AN EXAMINATION OF INFANT FEEDING PERCEPTIONS AND PRACTICES AMONG WOMEN IN YAOUNDÉ, CAMEROON

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

The impact of malnutrition on child morbidity and mortality has been extensively recorded (WHO. UNICEF. UNFPA. UNAIDS, 2019). Maternal and child undernutrition are projected to be the root cause of 3.5 million fatalities, accounting for 35% of the disease burden among children under the age of 5 (WHO, 2018). Among various interventions aimed at enhancing child survival, exclusive breast-feeding for the initial 6 months and continued breast-feeding for at least 12 months have demonstrated a significant impact on decreasing mortality rates associated with primary causes of childhood death, including hypothermia, hypoglycemia, diarrhoea, pneumonia, and neonatal sepsis. Nonetheless, the role of nutrition is frequently overlooked in the context of maternal, newborn, and child health (Doherty et al., 2022). The fundamental challenges of nutrition are perceived as complex to address, as they frequently intertwine with cultural factors, and no pharmaceutical intervention, vaccine, or product can alter human behaviour [Johnny, 2017]

The World Health Organisation (WHO, 2018) advocates for exclusive breastfeeding in the initial six months of a child's life to ensure optimal growth, development, and health outcomes. Breastfeeding is recommended to persist for a duration of two years or beyond, while nutritionally sufficient, safe, and suitable complementary foods ought to be introduced starting at six months to address the changing developmental requirements of the growing infant.

The choice of a woman to begin and persist with breastfeeding is shaped by her perspective on the practice, along with the breastfeeding beliefs held by important figures in her life, such as her mother, older sisters, and other close senior females (Kimani-Murage, 2019). Nevertheless, certain aspects of this information could potentially lead the mother astray, as they might not be grounded in empirical evidence. Nevertheless, these perceptions persist in shaping the breastfeeding and weaning practices of numerous mothers. Should a woman recognise that her breast milk sufficiently nourishes her infant and that breastfeeding is both convenient and beneficial for her child's health, she is likely to develop a favourable disposition towards the practice (Demirci et al., 2015). Nonetheless, the surrounding attitudes may hinder her attempts to breastfeed. The factors that shape a mother’s intention to breastfeed and wean differ significantly across countries and are deeply rooted in the prevailing cultural context. In Western societies, the practices surrounding women's breastfeeding exhibit distinct differences when compared to those found on the African continent or in Eastern regions. In Western contexts, it has been observed that fathers play a significant role in the decision-making process regarding infant feeding methods, serving as either crucial supporters or obstacles to the mother's choice to breastfeed. In numerous instances, mothers face challenges in effectively initiating and sustaining breastfeeding in the absence of emotional backing from their partners (Demontigny et al., 2018).

In Western societies, there exists a prevalent sentiment that public breastfeeding is deemed unsuitable (Amir, 2014). Studies indicate that in Western contexts, there exists a notable apprehension surrounding breastfeeding in public areas. This concern is exacerbated by the societal challenge of distinguishing between the sexual and biological functions of the breast, leading to a perception of public breastfeeding as shameful (Obeng, Dickinson, & GolzarriArroyo, 2020). The portrayal of breastfeeding in the media significantly contributes to the notion that public breastfeeding is deemed inappropriate. Positive representations of breastfeeding in television, film, and other public spaces can significantly contribute to normalising perceptions across various societies (Scott, 2011).

Kavitha, Nadhiya, and Parimalavalli (2014) contend that when breast milk fails to sufficiently satisfy the nutritional requirements of the infant, it is essential to incorporate complementary foods into the child's diet. While numerous mothers grasp the importance of breastfeeding, some remain less knowledgeable about the advantages of breastfeeding and the process of weaning. Anoshirike et al. (2014) observed that malnutrition among infants in Nigeria arises from various inappropriate child-feeding practices. These include the delayed introduction of complementary foods, insufficient energy and nutrient density in the foods provided, limited meal quantities, cultural restrictions on food, as well as factors like low birth weight and elevated morbidity rates.

