Analysis of the Nutritional Intake of Breastfeeding Mothers in Côte d'Ivoire: Challenges and Perspectives for Maternal and Child Health

*Corresponding author: Gnelle Assita Coulibaly Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution License 4.0. Analysis of the Nutritional Intake of Breastfeeding Mothers in Côte d’Ivoire: Challenges and Perspectives for Maternal and Child Health Gnelle Assita Coulibaly 1, *, Audrey Herbert Yépié 1, Naty Tadiogo Koné 2, Anin L. Anin-Atchibri 1 and Adjehi Dadié 2 1 Department of Food Sciences and Technology, Laboratory of Nutrition and Food Safety, Nangui Abrogoua University, 02 B.P. 801 Abidjan 02, Côte d’Ivoire. 2 Department of Food Sciences and Technology, Laboratory of Microbiology and Biotechnology of Food, Nangui Abrogoua University, 02 B.P. 801 Abidjan 02, Côte d’Ivoire. GSC Biological and Pharmaceutical Sciences, 2025, 33(01), 134-145 Publication history: Received on 06 September 2025; revised on 10 October 2025; accepted on 13 October 2025 Article DOI: https://doi.org/10.30574/gscbps.2025.33.1.0396 Abstract A balanced diet during breastfeeding is essential to meet the increased needs of lactating mothers and to ensure highquality breast milk. However, such a diet is often inadequate and insufficient. This study aims to assess the nutritional intake of breastfeeding women in Côte d’Ivoire and its implications for maternal and child health. A survey was conducted among 300 breastfeeding mothers in health centers located in Abobo, Cocody, Port-Bouët, Dabou, and Bonoua. Nutritional needs were calculated using the Müller equation, and intakes were estimated through biochemical food analysis and the Nutrisurvey 2007 software. Results showed that mothers had an average energy intake of 2157.97 kcal/day, significantly below the estimated requirement of 3629.43 kcal/day. On average, intakes covered 63.27% of lipid needs, 30.81% of protein needs, and 61.35% of carbohydrate needs. Three-quarters of the mothers had insufficient intake of energy and macronutrients. Significant deficits were observed in polyunsaturated fatty acids (9.36 g vs. 17.97 g) and fiber (20.1 g vs. 25 g). Calcium and zinc intakes were inadequate for all mothers. Only 5 to 10% of women aged 16 to 34 met the recommended intakes for potassium and iron. Conversely, phosphorus was consumed in excess by 80% of participants. Deficiencies in vitamins A, B1, B2, B6, B9, C, and E were observed in 75 to 90% of the participants. These results reveal widespread nutritional insufficiency among breastfeeding women in the studied population. Keywords: Breastfeeding mothers; Nutritional intake; Diet; Maternal and child health; Côte d’Ivoire 1. Introduction Breastfeeding is the optimal mode of nutrition for infants, providing a complete supply of essential nutrients needed for their growth and development. Breast milk, recognized by the World Health Organization as the gold standard for the first six months of life, not only supports rapid growth but also contributes to the maturation of the immune system due to its richness in biologically active substances [1]. The nutritional quality of breast milk directly depends on the mother's nutritional status, whose needs increase significantly during the breastfeeding period [2]. A varied and balanced diet is therefore essential to safeguard the health of both mother and child [3]. Globally, public health policies promote exclusive breastfeeding while emphasizing the need for appropriate nutritional support for mothers. In Africa, several studies have shown that maternal dietary practices are often inadequate [4], thereby compromising the quality of breast milk and infant health [5]. In Côte d’Ivoire, the nutritional intake of breastfeeding women remains poorly documented. This gap limits the development of targeted recommendations adapted to local realities. Thus, a better understanding of these nutritional GSC Biological and Pharmaceutical Sciences, 2025, 33(01), 134-145 135 intakes is necessary to guide maternal and child health interventions. This study is based on the hypothesis that the nutritional intake of breastfeeding mothers in Côte d’Ivoire is insufficient and unbalanced in relation to recommended physiological needs. It aims to assess these intakes, compare them to reference nutritional requirements, and identify their implications for maternal and infant health. Specifically, the objectives are: (i) to estimate the nutritional needs of breastfeeding women; (ii) to analyze their actual dietary intake; and (iii) to identify nutritional deficiencies or excesses. 2. Materials and Methods 2.1. Study Type and Setting This was a cross-sectional study with both descriptive and analytical purposes. It was conducted in three (03) health facilities in Abidjan. The selected facilities included the Houphouët Boigny General Hospital located in the municipality of Abobo, the Henriette Konan Bédié Health Complex in Cocody-Blockhaus (Cocody municipality), and the Port-Bouët General Hospital in the municipality of Port-Bouët. In Bonoua and Dabou, the study was carried out at the General Hospitals of Bonoua and Dabou, respectively (Figure 1). Source: Personal, QGIS software Figure 1 Geographic map showing the location of the different sites 2.2. Study Period and Population The study was conducted from September 2019 to December 2021. It involved 300 breastfeeding mothers. 