Maternal Knowledge, Attitudes, and Practices of Complementary Feeding and Child Undernutrition in the Vakinankaratra Region of Madagascar: A Mixed-Methods Study

ABSTRACT Background Data are limited on how feeding knowledge and practices relate to child undernutrition in the highlands of Madagascar. Objectives This study assessed maternal knowledge and practices of complementary feeding and their associations with anthropometrics of children aged 6–23 mo in the Vakinankaratra region of Madagascar. Methods Knowledge was assessed using WHO recommendations on child feeding, and WHO infant and young child feeding (IYCF) indicators were used to evaluate feeding practices. Child growth was measured as length-for-age, weight-for-age, and weight-for-length z-scores using the 2006 WHO growth standards. A z-score less than −2 was classified as child undernutrition. Logistic regression models were used to determine associations between independent variables and outcomes. Focus group discussions among mothers and in-depth interviews with key informants were conducted; barriers and facilitators of optimal feeding practices were identified using a thematic analysis approach. Results Maternal knowledge scores regarding child feeding averaged 6.4 of 11. Better knowledge scores were associated with higher odds of appropriate complementary feeding practices before and after covariate adjustments. The proportions of children achieving the minimum dietary diversity (35.8%), minimum acceptable diet (30.2%), and consuming meat, fish, and poultry (14.1%) were low. Only consumption of iron-rich foods was associated with lower odds of underweight (adjusted OR = 0.3; 95% CI: 0.1, 0.7; P < 0.05). None of the IYCF indicators were associated significantly with stunting or wasting. Maternal attitudes about complementary foods, as well as mothers’ workload and very low income, were identified as barriers to optimal feeding practices. Maternal perceived benefits of giving appropriate complementary foods as well as their positive relationship with the community health workers were the main facilitators of optimal child feeding. Conclusions Integrated nutrition-sensitive interventions addressing these barriers while enhancing the facilitators are critical in promoting better feeding practices in the Vakinankaratra region.

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Determinants and Current Level of Optimal Complementary Feeding Practices among Lactating Mothers of Children in Ambo Town, Oromia, Ethiopia

10.46619/fpns.2020.1-1004 ◽

2020 ◽

Vol 1 (1) ◽

pp. 31-50

Author(s):

Haile Abebe ◽

◽

Belay Assefa ◽

Keyword(s):

Complementary Feeding ◽

Dietary Diversity ◽

Feeding Practices ◽

Current Level ◽

Meal Frequency ◽

Maternal Knowledge ◽

Complementary Foods ◽

Chi Square ◽

Cross Sectional ◽

Chi Square Test

An appropriate diet is critical in the growth and development of children especially in the first two years of life. Poor complementary feeding of children aged 6 months - 23 months contributes to the characteristics negative growth trends and deaths observed in developing countries. Therefore, this study aimed to assess determinants and current level of optimal complementary feeding practices among mothers of children aged 6 months to 23 months in Ambo town, Oromia Region. The study used cross sectional study design and targeted 336 mothers with children 6 months - 23 months olds. Information from the respondents were collected using standard questionnaire. Data entry and analysis was done using SPSS version 21.0 windows statistical software. All (100%) the children 6 months - 8 months old had received solid, semi-solid/soft foods. The minimum meal frequency was attained by 88.3% (95% CI 84.3-91.4) whereas the minimum dietary diversity was attained by 17.9% (95% CI 14.1-22.5). The minimum acceptable diet was attained by 15.4% (95% CI 11.9-19.8). Maternal knowledge on: importance of breastfeeding (87.3%); age of introduction of complementary foods (85.4%) and correct meal frequency for age (74.5%) was high. On the contrary, knowledge on the importance of enriching complementary foods (34.5%) was low. Mothers who knew the importance of a diverse diet were likely (chi-square test; p=0.001) to feed their children on a diverse diet. On the other hand, mothers who knew the importance of enriching complementary foods were likely to feed their children on a minimum acceptable diet (chi-square test; p = 0.007) and maternal knowledge on enriching complementary foods (OR = 3.41, p = 0.040) were significant predictors of consumption of Vitamin A rich foods, minimum meal frequency and minimum acceptable diet, respectively. Behaviour change and communication involving all the stakeholders in infant and young child feeding should be emphasized. Messages on appropriate feeding practices should include importance of dietary diversity

