Exclusive breastfeeding : mothers' awareness and healthcare providers' practices during antenatal visits in Mvomero, Tanzania : a thesis presented for the partial fulfilment of the requirements for the degree of Master of Science in Human Nutrition at Massey University, Auckland, New Zealand

Chronic child malnutrition is high in developing countries such as Tanzania where approximately 42% of children below five years are stunted as a result of chronic malnutrition. Exclusive breastfeeding (EBF) may give the best start as an effective strategy to protect infants from malnutrition which causes 60% of infant deaths worldwide. Therefore, intentions to breastfeed, feeding practices decided and antenatal visits give a prime opportunity to provide counselling to ensure optimal practices. The aim of this study was to assess the awareness of exclusive breastfeeding among first time pregnant women attending antenatal clinics and breastfeeding counselling practices of healthcare providers in comparison with the WHO recommendations. A cross sectional study of eighty first time pregnant women attending antenatal clinics at Mzumbe Health Centre which is located in a town near main roads and Tangeni dispensary which is located in a remote area far from the main roads, and six out of eight nurses providing antenatal care in these facilities was carried out. Questionnaires were used to evaluate women’s breastfeeding knowledge and future intentions to breastfeed and nurses’ breastfeeding knowledge and counselling practices. About 94% of women intended to breastfeed, among these, only 23.8% intended to do so exclusively for six months. Women’s knowledge in EBF was generally limited; about 94% of women had never received breastfeeding counselling at the antenatal clinic, 61% received BF information from their mothers, grandmothers and mothers-in-law, 37.5% said glucose water should be given immediately after delivery. Common reasons for introducing solids were; baby will be old enough (55%), baby will be hungry (32.5%), advised by the nurse (7.5%). There were no differences in breastfeeding knowledge between the two facilities, that is being located near the main roads did not change or influence women’s knowledge in breastfeeding. Nurses had satisfactory knowledge of how to solve breastfeeding problems and breastfeeding in special situations. Much of this knowledge appeared to be based on personal and clinical experience as only nurse had received training in breastfeeding. However, nurses’ knowledge on WHO breastfeeding recommendations was limited. Only three nurses said they train mothers about exclusive breastfeeding and it is only these three who knew the recommended age for introduction of solid foods. Three nurses said they would recommend exclusive breastfeeding until four months and only two nurses were able to identify the correct picture of latching on and attachment of the baby to the breast. Generally pregnant women and the nurses had limited knowledge in EBF matters. Although the antenatal visits provide an excellent opportunity to ensure that pregnant women are aware of optimal breastfeeding practices, the nurses who provide care during these visits had limited knowledge on the recommendations. Findings highlight a need to focus on information and education to women and nurses