The relationship between infant feeding practices, caregivers’ nutrition knowledge and nutritional status of infants aged between 6 to 12 months in a rural community in Zimbabwe

Abstract

Introduction Undernourishment affects a child's potential lifespan from the beginning according to United Nations International Children's Emergency Fund (UNICEF) 2014: 18), and the International Food Policy Research Institute (IFPRI 2014: 7) noted at the time that 11% of African Gross Domestic Product (GDP) was lost to malnutrition, thereby justifying the urgent need to fight it. Malnutrition in the early stages of growth of an infant could cause irreversible damage to their metabolism, which would cause their health to deteriorate especially when children consumed high-energy, low-nutrient diets later in life which was common in developing countries, and this could result in adults being susceptible to noncommunicable diseases like hypertension, cardiovascular diseases, and Type 2 diabetes (Prendergast and Humphrey 2014: 250). Globally, 150.8 million children were recorded to be affected by stunting in 2017 (UNICEF/WHO/World Bank 2018: 1) and the United Nations stated that sub-Saharan Africa accounted for one-third of stunted children (UNICEF/WHO/World Bank 2020: 3). Child malnutrition is at a high level in sub-Saharan Africa (Akombi, Agho, Merom, Renzaho and Hall 2017: 1) and it is one of the main health issues especially in low–medium income countries (UNICEF 2015: 3). Poor infant feeding practices have been an endemic problem in sub-Saharan Africa for many years and this has led to malnutrition (Onyango, Borghi, De Onis, Casanovas and Garza 2013:1975). These practices have stemmed in part from the lack of nutrition knowledge on the part of caregivers and have resulted in improper weaning which has been one of the contributing factors to the persistence of malnutrition (Bewket, Welday, Mehretie and Abebe 2017: 10). Thus, poor feeding practices have significantly contributed to the high levels of malnutrition, diarrhoea and poor growth of infants, even leading to death. In Zimbabwe, only eight percent of children aged 6-23 months eat an acceptable diet (Zimbabwe Demographic Health Surveys 2015: 200). Multiple factors could cause infant malnutrition such as poverty, food insecurity and drought but this study looked specifically at the role that caregivers play in the feeding of infants in the village of Munjinga North (Ward 14) in Mashonaland West Province in Zimbabwe. Methods This was a cross-sectional study conducted in a rural community in Zimbabwe. The participants in this study included a sample of 100 purposively selected caregivers caring for infants between the ages of 6–12 months. The study was descriptive and quantitative in nature with different measuring instruments used to measure the sample population. The research tools used included a socio-demographic questionnaire, where the multidimensional poverty index (MPI) was calculated; anthropometric measurements (weight, length and Mid Upper Arm Circumference (MUAC)) were collected to give the Z-scores of the infants. A validated infant and young child feeding module and caregiver’s nutrition knowledge questionnaire were also completed. The food security coping strategy questionnaire was completed to find out about the mechanisms that the community used to adapt feeding practices during periods of food shortage in their households. Data was captured by the researcher on Excel® spreadsheets and analysed using descriptive statistics using the Statistical Package for the Social Sciences (SPSS) for Windows version 25. The anthropometrics data was analysed using WHO Anthro version 3.2.2 Results The sampling technique used in this study resulted in n=100 participants, and as the participants’ number of 100 is equal to the percentage, the percentages are not presented separately. All the caregivers were female and responsible for 37% (n=37) female infants and 63% (n=63) male infants. Most of the caregivers (90%) were the mothers of the infants whilst the remaining 10% were the grandmothers. The room density was 0.47, which showed that at least two members of the household shared a room. A significant number of the households(27%) had no toilet facilities, which compromised sanitation. Most of the women (55%) indicated that they had attained a secondary education but 98% of them were unemployed during the period of study with 55% doing piece jobs, which resulted in 92% of the families having a monthly income of between US$1 – US$100 and surviving below the Food Poverty Line for one person, which was recorded at US$31.20 per person in Zimbabwe in 2017. When measuring this community against the Multi-dimensional Poverty Index, health contributed 24.4%, education contributed 16.4% and standard of living contributed 59.2% to the poverty index. The final MPI score was 40.9%, which was well above the cut-off point of 30% and this indicated that the community of Munjinga North is living in poverty. The anthropometric measurements indicated that there is a prevalence of stunting (55%), wasting (7%), and underweight (33%) in the infants. MUAC was used to determine the level of malnutrition in the community and 23% of the infants were found to have a MUAC below -2 and -3 on the Z-score. The Z-scores for MUAC and length-for-age had a statistical significance of (p=0.01). All the infants were breastfed at birth and 95% were still breastfeeding at the time of the study. The infants were timeously introduced to solids, semisolids and soft foods (96%) and those who received a minimum meal frequency made up 81%. Minimum dietary diversity was accomplished by 36% of the participants, with 25% receiving the minimum acceptable diet. Most of the caregivers (78%) had not received training on infant nutrition hence 95% of them did not know the importance of complementary feeding. Those who had partial knowledge on the importance of breastfeeding made up 51% whilst 62% knew what exclusive breastfeeding meant. The level of training was compared to the MUAC, and a statistical significance (p=0.05) was established. The most commonly used coping strategy was to restrict the consumption by adults for children to eat with a mean score of 8.88(SD±8.572); the second most common strategy was to reduce the mothers’ consumption for the sake of the children with a mean score of 7.16 (SD±6.15), followed by buying food on credit with a mean score of 2.11 (SD±3.066). Conclusion The average age of the infants who participated in this research was nine months. The MPI score calculated showed that the Munjinga North Ward 14 community is living in chronic poverty. They are deprived of basic necessities such as electricity and safe water to drink. The health score signified a risk of raising malnourished children in the community and it was already manifesting as 23% of the infants were found to be malnourished. The majority of the households are living on an income below the poverty datum line. All the infants were breastfed at birth and the majority were still being breastfed at the time of the research; however, it was shown that only a few of the caregivers knew about the importance of breast milk and why they were breastfeeding their infants. Many caregivers were breastfeeding their infants simply because they were told to do so by their elders. This indicated a lack of nutrition knowledge which would have significant repercussions when they weaned their children. The majority of the infants were being timeously introduced to complementary feeding, which, statistically, was a good sign as it showed that they were following the WHO guideline of exclusive breastfeeding for the first six months even though the majority of the mothers were unaware why they were encouraged to do so. The majority of infants were given two meals a day (thin porridge in the morning and in the evening) and since they were also being breastfed according to the WHO guidelines it indicated an ideal meal frequency, hence the high percentage of minimum meal frequency in the community. Although the meal frequency was high, the minimum dietary diversity and minimum acceptable diet statistics were low, signifying that the infants were being introduced to foods with compromised quality. The food lacked variety and indicated deficiency in some macronutrients and many micronutrients. The poor diet quality consumed by the infants would inevitably affect their growth and development. In this study, the signs were already visible with more than half of the infants being stunted and several wasted and malnourished. Although there could be other factors that contributed to malnutrition, the research findings confirmed that there was a relationship between infant feeding practices and caregivers’ nutrition knowledge, but knowledge was not a significant predictor of MUAC (nutrition health status) of the infants aged between 6-12 months. More attention needs to be given to the training of the caregivers on infant nutrition so that they can understand the need for healthy infant feeding practices, especially considering that the first 2,000 days of an infant’s life are the most critical.