Socio-economic and demographic
characteristics of study participants
In-depth
interviews
60
households of high, medium and high incidence areas of malnutrition took part in
the interviews, in Lupalilo, Ikete and Ipepo wards by using instrument No. 5 of the questionnaire,
with 60 mothers of children below 2 years of age, who were maternal mothers
of the infants. The occupation of the respondents were farmers; some were
single but most of them were married; they work between 8 and 12 hours a day;
their spouses are small farmers; their level of education were mostly primary
school level and their spouses as well; and their age groups were between 17
and 40 years of age. These mothers who took part in the in-depth interviews
were selected during the sampling of the study, and one of the criteria of
taking part in the interview, was to have a child below two years of age.
Focus
Group Discussions (Refer Annex 2)
12
focus group discussions were carried out among them were mothers with children
below two years of age in Nkondo and Ikuwo villages; Kissinga and Mago
villages; and Ikete and Maliwa villages with instrument No.1 and 2 of the
questionnaires. Mothers with children
below two years of age by using
instrument No. 1; in the six
groups there were 84 discussants; whose age groups were between 17 and 35
years; most of them were married; of primary school level of education; they
work between 4 to 8 hours and their spouses were farmers of primary school
level of education. For mothers with
children below two years of age by using instrument No. 2, in the six groups had 66 discussants; whose
age were between 17 and 40 years; they worked between 4 and 11 hours; most of
the them are married; they are primary school leavers; and they are farmers;
their spouses are farmers and some are primary school leavers and some have
adult education level. Discussants had children of two year of age.
There were 6 groups for focus group discussions of
elderly men in Kisinga, Mago,
Nkondo, Ikuwo, Ikete and Maliwa villages respectively. Instrument No. 3(a) was used for the discussions, among the 62 discussants
who were in the age group of 38 and 83 years; most of them were married;
most of them were illiterate; their occupation were farmers; their working
hours were between 3 and 11 hours; whose spouses were also farmers and of
primary school level of education.
The 6 groups of elderly women
in the focus group discussions were from Kisinga, Mago, Nkondo, Ikete and
Maliwa villages. Instrument No. 3 (b)
was used for discussions, among the 66
discussants were in the age groups of 40 to 70 years; most of them were
married and widows; their main occupation was farming; primary school level of
education; they work between 4 to 12 hours; and their spouses were primary
school leavers and illiterate as well as farmers.
6
groups of discussants took part in the discussions with Extension &
Community workers, DMT/VGC/VHW in the study areas. Instrument No. 4 was used for discussions among 66 discussants took part in the
discussion were in the age groups of 32 to 60 years of age; among them male
were 34 and female were 22; most of them were married; primary school level of
education; their main occupation were farmers; they work between 6 to 10 hours;
and their spouses were primary school leavers and farmers as well.
15 key
informants took part in the study areas, instrument
No. 6 was used whereby 13 were males and 2 female took part in the
discussions. Most of the participants were married; with primary school level
of education; they were farmers; they work between 10 and 12 hours. Their
spouses were primary school leavers, and they were farmers as well.
Area of the study
Makete
District is bordered by Njombe and Mbarali Districts on the East and the North
respectively. The Southern part is bordered by Ludewa district, overlooking Lake Nyasa on the northern tip. Rungwe district lies on
the West. The District has a total land area of 5,800,000 hectares, of which
72% is suitable for agriculture. Makete District is among the eight districts
comprising Iringa Region, with an area of 5,800 sq. Kilometers. It is situated
on the South–Western part of the region within 08045’S and 09040S
degrees of Latitude and between 33085’ and 34030’ degrees
East of Greenwich Meridian (Makete District Council, Planning Department, 2005).
The climate of the district is characterized by two altitudinal zones of low and highland zones. The highland zone, with huge valleys and undulating mountains, lies between the altitudes of 1500m – 3000m above the sea level. The annual temperature range is between 4 to 20 degrees Celsius with average rainfall of 1300mm. The lowland is a relatively small land zone, which lies on the foot of Chimala escarpment to the North-Eastern side of the district, between the altitudes of 900m – 1500m above the sea level with its average temperatures of 20 degrees Celsius. The rainfall ranges between 500mm and 800mm per annum.
The
vegetation that is found in Makete is influenced by three types of soils. The broad zone of vegetation, which includes,
Savannah Kipengere Mt.
Ranges
The
land use in Makete is predominantly forest areas with farmland for cultivating
food crops for the households. Pasture grounds are available mainly for grazing
of goats and cattle for those households who keeps cattle. The forest reserves
comprises of pine trees and other trees for eucalyptus and indigenous trees. Plantation Tanzania
The
District is divided into administrative units. It consists of six divisions, 17
Wards, and 98 Villages. The villages are further sub divided into 465 sub
villages, popularly known as hamlets. These offices act as the local government
authorities in respective areas.
There are two autonomous levels of local
administration. There is a village government that is under the leadership of
an elected village chairperson. A Ward is an
intermediate administrative level, which plays the role of coordinating
activities of villages within its area of influence. The functional
responsibilities of this level are under Ward Development Committee. The
Committee also facilitates the flow of information between the District Council
and the village governments. The District Council caters for the second administrative structure.
Council matters are under the jurisdiction of a legislative body of
Councillors. There are 18 elected members together with six special
seats for women representatives to constitute the body. The District Executive Director runs the day to day activities of the
Council supported by a team of departmental heads. Duties and responsibility of
the Makete District Council include: To ensure provision of adequate and
quality social services to the community; To mobilize and co-ordinate use of
available economic social resources for the development purposes of the
district. To ensure that law and order prevails within each administrative unit;
and, The Council has the role of facilitating the existence of good
relationship between Central Government, on one hand, and the local
leadership/communities, on the other.
Main characteristic of the population
The
main tribal group in the council is Wakinga. The Wakinga tribe exists in a
number of dialects by the names of Wakinga (proper), Wamagoma, Wawanji and
Wamahanji. According to the year
2002 population Census, Makete district has a population of 105,775, out of which 57,463 (54%) are women, while
48,598 (46%) are men. The 1988 population census statistics showed that the
district total population figure stood at 102,470 by then, while growing at the
annual rate of 1.2 percent. Children under the age of one year are 2997 (1,467
males and 1,527 females) Children under the age of five are 14,680 (7,330 males
and 7,350 females). Life expectancy was 45 years for males and 55 years for
females.
Major
economic activities include agriculture and timber works which is carried out
in Makete District. Agriculture involves farming and animal husbandry. Majority
of the inhabitants are engaged in small-holder farming by the production of
food crops such as maize, irish potatoes, millets, and and sweet potatoes at
small scale level for households consumption.
Timber logging is practiced by both machine and manual operations. Also
bee-keeping is carried out and small scale mining at small scale levels is
carried out.
Agriculture
is the principal economic activity, which is carried out by almost 80 per cent
of the population. It consists of
subsistence type of agriculture involving smallholder farmers, of almost 25,433
of the households that comprises of 17,214 male and 18,648 female peasants
respectively. The main food crops of the district include, maize, wheat, rice,
round potatoes, peas, beans, vegetables, and fruits. The cash crop farming
involves Pyrethrum and Coffee, which are grown in a small scale. After the
introduction of a free market trade in Tanzania in 1980’s, Pyrethrum market
collapsed, while timber works and potato businesses surfaced rapidly as
alternative source of earning income for the households. Timber traders are involved
in lumbering and transportation to the markets with Makambako trading centre
which serves as a main marketing outlet.
Livestock
keeping is an important activity in Makete District. The livestock include cattle,
goats, pigs, donkeys, rabbits, guinea pigs, and those of the chicken family. The
most common breed which dominates in the area is the local breeds over the
improved breeds. The common practice which prevail among the peasant families
are the free range grazing system, and is carried out in unimproved pastures. There
is no supplementary feeding practice in the area. Moreover, few farmers own
large livestock species and there are few improved species.
Over
the past years, the economy of Makete District has not performed well. Showing
a remarkable decline in economic production and incomes, which are associated
with more reliance on pyrethrum, whose market has collapsed in early 1990’s?
The inaccessibility of the roads, high costs of road rehabilitation and
construction have been the contributing factors of the lower prices of farm
products, while imported goods were sold at higher prices. The current average income per capita of the district
stands below $110 (Tshs 120,000). The major sources of income still remain
to be lumbering and trading of Irish potatoes.
Makete
District councils is easily accessible by road. The road networks are about
732.9 km which consist of paved, gravel, and earth stretches. Majority of the
roads in the rural villages are virtually impassable during rainy season. Some
of the roads do not have tarmac, nevertheless quite a big section of the road
network cannot be accessible throughout the year. Especially during the heavy
and long rains, the land terrain is full of mountains and big valleys, and
relatively poor soils, which cannot be reachable. Only 30 per cent of the roads
are passable through out the year.
Health
service delivery system is divided into two levels. Services are provided at
health facility level and community level. Key health service providers at the
community level included Village Health Workers (VHWs) and Traditional Birth
Attendants (TBAs). VHWs – Are responsible for the following activities:
Monitoring nutrition status of children under the age of five years (<5s); Campaign
for active community participation in the National Immunization Days (NIDs); Maintain
the vital registration registers of births and deaths; Conduct health education
advocacy; and, Management of mild medical conditions in villages.
There are 29 Pre-school primary classes with a total
number of 2,655 pupils, and 89 primary Schools. Pupils’ registration in primary
school for the year 2004 stands at 26,110 of which 12,860 are boys and 13,250
are girls. Secondary school education consists of six schools all but one owned
by the government. There are also one teachers training college, and two pre-tertiary schools – one for
laboratory technology and the other one for vocational training. The progress
made so far in the education sector, with a particular emphasis on primary
school education, has been achieved as indicated by net enrolment rate (NER)
compared to gross enrolment rate (GER), intake and pass rates.
Water
supply systems for domestic purposes are of two types: gravity schemes through
public DPs and springs. The main
domestic water used by the district population are of four types: Drinking; Laundry
services; Cleaning; and, Washing oneself (bathing). The first pipe water system
became operational in 1979 and to-date is still functioning although with a
number of technical problems that has led to a declining of rate of flow. The
average population with access to clean water is 48%. The main causes of water
contamination include (i) animal dung and (ii) human excreta.
There
are social welfare threats which affect the improvement of standard of living
for Makete residents. In general terms, there are three significant features which
threat the health status of the people in Makete, namely: major health problems;
the top ten diseases and main causes of deaths are neumonia; Respiratory Infection;
Malaria; Diarrhea; Worms Infestation; Eye diseases; Urethratitis; STI -sexually transmitted infections and Skin disease.
