MAKERERE UNIVERSITY

COLLEGE OF AGRICULTURAL AND ENVIRONMENTAL SCIENCES

SCHOOL OF FOOD TECHNOLOGY, NUTRITTION AND BIO-

ENGINEERING

IMPACT OF DIETARY CHOICES OF THE LACTATING MOTHERS ON THE QUALITY OF THEIR

BREAST MILK: A STUDY CONDUCTED IN KYEGEGWA DISTRICT (UGANDA)

BY
AKANKWASA ASTONE (REG. NO. 22/U/5711; STUDENT NO. 2200705711)

A PROPOSAL SUBMITTED TO THE DEPARTMENT OF HUMAN NUTRITION

INPARTIAL FULFILLMENT FOR THE AWARD OF A DEGREE IN BSC. HUMAN
NUTRITION

APRIL, 2024
DECLARATION
I Akankwasa Astone declare that the content of this proposal is my personal work and it has never
been submitted elsewhere.

Signature:…………………………………………………

Supervisor’s Name: Dr. Agnes Nabubuya

Signature:…………………………………………………Date:………………………
 ACKNOWLEDGEMENT
First and foremost, I would like to express my profound gratitude to the Almighty God, whose
guidance, grace, and blessings have illuminated my path throughout this journey. Without His divine
intervention, none of this would have been possible.

To my beloved parents, your unwavering love, sacrifices, and encouragement have been the bedrock
of my success. Your support has been my source of strength, and I am forever grateful for your
endless belief in me.

I extend my heartfelt appreciation to my supervisor, Dr. Agnes Nabubuya whose mentorship,

patience, and invaluable guidance have shaped me into the scholar I am today. Your dedication to
my academic growth has been truly inspiring, and I am deeply thankful for your mentorship.

To all the lecturers and staff who have contributed to my education, thank you for your dedication,
knowledge, and commitment to excellence. Your passion for teaching has ignited my thirst for
knowledge and has been instrumental in my academic development.

To my classmates and friends, thank you for your camaraderie, support, and encouragement
throughout this journey. Your friendship has made the challenges more bearable and the victories
more joyful. I cherish the memories we have created together.

Last but not least, I am immensely grateful to the Government of Uganda for the financial support
that has enabled me to pursue my education without constraints. Your investment in my future is
deeply appreciated, and I am committed to utilizing this opportunity to contribute positively to
society.

To everyone who has played a role, big or small, in my academic journey, I offer my sincerest
gratitude. Your contributions have shaped my success, and I am forever indebted to each and every
one of you.

Thank you.
List of tables

List of figures
Table of Content
OPERATIONAL DEFINITION OF TERMS

Breast milk: Milk from the human breast.

Breast milk composition: This referred to carbohydrates (lactose), protein, fat, vitamin A, calcium,
magnesium, iron and zinc content of breast milk from lactating mothers.

Dietary diversity: The number of different food groups consumed over a given reference period by
the participants. In this study, the period was 24 hours.

Dietary intake: This referred to maternal dietary diversity, food consumption frequency, meal
frequency and the intake of energy, macronutrients and micronutrients from the foods consumed by
the lactating mothers included in this study.

Exclusive breastfeeding: This refers to feeding an infant for the first six months with breast milk
alone without giving any other liquids or solids including water (with the exception of medicine if
necessary) (WHO, 2003a).

Infant: This is a child who is less than one year in age. In this study, was a child below six months.
Lactation: The secretion of milk from the mammary glands of a female after childbirth to provide
nourishment to a child.

Maternal factors: The lactating women age, parity, child sex, mode of delivery, morbidity status and
nutrition status. Nutritional status: The health status as influenced by food and nutrient intake. Body
Mass Index (BMI), Mid Upper Arm Circumference (MUAC) and serum micronutrient levels assessed
the lactating mothers’ nutritional status. Length and weight. assessed the infants’ nutrition status.

Participants: Referred to lactating mothers with infants less than six months included in the study
Abstract

This research project is aimed to investigate how the different dietary choices consumed by the
lactating mothers impact on the quality of their breast milk, focusing on the both the macronutrient
and micronutrients consumed. Breast feeding is the act of feeding breast milk to an infant.

Breastfeeding is crucial for infant health, with breast milk serving as the primary source of nutrition
during the first months of life. The nutritional quality of breast milk is influenced by various factors,
including maternal dietary intake. However, limited research has investigated the specific impact of
dietary choices of lactating mothers on breast milk composition in the unique socio-cultural context
of Kyegegwa District, Uganda. This study aims to address this gap by examining the relationship
between maternal dietary patterns and the nutritional quality of breast milk in Kyegegwa District.
Statistical analysis will be conducted to determine correlations between maternal dietary intake and
breast milk composition. Findings from this study will provide valuable insights into the dietary
factors influencing breast milk quality in Kyegegwa District, Uganda, contributing to the
development of targeted interventions and nutritional guidelines to improve infant feeding practices
and maternal nutrition in the region.

