Knowledge, attitudes and perceptions on infant and young child nutrition and feeding among adolescent girls and young mothers in rural Bangladesh

Maternal misperception of under-five children weight status and associated factors: A cross-sectional study

Maternal perceptions, about the nutritional status of their children, may have implications for timely health care seeking and feeding behaviour. Shreds of evidence are limited in this area that assessed maternal perception about the nutritional status of the children in the context of Bangladesh. The objective of this study is to assess the differences in mothers' perceptions about their children's nutritional status who are less than 5 years of age and their associated factors in the context of urban slum areas. A cross-sectional study (Quantitative approach) was conducted in two of the largest urban slums of Dhaka city. A total of 437 mother-children dyads were included in the final analysis. The outcome of interest was the mother's 'varied perceptions' regarding the nutritional status of their children under five. 'Varied perception' refers to the difference between a mother's subjective assessment of her child's nutritional condition and the anthropometrically measured nutritional status. The prevalence of mother's varied perceptions was around 46%, and among them, 37% of mothers underestimated and 9% overestimated their child's nutritional status. 'The child doesn't want to eat' (AOR = 3.69; 95% CI: 2.34-5.85; p < 0.001) and 'Feels light when carried' (AOR = 3.39; 95% CI: 1.69-6.81; p = 0.001) were the significant reasons behind the mother's perception about the nutritional status of their under-five children. About one in two mothers' perceptions about their children varied from the anthropometry-derived status. Various research findings indicate that providing health education on proper feeding practices for children, along with anthropometric measurements, can assist mothers in enhancing their understanding and assessing their child's nutritional status with greater accuracy. Further qualitative research may be instrumental in getting deeper insights into maternal perception to develop context-specific interventions.

Development and validation of the Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa

BACKGROUND

In Sub-Saharan Africa, the nutritional status of children born to teenage mothers deserves critical attention. Maternal knowledge and attitudes concerning infant and young child feeding (IYCF) may predict actual practices and child nutritional status. This study created and validated the Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa.

METHODS

A literature search on IYCF knowledge and attitude gaps in teenage mothers generated scale items. Ten nutrition experts and six teenage mothers assessed content validity and comprehensibility, respectively. Construct validation was conducted by item response theory (IRT) and confirmatory factor analysis (CFA), in 150 teenage mothers in rural communities of Abuja, Nigeria. Model fit parameters were estimated by standardized chi-square tests. Internal consistency reliability was determined by marginal reliability and Cronbach's alpha. In a sub-sample of 40 women who completed the questionnaire two weeks later, test-retest reliability was assessed via intraclass correlations.

RESULTS

The IRT analysis retained 23 knowledge items on infant food type, breastfeeding and complementary feeding, with acceptable discrimination and difficulty. CFA produced a six-factor solution (exclusive breastfeeding, breast milk expression, meal frequency, responsive feeding, dietary diversity, and barriers) with 17 attitude items. Confirmatory fit and Tucker Lewis indices > 0.9; Root Mean Square Errors of Approximation and Standardized Root Mean Square Residuals < 0.08, showed good model fit. Overall Cronbach's alpha of the attitude scale (0.843), subscales (≥ 0.6) and high intraclass correlation coefficients (> 0.75) indicated reliability.

CONCLUSION

The Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa is a valid assessment tool for IYCF knowledge and attitudes of teenage mothers.

Barriers to breastfeeding are shaped by sociocultural context: an exploratory qualitative study in Bangladesh

Background

Breastfeeding practice is still not optimum in Bangladesh. Understanding barriers to breastfeeding is needed to prevent harmful practices. This study aimed to understand barriers to breastfeeding among infants and young children in Bangladesh.

Methods

This qualitative study was conducted in five rural sub-districts and one urban slum in Bangladesh. We conceptualized that barriers to breastfeeding can be broadly grouped into individual, society, and system level barriers. We conducted in-depth interviews with 33 breastfeeding mothers and 13 grandmothers of breastfed children (total n = 46 interviews). We observed 23 of these infants and young children being breastfed. These data were supplemented by 3 focus group discussions held with the children’s fathers. We managed the data using Atlas.ti software and analyzed the data thematically using an inductive approach.

Results

Important individual-level barriers perceived to influence breastfeeding included misconceptions about the adverse effects of breastfeeding on maternal health, nutrition and physical appearance, and lack of awareness of the value of breastfeeding among family members. Perceived society-level barriers included sociocultural norms, beliefs, and practices such as mother obliged to give more attention on household chores than breastfeeding to become a good housewife and feeding formula milk perceived as a symbol of parents’ financial solvency in the society. System-level barriers included attractive advertisements of breastmilk substitutes, and inadequate facilities and support processes in mothers’ work environments.

Conclusion

A range of barriers at individual, society and system level have important implications for infant and young children’s breastfeeding practices in Bangladesh. Development of interventions that address the range of barriers that many mothers face is essential to support breastfeeding practices. Potential interventions include strengthening information-giving during interaction between mothers and health workers on breastfeeding techniques, and engaging fathers and other “significant others” in counseling on breastfeeding.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41043-022-00312-y.

Effectiveness of interactive text messaging and structured psychosocial support groups on developmental milestones of children from adolescent pregnancies in Kenya: a quasi-experimental study (Preprint)

BACKGROUND

In sub-Saharan Africa, one-quarter of all pregnancies occur in adolescents. Children born to adolescent mothers have poorer physical and socio-cognitive development. One reason may be inadequate knowledge on childcare and psychosocial support during pregnancy and post partum, since adolescent mothers have less antenatal care attendance and overall interaction with the health care system. Mobile health technology has been used to relay health information to special groups; however, psychosocial support commonly requires physical interaction.

OBJECTIVE

We aimed to assess the efficacy of an interactive mobile text messaging platform and support groups in improving adolescent mothers' knowledge and practices as well as infant growth and development.

METHODS

This was a quasi-experimental study, conducted among adolescent mothers with infants younger than 3 months, in Homa Bay County, Kenya. Five of the 8 subcounties in Homa Bay County were purposively selected as study clusters. Four subcounties were assigned as intervention clusters and 1 as a control cluster. Adolescent mothers from 2 intervention subcounties received interactive text messaging only (limited package), whereas those from the other 2 subcounties received text messaging and weekly support groups, moderated by a community health extension worker and a counselor (full package); the control cluster only received the end-line evaluation (posttest-only control). The follow-up period was 9 months. Key outcomes were maternal knowledge on childcare and infant development milestones assessed using the Developmental Milestones Checklist (DMC III). Knowledge and DMC III scores were compared between the intervention and control groups, as well as between the 2 intervention groups.

RESULTS

We recruited 791 mother-infant pairs into the intervention groups (full package: n=375; limited package: n=416) at baseline and 220 controls at end line. Attrition from the intervention groups was 15.8% (125/791). Compared with the control group, adolescent mothers receiving the full package had a higher knowledge score on infant care and development (9.02 vs 8.01; P<.001) and higher exclusive breastfeeding rates (238/375, 63.5% vs 112/220, 50.9%; P=.004), and their infants had higher average DMC III scores (53.09 vs 48.59; P=.01). The limited package group also had higher knowledge score than the control group (8.73 vs 8.01; P<.001); this group performed better than the full package group on exclusive breastfeeding (297/416, 71.4% vs 112/220, 50.9%; P<.001) and DMC III scores (58.29 vs 48.59; P<.001) when compared with the control group. We found a marginal difference in knowledge scores between full and limited package groups (9.02 vs 8.73; P=.048) but no difference in DMC III scores between the 2 groups (53.09 vs 58.29; P>.99).

CONCLUSIONS

An interactive text messaging platform improved adolescent mothers' knowledge on nurturing infant care and the development of their children, even without physical support groups. Such platforms offer a convenient avenue for providing reproductive health information to adolescents.

TRIAL REGISTRATION

Pan African Clinical Trials Registry PACTR201806003369302; https://tinyurl.com/kkxvzjse.

