Association between malnutrition and knowledge practices and perceptions on infant and young child feeding among HIV negative mothers at Mulago Hospital
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Introduction: Appropriate knowledge, proper feeding practices together with good perceptions on infant and young child feeding among mothers are of fundamental importance for survival, growth, development and health of the children to prevent malnutrition and its complications. WHO recommends that early initiation of breastfeeding within the first hour of life, breastfeeding on demand more than eight to twelve times day and night, exclusive breastfeeding for six months, with proper complementary feeding at six months and continued breastfeeding up to two years or beyond remains crucial for child survival! Objectives: The aim of this study was to identify association between malnutrition and knowledge, practices and perceptions on infant and young child feeding among HIV negative mothers, attending Assessment Centre, Mulago hospital. Design and Method: Un- matched case-control study using both quantitative and qualitative methods was carried out in Assessment Centre, Mulago Hospital. The selection of 302 study participants was done by systematic recruitment of every second mother-child pair with 151 mother-child pair of malnourished (cases) and 151 mother-child pair of well nourished children(controls) between 1-24 months of age. Mothers were tested of their HIV status and only HIV negative mothers’ knowledge, practices and perceptions on infant and young child feeding were assessed in relation to WHO recommendations on infant and young child feeding. Perceptions on feeding an infant and a young child in the era of HIV/AIDS were assessed using Focus group discussions. Data management and analysis: Quantitative raw data was entered into EPI-DATA (version 3.1), analyzed using STATA (version 10) with the help of a statistician. P-value of < 0.05 was considered for statistical significance and the Confidence interval of 95% was reported. Odds ratios were estimated and reported to show the strength of associated factors. Categorical data was analyzed using Chi-square test; continuous variables were analyzed by Students t-test. Bivariate analysis was done to assess for independent associations of various factors and the binary Logistic regression for all significant factors was done to control for confounding. Data was summarized using tables and pie charts. The analysis of qualitative data was done in themes and sub-themes in identified form of information which was obtained from the focus group discussions. Direct quotations from the respondents were used in the presentation of the study findings. RESULTS: This study showed that lack of maternal knowledge on the frequency of breastfeeding a baby day and night(breastfeeding on demand) and lack of maternal knowledge on the frequency of feeding complementary foods were associated with malnutrition with (p-value 0.001,OR 3.2,CI:1.58-6.64,and (p-value 0.010 ,OR 2.2,CI:1.20-4.22) respectively. Maternal incorrect practices of stopping breastfeeding before 24 months of age (p-value 0.005 ,OR 2.4, CI: 1.28-4.69), lack of correct practice of frequency of exclusive breast feeding (p-value 0.004, OR 2.7,CI:1.34-5.79), lack of practicing breastfeeding with proper duration of six months (p-value 0.000,OR 2.5, CI: 1.51-4.04),lack of practicing correct frequency of feeding a child other feeds other than breast milk (p-value 0.042, OR 0.6, CI:0.31-1.00), lack of nutrition education (p-value 0.039, OR 0.5,CI:0.33-1.00) were associated with malnutrition. Poor maternal perceptions are still prevalent and contributed to malnutrition as elaborated in FGDs. Conclusion: The study revealed that there is an association between malnutrition and knowledge, practices and perceptions on infant and young child feeding among HIV negative mothers, attending Assessment Centre at Mulago Hospital. Recommendations: 1. There is need to health educate the mothers about proper feeding of infants and young children at every contact with a health worker more so during antenatal, immunization and Maternal-Child-Health Clinics if we have to reduce malnutrition among young children. More so to target mothers’ poor perceptions during Health Education Sessions since they are still very common and associated with malnutrition. 2. There is need to screen out children who come for treatment in Assessment Center, to exclude those who are malnourished so that mothers are advised for follow up in OTC-MNU before these children slip into severe malnutrition. 3. There is need to assess the knowledge, attitude and practices of health workers concerning infant and young child feeding and hence the government through MOH to put more emphasis on training and re-training health workers on infant and young child feeding, so that the health staffs are conversant on passing on up-to-date information to the mothers and other caregivers, as well as reviving community-based breast feeding support.