The top ten diseases are: AIDS; TB; Pneumonia; Malaria; Diarrhea; STI; Anaemia;
Malnutrition; Eye disease and Dental problems. The causes of deaths are: HIV/AIDS
and related opportunistic infections; Sepsis; Abortions; Malaria; Post Partum
Haemorrhage (PPH)
Initiation of Breastfeeding Practices
Early initiation into
breastfeeding is extremely important for a child for establishing successful lactation
as well as for providing “Colostrum” (mother’s first milk). Results from
in-depth interviews with sixty mothers of children under two years of age, show
that breastfeeding practices are less than optimal. Table3.1 show the results of the study in Makete district. Thirty
five (58%) of the mothers reported breastfeeding their infants within the first
hour of delivery, whilst 11 (18%) mothers breast feed within 24 hours after
delivery. 4 (7%) mothers breast feed their infants within the second hour after
delivery, and 2 (3%) mother respondents did not nurse
at all. According to the National guidelines on infant and young child feeding of India (2004) it has been
clarified that the baby should receive the first breastfeed as soon as possible
and preferably within half an hour of birth (Government of India , 2004).
Table 3.1
Initiation of
Breastfeeding [N = 60]
|
Incidence
of malnutrition
|
Low incidence
Lupalilo
|
Medium incidence
Ikuwo
|
High incidence
Ipepo
|
Total #
|
Total
in %
|
|||
|
|
Kisinga
[n=10]
|
Mago
[n=10]
|
Nkondo
[n=10]
|
Ikuwo
[n=10]
|
Ikete
[n=10]
|
Maliwa
[n=10]
|
||
|
Nursed within 1st hour of birth
|
6
|
6
|
7
|
3
|
6
|
7
|
35
|
58%
|
|
Nursed within 2nd hour after birth
|
0
|
2
|
0
|
1
|
1
|
0
|
4
|
7%
|
|
Nursed within 24 hours after birth
|
1
|
1
|
2
|
3
|
1
|
3
|
11
|
18%
|
|
Nursed within 5 days after
birth
|
0
|
1
|
0
|
1
|
0
|
0
|
2 |
3%
|
|
Did not Nurse at all
|
1
|
0
|
0
|
0
|
0
|
1
|
2
|
3%
|
The reasons for mother
initiation of breast feeding in the study are to avoid diarrhoea, baby to grow
healthy and strong, baby’s hungry, and baby cannot digest. However, mothers in
Lupalilo ward reported infants will receive colostrums and help to stimulate
milk production. Among the 2 (3%) mothers reported to nurse their infants
within 5 days after delivery as the breast milk was not coming out, hence they
were given finger millet porridge in order for the milk to come out. 2 (3%) of
mothers who did not nurse at all reported their infants did not like breast
milk, hence were forced to introduce other foods such as light porridge and
water. Recognizing the importance of child feeding practices and to re-focus
attention on them, the Tanzania National Strategy for Infant and Young Child
Nutrition (Ministry of Health, 2004), pointed out that early initiation and
exclusive breastfeeding for the first six months of life helped to ensure young
children the best possible start to life.
Among the reasons for
exclusive breastfeeding of the focus group discussions with mothers with
children under 2 years of age, Maliwa discussants reported breast milk
contained high nutrients than other foods. Kisinga focus group discussants said
it was the only food for small children. Ikete discussants reported giving
porridge as the breast milk was not adequate due to baby’s hunger and crying. Nkondo
discussants reported as being told at the MCH clinic, and they give water and
porridge. Mago and Ikondo respondents of in-depth interviews reported breast feeding
of two teats was not necessary and that one teat was adequate for the provision
of milk for the baby. The study has revealed that breast feeding was initiated
from birth on demand by the baby. It was also reported by elderly women
discussants of Ikete that the psychological state of the mother was considered
important to successful breast feeding, as milk of mothers who were sad or
emotionally disturbed was believed to cause diarrhoea. In Makete, according to
the report on nutritional baseline survey undertaken in Kibaha and Makete
(TFNC, 2001) 80.1% of children of under five years of age, had breast fed their
infants for two years and above.
Constraints of Initiation of Breast Feeding
Practices
There are many constraints or
issues that reduce the likelihood of families adopting better child feeding
behaviours which can be classified as environmental or attitudinal constraints.
Environmental factors include the availability or seasonal variations in the
accessibility of certain foods, the need to work outside the home, a scarcity
of cooking fuel or inadequate reception of information about child feeding
given by health care workers. Attitudes that prevent improvements in child
feeding are numerous. They will vary according to culture and belief but
certain issues are common.
Constraints of initiation of
breast feeding as pointed out by focus group discussion of Ikete and Maliwa by
elderly women that the nutritious status of the mother plays a critical part in
ensuring that the mother’s breast milk are adequate to for the baby that ensure
proper growth of the child. They
reported as follows:
“It
has been pointed out that breastfeeding be initiated immediately after the
child is born (Ruel and Menon, 2003). In this study, elderly women of Ikete and
Maliwa villages reported that in the past fifty years, lactating mothers
started to breast feed their infants immediately after delivery due to the adequate
of the flow of milk in the mother’s breasts. Due to good weather food security
in the household was adequate to feed the mother in order to produce more milk
for the child. Currently, the bad weather has rendered it impossible for the
mothers to have adequate food during weaning period, as reported in other
studies to cause decreased milk production.” [FGD Ikete & Maliwa]
The lack of income in the
households has also contributed to the factor of delay in breastfeeding for
some of the mothers. As it was reported in this study that the low purchasing
power has rendered it impossible for mothers to afford balanced nutritious diet
to ensure the early flow of milk in the mother’s breasts .As reported by focus
groups discussants of elderly men of Mago as follows:
“It
is recommended that a child be breast fed immediately after birth ( ). In this study elderly
men reported that the low income of the mothers would not allow them to buy
nutritious food for themselves. Such constraint has been reported in other
studies to cause decreased milk production in mother’s breasts” [FGD Mago]
Obstacles of Initiation of
Breast Feeding Practices
In Makete, most of the villages suffered increasing
shortage of human resources in farm labour which meant that farming has been
carried out by aging men and women. There was need to develop cheap, simple
tools, farm implements, small scale machines and animal drawn equipments, that
were within the means of small-holder farmers. Non-conventional food sources, should
receive attention, where they are practical, economical, and of high
nutritional value, especially for the vulnerable groups
Agriculture in the study areas has been geared to food
production. Considerations of human nutrition need to be emphasized in food
production. In Makete the main food crops are cereals and tubers, therefore adequate
emphasis should be placed on the research, production, and extension of
leguminous crops. Since fruits and vegetables, to some extent, make important
contributions to the Makete diet, production, and extension of these food crops
must not be neglected.
Actual Feeding Practices
The cultural beliefs of most
mothers appear to be important in determining the initiation of breast feeding
as well as termination of breast feeding. As they said that in their culture
that mothers are taught by their families and encouraged at home as well as at
the MCH clinics, in order for the child to grow well. Both of these practices
are closely associated with the growth and development of young infants. In a
number of developing societies, breast feeding is a universal practice, which
is initiated soon after birth (Harrison, et al 1993; Cominsky, Mhloyi and
Ewbank 1993; Almedom 1991a, 1991b). While the National Strategy on Infant &
Young Child Nutrition based on the Global Strategy on Infant & Young Child
Feeding address infant and young child feeding in the context of HIV/AIDS as
well as feeding in exceptionally difficult situations (MoH, 2004).
The beliefs and attitudes in
the study areas on the initiation of breastfeeding indicated that mothers need
for maternal rest and supervision of newborn baby as reported by elderly women
in focus group discussions. They said that mothers who are small farmers have
no time to rest and do not have enough to eat during lactation period, hence an
infant would not get enough milk from the mother. The need for ritual feeds for
celebrations of birth of children, causes food insecurity in the households for
mothers and children not having enough food to eat, as reported by elderly
women and key informants in the study areas. The perception of “colestrum” had
been reported by Ikete respondents as a cause of delay of initiation of breast
feeding for infants as they believe is not healthy for the child. The study
revealed a relationship between food insecurity, lack of rest of mothers and
rituals as factors of malnutrition for children in the study areas.
Studies have shown that
feeding and other child care practices have a great influence on child
nutrition outcome aside from the availability of food per se. There have been cases
of occurrence of malnutrition even in areas where food was abundant. For older
infants and toddlers, breast milk continues to be an important source of
energy, protein, and micronutrients (LINKAGES, 2003). In Makete the prevalence
of breastfeeding was estimated at 39.7 percent (TFNC Report, 2005)
Frequency of Breast feeding
Infants and young children
need to be fed 5 – 6 times a day in addition to breastfeeding. However,
findings from in-depth interviews with sixty
mothers with children of less than two years of age indicate that 26 (43%)
breast feed their infants for more than 7 times a day (See Table 3.2). Most of the respondents said every time a child cry,
was a sign of hunger, thus breastfeeding could not be counted. Hence, the
finding correlates with the recommended time of feeding an infant for more than
five times a day for optimal growth and development (WHO, 2005). The reason for
breastfeeding a child for 3 to 4 times a day as reported by 12 (20%)
respondents was that most of the time they are in the farm and hence they feed
light porridge as a substitute of breast milk, as they work longer hours in the
farm.
Table
3.2
Frequency
of Breast feeding [N =
60]
|
Incidence
of malnutrition
|
Low incidence
Lupalilo
|
Medium incidence
Ikuwo
|
High incidence
Ipepo
|
Total #
|
Total
%
|
|||
|
|
Kisinga
[n=10]
|
Mago
[n=10]
|
Nkondo
[n=10]
|
Ikuwo
[n=10]
|
Ikete
[n=10]
|
Maliwa
[n=10]
|
||
|
Less than twice a day
|
0
|
1
|
0
|
0
|
1
|
0
|
2
|
3%
|
|
3 to 4 times a day
|
3
|
1
|
3
|
2
|
2
|
1
|
12
|
20%
|
|
5 to 6 times a day
|
0
|
4
|
0
|
0
|
0
|
0
|
4
|
7%
|
|
More than 7 times a day
|
9
|
3
|
3
|
3
|
3
|
5
|
26
|
43%
|
|
I don’t know
|
0
|
0
|
2
|
0
|
0
|
0
|
2
|
3%
|
In the focus group discussions
with mothers of children under two years of age, reported breast feeding their
infants at night and day as well, but with more times during the day. The
reasons for less breast feeding at night are the child sleeps at night as
reported by Mago discussants, while Maliwa and Ikete discussants said they give
light maize porridge in the evening to discourage breast feeding at night. Frequency
of breast feeding was the key determinant factor for growth development. In
some studies it has been found that low energy density of complementary foods
given to young children and low frequency of breast feeding result inadequate
calories intake and thus malnutrition occurs (Arroyage et al. 1999). The study
has found the relationship between frequency, lack of knowledge of breast
feeding and malnutrition.