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Complementary Feeding Practices and Associated Factors Among Infants and Young Children 6–23 Months in Fort Portal Kabarole District Uganda (P11-049-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz048.p11-049-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Sharon Bagaaya ◽

Henry Wamani ◽

Richard Kajura

Keyword(s):

Young Children ◽

Low Income ◽

Associated Factors ◽

Complementary Feeding ◽

Dietary Diversity ◽

Feeding Practices ◽

Cross Sectional Study ◽

Child Feeding ◽

Cross Sectional ◽

Infants And Young Children

Abstract Objectives To determine the prevalence of appropriate complementary feeding practices and associated factors among infants and young children 6–23 months in Fort Portal municipality Kabarole Uganda Methods A community based cross sectional study was conducted among 206 mothers/caregivers of infants and young children 6–23 months using both quantitative and qualitative methods. Probability proportionate to population size technique was used to select study subjects. A pretested WHO standard questionnaire for measuring infant and young child feeding practices was adopted for assessing complementary feeding practices. Appropriate complementary feeding was defined as attaining both minimum meal frequency and minimum dietary diversity in the last 24 hours. Prevalence ratios and there 95% confidence intervals were generated. Modified poisson regression analysis method was used to generate factors associated with appropriate complementary feeding. Five focus group discussions were conducted to capture participants perceptions on appropriate complementary feeding practices. Results The prevalence of appropriate complementary feeding was 21.4%. Formal employment (PR: 7.05; CI:1.69-29.36), cohabiting (PR: 2.15; CI: 1.10-4.18) and having no child illness (PR: 1.85; CI: 0.88-4.35) were associated with appropriate complementary feeding. Qualitative results showed that inadequate information and low income as major challenges towards appropriate complementary feeding practices. Conclusions Appropriate complementary feeding practices were low. unless interventions such as; health services access and women entrepreneurship are put in place, the inappropriate complementary feeding practices are unlikely to change. Funding Sources Ministry of Health Uganda. Supporting Tables, Images and/or Graphs

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Maternal determinants of optimal breastfeeding and complementary feeding and their association with child undernutrition in Malawi (2015–2016)

BMC Public Health ◽

10.1186/s12889-019-7877-8 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Christine N. Walters ◽

Hasina Rakotomanana ◽

Joel J. Komakech ◽

Barbara J. Stoecker

Keyword(s):

Urban Areas ◽

Complementary Feeding ◽

Dietary Diversity ◽

Feeding Practices ◽

Child Growth ◽

Meal Frequency ◽

Maternal Characteristics ◽

Child Undernutrition ◽

Maternal Determinants ◽

Minimum Dietary Diversity

Abstract Background Optimal breastfeeding and complementary feeding practices are critical to prevent child undernutrition. Despite the occurrence of child undernutrition and widespread suboptimal feeding practices in Malawi, the association of breastfeeding and complementary feeding practices and undernutrition among Malawian children remains unclear. The purpose of the study was to determine the current breastfeeding and complementary feeding practices, to identify maternal determinants of each practice, and to analyze the associations between breastfeeding and complementary feeding practices with stunting, underweight, and wasting. Methods The most recent Malawi Demographic Health Survey (2015–2016) was used and data for 2294 children aged 0–23 months were included. A conceptual framework of five maternal domains: sociodemographic, health status, health behaviors, women’s empowerment, and media exposure was used. Each domain contained exposure variables and the WHO Infant and Young Child Feeding indicators were used as outcome variables. All analyses were adjusted for clustering, and variables that reached a p-value of < 0.05 were considered significant in the final model. Results Among children, 30.8% were stunted, 9.9% were underweight, and 3.7% were wasted. Many (78%) were breastfed within the first hour of birth, 89% were breastfed until their first birthday, yet 40% were not exclusively breastfed to 6 months. Only 32% met minimum dietary diversity, 23% met minimum meal frequency, 12% met minimum acceptable diet and 12% consumed iron-rich foods. Children whose mothers lived in urban areas were less likely to be breastfed within 1 hour of birth but more likely to meet minimum dietary diversity. Children whose mothers listened to radio were more likely to meet minimum meal frequency. Children (13–23 months) who met minimum meal frequency and minimum acceptable diet were less likely to be underweight. Conclusions Optimal breastfeeding and complementary feeding practices in Malawi remain suboptimal and child undernutrition remains problematic. Maternal characteristics from the five domains were significantly associated with optimal breastfeeding and complementary feeding indicators. Knowledge of these maternal determinants can assist in improving nutrition policies and interventions that aim to impact breastfeeding and complementary feeding practices and child growth in Malawi.

