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Niyigena A, Gato S, Alayande B, Miranda E, Hedt-Gauthier B, Goodman AS, Nkurunziza T, Mazimpaka C, Hakizimana S, Ngamije P, Kateera F, Riviello R, Boatin AA. Functional recovery after cesarean delivery: a prospective cohort study in rural Rwanda. BMC Pregnancy Childbirth 2023; 23:858. [PMID: 38087238 PMCID: PMC10717631 DOI: 10.1186/s12884-023-06159-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/26/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Women who deliver via cesarean section (c-section) experience short- and long-term disability that may affect their physical health and their ability to function normally. While clinical complications are assessed, postpartum functional outcomes are not well understood from a patient's perspective or well-characterized by previous studies. In Rwanda, 11% of rural women deliver via c-section. This study explores the functional recovery of rural Rwandan women after c-section and assesses factors that predict poor functionality at postoperative day (POD) 30. METHODS Data were collected prospectively on POD 3, 11, and 30 from women delivering at Kirehe District Hospital between October 2019 and March 2020. Functionality was measured by self-reported overall health, energy level, mobility, self-care ability, and ability to perform usual activities; and each domain was rated on a 4-point likert scale, lower scores reflecting higher level of difficulties. Using the four functionality domains, we computed composite mean scores with a maximum score of 4.0 and we defined poor functionality as composite score of ≤ 2.0. We assessed functionality with descriptive statistics and logistic regression. RESULTS Of 617 patients, 54.0%, 25.9%, and 26.8% reported poor functional status at POD3, POD11, and POD30, respectively. At POD30, the most self-reported poor functionality dimensions were poor or very poor overall health (48.1%), and inability to perform usual activities (15.6%). In the adjusted model, women whose surgery lasted 30-45 min had higher odds of poor functionality (aOR = 1.85, p = 0.01), as did women who experienced intraoperative complications (aOR = 4.12, 95% CI (1.09, 25.57), p = 0.037). High income patients had incrementally lower significant odds of poor physical functionality (aOR = 0.62 for every US$1 increase in monthly income, 95% CI (0.40, 0.96) p = 0.04). CONCLUSION We found a high proportion of poor physical functionality 30 days post-c-section in this Rwandan cohort. Surgery lasting > 30 min and intra-operative complications were associated with poor functionality, whereas a reported higher income status was associated with lower odds of poor functionality. Functional status assessments, monitoring and support should be included in post-partum care for women who delivered via c-section. Effective risk mitigating intervention should be implemented to recover functionality after c-section, particularly among low-income women and those undergoing longer surgical procedures or those with intraoperative complications.
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Affiliation(s)
- Anne Niyigena
- Partners In Health/Inshuti Mu Buzima, KG 9 Avenue 46, PO Box 3432, Remera, Kigali, Rwanda.
| | - Saidath Gato
- Partners In Health/Inshuti Mu Buzima, KG 9 Avenue 46, PO Box 3432, Remera, Kigali, Rwanda
| | | | | | | | | | | | - Christian Mazimpaka
- Partners In Health/Inshuti Mu Buzima, KG 9 Avenue 46, PO Box 3432, Remera, Kigali, Rwanda
| | - Sadoscar Hakizimana
- Partners In Health/Inshuti Mu Buzima, KG 9 Avenue 46, PO Box 3432, Remera, Kigali, Rwanda
| | - Patient Ngamije
- Kirehe District Hospital, Ministry of Health, Kirehe, Rwanda
| | - Fredrick Kateera
- Partners In Health/Inshuti Mu Buzima, KG 9 Avenue 46, PO Box 3432, Remera, Kigali, Rwanda
| | - Robert Riviello
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Adeline A Boatin
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
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Frumence G, Jin Y, Kasangala AA, Mang’enya MA, Bakar S, Ochieng B. A Qualitative Exploration on Perceived Socio-Cultural Factors Contributing to Undernutrition Among Under-Fives in the Southern Highlands of Tanzania. Int J Public Health 2023; 68:1605294. [PMID: 37546349 PMCID: PMC10400761 DOI: 10.3389/ijph.2023.1605294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Objective: Under nutrition especially among under-fives is a major public health challenge in Tanzania. However, the contribution of cultural practices to child under nutrition is often overlooked. This study aimed to explore the perceived socio-cultural factors contributing to the persisting under nutrition among under-fives in Tanzania. Methods: The study applied focus group discussion (FDGs) with forty practitioners to examine the sociocultural factors contributing to under nutrition during early childhood. The study participants were purposively selected and thematic analysis was used to identify themes within the data. Results: This study revealed that, under nutrition for under-fives is caused by a number of socio-cultural factors including existence of gender inequality related to dietary practices and qualities, women's excessive workload, patriarchy social-norm, excessive alcohol use and cultural taboos prohibiting women and girls from eating certain types of nutrient dense foods. Conclusion: The study highlights the multiplicity of factors including socio-cultural perspectives contributing to under nutrition among under-fives, and calls for a concerted efforts in developing and implementing issue-specific and culturally sensitive strategies towards elimination of child under nutrition.