Constraints of Frequency of Breast Feeding
Practices
The frequency of feeding
needed for infants to meet energy requirements depends on the energy density of
the foods. Due to their small stomach sizes, frequent feeding is essential for
breastfed children. Women’s numerous time commitments have been recognized as
one of the most important constraints to care McGuitre and Popkin (1990). These
time commitments include household production, particularly time and labour
intensive tasks such as carrying water and gathering fuel wood. Mothers in the
study areas who are mainly small farmers have been observed to have less time
to concentrate on the feeding of their infants, as observed during feeding of
their infants. The work load is a major constraint for the mothers to adhere to
the demand of frequency of breast feeding to children during their farm and
house work. Most of the others seemed to breast feed while continuing with
whatever task they were performing in the house.
Obstacles of Frequency of
Breast Feeding Practices
The results of the
in-depth interview indicated inadequate provision of body building and
protective foods like milk, eggs, milk, and lishe which are rich in
proteins, vitamins and minerals to children. The elderly women discussants of
Maliwa village complained that the poor diet of children was the result of poor
harvest which was caused by bad whether, as a result most of the fruits such as
bananas, pineapples, passion, and vegetables that thrived in cool climes such
as Makete were not adequate to meet the needs of the household especially for
children. Although the key informants and the village officials had said that
the poor diet was the result of poor cooking methods, but the elderly women
believed that the poor diet was due to poor income of most of the parents who
could not afford other ingredients to make the food tastier for a child to eat.
Hence, it was found out that the poor diet was the result of food insecurity
which hindered parents to sell and consume the food products such as grounds
nuts, fruits and legumes. Hence, poor health the mothers rendered it difficult
for increasing the frequency of breastfeeding of children.
Types of fluids given to children soon after
birth
Colostrum is all the food and
fluid that an infant needs soon after birth with no supplements of other food,
not even water. It is therefore essential that an infant is breast fed in order
to obtain colostrums which is thicker and yellowish than later milk which comes
only in small amounts in the first few days (Bentley, 1992). Pre-lactating
fluids offered to infants in the study areas are water, breast milk, porridge,
soda, cows milk, tea, and local herbs.
In the in-depth discussions, breast
milk was reported by almost 45 (75%) of the respondents, as the best
pre-lacteal fluid for an infant. 9 (15%) of the respondents said nothing. Water
was reported by 9 (15%) as the early pre-lactating liquid given to infants.
Porridge was another liquid as reported by 5 (8%) of respondents. 1.2% of the
mothers said cow milk is the best pre-lactating liquid, (see table
3.3).
According to Meyer GTZ – PMTCT project study (2003), solid nutrients were
introduced on average at 6 months while fluids were given at an earlier age, an
average of 4 months. The reasons given
by mothers in the in-depth interviews are that the baby was too young and
cannot digest other foods, and to stop the baby from crying. Also, warm water
was given to an infant to give warmth to the baby. Traditionally infants in
Mago were given finger millet porridge soon after birth. Currently, infants are
breastfeed and are given porridge after 6 months as reported in the elderly
women focus group discussion. The fact that breast milk was coming out in small
quantity the baby was given soda and cow milk as reported by Lupalilo in-depth
interviews. It was also reported breast milk was the best for the baby by all
the respondents and discussants. Over ninety percent of mothers in Tanzania
During structured and
unstructured observations in Ipopo ward, it was observed that the majority of
the infants were given light maize porridge at an earlier age, which resulted
in malnutrition and under weight when their stomachs could not digest such
foods. In the transect walks in Ipepo ward, seasonal foods were inadequate such
as fruits and maize and mothers were forced to feed their infants with boiled
irish potatoes and the low income forced them to give their infants tap water
as they cannot afford to buy charcoal nor wood which is in scarcity as observed
during transect walk. For mothers in Lupalilo and Ikuwo ward can afford to buy
cows and lishe porridge for their
infants, whilst for Ipepo ward mother’s low income forces them to given their
infants water, and nothing.
Table 3.3
Types of fluids introduced
immediately after birth [N = 60]
|
Incidence
of malnutrition
|
Low incidence
Lupalilo
|
Medium incidence
Ikuwo
|
High incidence
Ipepo
|
Total #
|
Total %
|
|||
|
Kisinga
[n=10]
|
Mago
[n=10]
|
Nkondo
[n=10]
|
Ikuwo
[n=10]
|
Ikete
[n=10]
|
Maliwa
[n=10]
|
|||
|
Breast milk
|
9
|
9
|
7
|
5
|
8
|
7
|
45
|
75%
|
|
Water
|
1
|
1
|
2
|
3
|
1
|
1
|
9
|
15%
|
|
Nothing
|
1
|
0
|
1
|
2
|
0
|
4
|
8
|
13%
|
|
Porridge
|
2
|
1
|
1
|
1
|
0
|
0
|
5
|
8%
|
|
Cows milk
|
0
|
0
|
2
|
0
|
0
|
0
|
2
|
3%
|
|
Local herbs
|
0
|
0
|
1
|
0
|
0
|
0
|
1
|
2%
|
|
Soda
|
0
|
0
|
1
|
0
|
0
|
0
|
1
|
2%
|
|
Tea
|
0
|
1
|
0
|
0
|
0
|
0
|
1
|
2%
|
Reasons
given for the introduction of fluids early in the infant’s life by mothers with
children below 2 years of age in the focus group discussions are, Maliwa
reported to give breast milk because it contains high nutrients than other
food, while Kisinga said it is the only food for baby as the stomach cannot
digest other food and to energy and avoid other diseases such as diarrhoea.
Ikete discussants said breast milk builds good health, also porridge when
breast milk was not enough due to thirst and hunger. Ikuwo discussants breast
feed infants as it is easy for digestion. Nkondo discussants reported giving breast
milk and porridge when the baby cried.
Constraints to fluids given
to children immediately after birth
The type of fluids that are
introduced immediately after birth differed according to the study areas, but
most mothers exclusively breastfed their infants for the first 6 months of life
and continue to breastfeed for 2 years and beyond. Furthermore, about 9 percent
of infants receive foods and drinks from bottles. (Ministry of Health, 2004).
For some mothers in Kisinga, Nkondo, Ikete and Maliwa reported that the
constraint of inadequate of support from families in the farm work increases
the chance of introduction of other fluids to their children. As they do need
to breastfeed for six months and more, they are forced to introduce soda, water
and light porridge as a way of reducing hunger to a child.
“It
is recommended that a child be breastfed breast milk in the first six months
and continue to be breastfeed for 2 years and beyond (MoH, 2004). In this
study, mothers reported that they do not get support from their families, thus
they introduced other fluids. The practice has been reported in studied to
cause poor nutritional status to majority of the children [FGD – Kisinga & Nkondo]
Obstacles to fluids given
to children immediately after birth
Most of the mothers
interviewed started breast feeding within
1 hour to five days after delivery in all the villages. For those who said,
they breastfed immediately, the reasons that were given, were that the milk was
forth coming and the fact that it was the best food for the children. For those
who said that they used boiled (warm) water, and the reasons were that the milk
was not forth coming and the child was crying.
Suggestions on the
improvements of nutrition in the community were identified on the efforts to
improve nutrition which would involve a wide range of activities such as
improvement of health services, empowerment of women in decision making,
effective policies to increase food production and introducing micronutrient
fortification. For a behaviour change to be effective in the improvement of
child nutrition, it must be taken into consideration on the increase of a child
intake of nutrients or reduce the occurrence of severity of disease. Therefore
the obstacle of fluids given to children immediately after birth will be deal
with in the activities, as mentioned in the focus group discussions.
Early Initiation of Breast feeding
Breast milk has remained to
the best food for babies. For the very best start in life, the World Health
Organization (WHO), the United Nations Children’s Fund (UNICEF) and the health
agencies worldwide recommend that mothers breastfeed their babies exclusively
for the first six months, and continue breastfeeding together with giving other
foods and drinks, up to two years or more, as long as mother and baby want to
(WHO, 2002).
Mothers in the in-depth
interviews, and focus group discussion with mothers of children under 2 years,
said that breast milk continue to be the best milk for the child. Most of the
mothers reported to breastfeed their infants exclusively for six months without
introduction of other food substitutes. The reasons for exclusive breastfeeding
among in-depth interviews and focus group discussions of elderly women in Ikuwo
ward are breast milk is high quality food, which is easy to digest. It also
contains factors that help with the absorption of nutrients, as babies who
continue to be breastfeed will not become hungry. Babies when hungry do cry or
reach to be breastfed as they are demand-fed and regulate their own food
intake. Breast milk provides protection against illness and reduces the
severity of diseases, as reported by elderly women in focus group discussion
and in-depth interviews of Lupalilo ward. While in-depth interview at Mago had
a different reason of introduction of water in the second month due to the baby
crying and that breast milk was not adequate.
Table
3.4
Exclusive
Breastfeeding [N =
60]
|
Theme
|
Behaviour
|
Reasons,
Belief
|
Citations
|
|
Time of exclusively
breastfeeding
|
·
First three months
Baby breastfeed frequently
during the day and night with no other food substitute.
|
Breast milk is high quality
food
|
·
In-depth interviews
·
FGDs - mothers with children <2 years
|
|
·
1st to 5 months
Baby continue to be
breastfed frequently with no other food substitute when on demand
|
Baby does not become hungry
|
·
In-depth interviews
·
FGDs – Elderly women
in Ikuwo ward
|
|
|
·
First 6 months
Baby continue to be
exclusively breastfed for the first six months
|
·
Breast milk is protective
·
Breast milk helps to recover from sickness
|
·
In-depth interviews
·
FGDs – Elderly Women in Lupalilo ward
|
|
|
·
Second month
Introduction of water in the
second month
|
Baby crying & breast
milk was not adequate
|
·
In-depth interview at Mago
|
Even though breastfeeding is a
natural act, breastfeeding is also a learned behaviour. In order for mothers to
exclusively breastfeed for six months and continue to breastfeed for 2 years
and beyond, they need to be provided with relevant information, support from
families communities, the health care system and supportive policies (MoH,
2004). The constraints faced by
mothers in the study areas for exclusively breastfeeding their infants was the
lack of information as with regards to exclusive breastfeeding, as key
informants in Nkondo, Ikete, Ikuwo and Maliwa reported. The reported that:
“It
is recommended that mothers who are exclusively breastfeeding their children
need support to ensure good nutrition to their children (Armstrong, 1995). In
this study key informants reported that they do not get support from their
families and community. Such a practice of lack of social support has been reported
in other studies to cause more constraints to duration of breastfeeding
(McGuire and Popkin (1990). [Key informants – Nkondo, Ikete, Ikuwo, and Maliwa]
Obstacles of early
initiation of breast milk
A child was supposed to be
breastfed on demand and for sufficient duration. From the survey it was found
out that at times, especially during the farming season mothers were too busy
to breastfeed frequently and for sufficient length of time. As a result
children got less milk during feeding than the optimal level. Elderly men focus
group discussants at Mago reported that lack of proper follow-up of instructions
given by health personnel, unsafe se, diseases, lack of proper nutrition and
drunkardness of mothers who spent more time in drinking local brews and for
elderly men focus group discussants from Maliwa said that most of the children
lacked proper nutrition due to parent drunkardness, lack of education on health
care and nutrition and some of the family have bigger family of orphans.
