A theory-based nutrition education intervention to promote optimal breastfeeding practices and healthful dietary practices among lactating women in Nekemte City, East Wollega, Ethiopia

The promotion of optimal breastfeeding practices is a simple and effective, strategy for improving infant nutritional status and reducing infant mortality rates globally. Furthermore, the promotion of healthful dietary practices among breastfeeding women is critical as dietary practices during lactation influence the health and nutritional outcomes of the nursing dyad. In Ethiopia, infant and child undernutrition and mortality rates remain unacceptably high despite impressive breastfeeding rates, and the dietary practices of breastfeeding women have been described as poor and inadequate. Thus, there is a need for continuous and sustained promotion of optimal breastfeeding practices and healthful dietary practices of breastfeeding women in Ethiopia. Community-based nutrition education interventions (NEI) are effective strategies to promote breastfeeding and healthful dietary practices, however, they are not widely implemented in Ethiopia. Purpose: The purpose of this study was therefore to 1) assess the breastfeeding practices, the dietary practices, and the nutritional status of mothers and their infants ages 0-21 months and 2) design and implement a nutrition education intervention to promote optimal breastfeeding and healthful dietary practices of breastfeeding women in Nekemte city, East Wollega Zone, Oromia Region of Ethiopia.
Methods: The study was conducted in two phases: a baseline assessment and a Nutrition Education Intervention (NEI). A total of 316 women and 185 infants (185 mother/infant pairs and 131 pregnant women) participated in the study. The NEI was based on the Theory of Planned Behavior (TPB) to motivate and educate mothers on optimal breastfeeding practices and healthful dietary practices during breastfeeding. The NEI was implemented by using a two-arm cluster randomized controlled trial design. The primary outcomes of the intervention were: changes in breastfeeding knowledge, nutrition knowledge, and TPB constructs (breastfeeding intentions, breastfeeding attitudes, perceived breastfeeding support, and perceived breastfeeding control). The Intervention Group (IG) received a one-day 5 hours intervention on breastfeeding and nutrition during breastfeeding while the Control Group (CG) received a 30-minute education on water, sanitation, and hygiene (WASH) and COVID-19 awareness. All data collected from this study were analyzed using descriptive statistics, linear mixed models, and generalized linear models. All analyses were processed with Statistical Package for the Social Sciences version 28.0 (SPSS 28.0) and R (Version 4.1.2). Results: Most of the mothers (96.2%) initiated breastfeeding and the rates of early initiation of breastfeeding, exclusive breastfeeding, and continued breastfeeding were 86.5%, 42.9%, and 90.3% respectively. About 43.9% of the mothers were food insecure. Most of the mothers achieved the minimum dietary diversity (MDD) (82.7%). Food insecurity, income, education, employment, making changes to the diet during lactation, vitamin A supplementation, feeding experiences, and daily vitamin/mineral use were the factors associated with meeting the MDD. Average dietary nutrient intake of energy, protein, vitamin A, vitamin C, thiamine, riboflavin, calcium, and iron among breastfeeding mothers was inadequate. Most of the mothers (64.3%) had normal body mass index (BMI), while 10.3% were underweight. About a quarter of the infants (25.4%) were stunted, 11.9% were underweight, 11.4% were wasted, and 5.4% were overweight. The odds of being underweight were lower among infants whose mothers achieved the MDD. After the intervention, nutrition knowledge, breastfeeding knowledge, breastfeeding intentions, breastfeeding attitudes, perceived breastfeeding support, and perceived breastfeeding control all increased significantly in the intervention and the control groups. Conclusion: Important conclusions that have implications for maternal and child health were derived from this study: Less than half of the mothers practiced exclusive breastfeeding, the average dietary intake of key nutrients was low among breastfeeding mothers, and mothers achieving the minimum dietary diversity were at reduced odds of having underweight infants. The results of the intervention suggest that community and theory-based nutrition education interventions are effective strategies for enhancing women’s motivation to practice optimal breastfeeding and to eat healthfully.

Embargo status: Restricted until 06/2172. To request the author grant access, click on the PDF link to the left.