Enablers and barriers to adoption of the recommended infant feeding practices among primary caregivers with infants and young children in BidiBidi Refugee Settlement, Yumbe District

Abstract

Introduction Infant and Young Child Feeding (IYCF) practices are vital for reducing childhood morbidity and mortality. Globally, only about 42 percent of women begin breastfeeding within the first one hour of birth, 41% of infants are exclusively breastfed, and only a third of breastfed infants 6–24 months of age meet the criteria of dietary diversity and feeding frequency that are appropriate for their age (Gupta, Holla et al. 2013). In Bidibidi refugee settlement, key IYCF indicators, such as timely breastfeeding initiation (70%), exclusive breastfeeding (60%), and complementary feeding (58%), fall short of optimal levels. This study investigated the enablers and barriers to the adoption of recommended IYCF practices among primary caregivers in Bidibidi Refugee Settlement, Yumbe district. Methodology A qualitative descriptive study design was employed for data collection. The study participants were identified purposively. Data from primary caregivers on enablers and barriers to IYCF practices was collected through nine conducted FGDs and in total 89 primary caregivers participated, utilizing structured FGD guides. Data were audio recorded, transcribed and manually analysed using thematic analysis techniques. Results The primary facilitators of IYCF adoption within the community were associated with health facility-related factors. These included the presence of IYCF-trained health workers, the translation of informational materials into local languages, the availability of IYCF guidelines, and the existence of breastfeeding support corners within maternity wards, offering assistance and close monitoring to mothers facing breastfeeding-related challenges. Conversely, several factors negatively influenced the adoption of IYCF practices among primary caregivers. The foremost factor was the lack of knowledge about IYCF, compounded by time constraints arising from competing activities like long journeys in search of firewood and lengthy queues at food distribution points. Cultural influences also played a significant role, with deeply rooted myths, misconceptions, and beliefs passed down through generations by influential and highly respected community figures. Household factors such as poverty and large family sizes, a limited variety of available complementary foods, lack of support from spouses (men), and the health status of primary caregivers or infants/young children further complicated IYCF adoption. The enablers and barriers to adoption of the recommended IYCF practices were grouped around six themes namely: (i) Primary caregivers’ knowledge about breastfeeding & IYCF (ii) influence of culture custodians (iii) household factors (iv) burden from other responsibilities (v) health facility related factors and (vi) health condition of primary caregiver & infant or young child. Conclusion In Bidibidi refugee settlement, inadequate knowledge about IYCF among primary caregivers poses a major obstacle to the adoption of recommended IYCF practices. Consequently, primary caregivers struggle to apply appropriate IYCF practices for the nutritional well-being of their children aged 0-24 months. Other hindrances to IYCF adoption among primary caregivers encompass the demands from additional responsibilities, influence from cultural norms, and the health status of both primary caregivers and the infants or young children. A crucial facilitator for IYCF adoption is linked to health facilities, particularly the presence of IYCF-trained health workers. The challenges encountered also underscore the potential for exploring various opportunities to bolster the execution of healthcare and community interventions, aimed at enhancing Infant and Young Child Feeding (IYCF) practices as a preventive measure against malnutrition. These opportunities span across the national, healthcare facility, community, and household levels, and as such I strongly recommend the need for further scientific research into the field of IYCF practice adoption in Uganda especially in the refugee setting.