1

ASSESSMENT OF MOTHERS ADHERENCE TO THE OPTIMAL INFANT AND

YOUNG CHILD FEEDING PRACTICES FOR CHILDREN AGED 0-24 MONTHS IN
THE MANZINI REGION

By
Mkhonta Andile Sebehlulekile

A Research Project Submitted to the Department of Consumer Sciences, Faculty of

Agriculture and Consumer Sciences of the University of Swaziland in Partial fulfillment
of the requirements for the degree of Bachelor of Science in Food Science, Nutrition and
Technology

Luyengo Campus, Swaziland

May, 2016

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ASSESSMENT OF MOTHERS ADHERENCE TO THE OPTIMAL INFANT AND
YOUNG CHILD FEEDING PRACTICES FOR CHILDREN AGED 0-24 MONTHS IN
THE MANZINI REGION

Author: Andile Sebehlulekile Mkhonta: .

Supervisor: Dr. T.E. Sibiya:
Date Approved: ...
Approved for inclusion in the Library of the University of Swaziland.

Dr. P.J. MUSI

Head of Consumer Sciences Department
Date:

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COPYRIGHT PAGE

Permission has been granted to the library of The University of Swaziland to lend copies of
this Research Project Report. The author reserves other publication rights and neither the
Research Project Report nor extensive extracts from it may be printed or reproduced without
the authors permission.

Copyright Andile Mkhonta, 2016

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DEDICATIONS
I dedicate this work of art to my Heavenly Father for his goodness and loving kindness that
enabled me to reach my potential. A special feeling of pride is dedicated to my Soul for
delivering to an expected level of performance, through faith and hard work. To my uncle,
Mr. J. M. Mkhabela, with this work I say thank you for your sustenance, it got me this far:
You Should Be World Renowned.

ACKNOWLEDGMENTS

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It is with immense Gratitude that I acknowledge the support of my supervisor Dr. T. E.
Sibiya, to whom I am thankful for the opportunity to be guided by an intellectual of such a
pleasant kind. I would like to express my deepest appreciation to the administrators of the
respective healthcare facilities engaged for data collection purposes. To the mothers who
sacrificed their time by making this piece of work successful, thank you for your humanity
and support. This work would not be possible without your cooperation. I would also like to
thank the Anglican Students Federation for their prayers, thoughtfulness and blessings. I am
truly indebted to the Swaziland National Nutrition Council and Swaziland Infant Nutrition
Action Network for inspiring such kind of passion towards Nutrition and health and also
helping me understand my area of research better by guiding me with their valuable
expertise. A special feeling of Gratitude to my Mothers Ms. Tenele. P. Mkhabela and Ms.
Thembile. M. Mkhabela and siblings (Nontokozo Mkhonta, Sinethemba Dlamini and Zanele
Ginindza) for entrusting me to represent them with dignity throughout the completion of my
degree course. To my niece Karen Louw, I thought of your bubbly self every time I needed to
put a smile back on my face, I am grateful for the calls and amusement. I am also thankful to
Mr. Thami B. Dlamini for his never-ending encouragement and constructive criticism
throughout the production of this work. It is with great pleasure that I acknowledge my
colleagues and friends (Ayanda Fakudze and Tessa Bhembe) for their humour and love that
sustained my sanity during the course of my graduate studies. Lastly, I offer my regards and
blessings to well-wishers and all those who supported me in any respect during the
completion of the project and my entire student life at Luyengo Campus.

ABSTRACT

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The link between child mortality and infant feeding has been well documented and
established. According to the Convention on the Rights of the Child, every infant and child
has the right to good nutrition. This can be accomplished through Optimal Infant and Young
Child Feeding (IYCF) practices of mothers. However, child nutrition and health indices in
Swaziland are not satisfactory with regard to the Millennium Development Goal (MDG) 4.
This is caused by the complex interplay of various determinants including inappropriate
IYCF practices. The purpose of the study was to assess the adherence of mothers to the
optimal infant and young child feeding practices for children aged 0-24 months in the
Manzini Region, Swaziland. The study employed the Quantitative descriptive research design
to obtain results and generalize them from a larger sample population. The target population
of the study comprised of mothers with children aged 0-24 months. Eighty respondents from
3 health care facilities in the Manzini region participated in the study for data collection. The
results of the study revealed that mothers have substantial knowledge of IYCF
recommendations yet there was a degree of turmoil in their implementation of the optimal
IYCF practices. Mothers lack the ingenuity to practice accordingly, especially complimentary
feeding in relation to dietary diversity and minimum meal frequency. It was also found that a
majority of the mothers did not experience skin-to-skin contact with their babies after
delivery. Key factors found to influence the adherence of mothers to optimal infant feeding
practices were antenatal care, praising women on breastfeeding and the support of healthcare
professionals. The implementation of an in country Infant and Young Child Feeding
regulatory health system is recommended to ensure consistent monitoring and evaluation of
mothers adherence to the optimal IYCF practices in a bid to promote child health, survival
and development.
TABLE OF CONTENTS
APPROVAL PAGE

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COPYRIGHT PAGE...................................................................................................................i
DEDICATION...........................................................................................................................ii
ACKNOWLEDGMENTS........................................................................................................iii
ABSTRACT..............................................................................................................................iv
TABLE OF CONTENTS...........................................................................................................v
LIST OF TABLES...................................................................................................................vii
LIST OF FIGURES................................................................................................................viii
LIST OF APPENDICES...........................................................................................................ix

CHAPTER 1 INTRODUCTION...............................................................................................1
1.1

Background..................................................................................................................1

1.2

Problem Statement.......................................................................................................4

1.3

Justification of the Study.............................................................................................5

1.4

Purpose and Objectives of the Study...........................................................................5

1.5

Limitations of the Study..............................................................................................6

1.6

Definition of Terms.....................................................................................................6

1.7

Acronyms....................................................................................................................7

CHAPTER 2 LITERATURE REVIEW.....................................................................................9

2.1

Background on Current National IYCF Guidelines....................................................9

2.2

Recommended IYCF Practices..................................................................................10

2.2.1

Exclusive Breastfeeding.....................................................................................10

2.2.2

Complementary Feeding....................................................................................11

2.3

Conceptual Framework for IYCF..............................................................................14

2.4

The Significance of Infant and Young Child Feeding...............................................16

2.5

Importance of Mothers Adherence to the Optimal IYCF Practices.........................17

2.6

Mothers Source of IYCF Information.......................................................................18

CHAPTER 3 METHODOLOGY............................................................................................21
3.1

Research Design........................................................................................................21

3.2

Sample Selection.......................................................................................................21

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3.3

Instrumentation..........................................................................................................22

3.4

Validity and Reliability..............................................................................................22

3.5

Ethical Considerations...............................................................................................23

3.6

Data Collection..........................................................................................................24

3.7

Data Analysis.............................................................................................................24

CHAPTER 4 RESULTS...........................................................................................................25
4.1

Mothers Level of IYCF Knowledge.........................................................................26

4.2

Infant and Young Child Feeding Practices................................................................28

4.2.1
Frequency Distribution of a 24 Hour Dietary Recall of Children Aged 6-24
Months (n=32)..................................................................................................................29
4.3

Factors Influencing Mothers Adherence to the Optimal IYCF Practices.................31

4.4

Demographic and Socio-economic Characteristics...................................................32

CHAPTER 5 DISCUSSION....................................................................................................36
5.1

Mothers level of Infant and Young Child Feeding knowledge................................36

5.2

Infant and Young Child Feeding Practices................................................................37

5.2.1

Feeding Practices of Mothers for the Age Group 6-24 Months (n=32).............40

5.3

Factors Influencing Mothers Adherence to the Optimal IYCF Practices.................41

5.4

Demographic and Socio-economic Characteristics...................................................44

CHAPTER 6 SUMMARY, CONCLUSION AND RECOMMENDATIONS.........................46

6.1

Summary....................................................................................................................46

6.2

Conclusion.................................................................................................................47

6.3

Recommendations.....................................................................................................48

Literature Cited.....................................................................................................................50

APPENDICES..........................................................................................................................53
LIST OF TABLES
TABLE

PAGE

1. Frequency Distribution of Mothers' Level of IYCF Knowledge (N=80)...................27

2. Frequency Distribution of IYCF Practices Of Mothers (N=80).................................29

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3. Mean Distribution of Factors Influencing Mothers' Adherence to the Optimal IYCF

Practices (N=80)...........................................................................................................31
4. Demographic and Socio-Economic Characteristics of Mothers..................................34

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LIST OF FIGURES
FIGURE

PAGE

1. Frequency Distribution of A 24 Hour Dietary Recall for Children Aged 6-24 Months

(N=32)..........................................................................................................................30

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LIST OF APPENDICES
APPENDIX

PAGE

1. REQUEST FOR RESEARCH PROJECT QUESTIONNAIRE VALIDATION.........53

2. QUESTIONNAIRE......................................................................................................54
3. REQUEST FOR RESEARCH PROJECT DATA COLLECTION..............................61
4. AUTHORIZATION TO CARRY OUT A RESEARCH..............................................62

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CHAPTER 1
INTRODUCTION
1.1

Background

The fundamental of Infant and Young Child Feeding (IYCF) entails all the types of foods and
care practices provided to children, from birth until the age of two. These differ from the ones
of other age groups, because the nutrition needs of infants and young children are different,
while the texture of food and frequency of feeding have to be adapted to their capacity to
chew and maturity of their digestive system. Moreover, optimal IYCF entails early initiation
of breastfeeding within 1 hour of birth, Exclusive breastfeeding for the first six months of life
and the introduction of nutritionally-adequate and safe complementary (solid) foods at 6
months, along with continued breastfeeding up to 2 years and beyond (WHO, 2003).
Optimal infant and young child feeding practices rank among the most effective interventions
to improve child health by reducing early childhood morbidity and mortality as well as
improving early child growth and development (Lamberti, Fischer, Noiman, Victoria &
Black; 2011). Children under the age of two grow rapidly and are susceptible to different
kinds of illnesses. Although under-nutrition typically spikes at the age of 3-18 months,
creating a window of opportunity for the prevention of growth faltering and under-nutrition
in the first two years of a childs life (Victoria, de Onis, Hallal, Blossoner & Shrimpton;
2010). The period from birth to two years of age is the best period for the promotion of
optimal growth, health and the development of sound behaviors in children to guarantee that
they reach their full growth potential and help prevent irreversible stunting and acute under
nutrition (UNICEF, 2007).
Poor breastfeeding and complementary feeding practices in infancy and childhood, coupled
with high rates of HIV/AIDS are the main underlying causes of malnutrition during the first

