Maternal Time Use Drives Suboptimal Complementary Feeding Practices in the El Niño-Affected Eastern Ethiopia Community
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Area and Setting
2.2. Study Design
2.3. Study Participants and Inclusion Criteria
- Health Development Army leader (a volunteer woman who leads a group of 25 to 30 women responsible for delivering health messages in rural Ethiopia) for their insights from a education provider perspective;
- Mother or father of children less than two years of age for their insights into the direct impacts of El Niño on caregiving and child-feeding practices;
- Traditional birth attendant who has insights into cultural knowledge related to child feeding; and
- Religious leader for their unique insights into community problems.
Participant Recruitment
2.4. Data Collection
2.5. Data Analysis
3. Results
“A different food is prepared when a child gets sick or malnourished. I buy potatoes, carrots, beetroots, cabbages, and other vegetables when only the child gets sick. Even during illness, the varieties of the foods I give the child depends on the seasonal availability.”
“The child feed on family foods after six months. I give him injera, a cereal-based food made from sorghum with some stew. We have been given orientation on how to prepare child foods from 16 ingredients of all varieties. However, we cannot afford it. Therefore, we make child food with limited ingredients. The better-off family’s babies can have bottle-feeding.”
3.1. Suboptimal Complementary Feeding from Limited Food Access
“Our villagers used to have cows, milk and milk products, sheep, and small-scale poultry. Though some households still own some, the last four-drought years have brought deadly livestock diseases that resulted in a significant loss, hence access to animal-based foods. Haramaya University has provided us with four heifers and a bull for our village.”
“The main harvest season of our major food crop, sorghum, is in February. We rely on it for three to six months (June). However, the last three years were tough. We purchase food for most months of the year. Previously, lower levels of child undernutrition occur which peak from July to September. Now, large numbers of children are affected by undernutrition throughout the year.”
3.2. Altered Livelihood and Coping Strategy
“The Khat, the primary cash crop in our community, has dried from prolonged drought. Besides, food produced from my ever-decreasing plot of land is estimated at two quintals, and it cannot sustain my nine household members. So, like any other communities members, I travel to the nearby cities/towns to work as a daily laborer. Some people get government assistance, and in the current state, most people need it.”
“We eat twice a day, in the morning and evening. The children also eat less and act fussy due to a lack of regular feeding. When children become irritable, they are given little food to calm them down.”
“In difficult seasons, we sell our cows, even when they are about to have a calf, sell our sheep and goats to buy food. Families who do not have these assets work as daily laborers by travelling to nearby towns like Dire Dawa, Awaday and Harar.”
“Children have a recurrent illness with swelling of their body. The health professional told us a food shortage caused it and gave us plumpy nut (a supplementary therapeutic food for malnourished children). The child gets undernourished because, in our community, the women leave the child at home in the morning and return in the afternoon to bring some food for the family.”
“Family members staying away from home (males) come home to nearby towns visits their family frequently when they are daily laborers or monthly when they are employed on a monthly basis.”
“If the mother is away from home, my first-born child girl is in charge of child care. She prepares and feeds the child. In my previous experience, my mother was living with me, and she used to care for my older child. However, now my daughter can handle it. I have never tried preparing the child food.”
3.3. Maternal Time Use and Father’s Involvement
“Compared to males (household heads), who have a better opportunity to eat first at home or get food from somewhere else, women usually serve their family breakfast at 7 AM, leave the house to bring food, return at 1 PM, breastfed their child, and prepare the food. Other family members could lend a hand to the women.”
“Children like to get food regularly, at 10 AM, 11 AM, 12 AM, 3 PM, and more. Mothers do not afford to feed this way. We used to feed children milk and eggs in good years, which they could no more do. Mothers neither prepare separate food for children as they leave home in the morning and return in the afternoon. Time limit them.”
“Child feeding is the primary responsibility of a woman. The male has to work and bring food home. But, he does not have anything to bring from the farm. I believe my child should be fed when hungry; hence, I probably ask the mother whether the child has had food or tells the mother to feed the child if the child cries. Otherwise, I have never cooked the child food nor attended its preparation at home or publicly.”
“During and after pregnancy, the husbands do not bother whether the women/ the child have food. Unless a woman cares for herself, she does not get suggestions on the food. However, husbands are supposed to ask about the food and should have cared more.”
“I have two kids. When my wife gives birth, I support her, and she gives what the child needs. The child gets only if the women get. For instance, if the woman drinks water, the child gets water; if the woman gets balanced food, so is the child. One thing that we can’t erase from our minds is giving water early, shortly after birth and butter from around four months.”
“In the afternoon, we go to the market or farm to protect crops from wild animals such as monkeys; hence, we do not have time to prepare child foods. Instead, older children look after the child, prepare and feed in the afternoon, and we prepare the food in the evening. One of the concerns for our absence is that older children share child food.”
“Every household has its own problems.… Women have extra burdens. Family members expect us to do everything. Even husbands do the same.”
3.4. Community Health Services Circumstances during El Niño
“All women must give birth at the health facility. We encourage and support them to start breastfeeding immediately. …Concerning colostrum, there are two types of colostrum. The one that older babies get from their pregnant mother [with a narrow birth spacing] and the newborn gets from his mother at birth. The one that the baby feeds on after birth is clean and good. The one that the child feed on while the woman is pregnant has water that causes swelling of the head and nutritional deficiency.”
“I have received orientation in multi-mix complementary food preparation and shared it with women in my group. However, they use it briefly and stop it due to lack of awareness, necessary ingredients, lack of knowledge and skills, and other women are tired of processing it separately from family foods.”
“The children get malnourished both when we feed breastmilk alone and also after we start giving other foods. If we have two young children in the same house and feed them the same type and amount of foods, one can get malnourished while the other remains normal. The malnourished child gets better after receiving the treatment. So, I think the problem might be with the mother. If the family failed to provide the child with better foods, the child would return to the clinic with malnutrition within three or four months.”
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Frequency | |
---|---|---|
Sex | Male | 25 |
Female | 51 | |
Age | 18–25 | 20 |
25–35 | 34 | |
More than 35 | 22 | |
Study Participants | Women development army leaders | 23 |
Mother of children less than two years | 20 | |
Fathers of children less than two years | 15 | |
Traditional birth attendants | 11 | |
Religious leaders | 7 |
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Irenso, A.A.; Letta, S.; Chemeda, A.S.; Asfaw, A.; Egata, G.; Assefa, N.; Campbell, K.J.; Laws, R. Maternal Time Use Drives Suboptimal Complementary Feeding Practices in the El Niño-Affected Eastern Ethiopia Community. Int. J. Environ. Res. Public Health 2022, 19, 3937. https://doi.org/10.3390/ijerph19073937
Irenso AA, Letta S, Chemeda AS, Asfaw A, Egata G, Assefa N, Campbell KJ, Laws R. Maternal Time Use Drives Suboptimal Complementary Feeding Practices in the El Niño-Affected Eastern Ethiopia Community. International Journal of Environmental Research and Public Health. 2022; 19(7):3937. https://doi.org/10.3390/ijerph19073937
Chicago/Turabian StyleIrenso, Asnake Ararsa, Shiferaw Letta, Addisu S. Chemeda, Abiyot Asfaw, Gudina Egata, Nega Assefa, Karen J. Campbell, and Rachel Laws. 2022. "Maternal Time Use Drives Suboptimal Complementary Feeding Practices in the El Niño-Affected Eastern Ethiopia Community" International Journal of Environmental Research and Public Health 19, no. 7: 3937. https://doi.org/10.3390/ijerph19073937