2.3. Sampling and Participant Selection The sample size was determined using Daniel Schwarz's formula : n = sample size; Z = 1.96; q = 1 – p; i = 0.05 p = Prevalence of metabolic diseases (0.235) GSC Biological and Pharmaceutical Sciences, 2025, 33(01), 134-145 136 After calculation, the minimum sample size required for a representative sample was 276.24, meaning 276 individuals to be surveyed. For the purpose of this study, the sample size was adjusted to 300 breastfeeding women, with a distribution of 60 women per health center. Included in the study were all breastfeeding mothers aged between 15 and 45 years, attending the study sites, apparently in good health, and who had given their informed consent. 2.4. Nutritional Survey This study required a cross-sectional survey. Data collection was carried out through face-toface interviews using questionnaires. The information collected concerned sociodemographic factors and the dietary intake of breastfeeding women. 2.5. Variable Selection The sociodemographic variables studied included sex, age, level of education, marital status, and occupation. Dietary intake was assessed using the 24-hour recall method over three non-consecutive days, allowing the determination of the quantity of food consumed per woman and by type of meal. This method is used to evaluate energy and nutrient intake [6]. Daily intakes of macronutrients and micronutrients were estimated using standard food analysis methods, as well as food composition software and food composition tables. 2.6. Estimation of Energy and Nutrient Intakes In order to limit biases related to regional and seasonal variations as well as nutrient losses during cooking, a biochemical analysis was carried out on certain local dishes commonly consumed by the respondents. These dishes, the most frequently consumed by the target population, included staple foods (rice, foutou banana, attiéké, and Kabato de maïs), sauces (eggplant sauce, peanut sauce, Vegetable sauce, and okra sauce), as well as protein sources (meat and fish) (Figure 2 et Table I). Each dish was sampled in triplicate in the three areas of Abidjan, for a total of 36 dishes. The values obtained from these analyses were entered into the Nutrisurvey software, version 2007. Prior to this, other dishes consumed by the mothers were also entered into the software, based on the quantities consumed. For West African foods not included in the Nutrisurvey database, the West African Food Composition Table was used to better reflect the study context. Thus, the nutritional composition of the identified foods was imported into Nutrisurvey to complement and refine the analysis. Nutrisurvey uses linear programming to automatically calculate the nutrient intake for each food, thereby allowing for an accurate estimation of daily nutritional intakes. Figure 2 Most Commonly Consumed Local Dishes GSC Biological and Pharmaceutical Sciences, 2025, 33(01), 134-145 137 Table 1 Most Commonly Consumed Local Dishes and Their Characteristics Local Dishes Nutritional Characteristics Vegetable sauce Sauce made from tomato, onion, chili pepper, cabbage, zucchini... okra sauce Sauce made from fresh or dried okra, ground into powder (Abelmoschus esculentus) peanut sauces Sauce made from peanut paste. Arachis hypogaea Sauce aubergine Sauce made from Eggplant (Solanum Torvum) Kabato de maïs Cornmeal cooked in water (Zea mays) Attiéké Steamed cassava semolina (Manihot esculenta) Foutou banana Plantain banana (Musa paradisiaca) and cassava (Manihot esculenta) cooked in water and then pounded 2.7. Biochemical Composition of Meals All analyses were carried out in triplicate. The contents of dry matter, lipids, proteins, ash, and dietary fiber were determined in accordance with the method described by AOAC, 2000 [7]. Carbohydrate content was estimated by differential calculation [8]. The energy value was calculated using the equation defined by the metabolizable energy conversion coefficient, also known as the general Atwater factors [9]. The mineral profile of the samples was determined using a Scanning Electron Microscope (SEM). 2.8. Determination of the Nutritional Requirements of Lactating Mothers The daily caloric needs of lactating women were calculated using the equation of Müller et al. (2004) [10], with a physical activity level ranging between 1.5 and 2.2 [11]. Macronutrient requirements for lactating mothers were calculated based on their total energy needs. Carbohydrates accounted for 50 to 55% of total energy intake (TEI), proteins for 12 to 15%, and lipids for 30 to 35% of TEI [12]. As for micronutrients, daily micronutrient intakes were compared with the nutritional recommendations of Anses (2019) [12]. 