Challenges and responses to infant and young child feeding in rural Rwanda: a qualitative study
Jeanine Ahishakiye1,2, Laura Bouwman3, Inge D Brouwer4
1Health and Society Chair Group, Wageningen University, Wageningen, The Netherlands. jeanine.ahishakiye@wur.nl.
Insights
In Rwanda, suboptimal infant and young child feeding practices persist due to various challenges. Community support and economic empowerment strategies are crucial for improving child nutrition outcomes.
Area of Science:
- Public Health
- Nutrition Science
- Sociology
Background:
- Chronic malnutrition remains a significant public health issue in Rwanda, with 38% of children under five stunted.
- Only 18% of children aged 6-23 months in Rwanda adhere to recommended infant and young child feeding practices.
Purpose of the Study:
- To explore the challenges affecting infant and young child feeding (IYCF) practices in Muhanga District, Rwanda.
- To identify the coping strategies employed by families to overcome these IYCF challenges.
Main Methods:
- Qualitative study employing 16 focus group discussions with mothers, fathers, grandmothers, and community health workers.
- Thematic analysis of transcribed discussions using Atlas.ti software.
Main Results:
- Participants demonstrated knowledge of optimal IYCF practices, including early and exclusive breastfeeding and timely complementary feeding.
- Key challenges included perceived insufficient breast milk, difficulty interpreting infant cues, heavy workloads, partner relations, and poverty.
- Coping mechanisms involved family/social support, financial aid from casual labor, savings groups, and kitchen gardens.
Conclusions:
- Infant and young child feeding practices are influenced by complex, multifaceted factors beyond just knowledge.
- Interventions must address the social and economic realities, including environmental constraints and opportunities, to effectively improve child nutrition.
Background:
Despite different interventions to improve child nutrition conditions, chronic malnutrition is still a public health concern in Rwanda, with a high stunting prevalence of 38% among under 5-year-olds children. In Rwanda, only 18% of children aged 6-23 months are fed in accordance with the recommendations for infant and young child feeding practices. The aim of this study was to explore challenges to infant and young child feeding practices and the responses applied to overcome these challenges in Muhanga District, Southern province of Rwanda.
Methods:
Sixteen (16) focus group discussions were held with mothers, fathers, grandmothers, and community health workers from 4 rural sectors of Muhanga District. The discussions were recorded, transcribed verbatim, and thematically analyzed using qualitative data analysis software, Atlas.ti.
Results:
Two main themes emerged from the data. Firstly, there was a discourse on optimal infant and young child feeding (IYCF) practices that reflects the knowledge and efforts to align with early initiation of breastfeeding, exclusive breastfeeding for the first 6 months, as well as initiation of complementary foods at 6 months recommendations. Secondly, challenging situations against optimal practices and coping responses applied were presented in a discourse on struggling with everyday reality. The challenging situations that emerged as impeding appropriate IYCF practices included perceived lack of breast milk, infant cues, women's heavy workload, partner relations and living in poverty. Family and social support from community health workers and health facility staff, financial support through casual labor, and mothers saving and lending groups, as well as kitchen gardens, were used to cope with challenges.
Conclusion:
Factors influencing IYCF practices are multifaceted. Hence, intervention strategies to improve child nutrition should acknowledge the socially embedded nature of IYCF and address economic and social environmental constraints and opportunities, in addition and above knowledge only.
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