Research consultancy
CHAPTER TWO
LITERATURE REVIEW
2.1 Introduction
This chapter highlights the literature review cited by other scholars about the knowledge and practices of mothers on complementary feeding in children under two years. The literature is presented in sequence of the specific objectives thus level of knowledge, practices and social economic factors affecting mothers who carry out complementary feeding.
2.2 The knowledge of mothers on complementary feeding in children under two years
Feeding practice has a lot of implication for the nutritional status of the child. Mothers‟ knowledge about nutritious meals for the children influences how the child is fed. In many developing countries infants and young children are most vulnerable to malnutrition because of lack of knowledge on how to feed a child (WHO, 2013). Many observational studies show that maternal knowledge of optimal child feeding practices like exclusive breastfeeding for six months, continued breastfeeding and the timely transition to adequate complementary food is basic to keep health of a child (WHO, 2010). In Ethiopia, majority of all under-five deaths are highly associated with abrupt cessation of breastfeeding and infectious diseases, but it is closely linked to gap of knowledge on how to feed appropriately (Central Statistical Authority Ethiopia and ORC Macro. 2012). Mother‟s nutritional knowledge is considered to have a great impact on the child feeding practices as she has the capacity to take diet related conscious decisions for the child.
A study by Hellen Keller International (2010) in Baitadi District, Nepal showed that majority of mothers had the perception that children of 6-12 months should not be fed on eggs and flesh meats, this translated to only 2.1% and 4.4% of their children being fed on eggs and flesh meats respectively. Scientific knowledge demonstrates that maternal knowledge on complementary feeding may positively influence practice or may lead to no change in feeding practices.
In India, an interventional study where nutritional education was given to mothers to improve awareness about infant feeding in the variety, quantity, quality and consistency of complementary feeding showed that, Majority of complementary feeding practices were inadequate in quality, quantity, frequency and consistency (Sethi et al., 2013). In a similar study in south India, mothers were counseled about the choice of appropriate complementary foods and feeding frequency. The intervention group had improved feeding practices such as avoiding feeding bottles and improved on dietary diversity and the types of complementary foods (Hague et al., 2012).
On the contrary, knowledge may not translate to practice. A study by Subedi et al. (2012) on infant and young child feeding practices in Chepang communities in Nepal showed that, only some of the mothers had knowledge about breastfeeding initiation within one hour, 62% had known about exact time for exclusive breastfeeding and majority of mothers had knowledge about appropriate time for introduction of complementary feeding and total time for
2.3 The complementary feeding practices of mothers with children under two years
A study by Qiong et al (2013) in Wuyi county, China among children aged 6-23 months showed similar results to those of Nisha (2012) which indicated that, their dietary diversity was quite poor as only one out of ten children (10.0%) was fed with foods from at least four food groups. Similarly, a study by Nisha (2012) on inadequate feeding of infants and young children in India revealed that although 92% of children were between the ages 12 and 18 months, only 17% of them were fed adequately from four or more food groups.
A study in the slums of Dhaka City showed that although complementary feeding is started early by some mothers, majority started at 6 months, as (64%) mothers started complementary feeding at 6-7 months while only 19.2% started at 4-5 months (Akhtar, et al.,2012). In Kenya, 60% of children aged 4-5 months are given complementary foods (KNBS and ICF Macro, 2010), and by 6 months 84% of the infants are already receiving complementary feeds (MOPHS, 2007-2010). This is an indication that majority of the mothers in Kenya practice early complementary feeding in contrast to the (Burns, J., et al, 2016) recommendation (introduction of solid, semi-solids and soft foods at 6-8 months).
According to (WHO 2010), breastfed children 6-8 months old be fed 2 times per day and those 9-23 months old be fed 2-3 times per a day while the non-breastfed ones be fed 4 times per day (Wyatt, A. J., et al (2015). In Kenya, the minimum meal frequency is low as per WHO recommendations, the Kenya Demographic and Health Survey of 2008-09 revealed that of all the children 6-23 months, only two thirds were fed the minimum number of times (KNBS and ICF Macro, 2010).
In Kenya, minimum acceptable diet is not achieved by many children. According to the KDHS (KNBS and ICF Macro, 2010), only 54% of the children 6-23 months had the minimum dietary diversity. A nutrition survey in Marsabit County (MOPHS/UNICEF, 2011), showed that only 34.9% of the children 6-23 months were fed with the minimum dietary diversity (≥4 food groups). This gives an indication of inadequate diversity of foods among the children.
Complementary foods should be given using a spoon and cup/ glass (Foterek, K., et al, 2016). Baby feeding bottles should be avoided because, in addition to being an important source of contamination for the infant, they interfere with oral dynamics (WHO, 2010). The tendency to use the bottle increases in relation to child’s increasing age.
A study by Shamin et al (2009), about infant feeding practices including the use of bottle and their determinants, from economically underprivileged mothers in a Peri-urban area of Karachi, Pakistan, showed that only 17% of the infants under the age of 3 months were offered bottle, 69% between 4 to 6 months increased to 76% in infants from 7 months to 1 year. The continued practice of bottle feeding is a concern because of the possible contamination leading to higher morbidity rates in children.
WHO recommends exclusive breastfeeding for 6 months and introduction of complementary foods at 6 months of age with continued breastfeeding (PAHO/WHO, 2013).The time of introduction and type of complementary food given to an infant are very important for the child’s nutritional status. According to current recommendations (Locks, L. M., et al, 2015), complementary feeding should be introduced into the child’s diet at the age of 6 months. Early introduction of complementary foods increases infant morbidity and mortality while late introduction of complementary foods is harmful to the health of the baby, because infant growth stops or slows down and the risk of malnutrition and micronutrient deficiency increases (Mekbib, E., et al, 2014).
