Nutrition education represents a key component of improving the health of the population and an essential support in a global strategy aimed at preventing malnutrition [23]. Thus, the role of qualified and experienced professionals such as health workers is fundamental in improving knowledge and changing the attitudes and feeding practices of mothers attending health centers.
At enrolment, the average age of mothers was 27.2 years. This average age of mothers is lower than those observed by [24] and [25] who found average ages of 29.2 years and 28.4 years in the peri-urban area of Bobo-Dioulasso and in the bourg of Lomé, respectively. This indicates that the age of mothers differs depending on the zones. These differences could be explained by several socio-economic and cultural factors [26]. A study in Ethiopia reported that the high average age of mothers may be due to their level of education [27]. The schooling rate of 30.7% observed among mothers is close to that reported by [28] in the health district of Ouargaye. In addition, it is higher than that observed in rural women in Burkina Faso [29]. This low rate of schooling could be due to the economic situation of parents and would result in the high proportion of women farmers and housewives (81.6%) observed among mothers. It should be noted that the location of the mothers' residence could be related to their schooling and their profession. Moreover, the presence and distance of educational infrastructure could influence the school enrolment rate of mothers.
All mothers performed the prenatal consultation and almost all gave birth in a maternity hospital. The proportion of primigest mothers is highest in the study; this observation was reported by other authors in Burkina Faso, Togo and India with rates of 21.3%, 36.4% and 60.2%, respectively [28, 25, 30]. These results could be firstly the result of the promotion of optimal use of prenatal consultation and assisted delivery services provided by health workers and support partners (NGOs and associations) of the Health District of Léo. On the other hand, they could show the importance that the particularly primigravida mothers surveyed attach to health centers.
Colostrum is the first very dense, yellowish milk produced by the mammary gland of the mother [31] WHO recommends colostrum as the first perfect food for newborns which should be started immediately in the first hour after birth. It is rich in macro- and micro-nutrient and antibodies which protect the newborn from diseases. It is a laxative that cleanses the stomach of newborn [32]. The proportions of mothers at the beginning (89.6%) and at the end (99.4%) of the evaluations who affirmed that colostrum has a beneficial effect on the infant's health are higher than those found by [28] in Burkina Faso and [33] in Egypt with respectively proportions of 82.8% and 87.6%. The proportions of good levels of knowledge at the beginning (14.7%) and end (37.4%) of mothers' assessment of the benefits of colostrum are higher than the proportion of 14.7% reported by [34]. These observed differences could be linked to mothers' sources of information on colostrum, mothers' opinions on the benefits of colostrum on the health of the newborn and the socio-cultural constraints of each community. Furthermore, the results showed that the sensitizations received by mothers changed their perceptions about colostrum and significantly increased their level of knowledge about the benefits of colostrum. This positive impact was more observed among farming mothers. This could be explained by the active listening and the time given to awareness sessions by mothers who are mostly farmers and housewives. However, awareness and motivations techniques or approaches need to be reviewed by health workers so that ultimately all mothers have a good or medium level of knowledge about colostrum.
The proportion of mothers (98.2%) who reported to have given colostrum is slightly higher than those found in the national nutritional survey of 2019 (94.3%) and 2020 (95.9%) in the West Central region of Burkina Faso [10, 11]. Similarly, this proportion is higher than those found by [28] in the health district of Ouargaye at 73.2%, by [35] in the province of Gnagna at 77%, and by [24] in the peri-urban area of Bobo Dioulasso at 91.2%. However, this proportion is close to 97.3% of that observed by [36] in Togo. It should be noted that the donation of colostrum by mothers is statistically linked to mothers' opinions on colostrum and profession. It is from this perspective that several studies have highlighted the need for mothers to be educated about the importance of human milk, in particular the benefits of colostrum [37].
According to WHO recommendations, the first breastfeeding after birth must be done within the first hour [38]. When done in a timely manner, it facilitates the expulsion of the placenta, stimulates the production of breast milk, reduces the risk of bleeding after delivery, protects the newborn and reduces the risk of mortality [39, 40]. The proportions of 77.9% and 89.6% of mothers knowing the appropriate time for early breastfeeding found at the initial and final assessments respectively are higher than the proportion of 54% found by [28].in Burkina Faso and the proportion of 10% reported by [41] in Nepal. However, the proportion observed at the start of the evaluation is close to that observed in Egypt by [33] or 79.8%. These differences could be explained by the impact of sensitization of health workers when consulting mothers at health facilities.
The results revealed that awareness raising on the benefits of early breastfeeding followed by mothers significantly increased their level of knowledge on this subject. This positive impact was most noted among farming mothers. This could show that farming mothers are diligent and give more time and importance to the advice of health providers.
Mothers who breastfed their children within the first hour after delivery (75.5%) are higher than those observed in the Central-West region of Burkina Faso in 2019 (54.7%) and in 2020 (70.8%), [10, 11]. Likewise, this percentage is higher than those found in Bobo Dioulasso by [24] with 67.5% and [35] in the province of Gnagna with 20%. These differences observed could be explained by the high proportion of farming mothers, to their positive opinion of the benefits of colostrum on the health of the child, to their level of knowledge on the benefits of colostrum and to their level of knowledge on the benefits early breastfeeding. Indeed, these different factors significantly influenced the practice of early breastfeeding among the mothers in the study. However, it is important to note that the implementation of the integrated package of IYCF services makes it systematic to breastfeed the newborn in the first hour after delivery at the health center by health providers. This obligatory practice could justify the high proportions of mothers with an insufficient level of knowledge who practiced early breastfeeding in this study. WHO recommends that children continue to be breastfed until the age of two [32]. Thus, some authors emphasize that breastfeeding the child until this age is beneficial for the well-being of the child and also protects the mother from certain diseases [42]. Unfortunately, many mothers are still unaware of this age. Indeed, among the mothers surveyed at the initial evaluation, only 74.8% found this age ablactation of children. This proportion is lower than that of 83.3% reported by [30] in their study of postnatal mothers in community health centers in India. The results on knowledge of the age of ablation revealed an increase of 14.8% of mothers who knew it at the final evaluation. This increase resulting from the assimilation of the age of ablactation by mothers could signify the positive effect of the awareness-raising followed in healthy infant consultation services.