COMPLICATIONS OF POOR WEANING PRACTICES AMONG MOTHERS WITH CHILDREN AGED 6-23M IN MUEA COMMUNITY

Abstract

Weaning is an entire process during which an infant change from full dependence on breast milk to independence from it. This period which is critical period, if not properly done has the following consequences on children: diarrhea and allergic diseases, underfeeding, malnutrition and even complications that lead to infant death.

This study was carried out in Muea from the month of May to July 2021. The specific objectives were to assess mother’s knowledge on weaning in the Muea community, and to determine the impacts of inadequate weaning on the nutritional status of children in the Muea community. This was a cross-sectional descriptive-based study, which took into consideration 50 mothers in the community.

A convenient sampling method was used and data was collected using a well-structured questionnaire based on the specific objectives. The results of this study revealed that the majority (68%) of the mothers knew the definition of weaning and could identify the types of foods used to begin weaning, few of them (14%) could identify the importance of weaning.

It was also realized that many mothers (88%) faced different challenges during this period, and few mothers (concerning sensitization of mothers during home visits in the community on the importance of weaning as well as some advice on the challenges faced by mothers and possible solutions was to educate mothers on the different consequences of weaning practices on children. 10%) could identify the consequences of poor weaning.

Therefore, the key recommendation concerning sensitization of mothers during home visits in the community on the importance of weaning as well as some advice on the challenges faced by mothers and possible solutions was to educate mothers on the different consequences of inadequate weaning process on children.

CHAPTER ONE

INTRODUCTION

1.1 Background

The term weaning describes the time period in which a progressive reduction of breastfeeding while the infant is gradually introduced to complementary foods. World Health Organization (WHO,2013) recommends early initiation of breastfeeding, followed by exclusive breastfeeding for the first 6 months and introducing complementary feeding timely and adequate in amount, frequency, consistency, and variety to address the nutritional needs of the growing infant at 6 months of age with continuing breastfeeding up to 2 years (ISFID,2013).

This gradual replacement of milk with solid food as the main source of nutrition is known as weaning or complementary feeding (CPS,2004). The introduction of complementary foods during the weaning period is generally progressive and leads the infant to reach the dietary pattern of an adult within the second year of life (Harrison et al., 2017). The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of age, and complementary breastfeeding at least until the second year of age.

According to the WHO(2009), the introduction of complementary foods should be safe, well-timed and adequate; it should start when exclusive breastfeeding can no longer provide enough nutrients and energy for the infant’s growth and development, and it should contain foods that offer these nutrients and energy (Sachs et al.,2011). The weaning period is a crucial time in an infant’s life since it not only involves a great deal of rapid change for the child but is also associated with the development of food preferences, eating behaviors and body weight in childhood, adolescence as well as in adulthood(Alvisi et al., 2015).

Globally, Infections and the malnutrition associated with them are responsible for a significant proportion of the 13 million deaths among infants and children under 5 years of age worldwide each year. It is indicated by WHO that poor infant feeding and their consequences are one of the world’s major problems and a serious obstacle to social and economic development (Danker et al.,2014).

During the first two years of life, poor feeding practices and weaning practices have both instant and long-standing consequences. Inappropriate feeding of infants has long been observed in our society to be one of the global problems responsible for about one-third of the cases of malnutrition worldwide (Anoshirike et al., 2014). However, breastfeeding rates in the United States fall far short of these recommendations.

Although 77% of US mothers initiate breastfeeding, just 16% of mother-infant did achieve the recommended 6 months of exclusive breastfeeding. Multiple factors impact breastfeeding duration and recent public health campaigns have drawn attention to social constraints Over the last 10–15 years, an alternative approach known as “baby-led weaning” (BLW), or “auto-weaning”, has grown in popularity, particularly in the United Kingdom and New Zealand and more recently also in other countries in Europe (Brown et al., 2017). The term “baby-led” weaning was first coined by Gill Rapley in 2011.

BLW is an alternative method of infant feeding which promotes infant self-feeding from six months of age, instead of conventional parent spoon-feeding. Although BLW is not especially mentioned in the WHO’s recommendations, it is becoming more popular. It means that although parents offer foods, the child himself controls the weaning process (thus the term “baby-led”): infants decide what, how much and how quickly to eat (Rapley et al., 2011).

In developing countries, the age of introduction of weaning food is of public health importance because of the risk of diseases such as diarrhea and malnutrition from delayed weaning (WHO,2017). Delay or premature initiation of complementary or weaning foods may lead to deterioration of nutritional status and increased risk of infections, especially diarrhoeal diseases; a phenomenon termed weaning dilemma (Osie et al., 2011). Contrary to recommendations, 9% of children aged 0-1 month, 16% of children aged 2-3 months, and 38% of children aged 4-5 months are given complementary foods in addition to breast milk. Each year, optimal breastfeeding and complementary feeding practices can save the lives of 1.5 million children under five years (WHO,2011).

Although breast feeding is universal in developing countries, complementary and appropriate weaning practice rates are not satisfactory as various socio-demographic factors influence these practices which vary from country to country. Breastfeeding rates have been on the increase worldwide in the last decade but only 38% of children less than 6 months of age are exclusively breastfed and 39% benefit from breastfeeding up to 2 yrs. of age in developing countries (Kamga.,2010).