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Affiliation(s)
- Gasto Frumence
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yannan Jin
- Leicester School of Allied Health Sciences, De Montfort University, Leicester, United Kingdom
| | - Amalberga A. Kasangala
- Department of Preventive Services, Health Promotion Section, Ministry of Health, Dar es Salaam, Tanzania
| | - Mary A. Mang’enya
- Department of Preventive Services, Health Promotion Section, Ministry of Health, Dar es Salaam, Tanzania
| | - Saidah Bakar
- Department of Community Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bertha Ochieng
- Centre for Primary Care Research, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
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Abukari AS, Acheampong AK. Breastfeeding practices and coping strategies adopted by lactating nurses and midwives: A qualitative study. J Pediatr Nurs 2022; 66:e61-e66. [PMID: 35637105 DOI: 10.1016/j.pedn.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 05/22/2022] [Accepted: 05/22/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to explore the breastfeeding practices and coping mechanisms of nurses and midwives to navigate the breastfeeding experience as health professionals. DESIGN AND METHODS A descriptive qualitative design was employed. Twenty-five registered nurses' and midwives' breastfeeding habits and coping methods were explored through five focus group discussions, each with five members. A purposive sampling approach was used to recruit participants. Only women who were currently breastfeeding an infant between the ages of 3 and 18 months were considered. For thematic content analysis, MAXQDA qualitative software was used. RESULTS Breastfeeding practices and breastfeeding coping mechanisms emerged as the two main themes. Theme 1: Breastfeeding practices had four sub-themes: breastfeeding positions, breastfeeding duration, lactation nutrition, and expressed breast milk. Theme 2: breastfeeding coping strategies had four subthemes, support from family and co-workers, crying, praying, and communicating with infants. CONCLUSIONS Due to work and other related pressures, our study indicates a disparity in exclusive breastfeeding practice among registered nurses and midwives. Working lactating health professionals can use some of the study's coping strategies and beneficial breastfeeding practices to enhance effective breastfeeding. PRACTICE IMPLICATIONS Breastfeeding in the ideal sitting posture, eating the right diet to increase milk flow, and freezing breast milk to feed the infant while at work are all strategies proposed to help practicing nurses, midwives, and other working women navigate breastfeeding.
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Affiliation(s)
- Alhassan Sibdow Abukari
- School of Nursing, Wisconsin International University College-Ghana, P.O Box LG, Accra, Ghana
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Naja F, Chatila A, Ayoub JJ, Abbas N, Mahmoud A, Abdulmalik MA, Nasreddine L. Prenatal breastfeeding knowledge, attitude and intention, and their associations with feeding practices during the first six months of life: a cohort study in Lebanon and Qatar. Int Breastfeed J 2022; 17:15. [PMID: 35209913 PMCID: PMC8867651 DOI: 10.1186/s13006-022-00456-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 02/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background Prenatal knowledge, attitude, and intention related to breastfeeding are postulated as important modulators of feeding practices. Using data from the Mother and Infant Nutritional Assessment (MINA) study, a three year cohort conducted in Lebanon and Qatar, this study aimed to characterize breastfeeding practices during the first six months postnatally and examine their associations with prenatal breastfeeding knowledge, attitude, exposure, and intention. Methods Pregnant women during their first trimester were recruited from primary healthcare centers in Beirut and Doha. Data collection was conducted in 2015 − 2018. Participants were followed-up until the child was twoyears old. Exposure, knowledge, attitude, and intentions regarding breastfeeding were assessed during the third trimester of pregnancy (n = 230), using validated questionnaires and scales. Breastfeeding practices were evaluated at four months (n = 185) and six months (n = 151) postpartum. Early initiation of breastfeeding was defined as putting the infant to the breast within one hour of birth, and exclusive breastfeeding (EBF) as feeding exclusively with breast milk. Results Breastfeeding practices were as follows: ever breastfeeding: 95.8%; early initiation of breastfeeding: 72.8%; breastfeeding at four and six months: 70.3% and 62.3%; EBF at four and six months: 35.7% and 18.5%. Over 95% of participants had high breastfeeding exposure, and 68.8% had strong / very strong intentions to breastfeed. Only 25% had very good knowledge, and 9.2% reported positive/strong positive attitude towards breastfeeding. After adjustment, high exposure was associated with greater odds of breastfeeding initiation (OR 10.1: 95% CI 1.25, 80.65). Both positive attitude towards