Date Published: February 11, 2019
Publisher: Public Library of Science
Author(s): Hye-Kyung Oh, Sunjoo Kang, Sung-Hyun Cho, Yeong-ju Ju, Daouda Faye, Michael L. Goodman.
Maternal undernutrition is a leading cause of maternal mortality. Furthermore, health statuses and habits of mothers influence health statuses of newborns as well as healthy habits and mortality of children. The Senegal government is aware of the severity of these issues and has devised a national policy goal of reducing maternal, infant, and adolescent mortality rates by the end of 2018. This study aimed to identify nutritional knowledge, attitudes, and practices of lactating women in Senegal, and determine factors related to nutritional practices to obtain basic data for developing a maternal and child nutrition project.
This study used a mixed–method approach, collecting data via structured questionnaires administered to lactating women in Senegal and semistructured interviews with seven stake–holders. Questions for stuctured questionnaires were about nutritional knowledge, attitudes, and practices. For the quantitative analysis of the structured questionnaires, data from 171 participants analyzed using independent t-tests, Pearson’s correlation coefficients, and multiple linear regression analysis. Interview data were analyzed using an inductive thematic analysis approach. The questions for the interviews concerned maternal and child nutritional status, causes of undernutrition, and restrictions.
Factors significantly related to healthy nutritional practices(explaining 27.1% of variance) included having a household (B = 1.03, p = .015) and a mother (B = 0.96, p = .017) with an above primary school education, and being in the 5th quintile of income level (B = 1.24, p = .014). The interviews with seven stakeholders revealed obstructive factors of nutritional management were insufficient nutritional programs within health centers, incomplete national policy on nutrition, lack of general interest in undernutrition-related topics, inadequate economic environment, and the absence of partnerships to produce sustainable solutions.
Education and income levels, rather than knowledge and attitudes, had a strong relationship with healthy nutritional practices. Therefore, economic factors and educational background must be considered to succeed in Senegalese nutrition projects.
In the present study, when we converted participants’ nutritional knowledge scores into categories, we found that 45.0% of participants had low knowledge scores, 11.7% had medium scores, and 43.3% had high knowledge scores. These results differ from those obtained by Perumal et al.,  with pregnant women in Kenya, East Africa, which indicated that 33.9% of the participants had low knowledge scores, 44.6% had medium scores, and 21.5% had high knowledge scores; similar percentages were found for Kenyan youths . By contrast, in this study, a much larger percentage of lactating women had high knowledge scores than medium knowledge scores. The observed difference might be due to differences in study participants’ level of education, exposure to nutritional education, and regional selection. The results for nutritional attitude in the study with the majority of the subjects having medium or high attitude scores were similar to those of many studies conducted in developing countries [21, 23, 25]. In this study, most participants had medium or low practice scores (85.9%), unlike in Perumal et al. , where 85.7% of participants reported medium practice scores. Low practice scores appear to directly reflect the poor nutrition status of lactating women, which is highly prevalent in Senegal due to the intergenerational cycle of undernutrition and poverty . The issue here is not just the high nutritional knowledge and attitude scores, but how much these scores affect participants’ nutritional practice scores. Many studies have shown conflicting results as to whether nutritional knowledge and attitude actually affect practice. Okunaiya et al.  showed that adequate nutritional knowledge and attitude influence practice. Masuku and Lan , on the other hand, found that the nutritional knowledge and attitude of pregnant and lactating women in Swaziland did not necessarily translate into nutritional practice. Kigaru et al. , in a study of youths, found that nutritional knowledge did not affect nutritional practice, but that attitude was an important influencing factor of practice. However, it is difficult to compare their results to that of this study, given that they measured attitude simply in terms of caring about eating or not. Therefore, the factors affecting nutritional practice should be analyzed with great consideration of the the regional and target population characteristics and the contents of the instrument being used.
The critical results obtained in this study are as follows: