Impact of Socio-Demographic Variables on Maternal Breastfeeding Knowledge and Practices: A Cross-Sectional Investigation in The Gambia

Research Article

Austin Emerg Med. 2024; 9(1): 1085.

Impact of Socio-Demographic Variables on Maternal Breastfeeding Knowledge and Practices: A Cross-Sectional Investigation in The Gambia

Karamo Bah*; Amadou Barrow

The University of The Gambia, School of Medicine, and Allied Health Sciences, Brikama Campus, Gambia

*Corresponding author: Karamo Bah The University of The Gambia, School of Medicine, and Allied Health Sciences; Brikama Campus, Gambia. Email: kamasbah@gmail.com

Received: March 25, 2024 Accepted: April 29, 2024 Published: May 06, 2024

Abstract

Background: Despite substantial evidence emphasizing the importance of breastfeeding, there is room for improvement in its prevalence in The Gambia, which currently stands at approximately 80% - 90%. Globally recognized as the preferred approach to infant feeding, the World Health Organization (WHO) recommends exclusive breastfeeding for the first six months, followed by continued breastfeeding alongside complementary foods until the age of two years.

Objective: This study aimed to evaluate the knowledge and practice of breastfeeding among postnatal mothers attending antenatal care at Fajikunda Health Center (FkHC) in The Gambia.

Methods: A descriptive cross-sectional study was conducted at FkHC, involving a randomly selected sample of 500 maternal mothers. Data was collected through face-to-face interviews using both structured and unstructured questionnaires.

Results: The study findings indicated that both the knowledge and practice of breastfeeding among maternal mothers were 99%. Most respondents were between the ages of 21 and 25, with 58% being married. Regarding education, 18% had primary education, 46% had secondary education, 20% had no formal education, and 16% had a diploma or university education. Additionally, 34% of the infants included in the study were less than one month old.

Conclusion: The study concludes that maternal knowledge and practice of breastfeeding were high. Socio-demographic factors such as age, education, and occupation were found to significantly influence the knowledge and practice of breastfeeding among mothers.

Keywords: Knowledge; Practice; Breastfeeding; Fajikunda; The Gambia

Introduction

According to health expert Dr. Rafeh, current research suggests that initiating breastfeeding within the first hour of life can reduce infant mortality by 22% and provide various health benefits. Early breastfeeding not only protects newborns from diseases but also fosters the bond between mothers and children, reduces the risk of breast cancer in mothers, and acts as a natural method of birth spacing [1]. Breastfeeding is universally acknowledged as the optimal method of infant feeding. The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of life, followed by continued breastfeeding alongside complementary foods until the age of two. Breastfeeding encompasses a wide range of health benefits for both the mother and baby, while also offering social and economic advantages to the community and contributing to a reduction in child morbidity and mortality. Recognizing the significance of breast milk, WHO and UNICEF strongly advocate for exclusive breastfeeding [2]. Despite awareness of many advantages of breastfeeding its rates often fall short of recommended practice. In an effort towards achieving better breastfeeding practices, the united International Children’s Emergency Fund (UNICEF) and WHO launched the Baby Friendly Hospital Initiative (BFHI) in 1991 to ensure that all maternity facilities support mothers in making thebest choice about feeding [2]. It is known that breastfeeding rates vary by demographic and socioeconomic factors and that these factors may impact differently on initiation and duration. Studies have indicated that characteristic such as increasing maternal, age, education, income and being a smoker are associated with higher rates of breastfeeding [1].

The first two years of a child’s life are critical for their growth and development, as any nutritional deficiencies during this period can lead to impaired cognitive development, compromised educational achievement, and reduced economic productivity [3]. Exclusive breastfeeding during the first six months of life plays a vital role in stimulating babies’ immune systems, protecting them against diarrhea and acute respiratory infections, which are major causes of infant mortality in developing countries. It also enhances their response to vaccinations [4].

Breast milk, being a unique gift from mother to baby, provides the best start in life. It is a complete food containing all the essential nutrients required for the baby’s growth and development in the initial months of life. Breast milk not only offers significant protection against diarrheal diseases but also helps prevent respiratory infections. Additionally, it fosters a strong bond between mother and baby [5]. Therefore, the goal of this study is to evaluate the knowledge and practice of breastfeeding among postnatal mothers who receive antenatal care at Fajikunda Health Center (FkHC) in The Gambia.

Literature Review

Breastfeeding in The Gambia

In Gambia, statistics suggest that approximately 36% of infants under four months exclusively rely on breastfeeding, while 36% of those aged between 6-9 months are introduced to a combination of breast milk along with solid or semi-solid foods [6]. The feeding practices of mothers in rural Gambia are intricately linked to their traditional beliefs and customs [7].

