Infant feeding in Mali, West Africa: variations in belief and practice.

Research conducted in Mali during 1982 and 1983 reveals a wide range of variation in both the growth and development of infants and infant feeding practices. Overall, growth patterns of the Malian children (N = 136) are similar to those reported for children in other West African urban or rural poor populations. However, the use of the averages of growth measures disguises the fact that some children are severely malnourished, while others are growing at or above the 50th percentile of NCHS standards. Socio-economic status, as an indicator of the family's financial ability to provide food and medical care, does not account for the variation in nutritional status. From a series of open-ended interviews with mothers, fathers and other relatives of children in the study, as well as observation of mealtimes, several fundamental beliefs regarding infant feeding can be identified: (1) a child does not need to eat solid food before approx. 8 months; (2) if a child is hungry, he will eat, if he does not want to eat he should not be forced to eat; and (3) only the child himself knows when he is hungry and when he is full. These beliefs are expressed in the community in a variety of specific practices and behaviors. Additionally, mothers differ with respect to the importance they attach to medical care for sick children. These various beliefs and practices concerning infant feeding and, tangentially, medical care, tend to form divergent clusters, which allows the ranking of women on a three level scale of 'maternal attitude.' In the sample, growth performance, as indicated by membership in 'low weight' or 'high weight' groups, is positively correlated with maternal attitude (Chi2 = 13.85, P = 0.001). It is clear that in Mali, the cultural belief system regarding infant feeding and the variations in implementation of this system reflected in maternal attitudes, play an important role in determining the nutritional status and growth patterns of children, primarily through their effect on diet, and secondarily through their effect on medical care. The data show that within the same general cultural framework, and in the face of abject poverty, subtle differences in maternal attitudes result in some children who thrive, while others suffer varying degrees of malnutrition.