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two years of life (MICS, 2014). In Swaziland, a majority of the nations children (60%)
admitted at health care facilities are suffering severe malnutrition while HIV is an underlying
cause (SDHS, 2006-2007). The prevalence of under-five mortality rates (per 1000 live births)
is on the rise in the country, with the rates of Manzini Region standing at 102 deaths,
consequently having the second highest cases of under-five deaths (112) relative to the other
regions.
The Executive Board of the World Health Organization, at its 101 session in January 1998,
called for a revitalization of the global commitment to appropriate infant and young child
nutrition, and in particular breastfeeding and complementary feeding. The Fifty-fifth World
Health Assembly in its resolution WHA55.25 of 18 May 2002 then endorsed a global strategy
for infant and young child feeding, as presented in the report on Infant and young child
nutrition (A55/15 of 16 April 2002).
The foundation of the Global Strategy is based on the evidence of nutritions significance in
the early months and years of life, and of the crucial role that appropriate feeding practices
play in achieving superlative health indices. This strategy describes essential interventions
necessary to protect, promote and support appropriate infant and young child feeding. It
focuses on the importance of investing in this crucial area to ensure that children develop to
their full potential, free from the adverse consequences of compromised nutritional status and
preventable illnesses. It further concentrates on the roles of humanitarian partners,
governments, international organizations and other concerned parties in the plight of
malnutrition.
Nevertheless, many Infants and children are still deprived of optimal feeds. Globally Under
nutrition is estimated to cause 3.1 million child deaths annually (45% of all child deaths).

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Over two-thirds of these deaths are associated with inappropriate feeding practices and occur
during the first year of life (WHO, 2009a; WHO, 2003).
In the developing countries like Swaziland, poor IYCF practices raise threat to child
development causing growth faltering (WHO, 2007). A majority of the nations children
(60%) admitted in health care facilities are suffering severe malnutrition (SDHS, 2006-2007).
Inadequate dietary intake of essential nutrients and inadequate mothers education and
nutritional knowledge are categorized as potential determinants of childhood malnutrition and
mortality in Swaziland.
The government of Swaziland through the National Nutrition Council (SNNC) and
Swaziland Infant Nutrition Action Network (SINAN) developed the National IYCF
guidelines (2010) according to the WHO-UNICEF recommendations in an effort to promote
optimal IYCF practices, through the integration of evidence based public health
interventions, by means of basic training of health care professionals. The primary objective
of training Counsellors/community workers/primary health care staff was to equip them with
the knowledge, skills and tools to support mothers, fathers and other caregivers to optimally
feed their infants and young children.
Despite the several child healthcare programs, the problem of elevated child malnutrition
levels places a hindrance towards the attainment of the Millennium Development Goals
(MDG) 4 on reduction of child mortality. In order to engage effective measures to control and
eliminate child malnutrition, there is a need for mothers adherence with optimal IYCF
practices (Arabi, Frongillo, Avula & Mangasaryan; 2012). The mother hence the direct care
giver of the child with regard to management of food choices and eating behavior is
responsible for fulfilling and adhering to the optimal IYCF requirements and to accomplish
them she should have the right kind of knowledge and should be able to practice this

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accordingly. If the mother has insufficient knowledge on the substance of optimal IYCF
practices, it would possibly lead to inadequate IYCF standard practices. The poor outcomes
of child nutrition and health ratios in Swaziland indicate a gap in the IYCF practices of
mothers, consequently necessitating a need to create an understanding of the ability of the
mother to optimally feed her infant along with the determinants to practice what she knows
about child health and nutrition. The mothers infant feeding choices if poorly chosen or
implemented can inadvertently jeopardize optimal IYCF practices.
1.2

Problem Statement

Child malnutrition, morbidity and mortality are reduced when mothers adhere to the national
IYCF recommendations (Nair, 2015). Child mortality in the country is on the rise totaling to
over 1,300 deaths in last the 6 years, with under nutrition associated to 8% of all child
mortalities (MICS, 2014). These are caused by the complex interplay of various determinants
including inappropriate infant and young child feeding practices (UNICEF, 2007). Adherence
to the optimal IYCF recommendations is in the mothers domain as they are the direct care
givers of the child with regard to management of food choices and eating behavior. Mothers
doubtful adherence is manifested in the pitiable child nutrition and health indices in
Swaziland which are not satisfactory with regard to the Millennium Development Goal
(MDG) 4. This will ultimately compromise the attainment of the MDG 4 for the country. The
study therefore sought to identify the gap in the mothers ability to practice in accordance
with the optimal IYCF recommendations. Similarly, the high-level of malnutrition contributes
significantly to the cost of health care for the country, including hidden costs that may be
attributable to poor productivity due to ill health.

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1.3

Justification of the Study

The essence of the study was advocated for by its aim to assess and identify if the standard
practices in relation to Infant and Young Child Feeding are implemented devotedly by
mothers and that there was no knowledge gap amongst the mothers. For this reason, it could
contribute to the work of government and non-government community with the hope of
influencing public policy in supporting and promoting optimal IYCF practices. By providing
a framework of essential interventions, mothers along with the nation at large can rejoice at
the rewards of optimal infant nutrition and longevity by later in life. Subsequently, improving
child nutrition and health indices could pledge for the countrys quest to be amongst the first
world countries at least by 2022.
1.4

Purpose and Objectives of the Study

The purpose of the study was to assess the adherence of mothers towards optimal infant and
young child feeding practices for children aged 0-24 months in the Manzini Region,
Swaziland.
The specific objectives of the study were to:
1. Determine the demographic and socio-economic characteristics of mothers with
children 0-24 months.
2. Ascertain the mothers level of knowledge on optimal IYCF practices amongst mothers
with children 0-24 months.
3. Determine the IYCF practices amongst mothers with infants 0-24 months.

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4. Identify the main factors influencing mothers adherence to optimal infant and young
child feeding practices.
1.5

Limitations of the Study

The duration of the research period was brief (approximately 12 weeks). Twelve weeks was
insufficient for the researcher to conduct the study on a national census thus limiting the
study to a regional level. Mothers with children aged 0-24 months but had children too ill
requiring immediate medical attention were unwilling to participate in the study, forcing the
researcher to exclude these.
1.6

Definition of Terms

Adherence- The extent to which mothers deliver their faithful support when feeding their
young ones by conforming to the recommended IYCF practices.
Breast Feeding- Feeding the infant and young child on breast milk.
Complementary Feeding - A process starting at six months when breast milk alone is no
longer sufficient to feed infant and young child hence the need to initiate semi-solid and solid
food in order to meet the nutritional requirements of infants while continuing with breast
feeding.
Compliance - The willingness of mothers to fulfill the nutritional needs of infants & young
children according to the guidelines.
Continued Breastfeeding - Is the status of children aged 6-24 months being fed on
breast milk and solids, semi-solid and soft foods.

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Exclusive Breastfeeding This is when the infant receives breast milk only without any
additional food or drink, not even water.
Infant A very young human being, from birth to 12 months of age.
Morbidity - The quality of being unhealthful due to the occurrence of illness or disease
leading to the in and out of hospital.
Mortality - the condition of infants & young children being susceptible to death.
Mixed Feeding- Giving a baby breast milk and other feeds or fluids in addition to breast milk
especially before the age of 6 months.
Recommendations A set of guidelines fostered to address the nutritional needs of infants &
young children.
Young Child a human being from 12 months to 24 months of age.
1.7

Acronyms

AIDS- Acquired Immune Deficiency Syndrome.

CHW-Community Health Workers
HIV- Human Immune Virus
IYCF- Infant and Young Child Feeding
MICS- Multiple Indicator Cluster Survey
PHU-Pubic Health Unit
PHC-Primary Health Care Review

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RHMs-Rural Health Motivators
SDHS-Swaziland Demographic Health Survey
SINAN-Swaziland Infant Nutrition Action Network
SNNC-Swaziland National Nutrition Council
UNICEF-United Nations Childrens Fund
USAID-United States Agency for International Development
WHO-World Health Organization

CHAPTER 2

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LITERATURE REVIEW
2.1

Background on Current National IYCF Guidelines

WHO (2003), published a global strategy for IYCF which is a global instrument aimed at the
protection, promotion and support of optimal IYCF. It assists in the development of national
strategies and action plans on IYCF for every countrys specific programs. The strategy was
developed to revitalise world attention to the impact that feeding practices have on the
nutritional status, growth and development, health, and survival of infants and young
children. The Global Strategy for infant and young child feeding Model Chapter summarizes
essential knowledge that every health professional should have in order to carry out the
crucial role of protecting, promoting and supporting appropriate infant and young child
feeding in accordance with the principles of the Global Strategy.
Swaziland is a signatory to these conventions and has affirmed its commitment to
breastfeeding through adopting the 2006 WHO consensus Statements (WHO, 2006) by
implementing the first set of National Infant and Young Child Feeding guidelines in 2010.
The Swaziland National Nutrition Council (SNNC) in collaboration with the Swaziland
Infant Nutrition Action Network (SINAN) through the government of Swaziland and other
non-government health stakeholders developed the National IYCF guidelines in 2010
according to the WHO-UNICEF recommendations in an effort to promote optimal IYCF
practices, through the integration of evidence based public health interventions by means of
basic training of health care professionals. The primary objective of training
Counsellors/community workers/primary health care staff is to equip them with the
knowledge, skills and tools to support mothers, fathers and other caregivers to optimally feed
their infants and young children.

