Is Respectful Care Provided by Community Health Workers Associated With Infant Feeding Practices? A Cross Sectional Analysis From India

Abstract Objectives: Breastfeeding and complementary feeding practices in India do not meet recommendations. Community health care workers (CHWs) are often the primary source of information for pregnant and postpartum women about Infant and Young child Feeding (IYCF) practices. While existing research has evaluated the effectiveness of content and delivery of information through CHWs, little is known about the quality of the interpersonal communication (respectful care). We analyzed the effect of respectful interactions on recommended IYCF practices. Methods: We use data from evaluation of an at-scale mHealth intervention in India that serves as a job aid to the CHWs (N=3,266 mothers of children <12m from 841 villages in 2 Indian states). The binary indicator variable for respectful care is constructed using a set of 7 questions related to trust, respect, friendliness during these interactions. The binary outcomes variables are exclusive breastfeeding, timely introduction of complimentary feeding, and minimum diet diversity for infants. We also explore if most of the pathway from respectful care to improved behaviors is through better recall of messages (mediation analysis). All models controlled for socio-economic-demographic characteristics and number of interactions with the CHW. Results: About half of women reported positive, respectful interactions with CHWs. More respectful interactions were associated with better recall of appropriate health messages. More respectful interactions were associated with a greater likelihood of adopting all child feeding behaviors except timely initiation of breastfeeding. After including recall in the model, the effect of respectful interactions alone reduced. Conclusions: Respectful care from CHWs appears to be significantly associated with some behaviors around infant feeding, with the primary pathway being through better recall of messages. Focusing on improving social and soft skills of CHWs that can translate into better CHW-beneficiary interactions can pay rich dividends.

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Community-based assessment of infant feeding practices within a programme for prevention of mother-to-child HIV transmission in rural Zimbabwe

Public Health Nutrition ◽

10.1079/phn2005881 ◽

2006 ◽

Vol 9 (5) ◽

pp. 563-569 ◽

Cited By ~ 16

Author(s):

J Orne-Gliemann ◽

T Mukotekwa ◽

A Miller ◽

F Perez ◽

M Glenshaw ◽

...

Keyword(s):

Infant Feeding ◽

Hiv Transmission ◽

Health Workers ◽

Feeding Practices ◽

Cross Sectional Study ◽

Infant Feeding Practices ◽

Structured Interviews ◽

Cross Sectional ◽

Mother To Child ◽

Hiv Negative

AbstractObjectiveTo describe the infant feeding practices and attitudes of women who used prevention of mother-to-child transmission of HIV (PMTCT) services in rural Zimbabwe.DesignA cross-sectional study including structured interviews and focus group discussions was conducted between June 2003 and February 2004.SettingThe study took place in Murambinda Mission Hospital (Buhera District, Manicaland Province), the first site offering PMTCT services in rural Zimbabwe.SubjectsThe interviews targeted HIV-infected and HIV-negative women who received prenatal HIV counselling and testing and minimal infant feeding counselling, and who delivered between 15 August 2001 and 15 February 2003. The focus groups were conducted among young and elderly men and women.ResultsOverall, 71 HIV-infected and 93 HIV-negative mothers were interviewed in clinics or at home. Most infants (97%) had ever been breast-fed. HIV-negative mothers introduced fluids/foods other than breast milk significantly sooner than HIV-infected mothers (median 4.0 vs. 6.0 months, P = 0.005). Infants born to HIV-negative mothers were weaned significantly later than HIV-exposed infants (median 19.0 vs. 6.0 months, P = 10−5). More than 90% of mothers reported that breast-feeding their infant was a personal decision, a third of whom also mentioned having taken into account health workers' messages.ConclusionThe HIV-infected mothers interviewed were gradually implementing infant feeding practices recommended in the context of HIV. Increased infant feeding support capacity in resource-limited rural populations is required, i.e. training of counselling staff, decentralised follow-up and weaning support.

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Feasibility of using WeChat to improve infant and young child feeding in rural areas in China: A mixed quantitative and qualitative study

PLoS ONE ◽

10.1371/journal.pone.0246942 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246942

Author(s):

Qiong Wu ◽

Yiwen Huang ◽

Michelle Helena van Velthoven ◽

Wei Wang ◽

Suying Chang ◽

...