At six months of age, children
need other foods in addition to breast milk to meet their nutritional needs (WHO
2000). The term used for giving other foods and drinks in addition to
breastfeeding is ‘Complementary feeding’. The foods given should ‘complement’,
and make complete the energy and nutrients provided by breast milk. This does
not mean that a 6 month child can move directly from exclusive breastfeeding to
eating exactly the same meals as the rest of the family.
Beliefs about appropriate time
of initiation of complementary feeding is seen to vary across cultures, with
the earliest incidence of complementary feeding seen in Indonesia (Kardjat
1996; Launer and Habicht 1989), where rice and mashed bananas are introduced in
the first week of life. The belief that supports this practice is that children
who are fed a meal will be more calm and sleepy, and this would help the mother
carry on with her work. Table 3.5 shows
the patterns of age of introduction to solid foods in the respective villages.
The table indicates that the majority of mothers do introduce solid foods to
their infants between four to six months. Alternatively, mothers who started
introduction of solid food between two and three months were 11 (18%), whilst
the other 11 (18%) reported to have began initiation solid food to their
infants between one and two months. 3 (5%) of mothers reported to have begun
initiation of solid food between 8 days and one month to their children In a
survey carried out in Kibaha and Makete Districts (TFNC report no. 2021 of
2005), 46.8 percent of the respondents reported that by the age of 6 months all
children had been given some kind of complementary food. The patterns of age of
introduction to solid foods in the study areas identified the months and the
type of food that has been introduced. Therefore, table 3.5, indicates the months for the respective village.
Table
3.5
Introduction
of Complimentary Food [N = 60]
|
Incidence
of malnutrition
|
Low incidence
Lupalilo
|
Medium incidence
Ikuwo
|
High incidence
Ipepo
|
Total #
|
Total %
|
|||
|
Kisinga
[n=10]
|
Mago
[n=10]
|
Nkondo
[n=10]
|
Ikuwo
[n=10]
|
Ikete
[n=10]
|
Maliwa
[n=10]
|
|||
|
8 days to <1 month
|
1
|
0
|
1
|
1
|
0
|
0
|
3
|
5%
|
|
1 month to <2 months
|
1
|
2
|
3
|
3
|
2
|
0
|
11
|
18%
|
|
2 to <3 months
|
1
|
2
|
3
|
3
|
2
|
0
|
11
|
18%
|
|
3 to <4 months
|
1
|
0
|
1
|
2
|
2
|
1
|
7
|
12%
|
|
4 to <6 months
|
5
|
6
|
1
|
1
|
3
|
6
|
22
|
37%
|
The reasons for feeding of
complementary food are to promote growth and ‘fatness’. It was also said to
help the mother do other work, especially farming as helping to reduce the time
of breast feed the child. The belief that breast feeding is time consuming is
wide spread, although in Makete, where almost 90% of the people are small
holder farmers, the time of farm and house work is longer for mothers.
Therefore, the feeding time has been reported as taking more time off farming. Cohen
et al. (1995a), in Honduras, report that mothers believed that exclusive breast
feeding (EBF) would take longer even though observational studies showed that
breast feeding and food preparation and serving took the same amount of time as
EBF for 4 to 6 months old children.
Food taboos in Makete limited
the types of food that can be offered to a child as reported by the elderly
women in the focus group discussion of Ikuwo, based on the perception that
beans would cause a delay of speech, and that children could not digest foods
available for the family if introduced before two years. This implies that
children may not have received adequate amounts of protein- and
micronutrient-rich foods until they were 2 years old, as similar study by
Rabiee and Geissler (1992) have revealed.
Many beliefs about the
termination of breast-feeding depend on characteristics of the child and the
child development. Among the reasons of termination of breast feeding in the
in-depth discussion was the onset of
walking and a perception that the child was old enough to consume an adult
diet, hence a child would be fed with left-overs of usuge with vegetable stew or maize porridge prepared before going
to the farm.
Constraints to
introduction of complimentary food
The appropriate time to
introduce complementary foods as recommended by WHO/UNICEF is at 6 months of
age when breast milk alone is no longer enough to meet the nutritional
requirements of the baby (MoH, 2004). This is the most crucial time to infants
and young children compared to any other periods in their life due to the high risk
of contracting infections particularly diarrhoeal diseases.
In the structured
observations, it was observed that mothers were feeding complementary food in a
tea cup and the mothers were not encouraging infants to eat. At the age of
about six months, infants need safe and adequate amounts of complementary foods
in addition to breast milk in order to meet their nutrient requirement for
optimal growth and development (WHO, 1994).
Mothers reported in Maliwa focus
group discussions that they lacked nutritional knowledge especially during
introduction of complementary foods. Hence, they said they did not have access
to skilled practical help from trained health workers, other service providers
and family community support groups. They reported:
“It
is the normal practice to offer complementary food to children when they grow
up. In this study, mothers reported that knowledge, belief and education
represents the core capacity of the caregiver to provide appropriate care. It
is important therefore that complementation should be timely, adequate, safe
and the feeding should be proper”. [FGD
– Maliwa]
Obstacles to introduction
of complimentary food
According to Richman (2003) many obstacles
or issues that reduced the likelihood of families adopting better child feeding
behaviors could be classified as environmental or attitudinal ones.
Environmental factors include the unavailability or seasonal variation in the
availability of certain foods, the need to work outside the home, a scarcity of
cooking fuel or poor information about child feeding given by health care
professionals.
Attitudes that prevented improvements in child feeding are
numerous. They would vary by culture, but certain issues are common: perceived
insufficient quantity or quality of breast milk; perceived inability of child
to swallow or digest particular foods or preparations; lack of maternal self –
confidence or feeling of powerlessness in the case of resistance from the
child; time constraints for food preparation and feeding; traditional rules for
food distribution within the family; and fear of spoiling the child with too
much food or special foods.
The result obtained from the research shows that the major obstacles
during introduction of complementary foods were: Women’s heavy workload was the major constraint in all villages.
Also income poverty as mentioned by
mothers with children below two years in Kisinga, Mago, Ikuwo and Nkondo who
said that they could not afford to buy nutritious food for their families. Nevertheless,
the other obstacle from women at Maliwa, were lack of time and ingredients
for food preparation. In Ikete village the other problems were in giving
supplementary foods to their babies were lack
of sustainable income, lack of resources for income generation and patriarchy system whereby only fathers
had the power of making decision on
what type of food should be fed to the baby. The mothers could not use food
items such as eggs to feed the child without the permission of the father. In
Kisinga village, mothers said that the main problems in making sure that their
babies got suitable supplementary food were lack of dairy cows hence they
lacked milk which was rich in protein and other nutrients for their babies and availability of lishe flour. Mothers from Ikuwo village said that fathers were
not responsible for ensuring their children got adequate food and care, food ingredients that was required for
preparation of lishe flour were
expensive, while mothers from Mago said that their main obstacle was lack of
agricultural inputs for example
fertilizers and seeds and also lack
of capital for starting income generating activities. Women at Nkondo
village reported lack of nutritional
knowledge such as knowledge on the best type of foods to feed their babies.
Food and Child Feeding Practices
Appropriate child-feeding
practices are age specific, and they are also defined within narrow age ranges.
They follow a continuum from exclusive breastfeeding, starting soon after
birth, to the point where the child receives the same family food as older
family member, with no special modifications or additions. Exclusive
breastfeeding practice of concern up to 6 months of age, after that the use of
complementary foods (quality, quantity, and frequency) are included. Similarly,
both the introduction of complementary foods (between 6 and 12 months of age)
and the transition from special foods to the family diet should ideally be
accomplished gradually. Thus, in order to characterize the adequacy of child
feeding practices, one needs to take into account the various dimensions of
child feeding, as well as the age-specific requirements of the child within
short time period.
Ingredients Added in Infant Food
Table
3.6 indicates
the different types of ingredients that are added in infant foods. The most
common food crop that is being grown in the study areas is Irish potatoes, and
thus it is one of the main ingredients added to infant foods, as reported by 28
(47%) of the mother respondents in the in-depth interviews. Maize flour has
been reported by 46 (77%) of mother respondents who said that maize flour is
easier to make it into porridge. Another common ingredient is beans, which was
said to add protein and other nutrients in baby’s diet, as reported by 4 (7%) of
mother respondents. Whilst, 4 (7%) mother respondents observed that finger
millet was also added to the infant food. Sugar which was the common ingredient
to most of the household, 36 (60%) mothers reported that they use sugar in the
food they prepared for their children.
Table
3.6
Types
of Ingredients used in preparation of infant food [N=60]
|
Incidence
of malnutrition
|
Low incidence
Lupalilo
|
Medium incidence
Ikuwo
|
High incidence
Ipepo
|
Total #
|
Total %
|
|||
|
Kisinga
[n=10]
|
Mago
[n=10]
|
Nkondo
[n=10]
|
Ikuwo
[n=10]
|
Ikete
[n=10]
|
Maliwa
[n=10]
|
|||
|
Maize flour
|
7
|
6
|
7
|
8
|
9
|
9
|
46
|
77%
|
|
Finger millet
|
1
|
0
|
0
|
3
|
0
|
0
|
4
|
7%
|
|
Groundnuts
|
0
|
0
|
0
|
1
|
0
|
0
|
1
|
2%
|
|
Wheat flour
|
0
|
0
|
0
|
2
|
0
|
0
|
2
|
3.%
|
|
Beans
|
0
|
0
|
0
|
2
|
1
|
1
|
4
|
7%
|
|
Vegetables
|
0
|
0
|
0
|
0
|
1
|
1
|
2
|
3%
|
|
Whole maize flour
|
1
|
1
|
0
|
1
|
0
|
0
|
3
|
5%
|
|
“Tetere”
|
0
|
0
|
0
|
1
|
6
|
6
|
13
|
22%
|
|
Irish potatoes
|
4
|
6
|
6
|
0
|
6
|
6
|
28
|
47%
|
|
Sugar
|
8
|
7
|
5
|
7
|
4
|
5
|
36
|
60%
|
|
Tea
|
1
|
0
|
0
|
0
|
0
|
0
|
1
|
2%
|
|
Yams
|
0
|
0
|
0
|
0
|
1
|
0
|
1
|
2%
|
Different type of vegetables
which were observed during the transect walk, were grown in ‘wetlands’ in
Maliwa and Ikete villages during the transect walk provided ingredients in
baby’s food for provision of energy and growth, and also reported by most
mothers in the focus group discussions in these areas. The ingredients of
groundnuts, wheat flour were obtained in shops whereby the well to do families
could buy them and add to the infant food such as Lupalilo ward. In Tanzania
During the unstructured
observation, and transect walk, vegetables were grown in most of the wetland
areas. Most of the mothers did not use frequently vegetables in the child’s
food as they said that vegetables were seasonal and that what was available in
the farms was used for the family food. Hence children were given very little
vegetable stew in their food.
