Feeding practices, mothers' experiences and support for children (0 to 24 months) with oral clefts presenting at a specialist hospital in Uganda
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Background: Appropriate feeding practices are vital for the nutrition of children. Despite a low incidence of 0.73 in 1000, Ugandan children with oral clefts face feeding difficulties that affect their feeding practices, nutrition status and health. Mothers and their children with oral clefts need feeding, healthcare and social support to cope; however adequate information on their experiences and services in Uganda is scarce. Objective: To determine the feeding practices, mothers’ experiences and support systems among children with oral clefts attending Comprehensive Rehabilitation Services of Uganda (CoRSU) hospital to inform related interventions. Methods: A mixed methods design was used. A feeding practices survey included a consecutive sample of 32 mothers of children with oral clefts (0 to 24 months) attending CoRSU hospital between April and May, 2018. Data was analyzed as descriptive statistics using SPSS. Qualitative data on feeding experiences and support was explored in 15 IDIs and 2 FGDs with mothers and 8 KIIs with health workers and was analyzed thematically. Results: Among this oral cleft group, early initiation of breastfeeding was 44%, exclusive breastfeeding was 35% and 0% continued breastfeeding beyond 12 months. There were differences in breastfeeding within the group; breastfeeding among children with Cleft Palate (CP) was 0%. Generally, timely introduction of complementary foods was 75% but 33% received a minimum acceptable diet. Mothers experienced breastfeeding difficulties, anxiety, stress and social stigma. Feeding and psychosocial support was not timely. Knowledge on cleft care among health workers was low and services were not easily accessible outside CoRSU hospital. Conclusions: The feeding practices in this cleft group were poor; especially among the CP group. Feeding was affected by feeding difficulties. Mothers’ stress, social stigma and limited access to timely support further affected feeding. Public health practice should include feeding, health and social services to help mothers cope with the cleft challenges. The findings and recommendations can guide design of appropriate feeding interventions for this group.