Familiar but neglected: identification of gaps and recommendations to close them on exclusive breastfeeding support in health facilities in Malawi
Tóm tắt
Exclusive breastfeeding is widely accepted as a key intervention with proven efficacy for improving newborn survival. Despite international commitments and targets to support and promote breastfeeding, there are still gaps in meeting and maintain coverage in many sub-Saharan African countries. This paper aimed to triangulate the perspectives of health workers, mothers, and their family members with facility assessments to identify gaps to improve breastfeeding support in in Malawi. The study on breastfeeding barriers and facilitators was conducted in 2019 at one tertiary hospital and three secondary-level hospitals in Malawi. We conducted 61 semi-structured interviews with health workers, postnatal mothers, grandmothers, aunts, and fathers. In 2017, we carried out a neonatal care facility assessment using the World Health Organization (WHO) Integrated Maternal, Neonatal, and Child Quality of Care Assessment and Improvement Tool. Qualitative data were analysed using a thematic analysis approach within the Systems Framework for Health Policy. The district-level hospitals rated high with an average score of 4.8 out of 5 across the three facilities indicating that only minor improvements are needed to meet standards of care for early and exclusive breastfeeding. However, the score fell to an average of 3.5 out of 5 for feeding needs with sick neonates indicating that several improvements are needed in this area. The qualitative data demonstrated that breastfeeding was normalized as part of routine newborn care. However, the focus on routine practice and reliance on breastfeeding knowledge from prenatal counselling highlights inequities and neglect in specialized care and counselling among vulnerable mothers and newborns. Revitalisation of breastfeeding in Malawian facilities will require a systems approach that reinforces policies and guidelines; contextualises knowledge; engagement and empowerment of other relatives to the baby and task-sharing among health workers. Breastfeeding is accepted as a social norm among health workers, mothers, grandmothers, aunts, and fathers in Malawi, yet vulnerable groups are underserved. Neglect in breastfeeding support among vulnerable populations exacerbates health inequities. Health systems strengthening related to breastfeeding requires a concerted effort among health workers, mothers, grandmothers, aunts, and fathers while remaining grounded in contexts to support family-centered hospital care.
Tài liệu tham khảo
Darmstadt GL, Bhutta ZA, Cousens S, Adam T, Walker N, de Bernis L, et al. Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet. 2005;365(9463):977–88. https://doi.org/10.1016/S0140-6736(05)71088-6.
Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS. Bellagio child survival study group. How many child deaths can we prevent this year? Lancet. 2003;362(9377):65–71. https://doi.org/10.1016/S0140-6736(03)13811-1.
Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475–90. https://doi.org/10.1016/S0140-6736(15)01024-7.
Victora CG, Horta BL, De Mola CL, Quevedo L, Pinheiro RT, Gigante DP, et al. Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil. Lancet Global Health. 2015;3(4):e199–205. https://doi.org/10.1016/S2214-109X(15)70002-1.
Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, et al. Why invest, and what it will take to improve breastfeeding practices? Lancet. 2016;387(10017):491–504. https://doi.org/10.1016/S0140-6736(15)01044-2.
Bhattacharjee NV, Schaeffer LE, Marczak LB, Ross JM, Swartz SJ, Albright J, et al. Mapping exclusive breastfeeding in Africa between 2000 and 2017. Nat Med. 2019;25(8):1205–12. https://doi.org/10.1038/s41591-019-0525-0.
Gupta A, Dadhich JP, Rundall P, Bidla N. Interpreting the world health assembly targets on exclusive breastfeeding by 2025: what is expected of each country? World Nutr. 2019;10(4):152–5. https://doi.org/10.26596/wn.2019104152-155.
Doherty T, Horwood C, Haskins L, Magasana V, Goga A, Feucht U, et al. Breastfeeding advice for reality: Women’s perspectives on primary care support in South Africa. Matern Child Nutr. 2020;16(1):e12877. https://doi.org/10.1111/mcn.12877.