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The Swaziland National IYCF guidelines state that mothers should; start breastfeeding within
the first hour of birth, breast feed exclusively for the first six months (180 days) of a childs
life and introduce nutritionally adequate and safe complementary feeding starting from the
age of 6 months with continued breastfeeding up to 2 years of age or beyond. The national
IYCF strategy of 2007-2010 derived from the global strategy of IYCF is crucial to help
optimize key strategies for improving IYCF in Swaziland (WHO, 2014 - 2019).
2.2
2.2.1

Recommended IYCF Practices

Exclusive Breastfeeding

Exclusive breastfeeding means that an infant receives only breast milk from his or her
mother, or expressed breast milk, and no other liquids or solids, not even water, with the
exception of oral rehydration solution, drops or syrups consisting of vitamins, minerals
supplements or medicines.
Initiation of exclusive breastfeeding (EBF) within one hour of delivery ensures that the child
gets to consume colostrum which is the initial special breast milk produced within the first 2
days after delivery and is rich in antibodies, anti-infective proteins, white blood cells and
growth factors (WHO, 2010). It also has cleansing effects that help clear the infants gut thus
preventing jaundice. Initiating EBF early in life is associated with greater appetite regulation
later in childhood leading to reduction of early overweight (Lahariya, 2008).
When EBF is initiated immediately after birth and is continued for six months, it reduces
risks of severe malnutrition, cough incidences, hypoxemia incidences and duration in
children with pneumonia, diarrhoea, gastro-intestinal tract conditions, respiratory conditions,
infections and anaemia (Lahariya, 2008). The breast fed children have less digestive troubles,
colic pains and best working immune system (Cohen, Hadash, Shehadeh & Pillar; 2012).

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In a study conducted by Cohen et al., in 2012 on the potential role of breast milk melatonin it
was found that breast milk is the best source of alpha-lindenic acid (ALA) and
docosahexaenoic acid (DHA) which are reported to play a role in the development of the
brain. Therefore, breastfeeding enhances good outcomes on the childs intelligence quotient
(IQ), education and behavior of the child. In addition, breast feeding for four months and
longer has better outcomes on fine motor skills at age one and three years; higher adaptability
at age two years and higher communication skills at ages one and three years.
Furthermore, continued breastfeeding at 12-15 months of age is associated with reduction of
higher risks of child underweight (Marriot, White, Hadden, Davies & Wallingford; 2012).
Other benefits of breastfeeding include the breast milks vitamin A important role in assisting
a child to build up hepatic stores of vitamin A that later become critical for survival after
introduction of solids, semi-solids and soft foods.
2.2.2

Complementary Feeding

An age is reached when breast milk alone is insufficient to meet the childs nutritional needs,
and at this point complementary foods must be added. Complementary feeding is defined as
giving other foods in addition to breast milk. These other foods are called complementary
foods. The target range for complementary feeding is generally taken to be 6 to 24 months of
age, even though breastfeeding may continue beyond two years.
These recommendations may be adapted according to the needs of infants and young children
in exceptionally difficult circumstances, such as pre-term or low-birth-weight infants,
severely malnourished children, and in emergency situations. Specific recommendation apply
to infants born to HIV-infected mothers.

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Timely introduction of solid, semi-solid and soft foods (complementary feeding) at 6 months
of age is associated with reduction in risk of underweight, illness and mortality in children.
According to a study done in 14 poor countries, complementary feeding at 6-8 months was
associated significantly with lower risks of both stunting and underweight (Marriot et al.,
2012). Stunting in older children shows failure of growth and development during the first
two years of life as revealed in a study done in Nairobis informal urban settlements (Marriot
et al., 2012). Hence, evidence of the need of nutrition intervention between 0-2 years of age.
As a child grows there is need for increased energy intake as from six months (WHO, 2010).
However, due to poor breastfeeding and complementary feeding practices the child is
exposed to greater risks of nutritional deficiency and growth retardation which occurs at three
to fifteen months.
Cases of malnutrition are more frequently observed during the transitional period of 6-24
months than in the first 4-6 months and is largely because the families may not be aware of
the special needs of the child or they may not know how to prepare complementary foods
from available ingredients or they are too poor to ensure food security at family level or are
due the ignorance of mothers/ fathers/ caregivers to use appropriately the knowledge
presented to them by health care workers especially the community health care workers about
IYCF practices (UNICEF/USAID, 2011).
In addition to complementary feeding is the importance of continued breastfeeding for 24
months and beyond since it provides up to half of the childs nutritional needs during the
second year of life (WHO, 2010). According to Ramakrishnan et al., (2009), complementary
feeding is the most effective intervention that can significantly reduce stunting during the first
two years of life.

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The minimum age for the introduction of the solids, semi-solids and soft foods is at times
dictated by the neuromuscular development of infants as pertaining to when they can ingest
particular types of foods. There is evidence of a critical window for introducing lumpy solid
foods: if these are delayed beyond ten months of age, it may increase the risk of feeding
difficulties later, the child will not receive the required nutrients, slow childs growth and
development and increase risk macro nutrient deficiencies causing malnutrition. Semi-solid
or pureed foods are needed at first, until the ability for munching (up and down mandibular
movements in their jaws) or chewing (use of teeth) appears. Now the digestive systems of the
children are mature enough to begin to digest a range of foods.
There is also need to give the child minimum meal frequency which is defined as; two times
for breastfed infants at six to eight months, three times for breastfed children aged nine to
twelve months and five times for breastfed children aged thirteen to twenty four months
which includes 1-2 snacks (Liyanage, 2010). Snacks are foods given in between meals which
are usually self-fed, convenient and easy to prepare (UNICEF/WHO/USAID/URC, 2007).
The complementary food should also meet the minimum dietary diversity defined as
receiving food from four or more food groups namely: grains, roots and tubers; legumes and
nuts; dairy products; flesh meat (animal source foods); eggs; vitamin A rich fruits and
vegetables (yellow fruits and vegetables); oil and other fruits and vegetables. Such varied
foods in a childs meal ensure that nutritional needs are met (Liyanage, 2010).
However, foods low in nutrient value such as tea, sugary drinks and sodas should be avoided
(Liyanage, 2010). Solids, semi solids and soft foods at 6 months are such as cereal porridge
that should be thin initially then made thicker as the infant grows older. Thereafter, between
6-12 months, leguminous and vegetables foods should be added to the cereal porridge. At 9

14
months of age, the infant may be introduced gradually to foods from the family pot and
thereafter between ages 12-24 months continue progressively omitting spices.
Introducing foods from the family pot gives the infant a varied taste of foods, variety of foods
and also ensure nutritional needs are met while living within the budget of the family. The
infant should be given small frequent feeds; about 4-6 feeds in a day. Meanwhile
breastfeeding is continued on demand. Evidence from a study by Dewey and Brown., (2003)
indicates that by 12 months, most infants are able to consume family foods of a solid
consistency. Family food provide adequate nutrient density for protein, thiamine, riboflavin,
vitamin B6, B12 and C but not vitamin A, niacin, folate, calcium, iron and zinc). However,
many of the children are still offered semi-solid foods presumably because they can ingest
them more efficiently, and thus less time for feeding is required of the mother (Dewey &
Brown, 2003).
2.3

Conceptual Framework for IYCF

Infant and young child feeding behaviours are influenced by the choices mothers make. Other
factors playing a role in the behaviour of IYCF are information and support given to the
mothers before infants are born, at birth and afterwards. Family and mothers norms also play
a role on mothers choices and practice of IYCF. Other factors include demographic,
economic and policy factors. The conceptualized interrelated factors influencing the mothers
choice of infants and young child feeding as first theorized by Lutter (2000) are numerous
and multidimensional.
The mothers level of education, level of knowledge of IYCF recommendations and the
mothers characteristics such as age, popular culture and past IYCF experience which is
captured as infants birth order are conceptualized as factors influencing IYCF practice. The

15
culture upheld by the mothers and the economic background them to comply with the
national IYCF recommendations or not. Employed mothers may not exclusively breast feed
as per national IYCF recommendations due to returning to work before the EBF period is
over. Mothers awareness of National IYCF recommendations influences their IYCF
practices. These factors were conceptualized as interacting and influencing the issue of IYCF
(Lutter, 2000).
Demographic characteristics that influence the IYCF practices include: maternal age, marital
status, mothers level of education and mothers attendance of ante-natal clinic. In a study
done in Norway by Lande et al. (2003), maternal age was found to have significant positive
trends of EBF at four months, breast feeding at 6 months and timely introduction of solids,
semi solids and soft food. However, in another study done by Lande et al. (2003), in
Bangladesh, older maternal age was a risk factor for bottle feeding.
Marital status is depicted in studies as affecting IYCF practices and the direction of
association is inconsistent within and between countries and regions (Senarath et al., 2012).
A study done in done in USA showed that being married had significant association with
multiple positive IYCF practices (Hendricks, Briefel, Novak & Ziegler; 2006).
Maternal level of education as shown in studies by Morgan et al., done in Kenya and Pakistan
respectively found out that mothers termination of breastfeeding was negatively influenced
by lower educational levels. According to Serenath et al., (2012) in a study done in Sri Lanka,
mothers with primary education were found to be more likely to exclusively breastfeed than
mothers with no education. Mothers with college level of education were associated with the
largest number of positive IYCF practices (Hendricks et al., 2006). Lower maternal education
was cited in a study by Serenath et al., (2012) done in India as a factor causing mothers to
practice non diversity of infant and young child foods in children meals.

16
Another maternal characteristic is the mothers attendance of ante-natal clinics. The depicted
scenario may cause the initiation of breastfeeding and IYCF patterns to be influenced by the
mothers uninformed decisions.
The prevalence of malnutrition and disease is often unequally distributed between groups of
different socioeconomic background. Such socioeconomic factors could be age, gender,
ethnicity, education, income, work, living situation and many more. For example, stunting is
most prevalent among the poorest children living in rural areas, likewise are 81 % of the
wasted children in the world living in South Asia or sub-Saharan Africa (UNICEF, 2007).
Hence adherence with the optimal IYCF practices is obtained in attempting to establish
factors influencing the challenges motherhood and breastfeeding may offer and attempting to
explain why mothers behave the way they do.
2.4

The Significance of Infant and Young Child Feeding

Optimal IYCF is universally accepted as the essential element for the satisfactory growth and
development of infants and young children for prevention of childhood illness. Adequate
nutrition during infancy and early childhood is essential to ensure the growth, health, and
development of children to their full potential. Poor nutrition increases the risk of illness, and
is responsible, directly or indirectly, for one third of the estimated 9.5 million deaths that
occurred in 2006 in children less than 5 years of age (UNICEF, 2007). Inappropriate nutrition
can also lead to childhood obesity which is an increasing public health problem in many
countries.
Early nutritional deficits are also linked to long-term impairment in growth and health.
Malnutrition during the first 2 years of life causes stunting, leading to the adult being several
centimetres shorter than his or her potential height. There is evidence that adults who were

