Background
Methods
Study setting
Study design
Study population and sampling procedure
Data collection
Period | Questions |
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First week | - For this new baby (the name of the baby), how long after birth was she/he breastfed? - [If less than one hour] What do you believe are the advantages of breastfeeding the baby within the first hour after birth? - What factors or circumstances enabled you to breastfeed the baby within the first hour after birth? - [If more than one hour] What factors or circumstances made it difficult for you to breastfeed the baby within the first hour after birth? - Was the baby given (by you or anyone else) anything to eat/drink before he/she was breastfed for the first time? - [If yes] What was given to the baby? - Why was it given to her/him? [Ask for each food/drink that was given to the baby] - Who advised you to give this to the baby? [Ask for each food/drink that was given to the baby] - At the moment, from birth till now, has the baby been given anything to eat or drink other than breastmilk? - What was given to the baby other than breast milk? - What was the reason that triggered you to offer your baby (drink or/food item)? - Who advised you to do that? |
4 months | Now let’s talk about how the baby was fed after these few days. Please think back from the first week through the first few months - Are you currently breastfeeding the baby? If yes, how often do you breastfeed? - Do you breastfeed 1) on a fixed schedule, or 2) each time the baby asks to be fed, or 3) depends on the mother’s availability? If not, at what age of the child did you discontinue breastfeeding? Why did you stop breastfeeding the baby? - What type of food was given to the baby; if any, what were the reasons that triggered you to offer your baby ____________ (drink or food mentioned)? - How did you learn about that? Did you learn it from someone? - From the last visit, in the first week postpartum, till now, did you make some changes in the ways you feed your baby? If yes, what did you change? - Did you have any problem or challenge (internal or external) impeding the ideal breastfeeding practices for your child? For every problem, probe to talk more about the problem. - What elements do you believe help you to overcome those challenges? Is it something inside you (physical, mental, or spiritual) or something outside yourself (social and physical context)? - |
6 months | Now let’s talk about how the baby was fed after these few months. From the last visit at fourth month till now, did you make some changes in the ways you feed your baby? If yes, what did you change? Probing questions: - Are you currently breastfeeding the baby? If yes, how often do you breastfeed? - Do you breastfeed 1) on a fixed schedule, or 2) each time the baby asks to be fed, or 3) depends on the mother’s availability? If not, at what age of the child did you discontinue breastfeeding? Why did you stop breastfeeding the baby? - Have you given any food/drink to your baby in addition to breastmilk? - If yes, what was the first food given to your baby? - How old was your baby when you gave him/her this particular food or drink? If food was introduced before six months, ask why. - How did you learn about that? Did you learn it from someone? - Did you have any problem or challenge (internal or external) impeding the ideal breastfeeding practices? For every problem, probe to talk more about the problem. - What elements do you believe help you to overcome those challenges? Is it something inside you (physical, mental, or spiritual) or something outside yourself (social and physical context)? |
9 months | Now let’s talk about how the baby was fed after these few months. From the last visit at 6 months till now, did you make some changes in the ways you feed your baby? If yes, what did you change? Probing questions: - Are you currently breastfeeding the baby? - If yes, how often do you breastfeed 1) on a fixed schedule or 2) each time the baby asks to be fed 3) depends on the mother’s availability 4) other.... - If not, at which age of the child did you discontinue breastfeeding? Why did you stop breastfeeding the baby? If complementary food was not yet introduced at 6 months: - Did you start giving CF to your child? - If the answer is yes, when did you start? What triggered you to start introducing complementary foods at that age? If the answer is no, then ask for reasons - If yes, what was the first food given to your baby? - Why did you decide to start with this particular food? - How did you learn about that? Did you learn it from someone? If complementary food was introduced at 6 months: - What triggered you to start introducing complementary foods at 6 months? - What was the first food given to your baby? - Why did you decide to start with this particular food? - Did you change anything in the food given to the child, how and when you feed the child during the last 3 months? If yes, what kind of foods (foods, dishes, drinks) is given to the child of about 9 months? - Are there any foods, dishes, or drinks served only to the child between 6 and 8 months that is no longer given to the baby at the moment? If so, which types of foods, dishes, or drinks? Why? - How much do you give to your child compared to your own amount (half what you consume, or a quarter)? How do you know that it is sufficient? If you realized it was necessary to increase the amount of food that you give the child, would you be able to do this? What difficulties would you have? What would help you to do this? - How many times did you feed your baby solid and semi