Improving Nepal's Female Community Health Volunteers’ (FCHV) Infant and Young Child Feeding (IYCF) Exposure and Knowledge: Results from Implementation Research on the
            Suaahara
            Program

Abstract Background Despite different interventions to improve child nutrition conditions, chronic malnutrition is still a public health concern in Rwanda, with a high stunting prevalence of 38% among under 5-year-olds children. In Rwanda, only 18% of children aged 6–23 months are fed in accordance with the recommendations for infant and young child feeding practices. The aim of this study was to explore challenges to infant and young child feeding practices and the responses applied to overcome these challenges in Muhanga District, Southern province of Rwanda. Methods Sixteen (16) focus group discussions were held with mothers, fathers, grandmothers, and community health workers from 4 rural sectors of Muhanga District. The discussions were recorded, transcribed verbatim, and thematically analyzed using qualitative data analysis software, Atlas.ti. Results Two main themes emerged from the data. Firstly, there was a discourse on optimal infant and young child feeding (IYCF) practices that reflects the knowledge and efforts to align with early initiation of breastfeeding, exclusive breastfeeding for the first 6 months, as well as initiation of complementary foods at 6 months recommendations. Secondly, challenging situations against optimal practices and coping responses applied were presented in a discourse on struggling with everyday reality. The challenging situations that emerged as impeding appropriate IYCF practices included perceived lack of breast milk, infant cues, women’s heavy workload, partner relations and living in poverty. Family and social support from community health workers and health facility staff, financial support through casual labor, and mothers saving and lending groups, as well as kitchen gardens, were used to cope with challenges. Conclusion Factors influencing IYCF practices are multifaceted. Hence, intervention strategies to improve child nutrition should acknowledge the socially embedded nature of IYCF and address economic and social environmental constraints and opportunities, in addition and above knowledge only.

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What is the impact of removing performance-based financial incentives on community health worker motivation? A qualitative study from an infant and young child feeding program in Bangladesh

BMC Health Services Research ◽

10.1186/s12913-021-06996-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jeffrey Glenn ◽

Corrina Moucheraud ◽

Denise Diaz Payán ◽

Allison Crook ◽

James Stagg ◽

...

Keyword(s):

Young Child ◽

Qualitative Study ◽

Community Health ◽

Health Worker ◽

Community Health Worker ◽

Financial Incentives ◽

Theory Approach ◽

Child Feeding ◽

Young Child Feeding ◽

Infant And Young Child

Abstract Background Community health worker (CHW) motivation is an important factor related to health service quality and CHW program sustainability in low- and middle-income countries. Financial and non-financial motivators may influence CHW behavior through two dimensions of motivation: desire to perform and effort expended. The aim of this study was to explore how the removal of performance-based financial incentives impacted CHW motivation after formal funding ceased for Alive and Thrive (A&T), an infant and young child feeding (IYCF) program in Bangladesh. Methods This qualitative study included seven focus groups (n = 43 respondents) with paid supervisors of volunteer CHWs tasked with delivering interpersonal IYCF counseling services. Data were transcribed, translated into English, and then analyzed using both a priori themes and a grounded theory approach. Results Results suggest the removal of financial incentives was perceived to have negatively impacted CHWs’ desire to perform in three primary ways: 1) a decreased desire to work without financial compensation, 2) changes in pre- and post-intervention motivation, and 3) household income challenges due to dependence on incentives. Removal of financial incentives was perceived to have negatively impacted CHWs’ level of effort expended in four primary ways: 1) a reduction in CHW visits, 2) a reduction in quality of care, 3) CHW attrition, and 4) substitution of other income-generating activities. Conclusions This study provides new evidence regarding how removing performance-based financial incentives from a CHW program can negatively impact CHW motivation. The findings suggest that program decision makers should consider how to construct community health work programs such that CHWs may continue to receive performance-based compensation after the original funding ceases.

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Off to the best start: The importance of infant and young child feeding

10.2499/9780896295889_03 ◽

2016 ◽

Author(s):

International Food Policy Research Institute (IFPRI)

Keyword(s):

Young Child ◽

Child Feeding ◽

Young Child Feeding ◽

Infant And Young Child

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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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Mothers’ perceptions on and learning from infant and young child feeding videos displayed in Mother and Child Health Centers in Kenya - a qualitative and quantitative approach

Public Health Nutrition ◽

10.1017/s1368980021002342 ◽

2021 ◽

pp. 1-38

Author(s):

Lauriina Schneider ◽

Mikko Kosola ◽

Kerttu Uusimäki ◽

Sari Ollila ◽

Crippina Lubeka ◽

...

Keyword(s):

Young Child ◽

Complementary Feeding ◽

Health Centers ◽

Child Feeding ◽

Young Child Feeding ◽

Infant And Young Child ◽

Mother And Child Health ◽

Mother And Child ◽

And Child Health ◽

Child Health Centers

Abstract Objective The objective was to explore mothers’ perceptions of educational videos on infant and young child feeding practices, and to assess whether viewing frequencies would influence maternal knowledge, attitudes and feeding practices (KAPs). Design A set of 47 videos were displayed in health centers for 6 months. At three months, we conducted focus group discussions (FGDs) with mothers and at six months, administered KAP-questionnaire-based interviews to mothers. Using a quasi-experimental design we compared groups according to video viewing frequencies. Setting The study was conducted in a slum in Nairobi and a rural area in Machakos, Kenya. We installed TV screens in waiting rooms of six Mother and Child Health Centers, where mothers could choose to watch them. Participants Forty-three mothers with children aged 0 to 48 months participated in six FGDs and 547 mothers of children aged 0 to 23 months in KAP interviews. Results The mothers from the FGDs found the videos acceptable and beneficial. Videos enhanced mothers’ learning and empowered them to support others in learning. The KAP data showed that after adjustments, breastfeeding (p=0.06) and complementary feeding knowledge (p=0.01), complementary feeding attitudes (p=0.08), as well as hygiene knowledge and practices (p=0.003) were better among mothers who had seen videos three to four times, or five or more times, compared to mothers who had seen the videos once or twice. Conclusions Videos were an accepted form of education and were beneficial when watched repeatedly. The videos could be a good addition to current IYCF education efforts in Kenya.

