Sociocultural factors influencing breastfeeding practices in two slums in Nairobi, Kenya

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Abstract

Background

Despite numerous interventions promoting optimal breastfeeding practices in Kenya, pockets of suboptimal breastfeeding practices are documented in Kenya’s urban slums. This paper describes cultural and social beliefs and practices that influence breastfeeding in two urban slums in Nairobi, Kenya.

Methods

Qualitative data were collected in Korogocho and Viwandani slums through 10 focus group discussions and 19 in-depth interviews with pregnant, breastfeeding women and community health volunteers and 11 key-informant interviews with community leaders. Interviews were audiotaped, transcribed verbatim, coded in NVIVO and analyzed thematically.

Results

Social and cultural beliefs and practices that result to suboptimal breastfeeding practices were highlighted including; considering colostrum as ‘dirty’ or ‘curdled milk’, a curse ‘bad omen’ associated with breastfeeding while engaging in extra marital affairs, a fear of the ‘evil eye’ (malevolent glare which is believed to be a curse associated with witchcraft) when breastfeeding in public and breastfeeding being associated with sagging breasts. Positive social and cultural beliefs were also identified including the association of breast milk with intellectual development and good child health. The beliefs and practices were learnt mainly from spouses, close relatives and peers.

Conclusion

Interventions promoting behavior change with regards to breastfeeding should focus on dispelling the beliefs and practices that result to suboptimal breastfeeding practices and to build on the positive ones, while involving spouses and other family members as they are important sources of information on breastfeeding.

Trial registration

ISRCTN83692672: December 2013 (retrospectively registered)

Related collections

Most cited references 26

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Delayed breastfeeding initiation increases risk of neonatal mortality.

Karen M. Edmond, Charles Zandoh, Maria A. Quigley … (2006)

Breastfeeding promotion is a key child survival strategy. Although there is an extensive scientific basis for its impact on postneonatal mortality, evidence is sparse for its impact on neonatal mortality. We sought to assess the contribution of the timing of initiation of breastfeeding to any impact. This study took advantage of the 4-weekly surveillance system from a large ongoing maternal vitamin A supplementation trial in rural Ghana involving all women of childbearing age and their infants. It was designed to evaluate whether timing of initiation of breastfeeding and type (exclusive, predominant, or partial) are associated with risk of neonatal mortality. The analysis is based on 10,947 breastfed singleton infants born between July 2003 and June 2004 who survived to day 2 and whose mothers were visited in the neonatal period. Breastfeeding was initiated within the first day of birth in 71% of infants and by the end of day 3 in all but 1.3% of them; 70% were exclusively breastfed during the neonatal period. The risk of neonatal death was fourfold higher in children given milk-based fluids or solids in addition to breast milk. There was a marked dose response of increasing risk of neonatal mortality with increasing delay in initiation of breastfeeding from 1 hour to day 7; overall late initiation (after day 1) was associated with a 2.4-fold increase in risk. The size of this effect was similar when the model was refitted excluding infants at high risk of death (unwell on the day of birth, congenital abnormalities, premature, unwell at the time of interview) or when deaths during the first week (days 2-7) were excluded. Promotion of early initiation of breastfeeding has the potential to make a major contribution to the achievement of the child survival millennium development goal; 16% of neonatal deaths could be saved if all infants were breastfed from day 1 and 22% if breastfeeding started within the first hour. Breastfeeding-promotion programs should emphasize early initiation as well as exclusive breastfeeding. This has particular relevance for sub-Saharan Africa, where neonatal and infant mortality rates are high but most women already exclusively or predominantly breastfeed their infants.

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Effect of mother’s education on child’s nutritional status in the slums of Nairobi

Benta A Abuya, James Ciera, Elizabeth Kimani-Murage (2012)

Background Malnutrition continues to be a critical public health problem in sub-Saharan Africa. For example, in East Africa, 48 % of children under-five are stunted while 36 % are underweight. Poor health and poor nutrition are now more a characteristic of children living in the urban areas than of children in the rural areas. This is because the protective mechanism offered by the urban advantage in the past; that is, the health benefits that historically accrued to residents of cities as compared to residents in rural settings is being eroded due to increasing proportion of urban residents living in slum settings. This study sought to determine effect of mother’s education on child nutritional status of children living in slum settings. Methods Data are from a maternal and child health project nested within the Nairobi Urban Health and Demographic Surveillance System (NUHDSS). The study involves 5156 children aged 0–42 months. Data on nutritional status used were collected between October 2009 and January 2010. We used binomial and multiple logistic regression to estimate the effect of education in the univariable and multivariable models respectively. Results Results show that close to 40 % of children in the study are stunted. Maternal education is a strong predictor of child stunting with some minimal attenuation of the association by other factors at maternal, household and community level. Other factors including at child level: child birth weight and gender; maternal level: marital status, parity, pregnancy intentions, and health seeking behaviour; and household level: social economic status are also independently significantly associated with stunting. Conclusion Overall, mothers’ education persists as a strong predictor of child’s nutritional status in urban slum settings, even after controlling for other factors. Given that stunting is a strong predictor of human capital, emphasis on girl-child education may contribute to breaking the poverty cycle in urban poor settings.

