Knowledge and practices of mother of infant on complementary feeding in mother and newborn hospital vientiane capital, lao pdr in 2019

i MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH AND MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH VILASITH MIKHASITH H P MATERNAL PRACTICES TIMING FOR COMPLEMENTERY FEEDINGS AND ASSOCIATED FACTORS IN A RURAL AREA OF VIENTIANE CAPITAL, 2019 U H MASTER OF PUBLIC HEALTH CODE: 8720701 Hanoi, 2020 ii MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH AND MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH VILASITH MIKHASITH H P MATERNAL PRACTICES TIMING FOR COMPLEMENTERY FEEDINGS AND ASSOCIATED FACTORS IN A RURAL AREA OF VIENTIANE CAPITAL, 2019 U MASTER OF PUBLIC HEALTH H CODE: 8720701 SUPERVISORS: Associate Prof Tran Huu Bich PhD Dr Kongmany Chaleunvong Hanoi, 2020 iii ACKNOWLEDGMENTS The success of this independent study would not have been possible without the help and support of many people I wish to acknowledge the support of the Medical Committee, Netherlands and Vietnam (MCNV), the Hanoi University of Public Health (HUPH), the Lao Tropical and Public Health Institute (Lao TPHI) and the University of Health Sciences (UHS) in producing this work My sincere and deep gratitude goes to both supervisors, Dr Kongmany Chaluenvong and H P Associate Prof Tran Huu Bich, Ph.D., for their constructive suggestions, guidance, and encouragement during the course of my studies I am most grateful to the head of the department of health, Vientiane Capital, and the Xaythany district health officers who kindly accepted to help and participate in this research project This study could not have been completed without their generous U assistance I am grateful to all the lecturers, teachers and staff of the HUPH and the UHS in the Faculty of Postgraduate Studies for their continuous assistance and helpful advice H I would like to thank my classmates for their kindness during the period of my studies at the HUPH and the UHS Finally, I would like to thank my family for their love, understanding, support and encouragement during the time I studied in Hanoi and Vientiane Mr Vilasith MIKHASITH iv Table of Contents Contents ACKNOWLEDGMENTS iii Table of Contents iv ABBREVIATIONS AND ACRONYMS vi List of Tables and Figures vii Summary ix Introduction Research Objectives H P CHAPTER LITERATURE REVIEW 1.1 Definition and Concepts 1.2 The concept of appropriate complementary feeding 1.3 Guiding principles for complementary feeding 1.4 Importance of infant feeding 1.5 Current status of infant complementary feeding 1.6 Complementary feeding practices 10 1.6.1 U Timely introduction of complementary foods 10 H 1.7 Factors associated with the timely introduction of complementary feeding 11 1.7.1 Parental complementary feeding of infants 11 1.7.2 Timely introduction, dietary diversity and feeding frequency 12 Inappropriate complementary feeding 12 1.7.3 Socio-demographic factors 12 1.7.4 Knowledge of mothers 14 1.7.5 Attitudes of mothers 15 1.7.6 Cultural beliefs 16 Conceptual Framework 18 Cultural factors 18 Chapter 2: Methodology 19 2.1 Study subjects 19 Inclusion criteria: 19 v Exclusion criteria: 19 2.2 Study sites and duration: 19 2.3 Study design 20 2.4 Sample size 20 2.5 Sampling procedure 21 2.6 Data collection: 21 2.7 Variables: 21 2.7.1 Independent variables: 21 2.7.2 Dependent variable: 22 2.8 Research instruments 22 H P 2.9 Data analysis: 25 2.9.1 Data entry 25 2.9.2 Statistical techniques 25 2.10 Ethical consideration 26 Chapter 3: Results 27 3.1 Descriptive analysis: 27 U 3.2 The relationship between the general characteristics of mothers and the timing to 39 start complementary feeding 39 3.3 Factors associated with the timing to start complementary feeding 43 H Chapter Discussion 45 4.1 General information 45 4.2 Complementary feeding practices of mothers in Xaythany District 46 4.3 Factors associated with complementary feeding practices 47 Conclusion 50 Recommendation 51 References 53 Annex 1: Questionnaires 66 Annex 2: Socio-economic characteristics of the study population 74 Annex 3: Information Sheet for Participants 75 Annex 4: Consent Form for Participants 77 Annex 5: BIOGRAPHY 79 vi Annex 6: Certificate of approval 80 Annex 7: Variables of the study 82 Annex 8: Thesis comment 85 Annex 9: Minutes of explanation after thesis defence 92 H P U H ABBREVIATIONS AND ACRONYMS CF Complementary Feeding PAHO Pan American Health Organization SDG Sustainable Development Goals vii UNICEF United Nations International Children’s Emergency Fund WHO World Health Organization H P U H List of Tables and Figures Table The proportion of the population by zone 27 Table Socio-demographic characteristics of respondents 27 Table 3 The housing of the respondent 29 viii Table Status for the economics characteristics of the study population 30 Table Mothers’ knowledge of complementary feeding 31 Table Knowledge of mothers 32 Table Attitudes of mothers about complementary feeding 33 Table Mothers’ practices for complementary feeding 34 Table Attitude of mothers about complementary feeding 36 Table 11 The food consumption pattern of children in the last 24 hours 37 H P Table 12 Cultural traditionals and beliefs 38 Table 13 Bivariate analysis of mothers’ socio demographic factors associated with the timing to start complementary feeding in Xaythany district, Vientiane Capital 39 Table 14 Bivariate analysis of mothers’ knowledge factors associated with the U timing to start complementary feeding in Xaythany district, Vientiane Capital 41 Table 15 Bivariate analysis of mothers’ attitude factors associated with the H timing to start complementary feeding in Xaythany district, Vientiane Capital 41 Table 16 Bivariate analysis of cultural factors associated with the timing to start complementary feeding in Xaythany district, Vientiane Capital 42 Table 17 Multiple logistic