Active and Responsive Feeding
Active and responsive feeding
implies the active participation of the care giver to make sure that the child
is consuming sufficient amount of food that has been offered. Active and
responsive feeding refers to the caregiver’s ability to feed responsively,
including encouragement to eat, offering additional foods, providing second
helpings, responding to poor appetite, and using a positive versus aversive
style of interaction, and the feeding situation which includes location,
organization, regularity, and frequency of feeding, supervision, and
distraction during eating events (Engle, Menon, and Haddad, 1997).
Table
3.7
Reactions
of Mother when Child Refuses to Eat [n = 60]
|
Theme
|
Behaviour
|
Reason,
Belief
|
Citation
|
|
Child refusal to eat
|
Encourage the child to eat
but not force child
|
Improve appetite
|
In-depth interviews
Lupalilo, & Ikuwo wards
|
|
Let the child eat as he/she
wished
|
Encouraged to eat more
frequent
|
In-depth interview of Ipepo
ward
|
|
|
Breastfeed the child in
place of feeding
|
Increase of micronutrients
in the body
|
Kisinga & Nkondo wards
|
|
|
Try different methods of
positive encouragement eg. Games, stories, or songs
|
Stimulate appetite
|
In-depth interview of Ikuwo
ward
|
|
|
Minimize distractions during
meals if child loses interest
|
Enable the child to
concentrate in eating
|
In-depth interview of Nkondo
ward
|
When mothers were asked what
they do when their children refused to eat, most of the respondents of Lupalilo
and Ikuwo wards reported to encourage the child to eat but not to use force.
The reason was to improve the appetite of the child. While respondents of Ipepo
ward said they would let the child eat as when he/she wished, because a child
would be encouraged to eat more frequently and increase appetite. For Kisinga
and Nkondo wards reported breastfeed the child in place of feeding other foods.
The belief is to increase micronutrients in the body of the child from mother’s
milk. Ikuwo mothers said they tried different methods of positive encourage by
means of games, stories or songs in order to stimulate appetite of the child.
Nkondo mothers reported to minimize distractions during meals if the child
loses interest. Results from several studies in developing countries suggest
that caregivers respond to responsive feeding employs different efforts to
encourage children to eat (Brown et a. 1988; Benteley et al. 1991; Almroth,
Mohale, and Latham 1997).
Constraints to Active
Feeding
Low
Income was found to be a major constrain for improving child
care and feeding practices in the study areas. As the research findings
indicated that, the majority (92%) of the mothers with children below the ages
of two years and their spouses were farmers. Few mothers (30%) in Kisinga
village were involved in petty trade and other small businesses. These
generated income which helped to reduce malnutrition, as compared to other
villages. Areas with high incidence of malnutrition of Ikete and Maliwa
villages seemed to be occupied with farming activities and they do not have any
other economic activities.
Furthermore,
in the focus group discussions with mothers of children below 2 years, when
they were asked to mention constrains in provision of complementary foods to
their children, they reported as follows:
“Low income has forced women in the areas to
resort to food with less nutrients. In this study, mothers reported that they
gave porridge with a little sugar as they do not have income to add sugar/butter/milk”[Maliwa].
“The economic
status of many people in this area is extremely poor, as such that they can not afford to buy good food, pay
for the good health services, and buy clothes for their children”[Key
Informants -Ikete].
“Low income which resulted from low
production of food crops such as maize, millet, and fruits forced mothers to
feed their children with less food, as well as lack of fertilizers to increase food
crop production”. [Elderly women - Maliwa]
This constrain was reported during
in-depth interview with mothers with children below two years. When asked if
they change the mode of feeding to a convalescence child, most of them reported
that, a convalescing child was fed the same food as a normal child. There were
no changes that were made in food pattern because of lack of money to buy
nutritious foods for the children as reported by Mago and
Ikuwo respondents in the in- depth interview ( See box
3.1)
Constraints
in feeding a convalescence child
[Focus
Group Discussion with mother’s of children <2years]
|
“I don’t have money to buy special foods for my
child even when she is sick”.
[Maliwa, Nkondo, Ikuwo Mago and Kissinga]
“I don’t have enough money to buy some important
foods to my child such as milk, eggs, meat and lishe flour. My child likes maize/millet/finger
millet porridge without milk or sugar for most of the time no matter he is
sick.
[Ikete]
“I gave her normal foods but if I could have enough
capital I could prepare nutritious food for her. Since we normally tough in
clinics to give nutritious foods to our children especially when they are
sick, but we failed due to poor economic status.
[Kisinga]
“It is difficult for me to buy special food for my
child during sickness due to lack of money, as my husband left me with all
the children (five). I don’t know where he is. I am responsible for
taking care of my children. What I am trying to do is to feed them whatever
food is available depending on the season.”
[Nkondo]
|
According to (UNICEF, 1992) hindrances to
improve child feeding practices arises from inadequate attention to the needs
and the role of women, resulting in inadequate care for pregnant women and
lactating women, were lack of education, lack of self confidence, low economic
status and heavy workload that allowed for little time for modifying practices
to improve nutrition. To be effective, programs need to improve child feeding
may have to address a range of factors affecting the care giving environment
and dynamics of the household. There are various interrelated causes of
food and nutrition problems and determinants of malnutrition, as follows:
immediate causes which are: inadequate food intake resulting from low feeding
frequency with insufficient energy, body building and protective foods and
other important food nutrients. This problem mainly affected children’s
nutrition. Frequent diseases such as malaria and diarrhoea, which resulted in
impaired digestion, absorption and utilization of the food nutrients in the body
and at the same time caused loss of appetite and thus intensify the problem of
inadequate feeding.
Also there are underlying
causes which consisted of food insecurity at any level, for
example at household, village or national level, caused by problems related to
production, harvesting, preservation, processing, distribution, preparation and
various uses of food, inadequate care for special groups for example, small
children, pregnant and lactating women, the elderly and the sick and inadequate essentials services such as health
education, water, environmental sanitation, housing and clothing. In addition, there were basic causes which arise
from poor economic situation, for example, at household, village and
national level inequitable distribution and utilization of services and other
resources and bad traditions and customs, which affected negatively the state
of nutrition particularly of women and children.
Ensuring Safety of Complementary Foods
Careful hygienic preparation
and storage of complementary foods is essential in order to prevent
contamination. Hygiene whether personal or of the environment plays an
important role in child care and feeding. Table 3.8 show the structured and
unstructured observation in the study areas. In most of the study areas the
surroundings of the houses were clean, but dust prevailed in Ipepo ward which
attracted flies to children’s eyes and skins. Children need to be washed all
the time to avoid flies. Good hygienic practise were observed in different
households especially in the low incidence areas of Lupalilo ward who have
higher income and could afford to wash their children and buy good clothes. Hygiene
of the child and the cleanliness of the child’s physical environment can affect
the incidence of diarrhoea.
Table
3.8
Considerations
while preparing foods for infants [N =
60]
|
Theme
|
Behaviour
|
Reasons,
Belief
|
Citation
|
|
Hygienic practices
|
Hands washed with soap and
water before handling food
|
Cleanliness, avoiding
cholera & diarrhoea
|
Structure & Unstructured
Observations – Lupalilo ward
|
|
Utensils washed well, dried
and kept covered
|
Avoiding diarrhoea &
stomach ache
|
Ikuwo & Mago village
|
|
|
Keeping the food in a
covered container
|
Avoiding pesticides &
insects in the food
|
Ipepo ward - Structured
observation
|
During the structured and
unstructured observations, the hygienic practices that were observed included
hand washing with soap and water before handling food. The reasons mentioned by
mothers in Lupalilo ward were for having cleanliness and avoid cholera and
diarrhoea which affect children. Mothers kept their home surrounding cleaned as
well as washing hands mostly in Lupalilo and Ikuwo wards. The washing of
utensils was also observed during the structured and unstructured observations,
but mothers in the areas of Ipepo ward washed their utensils, but were not kept
covered as they lacked a place to store utensils, as most of their kitchens did
not have locked doors. The reason for washing and keeping utensils covered was
to avoid diarrhoea and stomach ache as reported by Ikuwo and Mago village
respondents. Keeping of the food in covered container was reported as avoiding
of pesticides and insect in the food, as reported by Ipepo ward respondents as
well as in the unstructured observations.
It was observed during
structure and unstructured observations in the study areas that mothers washed
their hands after child’s defecation. Though, it was not common to wash the
hands of children with soap or rising with water. Pit latrines were available
in the study areas, hence child’s waste was disposed in the latrine. Rising of
children’s hands in a share water dish before a meal was most common in Ipepo
ward. Child growth has been associated with observational measures of
child-caregiver interaction (Barnard et al. 1989).
Availability of water services
in the household
Accessibility of water
services is detrimental to the survival and growth of children. The presence of
portable water close to the homesteads as observed in the study areas reduced
workload on the part of the women since they do not have to walk long distances
in search of water. Occurrences of the
most infectious and morbidities among children and women are due to poor water
and sanitation facilities. Based on the government date, clean and safe water
is available to 53% of the rural and 73% of the urban population, but
disruptions of supply do occur (UNICEF/WHO, 1999).
Many investigators recommend
that the quality of the home environment and the quality of the caregiver-child
interaction must be assessed through observation mean, even if the observation
is brief (Heffer and Kelly, 1994). During the structured and unstructured
observations in the study areas, water was available from the taps and rivers.
Majority of the homes had access to the nearest tap water which was situated on
the roadside after ten houses. The belief that tap water was safe was indicated
by mothers offering tap water to their children. As observed in the structured
and unstructured observations, tap water was available and adequate, most
mothers even sent their older children to bring water from the tap which made
it easier for them to tend to other household tasks.
Table
3.9
Availability
of Water Services in the Household [N =
60]
|
Theme
|
Behaviour
|
Reasons,
Belief
|
Citation
|
|
Availability of
water services in household:
·
Tap & River
|
Domestic use
|
Easily accessible & safe
|
Structure & Unstructured
observations
|
|
Un-boiled drinking water
|
Tap water is safe
|
|
|
|
Use of river water when tap
water is not available
|
To ensure that water is
available all time
|
|
|
|
Lack of water reservoirs eg.