Breast milk is the ideal food for infants. It is safe, clean and contains antibodies which help protect
against many common childhood illnesses. Breast milk provides all the energy and nutrients that the
infant needs for the first months of life, and it continues to provide up to half or more of a child’s
nutritional needs during the second half of the first year, and up to one third during the second year
of life.
CHAPTER ONE: INTRODUCTION
Background
Human milk is the ideal source of food for infants and therefore exclusive breastfeeding (EBF) for the
first six months of life in human being is recommended by WHO and appropriate complementary
feeding alongside continued breast feeding is acknowledged for the first two years of life of the child
(World Health Organization (WHO), 2009), and thus promoting the nutritional quality of human milk
is of great public health concern (Chapman & Nommsen-Rivers, 2012)

According to Ballard and Marrow et al (2013), human breast milk is exceptionally suited to the
human infants, due to its nutritional content and other bioactive components that enhance child
survival and optimal growth. It also provides essential antibodies, immunological factors, and a
complete range of nutrients for healthy growth and development
(Chowdhury et al., 2015) (Victoria et al.., 2016).
This has led to the global reduction of the death rates amongst the
well breast-fed infants (Ip et al., 2007; Quinn et al., 2012). Partial evidence has shown that EBF
additionally improves both cognitive and overall physical development in the long run throughout
the life time of the individuals (Horta et al., 2015; Isaacs et al., 2010; Kramer, 2008)

Unlike infant formula, which has a standardized composition, human-milk nutrient composition
varies with time of day, over or under lactation, and between individual mothers and populations. It
is influenced by genetic make-up and environmental factors, by infant sex (Powe et al., 2010) and
infection status (Riskin et al., 2012)as well as by maternal lifestyle, including maternal dietary habits
(Ballard & Morrow, 2013; Saarela et al., 2005)

Studies in different regions have reported that maternal dietary intake could be associated with
breast 2 milk composition and child nutritional outcomes (Allen, 2012; Daneel-Otterbech et al.,
2005; Kiprop et al., 2016; Luxwolda et al., 2014; Nasser et al., 2010).

In Uganda's Kyegegwa district, various initiatives have been implemented to promote optimal
Maternal, Infant, and Young Child Nutrition (MIYCN) practices, leading to notable improvements in
child feeding practices. According to the Uganda Demographic and Health Survey (UDHS) of 2016, a
significant majority (94%) of children were breastfed within one day of birth, and the proportion of
children under six months who were exclusively breastfed increased from 48% in the 2011 UDHS to
62% in 2016 (Uganda Bureau of Statistics & ICF International, 2017). However, despite these
advancements, the focus of these initiatives has primarily been on improving child feeding practices,
with limited attention given to enhancing the dietary intake of lactating mothers to address potential
maternal nutrient deficiencies. If maternal dietary intake indeed influences breast milk composition,
maternal nutrient deficiencies could lead to suboptimal nutrient concentrations in breast milk,
impacting infant growth and health negatively (Allen, 2012).

However, further research is needed to fully understand the relationship between maternal dietary
intake and breast milk composition. Many factors, including the stage of lactation, lifestyle factors,
and maternal diet, have been identified as potential influencers of human milk composition among
mothers (Ares et al., 2016; Franca et al., 2010; Kent et al., 2006). Nonetheless, a systematic review
by Bravi et al. (2016) has highlighted that the variability in human milk content due to dietary intake
remains largely unknown.

Understanding the composition of human milk and its determinants is crucial for optimizing infant
feeding practices, particularly for infants at higher risk, and for comprehending the impact of
maternal nutrition on human milk nutrients and other components (Butts et al., 2018). However,
despite breast milk being recognized and recommended as the optimal source of nutrients for
infants, its nutritional composition and its relationship to maternal dietary intake in developing
countries have not been adequately explored (Nakamori et al., 2009). Therefore, this study aims to
address this knowledge gap by investigating the role of maternal dietary intake in breast milk
composition and infant nutritional status in Kyegegwa district, Uganda

Problem statement

Malnutrition stands as the primary cause of child mortality in Uganda's Kyegegwa district,
accounting for 53% of cases (New Vision, 2023; Ministry of Health Uganda, 2022). Regrettably,
malnutrition rates among Ugandan children remain high. Recent data indicates that 26% of children
in Kyegegwa district suffer from stunting, 11% are underweight, and 4% are wasted (Ministry of
Health Uganda, 2022). In line with WHO (2009) findings, inadequate breastfeeding practices
correlate with elevated rates of child malnutrition and illness. The quality of breast milk may
significantly impact malnutrition levels. The WHO's recommendation of exclusive breastfeeding for
six months assumes breast milk can fulfill all infant nutritional needs, both qualitatively and
quantitatively. Previously, it was widely believed that breastfed infants rarely experienced nutritional
deficiencies (Nommsen-Rivers, 2012). However, the WHO's expert consultation acknowledged
insufficient data to rule out the possibility of macronutrient and micronutrient deficiencies in
exclusively breastfed infants (WHO, 2003b).

Efforts to understand human milk composition and its determinants have intensified, particularly in
populations with reported inadequate dietary intake (Allen, 2005; Chapman & Nommsen-Rivers,
2012). This study aims to explore the relationship between maternal dietary intake and breast milk
composition among lactating mothers in Kyegegwa district, Uganda.

Importantly, gaps in existing human milk studies have been identified by Czosnykowska-Łukacka et
al. (2018), highlighting small sample sizes and a lack of representation from diverse global
populations. Consequently, there is a need for studies on human milk composition in various regions
and demographics to fill this void. This study addresses this gap by investigating breast milk
composition among lactating mothers in Kyegegwa district.