In West African countries, weaning can be a period of problems and vulnerability for the survival of a child. Looking at the conventional or traditional weaning foods and weaning practices in some West African nations, the nutritive values, nutritional problems, and possible solutions were presented like in Nigeria for instance the usual first weaning food is called “pap”, “akamu”, and is made from maize, or guinea corn.  In Anambra State most mothers introduce the thin gruel at three to six months of age (Centre for Human Nutrition) (2011). The baby is fed on demand with a spoon or a cup, although in certain parts of the country, a few mothers use the traditional forced hand-feeding method. Most Ghanaian mothers start weaning by the third month of life.

A few mothers, however, start after one month. On the basis of interviews with breastfeeding Ghanaian mothers, Armar-Klemesu and Wheeler(2007) reported that the main weaning food for infants up to six months of age was a traditional fermented maize porridge (koko). Guiro et al. 2005 in his study found out that traditional weaning foods in West Africa are known to be of low nutritive value and are characterized by low protein, low energy density, and high bulk. Maize pap has been implicated as the cause of protein-energy malnutrition in children during the weaning period

The northern regions of Cameroon are the hardest hit by infant malnutrition (28.9%) and diarrhoeal diseases have been documented as the leading cause (26.7 %) of infant mortality in the same region (Balopa,et al.,1999). One of the main problems facing food scientists in Africa when it comes to combating and preventing infant malnutrition and diarrhoea-related diseases, is the lack of reliable information describing complementary food practices and preferences that could guide the development of intervention measures.

Infants are at particularly high risk of malnutrition especially those in the age range between 6-12 months, when exclusive breastfeeding has stopped, and protective levels of acquired immunity, mastication and swallowing skills have not yet developed (Kingam et al.,2000).

At this critical age, complementary foods are introduced that usually do not provide sufficient nutrients and that are often contaminated with food-borne agents, that lead to an increased risk of infection. Information from the literature indicates that mothers from West African countries usually breastfeed for 12-24 months, with urban poor and rural women falling within the upper limits (18 to 24 months). Mothers from low-income groups seldom feed meat, egg, or fish to infants, because of socio-economic factors, taboos, and ignorance (larri.,1999).

According to a study carried out in Yaoundé-Cameroon by Falake (2016), 14.8% of children of less than 5 years were moderate to severely underweight (weight for age Z score < -2). Also, 31.7% of children of less than five years were moderate to severely stunted (height for age Z score < -2. Furthermore, 5.2% of these children suffered from moderate and severe emaciation (weight for height Z score < -2).

It is well recognised that the period of 6-24 months of age is one of the most critical time periods in the growth of the infant. The incidence of stunting is highest in this period as children have high demand for nutrients and there are limitations in the quality and quantity of available foods, especially after exclusive breastfeeding. The way a mother views weaning is closely related to how she will perform weaning. Therefore, this study evaluated the perception of weaning by mothers and caregivers so as to get their views on weaning and correct their wrong views (Falake.,2016).

1.2 Statement of the problem

The period of weaning is a critical stage which often results in malnutrition and disease if the child does not have a diet that is adequate in quantity and quality, hygienically prepared and culturally, socially and economically acceptable.

Mothers need guidance to improve these traditional foods through combinations with other foods available to them locally. Poor infant-feeding practices and their consequences are one of the world’s major problems and a serious obstacle to social and economic development. It is not only a problem of the developing world: it occurs in many parts of the developed world as well. (WHO).Introduction of complementary foods before the age of 6months has often been discouraged by the WHO especially among mothers living in developing countries and low socioeconomic communities, because the inadequacy of enough replacement feeding can lead to weight loss, increased risks of infection, malnutrition and death among infants.

Falake (2016) who carried out research in Yaoundé, Cameroon stated that in spite of the good knowledge mothers and caregivers in Yaoundé have on exclusive breastfeeding, most of these mothers and caregivers have wrong perceptions concerning weaning. Average knowledge on weaning leads to wrong attitudes towards weaning resulting in inadequate practices while weaning and suggested that emphasis should be laid on the weaning process.

Traditional weaning foods from Cameroon are typically cereals and/or nuts-based. Ironically, inadequate attention is paid to the nutritional value of the weaning foods, especially in rural Cameroon, where natural food contaminants have been reported by the Scientific Committee on Food in 2002 and 2003 for adults, the scenario may be worse in children during the weaning process considering the under-fives and adults in the same household generally feed from the same pot, thereby leaving these infants highly vulnerable to nutrient deficiencies.

What urge the intend was the fact that during my stay in the Muea health Centre most malnourished babies and babies with infections who were admitted to the wards were those during the weaning period hence I was motivated to find out about poor weaning practices by mothers and its complications to babies in Muea community.

1.3 Objectives

1.3.1 General Objectives

To find out the complications of poor weaning practice among mothers of children aged 6-23months in the Muea community.

1.3.2 Specific Objectives

1. To assess the mother’s knowledge of the weaning practice in the Muea community.
2. To identify challenges faced by mothers during the period of weaning in the Muea Community.
3. To find out the consequences of poor weaning practices on the nutritional status of infants in the Muea community from the mothers.