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Deeney M, Harris‐Fry H. What influences child feeding in the Northern Triangle? A mixed-methods systematic review. MATERNAL & CHILD NUTRITION 2020; 16:e13018. [PMID: 32452642 PMCID: PMC7507456 DOI: 10.1111/mcn.13018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/21/2020] [Accepted: 04/09/2020] [Indexed: 12/23/2022]
Abstract
Optimising child feeding behaviours could improve child health in Guatemala, Honduras and El Salvador, where undernutrition rates remain high. However, the design of interventions to improve child feeding behaviours is limited by piecemeal, theoretically underdeveloped evidence on factors that may influence these behaviours. Between July 2018 and January 2020, we systematically searched Cochrane, Medline, EMBASE, Global Health and LILACS databases, grey literature websites and reference lists, for evidence of region-specific causes of child feeding behaviours and the effectiveness of related interventions and policies. The Behaviour Change Wheel was used as a framework to synthesise and map the resulting literature. We identified 2,905 records and included 68 relevant studies of mixed quality, published between 1964 and 2019. Most (n = 50) were quantitative, 15 were qualitative and three used mixed methods. A total of 39 studies described causes of child feeding behaviour; 29 evaluated interventions or policies. Frequently cited barriers to breastfeeding included mothers' beliefs and perceptions of colostrum and breast milk sufficiency; fears around child illness; and familial and societal pressures, particularly from paternal grandmothers. Child diets were influenced by similar beliefs and mothers' lack of money, time and control over household finances and decisions. Interventions (n = 22) primarily provided foods or supplements with education, resulting in mixed effects on breastfeeding and child diets. Policy evaluations (n = 7) showed positive and null effects on child feeding practices. We conclude that interventions should address context-specific barriers to optimal feeding behaviours, use behaviour change theory to apply appropriate techniques and evaluate impact using robust research methods.
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Affiliation(s)
- Megan Deeney
- Faculty of Epidemiology and Population HealthLondon School of Hygiene & Tropical MedicineLondonUK
| | - Helen Harris‐Fry
- Faculty of Epidemiology and Population HealthLondon School of Hygiene & Tropical MedicineLondonUK
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Matare CR, Craig HC, Martin SL, Kayanda RA, Chapleau GM, Kerr RB, Dearden KA, Nnally LP, Dickin KL. Barriers and Opportunities for Improved Exclusive Breast-Feeding Practices in Tanzania: Household Trials With Mothers and Fathers. Food Nutr Bull 2019; 40:308-325. [PMID: 31067996 DOI: 10.1177/0379572119841961] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Effective promotion of exclusive breast-feeding (EBF) is needed to improve child nutrition and survival. OBJECTIVE We explored barriers and facilitators to EBF in rural Tanzania and assessed parents' willingness and ability to try specific recommended EBF practices plus strategies for men to support breast-feeding. METHODS We conducted Trials of Improved Practices in 36 households with infants <6 months. Fathers participated in focus group discussions on ways to support breast-feeding. Fathers and mothers were individually interviewed 2 and 3 times, respectively, about their willingness to try and experience with selected new practices. We analyzed data thematically. RESULTS Common barriers to EBF were (1) use of gripe water and traditional medicines for perceived symptoms of infantile distress; (2) mothers' workloads and time away from infants, limiting availability for EBF; and (3) water given for perceived thirst. Although several mothers expressed concerns about breast-milk insufficiency, few were giving other foods. After counseling, most mothers reported breast-feeding more optimally. Some reported improved breast-milk supply. Fathers saw their roles as providing food to mothers to ensure sufficient breast-milk and encouraging new practices. Dominant gender roles and work away from home were barriers even if fathers were willing to help with household chores. Fathers mostly provided emotional support or encouraged others to help with chores. CONCLUSION Exclusive breast-feeding promotion needs to address concerns about infantile distress and help parents develop effective soothing techniques while avoiding nonprescribed medicines. Engaging men in EBF interventions could help change social norms and facilitate men's involvement in improving breast-feeding practices.