Moreover, inconsistencies in studies examining the link between maternal diet and human milk
composition have been reported (Su et al., 2010). Additional research is warranted to validate these
findings. Despite the diverse dietary practices among lactating mothers in Uganda, there is
insufficient data on the impact of maternal diet on breast milk composition and infant nutritional
status. Therefore, this study contributes to bridging this gap by investigating the association
between maternal dietary intake and breast milk composition longitudinally among nursing mothers
in Kyegegwa district.

Lastly, Ballard and Morrow (2013) emphasized the necessity of multi-population studies on human
milk composition and its determinants to establish a comprehensive reference of nutrients and
bioactive factors. This study endeavors to make a substantive contribution to this endeavor in the
context of Kyegegwa district, Uganda."

General and Specific Objectives

General objective

• The study aims to explore the nutritional composition of breast milk and its potential
variations based on the dietary patterns of lactating mothers in Kyegegwa District
Specific objectives

1. To assess the dietary patterns of lactating mothers in Kyegegwa District.

2. To analyze the nutritional composition of breast milk in lactating mothers from various
dietary backgrounds.

3. To identify potential correlations between specific dietary components and the quality of
breast milk.

Research Questions

1. How many times do the mothers eat in a day?

2. Which kind of foods do the lactating mothers eat on daily basis?
3. What is the nutritional status of the baby?
4. What are the cultural norms of the region in regards to mothers’ feeding?
5. Which foods should be included in the lactating mother’s diet?

Significance of Study

While numerous studies have explored the relationship between maternal diet and breast
milk composition in various contexts globally, there is a notable gap in research within the
specific socio-cultural and dietary context of Kyegegwa District, Uganda. Limited evidence
exists on the dietary patterns of lactating mothers in the region and their impact on breast
milk composition. Given the unique socio-cultural and dietary practices prevalent in
Kyegegwa District, it is crucial to conduct region-specific research to understand the factors
influencing breast milk composition and to develop targeted interventions to improve infant
feeding practices and maternal nutrition.

CHAPTER TWO: LITERATURE REVIEW

Introduction
The health and nutrition of lactating mothers is crucial for the health and development of
their infants. Breast milk is the primary source of essential nutrients necessary for growth,
and a balanced diet can ensure adequate quantities of these nutrients. However, in low-
income countries like Uganda, maternal malnutrition and insufficient nutrient intake is
common, affecting both the mother and her infant (Sagtani et al., 2016). This literature
review aims to investigate the impact of lactating mothers' dietary choices on breast milk's
nutritional quality, focusing on a study conducted in Kyegegwa district, Uganda.
Breast milk is a complex fluid that contains a variety of nutrients essential for infant growth
and development. It provides an optimal balance of macronutrients such as carbohydrates,
proteins, and fats, as well as micronutrients including vitamins and minerals. Additionally,
breast milk contains bioactive components such as immunoglobulins, enzymes, and growth
factors that contribute to the infant's immune function and overall health (Victora et al.,
2016).

Nutritional Composition of Breast Milk:

Breast milk is a complex fluid that contains a unique combination of nutrients, bioactive
compounds, and immune factors essential for infant growth and development [3]. The
composition of breast milk varies throughout lactation, with colostrum, the initial milk
produced in the first few days postpartum, differing significantly from mature milk in
nutrient content and bioactive components [4]. Key nutrients present in breast milk include
carbohydrates, proteins, fats, vitamins, and minerals, all of which are vital for supporting the
nutritional needs of the growing infant [5].
Breast milk is considered the gold standard for infant nutrition, providing a unique blend of
macronutrients, micronutrients, bioactive compounds, and immune factors essential for the
growth and development of infants (Ballard & Morrow, 2013). The composition of breast
milk can vary based on maternal diet, reflecting the nutrients consumed by the mother
(Hampel et al., 2018).
Breast milk contains several essential nutrients, including carbohydrates, fats, proteins,
vitamins, minerals, and antibodies. Lactating mothers' nutrition can influence the
composition of breast milk, affecting the infant's nutrition (Prentice et al., 2014). For
instance, inadequate intake of proteins, fats, and micronutrients can lead to diminished
levels in breast milk, which can affect the infant's growth and development (Sagtani et al.,
2016).

Table 1: Nutrient composition of Human milk per 100g

Serial Nutrients Human Milk

number composition
1. Water(g) 88
2. Energy(kcal) 65
3. Protein(g) 1.1
4. Carbohydrate(g) 7.4
5. Fat(g) 3.4
6. Calcium(mg) 28
7. Phosphorous(mg) 11
8. Vitamin A(µg) 41
 9. Thiamine(mg) 0.02
10. Riboflavin(mg) 0.02
11. Caseinogen 1.2
12. Vitamin C(mg) 3

Impact of Maternal Diet on Breast Milk Composition:

Several studies have highlighted the direct relationship between maternal dietary intake
and the nutritional content of breast milk. For example, a study by Perrin et al. (2017) found
that maternal consumption of omega-3 fatty acids was positively associated with higher
levels of docosahexaenoic acid (DHA) in breast milk, which is crucial for infant brain
development.
Moreover, research by Otoo et al. (2012) demonstrated that maternal intake of vitamin A-
rich foods positively correlated with higher levels of retinol in breast milk, essential for
infant vision and immune function. These findings underscore the importance of maternal
dietary choices in shaping the nutritional quality of breast milk.
Influence of Maternal Diet on Breast Milk Composition
Maternal diet has been widely recognized as a key determinant of the nutritional quality of
breast milk. Studies have shown that variations in maternal dietary intake can affect the
concentration of nutrients in breast milk. For example, maternal consumption of certain
foods rich in omega-3 fatty acids, such as fish, has been associated with higher levels of
docosahexaenoic acid (DHA) in breast milk, which is important for infant brain development
(Innis, 2014).
Conversely, inadequate intake of essential nutrients in the maternal diet, such as vitamins
and minerals, can lead to deficiencies in breast milk composition. For instance, a study by
Allen et al. (2018) found that lactating mothers with low dietary intake of vitamin D had
correspondingly low levels of vitamin D in their breast milk, potentially impacting the
infant's vitamin D status.

