The impact of maternal socio-demographic characteristics on breastfeeding knowledge and practices: An experience from Casablanca, Morocco

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Abstract

Background

Breastfeeding is universally recognized by the World Health Organization as the best way of feeding infants. Therefore, several countries have initiated health promotion interventions to support successful breastfeeding based on the factors influencing breastfeeding outcomes.

Objective

To examine the association between the knowledge of breastfeeding and maternal socioeconomic and demographic characteristics, and to determine any impact on child nutritional status.

Methods

A cross-sectional study using both qualitative and quantitative methods was conducted with mothers of infants aged six- to twenty-four months. Data was collected by a semi-structured questionnaire and face-to-face, in-depth interviews with mothers to get an insight into their breastfeeding perceptions and experiences. Educational achievement and occupational class were used as indicators of socio-demographic status. Nutritional status was assessed by anthropometric measurements.

Results

A significant relationship between exclusive breastfeeding and the mother's education ( P < .001) and socio-economic status ( P < .001) has been highlighted. A significant link was pointed out between breastfeeding and length-for-age Z score (LAZ) ( P < .001), and weight-for-age Z score (WAZ) ( P = .005). Moreover, a strong association was found between maternal employment and exclusive breastfeeding ( P < .001).

Conclusions

Our findings shed some light on challenges faced by mothers, as well as an association between socio-demographic characteristics and practices for facilitating exclusive breastfeeding to guide the mothers in breastfeeding management.

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Most cited references 41

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Delayed breastfeeding initiation increases risk of neonatal mortality.

Karen M. Edmond, Charles Zandoh, Maria A. Quigley … (2006)

Breastfeeding promotion is a key child survival strategy. Although there is an extensive scientific basis for its impact on postneonatal mortality, evidence is sparse for its impact on neonatal mortality. We sought to assess the contribution of the timing of initiation of breastfeeding to any impact. This study took advantage of the 4-weekly surveillance system from a large ongoing maternal vitamin A supplementation trial in rural Ghana involving all women of childbearing age and their infants. It was designed to evaluate whether timing of initiation of breastfeeding and type (exclusive, predominant, or partial) are associated with risk of neonatal mortality. The analysis is based on 10,947 breastfed singleton infants born between July 2003 and June 2004 who survived to day 2 and whose mothers were visited in the neonatal period. Breastfeeding was initiated within the first day of birth in 71% of infants and by the end of day 3 in all but 1.3% of them; 70% were exclusively breastfed during the neonatal period. The risk of neonatal death was fourfold higher in children given milk-based fluids or solids in addition to breast milk. There was a marked dose response of increasing risk of neonatal mortality with increasing delay in initiation of breastfeeding from 1 hour to day 7; overall late initiation (after day 1) was associated with a 2.4-fold increase in risk. The size of this effect was similar when the model was refitted excluding infants at high risk of death (unwell on the day of birth, congenital abnormalities, premature, unwell at the time of interview) or when deaths during the first week (days 2-7) were excluded. Promotion of early initiation of breastfeeding has the potential to make a major contribution to the achievement of the child survival millennium development goal; 16% of neonatal deaths could be saved if all infants were breastfed from day 1 and 22% if breastfeeding started within the first hour. Breastfeeding-promotion programs should emphasize early initiation as well as exclusive breastfeeding. This has particular relevance for sub-Saharan Africa, where neonatal and infant mortality rates are high but most women already exclusively or predominantly breastfeed their infants.

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Reproductive, maternal, newborn, and child health: key messages from Disease Control Priorities 3rd Edition.

Robert E Black, Carol Levin, Neff Walker … (2016)

As part of Disease Control Priorities 3rd Edition, the World Bank will publish a volume on Reproductive, Maternal, Newborn, and Child Health that identifies essential cost-effective health interventions that can be scaled up to reduce maternal, newborn, and child deaths, and stillbirths. This Review summarises the volume's key findings and estimates the effect and cost of expanded implementation of these interventions. Recognising that a continuum of care from the adolescent girl, woman, or mother to child is needed, the volume includes details of preventive and therapeutic health interventions in integrated packages: Maternal and Newborn Health and Child Health (along with folic acid supplementation, a key reproductive health intervention). Scaling up all interventions in these packages from coverage in 2015 to hypothetically immediately achieve 90% coverage would avert 149 000 maternal deaths, 849 000 stillbirths, 1 498 000 neonatal deaths, and 1 515 000 additional child deaths. In alternative calculations that consider only the effects of reducing the number of pregnancies by provision of contraceptive services as part of a Reproductive Health package, meeting 90% of the unmet need for contraception would reduce global births by almost 28 million and consequently avert deaths that could have occurred at 2015 rates of fertility and mortality. Thus, 67 000 maternal deaths, 440 000 neonatal deaths, 473 000 child deaths, and 564 000 stillbirths could be averted from avoided pregnancies. Particularly effective interventions in the Maternal and Newborn Health and Child Health packages would be management of labour and delivery, care of preterm births, and treatment of serious infectious diseases and acute malnutrition. Nearly all of these essential interventions can be delivered by health workers in the community or in primary health centres, which can increase population access to needed services. The annual incremental cost of immediately scaling up these essential interventions would be US$6·2 billion in low-income countries, $12·4 billion in lower-middle-income countries, and $8·0 billion in upper-middle-income countries. With the additional funding, greater focus on high-effect integrated interventions and innovations in service delivery, such as task shifting to other groups of health workers and supply and demand incentives, can help rectify major gaps in accessibility and quality of care. In recent decades, reduction of avoidable maternal and child deaths has been a global priority. With continued priority and expansion of essential reproductive, maternal, newborn, and child health interventions to high coverage, equity, and quality, as well as interventions to address underlying problems such as women's low status in society and violence against women, these deaths and substantial morbidity can be largely eliminated in another generation.