17
malnourished in early childhood have impaired intellectual performance. They may also have
reduced capacity for physical work. If women were malnourished as children, their
reproductive capacity is affected, their infants may have lower birth weight, and they have
more complicated deliveries (under-nutrition cycle). When many children in a population are
malnourished, it has implications for national development. The overall functional
consequences of malnutrition are thus immense.
The first two years of life provide a critical window of opportunity for ensuring childrens
appropriate growth and development through optimal feeding. Based on evidence of the
effectiveness of interventions, achievement of universal coverage of optimal breastfeeding
could prevent 13% of deaths occurring in children less than 5 years of age globally, while
appropriate complementary feeding practices would result in an additional 6% reduction in
under- five mortality. Optimal IYCF also matters in key practices such as skin-to-skin. What
is known by the national Guidelines on infant and young child feeding (MOH, October 2010)
is that the premature baby should be kept in skin-to-skin contact with the mother as this will
help to regulate his body temperature and breathing, and keep him in close contact with the
breast while Frequent skin-to-skin contact between mother and infant leads to bonding, better
psychomotor, affective brain and social development of the infant.
2.5

Importance of Mothers Adherence to the Optimal IYCF Practices

Generally the mothers compliance with national IYCF recommendation is low, making their
adherence with the optimal their IYCF practises questionable. Gaps are captured in the
national studies on IYCF. The demographic health survey of (2006-2007) indicate that the
prevalence rates of the key IYCF practices are still way below those required to ensure that
the Millennium Development Goal (MDG) number four is achieved by the year 2015 (World
Bank, 2006). According to WHO (2009) the incidences of EBF are low in many countries,

18
and is an indication of non-compliance with IYCF recommendations. The benefits of
compliance as is shown in a study by Torimiro, Onayade, Olumese & Makanjuola; (2004)
proved that mothers compliance with the IYCF recommendations had outcomes of fewer
episodes of the common signs of illnesses.
With all the risks of infectious diseases and under nutrition factors put together, the country is
suffering a downward spiral of a deteriorating health situation among children aged 0 24
months and beyond. It is therefore critical that mothers receive the necessary help and
education in order to break out of the situation. Knowing how dramatically advantageous
breastfeeding practices improves child health and survival; it may seem that much is to be
gained by improving the breastfeeding practices among the mothers.
Holding the valuable insight on the challenges motherhood and breastfeeding may offer is
important when attempting to explain why mothers behave the way they do. There is no
doubt that the role of a mother under the conditions of choosing the right feeding choices of
their infants and young ones is far more demanding than an ordinary mother beyond that
stage.
2.6

Mothers Source of IYCF Information

Mothers obtain information on IYCF from a variety of sources and numerous vehicles, the
quality of which may vary, and is not necessarily evidence-based. Dissemination of IYCF
information to mothers is best delivered through existing health systems. IYCF education
aligned to national policy should be strengthened in Primary Health Care (PHC) activities
(MOH, Swaziland, 2010). In Swaziland, the SNNC and SINAN through the Ministry of
health stipulated the need for the mothers to receive IYCF messages during their antenatal
visits in health care facilities, neighbourhood care points, and mother and child health clinics

19
through individualized one to one talk, group teachings and through demonstrations with
posters and pamphlets. These stipulated exhibitions all around the country is where many
primary health care activities are done and giving such IYCF messages is known to build
confidence in the mother once they return home after delivery at a Health Facility.
The dissemination of information, education & communication (IEC) materials in the form of
brochures and pamphlets is known to be an eye catching strategy. The materials contain
important messages on how to prepare for breastfeeding of infants and how to enable their
infants to latch on the breast along with introduction of solids, semi-solids and soft foods
after six months with appropriate, adequate and indigenous complementary foods while
breastfeeding is continued for two years and beyond. These key messages enable the mother
to be aware of the recommended IYCF from birth to 24 months and beyond. IYCF messages
given to the mothers at various levels in their life culminate to their level of knowledge in
IYCF. The IYCF messages are tailored in a manner to capture the key aspects of IYCF
recommended practices.
Primary health care providers have a role of disseminating IYCF information at the
community level and can thus reduce early introduction of solids, semi-solids, and soft foods
(MOH, Swaziland, 2010). Despite the advantages of daily dissemination of information in
support of IYCF, it seems that health education sessions are not carried out as per
recommendation due to heavy work load of the Public Health Unit Staff, Clinic Staff, and
Community Health Workers especially Rural Health Motivators (RHMs) in whose docket it
falls. This is evident on the pitiable health surveys which advocate for gaps in the mothers
level of knowledge on various aspect of IYCF hence their compliance.
However, according to the reporting of SNNC director Ms. Dansile Vilakati at the
commemoration of world breastfeeding week at the convention centre (August, 2015), there

20
is evidence of IYCF message dissemination during the ante-natal and post-natal period being
in accordance to the expectation of the Baby Friendly Hospital Initiative in Swaziland.
Skilled trained health workers such as Rural Health Motivators were also identified in various
studies to be potentially cost effective in IYCF information dissemination.
The Primary Health Care review of 2011 highlights that RHMs have been very instrumental
in the implementation of primary health care in Swaziland hence they have been identified as
a channel of communication and mobilization between health care systems and communities
to create public awareness on optimum IYCF.
However, IYCF information dissemination has various challenges amongst the identified
sources such as the health workers providing conflicting advice or guidance, being
unavailable and lack of resources especially time to support the mothers on IYCF practical
aspects. Grandmothers are sources of information to mothers. Other sources include: the mass
media such as television and the radio.
2.7

21
CHAPTER 3
METHODOLOGY
3.1

Research Design

The Quantitative descriptive research design was employed in this study. Jackson (2009)
distinguished that quantitative research is used to quantify attitudes, opinions and behaviors
by way of generating data that can be transformed into usable statistics to generalize results
from a larger sample population. The study successfully described the mothers level of IYCF
knowledge, their current IYCF practices, and factors that influenced these variables.
3.2

Sample Selection

The population of the study comprised of all mothers. However, the target population entailed
mothers with children aged 0-24 months attending the selected health care facilities in the
Manzini region at the point of data collection. The healthcare facilities were sampled entirely
by chance using simple random sampling so that each one of them had an equal chance of
being selected to avoid bias. An unbiased random selection of the health care facilities was
important so that the average sample will accurately represent the population.
The study utilized the non-probability sampling method to select the target population
because individual members of the population (all mothers) did not have a likelihood to be
selected as a member of the target population, since the population of mothers with children
is infinite, with an approximate value of 59 413 (HMIS, 2015). Only mothers with children
currently aged 0-24 months were considered as eligible respondents.
Eighty respondents from 3 health care facilities in the Manzini region participated in the
study for data collection. Health care facilities engaged for data collection purposes of the

22
study include: Raleigh Fitkin Memorial Hospital, King Sobhuza II Public Health Unit, and
Mankayane Government Hospital.
3.3

Instrumentation

A questionnaire with closed ended questions was developed based on the review of literature
to obtain responses that were anticipated to fulfill the objectives of the study. Questions were
written using simple- unambiguous language so that they were clear and easy to comprehend.
The questionnaire was divided into four parts:
Part A: mothers level of knowledge on optimal IYCF practices. Respondents replied with
either yes, no or dont know. Part B contained questions on the current IYCF practices of
mothers with infants 0-24 months in the form of a multiple choice and a 24 hour dietary
recall for the age group 6-24 months. Part C was based on questions that aim to assess the
major factors influencing mothers adherence to optimal infant and young child feeding
practices. These were presented on a six point likert scale as it is easy to analyze statistically
(Jackson, 2009). The points included strongly agree (6), agree (5), slightly agree (4), slightly
disagree (3), disagree (2), and strongly disagree (1) and Part D comprised of the demographic
and socio-economic characteristics of mothers with infants 0-24 months.
3.4

Validity and Reliability

The research instrument was presented to a panel of experts from the department of consumer
sciences, Swaziland National Nutrition Council and the Swaziland Infant Nutrition Action
Network for content and concurrent validity to validate the questionnaire as an instrument for
data collection. Comments and critics were incorporated for the development of a valid
instrument.

23
To determine the reliability of the now valid questionnaire, a pilot test was executed on 20
mothers who were not part of the population study at Luyengo Clinic in the Manzini region.
The data collected was used to adjust the questionnaire for any inconsistencies. Redundant
questions were also eliminated at this stage.
The researcher narrated the questions from the questionnaire in Siswati to mothers who were
not conversant with English, while supervising the whole data entry process to ensure that
there was no missing data. To ensure reliability, variables were computed in the Statistical
Package for Social Science (SPSS) version 20 and analyzed using the Cronbachs Alpha
model which is a measure of internal consistency and correlation. A positive correlation
represented by r = 0.76 was obtained.
3.5

Ethical Considerations

The researcher obtained permission to conduct the study from Administrators in all 3 health
care facilities. These included matrons, senior medical officers and sisters. After a written or
verbal informed consent had been obtained from the health care authorities, a full explanation
of the purpose of the study was given to participants before the instrument was administered
to them.
A request to complete the enclosed questionnaire was also inserted in the questionnaire for
participants to note and to further familiarize themselves with the purpose of the study.
Respondents were also assured of confidentiality of information provided and that all the
information gathered will be treated discretely, and used solely for the study. An interview
guide translated into Siswati was available to account for illiterate mothers.

24
3.6

Data Collection

Questionnaires were distributed to respondents and collected immediately after completion.

Primary data formed an integral part of the study because it contained first-hand, relevant
responses gathered directly from the target respondents. To control non response error, the
researcher supervised and provided guidance to all participants throughout the data collection
period. Observation of the child health cards was ensured to confirm the age of the infant.
3.7

Data Analysis

Data collected was computed and analyzed using the Statistical Package for Social Science
(SPSS) version 20. Descriptive statistics were utilized by the researcher to interpret the raw
data according to the objectives of the study.