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Complementary Feeding Practices and Child Growth in a Region with a High Burden of Child Undernutrition in Madagascar

Current Developments in Nutrition ◽

10.1093/cdn/nzaa053_096 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 891-891

Author(s):

Hasina Rakotomanana ◽

Deana Hildebrand ◽

Gail Gates ◽

David Thomas ◽

Barbara Stoecker

Keyword(s):

Complementary Feeding ◽

Dietary Diversity ◽

Survey Design ◽

Feeding Practices ◽

Optimal Growth ◽

Child Growth ◽

Linear Regression Models ◽

Cross Sectional ◽

Growth Standards ◽

Child Undernutrition

Abstract Objectives The Vakinankaratra region of Madagascar has the highest stunting rates of the country, yet it is one of most agriculturally productive regions. The purpose of this study was to assess maternal complementary feeding practices and their association with child growth. Methods Data from a cross-sectional study of 391 mothers and their infants aged 6–23 months were analyzed. The WHO infant and young child feeding (IYCF) indicators were used to assess complementary feeding practices. A questionnaire for collection of sociodemographic information and 24-hour dietary recall was translated and pre-tested before data collection. Child length and weight were converted to length-for-age (LAZ), weight-for-age (WAZ), and weight-for-length (WLZ) using the 2006 WHO Growth Standards. Linear regression models were conducted while adjusting for survey design and confounding variables. Results Stunting (69.4%) and undernutrition (23.4%) rates were very high. The proportion of children achieving minimum dietary diversity (35.8%), minimum acceptable diet (30.2%) and consuming flesh foods (14.1%) were low. Higher dietary diversity score was associated with increased LAZ [β = 0.2, P < 0.05, R2 = 0.16] in 9–11 months infants only. Consuming flesh foods was associated only with higher WAZ [β = 0.41, P < 0.01, R,2 = 0.10]. None of the indicators were associated with WLZ. Conclusions Complementary feeding practices were suboptimal in the Vakinankaratra region. Although crucial for optimal growth, improving feeding practices alone may not be sufficient to reduce the high prevalence of child undernutrition in the region. Funding Sources This study was funded by the Marilynn Thoma Chair in Human Sciences at Oklahoma State University.

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Qualitative, longitudinal exploration of coping strategies and factors facilitating infant and young child feeding practices among mothers in rural Rwanda

BMC Public Health ◽

10.1186/s12889-020-10095-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jeanine Ahishakiye ◽

Lenneke Vaandrager ◽

Inge D. Brouwer ◽

Maria Koelen

Keyword(s):