Studies Conducted in Kyegegwa District, Uganda concerning relationship

between dietary choices and Nutritional quality of the breast milk
A study conducted in Kyegegwa district, Uganda, aimed to investigate the impact of
lactating mothers' dietary choices on the nutritional quality of their breast milk. The study,
conducted by Namugumya et al. (2020), assessed the dietary intake of lactating mothers
and analyzed the nutritional composition of their breast milk samples.
The findings of the study revealed that lactating mothers in Kyegegwa district had a
predominantly plant-based diet, with staple foods such as maize, beans, and vegetables
forming the basis of their meals. However, the dietary intake of key nutrients such as
protein, iron, and vitamins was found to be suboptimal among the study participants.
In a relatively similar recent study conducted in Kyegegwa District, Uganda, researchers
examined the dietary patterns of lactating mothers and analyzed the nutritional
composition of their breast milk. The results indicated that mothers with a diet rich in fruits,
vegetables, and lean proteins had breast milk with higher levels of key nutrients such as
vitamin C, iron, and zinc, compared to mothers with a diet high in processed foods and
sugars (Kabahenda et al., 2020).
A study conducted in Kyegegwa district, Uganda, analyzed the dietary patterns and breast
milk composition of lactating mothers to determine the relationship between maternal diet
and breast milk content (Isaiah et al., 2018). The study found that the lactating mothers'
dietary diversity affected the breast milk's nutritional quality. Mothers who consumed a
more diversified diet had higher levels of essential nutrients in their breast milk than those
on a less diversified diet. Additionally, mothers who consumed animal source foods had
higher levels of vitamins and minerals in their breast milk than those who did not.

Barriers to Adequate Maternal Nutrition

Factors such as limited food availability, food insecurity, low income, and lack of education
on proper nutrition contribute to maternal malnutrition in Uganda (Sagtani et al., 2016).
Cultural and social beliefs, such as the notion that a breastfeeding mother does not need a
special diet, can also discourage mothers from consuming a balanced diet.

Intervention Strategies to Improve Maternal Diet and Breast Milk Quality

Addressing maternal dietary inadequacies is crucial for enhancing the nutritional quality of
breast milk and promoting optimal infant health and development. Interventions aimed at
improving maternal nutrition during lactation should focus on promoting dietary diversity,
ensuring adequate intake of essential nutrients, and addressing specific micronutrient
deficiencies.
Community-based nutrition education programs can play a key role in raising awareness
about the importance of maternal diet during lactation and providing guidance on healthy
eating practices. These programs can empower lactating mothers with knowledge and skills
to make informed dietary choices that optimize the nutritional quality of their breast milk.
In addition to education, interventions such as food supplementation and fortification may
be necessary to address specific nutrient deficiencies prevalent in the population. For
example, supplementation with micronutrient-rich foods or fortified products can help
bridge the gap between dietary intake and nutrient requirements, ensuring adequate
nutrient transfer to breast milk.
To improve maternal nutrition, interventions that promote dietary diversity and provide
essential nutrients are necessary. In Uganda, interventions such as promotion of household
food production, kitchen gardens, and micronutrient supplementation have shown positive
results in improving maternal nutrition (Sagtani et al., 2016). Additionally, educating
lactating mothers on the importance of a balanced diet and optimal breastfeeding practices
can improve both maternal and infant nutrition.
CHAPTER THREE: METHODOLOGY

Study Design:

This study will employ a cross-sectional design to investigate the impact of dietary choices of
lactating mothers on the nutritional quality of breast milk in Kyegegwa District, Uganda. A cross-
sectional approach will allow for the collection of data at a single point in time, providing insights
into the relationship between maternal dietary intake and breast milk composition.

Map of Kyegegwa District

Study Setting:

The study will be conducted in Kyegegwa District, located in the Western Region of Uganda.
Kyegegwa District was selected due to its high prevalence of breastfeeding and its diverse socio-
cultural and dietary practices, which may influence maternal dietary choices and breast milk
composition.

Sampling Strategy:

A multistage sampling technique will be utilized to recruit participants for the study. First, villages
within Kyegegwa District will be randomly selected. Subsequently, households with lactating
mothers will be identified within the selected villages. Lactating mothers aged 18 years and above,
who are currently breastfeeding infants aged 0-6 months, will be eligible to participate in the study.

Sample Size Determination:

The sample size for this study will be determined by random selection of lactating mothers with
babies aged between 0-9 months attending pediatric clinic at government hospitals in Kyegegwa
District.

Data Collection Methods:

The project will adopt a cross-sectional study design, utilizing both quantitative and qualitative data
collection methods. A sample of lactating mothers will be selected, and their dietary patterns will be
assessed through 24-hour dietary recall and food frequency questionnaires.

