Sociodemographic factors associated with mixed feeding practices among a cohort of mothers with infants aged 4-14 weeks in Tlokwe sub-district

Abstract

Background: The first-ever Lancet Series on breastfeeding has unequivocally established that breastfeeding (BF) is a cost-effective investment that contributes to a smarter, healthier and a more thriving future for the world. Globally, only one in three infants younger than six months of age are exclusively breastfed, and this rate (37%) has not improved for the last two decades. The mixed feeding (MF) practices in infants less than six months of age may shorten BF duration and expose the infant to increased risk of morbidity and mortality. The timely and adequate introduction and use of complementary feeding is important for optimal infant development and growth. In South Africa, more especially in the North-West Province, little is known about infant feeding practices of infants younger than 14 weeks. Aim: To identify the MF practices in a cohort of mothers with infants aged 4-14 weeks, in the Tlokwe sub-district of North West Province, South Africa. Objectives: The objectives were to determine the MF practices of a cohort of mothers with infants aged 10-14 weeks in the Tlokwe sub-district; secondly, to determine the association between sociodemographic factors and MF in a cohort of mothers with infants aged 10-14 weeks; and finally, to compare changes in sociodemographic factors and infant feeding practices from 4-8 weeks to 10-14 weeks in a cohort of mothers with infants aged 4 -14 weeks in the Tlokwe sub-district. Methodology: This sub-study formed part of a larger study that was a prospective cohort study designed to follow mothers from the early BF period (day 3-14) through to the infant age of 20-24 weeks. The recruitment was done in eight health facilities of the Tlokwe sub-district. One hundred and fifty-nine mothers with infants aged 4-14 weeks consented to complete a sociodemographic tool and a repeated 7-day infant feeding and food frequency questionnaire. Data was collected at 4-8 weeks and 10-14 weeks. Data was analysed using SPSS version 25.0 (IBM, USA). Normally distributed data was expressed as means ± standard deviation (SD) and skewed data was expressed as median (25th, 75th percentiles) values. Chi-square tests and logistic regression were used to analyse the association between sociodemographic factors and MF practices at time point two (10 -14 weeks). Results: Although the majority of mothers were not married, 89.3% reported being in a stable relationship, but only 28.9% lived with the father of their infant. While the majority (80.5%) of mothers had some level of high school education, 75.5% were unemployed. Most households reported an income of R3000 or less. Approximately half reported having received mobile health (mhealth) messages from MomConnect. At the age 10-14 weeks, 86.2% of the infants were breastfed with low exclusive breastfeeding (EBF) rates (38.5%), while 20% were mixed fed with formula milk. Of those who were MF (61.5%), 36.7% were mixed fed with water, while 15.6% were mixed fed with food only. Of the sociodemographic factors that were investigated, there was a significant association between parity and MF (p=0.003). There was a significant change with child support grants from time point 1 (4-8 weeks) to time point 2 (10-14 weeks) and infant feeding practices (p=0.009). Conclusion: A high proportion of mothers practiced MF, which increased with infant age. In line with literature, MF remains a common practice in South Africa. The majority of mothers mixed fed with water, less than expected mixed fed with formula and even less with food. At 10-14 weeks, there was a positive association or MF only with parity and access to the child support grant increased the risk for MF.