breastfeeding and strong intention to breastfeed were associated with EBF at four months (OR 2.51; 95% CI 1.02, 6.16 and OR 4.0; 95% CI 1.67, 9.6), breastfeeding at four months (OR 2.92: 95% CI 1.29, 6.62 and OR 5.00: 95% CI 2.25, 11.1), and breastfeeding at six months (OR 3.74: 95% CI 1.24, 11.32 and OR 8.29: 95% CI 2.9, 23.68). Conclusions Findings of this study documented suboptimal knowledge and attitude towards breastfeeding and showed that prior exposure, a positive attitude, and a strong intention to breastfeed prenatally were significant predictors of breastfeeding practices postnatally. This highlights the need to develop specific interventions and policies aimed at improving breastfeeding attitudes and creating an enabling environment that supports women throughout their breastfeeding journey. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-022-00456-x.
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Affiliation(s)
- Farah Naja
- Clinical Nutrition and Dietetics Department, College of Health Sciences, University of Sharjah, Sharjah, UAE.,Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE.,Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Aya Chatila
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Jennifer J Ayoub
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Nada Abbas
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Amira Mahmoud
- Public Health Department, Ministry of Public Health, Doha, Qatar
| | | | | | - Lara Nasreddine
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon.
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Mahumud RA, Uprety S, Wali N, Renzaho AMN, Chitekwe S. The effectiveness of interventions on nutrition social behaviour change communication in improving child nutritional status within the first 1000 days: Evidence from a systematic review and meta‐analysis. MATERNAL & CHILD NUTRITION 2022; 18:e13286. [PMID: 34842341 PMCID: PMC8710127 DOI: 10.1111/mcn.13286] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/23/2021] [Accepted: 10/05/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Rashidul A. Mahumud
- NHMRC Clinical Trials Centre, School of Medicine and Health The University of Sydney Camperdown New South Wales Australia
- Centre for Health Research University of Southern Queensland Toowoomba Queensland Australia
- Department of Statistics Health Research Group Rajshahi Bangladesh
| | - Sophiya Uprety
- Former UNICEF Consultant and Public Health Nutritionist Kathmandu Nepal
| | - Nidhi Wali
- School of Social Sciences Western Sydney University Penrith New South Wales Australia
| | - Andre M. N. Renzaho
- Translational Health Research Institute School of Medicine Campbelltown New South Wales Australia
- Maternal, Child and Adolescent Health Program Burnet Institute Melbourne Victoria Australia
| | - Stanley Chitekwe
- Nutrition Section United Nations Children's Fund (UNICEF) Kathmandu Nepal
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McLennan JD, Pérez Agramonte M, Mosquea Hernández M. A mixed method inquiry of early complementary feeding of infants in the Dominican Republic. Appetite 2021; 170:105873. [PMID: 34923031 DOI: 10.1016/j.appet.2021.105873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 12/05/2021] [Accepted: 12/13/2021] [Indexed: 11/02/2022]
Abstract
Exclusive breastfeeding (EBF) is infrequent and decreasing over time in the Dominican Republic. This study aimed to identify patterns of, and women's rationale for, early complementary feeding. Mothers of children under 12 months of age living in a low-resource peri-urban community had three opportunities to contribute: (i) responding to feeding questions embedded in a standardized questionnaire used at a well-baby clinic (n = 101), (ii) participating in focus groups (n = 31), and (iii) engaging in home-based, semi-structured individual interviews (n = 25). Quantitative questionnaire data were analyzed to identify feeding practices as a function of child age. Textual data from the individual interviews and focus groups were systematically reviewed and coded to identify key constructs through a qualitative descriptive approach. The majority (>86%) of mothers reported breastfeeding at all monthly age bands up to six months. However, EBF was rare, with more than half reporting use of other milks and other foods by the infants' second and fifth month, respectively. Overarching themes to explain early complementary feeding from the qualitative data can be broadly captured by the complementary perceptions that there are problems with relying on breastfeeding alone and that there are benefits to early complementary feeding in the early months of an infant's life. EBF was experienced as (A) insufficient, (B) not always available, (C) sometimes not safe, (D) having potentially negative effects on the mother, and (E) bringing challenges. Complementary feeding was identified as helpful in addressing each of these concerns. Although mothers typically endorsed breastmilk as the preferable and best option for infant feeding, this did not translate into EBF and was not presented as contradictory to the use and perceived benefits of early complementary feeds.