Structured Interviews: Trained research assistants will administer structured questionnaires to

collect data on maternal demographic characteristics, dietary habits, including frequency of
consumption of various food groups, and socio-economic status. The questionnaire will be pre-
tested prior to data collection to ensure clarity and reliability.

Inclusion criteria

Only lactating mothers with children aged 1 to 9 months and are willing to participate in the
study will be considered.

Exclusion criteria

Lactating mothers with children aged below 1 or above 9 months will not be considered.

Lactating mothers who are not willing to participate will be excluded.

Data analysis

Data from the study will undergo mixed-methods analysis using various tools. Quantitative
data from closed-ended questions will be processed using SPSS, allowing for descriptive
statistics, t-tests to compare means, and ANOVA for group comparisons. Chi-square tests
will assess associations between categorical variables. Qualitative data from open-ended
questions will undergo thematic analysis. The integration of both data types will yield a
comprehensive understanding of the research findings.

Ethical Considerations:

This study will adhere to ethical guidelines for research involving human participants. Ethical
approval will be obtained from the Institutional Review Board (IRB) or Ethics Committee of Makerere
University.

 Informed consent will be obtained from all study participants prior to data collection
 Confidentiality and privacy will be ensured throughout the study.
Study Design

The study will utilize a cross-sectional design to investigate the impact of lactating mothers' dietary
choices on the nutritional quality of their breast milk in Kyegegwa district, Uganda. Cross-sectional
studies are suitable for assessing relationships between exposure and outcome variables at a specific
point in time, making them appropriate for this research objective.

2. Sampling Strategy

2.1. Sample Size Calculation

A sample size will be calculated using appropriate statistical methods to ensure adequate power to
detect meaningful associations between dietary choices and breast milk quality. This calculation will
be based on the expected effect size, prevalence of dietary habits, and level of significance.

2.2. Selection Criteria

Lactating mothers residing in Kyegegwa district, Uganda, who have infants between 0-6 months old
will be eligible to participate. Exclusion criteria will include mothers with medical conditions affecting
breast milk composition and those unwilling to participate in the study.

2.3. Sampling Technique

A multistage cluster sampling technique will be employed. Firstly, Kyegegwa district will be divided
into clusters based on administrative units. Then, clusters will be randomly selected. Finally, lactating
mothers within the selected clusters will be recruited using systematic random sampling.

3. Data Collection

3.1. Questionnaire Survey

A structured questionnaire will be developed to collect data on socio-demographic characteristics,

dietary habits of lactating mothers, including frequency and types of foods consumed, as well as
breastfeeding practices. The questionnaire will be pretested and validated before implementation to
ensure reliability and validity.

3.2. Dietary Assessment

Dietary intake of lactating mothers will be assessed using dietary recall methods, preferably 24-hour
dietary recall. This will provide detailed information on the types and quantities of foods consumed,
allowing for the evaluation of nutrient intake.

3.3. Breast Milk Sampling and Analysis

Breast milk samples will be collected from lactating mothers using sterile containers. Samples will be
analyzed for macronutrient composition (e.g., protein, fat, carbohydrates) and micronutrient
content (e.g., vitamins, minerals) using established laboratory methods such as spectroscopy and
chromatography.

4. Data Analysis

4.1. Descriptive Analysis

Descriptive statistics will be used to summarize the demographic characteristics, dietary habits, and
breast milk composition of the study population. Measures such as mean, median, standard
deviation, and frequency distributions will be calculated.

4.2. Inferential Analysis

Inferential statistics, such as correlation analysis and regression analysis, will be employed to
examine the relationship between lactating mothers' dietary choices and the nutritional quality of
breast milk. Factors such as maternal age, education, and socio-economic status will be controlled
for as potential confounders.

4.3. Ethical Considerations

4.3.1. Informed Consent

Prior to participation, informed consent will be obtained from all study participants, ensuring that
they are fully aware of the study's purpose, procedures, risks, and benefits.

4.3.2. Confidentiality

Confidentiality of participant information will be strictly maintained throughout the study process.
Data will be anonymized and stored securely to protect participants' privacy.

4.3.3. Ethical Approval

Ethical clearance will be obtained from the relevant institutional review board or ethics committee
before commencing the study to ensure that it adheres to ethical standards and guidelines.

5. Limitations

5.1. Recall Bias

The dietary assessment method relies on participants' ability to accurately recall their dietary intake,
which may be subject to recall bias.

5.2. Generalizability

Findings from this study may not be generalizable to other populations outside of Kyegegwa district,
Uganda, due to regional variations in dietary patterns and cultural practices.

6. Conclusion

In conclusion, the proposed methodology will employ a cross-sectional design to investigate the
impact of lactating mothers' dietary choices on the nutritional quality of breast milk in Kyegegwa
district, Uganda. By employing rigorous sampling techniques, robust data collection methods, and
appropriate statistical analyses, the study aims to provide valuable insights into the relationship
between maternal nutrition and breast milk composition.
WORKPLAN

ITEM ACTIVTY MAR APR MAY JUN JUL MAR APR

NO
1. Proposal writing

2. Proposal
Presentation
3. Data collection

4. Data Analysis

5. Report Presentation

6. Final Report writing

BUDGET

ITEM ACTIVITY UNIT COST QUANTITY TOTAL

NO (UGX) COST(UGX)

Proposal writing 10,000 2 20000

i. Printing
ii. Binding 500 120 60000
Tools 40,000
i. Questionnaires
ii. MUAC tapes
Transportation to Data
collection site (Kyegegwa
Health Centre IV)

Research assistants 20000 4 80,000

Final report 3 30,000
i. Printing
ii. Binding

Miscellenous 50,000
GRAND TOTAL 280,000
EXPENDITURE
 References

1. Agostoni, C., et al., Maternal Nutrition in the First 1,000 Days: A Scoping Review of Available
Evidence, Reviews in Endocrine and Metabolic Disorders, vol. 20, no. 4, 2019, pp. 439-454.

