Challenges and responses to infant and young child feeding in rural Rwanda: a qualitative study

Springer Science and Business Media LLC - 2019
Jeanine Ahishakiye1, L.I. Bouwman1, Inge D. Brouwer2, Eric Matsiko2, Margaret Armar‐Klemesu3, M.A. Koelen1
1Health and Society Chair Group, Wageningen University, Wageningen, The Netherlands
2Nutrition and health over the life course chair group, Wageningen University, Wageningen, The Netherlands
3Nutrition Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana

Tóm tắt

AbstractBackgroundDespite different interventions to improve child nutrition conditions, chronic malnutrition is still a public health concern in Rwanda, with a high stunting prevalence of 38% among under 5-year-olds children. In Rwanda, only 18% of children aged 6–23 months are fed in accordance with the recommendations for infant and young child feeding practices. The aim of this study was to explore challenges to infant and young child feeding practices and the responses applied to overcome these challenges in Muhanga District, Southern province of Rwanda.MethodsSixteen (16) focus group discussions were held with mothers, fathers, grandmothers, and community health workers from 4 rural sectors of Muhanga District. The discussions were recorded, transcribed verbatim, and thematically analyzed using qualitative data analysis software, Atlas.ti.ResultsTwo main themes emerged from the data. Firstly, there was a discourse on optimal infant and young child feeding (IYCF) practices that reflects the knowledge and efforts to align with early initiation of breastfeeding, exclusive breastfeeding for the first 6 months, as well as initiation of complementary foods at 6 months recommendations. Secondly, challenging situations against optimal practices and coping responses applied were presented in a discourse on struggling with everyday reality. The challenging situations that emerged as impeding appropriate IYCF practices included perceived lack of breast milk, infant cues, women’s heavy workload, partner relations and living in poverty. Family and social support from community health workers and health facility staff, financial support through casual labor, and mothers saving and lending groups, as well as kitchen gardens, were used to cope with challenges.ConclusionFactors influencing IYCF practices are multifaceted. Hence, intervention strategies to improve child nutrition should acknowledge the socially embedded nature of IYCF and address economic and social environmental constraints and opportunities, in addition and above knowledge only.

Từ khóa


Tài liệu tham khảo

Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera J. Maternal and child undernutrition: global and regional exposures and health consequences. The Lancet. 2008;371(9608):243–60.

Lartey A. Maternal and child nutrition in Sub-Saharan Africa: challenges and interventions. Proceedings of the Nutrition Society. 2008;67(01):105–8.

Lawn JE, Cousens S, Zupan J. 4 Million neonatal deaths: When? Where? Why? Lancet. 2005;365(9462):891–900.

United Nations (UN): The millennium development goals report. 2014.

Stewart CP, Iannotti L, Dewey KG, Michaelsen KF, Onyango AW. Contextualising complementary feeding in a broader framework for stunting prevention. Maternal and Child Nutrition. 2013;9(S2):27–45.

Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, Haider BA, Kirkwood B, Morris SS, Sachdev HPS, et al. What works? Interventions for maternal and child undernutrition and survival. The Lancet. 2008;371(9610):417–40.

National Institute of Statistics of Rwanda (NISR), Ministry of Health (MOH) Rwanda, ICF International. Rwanda Demographic and Health Survey 2014-15. Rockville, Maryland, USA: NISR, MOH and ICF International; 2015.

National Institute of Statistics Rwanda (NISR): Population and housing census. Report on provisional results 2012.

United Nations World Food Programme Rwanda: Rwanda comprehensive food security and vulnerability analysis and nutrition survey. Report 2012.

Pelto GH, Armar-Klemesu M, Siekmann J, Schofield D. The focused ethnographic study ‘assessing the behavioral and local market environment for improving the diets of infants and young children 6 to 23 months old’ and its use in three countries. Maternal & Child Nutrition. 2013;9:35–46.

Pelto GH, Armar-Klemesu M. Identifying interventions to help rural Kenyan mothers cope with food insecurity: results of a focused ethnographic study. Maternal & Child Nutrition. 2015;11:21–38.

WHO: Indicators for assessing infant and young child feeding practices : conclusions of a consensus meeting held 6–8 November 2007 in Washington D.C., USA. 2008.

Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77–101.

Black MM, Aboud FE. Responsive feeding is embedded in a theoretical framework of responsive parenting. Journal of Nutrition. 2011;141(3):490–4.

Eshel N, Daelmans B, Mello MCD, Martines J. Responsive parenting: interventions and outcomes. Bulletin of the World Health Organization. 2006;84:991–8.

Black MM, Walker SP, Fernald LCH, Andersen CT, DiGirolamo AM, Lu C, McCoy DC, Fink G, Shawar YR, Shiffman J, et al. Early childhood development coming of age: science through the life course. The Lancet. 2017;389(10064):77–90.