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Affiliation(s)
- John D McLennan
- Departments of Psychiatry & Community Health Sciences, Cumming School of Medicine, Alberta Children's Hospital Research Institute, and Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Canada.
| | - Miki Pérez Agramonte
- Hospital Dr. Elías Santana, Los Alcarrizos, Santo Domingo Oeste, Dominican Republic
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Ragusa R, Marranzano M, La Rosa VL, Giorgianni G, Commodari E, Quattrocchi R, Cacciola S, Guardabasso V. Factors Influencing Uptake of Breastfeeding: The Role of Early Promotion in the Maternity Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094783. [PMID: 33946146 PMCID: PMC8124212 DOI: 10.3390/ijerph18094783] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 01/24/2023]
Abstract
Background: This study aimed to explore the prevalence of breastfeeding at birth points in Sicily and the relevance of the factors influencing the adoption of exclusive breastfeeding during hospitalization linked to childbirth. Methods: A survey was conducted to monitor the prevalence of breastfeeding in seven out of nine facilities providing maternity services in the province of Catania (Sicily, Southern Italy) in the years 2016–2018. An online questionnaire was administered using an electronic tablet by the midwife to the mother after discharge. Results: Women who had a higher educational qualification breastfed in a greater proportion (59.6%; odds ratio OR 0.60 for abandoning breastfeeding). Having had a caesarean section moderately impaired breastfeeding uptake, with an almost double chance of declining exclusive breastfeeding (OR = 1.74). Starting breastfeeding within 1 h from delivery showed a significant facilitating effect (OR = 0.58). Rooming-in had a strong facilitating effect on exclusive breastfeeding. A breastfeeding advocacy program was shown to protect from abandoning breastfeeding. Conclusions: It is important to offer in all hospitals the possibility and support for breastfeeding in the first moments after childbirth to increase the number of those who will then continue with exclusive breastfeeding.
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Affiliation(s)
- Rosalia Ragusa
- Health Technology Assessment Committee, University Hospital “G. Rodolico—San Marco”, 95123 Catania, Italy;
| | - Marina Marranzano
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy; (M.M.); (G.G.)
| | - Valentina Lucia La Rosa
- Department of Educational Sciences, University of Catania, 95124 Catania, Italy;
- Correspondence:
| | - Gabriele Giorgianni
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy; (M.M.); (G.G.)
| | - Elena Commodari
- Department of Educational Sciences, University of Catania, 95124 Catania, Italy;
| | - Rosalba Quattrocchi
- Health Promotion Unit, University Hospital “G. Rodolico—San Marco”, 95123 Catania, Italy;
| | - Salvatore Cacciola
- Health Education Unit, Azienda Sanitaria Provinciale 3, 95124 Catania, Italy;
| | - Vincenzo Guardabasso
- Research Promotion Office, University Hospital “G. Rodolico—San Marco”, 95123 Catania, Italy;
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Ahishakiye J, Vaandrager L, Brouwer ID, Koelen M. Qualitative, longitudinal exploration of coping strategies and factors facilitating infant and young child feeding practices among mothers in rural Rwanda. BMC Public Health 2021; 21:103. [PMID: 33419407 PMCID: PMC7796631 DOI: 10.1186/s12889-020-10095-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 12/20/2020] [Indexed: 11/29/2022] Open
Abstract
Background Mothers in low-income countries face many challenges to appropriately feed their children in the first year such as poverty, food insecurity and high workloads. However, even in the lowest income families there are mothers who succeed to feed their children according to the recommendations. In this paper, we explored the coping strategies that facilitate appropriate breastfeeding and complementary feeding practices among rural Rwandan mothers from birth to one year of a child’s life. Methods This qualitative longitudinal study recruited a purposive sample of 17 mothers who followed the infant and young child feeding recommendations (IYCF). They were selected from a larger study of 36 mothers. In-depth interviews were conducted with mothers of the total group (36 mothers) within the first week, at 4th, 6th, 9th and 12th months postpartum. Interviews were audio-recorded, transcribed verbatim and analyzed thematically. Results Coping strategies included improving mothers’ own diet for adequate breastmilk production, prioritizing child feeding over livelihood chores, livelihood diversification and mothers’ anticipatory behaviors such as preparing child’s food in advance. Some of those coping strategies were shifting overtime depending on the development of the children. Personal factors such as breastfeeding self-efficacy, religious beliefs and perceived benefits of breastfeeding were among the facilitating factors. Additionally, social support that mothers received from family members, other mothers in the community, Community Health Workers (CHWs) and health professionals played an important role. Conclusion In challenging contextual conditions, mothers manage to follow the recommended breastfeeding and complementary feeding practices through the interplay of active coping strategies, feeling to be in control and social support. Nutrition promotion interventions that aim to improve IYCF should consider strengthening mothers’ capability in gaining greater control of their IYCF practices and the factors facilitating their appropriate IYCF practices.