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Affiliation(s)
- Cynthia R Matare
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Hope C Craig
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Stephanie L Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | | | - Gina M Chapleau
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Rachel Bezner Kerr
- Department of Development Sociology, Cornell University, Ithaca, NY, USA
| | | | - Luitfrid P Nnally
- Tanzania Food and Nutrition Center, Ministry of Health Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Katherine L Dickin
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
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Bournez M, Ksiazek E, Wagner S, Kersuzan C, Tichit C, Gojard S, Thierry X, Charles MA, Lioret S, de Lauzon-Guillain B, Nicklaus S. Factors associated with the introduction of complementary feeding in the French ELFE cohort study. MATERNAL AND CHILD NUTRITION 2017; 14:e12536. [PMID: 29052955 DOI: 10.1111/mcn.12536] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 09/10/2017] [Accepted: 09/11/2017] [Indexed: 12/21/2022]
Abstract
The objectives of this study were to estimate the age of complementary feeding introduction (CFI) and investigate the related health, demographic, and socio-economic factors. Analyses were based on 10,931 infants from the French national birth cohort ELFE, born in 2011. Health, demographic, and socio-economic data concerning infants and parents were collected at birth (face-to-face interviews and medical records) and 2 months (telephone interviews). Data on milk feeding and CFI practices were collected at birth and 2 months then monthly from 3 to 10 months using online or paper questionnaires. The associations between both health and social factors and CFI age were tested by multivariable multinomial logistic regressions. The mean CFI age was 5.2 ± 1.2 months; 26% of the infants started complementary feeding before 4 months of age (CF < 4 months), 62% between 4 and 6 months of age, and 12% after 6 months of age (CF > 6 months). CF < 4 months was more likely when mothers smoked, were overweight/obese, younger (<29 years), and used their personal experience as an information source in child caregiving and when both parents were not born in France. CF < 4 months was less likely when the infant was a girl, second-born, when the mother breastfed longer, and had attended at least one birth preparation class. Mothers of second-born infants and who breastfed their child longer were more likely to introduce CF > 6 months. Couples in which fathers were born in France and mothers were not born in France were less likely to introduce CF > 6 months. CF < 4 months occurred in more than 25% of the cases. It is important to continue promoting clear CFI recommendations, especially in smoking, overweight, young, not born in France, and nonbreastfeeding mothers.
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Affiliation(s)
- Marie Bournez
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRA, Université Bourgogne Franche-Comté, Dijon, France.,Centre Hospitalier Universitaire de Dijon, Hopital d'Enfants, Peediatrics, Dijon, France
| | - Eléa Ksiazek
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRA, Université Bourgogne Franche-Comté, Dijon, France
| | - Sandra Wagner
- INSERM, CRESS, ORCHAD team, Villejuif, France.,Paris Descartes University, CRESS, Villejuif, France
| | - Claire Kersuzan
- ALISS UR1303, INRA, Université Paris-Saclay, Ivry-sur-Seine, France
| | - Christine Tichit
- ALISS UR1303, INRA, Université Paris-Saclay, Ivry-sur-Seine, France.,Centre Maurice Halbwachs, CNRS, ENS, EHESS, Paris, France
| | - Séverine Gojard
- ALISS UR1303, INRA, Université Paris-Saclay, Ivry-sur-Seine, France.,Centre Maurice Halbwachs, CNRS, ENS, EHESS, Paris, France
| | - Xavier Thierry
- Institut national d'études démographiques, Paris, France
| | - Marie-Aline Charles
- INSERM, CRESS, ORCHAD team, Villejuif, France.,Paris Descartes University, CRESS, Villejuif, France
| | - Sandrine Lioret
- INSERM, CRESS, ORCHAD team, Villejuif, France.,Paris Descartes University, CRESS, Villejuif, France
| | | | - Sophie Nicklaus
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRA, Université Bourgogne Franche-Comté, Dijon, France
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Gebremedhin S, Baye K, Bekele T, Tharaney M, Asrat Y, Abebe Y, Reta N. Predictors of dietary diversity in children ages 6 to 23 mo in largely food-insecure area of South Wollo, Ethiopia. Nutrition 2016; 33:163-168. [PMID: 27499206 DOI: 10.1016/j.nut.2016.06.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/01/2016] [Accepted: 06/03/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to assess the level and predictors of dietary diversity (DD) in predominantly food-insecure area of South Wollo, Ethiopia among children ages 6 to 23 mo. METHODS The study was conducted in October 2014. We selected 2080 children using a multistage sampling technique. DD in the preceding day of the survey was assessed with the standard seven-food group score. Predictors of DD were identified via Poisson regression model and the outputs are presented using adjusted incidence rate ratio (IRR) with 95% confidence interval (CI). RESULTS Only 7% (95% CI, 5.9%-8.1%) of the children met the recommended minimum DD. Child age and maternal knowledge of infant and young child feeding (IYCF) were significant predictors of DD with IRR of 1.027 (95% CI, 1.022-1.032) and 1.026 (95% CI, 1.010-1.043). Households with moderate and severe food insecurity had 9% (95% CI, 3.8-13.9%) and 24.9% (95% CI, 14.6-44%) reduced chance of providing diversified food. Husbands' direct involvement in IYCF increased DD by 13.7% (95% CI, 7.4-20.4). Caregivers who discussed IYCF with health extension workers, participated in cooking demonstrations, and heard radio spots about IYCF in the preceding 3 mo had 11.7% (95% CI, 3.4-20.7%), 18.9% (95% CI, 0.3-40.9%), and 11.4% (95% CI, 4.8-18.4) higher chance of providing diversified food, respectively. Backyard gardening (IRR, 1.088; 95% CI, 1.031-1.148) and number of chickens owned (IRR, 1.011; 95% CI, 1.001-1.021) also were significant predictors. CONCLUSIONS In predominately food-insecure areas, nutrition education, implementation of nutrition-sensitive agriculture, and husband involvement in IYCF can improve children's DD.