Keyword(s):

Young Child ◽

Infant Feeding ◽

Child Nutrition ◽

Rural China ◽

Feeding Practices ◽

Child Feeding ◽

Cross Sectional ◽

Young Child Feeding ◽

Infant And Young Child ◽

Education Platform

Background Appropriate infant and young child feeding practices are the basis for child nutrition. In China, WeChat is gradually changing the channels through which people receive information. The paper aims to explore the feasibility of using WeChat to improve infant and young child feeding in rural China. Methods A mixed-methods study was carried out in Huzhu County, Qinghai province, China. We conducted two cross-sectional surveys with children aged 6–23 months and their caregivers in 2012 (N = 1804) and 2018 (N = 754), respectively. Quantitative data were collected on feeding knowledge and practices, caregiver’s use of smartphones and WeChat. Qualitative data were from 33 semi-structured interviews with pregnant women and mothers. In addition, we developed a WeChat feeding health education platform and asked women about their experiences with using it. Results In both cross-sectional surveys, less than 10% of caregivers knew that breastfeeding can be continued up to two years, less than 50% knew the accurate duration of exclusive breastfeeding, and only around 20% knew meat can be given to children from the age of 6–8 months. Similarly, the feeding practices were suboptimal and most key infant feeding practices did not change over the years. Only around 30% of caregivers ever received feeding information during pregnancy or after delivery in both surveys. Around 50% of caregivers received information from their relatives and friends, followed by 30% from health facilities and communities. More than 80% of mothers were currently using both a smartphone and the WeChat app, and 75.4% of them were willing to receive feeding information from WeChat official accounts. The WeChat feeding health education platform developed by our study team was generally well accepted by women. Conclusions There was an absence of accurate information sources on infant feeding and child nutrition. WeChat could be a potential way to deliver infant feeding recommendations to pregnant women and mothers in rural China. Trial registration ChiCTR-PRC-11001446 (The controlled intervention trial for complementary food supplements “Yingyangbao”); ChiCTR1800017364 (the randomized controlled trial for WeChat)

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Factors influencing complementary feeding practices in rural and semi-urban Rwanda: a qualitative study

Journal of Nutritional Science ◽

10.1017/jns.2021.37 ◽

2021 ◽

Vol 10 ◽

Author(s):

Maryse Umugwaneza ◽

Lize Havemann-Nel ◽

Hester H. Vorster ◽

Edelweiss Wentzel-Viljoen

Keyword(s):

Qualitative Study ◽

Nutrition Education ◽

Complementary Feeding ◽

Health Workers ◽

Feeding Practices ◽

Common Belief ◽

Child Feeding ◽

Cross Sectional ◽

Knowledge And Beliefs ◽

Factors Influencing

Abstract The aim of the present study was to identify and describe the factors influencing feeding practices of children aged 6–23 months in Rwanda. This is a cross-sectional descriptive qualitative study. A total of ten focus group discussions were conducted separately with mothers, fathers, grandmothers and community health workers (CHWs) from five different districts in Rwanda. The discussions were recorded, transcribed verbatim, and thematically analysed using qualitative data analysis software, Atlas.ti. The study participants were mothers, fathers and grandmothers of children aged 6–23 months and CHWs in charge of child health. Caregivers’ knowledge and beliefs about the benefits of breast-feeding and timely introduction of complementary food were found to be the primary individual factors facilitating good infant and young child feeding practices. The common belief of caregivers that infants should be given liquids (thin gruel, fruit juices and meat broth) as first foods instead of semi-solid foods was a barrier to good feeding practices. The community-based nutrition education and counselling programmes were facilitators of good complementary practices at the group level. At the society level, poverty in rural agrarian households was a barrier to optimal feeding practices. The study shows that there is a need to empower caregivers with more specific guidelines, especially on complementary feeding.

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Challenges and responses to infant and young child feeding in rural Rwanda: a qualitative study

Journal of Health Population and Nutrition ◽

10.1186/s41043-019-0207-z ◽

2019 ◽

Vol 38 (1) ◽

Cited By ~ 8

Author(s):

Jeanine Ahishakiye ◽

Laura Bouwman ◽

Inge D. Brouwer ◽

Eric Matsiko ◽

Margaret Armar-Klemesu ◽

...

