P3.100: Maternal Perceptions and Infant Feeding Practices: A Survey of Postnatal Women from a Community Hospital in Malawi

Background: Lack of exclusive breastfeeding (EBF) is a strong predictor of infant mortality rate, and nearly half of child deaths under 5 years globally are due to undernutrition. The World Health Organization (WHO) recommends breastfeeding within 60 minutes of birth and EBF for the first 6 months of life for optimal nutrition. However, EBF rates are less than 40% in children under 6 months in low- and middle-income countries (LMICs). In Malawi, EBF rates begin declining at 3 months of age based on a recent national survey. Thus, the objectives of this study are to gain insight into breastfeeding knowledge, beliefs, and practices among mothers in a suburban district in Malawi to identify gaps in education or support that may contribute to decreases in EBF.

Methods: A prospective survey was designed to query 50 postpartum women in Area 25 Community Hospital in Lilongwe, Malawi. Questions encompassed demographics, breast milk knowledge, breastfeeding perceptions, infant feeding practices, household diet diversity, food insecurities, maternal mental health, and key neonatal outcomes (Table 1). Local data collectors administered surveys verbally in Chichewa or English at three time points: upon enrollment at < 20 weeks gestation, within 48 hours after delivery, and 4-6 weeks postpartum. IRB approval was obtained from participating institutions, and survey results were recorded via REDCap.

Results: Based on preliminary survey responses (n = 32), the average maternal age is 24.81 +/- 5.18 years old with partial or completed secondary school education (Table 2). Most respondents listed their occupation as homemaker or housewife (19/32, 59.4%) with a median annual household income of $460.83 U.S. dollars. Less than half of individuals have electricity in their homes (15/32, 46.9%), and about one-third have access to indoor tap water (12/32, 37.5%). Predominant maternal attitude towards breastfeeding is “mostly positive” on a Likert scale, and the primary breastfeeding concern is low milk supply. Regarding breast milk knowledge, mothers are more aware of the benefits of breastfeeding for infants than the benefits for mothers. From mothers who have delivered, almost all initiated breastfeeding within 60 minutes of birth (13/14, 92.9%), and the majority even within 30 minutes (10/14, 71.4%). Data collection from all time points is ongoing simultaneously.

Conclusion: This cohort of women in central Malawi have positive attitudes and a high establishment of breastfeeding within the first hour of life. Knowledge about breastfeeding and anticipatory education to help promote supply can be improved. Additionally, 4-6 week postpartum data may elucidate the later decline in EBF. Maternal knowledge, attitudes, and support may offer insights into initiatives to enhance WHO-recommended EBF in LMICs. Future avenues include improving breastfeeding education and enhancing breastfeeding support.