Social Support ◽

Young Child ◽

Coping Strategies ◽

Low Income ◽

Complementary Feeding ◽

Feeding Practices ◽

Personal Factors ◽

Child Feeding ◽

Young Child Feeding ◽

Infant And Young Child

Abstract Background Mothers in low-income countries face many challenges to appropriately feed their children in the first year such as poverty, food insecurity and high workloads. However, even in the lowest income families there are mothers who succeed to feed their children according to the recommendations. In this paper, we explored the coping strategies that facilitate appropriate breastfeeding and complementary feeding practices among rural Rwandan mothers from birth to one year of a child’s life. Methods This qualitative longitudinal study recruited a purposive sample of 17 mothers who followed the infant and young child feeding recommendations (IYCF). They were selected from a larger study of 36 mothers. In-depth interviews were conducted with mothers of the total group (36 mothers) within the first week, at 4th, 6th, 9th and 12th months postpartum. Interviews were audio-recorded, transcribed verbatim and analyzed thematically. Results Coping strategies included improving mothers’ own diet for adequate breastmilk production, prioritizing child feeding over livelihood chores, livelihood diversification and mothers’ anticipatory behaviors such as preparing child’s food in advance. Some of those coping strategies were shifting overtime depending on the development of the children. Personal factors such as breastfeeding self-efficacy, religious beliefs and perceived benefits of breastfeeding were among the facilitating factors. Additionally, social support that mothers received from family members, other mothers in the community, Community Health Workers (CHWs) and health professionals played an important role. Conclusion In challenging contextual conditions, mothers manage to follow the recommended breastfeeding and complementary feeding practices through the interplay of active coping strategies, feeling to be in control and social support. Nutrition promotion interventions that aim to improve IYCF should consider strengthening mothers’ capability in gaining greater control of their IYCF practices and the factors facilitating their appropriate IYCF practices.

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Knowledge, Food Vouchers, and Child Nutrition: Evidence from a Field Experiment in Ethiopia (P11-116-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz048.p11-116-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Seollee Park ◽

Yae Eun Han ◽

Hyuncheol Kim

Keyword(s):

Child Nutrition ◽

Dietary Diversity ◽

Study Groups ◽

Child Growth ◽

Control Group ◽

Maternal Knowledge ◽

Child Feeding ◽

Young Child Feeding ◽

Change Communication ◽

Randomized Design

Abstract Objectives Young children in developing countries often maintain poor diets, evidenced by strikingly low dietary diversity. Through formative research, we identified the lack of knowledge and affordability as key barriers to improved infant and young child feeding (IYCF) practices in Ethiopia. The aim of this study is to investigate ways to promote healthy IYCF by analyzing the impacts of an IYCF behavior change communication (BCC) program and food vouchers on mother's IYCF knowledge and practices, and child growth. Methods Using a clustered randomized design, we compare the effects of two independent interventions—IYCF BCC program and food vouchers—on four study groups: BCC only (BCC), voucher only (Voucher), BCC and voucher (BCC + Voucher), and the control group. The BCC program offered weekly group IYCF sessions to mothers who has children between 4 to 20 months of age for 16 weeks, employing participatory learning methods. The voucher program provided food vouchers worth approximately 10 USD per month for four months, which could be used at nearby markets for purchasing a wide variety of food items. We identified 641 eligible households residing in 79 villages in Ejere through census. As shown in Figure 1, 79 villages were randomly assigned to one of the four study groups: BCC, Voucher, BCC + Voucher, and control. All eligible mothers living in treatment villages were invited to participate in the program to which the village she lives in was assigned. Results We show that BCC improves maternal knowledge of nutrition and IYCF behaviors, while food vouchers alone do not (Figure 2). Impacts are largest when both knowledge and income constraints are addressed simultaneously through BCC + Voucher (Table 1). Only in this group do we see these treatments reducing stunting by 9 percentage points (Figure 3). Moreover, we show that BCC + Voucher prevented stunting from occurring during this critical age range rather than reversing it (Figure 4). Conclusions Our results suggest that, when both knowledge and income are intertwined challenges for improved child-feeding practices, addressing both constraints simultaneously may augment the positive impacts due to their complementary relationship. Funding Sources Africa Future Foundation. Supporting Tables, Images and/or Graphs

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Effect of Different Complementary Feeding on Iron Deficiency Anemia and Growth in Breastfed Infants: Home-Made VS Commercial

Folia Medica Indonesiana ◽

10.20473/fmi.v55i2.14337 ◽

2019 ◽

Vol 55 (2) ◽

pp. 112

Author(s):