CHAPTER 4
RESULTS

25
The following chapter demonstrates the results of the study. The main purpose of the study
was to assess the adherence of mothers towards optimal infant and young child feeding
practices for children aged 0-24 months in the Manzini Region. The findings of the study
were gathered as per the specific objectives of the study which were: To ascertain the
mothers level of knowledge on optimal IYCF practices amongst mothers with infants 0-24
months, To determine the IYCF practices amongst mothers with infants 0-24 months, To
identify the main factors influencing mothers adherence to optimal infant and young child
feeding practices and To determine the demographic and socio-economic characteristics of
mothers with infants 0-24 months.
A total of 80 women were interviewed by the researcher during their postnatal visits with
their ages ranging from 13 50 years old. Following a verbal informed consent between the
respondents and the researcher, data was collected using questionnaires with the return rate of
100 % (80/80 questionnaires). Data was collected at 3 health care facilities in the Manzini
Region namely: Raleigh Fitkin Memorial Hospital, King Sobhuza II Public Health Unit, and
Mankayane Government Hospital. Data was analyzed using the IBM Statistical Package for
Social Science (SPSS) version 20.0 to obtain frequencies, percentages, means and standard
deviations to analyze the descriptive data. Microsoft Excel was used to formulate bar charts
and tables for presentation purposes. Findings of the study are also presented in narrative
forms.

4.1

Mothers Level of IYCF Knowledge

To determine the level of knowledge of mothers on IYCF, 10 parameters of infant and young
child feeding were assessed. Key parameters included the definition of exclusive
breastfeeding, complimentary feeding, benefits of colostrum and poor IYCF implications.

26
Statements on these parameters were presented to mothers, to which they had to respond
either to the affirmative, the contrary, or by indicating that they dont know. This is illustrated
in Table1 in the succeeding page. A majority of mothers (87.5%) proved to be knowledgeable
about the timely introduction of solid, semi-solid and soft foods (complementary feeding) at 6
months as they disagreed to the statement the appropriate age to introduce semi-solids or
soft foods is at 4-5 months. Eighty percent of mothers were also knowledgeable about the
definition of exclusive breastfeeding. About 78.8% of mothers were aware that poor IYCF
practices lead to adverse health implications. Mothers were also aware that breast milk alone
is enough food for the baby during the first six months of life as they disagreed to the
contrary. Seventy five percent of mothers indicated that colostrum is good for the baby and
the mother should continue breastfeeding when suffering common illness. Some mothers
(3.8%) indicated that they did not know whether it is ok to give the baby infant formula when
the mother is sick or absent. Not one mother (0%), said that they didnt know if breast milk
alone is really sufficient during the first 6 months since they all responded by either agreeing
or disagreeing to the contrary statement.

Table 1: Frequency Distribution of Mothers' Level of IYC\F Knowledge (N=80).

VARIABLES

FREQUENCY
Yes

Colostrum is good for 60

No
2

PERCENTAGE (%)
Dont
know
18

Yes

No

75

2.5

Dont
know
22.5

27
the baby.
The appropriate age
to introduce solid
foods is 4-5 months.

70

10

87.5

2.5

At 4 months, infants
need water and other
drinks in addition to
breast milk.

20

56

25.0

70

Exclusive
breastfeeding
definition.

64

80

10

10

Breast milk alone is

not sufficient during
the first 6 months.

19

61

23.8

76.3

The mother should

60
continue to breastfeed
when sick.

13

75.0

16.3

8.8

Infant formula can be

given to the baby if
the mother is sick or
absent.

50

27

62.3

33.8

3.8

Suckling on demand
generates more milk
in the breast.

67

63.8

6.3

10.0

Knowledge of poor
IYCF.

63

11

78.8

7.5

13.8

Giving meats to
infants at 6-9 months
is not encouraged.

18

43

19

22.8

53.8

23.8

28
4.2

Infant and Young Child Feeding Practices

Table 2 illustrates the feeding practices of mothers with children aged 0-24 months.
Indicators used to assess the practices included: immediate contact with the baby after
delivery, practice of skin-skin contact, minimum duration of contact with the baby, infant
feeding method practised, breastfeeding frequencies per day, feeding of the child when the
mother is sick or absent and utensil used to feed the baby. A large stream of the mothers
(86.3%) had no practice of skin-to-skin contact with the baby after delivery. Timely initiation
of breastfeeding after delivery was established and it was found that 73.8 % of mothers
succeeded in this practice. About half of the mothers (51.3%) are breastfeeding. This includes
mothers who are exclusively breastfeeding and those who are breastfeeding along with
complimentary feeding. From these mothers, 55.1% is breastfeeding on demand. When asked
how they feed their infants and young ones if they are sick or absent, 52.5% indicated that
they use a bottle with teat to feed the baby expressed breast milk or infant formula. Thirty
five % of the respondents said that they prepare infant formula for the baby when they are
sick or absent, compared to a laudable (0 %) who gave their infants breast milk from a
lactating relative.

29
Table 2: Frequency Distribution of IYCF Practices Of Mothers (N=80).
VARIABLE

FREQUENCY PERCENTAGE
(%)

Immediate contact with baby after delivery

40

50

Practice of skin-to-skin contact

11

13.9

No practice of skin-to-skin contact

69

86.3

Minimum duration of contact with the baby

41

51.3

Timely initiation of breastfeeding after delivery 60

min:

59

73.8

7.5

15

18.8

Exclusive breastfeeding

39

48.8

Formula feeding

2.5

Complimentary feeding along with continued

breastfeeding

12

15.0

Mixed feeding

11

13.8

Complimentary feeding

16

20.0

3-4 times

5.0

5-8 times

26

32.5

44

55.1

7.5

Expressing breast milk

26

32.5

Giving breast milk from lactating relative

Giving infant formula

28

35

1hr 30 min:
2 hours:
Infant feeding method

Breastfeeding frequencies per day

8-12 times or more

N/A
Feeding of child when sick or absent

30

Giving solids or semi-solid foods

26

32

Bottle with teat

42

52.5

Cup

13

16.3

Bowl and spoon

25

31.4

Utensil used to feed baby

4.2.1

Frequency Distribution of a 24 Hour Dietary Recall of Children Aged 6-24

Months (n=32).

Figure 1 displays the feeding practices of mothers for the age group 6-24 months. This
comprises of mothers who are complimentary feeding, mixed feeding and complimentary
feeding along with continued breastfeeding (n=39). However, out of the total, 4 mothers did
not acknowledge directly that they were mixed feeding but were discovered by scrutiny of the
results by the researcher, resulting in n=32. A majority of the mothers (59.4%) said that they
feed their children dark green leafy vegetables at least once a day, followed by 56.3% of
mothers who indicated that they gave their minors water and other fruit juices (liquids) more
than three times a day. Fats, oils and sugars are included in the diet once a day for energy
density by 53.1% of mothers. Less than half of the mothers (46.9%) gave their children grains
and grain products twice a day. Vitamin A rich foods (yellow fruits and vegetables) were
given to children by 50% of the women three times a day. Meats were consumed in lower
amounts since 37.5% (less than half) of the mothers gave their children meat at least once a
day, 21.9% of them give children meats at least twice a day and 18.8% confirmed that they
did not give their children any meat in the last 24 hours, while a paltry (0%) gave their
children meat neither 3 times a day or more.

31

24-hour Dietary Recall for Children aged 6-24 months (n=32)

70
60
50
40
30
20

Percentages

10
0

Food groups
Once

Twice

Thrice

> 3 Times

Never

Figure 1: Frequency Distribution of A 24 Hour Dietary Recall for Children Aged 6-24
Months (N=32)
4.3

Factors Influencing Mothers Adherence to the Optimal IYCF Practices.

Table 3 displays the means and std. deviations for the results of the factors influencing
mothers adherence to the optimal IYCF practices. A list of possible parameters was
displayed for mothers to indicate their level of agreement.
The means and St. Deviations attributable to the Strongly Disagree descriptive equivalent
read: 5.86.443, 5.80.433, 5.80.664, 5.79.589, 5.78.986, 5.76.990, 5.661.078,
5.63.865, 5.451.301 and 5.441.558.
The mean and St. Deviation attributable to the Strongly Disagree descriptive equivalent was:
1.24.509.

32
Table 3: Mean Distribution of Factors Influencing Mothers' Adherence to the Optimal
IYCF Practices (N=80).
VARIABLE

MEAN

Std. Dev.

Health personnel know best about the childs health.

5.79

.589

Women should be praised for breastfeeding.

5.80

.433

Breast problems cannot be resolved unless the mother stops

breastfeeding.

3.44

1.742

All women should be given the opportunity to discuss IYCF.

5.80

.664

Breastfeeding is painful and it is embarrassing to breastfeed in

public.

1.40

1.143

Work is a major contributor of a mothers feeding choices.

5.45

1.301

Exclusive breastfeeding takes long and is exhausting.

2.07

1.874

Lack of quality support from family and healthcare workers

interferes with optimal IYCF practices.

4.69

1.920

A mothers perception of IYCF controls her feeding choices

despite the advice given by healthcare professionals.

3.89

2.050

Pressure from family and friends on feeding choices influences a

mothers feeding choice despite the advice given by health care
professionals.

2.58

1.826

Giving a variety of food to children is expensive and unnecessary. 3.29

2.136

Optimal IYCF practice is very important in the growth and

development of the child.

5.66

1.078

Preparing food to be in the right texture and consistency for the

child is important.

5.78

.968

Antenatal care is important for successful breastfeeding.

5.86

.443

VARIABLES

MEAN

St. Dev.

Giving information to a mother on how to feed her child is

5.63

.865

Table 3. Continued

33

effective in changing her infant feeding practices.

Lack of knowledge contributes to inadequate IYCF practices in
the community.

5.44

1.558

The information given by healthcare professionals on feeding

practices is satisfying to practice good infant feeding.

5.76

.990

Colostrum should be discarded.

1.24

.509

The LBW baby is too small and weak to be able to suckle/

breastfeed.

2.99

2.034

The sources of IYCF information provided contradicting or

confused messages.

1.89

1.599

Mothers should stop breastfeeding when they are sick or do not

have enough breast milk.

3.80

2.119

Legend: Scale limit

4.4

Descriptive Equivalent (DE)

5.5- 6.4

Strongly Agree

(SA)

4.5- 5.4

Agree

(A)

3.5- 4.4

Slightly Agree

(SA)

2.5- 3.4

Slightly Disagree

(SD)

1.5- 2.4

Disagree

(D)

0.5- 1.4

Strongly Disagree

(SD)

Demographic and Socio-economic Characteristics

The findings of the study showed that a majority of mothers had attended school since 100%
of them said that they were educated. They also indicated that they had attended IYCF
support classes or groups although 97.5% of the mothers said they found this exercise
helpful. Seventy percent of the mothers acknowledged that they had available source of
income to support themselves and their young ones. Most of the children (61.3%) were aged

34
0-5 months with 58.8% of the mothers age ranging between 20-30 years old. Only 2.5% of
the mothers age ranged between 41 and 50. Unemployment rates of the mothers stands at 41/
80 mothers (51.3%). A dreadful 23.8% of the mothers were formerly employed with the same
ratio obtaining their highest level of education being primary school. The marital status with
the highest ranking was single mothers (48.8 %), followed by married mothers (43.3%) and
the lowest rating was attributed to divorced and widowed mothers, both attaining a
percentage of 3.8%. Only one out of 80 mothers (1.3%) had attended a higher learning
institute (tertiary). All these findings are demonstrated in table 4 with other demographic and
socio-economic characteristics of the mothers.

