastfed at 4 months than those breastfed at 4 months. In multivariate analysis we found that living in the urban area, place of birth and literacy of the mother were independent predictors of exclusive breastfeeding at 4 months. While being food secure and living in the urban area were independent predictors of stunting.
ConclusionExclusive breastfeeding is not widely practised and it is more uncommon in the rural area than the urban area. There is need for more interventions focusing on breastfeeding promotion. Elderly community members can be used as an entry point for such kind of interventions. Although less of children who had been exclusively breastfed at four months were malnourished, being exclusively breastfed did not predict absence of malnutrition.