KNOWLEDGE, ATTITUDES AND PRACTICES OF FIRST LEVEL HEALTH WORKERS TOWARDS BREASTFEEDING, COMPLEMENTARY FEEDING AND MICRONUTRIENTS SUPPLEMENTS IN MEXICO: FORMATIVE RESEARCH FOR THE SPOON PROJECT

Background and objectives: Adequate breastfeeding (BF), complementary feeding (CF) and micronutrients intake (MI) are important determinants of children growth and development. The first-level health workers in most cases are the gatekeepers of child nutrition information to mothers or caregivers during their visits to primary health care. The objective of this work was to identify first-level health workers' knowledge, attitudes and practices related to the promotion of BF, CF and micronutrient supplements (MS). Methods: As part of the formative research of the SPOON project, which aims to implement a strategy to prevent chronic malnutrition and reduce the risk of future obesity in children aged 0-23 months, in-depth interviews with health workers (HW, n=8) were conducted to document their knowledge, attitudes and practices towards BF, CF and MS. Interviews were transcribed in verbatim, coded and analyzed using N-Vivo.11. Results: HW recognize that BF is the best food for children, and they recommend exclusive breastfeeding (EBF) without any other type of food or liquid during the first six months. They mentioned that illness is a motive to interrupt BF (HIV, or with intake of strong medicine such as penicillin). According to them weaning starts at six months, some think that during this period breastmilk is useless or less nutritious for infants. They also think that the total duration of BF should be one year, and prolonging BF beyond than a year might causes emotional dependence and problems with social integration. They recommend that CF starts with semisolid foods, and they prescribe MS, however their information about appropriate CF and MS is scarce. Most of their information about BF, CF and MS, comes from personal/familiar experiences and some from vocational training Conclusions: Even though HW recommend EBF, certainly their knowledge, attitudes and practices contradicts WHO recommendations towards total duration of BF. Since HW are important sources of information to mothers, they affect mothers knowledge and practices related to child nutrition. Therefore, it is important to design a multidimensional strategy that address HW' lack of knowledge to the adequate promotion of CF and the use of MS. Keywords: Health workers, infant and young child feeding practices, micronutrients supplements, knowledge, formative research, Mexico.