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Information seeking of French parents regarding Infant and Young Child Feeding: practices, needs and determinants

Public Health Nutrition ◽

10.1017/s1368980021003086 ◽

2021 ◽

pp. 1-34

Author(s):

Sofia De Rosso ◽

Sophie Nicklaus ◽

Pauline Ducrot ◽

Camille Schwartz

Keyword(s):

Young Child ◽

Information Seeking ◽

Parental Education ◽

Online Survey ◽

Medical Condition ◽

Communication Strategy ◽

Child Feeding ◽

Young Child Feeding ◽

Infant And Young Child ◽

Child Age

Abstract Objective: As part of an update of feeding benchmarks targeting children aged 0 to 3 years, this study aimed to explore parental perceptions, information-seeking practices and needs concerning infant and young child feeding (IYCF) to design an efficient communication strategy. Design: Participants were recruited using the quota sampling to complete an online survey. Effects of parity, child age, prematurity, parental education and financial situation on parents’ responses were evaluated separately. Setting: France. Participants: A nationally representative sample of 1001 parents of children <4 years. Results: Parents whose child had any medical condition affecting feeding (CMC, 17%) were considered separately from healthy children’s parents. All the healthy children’s parents recognized the importance of IYCF for children’s health and growth; however, one-third considered the available advice contradictory and not guilt-free. The most used information sources were healthcare professionals (HCPs, 81%), internet (72%) and parental networks (63%). The most influential sources (mean influence ± SDs) included HCPs (7.7±1.7/10), childcare professionals (7.3±1.8/10) and parental networks (6.9±1.8/10). Parents searched for practical tips for implementing IYCF starting when their child was 5 months old. Differences regarding the type of source used by parents with higher vs. lower educations were small. Search strategies differed according to parity or child age but not to prematurity. The CMC parents reported slightly different practices and needs. Conclusions: Parents receive information from multiple sources, which can lead to confusion when deciding which advice to follow. A public health communication strategy adapted to the current parental needs should target these various sources.

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Infant and young child feeding practices in Ethiopia: analysis of socioeconomic disparities based on nationally representative data

Archives of Public Health ◽

10.1186/s13690-021-00555-x ◽

2021 ◽

Vol 79 (1) ◽

Author(s):

Nigatu Regassa Geda ◽

Cindy Xin Feng ◽

Bonnie Janzen ◽

Rein Lepnurm ◽

Carol J. Henry ◽

...

Keyword(s):

Young Child ◽

Feeding Practices ◽

Health Concern ◽

Proportional Odds ◽

Child Feeding ◽

Gainful Employment ◽

Young Child Feeding ◽

Child Feeding Practices ◽

Infant And Young Child ◽

Unit Increase

Abstract Background Undernutrition among children is a priority area of public health concern in Ethiopia. The purpose of this study was to examine disparities in Infant and Young Child Feeding (IYCF) practices among children 6–23 months. Method Data were drawn from the 2016 Ethiopian Demographic and Health Surveys (EDHS). A total of 3240 children aged 6–23 months were used for the present analysis. The outcome variable was IYCF practice score (ranging 0–7) which was constructed based on the linear and combined effects of four sets of variables: breastfeeding, avoidance of bottle feeding, diet diversity score and minimum feeding frequency. IYCF practice score was further recoded into three categories. Proportional odds regression was used to assess the determinants of IYCF category. Results The proportional odds regression analysis showed that IYCF scores significantly decreased by 5% (Adjusted Odds Ratio (AOR) = 0.95; 95% CI: 0.93–0.97) for every unit increase in the child’s age. Households with fathers of primary and secondary and above level education were 1.37 times (95% CI: 1.14–1.66) and 1.67 times (95% CI: 1.26–2.23) more likely to be in the high IYCF category than in the poor IYCF category. The likelihood of being in the high IYCF practice category decreased for non-working mothers by 30% (AOR = 0.70; 95% CI: 0.59–0.83) compared to those working in gainful employment. The chance of being in the high IYCF practice category decreased by 29% for households with no access to radio (AOR = 0.71; 95% CI: 0.59–0.85). Those with medium and rich/richer wealth category were 1.54 times (95% CI: 1.22–1.94) and 1.40 times (95% CI: 1.11–1.75) more likely to belong to high IYCF practice category than being in poor IYCF category. For every unit increase in health service utilization, the chance of falling in higher IYCF category increases by 1.15 times (95% CI: 1.08–1.23). The chance of falling in higher IYCF practice category decreases for rural residents by 37% (AOR = 0.63; 95% CI: 0.47–0.84) compared to those residing in urban areas. Conclusion For a child, the first two years is the time span during which linear faltering of growth is most prevalent and the period when the process of becoming stunted is almost complete. This study recommends improving access to women for gainful employment, provision of economic support to poor rural women, education and promotion of nutrition messages using most accessible media and boosting the positive role of fathers in child feeding practices.

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