In Cameroon, especially in urban centres such as Yaoundé, the practices surrounding infant feeding are influenced by a blend of cultural beliefs, contemporary healthcare guidelines, and socioeconomic conditions. The World Health Organisation (WHO) promotes the practice of exclusive breastfeeding during the initial six months of life, subsequently recommending suitable complementary feeding while maintaining breastfeeding for a duration of up to two years or beyond (WHO, 2020). In Yaoundé, a multitude of factors plays a role in determining women's adherence to these recommendations, as the interplay between traditional and modern perceptions significantly influences feeding behaviours (Nguefack et al., 2016).

The cultural views regarding breastfeeding and complementary feeding are notably influential in Yaoundé. A significant number of women continue to follow traditional practices inherited from previous generations, which may occasionally clash with medical recommendations (Tchoumi & Ngongang, 2020). For example, certain communities hold the belief that breast milk by itself does not adequately fulfil the nutritional requirements of infants, resulting in the premature introduction of water, herbal remedies, or solid foods (Nana et al., 2017). The approach of mixed feeding, although prevalent, frequently heightens the likelihood of infants encountering infections, particularly in regions where access to clean water and sanitation is restricted (Ngwa et al., 2021). Furthermore, there exist notions regarding the necessity to eliminate colostrum—the initial milk produced following childbirth—due to perceptions of it being impure or detrimental to the newborn. The traditional perceptions significantly shape infant feeding practices, especially in urban environments where contemporary healthcare recommendations exist yet are frequently overlooked due to cultural influences (Chuwa & Yiga, 2020).

Researchers in the field of health communication have explored the impacts of attitudes and perceptions from diverse viewpoints (Rejeski & Fanning, 2019). Numerous frameworks have been developed to elucidate the ways in which these variables impact behavioural intentions. The Health Belief Model, the Theory of Planned Behaviour, and the Integrated Model of Behavioural Prediction are notable frameworks that have been proposed to examine the perceptions and attitudes influencing individuals' choices to either adhere to or deviate from established routines (Schiavo, 2014).

Recent research indicates that maternal influences, including limited educational attainment, infections, diverse socio-cultural dynamics, and dietary restrictions, are primarily linked to child undernutrition and elevated mortality rates among children under five years old worldwide (Maviso, Ferguson, Kaforau, & Capper 2021). Previous research has been conducted to explore the knowledge, attitudes, and practices related to breastfeeding among mothers, as documented by Akwara in 2015. The findings highlight the importance of evaluating maternal experiences within particular socio-cultural contexts and considering the beliefs of mothers that are prevalent in relation to health behaviours, as outlined by the Health Belief Model (Kuzma, 2013). This research aims to investigate the perceptions and practices surrounding infant feeding among women in Yaoundé, Cameroon.

1.2 Statement of the Problem

The practices surrounding infant feeding in Yaoundé, Cameroon, represent a significant public health issue, as they play a vital role in shaping the nutritional and developmental trajectories of children. Despite the global recommendations set forth by the World Health Organisation (WHO) highlighting the critical role of exclusive breastfeeding during the initial six months of life, compliance with these guidelines continues to be inadequate in Yaoundé (WHO, 2020). Conventional notions surrounding breastfeeding, coupled with insufficient understanding of contemporary infant feeding guidelines, lead to a variety of feeding practices that may not consistently adhere to health recommendations (Nana et al., 2017). Numerous mothers commence the introduction of complementary foods, water, or other liquids prematurely, frequently influenced by cultural beliefs that breast milk alone is inadequate. This practice heightens the risk of malnutrition and infections in infants (Tchoumi & Ngongang, 2020; Lartey, 2017). This deviation from established guidelines highlights a more extensive issue in which cultural practices clash with medical recommendations, ultimately jeopardising the health of infants.