Keyword(s):

Young Child ◽

Community Health ◽

Community Health Workers ◽

Child Nutrition ◽

Health Workers ◽

Feeding Practices ◽

Child Feeding ◽

Young Child Feeding ◽

Child Feeding Practices ◽

Infant And Young Child

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 We Are Going to Eat Today, We Are Looking for It Today”: Exploring Barriers and Enablers of Optimal Complementary Feeding in Madagascar

Current Developments in Nutrition ◽

10.1093/cdn/nzaa053_095 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 890-890

Author(s):

Hasina Rakotomanana ◽

Christine Walters ◽

Joel Komakech ◽

Deana Hildebrand ◽

Gail Gates ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Complementary Feeding ◽

Health Workers ◽

Average Length ◽

Feeding Practices ◽

State University ◽

Child Feeding ◽

Funding Sources ◽

Limited Food

Abstract Objectives Complementary feeding practices in Madagascar are inadequate. The purpose of this study was to identify maternal barriers to and enablers of optimal child feeding practices in the Vakinankaratra region of Madagascar. Methods Seven focus group discussions with mothers (n = 46) who had a child aged 6–23 months and eight in-depth interviews were conducted with community health workers (6), a nurse (1), and a program field monitor (1) in Malagasy, the local language. Discussions were transcribed verbatim, then back-translated into English. The average length of the interviews was 50 minutes. The translated transcripts from the discussions and interviews were analyzed using NVivo v.12 and a thematic analysis approach was used. Results Poverty, lack of money, and limited food availability were mentioned by the mothers as obstacles to adequate complementary feeding practices. Lack of time because of work as well as heavy workload also were cited as problems. Mothers generally decide alone on what food to give to their infants, with little to no help from spouse or relatives. All mothers considered their children's health and giving them appropriate complementary foods as important. Another potential enabler was that mothers trust the community health workers and usually ask them for help and/or information on child feeding. The key informants confirmed all of the mothers’ responses. Conclusions Interventions that aim to improve feeding practices in the Vakinankaratra region should address food insecurity and improve households’ income. Strengthening the local infrastructures with the community health workers appears to be important when aiming to reinforce appropriate feeding practices. Funding Sources This study was funded by the Marilynn Thoma Chair in Human Sciences at Oklahoma State University.

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Tekanan untuk makan dengan kejadian picky eater pada anak usia 2-3 tahun

Jurnal Gizi Klinik Indonesia ◽

10.22146/ijcn.24169 ◽

2017 ◽

Vol 13 (4) ◽

pp. 170

Author(s):

Carissa Cerdasari ◽

Siti Helmyati ◽

Madarina Julia

Keyword(s):

Infant Feeding ◽

Eating Behavior ◽

Eating Behaviors ◽

Feeding Practices ◽

Cross Sectional Study ◽

Early Age ◽

Infant Feeding Practices ◽

Child Feeding ◽

Cross Sectional ◽

Picky Eating

Background: Picky eater is potentially at risk for nutritional deficits. In a long term, this habit could affect child’s growth and could lead to malnutritionObjective: This study was conducted to assess the association of maternal food variation, infant feeding practices, and pressure to eat with picky eating behaviors in 2-3 years old children.Method: In this cross-sectional study, mothers (n=141) of children aged 2-3 years old were recruited from 26 integrated health care centers in Gamping, Indonesia between Juni-September 2015 using a cluster random sampling method. Picky eater was calculated using Child Eating Behavior Questionnaire (CEBQ). Maternal food variation and early age feeding variability data were measured using food variation questionnaire. Data on the pressure to eat were obtained based on subscale pressure to eat in Child Feeding Questionnaire (CFQ). Mann-Whitney test was used to evaluate the association between maternal food variation, infant feeding practices, and pressure to eat with picky eating behavior.Results: Picky eater was significantly associated with mother pressure to eat (p<0,05). There were tendencies of shorter exclusive breastfeeding practice, later in the introduction of solid food, and fewer variability of food at an early age on picky eater, however, there was no significant association (p>0,05).Conclusion: Mother has a major role in forming children eating behavior. Not pressing children to eat, will protect children from picky eating.

