Academic journal article Journal of Health Population and Nutrition

Barriers to Infant and Child-Feeding Practices: A Qualitative Study of Primary Caregivers in Rural Uganda

Academic journal article Journal of Health Population and Nutrition

Barriers to Infant and Child-Feeding Practices: A Qualitative Study of Primary Caregivers in Rural Uganda

Article excerpt


Worldwide, 6.9 million children below the age of five years died in 2011, and 33% of these deaths are linked to malnutrition (1). The number of children who die from malnutrition-related problems in developing regions of the world, such as sub-Saharan Africa, is more than those in developed regions (1,2). In Uganda, malnutrition is one of the major public-health problems affecting infants and children. The prevalence of malnutrition among Ugandan children below the age of five years is estimated at 40%, and most of the malnourished children live in rural households (3). In Uganda, like other developing countries, childhood malnutrition is compounded by other prevalent diseases, such as malaria, diarrhoea, and pneumonia and these synergistically impact child health, leading to lifelong effects or death (4-7).

Malnutrition in infants/children also leads to psychosocial problems, such as impaired mental and physical development, reduced educational achievement, increased morbidity, and more time and money spent on taking care of sick children due to frequent morbidity (8,9). Therefore, the sequelae and risks associated with malnutrition have significant implications for the wellbeing of the family and future quality of the population in a country where the affected infants/children live (10,11). To address the problem of malnutrition in infants/children, one has to address the contributing factors and causes.

Leading authorities, such as the World Bank and the World Disaster Report, have identified the core factors that contribute to malnutrition in infants/children to be: foods used; infant and young childfeeding practices; barriers faced by caregivers; and availability of support resources (12,13). The current study focused on the barriers that prevent primary caregivers living in rural areas from using appropriate infant and young child-feeding practices (IYCFP). The IYCFP that were addressed are those related to breastfeeding and complementary feeding of infants in the age-group of 0-24 month(s).

Primary caregivers play a key role in feeding of infants/children and ultimately in their nutritional outcomes (8,14). In Uganda, the responsibility of childcare and nurturing is left to the mother but because of social situations, such as maternal death, teenage pregnancy, and work responsibilities, some infants/children are cared for by other female caregivers (aunts, grandmothers, and others). Many times, the primary caregivers experience several barriers which prevent them from adopting appropriate IYCFP and ensuring good nutrition outcomes for the infant/child. The common factors that influence nutrition outcomes of infants/ children include socioeconomic status of the family, literacy levels, influence of relatives, and access to safe nutrient-rich complementary foods (15-19).

Unfortunately, many years of research and policy initiatives in sub-Saharan Africa have not effectively curtailed the prevalence of infant/childhood malnutrition (20). Some of the reasons behind the persistence of malnutrition in infants/children could be our limited understanding of the barriers faced by caregivers in rural areas where the majority of affected infants and children live. The purpose of this study was to explore the barriers to the use of appropriate IYCFP by primary caregivers of infants aged 0-24 month(s) living in a rural Ugandan district.


We conducted community-based focus group discussions (FGD) with primary caregivers to gain a comprehensive understanding of barriers to the use of appropriate IYCFP. Primary caregiver in this study is defined as any adult female person who is responsible for the day-to-day care and wellbeing of an infant/child between the age of 0 and 24 month(s), including biological mothers, grandparents, aunts, and others in cases where the biological parents are deceased or unavailable. A qualitative descriptive approach was adopted because it was found to be most suitable in generating a comprehensive initial understanding of the barriers to IYCFP in rural settings. …

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