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Affiliation(s)
- Jeanine Ahishakiye
- Department of Human Nutrition and Dietetics, College of Medicine and Health Sciences, University of Rwanda, P.O Box 3286, Kigali, Rwanda. .,Health and Society Chair Group, Wageningen University and Research, P.O Box 8130, 6700EW Wageningen, The Netherlands.
| | - Lenneke Vaandrager
- Health and Society Chair Group, Wageningen University and Research, P.O Box 8130, 6700EW Wageningen, The Netherlands
| | - Inge D Brouwer
- Division of Human Nutrition and Health, Wageningen University and Research, P.O Box 17, 6700AA Wageningen, The Netherlands
| | - Maria Koelen
- Health and Society Chair Group, Wageningen University and Research, P.O Box 8130, 6700EW Wageningen, The Netherlands
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Wood FE, Gage AJ, Bidashimwa D. Insights on exclusive breastfeeding norms in Kinshasa: findings from a qualitative study. BMC Pregnancy Childbirth 2020; 20:586. [PMID: 33023528 PMCID: PMC7539451 DOI: 10.1186/s12884-020-03273-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/21/2020] [Indexed: 08/24/2023] Open
Abstract
Background For optimal growth and development, the World Health Organization recommends that children be exclusively breastfed for the first 6 months of life. However, according to the nationally-representative 2013–2014 Demographic and Health Survey, under 50% of babies in the Democratic Republic of Congo are exclusively breastfed. Although breastfeeding was common in the capital city of Kinshasa, one in five newborns received alternatives to breastmilk during the first 3 days of life. This analysis aimed to identify social norms influencing exclusive breastfeeding, the role of a young first-time mother’s (FTM’s) social network for her choice to exclusively breastfeed, and perceived social sanctions associated with breastfeeding practices in Kinshasa. Methods The qualitative analysis was based on a vignette presented during 14 focus group discussions, with a purposively selected sample (n = 162) of FTMs age 15–24, and the male partners, mothers and mothers-in-law of FTMs age 15–24 in three health zones in Kinshasa in 2017. Thematic content analysis was performed to identify concepts and patterns in the participants’ discussions. Results Overall, community norms were not supportive of exclusive breastfeeding. The main barriers to exclusive breastfeeding were the belief held by most FTMs that exclusive breastfeeding was an uncommon practice; the desire to avoid negative sanctions such as name-calling and mockery for refusal to give babies water in the first 6 months of life; the desire to please key members of their social networks, specifically their mothers and friends, by doing what these influencers expected or preferred them to do; FTMs’ own lack of experience with infant feeding; and trust placed in their mothers and friends. Conclusion Social norms can be maintained by the belief about what others do, perceived expectations about what individuals ought to do, the negative sanctions they can face and their preference to conform to social expectations. Thus, addressing cultural beliefs and targeting sensitization efforts to key influencers that provide support to FTMs are needed to promote exclusive breastfeeding in Kinshasa. In doing so, strategies should address the barriers to exclusive breastfeeding including related misconceptions, and improve FTMs’ self-efficacy to overcome the influence of others.
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Affiliation(s)
- Francine E Wood
- School of Public Health and Tropical Medicine, Global Community Health and Behavioral Sciences, Tulane University, 1440 Canal Street, New Orleans, USA
| | - Anastasia J Gage
- School of Public Health and Tropical Medicine, Global Community Health and Behavioral Sciences, Tulane University, 1440 Canal Street, New Orleans, USA
| | - Dieudonné Bidashimwa
- School of Public Health and Tropical Medicine, Health Policy and Management, Tulane University, 1440 Canal Street, New Orleans, USA.
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