Buckets
|
Tap water is available &
adequate
|
|
Results from Structured and
un-structured observation in all six villages in Makete District indicated that,
unhygienic practices are likely to be the cause of number of diseases including
cholera, diarrhoea, respiratory infections and others. Many children were
extremely dirty with a lot of mucus in their nose and wore very dirty clothes.
Environmental sanitation was not so bad but due to poor construction of houses
some areas were not clean.
Poor hygiene practices
observed in this District was due to poor economic status. Many families had
built their houses of low quality with poor storage facilities. Most of the
storage facilities were plastic bags, sucks and in buckets. For the case of
food remained after eating, they just left it on the pots nearby fire. For
example in low incidence area of Kisinga village other houses were grass
thatched, so during rain they leaked and polluted the hygienic environment. In
areas with medium incidence of malnutrition of Nkondo village the possibility
of contamination to occur was great as environment which was not clean which
attracted breading area for insects and vectors to reproduce.
Personal hygiene was not
practiced thoroughly. For example, hand washing before and after eating was
found to be common across areas of low incidence of malnutrition. This was highly
practiced in medium and high incidence areas of malnutrition of Ipepo and Ikuwo
villages especially after defecation or after attending a child who had
defecated. Food was not prepared in hygienic condition. This was observed in
some areas of medium incidence of Nkondo, where mothers just cooked food in
dirty pots, water was pored and rinsed partially and the cooking would
commence. Also they saved meals while children sat on the ground with a lot of
dirty utensils around. Animals were kept in the same house where people slept.
Obstacles of ensuring
safety of complementary foods
Nkondo
inhabitants’ main obstacle was a market for selling and buying of food
products. Marketing of farm produce, especially vegetables, cereals, requires
proximity to nearby markets of Mbeya or Makete districts. Yet, the distance to the
market or trading centres were very far from the villages, which rendered it
difficult for the inhabitants to have access to markets.
Factors
that the villagers perceived as leading to poverty were: drought; small farm
area; declining soil fertility; poor crop production; changing of climatic
season; and sickness. The recent increase in prizes of fertilizer and the low
and fluctuating producers’ prices worsened their situation and contributed even
more to their poverty. Death or ill-health of the male head of the household,
or the wife, had impact on the loss of labour, which lead to the decline in the
status of the household and income that lead to poverty. The same applied to
divorce, which impacted negatively to both men and women. Women in patrilineal
societies and men in matrilineal societies were adversely affected by divorce
because, in addition to the loss of labour necessary for the normal functioning
of the production unit, they lost their users' rights to the land, which was acquired
through their spouses. They must return to their original household and tried
to acquire land, but, in areas where land pressure was high, or where the
original household has very limited land resources, they might end up in
semi-landless.
Maternal Care
Providing women with prenatal,
postpartum, and delivery care by qualified health care providers was associated
with positive nutritional and health outcomes for children (WHO, 2004).
Prenatal care would help reduce many of the factors that lead to low birth
weight babies and safe delivery procedures would reduce complications of child
birth which could cause disability and death of women and their children. Fifty nine percent of mothers interviewed in the research
reported having had at least one prenatal visit at a health centre during their
most recent pregnancy; of this group, 43% had four or more visits.
Table 3.10
Place of Birth [N = 60]
|
Incidence
of malnutrition
|
Low incidence
Lupalilo
|
Medium incidence
Ikuwo
|
High incidence
Ipepo
|
Total #
|
Total in %
|
|||
|
Kisinga
[n=10]
|
Mago
[n=10]
|
Nkondo
[n=10]
|
Ikuwo
[n=10]
|
Ikete
[n=10]
|
Maliwa
[n=10]
|
|||
|
Hospital
|
4
|
6
|
5
|
3
|
6
|
7
|
31
|
52%
|
|
Health Centre
|
0
|
1
|
0
|
0
|
0
|
0
|
1
|
2%
|
|
Dispensary
|
6
|
1
|
2
|
6
|
4
|
6
|
25
|
41%
|
|
Home
|
0
|
1
|
2
|
1
|
0
|
1
|
5
|
8.%
|
|
On route to hospital
|
0
|
0
|
1
|
0
|
2
|
3
|
6
|
10%
|
Table 3.10 indicates that mothers in the study areas
were also asked where they gave birth to their children. At least 31 (52%) of
the respondents said they delivered at the hospital where there were health
facilities with the assistance of a qualified health provider, such as a
doctor, or midwife. 25 (41%) of the mothers reported having delivered at the
dispensary. For the cases of mother who delivered at home 5 (9%), were attended
by traditional birth attendants, whilst, 6 (10%) mothers delivered on their way
to the hospital. The respondents in the study areas reported that due to the
fact that the high transport costs and the long distance to the hospital
rendered it difficult for the mothers to reach for health services in time.
Table 3.11
Type of Birth [N = 60]
|
Incidence
of malnutrition
|
Low incidence
Lupalilo
|
Medium incidence
Ikuwo
|
High incidence
Ipepo
|
Total #
|
Total
in %
|
|||
|
Kisinga
[n=10]
|
Mago
[n=10]
|
Nkondo
[n=10]
|
Ikuwo
[n=10]
|
Ikete
[n=10]
|
Maliwa
[n=10]
|
|||
|
Normal
Birth
|
10
|
10
|
10
|
10
|
8
|
9
|
57
|
95%
|
|
Caesarean
operation
|
0
|
0
|
0
|
0
|
2
|
1
|
3
|
5%
|
Table
3.11 indicates the
way mothers delivered, 57 (95%) of the mothers with children
below the age of two years who were interviewed reported normal delivery.
Whilst, the remaining 3 (5%) of the reported caesarean operation. It was
eminent that most of the respondents had normal deliveries. For emergency
cases, it was reported that most of the deliveries were handled at the hospital
where there were qualified doctors and equipments which could handle such
cases. However the majority of the women reported that medical fees and the
transport costs were very high. Thus, it was difficult for most of the women to
afford high medical charges, especially for the caesarean cases.
Care to Mothers and Infant Support Systems
Table
3.12
Work
Resumed After Delivery [N =
60]
|
Theme
|
Behaviour
(What
is being practiced)
|
Beliefs,
Reasons (for doing so)
|
Citation
|
|
Work resumed after delivery
|
Three weeks
|
No support & family need
food
|
Ikete & maliwa -
in-depth interviews
|
|
Six weeks
|
No financial support from
spouse
|
Nkondo and Ikuwo – in-depth
interviews
|
|
|
Nine weeks
|
Enough time to gain strength
|
Kisinga & Mago villages:
in-depth interviews
|
|
|
Alternate child care
practices
|
Availability of alternate
caregivers
|
Enable mother to do other
roles and responsibilities
|
Kisinga & Mago –
in-depth interviews & structured observation
|
|
Father’s provision of
emotional support
|
Father sharing of household
and child care tasks
|
Ikete & Maliwa –
in-depth interviews & structured observation
|
|
|
Community support
|
To allow mother to work
without stress in the farm & house
|
Nkondo & Ikuwo –
in-depth interviews & structured observation
|
Support provided to the mother
after child birth was an important factor in affecting both the mother’s and
child’s health and nutrition. From this study it was reported that provision
made for the mothers to rest after birth varied from household to household
depended on presence of spouses, other relatives and friends to assist with
household duties and farm work. In most cases such support was lacking and
mothers often left their children of above 3 years under in the care of their
siblings or neighbouring children. Feeding
practices and child care always influenced nutrition status and well-being. One
of the most important types of social support is alternate child care (Engle
1992).
During the in-depth
discussions, mothers of Ikete and Maliwa areas of high incidence of malnutrition
reported to resume their routine work of farming and house chores after three
weeks of delivery. They said the reason was the family need food and they have
no support from their families and neighbours as they have low income which
rendered it difficult for the community to support each other. For the medium
incidence areas of Nkondo and Ikuwo mothers reported the lack of support from
spouses after delivery. The reason for resuming work after nine weeks mothers
of Kisinga and Mago reported resuming work after nine weeks, was to gain
strength and have more time to breast feed the infant. For the aspect of
alternative care mothers in the in-depth discussions and structured observation
reported the availability of alternate caregivers which enable the mother to
carry out other tasks for the family (See Table ….). Mothers of Ikete and
Maliwa said that the provision of support by father of sharing the work in the
house is essential as it provides time for the mother to breast feed and do
other house chores. Nkondo and Ikuwo mothers reported that the community
support allows the mother to do other work without stress either in the farm or
the house. For most of the mothers in Makete district resume work after 40 days
of delivery as they lack money to pay for the house girl who can assist them
with their daily activities. Most of the mothers reported carrying their
children below two years to the farm, as they do not have anybody to leave
their children with.
Constraints to Care to
Mothers and Infant Support Systems
Women workload resulted into
inadequate time for feeding young children during the first two years which was
the main cause of malnutrition. Women are often the main food producers and
undertook a disproportionate amount of work in rural arrears of Tanzania
“We really don’t
have enough time to ensure cleanliness to our children. As we wake up early try
to prepare something for breakfast quickly and then we go to the farm. So how
can we manage to ensure good hygiene to our children? You can see most of
children are dirty, with a lot of mucus in their nose, worn dirty clothes and
many more. All these are because of limited time we have to look after
them”[Mothers with children below 2 years during Focus Group Discussion at Nkondo Village
In addition to the
time spent agricultural activities women from Makete District reported that,
they were responsible for other key household tasks including fetching water
and fire wood, preparing foods, etc) as well as for many other productive and
remunerative activities. Information from those women during focus group
discussion yielded several interesting insights about the relationship between
women’s workload and child care. Women from Nkondo, Kisinga, Maliwa and Ikuwo
villages stated that; the heavy demands on their time for agricultural activities,
reduced their time to properly take care for their children including good
hygiene and feeding practices.
Obstacles to Mothers and
Infant Support Systems
Most of the respondents were ignorant about nutrition
and the contributions of food to health and human growth. Ignorance on food
requirements for a healthy growth and its preparation was a major cause of
malnutrition even in the presence of an adequate food supply. It was necessary
that basic nutrition education and information be provided at all levels of
capacity building and awareness on nutrition for all inhabitants. Such
programmes would require periodic evaluation of their effectiveness.