2. Allen, L. H., Hampel, D., & Shahab-Ferdows, S. (2018). Assessing vitamin B-12 and
folate status in resource-poor areas. The American Journal of Clinical Nutrition,
108(6), 1248S-1255S.
Ballard, O., & Morrow, A. L. (2013). Human Milk Composition. Pediatric Clinics of North America, 60(1),
49–74. https://doi.org/10.1016/j.pcl.2012.10.002

Chapman, D. J., & Nommsen-Rivers, L. (2012). Impact of Maternal Nutritional Status on Human Milk
Quality and Infant Outcomes: An Update on Key Nutrients. Advances in Nutrition, 3(3), 351–352.
https://doi.org/10.3945/an.111.001123

Chowdhury, R., Sinha, B., Sankar, M. J., Taneja, S., Bhandari, N., Rollins, N., Bahl, R., & Martines, J. (2015).
Breastfeeding and maternal health outcomes: A systematic review and meta-analysis. In Acta
Paediatrica, International Journal of Paediatrics (Vol. 104, pp. 96–113).
https://doi.org/10.1111/apa.13102

Horta, B. L., Loret de Mola, C., & Victora, C. G. (2015). Long‐term consequences of breastfeeding on
cholesterol, obesity, systolic blood pressure and type 2 diabetes: a systematic review and meta‐
analysis. Acta Paediatrica, 104(S467), 30–37. https://doi.org/10.1111/apa.13133

Ip, S., Chung, M., Raman, G., Chew, P., Magula, N., DeVine, D., Trikalinos, T., & Lau, J. (2007).
Breastfeeding and maternal and infant health outcomes in developed countries. Evidence
Report/Technology Assessment, 153, 1–186.

Isaacs, E. B., Fischl, B. R., Quinn, B. T., Chong, W. K., Gadian, D. G., & Lucas, A. (2010). Impact of Breast
Milk on Intelligence Quotient, Brain Size, and White Matter Development. Pediatric Research, 67(4),
357–362. https://doi.org/10.1203/PDR.0b013e3181d026da

Kramer, M. S. (2008). Breastfeeding and Child Cognitive Development. Archives of General Psychiatry,
65(5), 578. https://doi.org/10.1001/archpsyc.65.5.578

Powe, C. E., Knott, C. D., & Conklin‐Brittain, N. (2010). Infant sex predicts breast milk energy content.
American Journal of Human Biology, 22(1), 50–54. https://doi.org/10.1002/ajhb.20941

Quinn, E. A., Largado, F., Power, M., & Kuzawa, C. W. (2012). Predictors of breast milk macronutrient
composition in filipino mothers. American Journal of Human Biology, 24(4), 533–540.
https://doi.org/10.1002/ajhb.22266

Riskin, A., Almog, M., Peri, R., Halasz, K., Srugo, I., & Kessel, A. (2012). Changes in immunomodulatory
constituents of human milk in response to active infection in the nursing infant. Pediatric Research,
71(2), 220–225. https://doi.org/10.1038/pr.2011.34

Saarela, T., Kokkonen, J., & Koivisto, M. (2005). Macronutrient and energy contents of human milk
fractions during the first six months of lactation. Acta Paediatrica, 94(9), 1176–1181.
https://doi.org/10.1111/j.1651-2227.2005.tb02070.x

3.
 4. Brown, A., Maternal Diet During Lactation, Breastfeeding Medicine, vol. 12, no. 9, 2017, pp.
510-517.

5. Hampel D, Shahab-Ferdows S, Islam MM, Peerson JM, Allen LH. Vitamin

concentrations in human milk vary with time within feed, circadian rhythm, and
single-dose supplementation. The Journal of Nutrition. 2017; 147(1):30-38.
6. Innis, S. M. (2014). Impact of maternal diet on human milk composition and
neurological development of infants. The American Journal of Clinical Nutrition,
99(3), 734S-741S.
7. Kabahenda M, Ssempijja F, Mukama T. Maternal dietary patterns and breast milk
composition in Kyegegwa District, Uganda. Journal of Nutrition and Infant Health.
2020; 14(2):78-86
Ballard, O., & Morrow, A. L. (2013). Human Milk Composition. Pediatric Clinics of North America, 60(1),
49–74. https://doi.org/10.1016/j.pcl.2012.10.002

Chapman, D. J., & Nommsen-Rivers, L. (2012). Impact of Maternal Nutritional Status on Human Milk
Quality and Infant Outcomes: An Update on Key Nutrients. Advances in Nutrition, 3(3), 351–352.
https://doi.org/10.3945/an.111.001123

Chowdhury, R., Sinha, B., Sankar, M. J., Taneja, S., Bhandari, N., Rollins, N., Bahl, R., & Martines, J. (2015).
Breastfeeding and maternal health outcomes: A systematic review and meta-analysis. In Acta
Paediatrica, International Journal of Paediatrics (Vol. 104, pp. 96–113).
https://doi.org/10.1111/apa.13102

Horta, B. L., Loret de Mola, C., & Victora, C. G. (2015). Long‐term consequences of breastfeeding on
cholesterol, obesity, systolic blood pressure and type 2 diabetes: a systematic review and meta‐
analysis. Acta Paediatrica, 104(S467), 30–37. https://doi.org/10.1111/apa.13133

Ip, S., Chung, M., Raman, G., Chew, P., Magula, N., DeVine, D., Trikalinos, T., & Lau, J. (2007).
Breastfeeding and maternal and infant health outcomes in developed countries. Evidence
Report/Technology Assessment, 153, 1–186.