solid or soft food other than liquids during the day and night yesterday? How do you know this is sufficient to give … … times a day? - [if the frequency is less than the recommended frequency for the age group] If you are advised to increase the number of times you feed the child each day and you agreed with this, would you be able to do it? What difficulties would you have? What would help you to do this? - [if the frequency is much more than the recommended frequency for the age group] If you are advised to decrease the number of times you feed the child each day, what would be your reaction? Which person would you listen to? - If complementary food is not yet introduced, what factors or circumstances make it difficult for you to provide CF to your baby? Were there any individuals or groups that disapprove or discourage you from providing CF to your baby? - Did you have any problem or challenge (internal or external) impeding the ideal breastfeeding practices and giving CF to the baby? For every problem, probe to talk more about the problem. - What are your current responses to those challenges? For every response, probe to talk more about the response. Are those responses your preferred ones? If not your preferred ones, what would be needed according to you to do this in a better way? - Have you been advised on breastfeeding practices and CF by anyone during the last 3 months, if yes, who and type of advice received from each? |
12 months | Now let’s talk about how the baby was fed after these few months. From the last visit at 9 months till now, did you make some changes in the ways you feed your baby? If yes, what did you change? Probing questions: - Are you currently breastfeeding the baby? - If yes, how often do you breastfeed 1) on a fixed schedule or 2) each time the baby asks to be fed 3) depends on the mother’s availability 4) other..... - If not, at which age of the child did you discontinue breastfeeding? Why did you stop breastfeeding the baby? - During the last 3 months, did you change anything in the food given to the child, how and when you feed the child? - What kind of foods (foods, dishes, drinks) is given to the child of about 12 months? - Are there any foods, dishes, or drinks served only to the child before that is no longer given to the baby at the moment? If so, which types of foods, dishes, or drinks? Why? - How much do you give to your child compared to your own amount (half what you consume, or a quarter?)? How do you know that it is sufficient? If you realized it was necessary to increase the amount of food that you give the child, would you be able to do this? What difficulties would you have? What would help you to do this? - How many times did you feed your baby solid and semi solid or soft food other than liquids during the day and night yesterday? How do you know this is sufficient to give … … times a day? - [if the frequency is less than the recommended frequency for the age group]: If you are advised to increase the number of times you feed the child each day and you agreed with this, would you be able to do it? What difficulties would you have? What would help you to do this? - Did you have any problem or challenge (internal or external) impeding the ideal breastfeeding practices and giving CF to the baby? For every problem, probe to talk more about the problem. - What are your current responses to those challenges? For every response, probe to talk more about the response. Are those responses your preferred ones? If not your preferred ones, what would be needed according to you to do this in a better way? - Have you been advised on breastfeeding practices and CF by anyone during the last 3 months, if yes, who and type of advice received from each? |
Ethical consideration
Data analysis
Results
Characteristics of the study participants at the beginning of the study
Characteristic | Total (n=36) | Sub-sample (n=17) |
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Age of the mother (years) | ||
< 21 | 2 | 1 |
21–30 | 12 | 4 |
> 30 | 22 | 12 |
Marital status (with partner) | 32 | 16 |
Ability to read and write | 34 | 15 |
Education level of the mother | ||
Illiterate | 2 | 2 |
Primary incomplete | 17 | 4 |
Primary complete | 15 | 9 |
Secondary incomplete | 2 | 2 |
Main occupation (farming) | 36 | 17 |
Average number of children | 2.3 | 2.1 |
Overview of the results
Coping strategies for appropriate breastfeeding and complementary feeding practices
Improving mothers’ own diet for adequate breastmilk production
“I try my best to get porridge and to eat a balanced diet so that by the time the baby will breastfeed he will get adequate breastmilk.” (W− 26, month 4).
Prioritizing child feeding over livelihood chores
“Tasks never end; I only mix them with caring for the child. No rural mother can find time to care for a child exclusively, people are always busy even during dry seasons, so I try to find a way to do the work and take care of the child.” (W− 34, month 4).“Workload is not a big challenge. In my case, I reduce it and fulfil my responsibility of childcare first including feeding.” (W− 8, month 12).
Livelihood diversification
“I do not have a job from which I can get a salary. I grow crops, but our harvest depends on the weather. When it is favorable, we get a good harvest, but if I produce sweet potatoes or beans, I have to take some to market so that I can buy something else that children need like fruit or rice.” (W-24, month 12).
“I, personally, I am very poor, fortunately it happens that I work in the plots of well- off people in the neighborhood and I get money or food for the child.” (W-18, month 9).