Alongside cultural beliefs, socioeconomic factors play a crucial role in influencing infant feeding practices in Yaoundé. A significant number of mothers, especially those belonging to lower-income households, encounter financial limitations that hinder their ability to practise exclusive breastfeeding and provide optimal complementary feeding (Nguefack et al., 2016). The obligation to resume professional duties, alongside the scarcity of supportive breastfeeding workplaces and economical childcare options, compels numerous women to initiate formula or alternative food sources sooner than advised (Tawiah et al., 2019). The economic pressures, alongside the pervasive marketing tactics employed by formula companies, create significant challenges for mothers as they navigate their choices regarding infant feeding (Ndiaye et al., 2018). Moreover, the swift urban development in Yaoundé presents women with a blend of traditional and contemporary values, leading to ambiguity and varied feeding practices (Ngwa et al., 2021). The convergence of economic challenges and diverse cultural factors leads to an increased occurrence of malnutrition, stunting, and adverse developmental outcomes in infants within the urban environment.

Healthcare institutions and providers navigate a multifaceted role in addressing infant feeding practices, frequently encountering challenges in reconciling cultural beliefs with medical guidance. In spite of the presence of healthcare services, numerous women in Yaoundé encounter irregular or insufficient guidance regarding breastfeeding and complementary feeding (Tchoumi & Ngongang, 2020). In certain instances, health professionals may not possess the necessary training or resources to adequately convey the significance of exclusive breastfeeding and assist mothers in understanding appropriate feeding practices (Nguefack et al., 2016). Furthermore, the impact of elders and extended family frequently takes precedence over healthcare guidance, resulting in mothers adhering to traditional practices that may not correspond with evidence-based recommendations (Nana et al., 2017). The gap between healthcare professionals and the communities they serve highlights the necessity for culturally aware and focused interventions that can assist mothers in making informed choices about infant feeding in Yaoundé. This research seeks to tackle these challenges.

1.3 Objectives of the study

The primary objective of this study is to critically examine the infant feeding perceptions and practices among women in Yaoundé, Cameroon. Specific objectives of this study are to:

1. To identify the common perceptions and beliefs surrounding infant feeding practices among women in Yaoundé

2. To examine perceived factors influencing the initiation and duration of breastfeeding among women in Yaoundé

3. To determine perceptions concerning health outcomes of infants related to the feeding practices employed by their mothers

4. To evaluate perceived challenges women face in adhering to recommended infant feeding practices, particularly in urban settings

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

1. 1. 1. What are the common perceptions and beliefs held by women in Yaoundé regarding infant feeding practices?

      2. What factors do women in Yaoundé perceive as influencing the initiation and duration of breastfeeding?

      3. How do women in Yaoundé perceive the impact of their infant feeding practices on the health outcomes of their children?

      4. What challenges do women in Yaoundé perceive as barriers to adhering to recommended infant feeding practices, particularly in urban settings?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: There are no significant perceptions and beliefs surrounding infant feeding practices among women in Yaoundé

Ha: There are significant perceptions and beliefs surrounding infant feeding practices among women in Yaoundé.

1.6 Significance of the study

This research is of considerable importance to various parties, as it investigates a crucial element of public health and child development in Yaoundé, Cameroon. Comprehending the views and behaviours related to infant feeding among women in this area is essential for enhancing the health and welfare of both mothers and their infants. The results of this study will provide an important resource for healthcare practitioners, policymakers, and public health entities aiming to tackle the nutritional requirements of infants and the difficulties mothers encounter in following suggested feeding guidelines. The knowledge acquired will guide the creation of programs and interventions that are attuned to cultural nuances, with the objective of enhancing infant feeding practices, thereby fostering improved health outcomes for children and decreasing instances of malnutrition and stunting.

This study offers valuable insights for healthcare providers, especially midwives and paediatricians, by enhancing their comprehension of the cultural and socioeconomic factors that shape infant feeding choices among women in Yaoundé. The study will assist these experts in customising their guidance and strategies to more effectively resonate with the values and customs of the populations they support. This may result in enhanced communication approaches, greater compliance with suggested feeding methods, and ultimately, better health outcomes for infants. Furthermore, decision-makers can leverage the insights to formulate and execute strategies that promote breastfeeding and suitable complementary feeding practices, including the establishment of supportive work settings for breastfeeding and the extension of maternity leave to facilitate exclusive breastfeeding.