35
Table 4: Demographic and Socio-Economic Characteristics of Mothers
Variable

Frequency

Percentage
(%)

0-5 months

49

61.3

6-24 months

31

38.8

Male

45

56.3

Female

35

43.8

13-19

21

26.3

20-30

47

58.8

31-40

10

12.5

41-50

2.5

80

100

Non-formal

Primary

19

23.8

Secondary

41

51.3

High school

19

13.8

Tertiary

1.3

Self employed

20

25.0

Formerly employed

19

23.8

Unemployed

41

51.3

Nuclear Family

28

35

Single parent

1.3

Extended family

45

56.3

Age of child

Sex of child

Age of mother

Educated
Highest level of education

Employment status

Type of family

36

Cohabiting with partner as if married

Attendance of IYCF support class or group

7.5

Yes

80

100

No

Mean

Std. Dev.

Yes

78

97.5

No

2.5

Table 4. Continued
Variable

Significance of IYCF support group or class

37
CHAPTER 5
DISCUSSION
5.1

Mothers level of Infant and Young Child Feeding knowledge

Looking at the responses of mothers on questions asked to ascertain their level of knowledge
of Infant and Young Child Feeding, it can be said that mothers level of knowledge on IYCF
was satisfactory, which is in line with the findings of Cohen et al., (2012). This may be
attributed to the fact a majority of the mothers (100%) had attended IYCF support class or
group and still 97.5% of the mothers found the sessions significant. Furthermore, the index of
IYCF recommendation indicated as best known amongst mothers in the Manzini region was
the timely introduction of solid, semi-solid and soft foods (complimentary foods) at 6 months
since 87.5% of the mothers disagreed that that complimentary foods must be introduced at 45 months, while none of the mothers (0%) said that they did not know if breast milk alone is
really sufficient to meet the needs of the infant during the first six months.
Instead, 76.3% of the mothers were aware that breast milk alone is sufficient to cater for all
the nutritional needs of the infant during the first 6 months of life as reported by Torimiro et
al., (2004). This could mean that mothers are knowledgeable on the talks of breastfeeding,
taking into account that 80% of them knew the definition of exclusive breastfeeding and
78.8% of them were well-informed that poor child feeding during the first 2 years of life
harms growth and brain development of the infant or young one. In view of the 75% of the
mothers who identified that colostrum is good for the baby and that a mother should continue
breastfeeding when suffering from common illness, it can further be suggested that mothers
are conversant with IYCF focuses.
Even so, 62.3 % of the mothers then went on to say that it is proper to give the baby infant
formula if the mother is sick or absent, which disproves that the mothers are conversant with
the details of feeding of the child if the mother is sick. This suggests that mothers are either

38
not well-informed of the risks of artificial feeding or that mothers are ignorant of the benefits
of breastfeeding for the child, of which in any case the greater risk is death (Lande et al.,
2003) . Moreover, a respectable 70 % of the mothers went on to disagree that at 4 months,
infants need water and other drinks in addition to breast milk, which could suggest that this
proportion of mothers feed their infants optimally because they disagreed to the contrary of
exclusive breastfeeding (mixed feeding).
Moreover, only 63.8 % of the mothers were aware that the more milk a baby imbibes from
the breasts, the more breast milk the mother makes. Mothers need to be encouraged to
breastfeed their infants on demand to avoid breast feeding difficulties such as not enough
breast milk which may be due to poor breastfeeding patterns. An alarming 53.8% of the
mothers accurately responded that a young child (aged 6 up to 9 months) can now be given
animal foods such as fish and meat. This can mean that the remaining portion of mothers
were depriving their young ones proteins from animal foods such as meat, poultry and fish
which can create a window of opportunity for malnutrition, particularly kwashiorkor
(Victoria et al., 2010).
5.2

Infant and Young Child Feeding Practices

It is a pity that the highest percentage (86.3%) in this category is attributed to mothers who
did not experience skin-to-skin contact with their babies after delivery. When asked to
elaborate, mothers disclosed that the babies were handed to them while wrapped in sheets, no
one would communicate that they should uncover the sheets so that they were able to come
into direct contact with the baby. This calls for a refresher training of health care workers on
this recommended breasting practice of placing the infant skin-to-skin with the mother
immediately after delivery. Those new-borns who did not come into direct contact with their
mothers immediately after birth could have been exposed to pneumonia and other defects

39
since skin-to-skin contact with the mother keeps the new born warm and helps stimulate
bonding or closeness, and brain development (MOH, October 2010).
Skin-to-skin also helps in the let-down of the colostrum/milk, so if this recommendation was
not put into practice it could delay the let-down of colostrum from the breast, deceiving the
mother of not having breast milk while depriving the infant of antibodies or immunization
against many diseases, consequently resulting to a sickly child.
On a positive aspect, a total of 73.8% of the mothers were able to achieve timely initiation of
breastfeeding after delivery. This is an achievement that needs appraisal because initiating
breast feeding within the first hour of birth ensures that milk production is stimulated and the
let-down of colostrum is not delayed therefore guaranteeing that infants were immunized
from many diseases, thus mothers and the nation at large can rejoice for the healthy babies
and longevity by later in life.
On the note of breastfeeding frequencies per day, only 55.1% of mothers breastfeed their
infants on demand (8-12 times or more) while 32.5% breasted 5-8 times a day. It is clear that
plus or minus half of the infants were not breastfed on demand. Some of the children were
starved yet under-nutrition usually spikes at the age of 3-18 months making the childs first
two years of life a critical window of opportunity for the prevention of growth faultering and
under-nutrition (Victoria et al., 2010).
Mothers also take into practice the use of bottles with teats for giving their infants expressed
breast milk or liquids and semi-solids. About 52.5% of the mothers use bottles with teats
while only 16.3% take into practice the recommended utensil which is a cup. The use of
bottles and teats should be avoided due to the difficulty in cleaning them and can lead to
infection in the infant if not well cleaned (Ramakrishnan et al., 2009), while cups are very
easy to clean on the other hand.

40
Feeding of the child when the mother is sick or absent indeed proved to be a confusing
practise whose awareness still needs to be improved. Thirty five percent of the mothers then
tend to infant formula during this period while 32.5% give solids or semi-solids, all of which
result to mixed feeding. Only 32.5% resolved to express breast milk for their infants. Giving
solids or liquids to a breastfeeding child less than 6 months (mixed feeding) increases HIV
transmission risk. Mothers still need to be advised to either exclusively breastfeed or
exclusively replacement feed their children up to 6 months of age in order to mitigate mixed
feeding. Mixed feeding is exclusively dangerous for all infants less than 6 months,
irrespective of knowing the HIV status of mother. In an HIV prevalent area, there is even
more reason to support exclusive breastfeeding.
Even though the above mentioned findings of infant feeding practices were from a detailed
inspection by the researcher, when asked specifically of their infant feeding method, mothers
stated otherwise. About 48.8% of the mothers were found to exclusively breastfeed, 2.5%
were formula feeding, 15% were giving complimentary feeds along with continued
breastfeeding, 13.8% were mixed feeding and 20 % were giving complimentary feeds only.
It is very clear that comprehensive strategies of ensuring that mothers feed their infants
optimally need to be implemented because from the findings of the mothers level of
knowledge it was without doubt that mothers are aware of the recommendations of infant
feeding and yet their practices are disobedient of the IYCF recommendations.
Then again, there is a problem if only 12 out of 32 mothers are complimentary feeding along
with continued breastfeeding. Reason being, continued breastfeeding to 2 years and beyond
contributes to the food and fluid security of the young child. It is especially important in
contexts where water, sanitation and hygiene conditions are poor, and where breast milk is

41
likely to be the most nutritious and accessible food available for the young child in
emergency situations (Arabi et al., 2012).
5.2.1

Feeding Practices of Mothers for the Age Group 6-24 Months (n=32).

Looking at the takes of the complimentary feeding practices of mothers in terms of dietary
diversity and minimum frequency, scrutiny of complimentary feeding of mothers is required.
One can cite that there was poor feeding of children at the age of 6-24 months. The
implication being stunting, and could not be limited to macro nutrient disorders. According to
Ramakrishnan et al., (2009), complementary feeding is the most effective intervention that
can significantly reduce stunting during the first two years of life. (Liyanage, 2010) cited that
complementary food should meet the minimum dietary diversity defined as receiving food
from four or more food groups at every meal.
From the findings of the study, dietary diversity and minimum meal frequency contradicts the
recommended amounts which indicates that mothers do not adhere to the recommendations,
children may have been given food for satiety purposes. The highest ranks of minimum
frequency and dietary diversity are dominantly attributable to once a day, which contradicts
the recommendation of four or more food groups at every meal and at least 2-5 times
minimum meal frequency per day. The percentages in any case, do not go beyond 60%, a
slight deviation from below acceptable levels. Only water and other fruit juices are consumed
fairly well (3 times a day), although only by 50% of the mothers.
Dark green leafy vegetables were indicated to be consumed once a day by a majority of the
mothers. Below that, less than half of the mothers (46.9%) gave their children grains and
grain products twice a day. Vitamin A rich foods (yellow fruits and vegetables) were given to
children by 50% of the women three times a day. Meats were consumed in lower amounts
since 37.5% (less than half) of the mothers gave their children meat at least once a day,

