Parental and caregivers’ nutrition knowledge, attitudes, perceptions and practices on infant and young child feeding (aged zero to 24 months) in Mzimba-north district, Malawi

Abstract

Introduction: Adequate nutrition knowledge, positive attitudes and perceptions, and good practices of parents on infant and young child feeding (IYCF), among others, are essential for the optimal growth of children. Hence, the involvement of both parents in IYCF is essential. Aim: To explore and describe the involvement of both biological parents and caregivers in IYCF in Mzimba-north district, Malawi by assessing their nutrition knowledge, attitudes, perceptions and practices, and identifying the factors that affected their involvement. Study design: A cross sectional descriptive study employing quantitative and qualitative research methodologies. Setting: Five agriculture extension planning areas in Mzimba-north district, Malawi. Sampling technique: Stratified random sampling in the quantitative domain and purposive sampling in the qualitative domain. Sample: Quantitative domain: Households [mothers (n = 154) and fathers (n = 127)] with children aged zero to 24 months and caregivers (n = 4) where the biological parents were absent. Qualitative domain: A different sample of fathers (n = 41), mothers (n = 53) and local leaders (n = 3). Methodology: Quantitative domain: Participants were stratified into three groups based on the age of their children, i.e. <six months, six to 12 and >12 to 24 months. Data were collected using modified FAO nutrition knowledge, attitudes and practices (KAP) questionnaires. Data were analysed using Stata version 14.0 and Microsoft Excel 2013 version. The Chi-square, Fisher’s exact and McNemar's tests were used to compare the nutrition KAP between males and females. Testing was done at 0.05 significance level. Qualitative domain: Eleven focus group discussions (FGDs): five with males and six with females, and three in-depth interviews with three local leaders were conducted using three interview guides (one for each group). Creswell’s method of data analysis was used to identify themes and sub-themes. Ethical approval was obtained from the Ethics Committee, Faculty of Natural and Agricultural Sciences, University of Pretoria (Ref no EC151204-26) and the Ministry of Agriculture, Mzuzu Agriculture Development Division, Malawi. Results: Quantitative domain: More than half of the participants knew the recommended IYCF practices. More than 80% of the participants showed positive attitudes on the appropriate IYCF practices. No significant differences were observed between the male and female participants’ mean knowledge scores and their responses on the attitude statements (P > 0.05). All participants with children <six months reported having their children breastfed both during the previous day and night. Half of the children <six months were exclusively breastfed. Poor food diversity with low consumption of animal foods was observed for children aged six to 24 months. The majority of the participants reported to have given their children food from only two food groups out of seven food groups. Qualitative domain: The participants identified the roles of mothers, fathers and local leaders in IYCF; mothers had direct roles while fathers and local leaders had supporting roles. The roles and influence of grandmothers on IYCF were also discussed. The participants identified the motivating factors and the factors limiting parental involvement in IYCF, and made recommendations on improving parental involvement in IYCF. Conclusion: Findings from the qualitative study were in support of quantitative study findings. Both parents were involved in IYCF. However, mothers had direct roles while fathers had supporting roles. Good nutrition knowledge, positive attitudes and perceptions, and poor practices on IYCF were reported. Recommendations: Participants in the FGDs made recommendations on improving parental involvement in IYCF. Recommendations are also made for future research and the implementation of IYCF practices in Mzimba-north district, Malawi.