2.9. Data Analysis IBM SPSS Statistics version 20.0 was used to process the survey data, which was based on the calculation of means. 2.10. Ethical Considerations The protocol for this study was approved by the National Ethics Committee for Life Sciences and Health of Côte d’Ivoire (CNESVS), under reference number N°107-22/MSHPCMU/CNESVS-kp. Informed consent was obtained from all participants prior to their inclusion in the study. 3. Results 3.1. Water Intake Figures 3 and 4 show the data on water intake. The results reveal that the majority of mothers, regardless of their age group, consumed between 1 and 1.5 liters of water per day: 55.74% among those aged 16–24, 54.48% among those aged 25–34, and 58% among those aged 35–45. On the other hand, a significant proportion of mothers had a water intake of less than one liter: 27.87% for the 16–24 age group, 16.42% for the 25–34 group, and 14% for the 35–45 group. Only 16.39%, 29.1%, and 28% of mothers aged 16–24, 25–34, and 35–45 respectively drank more than 1.5 liters of water per day. Moreover, the average water intake from food was 1309.66 ± 420.21 mL, with respective intakes of 1341.396 mL, 1304.433 mL, and 1258.069 mL for the 16–24, 25–34, and 35–45 age groups. GSC Biological and Pharmaceutical Sciences, 2025, 33(01), 134-145 138 Figure 3 Distribution of mothers according to the amount of water consumed per day Figure 4 Distribution of mothers according to the amount of water provided by food 3.2. Coverage of Energy and Macronutrient Requirements Overall, the mothers did not meet their energy requirements, except for 25% of those aged 16–24 and 25–34 who managed to meet half of their needs. As for macronutrients, protein requirements were not met by the mothers, regardless of their age group. However, carbohydrate and lipid requirements were better covered by the younger mothers. In fact, 25% of mothers aged 16–24 and 25–34 met their lipid and carbohydrate requirements, unlike their 35–45-year-old counterparts who met only a portion (half) or none of their respective lipid and carbohydrate needs (Figure 5). GSC Biological and Pharmaceutical Sciences, 2025, 33(01), 134-145 139 Figure 5 Energy and macronutrient intake and requirements of mothers by age group 3.3. Coverage of PUFA, Cholesterol, and Fiber Requirements The results show that 75% of the mothers did not meet their fiber requirement (25 g). Moreover, the majority of mothers (80 to 100%) had daily intakes of PUFAs and cholesterol below the respective recommendations of 11.98 to 23.97 g and 300 mg (Figure 6). GSC Biological and Pharmaceutical Sciences, 2025, 33(01), 134-145 140 Figure 6 Fiber, PUFA, and cholesterol intake according to mothers' age 3.4. Micronutrient Requirement Coverage The results on mineral requirement coverage showed that calcium and zinc needs were not met by the mothers, regardless of age group. As for potassium and iron, only 5 to 10% of mothers aged 16–24 and 25–34 met their needs, unlike mothers aged 35–45. Magnesium requirements, however, were met by about 50% of the mothers across all age groups. Furthermore, phosphorus intake in the majority of mothers (80%) was significantly higher than the requirements across all age groups (Figure 7). Regarding vitamin A, B2, and B9 requirements, they were not met by the mothers in any age group. On the other hand, only 10 to 25% of mothers aged 16–24 and 25–34 met their requirements for vitamins B1, B6, C, and E, while their 35– 45-year-old counterparts met little (5 to 10%) or none of their respective needs for vitamins B6, C, B1, and E (Figure 8). GSC Biological and Pharmaceutical Sciences, 2025, 33(01), 134-145 141 Figure 7 Mineral intake according to mothers' age GSC Biological and Pharmaceutical Sciences, 2025, 33(01), 134-145 142 Figure 8 Vitamin intake according to mothers' age 4. Discussion This study aimed to assess the nutritional intake of breastfeeding women in Côte d’Ivoire and its implications for maternal and child health. The results reveal several concerning deficiencies, both in terms of hydration and nutrition. Regarding hydration, 71.67% of the mothers consumed between 1 and 1.5 liters of water per day, which falls below international recommendations. Indeed, the Institute of Medicine recommends a total water intake of 3.3 L/day for lactating women [13]. In China, this value is set at 3.8 L/day [14, 15], while the European Food Safety Authority recommends a total intake of 2.7 L/day, including about 1.7 L from beverages and 1 L from food sources [16]. In our sample, the average water intake from food was 1309.66 ± 420.21 mL, thus exceeding the EFSA’s food-based intake recommendation. Although beverage intake was lower than recommended, overall hydration could be considered acceptable. However, due to variability in the guidelines, drawing definitive conclusions remains uncertain. Further studies tailored to the context of Côte d’Ivoire are necessary to establish appropriate local standards.