regression analysis of the factors associated with the timing to start complementary feeding children aged to 12 months in Xaythany district in 2019 43 ix H P U H Summary Appropriate complementary food is essential for the optimal physical, mental and behavioral development of infants The World Health Organization (WHO) defines infant complementary feeding as “a process starting when breast milk alone is no longer sufficient to meet the nutritional requirements of infants, and therefore other foods and liquids are needed, along with breast milk” In order to provide infants with additional nutrients, x complementary foods (foods other than breast milk or infant formula) should consequently be introduced to the infants Inappropriate infant complementary feeding practices result in aggravating the risks of malnutrition, morbidity, and mortality among infants and children In the long term, malnutrition impairs the optimal physical, intellectual and behavioral growth of children In addition, inappropriate complementary feeding practices negatively affect the work performance capacity, productivity and overall health status of children in adolescent years A cross-sectional study was conducted from August 2019 to April 2020 A sample of 380 mothers/caregivers who had children aged between to 12 months and living in the rural H P villages selected in Xaythany district agreed to participate in this study The data was collected through face-to-face interviews with the mothers/caregivers using a structured questionnaire The data was analyzed using the STATA programme Descriptive statistics, univariate analysis and multiple logistic regression analysis were used The main results drawn from this study showed that nearly all of the mothers had a good U knowledge about complementary feeding Only less than 5% of the mothers had a poor knowledge about complementary feeding and more than half of the mothers had a positive attitude about infant complementary feeding With respect to mothers’ practices almost H three quarters reported that their practices were inappropriate when giving complementary feedings for their children The factors associated significantly with the timing to start complementary feeding were the mother’s religion (AOR= 7.2, 95% CI=1.3-40.6), economic status (AOR=0.3, 95% CI=0.1-0.9) and ethnicity (AOR=-0.04, 95% CI=0.0060.3) In order to improve the complementary feeding of the children aged six to twelve months there is a need to have guidelines for infant and young child feeding for medical staff In addition, the authorities need to translate health directives into local languages then produce informational resources to disseminate in rural areas 81 H P H U 82 Annex 7: Variables of the study The independent variables consisted of general characteristics such as age of the mother, gender, education level, ethnicity and economic status No Variables name Source/data collection method Definition Dependent Variable  Timing of complementary feeding Age of starting complementary feeding: will be considered correct if it is started at six months of age H P Independent Variables Socio-demographic characteristics of the mother Ethnicity U A social group that shares a common and distinctive culture, religion, language, or the like People from different ethnic groups will show different traditions and also complementary practices H Religion Educational status Face-to-face interview with maternal / caregiver guided by questionnaire Lao Khmu Hmong Other The belief in and worship of a Buddhism superhuman controlling power, especially a personal god or gods Animism Differences in religion will result in Christianity varying attitudes and beliefs about Others complementary practices - No schooling Based on the educational background of - Preschool the mother - Primary It is measured using an ordinal scale - Secondary - Tertiary formal 83 The age of the mother at the time when Age in years the researcher interviewed her Maternal Age (Years) Occupation mother of It included the major share of involvement of the mother in activities such as household tasks, agriculture, salaried jobs, small scale business contracts, and seasonal labor to generate earnings and finance livelihood needs completed Government officer State enterprise worker Agriculturist Private business staff Housewife Other If the answer is yes = score, but if the answer is no = score The total was then divided into three groups according to the Likert Scale Economic status Annual household income is a measure of the combined income of all people sharing a particular household or place of residence It includes every form of income in a year if the family has a low income, the mother will most likely have a finite amount of money to buy Poor 10-40% food-related to the preparation of Moderate 50-70% complementary feeding for her infant Wealthy 80-100% Indexed age child (month) H P U of Children who are aged six months to twelve months H Knowledge of complementary feeding The total for the section covering the knowledge of infant feeding had 13 point which were then divided into two groups: - Yes - No Good knowledge - scores ranging from to 13 points Poor knowledge - score receiving less than points Attitudes towards complementary feeding Attitude of mother/caregiver about complementary Strongly agree feeding measured with a Likert Scale Agree Neutral Disagree Strongly disagree 84 Cultural and family factors Traditional beliefs Refers to the transmission of customs or Face-to-face and customary beliefs from generation to generation, or interview with practices the fact of being passed on in this way mother/caregiver guided by questionnaire H P H U the 85 Annex 8: Thesis comment H P H U 86 H P H U 87 H P H U 88 H P H U 89 H P H U 90 H P H U 91 H P H U 92 Annex 9: Minutes of explanation after thesis defence H P H U 93 H P H U 94 H P H U 95 H P H U