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Patterns and determinants of breastfeeding and complementary feeding practices in urban informal settlements, Nairobi Kenya

Elizabeth W. Kimani-Murage, Nyovani Madise, Jean Fotso … (2011)

Background The World Health Organisation (WHO) recommends exclusive breastfeeding during the first six months of life for optimal growth, development and health. Breastfeeding should continue up to two years or more and nutritionally adequate, safe, and appropriately-fed complementary foods should be introduced at the age of six months to meet the evolving needs of the growing infant. Little evidence exists on breastfeeding and infant feeding practices in urban slums in sub-Saharan Africa. Our aim was to assess breastfeeding and infant feeding practices in Nairobi slums with reference to WHO recommendations. Methods Data from a longitudinal study conducted in two Nairobi slums are used. The study used information on the first year of life of 4299 children born between September 2006 and January 2010. All women who gave birth during this period were interviewed on breastfeeding and complementary feeding practices at recruitment and this information was updated twice, at four-monthly intervals. Cox proportional hazard analysis was used to determine factors associated with cessation of breastfeeding in infancy and early introduction of complementary foods. Results There was universal breastfeeding with almost all children (99%) having ever been breastfed. However, more than a third (37%) were not breastfed in the first hour following delivery, and 40% were given something to drink other than the mothers' breast milk within 3 days after delivery. About 85% of infants were still breastfeeding by the end of the 11th month. Exclusive breastfeeding for the first six months was rare as only about 2% of infants were exclusively breastfed for six months. Factors associated with sub-optimal infant breastfeeding and feeding practices in these settings include child's sex; perceived size at birth; mother's marital status, ethnicity; education level; family planning (pregnancy desirability); health seeking behaviour (place of delivery) and; neighbourhood (slum of residence). Conclusions The study indicates poor adherence to WHO recommendations for breastfeeding and infant feeding practices. Interventions and further research should pay attention to factors such as cultural practices, access to and utilization of health care facilities, child feeding education, and family planning.

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Author and article information

Contributors

Milka Wanjohi:

ORCID: http://orcid.org/0000-0001-7585-4965

mwanjohi@aphrc.org

Journal

Journal ID (nlm-ta): Int Breastfeed J

Journal ID (iso-abbrev): Int Breastfeed J

Title: International Breastfeeding Journal

Publisher: BioMed Central (London )

ISSN (Electronic): 1746-4358

Publication date (Electronic): 11 January 2017

Publication date PMC-release: 11 January 2017

Publication date Collection: 2016

Volume: 12

Electronic Location Identifier: 5

Affiliations

[1 ]African Population and Health Research Center (APHRC), Nairobi, Kenya

[2 ]Centers for Global Health and Human Development; Loughborough University, Loughborough, UK

[3 ]MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

[4 ]Departments of Pediatrics, University of Nairobi, Nairobi, Kenya

[5 ]Department of Child and Family Studies, University of Tennessee, Knoxville, USA

[6 ]Center for Global Health, Population, Poverty, and Policy University of Southampton, Southampton, UK

Author information

Milka Wanjohi http://orcid.org/0000-0001-7585-4965

Article

Publisher ID: 92

DOI: 10.1186/s13006-016-0092-7

PMC ID: 5225512

PubMed ID: 28096888

SO-VID: 7ff86920-c5cd-40b1-b313-8922507b911a

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 2 June 2016

Date accepted : 12 December 2016

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100004440, Wellcome Trust;

Award ID: Grant # 097146/Z/11/Z

Award Recipient : Elizabeth W. Kimani-Murage

Custom metadata

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: culture,sociocultural,breastfeeding,slums,kenya

Data availability:

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: culture, sociocultural, breastfeeding, slums, kenya

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Sociocultural factors influencing breastfeeding practices in two slums in Nairobi, Kenya

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Abstract

Background

Methods

Results

Conclusion

Trial registration

Related collections

Bacterial vaginosis and biofilm

Most cited references 26

Delayed breastfeeding initiation increases risk of neonatal mortality.

Effect of mother’s education on child’s nutritional status in the slums of Nairobi

Patterns and determinants of breastfeeding and complementary feeding practices in urban informal settlements, Nairobi Kenya

Author and article information

Contributors

Journal

Affiliations

Author information

Article

History

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 1,026

Cited by 35

Most referenced authors 706