Isaacs, E. B., Fischl, B. R., Quinn, B. T., Chong, W. K., Gadian, D. G., & Lucas, A. (2010). Impact of Breast
Milk on Intelligence Quotient, Brain Size, and White Matter Development. Pediatric Research, 67(4),
357–362. https://doi.org/10.1203/PDR.0b013e3181d026da

Kramer, M. S. (2008). Breastfeeding and Child Cognitive Development. Archives of General Psychiatry,
65(5), 578. https://doi.org/10.1001/archpsyc.65.5.578

Powe, C. E., Knott, C. D., & Conklin‐Brittain, N. (2010). Infant sex predicts breast milk energy content.
American Journal of Human Biology, 22(1), 50–54. https://doi.org/10.1002/ajhb.20941

Quinn, E. A., Largado, F., Power, M., & Kuzawa, C. W. (2012). Predictors of breast milk macronutrient
composition in filipino mothers. American Journal of Human Biology, 24(4), 533–540.
https://doi.org/10.1002/ajhb.22266

Riskin, A., Almog, M., Peri, R., Halasz, K., Srugo, I., & Kessel, A. (2012). Changes in immunomodulatory
constituents of human milk in response to active infection in the nursing infant. Pediatric Research,
71(2), 220–225. https://doi.org/10.1038/pr.2011.34
 Saarela, T., Kokkonen, J., & Koivisto, M. (2005). Macronutrient and energy contents of human milk
fractions during the first six months of lactation. Acta Paediatrica, 94(9), 1176–1181.
https://doi.org/10.1111/j.1651-2227.2005.tb02070.x3

8. Namugumya, B. S., Ayishatu, A., Kugonza, L. B., Nankinga, O., Namuwenge, D., &
Ojok, L. (2020). Dietary practices of lactating women in Kyegegwa District, Uganda.
BMC Nutrition, 6(1), 1-9.
9. Otoo GE, Lartey AA, Pérez-Escamilla R. Perceived incentives and barriers to exclusive
breastfeeding among periurban Ghanaian women. Journal of Human Lactation.
2012; 28(3): 277-282.
10. Perrin MT, Pawlak R, Dean LL, Christis A. The relationship between dietary long-chain
omega-3 fatty acid intake and blood omega-3 fatty acid levels in lactating women: a
systematic review. Advances in Nutrition. 2017; 8(2):280-289.
11. Uganda Bureau of Statistics (UBOS) and ICF. (2018). Uganda Demographic and Health Survey
2016: Key Indicators Report. Kampala, Uganda, and Rockville, Maryland, USA: UBOS and ICF.

12. Victora, C. G., Bahl, R., Barros, A. J., França, G. V., Horton, S., Krasevec, J., ... & Rollins,
N. C. (2016). Breastfeeding in the 21st century: epidemiology, mechanisms, and
lifelong effect. The Lancet, 387(10017), 475-490.
13. World Health Organization (WHO). (2010). Indicators for assessing infant and young child
feeding practices: Part 1: Definitions: conclusions of a consensus meeting held 6-8
November 2007 in Washington DC, USA.

14. Isaiah, G. J., Odeho, M. O. G., Apuke, O. D., & Chinweuba, A. U. (2018). Dietary
diversity predicts the nutritional quality of breast milk among lactating mothers
attending health facilities in Kyegegwa district, western Uganda. Journal of Health,
Population, and Nutrition, 37(1), 1-9.
15. Prentice, A. (2014). Maternal nutrition and lactation. Nestle nutrition institute
workshop series, 77, 85-98.
16. Sagtani, R. A., Thorne-Lyman, A. L., Sharma, P., & Gittelsohn, J. (2016). Nutrition in
pregnancy and early childhood and associations with maternal and infant health: a
systematic review and meta-analysis. American Journal of Clinical Nutrition, 104(3),
903-922.
17. Ballard, O., & Morrow, A. L. (2013). Human milk composition: nutrients and bioactive
factors. Pediatric Clinics, 60(1), 49-74.
18. Prentice, A. (2014). Maternal calcium requirements during pregnancy and lactation.
The American Journal of Clinical Nutrition, 99(4), 1122S-1126S.
19. World Health Organisation. (2009). Infant and young child feeding Model Chapter
for textbooks for medical students and allied health professionals.
https://www.ncbi.nlm.nih.gov/books/NBK148965/pdf/Bookshelf_NBK148965.pdf
Ballard, O., & Morrow, A. L. (2013). Human Milk Composition. Pediatric Clinics of North America, 60(1),
49–74. https://doi.org/10.1016/j.pcl.2012.10.002
Chapman, D. J., & Nommsen-Rivers, L. (2012). Impact of Maternal Nutritional Status on Human Milk
Quality and Infant Outcomes: An Update on Key Nutrients. Advances in Nutrition, 3(3), 351–352.
https://doi.org/10.3945/an.111.001123