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Major factors influencing breastfeeding rates: Mother's perception of father's attitude and milk supply.

S. Arora, C McJunkin, J Wehrer … (2000)

To determine factors influencing feeding decisions, breastfeeding and/or bottle initiation rates, as well as breastfeeding duration. A family medicine practice of a 530-bed community-based hospital in northwestern Pennsylvania. All mothers whose infants received well-child care from birth to 1 year of age. A survey of 28 simple questions was developed and mailed to 245 mothers. The survey assessed: 1) demographics, 2) prenatal and postnatal care, 3) sources of breastfeeding information, 4) timing of decision, 5) preference, 6) type of feeding selected, 7) duration of breastfeeding, 8) factors influencing decisions to breastfeed and/or to bottle-feed, and 9) factors that would have encouraged bottle-feeding mothers to breastfeed. The breastfeeding initiation rate was 44.3%. By the time the infant was 6 months old, only 13% of these were still breastfeeding. The decision to breastfeed or to bottle-feed was most often made before pregnancy or during the first trimester. The most common reasons mothers chose breastfeeding included: 1) benefits the infant's health, 2) naturalness, and 3) emotional bonding with the infant. The most common reasons bottle-feeding was chosen included: 1) mother's perception of father's attitude, 2) uncertainty regarding the quantity of breast milk, and 3) return to work. By self-report, factors that would have encouraged bottle-feeding mothers to breastfeed included: 1) more information in prenatal class; 2) more information from TV, magazines, and books; and 3) family support. To overcome obstacles, issues surrounding perceived barriers, such as father's attitude, quantity of milk, and time constraints, need to be discussed with each parent. To achieve the goal of 75% of breastfeeding mothers, extensive education regarding the benefits must be provided for both parents and optimally the grandmother by physicians, nurses, and the media before pregnancy or within the first trimester.

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Author and article information

Contributors

Mouna Habibi

Fatima Zahra Laamiri

Hassan Aguenaou

Loubna Doukkali

Mustapha Mrabet

Amina Barkat

Journal

Journal ID (nlm-ta): Int J Pediatr Adolesc Med

Journal ID (iso-abbrev): Int J Pediatr Adolesc Med

Title: International Journal of Pediatrics & Adolescent Medicine

Publisher: King Faisal Specialist Hospital and Research Centre

ISSN (Electronic): 2352-6467

Publication date PMC-release: 01 May 2018

Publication date (Print): June 2018

Publication date (Electronic): 01 May 2018

Volume: 5

Issue: 2

Pages: 39-48

Affiliations

[a ]Research Team on Health and Nutrition of Mother and Child, University Mohammed V, Faculty of Medicine and Pharmacy, Rabat, Morocco

[b ]National Reference Center for Neonatology and Nutrition, Children's Hospital, Ibn Sina University Hospital Centre, Rabat, Morocco

[c ]Higher Institute of Nursing Professions and Technical Health, Rabat, Morocco

[d ]Joint Unit for Nutrition and Food Research at Ibn Tofaïl University (URAC 39), National Centre for Nuclear Energy, Sciences and Technology (CNESTEN), RDC-Nutrition AFRA/AIEA, Morocco

Author notes

[∗ ]Corresponding author. Research Team on Health and Nutrition of Mother and Child, Emergency Medical Department, University Children's Hospital Rabat-Salé, BP 6527, Rue Lamfadel Cherkaoui Rabat Institut, Morocco. mouna.habibi@ 123456um5s.net.ma

Article

Publisher ID: S2352-6467(17)30157-6

DOI: 10.1016/j.ijpam.2018.01.003

PMC ID: 6363246

PubMed ID: 30805532

SO-VID: 075c8e88-cb83-42e9-a8fb-cba105f758f1

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

History

Date received : 11 September 2017

Date revision received : 24 December 2017

Date accepted : 18 January 2018

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The impact of maternal socio-demographic characteristics on breastfeeding knowledge and practices: An experience from Casablanca, Morocco

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Abstract

Background

Objective

Methods

Results

Conclusions

Related collections

The International Journal of Person Centered Medicine

Most cited references 41

Delayed breastfeeding initiation increases risk of neonatal mortality.

Reproductive, maternal, newborn, and child health: key messages from Disease Control Priorities 3rd Edition.

Major factors influencing breastfeeding rates: Mother's perception of father's attitude and milk supply.

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Cited by 9

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