Infant feeding practices and determinants of poor breastfeeding behavior in Kinshasa, Democratic Republic of Congo: a descriptive study

BACKGROUND

Although breastfeeding is almost universally accepted in the Democratic Republic (DR) of Congo, by the age of 2 to 3 months 65% of children are receiving something other than human milk. We sought to describe the infant feeding practices and determinants of suboptimal breastfeeding behaviors in DR Congo.

METHODS

Survey questionnaire administered to mothers of infants aged ≤ 6 months and healthcare providers who were recruited consecutively at six selected primary health care facilities in Kinshasa, the capital.

RESULTS

All 66 mothers interviewed were breastfeeding. Before initiating breastfeeding, 23 gave their infants something other than their milk, including: sugar water (16) or water (2). During the twenty-four hours prior to interview, 26 (39%) infants were exclusively breastfed (EBF), whereas 18 (27%), 12 (18%), and 10 (15%) received water, tea, formula, or porridge, respectively, in addition to human milk. The main reasons for water supplementation included "heat" and cultural beliefs that water is needed for proper digestion of human milk. The main reason for formula supplementation was the impression that the baby was not getting enough milk; and for porridge supplementation, the belief that the child was old enough to start complementary food. Virtually all mothers reported that breastfeeding was discussed during antenatal clinic visit and half reported receiving help regarding breastfeeding from a health provider either after birth or during well-child clinic visit. Despite a median of at least 14 years of experience in these facilities, healthcare workers surveyed had little to no formal training on how to support breastfeeding and inadequate breastfeeding-related knowledge and skills. The facilities lacked any written policy about breastfeeding.

CONCLUSION

Addressing cultural beliefs, training healthcare providers adequately on breastfeeding support skills, and providing structured breastfeeding support after maternity discharge is needed to promote EBF in the DR Congo.

The association between posttraumatic stress symptoms and functional impairment during ongoing conflict in the Democratic Republic of Congo

The Democratic Republic of Congo (DRC) has suffered from a bloody conflict for more than a decade. More than 5,400,000 people died from war-related causes since 1998 and exposure to violence was wide-spread. This study investigated the impact of posttraumatic stress disorder (PTSD) symptoms on perceived health and physical and social functioning, filling an important gap in the current literature. Data were collected from a sample of 93 adults living in Bunia, Eastern Democratic Republic of Congo. Structured in-person interviews included the PTSD section of the Composite International Diagnostic Interview and the World Health Organization Disability Assessment Scale. Additional questions were included to assess social resources. Study recruitment was balanced to achieve equal representation of both sexes and each quarter of town. Forty percent met symptom criteria for probable PTSD. Individuals with PTSD reported poor perceived general health and had high disability scores compared to those without PTSD. Of the three PTSD symptom clusters, hyperarousal was most strongly associated with disability. Individuals with PTSD were significantly more emotionally affected by their health problems than those without PTSD (85% versus 41%), had more difficulties in activities involving social contact (54% versus 16%) and in doing their daily work (54% versus 20%). The impact of war-related violence on mental health is severe in the DRC. Psychosocial interventions developed in conflict areas might be best targeted primarily to supporting social functioning and reducing hyperarousal. Implications for clinical treatment and future directions are discussed.