Roedi Irawan ◽

Nur Aisiyah Widjaja ◽

Meta Herdiana Hanindita

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Serum Iron ◽

Complementary Feeding ◽

Feeding Practices ◽

Child Growth ◽

Complementary Food ◽

Deficiency Anemia ◽

Complementary Foods ◽

Breastfed Infants

After approximately 6 months of age, term breastfed infants are increasingly depend on other sources of iron to avoid iron deficiency anemia, due to the depletion of the low concentration of iron in human milk. The appropriate complementary feeding must include a balance composition of foods containing an adequate amount of macro- and micronutrients to avoid iron deficiency anemia. This study aimed to compare the risk of iron deficiency and growth in breastfeed infants receiving commercial fortified complementary foods or home-made. A cross-sectional study was held on April-June 2016 to evaluate infants aged 6-24 months with breast feeding intake for 6 month of life. Complementary feeding practices were determined by questionnaire; an unquantified food frequency and feeding practices questionnaire was used to determine usual food intake. Biochemical assessment of haemoglobin (Hb), serum ferritin (SF) and serum iron (SI) level were measured. Anthropometric were assessed using WHO Child Growth Standard 2005. Statistical analysis used were Chi-square Test. Thirty eight infants were enrolled, mean age of 16.2 (SD 10.5) months. 17 infants consumed commercial complementary foods and 21 infants use home-made. Infants with home-made had lower Hb level, SF and SI than those receiving commercial complementary food, and had higher risk of underweight, stunted and wasted. Infants with home-made complementary food had lower haemoglobin, serum feritin and serum iron levels than those in fortified complementary food CF; and a higher risk of stunted and wasted than children with commercial fortified CF.

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Qualitative, longitudinal exploration of coping strategies and factors facilitating infant and young child feeding practices among mothers in rural Rwanda

10.21203/rs.3.rs-20716/v1 ◽

2020 ◽

Author(s):

Jeanine Ahishakiye ◽

Lenneke Vaandrager ◽

Inge D. Brouwer ◽

Maria Koelen

Keyword(s):

Young Child ◽

Coping Strategies ◽

Low Income ◽

Complementary Feeding ◽

Feeding Practices ◽

Low Income Countries ◽

Child Feeding ◽

Young Child Feeding ◽

Infant And Young Child ◽

Breast Feed

Abstract Purpose Mothers in low income countries face many challenges to appropriately (breast) feed their children in the first year such as poverty, food insecurity and high workloads. However, even in the lowest income families there are mothers who strive and succeed to feed their children according to the recommendations. In this paper, we explored the coping strategies that facilitate appropriate breastfeeding and complementary feeding practices among rural Rwandan mothers from birth to one year of a child’s life.Methods Mothers (n=17) who followed the recommended infant and young child feeding (IYCF) practices were selected from a larger sample of 36 mothers. Mothers of the total group were interviewed within the first week, at four, six, nine and twelve months postpartum. In the analysis, coping strategies and factors facilitating coping were extracted.Results Coping strategies included mothers’ effort to strengthen their diet to improve breastmilk production, balancing work and child feeding, prioritizing childcare, preparing child’s food in advance active uptake of the recommendations and persistence in overcoming barriers. Personal and social factors facilitated these coping strategies of the mothers.ConclusionIn challenging contextual conditions, mothers manage to follow the recommended breastfeeding and complementary feeding practices through the interplay of active coping strategies, feeling to be in control and social support.

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Minimum Diet Diversity and Minimum Meal Frequency – Do They Matter Equally? Understanding IYCF Practices in India

Current Developments in Nutrition ◽

10.1093/cdn/nzaa054_084 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1012-1012

Author(s):

Ayushi Jain ◽

Muneer Kalliyil ◽

Satish Agnihotri

Keyword(s):

