Exclusive breastfeeding in first-time mothers in rural Kenya: a longitudinal observational study of feeding patterns in the first six months of life

Abstract

Background: Exclusive breastfeeding up to 6 months of age is recommended by the World Health Organization as the optimal mode of infant feeding, providing adequate nutrition for the baby and protection against infectious diseases. Breastfeeding can be adversely affected by individual, cultural and socioeconomic factors. The study aimed to explore barriers of exclusive breastfeeding in the first 6 months of life among first-time mothers in rural Kenya. Methods: An observational longitudinal design aimed to provide rich data on breastfeeding behaviour. Twenty pregnant first-time mothers were recruited through antenatal clinics and snowballing. Mothers were visited nine times at home from late pregnancy, at 1 week and 2 weeks post-delivery, then monthly until the baby was aged 6 months. Visits were conducted between November 2016 and April 2018. At the first visit, participants were asked about breastfeeding intentions and infant feeding education received. At each postnatal visit, direct observation of breastfeeding, a recorded semi-structured interview on feeding, mother's and baby's health was performed. Interviews were transcribed, checked, content was grouped into categories and analyzed using a qualitative descriptive approach. Results: Most participants were adolescent (75%) and unmarried (65%). All 20 mothers intended to and did breastfeed, however additional fluids and semi-solids were commonly given. Only two mothers exclusively breastfed from birth up to 6 months of age. Prelacteal feeds, home remedies and traditional medicine were given by over a third of mothers in the first week of life. Concern over babies' bowel habits and persistent crying perceived as abdominal colic led to several mothers receiving advice to give gripe water and traditional remedies. Early introduction of maize porridge from 3 months of age because of perceived hunger of the child was recommended by other family members. Breastfeeding observation showed persistent problems with positioning and attachment of infants. Conclusions: Exclusive breastfeeding from birth to 6 months was uncommon. Prioritization of capacity to detect mothers with breastfeeding problems and provide breastfeeding education and support is necessary, particularly during the antenatal and early postnatal period. It is important to engage with other women resident in the household who may offer conflicting feeding advice.

Less than one-fifth of the mothers practised exclusive breastfeeding in the emerging regions of Ethiopia: a multilevel analysis of the 2016 Ethiopian demographic and health survey

“…Some of the documented factors associated with failure to exclusively breastfeeding includes residence, marital status, types of occupation, accessibility of health facilities, knowledge of mothers about exclusive breastfeeding, maternal health problem, and low utilisation of maternal health services [30][31][32][33][34]. EBF is affected by factors such as the perception that babies continued to be hungry after breastfeeding, maternal health problems, fear of babies becoming addicted to breast milk, pressure from the mother-in-law, pains in the breast, and the need to return to work [7].…”

Abandono do aleitamento materno exclusivo em mães adolescentes: um estudo de coorte em serviços primários de saúde

“…Um estudo realizado na zona rural do Quênia com mães adolescentes corrobora com o efeito dessas avaliações sobre o aleitamento materno (31) .…”

Abandono de la lactancia materna exclusiva en madres adolescentes: un estudio de cohorte en los servicios de atención primaria de salud

“…La valoración materna sobre la calidad de su leche y la satisfacción del bebé con la LME son dos variables que están estrechamente relacionadas e involucran directamente las evaluaciones maternas, en concordancia con los descubrimientos de un estudio descriptivo longitudinal en el ámbito español (30) . Una investigación realizada con madres adolescentes en la zona rural de Kenia, corrobora el efecto de estas evaluaciones sobre la lactancia materna (31) .…”