Protocol study about Infant feeding practices in relation to socioeconomic factors in Yaoundé in Cameroon
Linnea Lundstrom* and Frida Johansson *
Background
Breastfeeding, and specifically exclusive breastfeeding, for a certain period of time is connected with gains involving natural growth and development of the baby (1). The mother’s milk contains all the essential nutrients and also antibodies for the baby’s protection while the immune defence develops. Introducing other foods too early is putting the baby at risk for infection due to the existing pathogens, such as bacteria and viruses (for example the human immunodeficiency virus, HIV), and possible damage to the GI-tract. Furthermore breastfeeding is important for the neurological development of the baby and also the bonding between mother and child.
Colostrum, the breast milk produced at the end of pregnancy and the first milk to come out, is recommended by WHO as the optimal food for the newborn, and feeding should preferably be initiated within the first hour after birth (2). Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. Mixed feeding, compared to exclusive breastfeeding, during the first 6 months of life is associated with increased morbidity and mortality in infants (3).
WHO defines exclusive breastfeeding as feeding a child only with breast milk and no additional supplementation such as water, cow milk, juices or solids (2). In a study reviewing the cultural barriers to exclusive breastfeeding in Cameroon, mixed feeding was a common practice (4). It was noted that 93 % supplemented water respectively 62, 5 % food within the first six months. Almost 40% gave additional water within the first three weeks. The principles of mixed feeding are believed to be common in much of rural Africa.
Because of the importance of an optimal feeding regime for infants, studies have to be made on reasons for using mixed feeding. This subject involves understanding the social, cultural, habitual and information-bound-aspects of choosing feeding regime.
Aims
The aim of this study is to describe infant feeding practices in Yaoundé and to explore believes and thoughts regarding infant feeding among mothers from different socioeconomic groups in Yaoundé and Bandja (rural area) in Cameroon.
Method
In order to do a well composed qualitative study, quantitative data will also be collected, this data will, for example, contain information about the sources of counseling for the lactating women and what this counseling consists of. Time wise, the data will be collected in Cameroon during a period of two months.
The qualitative data will be collected through focus group discussions, as used in a study by L. T. Fadnes et al (3), consisting of lactating women from Yaoundé and surrounding areas, depending on the feasibility. If made possible both rural and urban areas, as well as high and low socioeconomic groups, will be included. The women will be contacted in the hospital when attending vaccination for their babies. They are then asked to attend a focus group discussion involving the subject of infant feeding. The questions will be phrased in a way so that the informants can expand their answers and not in any sense feel restricted.
Separate meetings will be arranged with the different groups and discussions are lead by us, when English is used, otherwise by an interpreter, and/or the native supervisor present. Irrespective of the language used, we will be present and notes will also be taken by us during the discussion. The text produced will further be translated when necessary from French or local dialects to English and transcribed into a full text. The data will be analyzed using qualitative content analysis as described by Granheim et al (5). This content analysis can be used focusing on either the manifest or the latent content of the discussions, proceeding from each discussion group as one unit of analysis. The text transcribed from the units will be analyzed in two levels, the individual groups and for all groups united. Meaning units will be extracted, condensated and coded. The meaning units will further be divided into categories. From this conclusions will be made and discussed.
Importance of the study
With this study we hope to contribute to the knowledge about infant feeding in Cameroon. The results might be used to increase awareness and develop counseling for individuals and communities on the subject of nutrition for children.
Ethics
The participation in the focus group discussions will be voluntary and the participants will be informed that the results are confidential, and that they, at any point, can withdraw their participation in the study. They will also be informed that the discussion will be auditaped. No specific setting/area will be mentioned in the article. To show our gratitude towards the women attending, small gifts will be given to them. To ensure that the participation is vonulary, this compensation will be given to the women after rather than before participation. The compensation will not be mentioned beforehand. The interview questions will be developed regarding choice of words and phrasing to ensure that they are well received and that the risk of misunderstandings are minimized.
To obtain an objective point of view thoughout the study and give a fair picture, we will consult our tutors on subjects of incertainty. To us it is important not to judge, but to remember our aim to increase awareness and understanding about infant feeding practices in Cameroon.
