Socio-economic and environmental factors affecting breastfeeding and complementary feeding practices among Batwa and Bakiga communities in south-western Uganda

Abstract

Improving breastfeeding and complementary feeding practices is needed to support good health, enhance child growth, and reduce child mortality. Limited evidence is available on child feeding among Indigenous communities and in the context of environmental changes. We investigate past and present breastfeeding and complementary feeding practices within Indigenous Batwa and neighbouring Bakiga populations in south-western Uganda. Specifically, we describe the demographic and socio-economic characteristics of breastfeeding mothers and their children, and individual experiences of breastfeeding and complementary feeding practices. We investigate the factors that have an impact on breastfeeding and complementary feeding at community and societal levels, and we analysed how environments, including weather variability, affect breastfeeding and complementary feeding practices. We applied a mixed-method design to the study, and we used a community-based research approach. We conducted 94 individual interviews (n = 47 Batwa mothers/caregivers & n = 47 Bakiga mothers/caregivers) and 12 focus group discussions (n = 6 among Batwa & n = 6 among Bakiga communities) from July to October 2019. Ninety-nine per cent of mothers reported that their youngest child was currently breastfed. All mothers noted that the child experienced at least one episode of illness that had an impact on breastfeeding. From the focus groups, we identified four key factors affecting breastfeeding and nutrition practices: marginalisation and poverty; environmental change; lack of information; and poor support. Our findings contribute to the field of global public health and nutrition among Indigenous communities, with a focus on women and children. We present recommendations to improve child feeding practices among the Batwa and Bakiga in south-western Uganda. Specifically, we highlight the need to engage with local and national authorities to improve breastfeeding and complementary feeding practices, and work on food security, distribution of lands, and the food environment. Also, we recommend addressing the drivers and consequences of alcoholism, and strengthening family planning programs.

Fig 1. Conceptual framework used to analyse breastfeeding and complementary feeding among the Batwa and Bakiga communities.

The group level refers to the level of household and community; the societal level refers to the level of region, ethnicities and country. There is interaction across all levels; for example, the environmental level interacts with the societal and group levels.

Fig 2. In the map we represented the ten Batwa settlements that participated in the research; there is a correspondent Bakiga settlement for each Batwa settlement.

In our study, we involved 6 Batwa and 6 Bakiga settlements: Bikuuto (Batwa) & Bikuuto cell (Bakiga), Kihembe (Batwa) & Kengoma cell (Bakiga), Kitariro (Batwa) & Kitariro cell (Bakiga), Mpungu (Batwa) & Kikome cell (Bakiga), Kebiremu (Batwa) &Kebiremu cell (Bakiga) and Byumba (Batwa) & Byumba cell (Bakiga). Map adapted from Patterson, 2017 [24]. Coordinates of settlements described in S1 Data.

Fig 3. Word frequency analysis with the most recurrent terms used by the participants to articulate the key drivers at the nexus of alcoholism, domestic violence, and child nutrition (breastfeeding and complementary feeding).

The bigger the word, the more often it was mentioned during the FGDs (Scale: 1–50).