42
21.9% of them give children meats at least twice a day and 18.8% confirmed that they did not
give their children any meat in the last 24 hours, while a paltry (0%) gave their children meat
neither 3 times a day or more. The latter suggests that the children are starved. As a child
grows there is need for increased energy intake as from six months. The children are deprived
of a nutritionally adequate diet which is similar to findings of studies by Seranath et al.,
(2012) and Marriot et al., (2012). The consequences of these mothers actions endanger the
health of the children in many ways, with underweight, stunting and illness being just the tip
of the iceberg.
However the case, mothers in the study were found to be ignorant of the serving ratios with
regard to the recommended increased meal portions by virtue of the childrens age groups
since the data variation in the age group 6-24 months was limited. There was barely a notable
difference between the meals given to a 6months baby and a 24 months child. Generally, the
studys findings showed that there was a discrepancy in what was recommended and what the
mothers practiced. This is in line with the findings of Serenath et al., (2012). This may have
been due to that some foods may have been out of season, or that mothers do not comprehend
the necessity of a nutritionally adequate or nutrient dense diet for this age group, and possibly
because families are too poor to procure the right foods for the right amounts.
The current drought dilemma threatening the economic and social viability of Swazi citizens
is imagined to be possibly a contributing factor to the deplorable diets prepared for the
children. This necessitates for the advocation of sustainable livelihood strategies amongst
families in order for mothers to adhere to the optimal IYCF recommendations.
5.3

Factors Influencing Mothers Adherence to the Optimal IYCF Practices

Factors influencing mothers adherence to the optimal IYCF practices were adapted from
parameters of IYCF indicators which included: source of IYCF information, support for

43
IYCF, popular IYCF culture/ beliefs and mothers IYCF knowledge. When asked for their
level of agreement, mothers strongly agreed that antenatal care is important for successful
breastfeeding. This is advocated for by the highest mean value and the smallest St. Deviation,
resulting in a reliable coefficient of variance. Antenatal care at health facilities is depicted in
many studies as a key contact point for implementing Essential Nutrition Actions (ENAs).
This level of agreement by mothers on antenatal care visits guaranteed that mothers were:
reminded to take their iron/folate tablets, encouraged on breastfeeding immediately after birth
in order to give the first thick yellowish milk (colostrum) to the baby, were made aware of
post-natal visits to health care facilities when the infant/child is sick, or for infant/child's
Integrated Community Based Growth Monitoring & Promotion (ICBGM&P) and also for
Immunizations. Such guidance can make a mother to either adhere to the optimal IYCF
feeding practices or disobey the recommendations of optimal IYCF feeding practices.
Most mothers also showed interest in that all women should be given the opportunity to
discuss IYCF. This revealed that mothers were hungry to review their IYCF experience with
qualified personnel. They may have found the IYCF support classes/groups very significant
in their IYCF experience and wanted other mothers to get the opportunity to benefit from
such conferences, or they may have had issues on IYCF which needed clarity for their
satisfactory comprehension thereby good adherence. Furthermore, mothers strongly felt that
women should be praised for breastfeeding as this assured them that they were proceeding
methodically in accordance with the recommended IYCF practices and it also motivate them
to continue doing justice to the health of their infants and young children through optimal
nutrition implementation.
Health personnel were also highly perceived by mothers to know best about the childs health
and duration of breastfeeding more than anyone else. This perception of mothers is
safeguarded by the fact that health care professionals are trained to well vest in the aspect of

44
IYCF. The primary objective of training Counsellors/community workers/primary health care
staff was to equip them with the knowledge, skills and tools to support mothers, fathers and
other caregivers to optimally feed their infants and young children.
Mothers also strongly agreed that giving information to a mother on how to feed her child is
effective in changing her prior plan or current infant feeding practices. On that note, mothers
also reflected that the information given by healthcare professionals on infant feeding
practices is satisfying to practice good infant feeding. This suggested that there was no
knowledge gap in the mothers and for that reason, mothers were expected to implement the
standard practices in relation to IYCF devotedly to ensure the optimum health of their infants
and young ones as suggested by Cohen et al., (2012).
The mothers also felt that work is a major contributor of a mothers feeding choices. Work is
depicted in many studies to be detrimental to exclusive breastfeeding practices. This could be
because they have no designated spaces to breastfeed their infants at work among other
administrative challenges (Nair, 2015). In the lines of a mothers knowledge influencing her
IYCF practices, the mothers level of agreement to the statement preparing food to be in the
right texture and consistency for the child is important signaled that mothers knowledge on
preparing complimentary food to be in the right consistency and texture was sound. This
guarantees that mothers knowledge is a contributing factor to her adherence of optimal IYCF
practices as they were also for the opinion that lack of knowledge contributes to inadequate
IYCF practices in the community.
However, mothers notion of IYCF support was not weighed out by the fact that lack of
quality support from family and healthcare workers interferes with optimal IYCF practices as
per the descriptive equivalence of the mean attained (4.691.920). This could be because
mothers still follow their intuitions when feeding their young ones and rely less on the

45
support of others. This is in line with the findings of Lande et al., (2003). Mothers however
disagreed that pressure from family and friends on feeding choices influences a mothers
feeding choice despite the advice given by healthcare professionals. This reveals that mothers
have somewhat a degree of respect for the concept of IYCF together with its runners and so
they could be trusted to feed their infants/ children by the book. On the note of popular belief
or culture influencing the adherence of mothers, IYCF policy makers can rejoice at a job well
done because mothers disagreed that babies above 6 months should not be given meat
because it belongs to the family whilst strongly disagreeing that colostrum should be
discarded. This discloses that mothers are capable of change and have a strong will to
conform to what seems best for the health of their infants and young ones by staying
informed and up-to-date instead of holding onto ancient beliefs or practices.
5.4

Demographic and Socio-economic Characteristics

The findings in this study reflect that a majority (n=80, 100%) of the mothers were educated
and had all attended an IYCF support class or group. Mothers also declared that they had
heard of IYCF at health care facilities during their pre-natal visits and 97.5% of them said
that these groups were very significant in the support of their IYCF practices. The remaining
portion of mothers who had attended IYCF classes but did not find them helpful either
needed clarity in order to comprehend the information provided by health care personnel or
they relied elsewhere for support of IYCF. Seventy percent of the mothers said that they had
available sources of income. This reflects that mothers were not poor but could afford to
procure food for their young ones and their families at large and attain other necessities such
as medical attention when there is a need. This was also revealed in a study conducted by
Dewey and Brown., (2003) which narrates on technical issues concerning complimentary
feeding.

46
Furthermore, a large amount of the respondents (61.3%) had infants between 0-5 months.
This signaled that mothers still devote to post-natal visits at health care facilities for services
such as vaccines and the like. Furthermore, a high percentage (58.8%) of young mothers (2030 years old) could mean that mothers have special needs of IYCF guidance particularly the
recommendations due to lack of their experience on IYCF may be due to birth order.
Most of the mothers (56.3%) lived in extended families, while 35% lived in nuclear families,
7.5% were cohabiting with their partners as if married and only 1.3 % was a single mother.
These fractions reflect that mothers had support of IYCF other than that of health care
professionals. Praise words, opportunities for discussion, reassurances, motivating mothers
and attending to mothers concerns in support of IYCF practices at home may have come set
up of the nuclear and extended families from which fathers, grandmothers, grandfathers,
siblings, aunties, cousins, midwives, doctors, nurses, religious leaders and elders were found.
After all, it takes a village to raise a child, and the entire village to support a mother to
optimally feed her child. Fathers are identified by (MOH, Swaziland, 2010) as key in
provision of IYCF support by improving the nutrition of their wives/partners and
babies/children. The same philosophy applies for 43.3% of the mothers who were married.
In spite of the mothers who said they have available sources of income, a whole 51.3% of the
mothers were unemployed with their highest level of education being secondary. Twenty five
percent were self-employed and only 23.8% were formerly employed with only 1.3 % of the
mothers being qualified for the tertiary education criterion. This calls revitalization of women
labour rights because if this dreadful fraction of mothers was unemployed, it indicates that
they did not receive the wages necessary to procure foods for adequately nutritional diets for
themselves and their children. Their standard of living was inferior denoting that they could
not enjoy a better quality of life (Dewey & Brown, 2003).

47
CHAPTER 6
SUMMARY, CONCLUSION AND RECOMMENDATIONS
6.1

Summary

Infant and young child feeding during the first two years of life is a crucial area to improve
child survival, promote healthy growth and generally cultivate better development. The
mother hence, the direct care giver of the child with regard to management of food choices
and eating behavior is responsible for fulfilling and adhering to the optimal IYCF
requirements by practicing accordingly to ensure child survival and development.
This therefore demanded the assessment of mothers adherence to the optimal infant and
young child feeding practices for children aged 0-24 months. The study was successfully
conducted since the mothers level of IYCF knowledge, her IYCF practices and factors
influencing her adherence to the optimal infant and young child feeding practices were
obtained by virtue of the studys objectives.
This was done by means of a Quantitative descriptive research design to obtain results and
generalize them from a larger sample population. The target population of the study
comprised of mothers with children aged 0-24 months. Eighty respondents from 3 health care
facilities in the Manzini region participated in the study for data collection.
A questionnaire with closed ended questions was developed based on the review of literature
to obtain responses that were anticipated to fulfill the objectives of the study. For analysis of
the data collected, the programme Statistical Package for Social Science (SPSS) version 20.0
was used to compute the standard deviations, means, frequencies, and percentages of the
results. The key findings of the study proved that mothers had sustainable knowledge of
infant and young child feeding which indicates that IYCF custodians await the appraisal of
effectively disseminating consistent, evident based information on infant feeding to parents.
Timely initiation of breastfeeding after delivery was effortlessly practised by mothers.