In the provision of the kind
of assistance do they need in order to achieve their goals on nutrition
activities, District management team came up with the insights of support to
establish food preservation factories, facilitation of nutrition, food
preservation and storage of food. The improvement of small livestock production
through increase distribution of cocks, and improve agricultural inputs and
supplies at subsidized prices, were pointed out. On the other hand, village
government leaders said, that the provision of education on good nutrition,
livestock husbandry and modern agricultural techniques. Other requested assistances on food for most
vulnerable children, medical expenses, education, clothing and housing,
agricultural inputs and supplies e.g. fertilizers, improved seeds (maize,
beans, potatoes and sunflower). Loans for running income generating activities,
improvement of the transport system, establishment of centre for orphans, build
hospital, and provision of electricity, were also sighted. Improved health
services, control of vermins, and improved irrigation system.
Care Seeking and Management of Child
Illness
Child Feeding During and After Illness
During the weaning period of
six months, children of below two years of age, often suffer from infections
like diarrhoea, measles, cold or coughs as reported by mothers in the in-depth
interviews (see table 4.8). Feeding during sickness, mothers reported
continuing or stopping breastfeeding on the belief that breast milk can cause
or worsen an illness. The other reason was the changes in amount or frequency
of feeding other foods or changes in food preparation on the perception that
some foods perceived to worsen or cause illness. Some of the mother reported
getting advice of health care providers as well as encouraging children to eat
on the perception of increasing the child appetite. The attitude was that the
child is that the diet contributes to good health. Appropriate feeding during
and after illness was important to avoid weight loss and other nutrient
deficiencies.
Some mothers in the study area
reported to change in the amount or frequency of food or breast milk on the
concept of convalescence and the need for extra feeding during convalescence.
It was also reported that the control of feeding a child after illness depended
on the control of either the mother or the child who initiates the change, on
the attitude that the child is regaining health. While mothers also reported
that mothers withhold food from children during illness, particularly during
diarrhoea (Chen 1983; Khan and Ahmad 1986; Kumar et al. 1985).
Child Illness and Medical Treatment
Perceptions about
the child’s state of health have been reported to influence decisions about
breast-feeding, particularly duration of breast-feeding. Adair and Popkin
(1996) have reported that a mother’s perception that her infant was small
increased the likelihood of her not breast-feeding, even when she had the
intent to do so before the birth of the infant. The survey
findings in Makete showed that over half of the children below 2 years of age
had suffered form various diseases, for instance when mothers were asked
whether their children had at least one disease episode since birth, 46 (77%)
of the mothers said “Yes”, while 6 (10%) said their children did not have any
diseases (See Table 3.13).
Table 3.13
Occurrence of Childhood Diseases [N=60]
|
Incidence
of malnutrition
|
Low incidence
Lupalilo
|
Medium incidence
Ikuwo
|
High incidence
Ipepo
|
Total #
|
Total in %
|
|||
|
Responses
|
Kisinga
[n=10]
|
Mago
[n=10]
|
Nkondo
[n=10]
|
Ikuwo
[n=10]
|
Ikete
[n=10]
|
Maliwa
[n=10]
|
||
|
YES
|
8
|
4
|
10
|
5
|
10
|
9
|
46
|
77%
|
|
NO
|
1
|
0
|
0
|
4
|
0
|
1
|
6
|
10%
|
Table 3.14, show that 31 (52%) of the mothers reported
diarrhoea and fever as the common diseases to their children. While 27 (45%) reported that coughing was the
main problem. Stomach ache was reported by 22 (36%), while 18 (30%) of the
respondents reported flu. 11 (18%) said their children were not sick. Vomiting
was reported by 14 (23%) of the respondents. Diarrhoea and stomach ache are
very likely to have been caused by poor hygiene. The majority of the mothers took their
children to the health facilities for treatment.
Table 3.14
Common Type of Childhood Disease [N = 60]
|
Incidence
of malnutrition
|
Low incidence
Lupalilo
|
Medium incidence
Ikuwo
|
High incidence
Ipepo
|
Total #
|
Total in %
|
|||
|
|
Kisinga
[n=10]
|
Mago
[n=10]
|
Nkondo
[n=10]
|
Ikuwo
[n=10]
|
Ikete
[n=10]
|
Maliwa
[n=10]
|
||
|
Diarrhoea
|
5
|
4
|
6
|
4
|
6
|
6
|
31
|
52%
|
|
Fever
|
7
|
5
|
5
|
5
|
4
|
5
|
31
|
52%
|
|
Cough
|
5
|
4
|
3
|
5
|
6
|
4
|
27
|
45%
|
|
Stomach ache
|
1
|
3
|
4
|
5
|
4
|
5
|
22
|
36 %
|
|
Rashes
|
1
|
1
|
1
|
1
|
3
|
3
|
10
|
17%
|
|
Flu
|
4
|
3
|
2
|
2
|
2
|
5
|
18
|
30%
|
|
Yellow Fever
|
0
|
0
|
1
|
1
|
0
|
0
|
2
|
3%
|
|
Pneumonia
|
0
|
0
|
1
|
0
|
0
|
1
|
2
|
3%
|
|
Vomiting
|
0
|
0
|
4
|
3
|
4
|
3
|
14
|
23%
|
|
Failure to breath
|
0
|
0
|
2
|
1
|
1
|
1
|
5
|
8.%
|
|
Measles
|
0
|
0
|
1
|
0
|
1
|
0
|
2
|
3%
|
|
Convulsion
|
0
|
0
|
1
|
0
|
0
|
0
|
1
|
2 %
|
Mothers in the in-depth
interviews, focus groups discussions and structured observation reported
increasing the amount of water given to a sick child, and increasing breast
milk as they believed to increase energy. Some of the mothers reported reducing
the amount of breast milk given during sickness of a child especially during
diarrhoea cases as to increase sickness. Other reasons are poor child appetite
played a major role in inadequate nutrient appetite may include monotonous
diet, lack of nutrients needed for appetite (eg., zinc), illnesses such as
fever (Neumann 1993), diarrhoea, malaria, measles, intestinal parasites,
chronic malnutrition, sores in the mouth (such as caused by teething, or
anxiety (Dettwyler 1986; 1987). Thus the caregiver’s ability to deal with child
during sickness is significant for child intake.
Constraints to care giving practices during sickness
Despite of efforts made by
health workers in providing nutrition education to some women, yet majority of
mothers in surveyed areas were not feeding their children nutritious food due
to low income status. Most of women were taught in the clinics how to feed the
child nutritious food but they don’t do that due to poverty and heavy workload.
They acquired that knowledge on how to prepare and feed the child nutritious
food. This was factor which caused malnutrition to people particularly children
in researched areas. Box 3.2
Causes
of nutrition problems in societies [Focus
Group Discussion]
|
“Due to heavy workload and
poor economic status of majority of women, we failed to feed our children
nutritious foods. We cannot blame health workers because they played their
roles in educating us but we failed”. [Ikuwo ward]
“They usually taught us how
to feed our children nutritious foods like eggs, milk, meat, vegetables and
other foods but we really unable to do so. We feed our children whichever
food was available in the family. Only rich people can afford to feed their
children nutritious foods”. [Ikete ward]
|
Further more, Kisinga
residents when asked what were the good healthy behaviours mothers should
practice to ensure good health status of the child; they revealed that, “to
ensure hygiene and cleanliness of the child including to bath him/her,
frequently, to feed him/her with clean food, to make sure the child sleeps in a
clean environment, to prepare foods in clean environment and to feed them fresh
and nutritious foods.” This was to prove that they knew but circumstances made
them unable to practices that. District planning Officer added that; nutrition
status of children changed from year to year. For example last year Matamba
ward had plenty of food yet the children were malnourished. It was observed
that, mothers had heavy workload therefore had no time to feed their children
frequently as is required.
Inadequate
food in the households was observed as the contributing factors to poor
nutrition status of majority of children in Makete District. Over 80% of
District management team, CORPS, Extension and VEOs stated that the cause of
malnutrition to young children in their District was the household food
insecurity. As the majority of people depended on their agricultural produce,
they tended to consume what was available. This resulted to inadequate and
unbalanced food to family members particularly children. Some foods become too
monotonous to children and some times refused to eat which resulted to
malnutrition. This was observed more in high incidence area of malnutrition of
Maliwa and Ikete villages. Leaders from these villages depicted that, “due to
inadequate food in many households, most of the children suffered from
kwashiorkor and marasmus”.
The
improvement of manpower in training of health personnel would improve nutrition
status of the children because there was a chronic shortage of manpower for
training, extension, and implementation of various agricultural, food,
nutrition, and public health. In each village, effective training programmes
should be developed as required, at all levels, and meaningful execution as far
as resources permitted. Required personnel in human nutrition and food production
programmes for improved food products and better human nutrition, continuous
monitoring and evaluation are essential for their necessary modification in the
light of new knowledge and changing conditions.
Obstacles to care giving
practices during sickness
Mothers often did not received
adequate support from their spouses for instance farming activities. For
example, mothers in Mago said they did most of the farm work ourselves since
our spouses are involved in timber works, as a result they had high workload,
since they had to do farm work, household activities at the same time took care
of the children. Heavy workload and poor diet, with inadequate consumption of
body building and protective foods resulted in diminished production of breast
milk for the child and loss of strength on the part of the mother.
Many
factors influenced the care of children. These included understanding of
illness, social and cultural beliefs, local resources and the family socio-economic
status. To have a measurable impact on child mortality and morbidity, there was
a need to focus more attention on health related behaviors in the home
particularly those of child caretakers. Health workers needed to understand
socio-cultural and economic environment in which caretakers operated and gave
them the most relevant and appropriate advice and support.
3.11
Roles,
Responsibilities and Capacity Concerns
In the focus group
discussants older men discussants reported that the head of the household
(father) has the responsibility of ensuring that the household expenses are met
and that he has to ensure the safety/security of the family. Although women has
responsibilities in their households, the majority said that the patriarchy
system forces them to have more responsibilities than men, such as caring for
elderly, sick people, children, and ensuring that there was food security in
the household. It ware reported by elderly women in focus But, during food
insecurity the households women reported to take up measures in order to obtain
food for the children, such as undertaking casual labour, borrow food from
neighbours and even sell what ever food was available in the store. Whilst,
older women said that the father’s role in child care was for the most part
limited to provision of food for the family and financial support to women and
children health care. It has also been reported that fathers have minimal
involvement in day-to-day care and management of children. Food provision for
the children was reported as the responsibility of both the mother and the
father in Makete district. Lack of support to care givers stimulates
malnutrition as reported by mothers that the irresponsibility of their spouses
in farming decreases food security at the household and thus children lacks
proper food.
