Traditional oral remedies and perceived breast milk insufficiency are major barriers to exclusive breastfeeding in rural Zimbabwe.

Only 5.8% of Zimbabwean infants are exclusively breastfed for the first 6 mo of life despite substantial investment in exclusive breastfeeding (EBF) promotion throughout the country. We conducted a survey of 295 mothers of infants <6 mo of age who were recruited from rural immunization clinics and outreach sites in the Midlands Province of Zimbabwe. We explored infant feeding knowledge, beliefs and attitudes, and details regarding facilitators for EBF mothers and first foods fed by non-EBF mothers to identify and understand barriers to EBF. Among mothers of infants <1 mo, 1 to <2 mo, and 2-6 mo of age, 54%, 30%, and 12%, respectively, were practicing EBF. In adjusted multivariate analyses, EBF practice was positively associated with belief in the sufficiency of EBF (P = 0.05), belief in the avoidance of cooking oil feeding (a common traditional practice) in the first 6 mo (P = 0.001), and perceived pressure from others regarding infant feeding and traditional medicine use (P = 0.03). Psychosocial support and viewing breast milk as sufficient were reported as primary facilitators of EBF practice. Maternal responses to open-ended questions identified protection, nutrition, and crying as the main reasons for EBF interruption. During the first 2 mo of life, "protection feedings" using traditional oral remedies (such as cooking oil and water) to prevent or treat perceived illness, specifically colic and sunken/depressed fontanel, made up 78.5% of the non-breast milk feeds. From the second month of life, "nutrition feedings," mainly of water and porridge, were given when mothers believed their breast milk was insufficient in quantity or quality to meet the hunger or thirst needs of their infants. Our findings underscore the importance of exploring cultural beliefs and practices as they pertain to infant feeding and care and present insights for designing and targeting EBF promotion interventions.

Desai A ，Mbuya MN ，Chigumira A ，Chasekwa B ，Humphrey JH ，Moulton LH ，Pelto G ，Gerema G ，Stoltzfus RJ ，SHINE Study Team ... -  《-》

Determinants of exclusive breastfeeding among mothers of infants aged 6 to 12 months in Gwanda District, Zimbabwe.

Mundagowa PT ，Chadambuka EM ，Chimberengwa PT ，Mukora-Mutseyekwa F ... -  《International Breastfeeding Journal》

Barriers and Opportunities for Improved Exclusive Breast-Feeding Practices in Tanzania: Household Trials With Mothers and Fathers.

Matare CR ，Craig HC ，Martin SL ，Kayanda RA ，Chapleau GM ，Kerr RB ，Dearden KA ，Nnally LP ，Dickin KL ... -  《-》

Using community volunteers to promote exclusive breastfeeding in Sokoto State, Nigeria.

Qureshi AM ，Oche OM ，Sadiq UA ，Kabiru S ... -  《-》

Addressing social barriers and closing the gender knowledge gap: exposure to road shows is associated with more knowledge and more positive beliefs, attitudes and social norms regarding exclusive breastfeeding in rural Zimbabwe.

Exclusive breastfeeding (EBF) is rarely practiced despite its significant child survival benefits. A key constraint to increasing EBF rates in Zimbabwe and most of the developing world is that key decision makers (fathers/partners and other family members) are often poorly informed about EBF and do not attend antenatal clinics where health information is routinely provided. Informed by formative research, a district-wide campaign was conducted in rural Zimbabwe to encourage EBF and expressing and heat treating (EHT) breast milk as a means to maintain EBF. The campaign combined traditional strategies of education, counselling and outreach through health service delivery with a novel road show 'edutainment' intervention to reach men and other community members. A post campaign evaluation measured the association of road show exposure with 20 knowledge items and summative scores of social norms, beliefs and attitudes obtained through exploratory factor analysis. In adjusted models, road show exposure was associated with correct EBF knowledge (β=1.0, 0.001), EHT knowledge (β=1.3, P<0.001) and greater perceived benefits of condom use during pregnancy and breastfeeding (β=0.5, P<0.001), and more positive EBF social norms (β=0.6, P<0.001), EBF beliefs and attitudes (β=1.0, P<0.001) and attitudes towards condom use during breastfeeding (β=0.6, P<0.001). Road show exposure was more strongly associated with EBF knowledge among men (P-value for gender×exposure group interaction=0.03), suggesting that it also closed the knowledge gap between men and women. Longitudinal studies will determine whether road shows were associated with changes in EBF practices.

Jenkins AL ，Tavengwa NV ，Chasekwa B ，Chatora K ，Taruberekera N ，Mushayi W ，Madzima RC ，Mbuya MN ... -  《-》