Levels and determinants of exclusive breastfeeding (EBF) in Malawi

Gama, Nomthandazo Jane
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Background: Exclusive breastfeeding (EBF) for the first 6 months of a child’s life is a WHO recommendation. EBF can prevent 13% of under-five mortality and increase child survival. It is, therefore, essential for countries with high under5 and infant mortality to practice exclusive breastfeeding. This is specifically true of countries in Sub-Saharan Africa that suffer from malnutrition, high levels of infant and under 5 mortality and morbidity. However, in Africa only 25% of children are exclusively breastfed for first 6 months. Malawi faces major challenges in child malnutrition and under-5 mortality. Understanding the levels and determinants of EBF will help the country better address the low levels of EBF and, as a result, decrease malnutrition and under-5 mortality in the country. Methodology: The study used a secondary data acquired from the Malawi Demographic and Health Survey 2015/16with a total number of 1487mothers who are between 15-49 with children 0-<6.In addressing the objectives of the study there were 3 phases. First a descriptive analyses was conducted for the levels of EBF in Malawi. Results were displayed using frequency tables and graphs. For the bivariate analysis determining the relationship between EBF and each independent variable a chi square test was used. Lastly ,to determine the association between the selected variables and EBF two binary logistic regressions were run. Results: EBF in Malawi was62%among mothers 15-49 with children 0-< 6 months. Majority of the respondents in this study were married (80%), and majority had no education (69%). A large number (85%) received counselling on breastfeeding, and 82% had at least 1-4 ANC visits. The rates of EBF among respondents was highest among non-educated women as well as women who attended ANC. When assessing for the association with EBF results revealed postnatal counselling, ANC, education, religion, region, ethnicity and infant age had an influence on EBF. A negative association was found for counselling and EBF, with 0.71 decreased odds of mothers EBF their babies. This was a surprising result found. For ANC the more visits mothers had the higher the odds of EBF. Mothers who were protestant had higher odds of EBF compared to mothers affiliated under catholic. Muslim mothers were also found have increased odds of EBF. Mothers with an education also had higher odds of EBF compared to mothers with no education, except for mothers with a primary education. Interestingly mothers with a primary education had decreased odds of practising EBF. Also alarming about this is that a large number (968) of mothers had a primary education as their highest educational attainment. Mothers from the central region of Malawi had 1.91 increased odds of EBF compared to mothers from the Northern region. Additionally, mothers from the Ngoni ethnic group had 1.76 increased odds of EBF their babies. Lastly, child age had a negative association with EBF. Babies 2-3 had 0.53odds of EBF and babies 4-5 had 0.14 odds of EBF. Conclusion: This research will contribute to literature on EBF in Malawi and through further investigation of the determinants found to have an association with EBF in this study, this research can be utilised as a valuable source of information. From this research a conclusion can be drawn that maternal health seeking behaviours and some socio-demographic determinants have an association with EBF. Although EBF in Malawi has decreased, Malawi has in the past been able to increase the level of EBF. Therefore by focusing and monitoring counselling sessions, this could yield to more mothers EBF their children. ANC visits had a positive influence on EBF therefore a continuation in promoting ANC visits must continue in order to yield better levels of EBF. More campaigns should be aimed in the Northern region as the other regions had higher odds of EBF, this will ensure that there is an increase all over Malawi. Postnatal counselling outside the hospital could also help improve breastfeeding practices when people are back in their communities. This will can aid as a form of support, in cases where negative impacts of counselling after delivery are observed (as found in this study). However, in the meantime further campaigns should target everyone in communities and families as literature shows that EBF is also highly dependent on support
A research report submitted to the Faculty of Humanities, School of Social Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the award of the degree of Master of Arts in Demography and Population Studies, 2020