Knowledge and Attitudes on Complementary Feeding Practices Among the Healthcare Workers in Level 2 and 3 Health Facilities in Nairobi County

Abstract

Background: World Health Organization (WHO) recommendations on infant nutrition state that mothers should exclusively breastfeed their children for the first six months of life. At six months, an infant‟s energy requirements exceed that provided in breast milk. Complementary foods are therefore required besides breast milk to meet these nutritional needs. Whereas there are many studies on knowledge and attitudes of mothers on complementary feeding, there are fewer studies on health workers and their knowledge and attitude on complementary feeding. Health care workers (HCWs) are vanguards of knowledge on complementary feeding, and mothers trust them. HCWs working in primary healthcare facilities are often the first point of contact for mothers. As such, there is a need for these HCWs to have current updated knowledge on appropriate complementary feeding. It is therefore essential to have background knowledge of HCWs and their attitudes towards complementary feeding. Primary objective: To assess the knowledge and attitudes towards complementary feeding practices among HCWs in level 2 and 3 health facilities in Nairobi county. Secondary objectives: To describe factors associated with good knowledge and attitudes on complementary feeding practices among HCWs in level 2 and 3 health facilities in Nairobi County. Methodology: A multistage sampling method was done. Random sampling was done to select 6 sub counties. Then stratified method was done to select the health facilities (33 dispensaries and 16 health centres) and also for the different cadres in the health facilities. Random sampling method was then applied in each stratum until the desired sample was achieved. Data collection was done using a researcher administered structured questionnaire to obtain data on HCWs knowledge and attitude of complementary feeding and attitude. The target population of the study included nurses, clinical officers, and nutritionists in the above facilities. HCWs in the selected health facilities were eligible for the study. The exclusion criteria included HCWs who did not give consent and those who were on leave during the study period. A scoring system was used to analyse the knowledge and 5-point Likert scale was used to assess the attitudes of HCWs on complementary feeding. Logistic regression model was done to look for factors associated with knowledge and attitude of HCWs on complementary feeding. Results: The study included a total of 33 dispensaries and 16 health facilities. A total of 224 HCWs who included nurses, clinicians and nutritionists were enrolled. When it came to knowledge, 8% had poor knowledge (scored below 50%) 21% had good knowledge (scored between 50-64%), 37% had very good knowledge scored between (65%-74%) and 34% had excellent knowledge (scored above 75%).Nutritionists had the highest level of knowledge with a mean score of 75% while enrolled nurses had the lowest mean score at 61%. There was good knowledge on timely introduction of complementary feeds after 6 months at 92%, while only 61% of the HCWs knew that children should be fed a minimum of 4 food groups daily. There was good knowledge on correct frequency and amount of complementary feeds with 84% of the HCWs having the correct response, while only 52% of the HCWs had correct knowledge on nutrient content of complementary feeds and only 51% had correct knowledge on food hygiene and handling. The multivariable analysis showed that factors associated with good knowledge included cadre, years worked after basic training and sub counties. The multivariable analysis associated with positive attitude included cadre and age. When it came to attitude, majority had positive attitudes with...................................................................................