656 - Maternal Perceptions and Infant Feeding Practices: A Survey of Women from a Community Hospital in Malawi

Publication Number: 3635.656

Hillary C. Lee, Baylor College of Medicine, Arlington, TX, United States; Monika S.. Patil, Baylor College of Medicine, Houston, TX, United States; Gregory C. Valentine, University of Washington School of Medicine, Tacoma, WA, United States; Joseph Hagan, Baylor College of Medicine, Houston, TX, United States; Benjamin C. Shayo, Baylor College of Medicine, Houston, TX, United States

Background: Lack of exclusive breastfeeding (EBF) contributes to undernutrition, which causes nearly half of global deaths in children under five annually. The World Health Organization recommends breastfeeding within 60 minutes of birth and EBF for six months. However, EBF rates remain below 40% in many low- and middle-income countries (LMICs), with Malawi data showing declines starting at three months of age.

Objective: To characterize breastfeeding knowledge, beliefs, and practices among women in a suburban district of Malawi and identify factors supporting EBF adherence.

Design/Methods: A prospective survey of women was conducted at Area 25 Community Hospital in Lilongwe, Malawi. Surveys were administered in Chichewa at < 20 weeks gestation, within 48 hours postpartum, and 4-8 weeks postpartum. Spearman's correlation, Wilcoxon rank-sum, and Kruskal-Wallis tests assessed associations between demographic, psychosocial, and nutritional factors with breastfeeding knowledge and infant weight. IRB approval was obtained, and data were recorded in REDCap.

Results: Among 44 participants (mean age 24.0 ± 4.7 years), 68.1% did not complete secondary education, and the majority were homemakers with a median annual income of $405 USD (Table 1). Less than 50% had electricity or indoor tap water. Skin-to-skin contact strongly correlated with early breastfeeding initiation, and nearly all began breastfeeding within 60 minutes of birth (Figure 1). At the postpartum visit, 42 of 44 infants (95.5%) were still exclusively breastfeeding, and six mothers (13.6%) planned to introduce other feeds before six months. Positive trends were observed between education, age, and prior breastfeeding experience with breast milk knowledge. Breastfeeding attitudes, confidence, and comfort were largely positive (Figure 2). Participants recognized infant breastfeeding benefits more than maternal ones, and low milk supply remained a common concern. Antenatal food security correlated with higher birthweight (ρ=0.43, p=0.004), while postpartum psychosocial and dietary factors were not linked to infant weight gain.

Conclusion(s): This cohort demonstrated high early and sustained EBF rates, reflecting strong breastfeeding culture and maternal engagement. Reinforcing maternal benefits and addressing milk supply concerns may further sustain these outcomes. Antenatal household food security was the strongest correlate of infant birthweight, underscoring the importance of nutritional stability during pregnancy. These findings highlight facilitators of successful EBF that can inform future interventions to strengthen infant nutrition in Malawi and similar LMICs.

Table 1. Demographic and maternal characteristics of survey participants (n = 44).


Figure 1. Comparison of time to skin-to-skin contact and breastfeeding initiation after birth.
Nearly all mothers initiated skin-to-skin contact within 60 minutes (40/44, 90.9%). 40 out of 44 (90.9%) began breastfeeding within 60 minutes of birth, and 29 out of 44 (65.9%) within 30 minutes. Survey was administered within 48 hours after delivery of infant.

Figure 2. Distribution of survey responses related to personal beliefs and impact of external influences on breastfeeding.