Breastfeeding holds significant cultural importance in Gambia, similar to many African nations, with mothers often engaging in prolonged breastfeeding. Although Gambian mothers typically breastfeed their infants for 18 to 24 months, the commencement of breastfeeding is commonly delayed post-delivery [7]. The introduction of the Baby-Friendly Community Initiative (BFCI) strategy played a role in boosting the national average of exclusive breastfeeding, from 0% in 1989 to 17.4% in 1998, further increasing to 36% in 2000 [8] and 41% in 2006 [6]. Exclusive breastfeeding provides optimal nutrition for infants, fostering healthy growth and development, and reducing the occurrence of diseases such as diarrhea and pneumonia, consequently lowering infant morbidity and mortality rates [7].

Despite cultural practices like giving infants water for hydration, exclusive breastfeeding for the initial six months remains relatively low, standing at 33.5% at the national level [6]. In response, the National Nutritional Agency (NaNA) and the Ministry of Health, supported by the United Nations International Children's Emergency Fund (UNICEF), are set to implement Interventions, focusing on creating awareness in vulnerable areas, particularly in the Upper River Region (URR) where only 34.1% of the children are breastfed [6].

In the Gambia, it has been reported that 36% of infants under four months are exclusively breastfed, while 36% of those between 6-9 months receive a combination of breast milk and solid or semi-solid foods [10]. Maternal feeding practices in rural Gambia are strongly influenced by traditional beliefs and customs [11].

Method

Study site, Fajikunda Health Center (FkHC)

Fajikunda, situated approximately 15km west of Banjul, isa significant settlement within the Serrakunda East district of The Gambia, with a population of 162,709 inhabitants [6]. The health center serves as a primary healthcare facility catering tothe healthcare needs of the population. The center is staffed by over 110 healthcare professionals and offers a range of services, including outpatient care, inpatient care, laboratory services, Reproductive and Child health (RCH), chest clinic, eye clinic counselling unit, and public health unit. The center is led by a Senior Nursing Officer (SNO) and is recognized as one of the busiesthealth centers in The Gambia, with the Medical Research Council (MRC) also extending its coverage to the facility [12,13].

Study Design and Statistical analysis

Given the nature of the research problem, a descriptive cross- sectional research approach was employed [14]. This approach allows for the simultaneous assessment of an individual’s status in terms of characteristics and events, providing a snapshot of the population at a specific time [15].

Descriptive statistics were utilized to analyze the obtained data, and the results were subsequently presented through tables [12]. The data analysis was conducted using Excel and R programming software. Categorical values are presented as absolute values and percentage (%).

Sampling

A convenient sampling technique was employed, which is commonly used when the sample is drawn from a readily available and convenient part of the population. The selection of participants was based on availability and proximity rather than a systematic sampling approach. This approach was considered appropriate given the study’s setting in a health facility. However, it is important to note that convenience sampling limits the generalizability of the findings to the entire population of Fajikunda Town [12]. The study included a random enrollment of 500 maternal breastfeeding mothers attending the Maternal and Child Health (MCH) clinic at FkHC.

Study Variables

The study assessed the outcome variable of breastfeeding knowledge and practices among maternal mothers, considering various covariates such as age, gender, marital status, education level, occupation, place of delivery, type of delivery, breastfeeding initiation, source of breastfeeding information, colostrum feeding, bottle feeding, type of bottle feeding, and timing counselling.

Data Collection

According to Burns and Grove [13], data collection is a systematic process of gathering relevant information that aligns with the research purpose or questions. In this study, data was collected through observation and the administration of structured and semi-structured questionnaires. Observation was done to examine the behavior and positioning of research subjects during breastfeeding, allowing for triangulation of findings using multiple methods. Interviews were also conducted to generate data, aiming to provide an accurate portrayal of breastfeeding knowledge and practices among maternal mothers at FkHC. A structured questionnaire was utilized, and face-to-face interviews were conducted with prospective subjects attending the Maternal and Child Health (MCH) clinic at FkHC. Detailed information about the study was explained to the respondents in a language they understood. Data collection occurred between 8:00 a.m. and 1:00 p.m. on the days when mothers attended the MCH clinic. Approximately 30 minutes were allocated to each respondent for data collection purposes.

Inclusion and Exclusion Criteria

The study focuses on maternal mothers who are actively breastfeeding infants aged one year and below, and who sought healthcare services, specifically Maternal and Child Health (MCH) services or treatment for minor illnesses for their babies, at FkHC.

For exclusion criteria, mothers whose children were older than one year and those who were not present at the health center during the study period were excluded from participation. This research aims to investigate breastfeeding practices and maternal knowledge among this specific group of mothers.

Result

Characteristics of the Respondents

In our study, we enrolled a total of 500 participants, male infants were 342 (68%) while female infants were 158 (32%) (as detailed in Table 1). There are 134 (27%) infants under 1 month, 134 (27%) were between 1-2 months, 132 (26%) between 3-6 months, and 108 (22%) were within the 7-12 months age group.