Determinants of exclusive breastfeeding in infants of six months and below in Malawi: A cross sectional study

BMC Pregnancy and Childbirth, Volume 20, No. 1, Year 2020

Interpretation

Background: UNICEF and WHO recommend that all children should be exclusively breastfed for the first 6 months of life as breastmilk contains all the nutrients an infant needs during this period. In Malawi, exclusive breastfeeding has been declining from 72% (2009), 70.2% (2014) and 61% in the most recent survey (2015-16). We aimed to determine factors associated with exclusive breastfeeding in Malawi. Methods: We used data from the Malawi Demographic and Health Survey (MDHS) 2015-2016. Survey records for 2059 mothers of children aged 6 months and below were identified and potential factors influencing infant feeding were examined. Logistic regression analysis was carried out to model determinants of exclusive breastfeeding (EBF). Results: EBF declined in proportion to the age of the infant. Significant associations with continuing EBF were age of the mother, ethnicity of the mother, sex of infant and number of siblings. Members of the Tumbuka (OR = 1.71, CI. 1.13-2.59) and Ngoni (OR = 2.05, CI. 1.38-3.05) communities were more likely to practice EBF. In addition, mothers with female babies (OR = 1.35, CI. 1.08-1.70) and those with 3-4 children (OR = 1.47, CI. 1.04-2.08) were more likely to engage in EBF. Conclusion: We identify important variations in EBF practices among population sub-groups in Malawi that need to be considered when framing health education messaging. Work is needed to assess the impact of more targeted messaging, whether delivered via ‘ten steps’ to successful breastfeeding under Baby Friendly Hospital Initiative (BFHI) programming or other health education and awareness campaigns to sensitize communities on implications of some cultural practices on the lives of babies. The potential role for mass media, targeted Health Surveillance Assistants’ (HSA) home visits and male involvement also require exploration. We used data from the 2015–16 MDHS. The dependent variable was exclusive breastfeeding and the independent variables were the factors potentially affecting exclusive breastfeeding. We examined the influence of maternal determinants (age of mother, education of mother, religion of mother, employment status of mother, ethnicity of mother, region where mother resides, wealth index of mother and marital status), and infant determinants (sex of the baby, age of the baby and number of children born to the mother). These variables were assessed quantitatively to measure their significance in affecting exclusive breastfeeding. The study used the data set which involved information on women with infants of 6 months and below. This data set was used because the women would have provided the most current information about feeding status and on the determinants of exclusive breastfeeding. The MDHS was a nationally representative sample of 25,146 women aged 15–49 of whom 24,562 were interviewed during the survey, representing a response rate of 98%. The 2015–16 MDHS provides reliable estimates at the national and regional levels, for urban and rural areas, and for each of the 28 districts in Malawi. The survey methods are described in detail in the MDHS report [7]. After access to dataset was granted, the data were analyzed using statistical software (STATA Version 12 S/E) and bivariate tables generated. Logistic regression analysis was carried at two levels to identify factors associated with exclusive breastfeeding. Firstly, binary logistic regression analysis was carried out and variables with p-value < 0.05 were included in the final multivariable logistic regression analysis. Strength of association was measured using odds ratios and 95% confidence intervals. A p-value < 0.05 was set for statistical significance. MDHS used sample weights to ensure accurate representation of the proportion of women at national and regional levels. Therefore, in this analysis, only the weighted numbers are shown in the tables. The data used in this analysis were from woman’s questionnaire in which women with babies from 0 to 6 months were considered. A variable of exclusive breastfeeding was generated by considering those women who gave their children food other than breastmilk including water within the period of 6 months from birth of the child. Whether currently breastfeeding or not, a woman with child within age of 6 months and below was considered during the process of generating the variable of exclusive breastfeeding. Permission to use the secondary data was sought from the Demographic and Health Surveys (DHS) Program and a waiver of ethical review was granted by the College of Medicine Research Ethics Committee (COMREC).

AI Digest

Study Justification:

The study aimed to determine the factors associated with exclusive breastfeeding in infants of six months and below in Malawi. This research is important because UNICEF and WHO recommend exclusive breastfeeding for the first six months of life, as breastmilk provides all the necessary nutrients for infants during this period. However, exclusive breastfeeding rates in Malawi have been declining, and it is crucial to identify the factors influencing this decline to develop effective interventions and improve infant feeding practices.

Highlights:

1. The study used data from the Malawi Demographic and Health Survey (MDHS) 2015-2016, which provided a nationally representative sample of women aged 15-49.
2. Logistic regression analysis was conducted to identify determinants of exclusive breastfeeding.
3. The study found that exclusive breastfeeding declined with the age of the infant.
4. Significant associations were found between exclusive breastfeeding and the age and ethnicity of the mother, sex of the infant, and number of siblings.
5. The Tumbuka and Ngoni communities were more likely to practice exclusive breastfeeding.
6. Mothers with female babies and those with 3-4 children were also more likely to engage in exclusive breastfeeding.
7. The study highlights the need for targeted health education messaging to address variations in exclusive breastfeeding practices among different population sub-groups in Malawi.
8. The potential role of interventions such as the Baby Friendly Hospital Initiative (BFHI), health education campaigns, mass media, Health Surveillance Assistants’ (HSA) home visits, and male involvement in promoting exclusive breastfeeding is also emphasized.

Recommendations:

1. Develop and implement targeted health education messaging to address variations in exclusive breastfeeding practices among different population sub-groups in Malawi.
2. Assess the impact of more targeted messaging, including the ‘ten steps’ to successful breastfeeding under the Baby Friendly Hospital Initiative (BFHI) programming.
3. Conduct health education and awareness campaigns to sensitize communities on the implications of cultural practices on infant feeding.
4. Explore the potential role of mass media in promoting exclusive breastfeeding.
5. Investigate the effectiveness of targeted home visits by Health Surveillance Assistants (HSA) in promoting exclusive breastfeeding.
6. Encourage male involvement in supporting and promoting exclusive breastfeeding.

Key Role Players:

1. Ministry of Health: Responsible for developing and implementing policies and programs related to infant feeding and breastfeeding promotion.
2. Health Surveillance Assistants (HSAs): Provide community-based health services and can play a role in promoting exclusive breastfeeding through home visits and counseling.
3. Non-Governmental Organizations (NGOs): Engage in health education and awareness campaigns to promote exclusive breastfeeding.
4. Media Organizations: Collaborate with health authorities and NGOs to disseminate information and messages on exclusive breastfeeding through various media channels.
5. Community Leaders: Act as influencers and advocates for exclusive breastfeeding within their communities.

Cost Items for Planning Recommendations:

1. Development and production of targeted health education materials and messaging.
2. Training and capacity building for health workers, including HSAs, on promoting exclusive breastfeeding.
3. Implementation of health education and awareness campaigns, including costs for materials, venues, and logistics.
4. Collaboration with media organizations for the dissemination of messages on exclusive breastfeeding.
5. Monitoring and evaluation of interventions to assess their effectiveness and make necessary adjustments.
6. Research and data collection to monitor exclusive breastfeeding rates and identify any changes or trends.
7. Collaboration with community leaders and stakeholders to engage and mobilize support for exclusive breastfeeding initiatives.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is rated 7 because it provides a clear description of the study design, data source, and statistical analysis. However, it lacks specific details on the sample size and the specific variables included in the analysis. To improve the evidence, the abstract could include more information on the sample size, the specific variables included in the analysis, and any potential limitations of the study.

Abstract

We used data from the 2015–16 MDHS. The dependent variable was exclusive breastfeeding and the independent variables were the factors potentially affecting exclusive breastfeeding. We examined the influence of maternal determinants (age of mother, education of mother, religion of mother, employment status of mother, ethnicity of mother, region where mother resides, wealth index of mother and marital status), and infant determinants (sex of the baby, age of the baby and number of children born to the mother). These variables were assessed quantitatively to measure their significance in affecting exclusive breastfeeding. The study used the data set which involved information on women with infants of 6 months and below. This data set was used because the women would have provided the most current information about feeding status and on the determinants of exclusive breastfeeding. The MDHS was a nationally representative sample of 25,146 women aged 15–49 of whom 24,562 were interviewed during the survey, representing a response rate of 98%. The 2015–16 MDHS provides reliable estimates at the national and regional levels, for urban and rural areas, and for each of the 28 districts in Malawi. The survey methods are described in detail in the MDHS report [7]. After access to dataset was granted, the data were analyzed using statistical software (STATA Version 12 S/E) and bivariate tables generated. Logistic regression analysis was carried at two levels to identify factors associated with exclusive breastfeeding. Firstly, binary logistic regression analysis was carried out and variables with p-value < 0.05 were included in the final multivariable logistic regression analysis. Strength of association was measured using odds ratios and 95% confidence intervals. A p-value < 0.05 was set for statistical significance. MDHS used sample weights to ensure accurate representation of the proportion of women at national and regional levels. Therefore, in this analysis, only the weighted numbers are shown in the tables. The data used in this analysis were from woman’s questionnaire in which women with babies from 0 to 6 months were considered. A variable of exclusive breastfeeding was generated by considering those women who gave their children food other than breastmilk including water within the period of 6 months from birth of the child. Whether currently breastfeeding or not, a woman with child within age of 6 months and below was considered during the process of generating the variable of exclusive breastfeeding. Permission to use the secondary data was sought from the Demographic and Health Surveys (DHS) Program and a waiver of ethical review was granted by the College of Medicine Research Ethics Committee (COMREC).

Materials

N/A

Innovations

Based on the provided information, here are some potential innovations that could improve access to maternal health:

1. Targeted Health Education Messaging: Develop and implement health education messaging specifically tailored to different population sub-groups in Malawi. This messaging should address the importance of exclusive breastfeeding and the implications of cultural practices on the lives of babies.

