title: Breastfeeding and mixed feeding practices in Malawi: timing, reasons, decision makers, and child health consequences.
abstract: BACKGROUND
  In order to effectively promote exclusive breastfeeding, it is important to first understand who makes child-care and child-feeding decisions, and why those decisions are made; as in most parts of the world, exclusive breastfeeding until 6 months of age is uncommon in Malawi.
  
  
  OBJECTIVE
  To characterize early infant foods in rural northern Malawi, who the decision-makers are, their motivation, and the consequences for child growth, in order to design a more effective program for improved child health and nutrition.
  
  
  METHODS
  In a rural area of northern Malawi, 160 caregivers of children 6 to 48 months of age were asked to recall the child's age at introduction of 19 common early infant foods, who decided to introduce the food, and why. The heights and weights of the 160 children were measured.
  
  
  RESULTS
  Sixty-five percent of the children were given food in their first month, and only 4% of the children were exclusively breastfed for 6 months. Mzuwula and dawale (two herbal infusions), water, and porridge were common early foods. Grandmothers introduced mzuwula to protect the children from illness; other foods were usually introduced by mothers or grandmothers in response to perceived hunger. The early introduction of porridge and dawale, but not mzuwula, was associated with worse anthropometric status. Mzuwula, which is not associated with poor growth, is usually made with boiled water and given in small amounts. Conversely, porridge, which is associated with poor child growth, is potentially contaminated and is served in larger amounts, which would displace breastmilk.
  
  
  CONCLUSIONS
  Promoters of exclusive breastfeeding should target their messages to appropriate decision makers and consider targeting foods that are most harmful to child growth.
authors: Department of Geography, The University of Western Ontario, London, Ontario, Canada. rbeznerkerr@uwo.ca
authors: Rachel Bezner
authors: RB
authors: Kerr
authors: Peter R
authors: PR
authors: Berti
authors: Marko
authors: M
authors: Chirwa
mesh_terms: D000328:Adult; D000886:Anthropometry; D001827:Body Height / Q000502:physiology; D001942:Breast Feeding / Q000453:epidemiology* / Q000523:psychology; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007223:Infant; D007225:Infant Food / Q000592:standards*; D007227:Infant Nutritional Physiological Phenomena / Q000502:physiology*; D008295:Malawi; D008297:Male; D009035:Mothers / Q000193:education / Q000523:psychology*; D009753:Nutritive Value; D014886:Weaning