2.4 The social economic factors affecting mothers who are on complementary feeding with children under two years
Study by Camara, S., et al (2015) found that mothers’ educational status and insufficient antenatal care visits were significant factors affecting mothers in carrying out complementary feeding. According to, literate mothers are more likely adhere to complementary feeding rules than the illiterate ones.
Camara, S.et al (2015) further reported that the occupation of the mothers can prevent them from properly administering complementary feeding of their children. Nutrition Officers in Tanzania reported the infants born to working mothers were more likely to consume processed food due to their mothers’ work. Such mothers end up leaving their children with caretakers like aunties, young brothers or sisters and sometimes maid who are not well trained to administer complementary feeding to their young children.
The number of children born to one single woman also can affect complementary feeding of the mother. According to most mothers trust their other children to administer complementary feeding especially when they leave for work or go to the garden. It is common for mothers to leave a little cash with the caregiver who are usually children too, so they can buy food from local groceries or vendors to feed themselves and the young baby. There are also some home-cooked meals at home, but caregivers (elder sibling, neighbor, elderly relative/kin) are generally ªunableº to properly feed young children below to years of age because they lack knowledge about nutrition and hygiene needs (Gardner, H, et al 2015).
Nestle, M. (2013) states that though young mothers are generally aware of the nutritional value of different kinds of food, appropriate feeding times, and hygiene practices, they are often inconsistent about feeding their children accordingly because they are away from home due to their school work or employment. Young mothers that are engaged in a variety of cash-earning activities that make taking care of their children difficult cooking at home difficult.
CHAPTER THREE
METHODOLOGY
3.1 Introduction
The chapter focused on methodology which includes the study design, study setting, study population, sample size determination, sampling procedure, inclusion criteria, definition of variables, research instruments, data collection procedure, data management, data analysis, ethical consideration, limitation of the study and dissemination of results.
3.2 Study Design and rationale
The study design was a cross sectional and a descriptive study was employed with both quantitative and qualitative data collection methods. This design was used because it assists the researcher in easy access to the required data for the study.
3.3 Study setting and rationale
The study was conducted in Katabi military hospital which is located in Entebbe town council Katabi village. Entebbe sits on the northern shores of Lake Victoria, Africa’s largest lake. The town is situated in Wakiso District, approximately 37 kilometres (23 mi) southwest of Kampala, Uganda’s capital and largest city. The municipality is located on a peninsula into Lake Victoria, covering a total area of 56.2 square kilometres (21.7 sq mi), out of which 20 km2 (7.7 sq mi) is water. The coordinates of Entebbe are: 0°03’00.0″N, 32°27’36.0″EEntebbe has a population of 69,958 people according to the national population census (2014). Katabi military hospital is located in Katabi Sub-county Division A 3Km From Entebbe municipality near the sub county headquarters. The Hospital offers the following services to its clients: HAART services; ANC, PNC, OPD, Nutrition, Deliveries, Immunization services, Family Planning, radiography services and many others to mention but a few. The study area was selected because of the prevalence of the study problem.
3.4 Study Population
The study population included the women attending young child clinic in Katabi Military Hospital with children under 2 years of age who are carrying out complementary feeding
3.4.1 Sample Size Determination
The study consisted of 30 women having children who are under two years of age, and attend Katabi military hospital.
3.4.2 Sampling Procedure
The researcher used simple random sampling procedure to get the required respondents for the study. In this procedure, the researcher wrote two words YES and NO on different pieces of paper folded them put in a box and shook then respondents were told to pick one per person and this enabled the researcher select all the respondents with minimal bias , the selected respondents were those who picked yes and voluntarily consent to participate. This was done until a total of 30 respondents were obtained.
3.4.3 Inclusion criteria
The study targeted mothers who attend katabi military hospital young child clinic and are carrying out complementary feeding and health workers who were available at the hospital during data collection, and were free and willing to voluntarily consent to participate in the study.
3.5 Definition of Variables
The independent variables for the study included:
Knowledge and practices influencing the use of complementary feeding of children below two years of age
3.6 Research Instrument
The researcher collected data using questionnaires which were developed and pre-tested for the study, this was used because most of the respondents knew how to read and write. It had both closed and open-ended questions written in English.
3.7 Data Collection Procedure
The researcher administered the self-administered questionnaires to respondents from their various wards or departments where they were being provided services. This was done to increase efficiency and privacy during data collection.
3.7.1 Data analysis and management
The study data was analyzed manually for completion of questionnaire, edited and after the data will be transferred to Microsoft Excel 2010 for the graphical presentation of results and was presented in both figures and tables.
3.8 Ethical Consideration
A letter of introduction was obtained from Public Health Nurses College, introducing the researcher to the administration of katabi hospital seeking permission to carry out the study. After permission was granted, the Health Centre administrator introduced the researcher to the in charge who then introduced the researcher to the respondents. The study commenced after the objectives of the study had been clearly and well explained to participants and the researcher they understand and voluntarily consented to participate in the study. Respondents were assured of maximum confidentiality of all the information they give and numbers were used instead of respondents’ names.
3.9 Limitations of the study
The researcher might encounter financial constraints in gathering information from the internet and libraries as well as printing and transport costs.
The researcher might encounter language barrier from some of the mothers who can’t speak English therefore the researcher sought for a local interpreter who helped interpret some of the questions for them.
The researcher encountered time constraints in the course of the study, balancing the research study and other demanding course works.
During the study some respondents feared to be interviewed but the research told them that the research was strictly for academic purposes and therefore they should not fear.
3.10 Dissemination of results
The results will be forwarded to the following bodies:
Uganda Nurses and Midwives Examinations Board (UNMEB),
Public Health Nurses’ College Kyambogo
The administration of Katabi Military Hospital
The research had a copy for further references.