2. Baby Friendly Hospital Initiative (BFHI) Programming: Strengthen and expand BFHI programming in hospitals and healthcare facilities to promote and support exclusive breastfeeding. This can include training healthcare providers on breastfeeding support and counseling, implementing the “ten steps” to successful breastfeeding, and creating a supportive environment for breastfeeding mothers.

3. Mass Media Campaigns: Launch mass media campaigns, such as radio or television advertisements, to raise awareness about the benefits of exclusive breastfeeding and address common misconceptions or cultural barriers. These campaigns can reach a wide audience and help change societal norms and attitudes towards breastfeeding.

4. Health Surveillance Assistants’ (HSA) Home Visits: Utilize HSAs to conduct home visits and provide personalized support and counseling to mothers on exclusive breastfeeding. HSAs can address any challenges or concerns mothers may have and provide guidance on proper breastfeeding techniques.

5. Male Involvement: Engage and involve fathers and male family members in promoting and supporting exclusive breastfeeding. This can include educating them about the benefits of breastfeeding, encouraging their support and involvement in the breastfeeding process, and addressing any cultural or societal barriers that may exist.

These innovations aim to address the factors identified in the study that influence exclusive breastfeeding in Malawi and improve access to maternal health services.

AI Innovations Description

Based on the description provided, the recommendation to improve access to maternal health in Malawi would be to develop targeted health education messaging and awareness campaigns. These campaigns should focus on addressing the factors identified in the study as influencing exclusive breastfeeding practices, such as the age of the mother, ethnicity of the mother, sex of the infant, and number of siblings.

The messaging should emphasize the importance of exclusive breastfeeding for the first 6 months of life and highlight the benefits of breastmilk for infant nutrition. It should also address cultural practices that may hinder exclusive breastfeeding and educate communities on the implications of these practices on the lives of babies.

To ensure effective dissemination of the messaging, the potential role of mass media, targeted Health Surveillance Assistants’ (HSA) home visits, and male involvement should be explored. Mass media can be used to reach a wide audience, while HSA home visits can provide personalized education and support to mothers. Involving men in the breastfeeding process can also help create a supportive environment for exclusive breastfeeding.

Overall, by implementing targeted health education messaging and awareness campaigns, Malawi can work towards improving access to maternal health and increasing the practice of exclusive breastfeeding.

AI Innovations Methodology

Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Targeted Health Education Messaging: Develop and implement health education campaigns that specifically address the variations in exclusive breastfeeding practices among different population sub-groups in Malawi. This messaging should be culturally sensitive and aim to raise awareness about the importance of exclusive breastfeeding for the first 6 months of life.

2. Baby Friendly Hospital Initiative (BFHI) Programming: Strengthen the implementation of the BFHI in hospitals and healthcare facilities across Malawi. This initiative promotes and supports breastfeeding through the “ten steps” to successful breastfeeding. Training healthcare providers and ensuring consistent messaging and support for breastfeeding can help improve exclusive breastfeeding rates.

3. Community Sensitization: Conduct community-based awareness campaigns to educate and sensitize communities about the implications of cultural practices on the lives of babies. Engage community leaders, elders, and influencers to promote exclusive breastfeeding and address any misconceptions or barriers.

4. Male Involvement: Involve fathers and male family members in breastfeeding education and support. Engage men through targeted messaging and awareness campaigns to encourage their active participation in supporting exclusive breastfeeding.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define the indicators: Identify specific indicators that will be used to measure the impact of the recommendations. For example, the percentage of infants exclusively breastfed for the first 6 months of life, the knowledge and awareness of exclusive breastfeeding among mothers and community members, and the level of male involvement in supporting breastfeeding.

2. Baseline data collection: Collect baseline data on the identified indicators before implementing the recommendations. This can be done through surveys, interviews, or data analysis from existing sources such as the Malawi Demographic and Health Survey.

3. Implement the recommendations: Roll out the recommended interventions, such as targeted health education messaging, BFHI programming, community sensitization campaigns, and male involvement initiatives.

4. Monitoring and evaluation: Continuously monitor and evaluate the impact of the interventions on the identified indicators. This can be done through follow-up surveys, interviews, or data analysis. Compare the post-intervention data with the baseline data to assess the changes and improvements.

5. Data analysis: Analyze the collected data using statistical software to determine the statistical significance of the impact of the recommendations. Calculate odds ratios, confidence intervals, and p-values to measure the strength of association and statistical significance.

6. Interpretation and reporting: Interpret the results of the data analysis and report on the impact of the recommendations on improving access to maternal health. Provide clear and concise summaries of the findings, highlighting any significant changes and improvements observed.

By following this methodology, it will be possible to simulate the impact of the recommendations on improving access to maternal health and assess their effectiveness in addressing the decline in exclusive breastfeeding rates in Malawi.

Authors & Co-Authors

Statistics:

Citations: 6

Authors: 2

Identifiers:

DOI: 10.1186/s12884-020-03160-y

Research Areas:

Community Interventions, Environmental, Food Security, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants

Study Countries:

Malawi

Study Design:

Cross Sectional Study

Study Approach:

Quantitative

Participants Gender:

Male & Female