Chowdhury, R., Sinha, B., Sankar, M. J., Taneja, S., Bhandari, N., Rollins, N., Bahl, R., & Martines, J. (2015).
Breastfeeding and maternal health outcomes: A systematic review and meta-analysis. In Acta
Paediatrica, International Journal of Paediatrics (Vol. 104, pp. 96–113).
https://doi.org/10.1111/apa.13102

Horta, B. L., Loret de Mola, C., & Victora, C. G. (2015). Long‐term consequences of breastfeeding on
cholesterol, obesity, systolic blood pressure and type 2 diabetes: a systematic review and meta‐
analysis. Acta Paediatrica, 104(S467), 30–37. https://doi.org/10.1111/apa.13133

Ip, S., Chung, M., Raman, G., Chew, P., Magula, N., DeVine, D., Trikalinos, T., & Lau, J. (2007).
Breastfeeding and maternal and infant health outcomes in developed countries. Evidence
Report/Technology Assessment, 153, 1–186.

Isaacs, E. B., Fischl, B. R., Quinn, B. T., Chong, W. K., Gadian, D. G., & Lucas, A. (2010). Impact of Breast
Milk on Intelligence Quotient, Brain Size, and White Matter Development. Pediatric Research, 67(4),
357–362. https://doi.org/10.1203/PDR.0b013e3181d026da

Kramer, M. S. (2008). Breastfeeding and Child Cognitive Development. Archives of General Psychiatry,
65(5), 578. https://doi.org/10.1001/archpsyc.65.5.578

Powe, C. E., Knott, C. D., & Conklin‐Brittain, N. (2010). Infant sex predicts breast milk energy content.
American Journal of Human Biology, 22(1), 50–54. https://doi.org/10.1002/ajhb.20941

Quinn, E. A., Largado, F., Power, M., & Kuzawa, C. W. (2012). Predictors of breast milk macronutrient
composition in filipino mothers. American Journal of Human Biology, 24(4), 533–540.
https://doi.org/10.1002/ajhb.22266

Riskin, A., Almog, M., Peri, R., Halasz, K., Srugo, I., & Kessel, A. (2012). Changes in immunomodulatory
constituents of human milk in response to active infection in the nursing infant. Pediatric Research,
71(2), 220–225. https://doi.org/10.1038/pr.2011.34

Saarela, T., Kokkonen, J., & Koivisto, M. (2005). Macronutrient and energy contents of human milk
fractions during the first six months of lactation. Acta Paediatrica, 94(9), 1176–1181.
https://doi.org/10.1111/j.1651-2227.2005.tb02070.x

.
Dietary Choices Frequency Questionnaire for Lactating Mothers

Research questions:
Dear Participant,

Thank you for participating in our research study. Your valuable input will contribute to a better
understanding of the impact of lactating mothers' dietary choices on the quality of breast milk in
Kyegegwa District. Please answer the following questions honestly and to the best of your
knowledge. Your responses will remain confidential, and the information gathered will be used
solely for research purposes.
Section 1: Demographic Information

1.1. Name (Optional): _____________

1.2. Age: _____________

1.3. Marital Status:

 Single

 Married

 Widowed

 Divorced

1.4. Educational Level:

 No formal education

 Primary

 Secondary

 Tertiary

1.5. Occupation: _____________

1.6. Monthly Household Income: _____________

Section 2: Maternal Dietary Patterns

Stable foods normally consumed

2.1. What is the typical daily diet for you? Please provide details of your meals and snacks.

2.2. Are there specific cultural or traditional foods that you commonly consume during lactation?

2.3. How often do you consume the following food groups? (Daily, Weekly, Monthly, Rarely)

 Fruits and Vegetables

 Protein-rich foods (meat, fish, eggs, legumes)

 Dairy products

 Grains and cereals

2.4. Do you take any dietary supplements during lactation? If yes, please specify.

Section 3: Breastfeeding Practices

3.1. How many times do you breastfeed your infant in a 24-hour period?( objectives)
Less or more than 12

3.2. Have you faced any challenges related to breastfeeding? If yes, please describe.

Breast feeding challenges such as engorgement etc

Breast feeding challenges on the kid ie failure to suckle

3.3. Do you follow any specific breastfeeding guidelines or cultural practices?

Section 4: Infant Growth and Development

4.1. How would you describe the overall health and development of your infant?(incidence of
frequent illness) or weight gain

4.2. Are there any concerns or issues related to your infant's growth and development that you have
observed?

Section 5: Cultural and Socio-Economic Factors

5.1. How do cultural beliefs and practices influence your dietary choices during lactation? (foods
restricted by culture during lactation)

5.2. Are there any socio-economic factors that impact your ability to maintain a diverse and
nutritious diet? (income level, supportive household etc)

Section 6: Additional Comments

6.1. Is there anything else you would like to share about your experiences as a lactating mother and
your dietary choices?

Thank you for your participation! Your insights are invaluable to our research.

Thank you for completing the questionnaire. Your input is invaluable to our research. Please
return the completed questionnaire to the study coordinator by [insert deadline or return
instructions].
If you have any further questions or would like to discuss anything related to the study,
please feel free to contact us.
Sincerely,
[Research Team Contact Information]