A Path Analysis to Identify Factors Influencing the Provision of Water in Addition to Breast Milk by Mothers of Infants under Six Months of Age in Conakry and Kindia Regions, Republic of Guinea

Nèmanan R Ninamou,Noël-Marie Zagré,Mamady Daffé,Sonia Blaney,Jérémie B Dupuis

doi:10.6000/1929-4247.2021.10.04.1

Nèmanan R Ninamou, Noël-Marie Zagré + Show 3 more

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https://doi.org/10.6000/1929-4247.2021.10.04.1

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Abstract

Water provision to infants under six months of age (IU6M) can hamper exclusive breastfeeding (EBF). Understanding factors and their relationships influencing this practice is needed to tailor EBF promotion programs. Using a validated questionnaire, this study aims to identify pathways in which individual factors and the environment interact to affect the provision of water in addition to breast milk among 300 mothers of IU6M. Our finding shows that 75% of mothers intended to provide water in addition to breast milk to their IU6M and that about 60% reported doing it. Results of the final path show that the subjective norm/SN (β = 0.432, p < 0.001), the attitude (β = 0.349, p < 0.001), and to a lesser extent the perceived control/PC (β = 0.141, p = 0.005) predict the intention of mothers to provide water in addition to breast milk to their IU6M. The environment scores predict the attitude (β = 0.210, p = 0.001) and the SN (β = 0.284, p < 0.001). Having the mother practicing early breastfeeding initiation at birth positively predicted the PC score (β = 0.157, p = 0.017) and predicted an increasing score of SN (β = 0.221, p = 0.003). Even though predicting the final behavior is complex, this research provides directions to nutrition education programs to tailor their content to the context and be more efficient in reducing the proportion of women providing water to their IU6M, hence contributing to the improvement of EBF.

Highlights

Breastfeeding is a cost-effective, proven public health intervention with significant positive impacts on child morbidity and mortality while providing health benefits to mothers
Using an extended version of the theory of planned behavior [23], this study aims to identify pathways by which individual factors and the environment interact to affect the provision of water to infants under six months of age in addition to breast milk
This research used the extended theory of planned behavior to identify pathways in which individual factors and the environment interact to influence the provision of water by mothers to their infants under six months of age in addition to breast milk

Summary

Introduction

Breastfeeding is a cost-effective, proven public health intervention with significant positive impacts on child morbidity and mortality while providing health benefits to mothers. Individual and environmental factors determine the mother's decision to provide water to their baby under six months, not exclusively breastfeeding [4, 5]. To address the provision of water to infants under the age of 6 months, it is essential to understand the underlying factors of this practice for effective behavior change interventions [6]. Behavioral theories are of valuable use to investigate which factors, either individual or environmental-related, determine the provision of water [7]. One practice that undermines exclusive breastfeeding is the provision of water to babies aged below six months. In the Republic of Guinea, 35% of children under six months are provided water in addition to breast milk, a practice that may be detrimental to their nutritional and health status and development [3]

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