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Affiliation(s)
- Samson Gebremedhin
- School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia.
| | - Kaleab Baye
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tilahun Bekele
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Yonas Asrat
- Alive and Thrive Ethiopia, Addis Ababa, Ethiopia
| | | | - Nigusse Reta
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
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Colombara DV, Hernández B, Gagnier MC, Johanns C, Desai SS, Haakenstad A, McNellan CR, Palmisano EB, Ríos-Zertuche D, Schaefer A, Zúñiga-Brenes P, Zyznieuski N, Iriarte E, Mokdad AH. Breastfeeding Practices among Poor Women in Mesoamerica. J Nutr 2015; 145:1958-65. [PMID: 26136592 DOI: 10.3945/jn.115.213736] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/08/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Breastfeeding is an effective intervention to reduce pediatric morbidity and mortality. The prevalence of practices and predictors of breastfeeding among the poor in Mesoamerica has not been well described. OBJECTIVES We estimated the prevalence of ever breastfeeding, early initiation of breastfeeding, exclusive breastfeeding, and breastfeeding between 6 mo and 2 y of age using household survey data for the poorest quintile of families living in 6 Mesoamerican countries. We also assessed the predictors of breastfeeding behaviors to identify factors amenable to policy interventions. METHODS We analyzed data from 12,529 children in Guatemala, Honduras, Mexico (Chiapas State), Nicaragua, Panama, and El Salvador using baseline survey data from the Salud Mesoamérica 2015 Initiative. We created multivariable Poisson regression models with robust variance estimates to calculate adjusted risk ratios (aRRs) and 95% CIs for breastfeeding outcomes and to control for sociodemographic and healthcare-related factors. RESULTS Approximately 97% of women in all countries breastfed their child at least once, and 65.1% (Nicaragua) to 79.0% (Panama) continued to do so between 6 mo and 2 y of age. Breastfeeding in the first hour of life varied by country (P < 0.001), with the highest proportion reported in Panama (89.8%) and the lowest in El Salvador (65.6%). Exclusive breastfeeding also varied by country (P = 0.037), ranging from 44.5% in Panama to 76.8% in Guatemala. For every 20% increase in the proportion of peers who exclusively breastfed, there was an 11% (aRR: 1.11, 95% CI: 1.04, 1.18) increase in the likelihood of exclusive breastfeeding. CONCLUSION Our study revealed significant variation in the prevalence of breastfeeding practices by poor women across countries surveyed by the Salud Mesoamérica 2015 initiative. Future interventions to promote exclusive breastfeeding should consider ways to leverage the role of the community in supporting individual women.
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Affiliation(s)
| | | | | | - Casey Johanns
- Institute for Health Metrics and Evaluation, Seattle, WA; and
| | - Sima S Desai
- Institute for Health Metrics and Evaluation, Seattle, WA; and
| | | | | | | | - Diego Ríos-Zertuche
- Salud Mesoamérica 2015, Inter-American Development Bank, Panama City, Panama
| | | | - Paola Zúñiga-Brenes
- Salud Mesoamérica 2015, Inter-American Development Bank, Panama City, Panama
| | | | - Emma Iriarte
- Salud Mesoamérica 2015, Inter-American Development Bank, Panama City, Panama
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, Seattle, WA; and
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Okoye UO, Ngwu CN, Tanyi PL. Knowledge of nutritional and health needs of children among rural residents of Enugu north senatorial zone in Enugu State, Nigeria. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2015; 35:148-62. [PMID: 25856806 DOI: 10.1177/0272684x15569489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article assessed knowledge of the nutritional and health needs of children among rural dwellers in Nigeria. Focus group discussions were conducted with all male and female groups in four purposively chosen rural communities in Nsukka Senatorial zone of Enugu State. These generated data on participants' knowledge on the nutritional and health needs of the children as well as their socio-demographic characteristics. All the participants were married with mean age of 41 and 36 years for males and females, respectively. The participants had six and four children on the average for male and female participants, respectively. Findings show that participants demonstrate knowledge of basic dietary needs of children; however, actual practice is lacking. Men believe women have the sole responsibility for children's nutrition. Exclusive breastfeeding is not adhered to by participants. Some reservation still exists about immunization. Sustained health education on exclusive breastfeeding and child immunization targeting both sexes is still needed.
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Affiliation(s)
- Uzoma O Okoye
- Department of Social Work, University of Nigeria, Nsukka, Nigeria
| | | | - Perpetua L Tanyi
- Department of Social Work, University of Nigeria, Nsukka, Nigeria
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