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Study on infant feeding practice among children up to 6 months in an urban slum of Bhopal

Public Health Review: International Journal of Public Health Research ◽

10.17511/ijphr.2021.i03.02 ◽

2021 ◽

Vol 8 (3) ◽

pp. 39-44

Author(s):

Dr. Ria Sarkar ◽

◽

Dr. Harshal Kawanpure ◽

Keyword(s):

Infant Feeding ◽

Feeding Practices ◽

Educational Status ◽

Urban Slum ◽

Cross Sectional Study ◽

Morbidity And Mortality ◽

Feeding Practice ◽

High Morbidity ◽

Child Feeding ◽

Cross Sectional

Introduction: High morbidity and mortality among the under 5 children are highly prevalent inIndia. Appropriate child feeding practices in the initial six months of age act as a preventiveintervention against childhood morbidity and mortality. Methods: A questionnaire-based cross-sectional study was conducted in an urban slum to study various feeding practices prevalent amongchildren up to 6 months of age. Also associated socio-demographic factors were studied. SPSSsoftware version 25 was used to analyze the results. Results: The study included 55 children up to6 months of age. Out of these 76.4% were exclusively breastfed. Among 45.5%, breastfeeding waswithin 1st hour of the birth. 56.4% have received pre-lacteal feeds, while 72.72% receivedcolostrum. The educational status of the mother and place of delivery were major determinants ofappropriate infant feeding practices. Conclusion: Most mothers are practising exclusivebreastfeeding. Colostrum was fed to most of the children. Animal milk was given in cases whereinitiation of breastfeeding was delayed.

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Prelacteal Feeding Practices and Its Associated Factors among Mother of Children Less Than 2 Years of Age in Kersa District, Eastern Ethiopia

Global Pediatric Health ◽

10.1177/2333794x211018321 ◽

2021 ◽

Vol 8 ◽

pp. 2333794X2110183

Author(s):

Ahmedzekuwan Adem ◽

Nega Assefa ◽

Merga Deresa ◽

Mohammed Yuya ◽

Galana Mamo Ayana ◽

...

Keyword(s):

Associated Factors ◽

Feeding Practices ◽

P Value ◽

Binary Logistic Regression Analysis ◽

Contributing Factors ◽

Prelacteal Feeding ◽

Cross Sectional ◽

Timely Initiation ◽

Eastern Ethiopia ◽

Initiation Of Breastfeeding

Background. Prelacteal feeding is defined as administration of any substances other than breast milk to newborn babies during the first 3 days after birth. Despite its negative health outcomes, it is commonly practiced in developing countries. Therefore, this study aimed at assessing the prevalence of pre-lacteal feeding practices and associated factors among mothers of children aged less than 2 years of age in Kersa district, Eastern Ethiopia. Method. A community-based cross-sectional study design was conducted among 465 mothers having children aged less than 2 years in Kersa district. A multistage sampling technique was used to select study participants. Binary logistic regression analysis was fitted to identify factors associated with prelacteal feeding practices. Variables with a P-value <.05 were identified as statistically significant factors. Results. The prevalence of pre-lacteal feeding in Kersa district was 46.4% (95% CI; 42.0%, 51.5%). Initiating breastfeeding after 1 hour of delivery (AOR = 10.80, 95% CI: (5.79, 20.17)), giving birth at home (AOR = 2.77, 95% CI: (1.41, 5.46)), not knowing risks associated with pre-lacteal feeding (AOR = 3.25, 95% CI: (1.72, 6.15)) and perceiving pre-lacteal feeding as beneficial (AOR = 9.56, 95% CI: (4.45, 20.52)) were factors significantly associated with practice pre-lacteal feeding practices. Conclusion. Significant proportions of mothers were practicing pre-lacteal feeding in the study area. Late initiation of breastfeeding, home delivery, not knowing risks of prelacteal feeding, and perceiving pre-lacteal feeding as beneficial were contributing factors for practicing of pre-lacteal feeding. Therefore, promoting institutional delivery and timely initiation of breastfeeding would reduce prelacteal feeding in Kersa district.

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