“I also keep a hen and I can sell eggs or chickens and I can buy flour for porridge or baby’s foods in case of food shortage.” (W-24, month 9).“Sometimes I buy avocadoes or tomatoes and resell them and I use the interest to buy the infant’s food like fruits and keep the capital for further investment. For instance, if I make 1000 Rwandan francs (Frw) I can use 500 Frw and save the remaining.” (W-18, month 12).
“As for complementary feeding, sometimes it becomes not easy to get food, however one has to try and get food for the infant. For instance, we are belonging to women’s saving groups, in case of food shortage; I borrow money and buy food for the infant. Nothing cannot preclude me to care for my infant.” (W-13, month 12).“When I have got a little money, I buy a half kilo of rice and prepare some grains for the child when I can’t find it for the entire family. I cannot let my child suffer from hunger; I prepare a few spoons for the child and keep another portion for his next meals.” (W-32, month 12).
Mothers’ anticipatory behaviors
“Sometimes I prepare baby’s cereal in advance, early in the morning and take it to the farm. For instance, if I breastfeed the bay at 6:30 in the morning, I give her the cereal around 9:00 because she gets hungry at this time instead of waiting until my return back home to prepare lunch meals.” (W-34, month 9).
Changes in coping strategies overtime
Factors facilitating mothers to cope
Personal factors
“It is that mother’s affection and love, even when I feel weak I have to make an effort and I breastfed her even while lying on the bed and put her closer to me so that she could feel me and recognize me as her mother.”(W-34, week1).
“The first one is my knowledge that the baby should depend on mother’s milk only and I have my own breasts, I don’t have to pay for them. The second is the will. I think there is no obstacle, therefore, I will succeed in breastfeeding her, except in the case of force majeure but I don’t expect it, I trust in God.” (W-34, week 1).
“Within the first hour after birth, I breastfed the baby with confidence that she was going to accept it eagerly as it used to be for the older siblings.” (W- 36, week 1).“The baby will be exclusively breastfed until 6 months, because this is not new as I also managed to exclusively breastfeed the older siblings.” (W-01, month 4).
My goal is to exclusively breastfeed my baby for his first 6 months from birth. However, as he grows up he expresses envy to eat as he observes others eating. I usually respond to that challenge by isolating the baby whenever I or other siblings are going to eat but what happens is that he sometimes refuses. What I started doing hence forth was not to let the baby stay in own room while we all go and take our meal but rather I used to stay with him and not eat until his siblings are finished to eat and join him to keep his company.(W-15, month 6).
“The challenge was that since last time you visited our home I have been sick of malaria. My husband and mother- in law advised me to give cow’s milk to baby and I said no, I cannot give it to the baby before he turns 6 months.” (W-1, month 6).“I do not give up; I try to find a solution whatever the problem is because if I gave up it would affect the child’s health.” (W-34, month 6).
“Sometimes I face food related challenges. But, once I deeply pray, it helps me a lot as I believe that there is God’s plan for me. I don’t give up instead I keep on working very hard because I know that God will intervene at the right time.” (W-24, month 12).“When I pray and join praying groups, I convey to God all my worries including not having access to sufficient food, I feel relaxed because I believe God will provide.” (W-10, month 12).
Social factors
“Also, my husband is helping me in cooking and doing other household duties in these early days after delivery.” (W-11, week 01).“When my partner gets a casual labour, I tell him what is needed for the infant. He doesn’t reject my request; he provides me money and buys the infant’s food item we don’t grow.” (W-20, month 9).
“By the time I met with other mothers at the health center for child’s vaccination at 3 months and a half, EB for 6 months was the focus of our conversation. One mother expressed her concern that her baby wants foods and I said that mine also wants foods. Then another mother encouraged us to make more effort to keep going and delay the introduction until 6 months. Now I managed to do so.” (W-17, month 6).
“We receive the advice and teachings from health center professional that we have to introduce other foods to our babies from six months, in addition to breastmilk and that foods should be pureed. Therefore, we try to put into practice what we hear from them for the well-being of our babies”. (W- 26, month 6).
“We are educated by CHWs when we meet during village kitchen activities. They tell us that under 6 months, infants should only be breastfeed and that the mother should eat a balanced diet so that the baby gets adequate breastmilk. In addition, we bring different food items and learn together at that moment how to prepare a balanced diet for our children using locally available food items.” (W-17, month 4).
Discussion
Conclusion
Recommendations
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Integrating self-efficacy enhancing strategies in antenatal and postnatal education
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Creating a supportive environment such as family and community-wide awareness to provide optimal support to mothers in order to practice the WHO recommended IYCF practices.
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Strengthening mothers’ capability in gaining greater control of the strategies and factors facilitating appropriate IYCF practices