Complementary feeding knowledge and practices of health care personnel in Primary Health Care facilities in West Rand Health District

Abstract

Background: The United Nations Children’s fund (UNICEF) regard the complementary feeding period (6 – 24 months of age) as critical to ensure optimal child health, growth and development (UNICEF, 2019:2). Inadequate and inappropriate complementary feeding practices are identified as one of the key determinants of the high rates of stunting as well as overweight and obesity that is currently prevalent among infants and young children in South Africa (NDoH, Statistics SA, SAMRC & ICF, 2017:27). The provision of adequate and appropriate complementary feeding education and counselling by health care personnel to mothers/caregivers of infants and young children in Primary Health Care (PHC) facilities is considered to be one of the key strategies to improve complementary feeding practices at household level (Mushaphi et al., 2015:99). Even though there is limited recent studies on the knowledge and practices of health care personnel on complementary feeding practices, some resources have been able to identify selective provision of education and counselling on complementary feeding practices, and the communication of inaccurate and inconsistent complementary feeding messages to mothers/caregivers of infants and young children (Matlala, 2017:6). The aim of this study was to determine the knowledge and practices of health care personnel regarding the provision of adequate and appropriate complementary feeding education and counselling to mothers/caregivers of infants and young children in PHC facilities in West Rand Health District (WRHD). Objectives: The objectives of this study were to determine the knowledge of health care personnel with regard to adequate and appropriate complementary feeding practices as stipulated in the Road to Health Booklet (RtHB)/Side-by-Side booklet. Secondly, to assess the current practices of health care personnel in providing adequate and appropriate complementary feeding education and counselling to mothers/caregivers of infants and young children. The final objective was to compare the knowledge and practices of clinical and non-clinical health care personnel on the adequate and appropriate complementary feeding education and counselling provided to mothers/caregivers in line with the promotional messages in the RtHB/Side-by-Side booklet. Methods: This study was an observational study with a descriptive cross-sectional design that employed a quantitative approach to determine and assess the knowledge and practices of health care personnel with regard to complementary feeding education and counselling in PHC facilities in WRHD. The study population included health care personnel who regularly engage with mothers/caregivers of infants and young children aged 6 – 24 months (complementary feeding period) in 23 PHC facilities in WRHD. Health care personnel included in the study were professional nurses (PNs), enrolled nurses (ENs), enrolled nursing assistants (ENAs) (clinical health care personnel), and community health care workers (CHWs), lay counsellors, health promoters (HPs) and mentor mother counsellors (MMCs) (non-clinical health care personnel). Health care personnel excluded from the study were community district dietitians and medical practitioners. Participants were required to complete a pre-tested knowledge and practices questionnaire (Only available in English) that was developed based on the complementary feeding promotional messages in the RtHB/Side-by-Side booklet. Main findings: The total mean knowledge score on adequate and appropriate complementary feeding for health care personnel in the present study was only 44% (SD 18), despite the fact that the majority of them (77%; n=85) indicated that they have received some form of training on infant and young child feeding (IYCF). Clinical health care personnel achieved a higher knowledge score compared to non-clinical health care personnel [53 (46, 60)% vs. 33 (20, 47)%, p<0.001]. Knowledge regarding the correct age for the introduction of complementary foods, recognition that animal foods and mashed legumes are examples of appropriate complementary foods, identification of food sources rich in Vitamin C and food safety principles were good. However, knowledge regarding meal frequency, meal quantity, identification of food sources rich in Vitamin A, recommended drinks/milk in the complementary feeding period and responsive feeding practices was generally poor. Although the majority of health care personnel reported that they ‘routinely’ give complementary feeding advice (77%; n=86 ), complementary feeding education and counselling was mostly provided to pregnant women only (63%; n=70) and when baby is 6 months old (50%; n=56). Only 31% (n=34) of health care personnel reported that they utilise routine well-baby visits for the provision of complementary feeding education and counselling. The RtHB was the most common (67%; n=74) reported source of information on IYCF. Conclusion: Although health care personnel working in PHC facilities in WRHD do provide education and counselling regarding complementary feeding, mostly during pregnancy and when the infant is six months old, the overall mean knowledge score in this study was low. The non-clinical health care personnel achieved the lowest scores and areas of particular concern included meal frequency, meal quantity, recommended drinks/milk from 12 months of age, Vitamin A rich sources of complementary foods and responsive feeding practices. This study highlights the need to improve the knowledge and practices of health care personnel pertaining to adequate complementary feeding. Capacity can be built by providing regular refresher trainings on adequate and appropriate complementary feeding practices, with emphasis on meal frequency, meal quantity, recommended drinks/milk from 12 months of age, Vitamin A rich sources of complementary foods and responsive feeding practices. Furthermore, routine provision of complementary feeding education and counselling, not only to pregnant women but also to mothers/caregivers with infants and young children up to two years of age should be emphasised, and the particular barriers for not providing routine education should be identified and addressed.