Bentley ME, Wasser HM, Creed-Kanashiro HM. Responsive feeding and child undernutrition in low- and middle-income countries. Journal of Nutrition. 2011;141(3):502–7.

Dearden KA, Hilton S, Bentley ME, Caulfield LE, Wilde C, Ha PB, Marsh D. Caregiver verbal encouragement increases food acceptance among Vietnamese toddlers. The Journal of Nutrition. 2009;139(7):1387–92.

Ministry of Health (MoH) Rwanda, United Nations Children’s Fund in Rwanda (UNICEF Rwanda). Knowledge, attitudes and practices assessment on early nurturing of children. In: Report. Ministry of Health, Rwanda and UNICEF Rwanda; 2014.

Fotso JC, Madise N, Baschieri A, Cleland J, Zulu E, Kavao Mutua M, Essendi H. Child growth in urban deprived settings: does household poverty status matter? At which stage of child development? Health & Place. 2012;18(2):375–84.

Kimani-Murage EW, Wekesah F, Wanjohi M, Kyobutungi C, Ezeh AC, Musoke RN, Norris SA, Madise NJ, Griffiths P. Factors affecting actualisation of the WHO breastfeeding recommendations in urban poor settings in Kenya. Maternal and Child Nutrition. 2015;11(3):314–32.

Monterrosa EC, Pelto GH, Frongillo EA, Rasmussen KM. Constructing maternal knowledge frameworks. How mothers conceptualize complementary feeding. Appetite. 2012;59(2):377–84.

Pelto GH, Armar-Klemesu M. Balancing nurturance, cost and time: complementary feeding in Accra, Ghana. Maternal & Child Nutrition. 2011;7:66–81.

Njuki J, Sanginga PC. Women, livestock ownership and markets: bridging the gender gap in Eastern and Southern Africa. International Livestock research Institute and the International Development Research Centre. 2013.

Keatinge JDH, Chadha ML, D'Hughes JA, Easdown WJ, Holmer RJ, Tenkouano A, Yang RY, Mavlyanova R, Neave S, Afari-Sefa V, et al. Vegetable gardens and their impact on the attainment of the millennium development goals. Biological Agriculture and Horticulture. 2012;28(2):71–85.

Wilcox CS, Grutzmacher S, Ramsing R, Rockler A, Balch C, Safi M, Hanson J. From the field: empowering women to improve family food security in Afghanistan. Renewable Agriculture and Food Systems. 2015;30(1):15–21.

Affleck W, Pelto G. Caregivers’ responses to an intervention to improve young child feeding behaviors in rural Bangladesh: a mixed method study of the facilitators and barriers to change. Social Science & Medicine. 2012;75(4):651–8.

Dearden KA, Quan LN, Do M, Marsh DR, Pachón H, Schroeder DG, Lang TT. Work outside the home is the primary barrier to exclusive breastfeeding in rural Viet Nam: insights from mothers who exclusively breastfed and worked. Food and Nutrition Bulletin. 2002;23(4_suppl 2):99–106.

Abubakar A, Holding P, Mwangome M, Maitland K. Maternal perceptions of factors contributing to severe under-nutrition among children in a rural African setting. Rural and Remote Health. 2011:11(1).

Nankumbi J, Muliira JK. Barriers to infant and child-feeding practices: a qualitative study of primary caregivers in rural Uganda. Health Population and Nutrition. 2015;33(1):106–16.

Aubel J. The role and influence of grandmothers on child nutrition: culturally designated advisors and caregivers. Maternal & Child Nutrition. 2012;8(1):19–35.

Mukuria AG, Martin SL, Egondi T, Bingham A, Thuita FM. Role of social support in improving infant feeding practices in Western Kenya: a quasi-experimental study. Global Health: Science and Practice. 2016;4(1):55–72.

Su M, Ouyang YQ. Father’s role in breastfeeding promotion: lessons from a quasi-experimental trial in China. Breastfeeding Medicine. 2016;11(3):144–9.

Susin LRO, Giugliani ERJ. Inclusion of fathers in an intervention to promote breastfeeding: impact on breastfeeding rates. Journal of Human Lactation. 2008;24(4):386–92.

Mwangome M, Prentice A, Plugge E, Nweneka C. Determinants of appropriate child health and nutrition practices among women in rural Gambia. Health Population and Nutrition. 2010;28(2):167–72.

Aubel J, Touré I, Diagne M. Senegalese grandmothers promote improved maternal and child nutrition practices: the guardians of tradition are not averse to change. Social Science & Medicine. 2004;59(5):945–59.

Bernie K. The factors influencing young mothers’ infant feeding decisions: the views of healthcare professionals and voluntary workers on the role of the baby's maternal grandmother*. Breastfeeding Medicine. 2014;9(3):161–5.

Grassley J, Eschiti V. Grandmother breastfeeding support: what do mothers need and want? Birth. 2008;35(4):329–35.

Thông tin
Thông tin xuất bản

Springer Science and Business Media LLC

Thông tin tác giả