Exclusive breastfeeding and risk of malnutrition in children: the healthcare provider-led education in Mwanza, Tanzania

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Background: Malnutrition continues to pose a significant threat to children's survival, growth, and development. It manifests in various forms, including stunting, wasting, overweight, and underweight. Furthermore, exclusive breastfeeding protects children from gastrointestinal infections and promotes healthy weight gain, which in turn helps reduce the risk of malnutrition. Healthcare providers are crucial in the prevention & reduction of malnutrition by providing ongoing support during the maternal sequence of care and through the provision of nutritional health-related education. Objective: This study aims to determine the relationship between exclusive breastfeeding and malnutrition, and to triangulate healthcare providers' practice in delivering health education to reduce malnutrition. Methodology: Five hundred mothers with their children aged 6-24 months and 15 healthcare providers were recruited for the study. Bayesian logistic regression with three Markov Chain Monte Carlo (MCMC), 10,000 iterations, and non-informative priors was performed to assess the association between exclusive breastfeeding and malnutrition, with 95% credible intervals used to assess statistical significance. Result: In this study, only 18% of mothers reported exclusive breastfeeding in the first 6 months, and the overall prevalence of malnutrition was 27.8%. After adjusting for marital status and the mother's education, we obtained the non-significant lower odds of malnutrition among exclusively breastfed children compared to babies who are not exclusively breastfed (OR = 0.9, 95% CI:0.7-1.1). Based on health education sessions observed, healthcare providers rarely discussed breastfeeding position, exclusive breastfeeding, food and general hygiene, and early recognition of danger signs among children. Overwhelming workload and shortage of staff were common challenges mentioned by healthcare providers. Conclusion: In this study, more than a quarter of children aged 6-24 months were found to have malnutrition, with exclusive breastfeeding being a rare practice among participants. This highlights the need for continuous feeding support through nutritional education sessions to promote exclusive breastfeeding among postnatal women. However, limited nutritional education talks on nutrition, breastfeeding, hygiene, and recognition of early signs of illness were provided by healthcare providers due to reported health system operational challenges. This could explain the gap observed among postnatal mothers on exclusive breastfeeding practice, hygiene, and recognition of early signs of illness.

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