Heavy Workloads and Limited Time
The ability of
families to adopt recommended practices and behaviours depend on having
knowledge of the benefits of a particular practice and the know-how to adapt
knowledge of a particular practice to their daily lives. However, knowledge
alone would not assure their sustainable adoption. Care provided to children,
in all its manifestations, was directly affected by the workload and time
constraints of the attending caregiver. Since children of less than 2 years
of age are cared for primarily by their mothers, a women’s workload plays a
major role in shaping the care given to a child. According to the findings of
this survey mothers with children below the ages of 2 years in Makete spent on
average 5 to 8 hours in farming activities during the farming season (refer Annex 2). The implication that
mothers neither have the time for breastfeeding and for giving their children
proper care nor do they have adequate breast milk with which to breastfeed
their children. Increased workload and breastfeeding at the same time result in
depletion of body reserves unless the mother has good balanced diet which is
far from the reality.
In addition to the time spent
on caring or managing the care of children, women reported that women were
responsible for the household tasks namely gathering wood, preparing food,
farming, fetching water and other productive activities. Focus group
discussants in the study areas had different views of the relationship between
women’s work load and child care and they are:
i)
Mothers of Ipepo ward said that the heavy work on the
household and the farm demands most of their time thus reduces the time to care
for their children.
ii)
Extensions workers in the extension workers discussion
group reported that most of the spouses in Makete district do not support their
wives in the tasks of collection of wood, water and farm work. They also stated
that women have a lot of work in agricultural tasks such as weeding, harvesting
which affects the mother’s ability to care for children.
iii)
Mothers in focus group discussions in Lupalilo ward,
reported that they do not have enough time to feed and take care of their
children, as they believe that a child need to be actively encouraged and
supervised in order to grow up healthy.
iv)
The focus group discussion of Ikuwo ward reported the
time consumption of household tasks and the agricultural work, which does not
allow them to take care of their children.
v)
Some of the mothers at Ipepo ward said that they do
not have support from their neighbours as most of them are small farmers and
have to be in the farms all the time.
The reasons indicate how mothers
in the study areas, have to work for longer hours with low agricultural
productivity. Women also performed their daily household tasks and farming,
which threaten their health and of their children. The practice of exclusive
breastfeeding has been r
Constraints of
Heavy Workload and Limited Time
Research findings show that, generally women (mothers) in Makete district spent
more (90%) of their time on economic activities than in caring for their
children. About 60% of the mothers
with children below the age of two years who participated in the in-depth
interview and focus group discussion
said that, they spent 5 to 8 hours on economic activities (mainly
farming), while some 30% claimed to spend 9 to 12 hours. The implication was
that mothers hardly have limited time to breastfeed and care for their children
properly. It was obviously that, mothers who were overloaded with work were
likely to have less time to spend for caring of young children. Thus, their
children were likely to suffer from malnutrition. It was further observed in
focus group discussion with District management team that “engagements of mothers in their agricultural activities reduce their
time to take care of their babies. This result to increased number of
malnourished children aged 2-4 years in our community”. [FGD-DMT]
Obstacles of heavy workload and time
Elderly men at Nkondo responded by saying that the causes of
malnutrition were low income in the
families which makes them difficult to obtain food and lack of education on how to prepare a balance diet. Elderly men in
Kisinga said that drinking local brew
by the parents, eating the same type of food, poor families in exchange of
other foods, delay of getting health services when ever the member of family
needs, large number of family member contributed to consumption of the
available foods, early pregnancies which reduced less care for the children,
single parent who were taking all the responsibility for the family and culture
breakdown. Ikete elderly men focus group discussants said that vermin which
destroyed some of the crops, and the storage structure or in the farm.
While, elderly men from Ikuwo responded that lack of money to buy
food, lack of education on how to prepare foods, ignorance of the parents to
ignore a certain type of foods for their children and heavy workload of the
mothers. Elderly men focus group discussants at Mago responded that lack of
proper follow-up of instructions given by health personnel, unsafe sex,
diseases, lack of proper nutrition and drunkardness of mothers who spent more
time in drinking local brews and for elderly men focus group discussants from
Maliwa said that most of the children lacked proper nutrition due to parent
drunkenness, lack of education on health care and nutrition and some of the
family have bigger family load of orphans thus why failed to accommodate them
in terms of shelter and foods.
Factors and
Determinants that Influence Child Care and Feeding Practices
There is strong evidence that
caregivers, parents and communities knowledge remain a major constraint to the
adoption of practices that would have a positive impact on children’s health
and well-being. Mother in the in-depth discussions reported that they
exclusively breast feed their infants for the first six months and the reasons
they reported were that breast milk is protective and the child to recover from
sickness. Other reasons for initiation of complementary foods to children of
below 4 months was the child’s hunger and crying, as well as breast milk was
inadequate. Effective communication strategies need to be developed at the
district and community level with objective and involvement of partners from
all sectors. Proper evaluations of programmes will identify successful interventions
and identify successful interventions and their specific conditions for their
success and their cost. The impact of these strategies will depend largely on
their close monitoring and evaluation, and documentation and dissemination of
experience.
Communication strategies
cannot overlook the importance of establishing effective communication
mechanisms to support positive nutrition and health behaviours. Behaviour
change is not, however, simply an issue of providing caregivers with correct
information. Certain conditions and enabling factors that cut across sectors
must exist for change to be effective and sustainable. They include social
support systems, reduced workloads and time savings from heavy labour
productivity and access to financial productive resources. There is evidence
that mothers work and child care demands complete women’s time. Innovative
strategies to increase adequate child care options for women need to be tested.
Actions may include community day care centre, increase men’s role in child
care and sharing of work within the household. The lessons and methods used by
successful projects to develop effective, transparent management structures in
community organizations must be documented and disseminated so that they can be
replicated in village and community development programmes.
Recommendations for Respondents on Current
Child Feeding Practice
Recommendations from Mothers of Children below
2 years old
- Knowledge on the improvement of feeding of children specifically on
how to prepare and identify food rich in nutrients. This was reported by
mothers who had low levels of knowledge on nutrition.
- Special women programmes need to be initiated for income generating activities in order to raise the household income that would enable women to afford child feeding care of their children.
- Provision of free clinic services, hence mothers could send their sick children and themselves to the clinics for medical services.
- Donors and government need to provide fertilizers and agricultural inputs at subsidized prices to enable mothers who are small farmers to increase food production for consumption by their families and sell to increase household income.
- Mothers need support from spouses and other family members to ensure that children receive proper care and nutritious foods.
- Women should be assisted in other activities such as farm work, and house chores especially in times of care and feeding children. While pregnant mothers should get enough care and support from their families and community members.
Recommendations from Elderly women
- Donors need to provide training on poultry farming to women for raising household income and improve nutritious status of children and mothers.
- Parents should ensure the cleanliness and good hygiene of surroundings and provide food, clothes, shelter and ensure that their children sleep at the right time.
- Government and donors need to provide training on the preservation
and processing of vegetables and fruits for consumption during off-seasons
and selling, as the way of improving nutritious status of women and
children under 2 year of age, as well as for raising the income of the
household.
i.
Government need to ensure that mothers and children
need to get proper treatment for their illness so that their bodies are strong
and healthy.
ii.
Government should provide transport facilities to
enable mothers, children and pregnant women to reduce the walking distances to
the hospitals.
iii.
Extension staff needs to be motivated with working
gears such as bicycles, weighing scales, gloves, monitoring cards, in order to perform
their tasks efficiently and effectively.
iv. Improvement of health services on child feeding and
care on the immunization and vaccination services to children below 2 years
old.
v. Government and donors need to provide support on
training and seminars on family planning, preparation of nutritious food, child
care, child feeding practices as well as printing of information materials such
as brochures, fliers, and leaflets that will provide more knowledge to mothers
with children below 2 years old.
Recommendations from Village Government Councils [VGC],
Village Health Workers [VHW], Extension
Workers and Community Workers
i.
The government should provide training to extension
staff on health, nutrition, agriculture and child caring as a way of ensuring
that they provide best services to the mother and children, as well as the
community.
ii.
Government need to motivate Community Health Workers,
with allowances when conducting seminars for mothers with children below 2
years of age, in order to implement their duties efficiently.
iii.
Village government leaders should be educated on
nutrition and child care issues so that they can solve some nutrition problems
at their own levels, as the knowledge would enable them to identify nutritional
problems in their areas.
Recommendation by Government officials
(District level)
i.
Government and donors should provide agricultural
inputs at subsidized prices to enable mothers produce more food crops for their
families, in order to increase food security in the household.
ii.
Women should be supported financially by the
government by ensuring that soft loans are obtained by women at a low level of
interest. This will encounter the problem of income generating activities which
would help women to improve their livelihoods.
iii.
Government and donors need to provide for health
centres, and dispensaries in each village. Thus women will reach for the health
services at the shortest period.
iv.
Working equipments and trainings should be provided to
the respective extension workers for effective and efficient of provision of
assistance to the mothers, children and community.
v.
Village leaders should be educated on the nutrition,
health and child care issues so that they can identify health issues as with
regards to children below 2 years of age.
vi.
Government and donors need to improve roads to ensure
the ease of communication for mothers to reach the health care centres in time,
and markets for selling and buying of food mothers and their families,
especially for Ipepo ward.
Recommendations from Key Informants
- Village Authorities need to formulate by-laws which would cater for
the caregivers and parents who are not responsible for upbringing of
children. As most of the mothers have to take the burden of child care on
their own.
- Government and donors need to support NGOs which serves children in
the villages in order to ensure that they carry out their work on child
care and feeding of children under 2 years old efficiently.
- Government should build a market at Ipepo ward to reduce the long walking distances for mothers to sell and buy commodities for their families.
Conclusion
In this research, the term
“caregiver” has been used and sometimes “mother”. Most of the time, the
caregiver is the mother, but other females in the household also provide care.
In this study the mother is the caregiver for a child below 2 years of age, and
continues to be assisted by other caregivers when the child gets older. In
virtually every culture, women are the primary providers of food, as well as
the primary caregivers for children (Rogers and Youssef 1988). It is usually
women who shop, prepare, and distribute the food for family meals, and women
who provide the basic nurturing and caregiving activities for children, such as
feeding, cleaning, dressing, attending to illnesses, and keeping a watchful eye
on the children’s activities. As the classic paper by Weisner and Gallimore
(1977) illustrated, in many cultures, siblings (primarily females) begin to be
major caregivers when children are beyond one or two years of age.
Women’s time
in direct child care has been found to decline precipitously as a child moves
from breast-feeding and infancy status to walking, during the second year of
life (Ho 1979; Cassidy 1987) although they may continue to supervise the care.
When infants are ill, older female siblings may increase time in child care
(Pitt and Rosenzweig 1990). When women are employed, care may be provided by
others without supervision. Men also pr vide some care, although it tends to be
holding and carrying rather than physical care (Engle and Breaux 1994). In Nepal Pakistan
[Extracted from a report by GAD Consult, titled "Formative
Research on Nutrition and Child Care Practices” Makete District. UNICEF’s ECD Programme. GAD Consult – January 2007]
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