Early initiation of breastfeeding is one of the measures of determining the effective practice of feeding infants and young children, and it is also one of the ten effective steps of breastfeeding practice. The WHO/UNICEF recommended that breastfeeding should be initiated within the first hour after birth [20]. Most mothers in the current study initiated breastfeeding within an hour after birth. This may be attributed to the fact that health professional assists with deliveries and this health professional are the one who also encourage early initiation of breastfeeding within the first hour after delivery. In the study conducted in Ghana, reported that women who were assisted by health professionals to initiated breastfeeding within the first hour of delivery [21]. Several health benefits such as increased ability of the immune system to resist infections, reduction in the risk of diarrhoea and increased survival rate of children have been linked to early initiation of breastfeeding [22].
Despite the benefit of breastfeeding, less than ten percent of children in the current study were exclusively breastfed up to 6 months. Congruently, South African National Health and Nutrition Examination Survey (SANHANES-1) found that seven percent of children aged ≤ 6 months were exclusively breastfed [23]. Previous studies have reported that exclusive breastfeeding is rarely practiced in South Africa [5, 13, 24, 25, 26,]. Poor exclusive breastfeeding practice in the current study is due to the fact that most mothers indicated that returning to schools, influence by the family members and insufficient milk as the main reason for terminating breastfeeding and introducing complementary food. Similarly, several studies have also reported going back to school or work, insufficient breastmilk as the main reasons for introducing complementary foods early [15, 24, 27, 28, 29, 30, 31]. Despite a high level of awareness by health professionals and Department of Health on exclusive breastfeeding, practicing exclusive breastfeeding is still a problem in many rural areas of South Africa. Exclusive breastfeeding is one of the strategies which can be used to achieve sustainable development goals 1 and 2 (zero hunger, and good health and well-being respectively).
Even though, WHO/UNICEF recommended that complementary foods should be introduced at six months of age to ensure that the child obtains all the required nutrients. Most mothers in the current study were unable to do this [20]. Congruently, several studies conducted in South Africa reported introduction of complementary foods before the recommended period of six months [15, 32, 33, 34, 35, 36]. Most children were given soft maize meal porridge mixed with water only and this was given as breakfast, lunch, and supper throughout the week. Despite maize meal being fortified with minerals and vitamins, introduction of maize meal as the main or sole solid ingredients during complementary feeding provide adequate energy, fibre, and B vitamins only and is deficient in protein and minerals such as iron, calcium, and zinc. Introduction of variety of food during childhood is necessary to meet the energy and nutrient requirements and prevent deficiencies that could result into undernutrition [37]. Children who are likely to be wasted are those who are weaned only on the maize meal porridge [38].
Appropriate feeding practice during the first 1000 days of life, from conception to two years of age, is a critical period for the promotion of optimal growth, health, and development. In the current study, early introduction of water was associated to underweight and stunting, while introduction of food early was associated to children being wasted. Introduction of solid food may have detrimental effects on the child’s growth and development as infant below six months of age have the gastrointestinal track that is not fully developed to digest other solid foods apart from breastmilk. Insufficient intake of quality diet is one of the contributing factors of undernutrition [37, 39]. Timing of introducing complementary feeding is nutritionally crucial as requirements for nutrients are greater during the second half of infancy [38]. Introduction of fluid and food before six months may increase the risk of diarrheal disease, food allergies, hamper optimal growth and development of the child [40, 41]. Short-term adverse effects of undernutrition include recurring illness, weakness, delayed physical and mental development, irritability, poor appetite, low weight for age while the long-term adverse effects are short height for age, poor learning ability, poor performance at school and poor general health [42].