48
Unfortunately, it was found that a majority of the mothers did not experience skin-to-skin
contact with their babies after delivery which is a practice left on the watch of health care
nurses to ensure its successful implementation.
Furthermore, scrutiny of feeding practices in relation to dietary diversity and minimum meal
frequency is required due to the imbalance in frequencies of practices. This studys finding
showed that there was a discrepancy in what was recommended and what the mothers
practiced inducing a gap in the adherence ingenuity of mothers to practice methodically
optimal nutrition for their children. Key factors found to influence the adherence of mothers
to optimal infant feeding practices were antenatal care, praising women on breastfeeding and
the support of health care professionals.
6.2

Conclusion

Based on the findings of the study, mothers level of knowledge of national IYCF
recommendations was satisfactory. However, their knowledge needed improvement on giving
animal foods such as meat, poultry and fish to ensure optimal development of the children.
Despite the afore mentioned, mothers remarkable level of IYCF knowledge unfortunately
did not transpire into satisfactory infant and young child feeding practices particularly the
administering of nutritionally adequate diets in terms of dietary diversity and minimum meal
frequency of complimentary foods . Their adherence is greatly compromised by their
ignorance of what is right and the discrepancy in doing what is right. Exclusive
breastfeeding rates are gratifying as discovered in many studies, although emerging portions
of mixed feeding could still hinder optimal infant feeding. The support of health care
professionals on IYCF delivered during antenatal visits is greatly renowned by mothers. This
is an opportunity that can be seized strategically to enforce stringent regulations for mothers
who make IYCF demeaning to policy makers. Innovative ways of addressing mothers IYCF
issues need to be implemented as the nature of mothers has proved to be an ad-hoc,

49
retroactive, and end-of-pipe manner which continues to escalate the cost of health care for the
country due to ill health.
6.3

Recommendations

To the Government and Relevant Stakeholders

1. It is recommended that the role of Community Health Workers (CHWs) especially
Rural Health Motivators (RHMs) be carefully monitored and evaluated since the
despicable level of adherence of mothers to practise accordingly what they have been
taught falls in the docket of community health workers. It is the role of community
health workers to visit families and equip them with the right knowledge and skills to
optimally feed their infants and young children by performing a supervisory role
while responding satisfactorily to their concerns.
2. It is also suggested that behavior change communication interventions be revised
along the chain of community health workers and mothers to promote behavior
change in mothers so that they are accustomed and motivated to practice by the book
in place of their intuition.
3. Policy makers should come up with stringent adherence measures to get mothers
drilled to IYCF recommendations so that compliance is not an option and justice is
served for the survival and development of every child.
4. Dissemination of IYCF information by implementers should emphasize on
complementary feeding in relation to dietary diversity and minimum meal frequency
along with continued breastfeeding up to 2 years and beyond.
5. The implementation of an in country IYCF regulatory health system is advised to
ensure monitoring and evaluation of mothers adherence to the optimal IYCF
practices.
For Further studies

50
1. The assessment of mothers adherence to the optimal IYCF practices should be
broadened to a national census in order to get a true reflection of results based on the
entire population.

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1818 H Street, NWT.

LIST OF APPENDICES
APPENDICES 1: REQUEST FOR RESEARCH PROJECT QUESTIONNAIRE
VALIDATION

54

APPENDICES 2: QUESTIONNAIRE

55
ASSESSMENT OF MOTHERS ADHERENCE TO THE OPTIMAL INFANT AND
YOUNG CHILD FEEDING PRACTICES FOR CHILDREN AGED 0-24 MONTHS IN
THE MANZINI REGION.
QUESTIONNAIRE

University of Swaziland
Faculty of Agriculture
Department of Consumer Sciences

Luyengo, Swaziland
February, 2016

56

57
SECTION A
Mothers level of IYCF knowledge
Instruction: Please circle the correct answer for the statements below. Use the scale (1)
=Yes, (2) = No and (3) = dont know.
Example: Colostrum is the first milk from the breast after delivery.
Yes

No

dont know
3

Question

Statement

Yes

No

The first milk from the breast after delivery

(colostrum) is good for the baby.
The appropriate age to introduce solids, semi-solids
and soft foods is 4-5 months.
At 4 months, infants need water and other drinks in
addition to breast milk.
Exclusive breastfeeding is when the infant receives
breast milk alone without any additional food or
drink, not even water.
Breast milk alone is really not sufficient to meet the
needs of an infant during the first 6 months.
When the mother is suffering from common illnesses
she should continue to breastfeed her baby.
It is ok to feed a baby infant formula if the mother is
sick or absent.
The more milk a baby removes from the breast, the
more breast milk the mother makes.
Poor child feeding during the first 2 years of life
harms growth and brain development.
A young child (aged 6 up to 9 months) should not be
given animal foods such as fish and meat.

Dont
know
3

2
3
4

5
6
7
8
9

10

SECTION B
Infant and Young Child Feeding (IYCF) practices of mothers.
Instructions: Please respond by circling the letter that best suits your IYCF practice.
Example: What Infant feeding method do you use?
a)
b)
c)
d)
d)

Exclusive breastfeeding
Partial breastfeeding
Bottle-feeding
Mixed feeding

58
11. How long after birth did you first come into contact with the baby?
a)
b)
c)
d)

Within 30 minutes
Within an hour
Within one hour 30 minutes
Within two hours or more

12. In what manner or fashion was your baby when you first came into contact with him/her?
a)
b)
c)

Baby was naked apart from nappy and cap and was placed in skin-to-skin contact
Baby was completely naked and placed in skin-to-skin contact
Baby was covered and there was no skin-to-skin contact

13. How long were you kept in contact with the baby?
a)
b)
c)
d)

30 minutes
One hour
One hour 30 minutes
Two hours

14. How long did it take you to breastfeed your baby after delivery?
a)
b)
c)
d)

30 minutes
One hour
One hour 30 minutes
Two hours or more

15. What infant feeding method do you use to feed your baby?
a)
b)
c)
d)
e)

Exclusive breastfeeding
Formula feeding
Complimentary feeding along with continued breastfeeding
Mixed feeding
Complimentary feeding

16. How often do breastfeed your baby in a day?

a)
b)
c)
d)
e)

3-4 times
5-8 times
8-12 times
More than 12 times
Not applicable

17. How do you feed your child when you are sick or absent?
a)
b)
c)
d)

I express breast milk

I ask my lactating relative to breast feed for me
I give the baby infant formula
I give the baby solid or semi-solid food

18. What do you use to feed him or her?

a)
b)
c)

Bottle with teat

Cup
Spoon

59
d)

Bowl and spoon

The following section requires mothers with children aged 6-24 months only.
Instruction: Please indicate with a tick for the correct response.
19. How many times has your child eaten the following foods in the last 24 hours?
Food eaten in the last 24 hours

A
B
C

D
E
F
G
H
I

Onc
e

Twice

Thrice

More
than
3time
s

Never

Bread, rice, pasta, porridge, thin porridge or

other foods made from grains.
Potatoes, sweet potato, cassava, or any other
foods made from roots?
Pumpkin, carrots, butternut, mangoes, oranges
or other fruits and vegetables that are yellow
or orange inside?
Foods made from beans, peas, lentils or nuts,
including seeds?
Any dark green leafy vegetables?
Chicken, beef, pork, fish, goat and any other
meat including insides?
Cheese, yogurt, eggs, milk and other milk
products?
Any oil, fat, butter and sugary foods like
chocolate and biscuits?
Pure water, juice or any other juice drinks?

SECTION C
Factors influencing mothers adherence to the optimal infant and young child feeding
practices.
Please indicate the extent in which you agree with the following statements using the
following scale: 6= strongly agree (SA)
5= agree (A) 4= slightly agree (SLA) 3=
slightly disagree (SLD) 2= disagree (D)
1= strongly disagree (SD)

Example:
STATEMENT
Improving infant and young child feeding practices in
children 024 months of age is therefore critical to
improved nutrition, health and development of children.

SA A
6
5

SLA
4

SLD
3

D
2

SD
1

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RESPONSE: The respondent agrees that Improving infant and young child feeding practices
in children 024 months of age is therefore critical to improved nutrition, health and
development of children.

20

21
22
23
24
25
26
27
28

29

30

31

32
33
34
35

Factors influencing mothers adherence to optimal

infant and young child feeding practices
Health personnel know best about the childs health
and how long the child should breastfeed than anyone
else.
Women should be praised for breastfeeding because
it motivates them.
Breast problems cannot be resolved unless the
mother stops breastfeeding.
All women should be given the opportunity to
discuss IYCF issues.
Breastfeeding is painful and it is embarrassing to
breastfeed in public.
Work is a major contributor of a mothers feeding
choices.
Exclusive breastfeeding takes long and is exhausting.
Lack of quality support from family and health care
workers interferes with optimal IYCF practices.
A mothers IYCF perception controls her feeding
choices despite the advice given by health care
professionals.
Giving a variety of food to children is expensive and
unnecessary.

SA A

SLA

SLD

SD

6
6

5
5

4
4

3
3

2
2

1
1

Pressure from family and friends on feeding choices

influences a mothers feeding choice despite the
advice given to her by health care professionals.
Pressure from family and friends on feeding choices
influences a mothers feeding choice despite the
advice given by health care professionals.
Optimal IYCF practice is very important in the
growth and development of the child.
Preparing food to be in the right texture and
consistency for the child is important.
Antenatal care is important for successful
breastfeeding.
Giving information to a mother on how to feed her
child is effective in changing her infant feeding
practices.

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36
37

38
39

40

Lack of knowledge contributes to inadequate IYCF

practices in the community.
The information given by healthcare professionals on
feeding practices is satisfying to practise good infant
feeding.
Colostrum should be discarded.
The low birth weight baby or premature baby is too
small and weak to be able to suckle/breastfeed.

6
6

5
5

4
4

3
3

2
2

1
1

Factors influencing mothers adherence to optimal SA A

infant and young child feeding practices continued

SLA

SLD

SD

The sources of IYCF information provide

contradicting/ confused messages.
Mothers should not give babies above 6months meat
because it belongs to the head of the family.

Mothers should stop breastfeeding when they are sick 6

5
4
3
or do not have enough breast milk.
SECTION D: Demographic and socio-economic characteristics of mothers.

41
42

Instructions: Circle only one answer per question. Please write clearly where writing is
required.
Date of birth of child

43
44
45
46
47

How old is (childs name)? Record

age in completed months.
Sex of child
How old are you (mother)?
Completed years
Have you ever been to school?
If NO, continue to 47
If yes, what is the highest level of
school you attended?

48

Employment status:

49

Do you have any source of income?

50

What is your marital status?

Months

1. Male

2. Female

..
1. YES
2. NO
1.
2.
3.
4.
5.
1.
2.
3.
1.
2.
1.
2.

Non-formal
Primary
Secondary
High school
Tertiary education
Self employed
Formerly employed
Unemployed
Yes
No
Married
Divorced

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51

Type of family

52

Have you ever attended any IYCF

support class or group?
If yes, did you find it helpful?

3.
4.
5.
1.
2.
3.
1.

Single
Widowed
Cohabiting with a man as if married
Nuclear family
Single parent
Extended family
YES
2. NO

1. YES

2. NO

53
***Thank you for your time and co-operation ***
APPENDICES 3: REQUEST FOR RESEARCH PROJECT DATA COLLECTION

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APPENDICES 4: AUTHORIZATION TO CARRY OUT A RESEARCH

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