Menu
Menu
Menu
Menu
Background While lactation is a physiological process requiring high energy demand to fulfill the nutrient requirements of the mother and the breastfeeding child, many factors affecting maternal nutrient intake can lead to nutritional deficits. Previous studies in Ethiopia have reported the prevalence of maternal and child undernutrition and related complications. However, qualitative studies exploring potential barriers to utilizing available nutrition interventions are limited. This study, therefore, sought to qualitatively explore barriers hindering the uptake of nutrition services among lactating mothers from rural communities in Tigray, northern Ethiopia. Methods We conducted 6 in-depth interviews, 70 key informant interviews, and 13 focus group discussions among purposively selected community groups, experts, and lactating mothers between November- 2017 and January- 2018. Audio records of all interviews and focus group discussions were transcribed verbatim (word-to-word) and translated into English. Then, translated data were analyzed thematically using qualitative data analysis software Atlas ti-version 7.4. Results The participants in this study perceived that lactating mothers in their study area are not properly utilizing available and recommended nutrition interventions, and as a result, their nutrient intake was reported as inadequate. Participants identified inadequate accessibility and availability of foods, feeding practices, cultural and religious influences, focus on agricultural production and productivity, barriers related to health services and poor access to water, sanitation and hygiene as major barriers hindering the uptake of nutrition interventions by lactating women in Tigray, northern Ethiopia. Conclusion The uptake of nutrition intervention services was low among lactating mothers and was hindered by multiple socio-cultural and health service related factors requiring problem-specific interventions at community, health facility, and administrative levels to improve the nutritional status of lactating mothers in the study area.
This study was conducted in five woredas in the Tigray region, northern Ethiopia between November- 2017 and January- 2018. Tigray is the northernmost region of Ethiopia. The population of Tigray is estimated to be about 5,541,736 (CSA projection for 2019). About 80% of the population lives in rural areas. The region is administratively divided into seven zones, 52 districts, and 763 kebeles, the smallest administrative division. Currently, there are 2 referral hospitals, 14 general and 24 primary hospitals, 226 health centers, and 740 health posts. Details of the study design were reported elsewhere [18]. In brief, three food-insecure woredas (Ofla, Samre Seharti, and Tanqua Abergele) and two food-secure woredas (Laelay Maichew, Medebay Zana) were purposively selected for this study. Then two kebeles, the smallest administrative unit of about 5000 people, were selected from each woreda. Therefore, the study was conducted in 10 kebeles in the region. An exploratory qualitative study design was utilized in this study. Taking into consideration the principle of maximum variation, participants were purposively selected from different community groups and areas of expertise with the help of kebele leaders and health extension workers. For in-depth interviews (IDI), lactating mothers were selected; for key informants interviews (KII), participants from different community groups such as religious leaders, women development groups (WDG), kebele leaders, health extension workers (HEWs), agriculture extension workers (AEWs), and experts from various nutrition-sensitive and nutrition-specific sectors such as agriculture, nutrition, education, water, health, youth and sports services, and women’s affairs were selected. Lactating mothers, WDG, and women of reproductive age were selected for focus group discussions (FGD). Qualitative data for this study were explored from KIIs, IDIs, and FGDs. While KIIs and IDIs were carried out to explore people’s opinions towards potential barriers to accessing nutrition interventions during lactation in the studied communities, FGDs were conducted to investigate people’s interactions regarding the research objective and to triangulate the findings of the study from the perspectives of different community groups and experts. After consulting experts from different disciplines such as public health, nutrition, agriculture, and food sciences and reviewing the literature, interview and discussion guides were developed to facilitate the KIIs, IDIs, and FGDs. The guides mainly covered the types of nutrition interventions available and barriers to the uptake of the available interventions in the study area. The guides were developed in English, translated into the local language for the study area, and back-translated to ensure consistency. They were also pre-tested before the actual data collection was carried out, and comments identified during the pre-test were used to modify the tools. The pilot test was conducted in Ofla district; one FGD for each FGD category and one IDI each for district-level experts were conducted. KIIs, IDIs, and FGDs were facilitated by MSc/MPH holders with previous experience in qualitative data collection (with one note taker and one facilitator). While KIIs and IDIs were conducted in locations preferred by participants, FGDs were carried out either in a health post or community development center where the discussion could be held with minimal destructions. While the average time of KII and IDI was 45 minutes, FGDs took 70 to 90 minutes. All KIIs, IDIs, and FGDs were audio-recorded. Investigators listened to the audiotaped FGDs, KIIs, and IDI data several times to familiarize themselves with the data. All KII, IDI, and FGD audio records were transcribed verbatim and translated into English. Then, translated transcripts were imported into Atlas ti-version 7.4 qualitative data analysis software for coding. Following the principles of thematic analysis set out by Braun and Clarke, investigators applied line-by-line coding to inductively explore the potential barriers to accessing nutrition interventions during lactation in the studied communities. Following coding, identified codes were grouped based on similarities and differences to form categories. Finally, themes were identified. Participants’ quotes were reported directly as they were spoken, without editing the grammar, to avoid any loss of meanings. Member checks and prolonged engagement with participants were done to strengthen the credibility of the accounts. Data collectors, supervisors, and investigators spent a prolonged time in field work to facilitate sustained engagement with the study participants. For the member checks, participants who were willing to stay following each focus group discussion were asked to listen to the sound recordings and asked if they agreed with what had been said. Research assistants and investigators also conducted peer debriefing during data collection on a daily basis. To ensure the reliability of the data, data from FGD and IDI were triangulated. Coding was done by at least two investigators, and differences in coding were resolved via discussion. Transparency was maintained by recording each step taken from the start of the project until reporting the research findings. Researchers sought to set aside their assumptions, perceptions, and values, and prior knowledge to reduce bias during the collection, coding, and interpretation of data. The study was approved by the ethical review committee of the College of Health Sciences, Mekelle University, and permission to conduct the study was also obtained from Tigray Regional Health Bureau. Before conducting data collection, participants were informed about the purpose of the study, their right to participate and refuse at any stage of the study, and confidentiality. Consequently, verbal consent was sought from each participant. Verbal consent was audiotaped after information about the study was provided to study participants.
