Improving infant and young child feeding practices in rural Zimbabwe: Socio-cultural factors and perspectives

Globally, over 30% of children under 5 years of age are stunted, which leads to long-term cognitive deficits and loss in economic productively that is likely to be perpetuated into future generations. There is a critical need for effective nutrition interventions particularly targeting infants under 2 years of age. This dissertation was designed to identify the various factors that are associated with exclusive breastfeeding (EBF) in rural Zimbabwean mothers, determine the socio-cultural beliefs and practices that serve as barriers to EBF among these mothers, and evaluate the impact of a complementary feeding intervention on maternal learning in rural Zimbabwe. In our first study, we conducted a survey of 295 mothers who were breastfeeding infants less than 6 months of age. We explored infant feeding knowledge, beliefs and attitudes, and facilitators and barriers to EBF. We found that the two primary causes of EBF interruption are the use of traditional remedies for the protection of infants and concerns regarding the sufficiency of breast milk. In the second study, we conducted in-depth interviews with 30 mothers with infants less than 6 months of age. We used content analysis to identify the salient infant feeding and care issues from an emic (insider's) perspective. Our results identified maternal concerns regarding protection and milk sufficiency, similar to the survey findings. The third study evaluated the effects of a complementary feeding intervention delivered by Village Health Workers on maternal knowledge and learning. Using in-depth interviews and questionnaires, we found that the intervention increased acquisition and depth of maternal knowledge regarding complementary feeding. In addition, substantial evidence of transformational learning demonstrated that mothers engaged in a 11 process of learning that is necessary for behavior change. These projects resulted in the development of an EBF intervention for mothers with infants from 0 to 6 months and a complementary feeding intervention for mothers with infants from 6 months to 2 years that will be used in the SHINE trial, a cluster-randomized 2x2 factorial trial testing the independent and combined effects of two interventions (a sanitation/hygiene intervention and an infant feeding intervention) on infant growth and health in rural Zimbabwe.