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Barriers to Compliance to Exclusive Breastfeeding and Timely Introduction of Complementary Feeding Practices in Ethiopia

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Barriers to Compliance to Exclusive Breastfeeding and Timely Introduction of Complementary Feeding Practices in Ethiopia BARRIERS TO COMPLIANCE TO EXCLUSIVE BREASTFEEDING AND TIMELY INTRODUCTION OF COMPLEMENTARY FEEDING PRACTICES IN ETHIOPIA by MESFIN TESFAY TEKLE submitted in accordance with the requirements for the degree of MASTER OF PUBLIC HEALTH at the UNIVERSITY OF SOUTH AFRICA SUPERVISOR: PROF LM MODIBA November 2015 Student number: 45 100 365 DECLARATION I declare that BARRIERS TO COMPLIANCE WITH EXCLUSIVE BREASTFEEDING AND TIMELY INTRODUCTION OF COMPLEMENTARY FEEDING PRACTICES IN ETHIOPIA is my own work and that all the sources that I have used or quoted have been indicated and acknowledged by means of complete references. 28 November 2015 SIGNATURE DATE (Mesfin Tesfay Tekle) BARRIERS TO COMPLIANCE WITH EXCLUSIVE BREASTFEEDING AND TIMELY INTRODUCTION OF COMPLEMENTARY FEEDING PRACTICES IN ETHIOPIA STUDENT NUMBER: 45 100 365 STUDENT NAME: MESFIN TESFAY TEKLE DEGREE: MASTER OF PUBLIC HEALTH DEPARTMENT: HEALTH STUDIES, UNIVERSITY OF SOUTH AFRICA SUPERVISOR: PROF LM MODIBA ABSTRACT This study aimed at exploring Barriers to compliance with exclusive breastfeeding and timely introduction of complementary feeding practices in Ofla District, Tigray Region in Ethiopia. A quantitative exploratory descriptive study was conducted to explore and describe the barriers that restrict mothers /caregivers to comply with exclusive breast feeding practice until six months and with introduction of solid, semi-solid and soft foods at six months in Ofla District. Data were collected using structured questionnaire, from a total of 112 samples of which 75 mothers and care givers with children aged 0-5 months and 38 children aged 6-8 months participated. The data were entered into a computer and analysed though the Statistical Package for Social Sciences (SPSS) software. The findings revealed that there are barriers related Doer mothers and Non-Doer mothers perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived self-efficacy, cues for actions, perceived social acceptability and positive and negative attitudes towards exclusive breastfeeding and initiation of complementary feeding. On the other hand, the participant’s perception of both groups with regard to perception of Divine (God’s) Will on two child feeding practices was insignificantly the same. Both groups perceived that children could get sometimes malnourished because of spiritual or supernatural causes. KEY WORDS Exclusive breastfeeding; initiation of complementary feeding; perceived susceptibility; Perceived severity; Perceived action efficacy; perceived social acceptability; perceived self-efficacy; cues for action: perception of Divine Will, positive attributes. ACKNOWLEDGEMENTS I would like to express my deepest gratitude to my advisor Prof LM Modiba, for her continued advice, expert guidance and concerned supervision. This study would not have been possible without her continuous supervision and valuable input My thankfulness goes also to Sebele Hailu, for she has been the very source of my inspiration to join this programme. To all the participants of this study in Ofla District, Tigray Region, Ethiopia who volunteered to share personal and emotional information. I thank you all. Dedication This dissertation is dedicated to my wife, W/ro Birikti Habte, for her persistent love, support and encouragement during the course of this study. In addition, my love goes to my daughters, Lina (who is still with us spiritually) and Hilina, and my son Samuel, whose patience and understanding was kindling light of courage that helped me to uphold my work to the end. i Table of Contents CHAPTER 1 ............................................................................................................................... 1 ORIENTATION TO THE STUDY ................................................................................................ 1 1.1 INTRODUCTION ...................................................................................................... 1 1.2 BACKGROUND OF THE STUDY............................................................................. 1 1.3 PROBLEM STATEMENT ......................................................................................... 3 1.4 AIM OF THE STUDY................................................................................................ 4 1.4.1 Research objectives ................................................................................................. 4 1.4.2 Research questions ................................................................................................. 5 1.5 SIGNIFICANCE OF THE STUDY ............................................................................. 5 1.6 DEFINITION OF CONCEPTS AND TERMS ............................................................ 5 1.6.1 Conceptual definitions .............................................................................................. 5 1.6.2 Operational definitions .............................................................................................. 7 1.7 FOUNDATION OF THE STUDY .............................................................................. 9 1.8 RESEARCH DESIGN AND METHODS.................................................................. 11 1.8.1 Paradigm ................................................................................................................ 11 1.8.2 Research design .................................................................................................... 11 1.9 SCOPE OF THE STUDY ....................................................................................... 12 1.10 STRUCTURE OF THE DISSERTATION ................................................................ 12 1.11 CONCLUSION ....................................................................................................... 12 CHAPTER 2 ............................................................................................................................. 13 LITERATURE REVIEW ............................................................................................................ 13 2.1 INTRODUCTION .................................................................................................... 13 2.2 INFANT FEEDING PRACTICES, TRENDS AND CONSEQUENCES .................... 14 2.2.1 Infant feeding practices .......................................................................................... 14 2.2.2 Trends of infant feeding practices globally, in Ethiopia and in the study Region, Tigray ..................................................................................................................... 15 2.2.3 Consequences of sub-optimal infant feeding practices ........................................... 16 2.3 THEORY OF BARRIER ANALYSIS AND INFANT FEEDING PRACTICES ........... 16 2.3.1 Theory of barrier analysis ....................................................................................... 16 2.3.2 Barriers to exclusive breast feeding and complementary feeding practices ............ 18 2.3.2.1 Perceived-social acceptability in contrast with exclusive breast feeding and complementary feeding practices ........................................................................... 19 2.3.2.3 Negative and positive attitudes in contrast with exclusive breast feeding and complementary feeding practices ........................................................................... 25 ii 2.3.2.4 Perceived-severity, perceived susceptibility and perceived action efficacy versus exclusive breast feeding and complementary feeding practices .................. 28 2.3.2.5 Cues for action in contrast with exclusive breast feeding and complementary feeding practices .................................................................................................... 29 CHAPTER 3 ............................................................................................................................. 32 RESEARCH DESIGN AND METHODS ................................................................................... 32 3.1 INTRODUCTION .................................................................................................... 32 3.2 RESEARCH DESIGN ............................................................................................. 32 3.3 RESEARCH METHOD ........................................................................................... 33 3.3.1 Sampling ................................................................................................................ 33 3.3.1.1 Population .............................................................................................................. 33 3.3.1.2 Sampling ................................................................................................................ 34 3.3.1.2 Sample ................................................................................................................... 36 3.3.2 Data collection........................................................................................................ 37 3.3.2.1 Data collection approach and method .................................................................... 37 3.3.2.2 Development and testing of the data collection instrument ..................................... 38 3.3.2.3 Characteristics of the data collection instrument ..................................................... 38 3.3.2.4 Data collection process .......................................................................................... 39 3.3.2.5 Ethical considerations related
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