Senbanjo IO, Oshikoya KA, Ogbera OA, Wright KO, Anga AL. Breastfeeding policy and practices at the general paediatric outpatient clinic of a teaching hospital in Lagos, Nigeria. Int Breastfeed J. 2014;9(1):10. https://doi.org/10.1186/1746-4358-9-10.
Moussa Abba A, De Koninck M, Hamelin AM. A qualitative study of the promotion of exclusive breastfeeding by health professionals in Niamey, Niger. Int Breastfeed J. 2010;5(1):8. https://doi.org/10.1186/1746-4358-5-8.
Agbozo F, Ocansey D, Atitto P, Jahn A. Compliance of a baby-friendly designated hospital in Ghana with the WHO/UNICEF baby and mother-friendly care practices. J Hum Lact. 2020;36(1):175–86. https://doi.org/10.1177/0890334419848728.
Fetters MD, Curry LA, Creswell JW. Achieving integration in mixed methods designs - principles and practices. Health Serv Res. 2013;48(6 Pt 2):2134–56. https://doi.org/10.1111/1475-6773.12117.
Nyondo-Mipando AL, Kinshella M-LW, Salimu S, Chiwaya B, Chikoti F, Chirambo L, et al. “It brought hope and peace in my heart:” caregivers perceptions on kangaroo mother care services in Malawi. BMC Pediatr. 2020;20(1):541. https://doi.org/10.1186/s12887-020-02443-9.
Kawaza K, Kinshella MLW, Hiwa T, Njirammadzi J, Banda M, Vidler M, et al. Assessing quality of newborn care at district facilities in Malawi. BMC Health Serv Res. 2020;20(1):227. https://doi.org/10.1186/s12913-020-5065-2.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. https://doi.org/10.1191/1478088706qp063oa.
Commonwealth Secretariat. A Systems Framework for Healthy Policy advancing, global health security and sustainable well-being for all.The Commonwealth Secretariat (2016). https://www.thecommonwealth-healthhub.net/systems-framework-healthy-policy/. (last Accessed on 11 August 2021)
Hasselberg M, Huus K, Golsäter M. Breastfeeding preterm infants at a neonatal care unit in rural Tanzania. J Obstet Gynecol Neonatal Nurs. 2016;45(6):825–35 Available from: https://doi.org/10.1016/j.jogn.2016.07.010.
Tawiah-Agyemang C, Kirkwood BR, Edmond K, Bazzano A, Hill Z. Early initiation of breast-feeding in Ghana: barriers and facilitators. J Perinatol. 2008;28(S2):S46–52. https://doi.org/10.1038/jp.2008.173.
Nii Okai Aryeetey R, Antwi CL. Re-assessment of selected baby-friendly maternity facilities in Accra, Ghana. Int Breastfeed J. 2013;8:15.
Nabwera HM, Jepkosgei J, Muraya KW, Hassan AS, Molyneux CS, Ali R, et al. What influences feeding decisions for HIV-exposed infants in rural Kenya? Int Breastfeed J. 2017;12(1):31. https://doi.org/10.1186/s13006-017-0125-x.
Morgan JJ, Jeggels JD. Factors influencing the infant feeding choices of HIV-positive mothers at a level two hospital in Cape Town. Afr J Midwifery Womens Health. 2015;9(2):66–70. https://doi.org/10.12968/ajmw.2015.9.2.66.
Malawi Ministry of Health Nutrition Unit. The World Breastfeeding Trends Initiative: Malawi Assessment Report (2008). https://www.worldbreastfeedingtrends.org/wbti-country-report.php. (Last Accessed on 11 August 2021).
Kalisa R, Malande O, Nankunda J, Tumwine JK. Magnitude and factors associated with delayed initiation of breastfeeding among mothers who deliver in Mulago hospital, Uganda. Afr Health Sci. 2015;15(4):1130–5. https://doi.org/10.4314/ahs.v15i4.11.
Chipojola R, Chiu HY, Huda MH, Lin YM, Kuo SY. Effectiveness of theory-based educational interventions on breastfeeding self-efficacy and exclusive breastfeeding: a systematic review and meta-analysis. Int J Nurs Stud. 2020;109:103675. https://doi.org/10.1016/j.ijnurstu.2020.103675.
Acheampong AK, Aziato L, Marfo M, Amevor P. Breastfeeding and caring for children: a qualitative exploration of the experiences of mothers with physical impairments in Ghana. BMC Pregnancy Childbirth. 2020;20(1):331. https://doi.org/10.1186/s12884-020-03028-1.
Shobo OG, Umar N, Gana A, Longtoe P, Idogho O, Anyanti J. Factors influencing the early initiation of breast feeding in public primary healthcare facilities in Northeast Nigeria: a mixed-method study. BMJ Open. 2020;10(4):e032835. https://doi.org/10.1136/bmjopen-2019-032835.
Gejo NG, Weldearegay HG, Wtinsaie KT, Mekango DE, Woldemichael ES, Buda AS, et al. Exclusive breastfeeding and associated factors among HIV positive mothers in northern Ethiopia. PLoS One. 2019;14(1):e0210782. https://doi.org/10.1371/journal.pone.0210782.
Minas AG, Ganga-Limando M. Social-cognitive predictors of exclusive breastfeeding among primiparous mothers in Addis Ababa, Ethiopia. PLoS One. 2016;11(10):e0164128–9.
Acheampong AK, Ganga-Limando M, Aziato L. Perceived enablers of exclusive breastfeeding by teenage mothers in Ghana. S Afr Fam Pract. 2020;62(1):a5108. https://doi.org/10.4102/safp.v62i1.5108.
Daniels L, Jackson D. Knowledge, attitudes and practices of nursing staff regarding the baby-friendly hospital initiative in non-accredited obstetric units in Cape Town. South African J Clin Nutr. 2011;24(1):32–8. https://doi.org/10.1080/16070658.2011.11734347.
Kavle JA, Welch PR, Bwanali F, Nyambo K, Guta J, Mapongo N, et al. The revitalization and scale-up of the baby-friendly hospital initiative in Malawi. Matern Child Nutr. 2019;15(S1):e12724. https://doi.org/10.1111/mcn.12724.
Mgolozeli SE, Shilubane HN, Khoza LB. Nurses’ attitudes towards the implementation of the mother-baby friendly initiative in selected primary healthcare facilities at Makhuduthamaga municipality, Limpopo province. Curationis. 2019;42(1):e1–9. https://doi.org/10.4102/curationis.v42i1.2119.
Okolo SN, Ogbonna C. Knowledge, attitude and practice of health workers in Keffi local government hospitals regarding baby-friendly hospital initiative (BFHI) practices. Eur J Clin Nutr. 2002;56(5):438–41. https://doi.org/10.1038/sj.ejcn.1601331.
Chintalapudi N, Hamela G, Mofolo I, Maman S, Hosseinipour MC, Hoffman IF, et al. Infant and young child feeding decision making and practices: Malawian mothers’ and fathers’ roles in the context of HIV. J Hum Lact. 2018;34(1):68–76. https://doi.org/10.1177/0890334417719245.
Mensah KA, Acheampong E, Anokye FO, Okyere P, Appiah-Brempong E, Adjei RO. Factors influencing the practice of exclusive breastfeeding among nursing mothers in a peri-urban district of Ghana. BMC Res Notes. 2017;10(1):466. https://doi.org/10.1186/s13104-017-2774-7.
Wainaina CW, Wanjohi M, Wekesah F, Woolhead G, Kimani-Murage E. Exploring the experiences of middle income mothers in practicing exclusive breastfeeding in Nairobi, Kenya. Matern Child Health J. 2018;22(4):608–16. https://doi.org/10.1007/s10995-018-2430-4.