Child Nutrition ◽

Complementary Feeding ◽

Dietary Diversity ◽

Family Health ◽

Feeding Practices ◽

Meal Frequency ◽

Child Feeding ◽

Diet Diversity ◽

Minimum Dietary Diversity ◽

Nutritional Outcomes

Abstract Objectives Infant and Young Child Feeding practices, mainly, complementary feeding in children between 6 months and two years of age, is found to be sub-optimal and emerge as the weakest link in improving child nutrition outcomes in India. Minimum Acceptable Diet (MAD), comprising of two sub-indicator – Minimum Dietary Diversity (MDD) and Minimum Meal Frequency (MMF), serves as an essential indicator to understand the diet adequacy pattern in children. The objective of this study was thus to investigate the role of MDD-MMF dyad in influencing the nutritional outcomes in children and its pattern across regions in India. Methods Data was obtained from the National Family Health Survey – 4 (NFHS-4) from the DHS Program website. The prevalence of MMF and MDD was calculated for 640 districts in India. The MMF and MDD were classified into three categories - high, medium and low based on equal percentile distribution of their prevalence range. Districts with high MMF and high MDD formed one cohort. Similarly, eight other cohorts were created based on their performance on MMF and MDD indicator. The prevalence of Stunting (St), Wasting (Wa) and Underweight (Uw) in children between 6 months and two years of age was then calculated for each of the nine cohorts. The districts were also mapped based on their cohort category to study the variation across regions in India. Results All three anthropometric indicators – stunting, wasting and underweight showed significant decline moving across low MMF- low MDD cohort (40% St; 26.2% Wa; 37.1% Uw) to medium MMF – medium MDD cohort (38.6% St; 23.8% Wa; 35.4% Uw) to high MMF – high MDD cohort (29% St; 15.5% Wa; 19.2% Uw). Second, the importance of minimum dietary diversity in improving nutritional outcomes was revealed, as opposed to minimum meal frequency, which shows improvement only when it reaches a certain threshold. Third, mapping revealed sharp differences across various regions in MMF-MDD pattern, especially in the states like Odisha, Assam and Andhra Pradesh. States in the central region performed poorly on complementary feeding indicators, specifically diet diversity. Conclusions The study highlights the importance of optimal complementary feeding practices in improving nutrition outcomes and the need to consider the regional heterogeneities while promoting IYCF practices in India. Funding Sources None.

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Effect of an Integrated Package of Nutrition Behavior Change Interventions on Infant and Young Child Feeding Practices and Child Growth from Birth to 18 Months: Cohort Evaluation of the Baduta Cluster Randomized Controlled Trial in East Java, Indonesia

Nutrients ◽

10.3390/nu12123851 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3851

Author(s):

Umi Fahmida ◽

Min Kyaw Htet ◽

Elaine Ferguson ◽

Tran Thanh Do ◽

Annas Buanasita ◽

...

Keyword(s):

Young Child ◽

Dietary Diversity ◽

Age Groups ◽

Intervention Group ◽

Feeding Practices ◽

Child Growth ◽

Child Feeding ◽

Young Child Feeding ◽

Behavior Change Interventions ◽

Infant And Young Child

The need for a multisectoral approach to tackle stunting has gained attention in recent years. Baduta project aims to address undernutrition among children during their first 1000 days of life using integrated nutrition-specific and nutrition-sensitive interventions. We undertook this cohort study to evaluate the Baduta project’s effectiveness on growth among children under 2 years of age in two districts (Sidoarjo and Malang Districts) in East Java. Six subdistricts were randomly selected, in which three were from the intervention areas, and three were from the control areas. We recruited 340 pregnant women per treatment group during the third trimester of pregnancy and followed up until 18 months postpartum. The assessment of breastfeeding and complementary feeding practices used standard infant and young child feeding (IYCF) indicators in a tablet-based application. We measured weight and length at birth and every three-months after that. The enumerators met precision and accuracy criteria following an anthropometry standardization procedure. Among the breastfed children, the percentage of children who achieved the minimum dietary diversity score (DDS) and minimum acceptable diet (MAD) was higher for the intervention group than the comparison group across all age groups. The odd ratios were 3.49 (95% CI: 2.2–5.5) and 2.79 (95% CI: 1.7–4.4) for DDS and 3.49 (95% CI: 2.2–5.5) and 2.74 (95% CI: 1.8–5.2) for MAD in the 9–11 month and 16–18-month age groups, respectively. However, there was no significant improvement in growth or reduction in the prevalence of anemia. The intervention was effective in improving the feeding practices of children although it failed to show significant improvement in linear growth of children at 18 months of age.

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