This study will also provide valuable insights for public health organisations and international bodies focused on child nutrition and maternal health, including UNICEF and the WHO. The results will aid in the enhancement of initiatives and strategies designed to advocate for exclusive breastfeeding and suitable infant feeding practices. This research will assist these organisations in pinpointing deficiencies in their existing methodologies and refining their strategies to more effectively address the needs of women in Yaoundé, guaranteeing that interventions are grounded in evidence and culturally pertinent. The findings of this study will enhance our comprehensive understanding of the obstacles and supports related to effective infant feeding practices in urban Cameroon, fostering beneficial transformations at both local and national scales.

The research will yield significant benefits for mothers and families in Cameroon, as the results will aid in the development of community-focused initiatives that respect their cultural values while enhancing infant feeding practices. This study seeks to shed light on the impact of family members, especially elders, on the establishment of feeding practices, thereby promoting more informed and supportive environments for nursing mothers.

This study will be of significant interest to students and researchers, as it enhances the existing knowledge on maternal and child health in Cameroon. The study will provide a foundational reference for subsequent investigations into infant feeding practices, the impact of cultural influences on health behaviours, and the effectiveness of public health interventions. For students engaged in the fields of public health, nutrition, or anthropology, this study presents essential insights into the interplay between cultural beliefs and healthcare practices, enhancing their academic comprehension and equipping them with practical knowledge for their future professions. Scholars interested in investigating infant nutrition, child development, and health promotion within comparable frameworks will have the opportunity to expand upon the findings, allowing for the creation of more thorough and focused studies. This study, consequently, offers potential for enhancing both theoretical and practical understanding in the domains of maternal and child health.

1.7 Scope of the study

Broadly, this study focus is to critically examine the infant feeding perceptions and practices among women in Cameroon. Empirically, the study will explore the common perceptions and beliefs surrounding infant feeding practices among women in Cameroon, perceived factors influencing the initiation and duration of breastfeeding among women in Cameroon, perceptions concerning health outcomes of infants related to the feeding practices employed by their mothers and health in Cameroon and perceived challenges women face in adhering to recommended infant feeding practices, particularly in urban settings

Geographically, the study will be carried out in Yaoundé, Cameroon.

1.8 Limitations of the study

During the examination, the researchers carefully examined the inherent limitations that are present in all human behaviours. One of the main challenges we faced was the lack of extensive scholarly research on the subject. A notable factor that contributed to the issue was the limited data available regarding an examination of infant feeding perceptions and practices among women in Yaoundé, Cameroon. Given the task at hand, it was quite demanding to find the required materials, books, or information and organise the data, requiring a significant investment of time and effort.

In addition, the study's findings may be constrained by the small number of participants and the limited scope of the research, which mainly revolves around Yaoundé, Cameroon. Therefore, the findings of the study have limited practical implications, highlighting the need for further research.

In addition, the individual experienced significant constraints due to financial constraints. As a student with limited financial resources, they had to carefully navigate these constraints throughout their study. The exorbitant transportation fees at the research site proved to be a significant hindrance in meeting the financial obligations tied to travel expenses.

Furthermore, the person had a packed schedule due to their scholarly obligations, including attending lectures and participating in a range of educational pursuits.

1.9 Definition of terms

Exclusive breastfeeding: Exclusive breastfeeding (EBF) refers to the practice of giving an infant breast milk only up to the age of six months, except for oral rehydration solutions or drops/syrups of vitamins, minerals or medicines.

Complementary feeding: Complementary feeding has been defined as “the process starting when breast milk alone is no longer sufficient to meet the nutritional requirements of infants, and therefore other foods and liquids are needed, along with breast milk.

---

---