Constrained maternal agency is associated with poor child feeding practices and child undernutrition: evidence from twelve low‐income countries

Abstract Objectives To explore how food security (FS) and food resource management (FRM), strategies to stretch limited food resource dollars, are associated with child feeding practices in low-income preschoolers. Methods In a cross-sectional sample of 364 Head Start households, caregivers completed the 18-item FS module, 6-item FRM behavior subscale, Comprehensive Feeding Practices Questionnaire (e.g., monitoring, restriction, food as reward), and Perceived Stress scale. Households were categorized into four food environment subgroups: FS/good FRM, FS/poor FRM, food insecure/good FRM, and food insecure/poor FRM. Multivariable linear regressions were applied to examine if feeding practices differed across FS-FRM categories, adjusting for demographic and socio-economic covariates that differed significantly by FS-FRM subgroups (race, SNAP participation, parent BMI status). For all models, FS/good FRM was the referent. Lastly, we explored the effect of adding perceived stress to the model. on feeding practices. Results 37% of households were food insecure. The use of parent monitoring, modeling, involvement, and food as reward were significantly different by FS-FRM subgroups (all p-values <0.02). After adjusting for covariates, the FS/poor FRM group used less monitoring (–0.48, 95% CI: –0.71, –0.24), modeling (–0.42, 95CI: –0.66, –0.18), and involvement in feeding (–0.56, 95% CI: –0.80, –0.31). A similar pattern emerged for the food insecure/poor FRM group compared to referent. The use of food as reward was higher in the FS/poor FRM (0.29, 95CI: 0.03, 0.55), food insecure/good FRM (0.39, 95CI: 0.09, 0.70) and food insecure/poor FRM groups (0.33, 95% CI: 0.03, 0.64). These differences observed in feeding practices became insignificant in all but one food insecure subgroup once perceived stress was added to the model. Conclusions Suboptimal child feeding is evident in low-income caregivers with poor FRM skills with or without food insecurity. Promoting FRM skills in addition to addressing FI and stress could potentially synergistically improve child feeding practices in low-income households. Funding Sources This study was funded by USDA's Supplemental Nutrition Assistance Program (SNAP) through the PA Department of Human Services (DHS). This institution is an equal opportunity provider.

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Relationship of child-feeding practices to overweight in low-income Mexican-American preschool-aged children

Journal of the American Dietetic Association ◽

10.1016/j.jada.2004.04.030 ◽

2004 ◽

Vol 104 (7) ◽

pp. 1110-1119 ◽

Cited By ~ 83

Author(s):

Hugo R. Melgar-Quiñonez ◽

Lucia L. Kaiser

Keyword(s):

Low Income ◽

Mexican American ◽

Feeding Practices ◽

Child Feeding ◽

Child Feeding Practices ◽

Relationship Of ◽

Preschool Aged Children

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Child feeding practices and household food insecurity among low-income mothers in Buenos Aires, Argentina

Ciência & Saúde Coletiva ◽

10.1590/s1413-81232012000300012 ◽

2012 ◽

Vol 17 (3) ◽

pp. 661-669 ◽

Cited By ~ 7

Author(s):

Ana Cristina Lindsay ◽

Mabel Ferarro ◽

Alejandra Franchello ◽

Raul de La Barrera ◽

Marcia Maria Tavares Machado ◽

...

Keyword(s):

Food Insecurity ◽

Low Income ◽

Family Relationships ◽

Maternal Employment ◽

Weight Status ◽

Buenos Aires ◽

Feeding Practices ◽

Child Feeding ◽

Child Feeding Practices ◽

Low Income Mothers

This qualitative study of low-income mothers in Buenos Aires, Argentina, examines the influence of socio-economic conditions, organizational structures, family relationships, and food insecurity on child feeding practices and weight status. Thirty-eight mothers of preschool children living in urban Buenos Aires participated in four focus group discussions. The results indicated that many mothers were aware that obesity may be detrimental to the child's health, but most of them are unclear about the specific consequences. Maternal employment, family pressures, food insecurity and financial worries seem to influence child feeding practices. These findings have important implications for developing strategies for nutritional assistance that could benefit the health of children and provide opportunities for educational programs that are directed to nutritional awareness in Buenos Aires, Argentina. The right to eat regularly and properly is an obligation of the State and must be implemented taking into account the notion of food sovereignty and respecting the importance of preserving the culture and eating habits of a country and its diverse population groups

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Perceptions of Child Body Size and Health Care Seeking for Undernourished Children in Southern Malawi

Qualitative Health Research ◽

10.1177/1049732315610522 ◽

2016 ◽

Vol 26 (14) ◽

pp. 1939-1948 ◽

Cited By ~ 4

Author(s):

Valerie L. Flax ◽

Chrissie Thakwalakwa ◽

Ulla Ashorn

Keyword(s):

Health Care ◽

Low Income ◽

Child Growth ◽

Low Income Countries ◽

Health Care Seeking ◽

Care Seeking ◽

Health Seeking ◽

Poor Child ◽

Child Undernutrition ◽

Growth Faltering

Child undernutrition affects millions of children globally, but little is known about the ability of adults to detect different types of child undernutrition in low-income countries. We used focused ethnographic methods to understand how Malawian parents and grandparents describe the characteristics they use to identify good and poor child growth, their actual or preferred patterns of health seeking for undernourished children, and the perceived importance of child undernutrition symptoms in relation to other childhood illnesses. Malawians value adiposity rather than stature in assessing child growth. Symptoms of malnutrition, including wasting and edema, were considered the least severe childhood illness symptoms. Parents delayed health care seeking when a child was ill. When they sought care, it was for symptoms such as diarrhea or fever, and they did not recognize malnutrition as the underlying cause. These findings can be used to tailor strategies for preventing and treating growth faltering in Malawian children.

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Low-income mothers' feeding goals predict observed home mealtime and child feeding practices

Child Care Health and Development ◽

10.1111/cch.12396 ◽

2016 ◽

Vol 42 (6) ◽

pp. 934-940 ◽

Cited By ~ 2

Author(s):

M. H. Pesch ◽

A. L. Miller ◽

D. P. Appugliese ◽

N. Kaciroti ◽

K. L. Rosenblum ◽

...

Keyword(s):

Low Income ◽

Feeding Practices ◽

Child Feeding ◽

Child Feeding Practices ◽

Low Income Mothers

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

Current Developments in Nutrition ◽

10.1093/cdn/nzaa162 ◽

2020 ◽

Vol 4 (11) ◽

Author(s):

Hasina Rakotomanana ◽

Deana Hildebrand ◽

Gail E Gates ◽

David G Thomas ◽

Fanjaniaina Fawbush ◽

...

Keyword(s):

Low Income ◽

Complementary Feeding ◽

Dietary Diversity ◽

Feeding Practices ◽

Child Growth ◽

Maternal Knowledge ◽

Complementary Foods ◽

Child Feeding ◽

Attitudes And Practices ◽

Child Undernutrition

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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