Assessment of knowledge, attitude and practice of mothers/caregivers on infant and young child feeding in Assosa Woreda, Assosa Zone, Benshangul Gumuz Region, Western Ethiopia: a cross-sectional study

BACKGROUND

Through the health extension package, Ethiopia had practiced infant and young child feeding. However, infant and young child feeding (IYCF) practice has been poor. Hence, in this study, the knowledge, attitude, and practice of the mothers/caregivers on infant and young child feeding were assessed.

METHODS

A cross-sectional study was carried out among 486 mothers/caregivers from Assosa Districts in the Assosa Zone of Benshangul Gumuz Region, Western Ethiopia. A semi-structured interviewer-administered questionnaire was used. To isolate independent predictors for good knowledge, good practice, and favorable attitude of the mothers/caregivers related to child feeding, multivariable logistic regression analyses were performed.

RESULTS

Out of 486 study participants, 456 (93.8 %) of mothers had good knowledge, 432 (88.9 %) had a positive attitude, and 380 (78.2 %) mothers had good practice of IYCF practice recommendations. Furthermore, age of mothers, educational status of the mother, place of delivery, father's educational status, father's involvement & support, previous knowledge about IYCF, discussion with their husband about IYCF, and ANC follows up were significantly associated with mother's knowledge on IYCF recommendation.

CONCLUSIONS

Overall mothers had good knowledge and a positive attitude about IYCF practices. To support IYCF practices, behavior change communications intervention strategies should be introduced in mothers to bridge the gap between knowledge and practices.

Infant and Young Child Feeding Practices among Adolescent Mothers and Associated Factors in India

Adequate infant and young child feeding (IYCF) improve child survival and growth. Globally, about 18 million babies are born to mothers aged 18 years or less and have a higher likelihood of adverse birth outcomes in India due to insufficient knowledge of child growth. This paper examined factors associated with IYCF practices among adolescent Indian mothers. This cross-sectional study extracted data on 5148 children aged 0–23 months from the 2015–2016 India National Family Health Survey. Survey logistic regression was used to assess factors associated with IYCF among adolescent mothers. Prevalence of exclusive breastfeeding, early initiation of breastfeeding, timely introduction of complementary feeding, minimum dietary diversity, minimum meal frequency, and minimum acceptable diet rates were: 58.7%, 43.8%, 43.3%, 16.6%, 27.4% and 6.8%, respectively. Maternal education, mode of delivery, frequency of antenatal care (ANC) clinic visits, geographical region, child’s age, and household wealth were the main factors associated with breastfeeding practices while maternal education, maternal marital status, child’s age, frequency of ANC clinic visits, geographical region, and household wealth were factors associated with complementary feeding practices. IYCF practices among adolescent mothers are suboptimal except for breastfeeding. Health and nutritional support interventions should address the factors for these indicators among adolescent mothers in India.

Spatial variations and associated factors of knowledge of ORS packet or pre-packaged liquids for the management of diarrhea among women of reproductive age in Ethiopia: A spatial and multilevel analysis

Background

Even though diarrhea is not lethal by itself, the lack of knowledge about its management results in devastating complications such as dehydration and lastly death. Using an oral rehydration solution (ORS) is an easy, inexpensive, and most reliable way of treating dehydration and reducing diarrhea-related mortalities. The literature revealed that Knowledge of ORS packet or pre-packaged liquids is a very important and critical factor for the utilization of ORS during the management of diarrhea.

Methods

We used the 2016 Ethiopian Demographic and Health Survey data, which is the fourth survey conducted by the Central Statistical Agency. A total weighted sample of 7590 reproductive-age women who gave birth within five years preceding the survey was used. Multilevel logistic regression analysis was done to assess factors associated with knowledge of ORS packet or pre-packaged liquids. Arc GIS version 10.3 and Kuldorff’s SaTScan version 9.6 software were used for the spatial analysis.

Results

In the multilevel analysis maternal education, media exposure, residence, community illiteracy level, and region were significantly associated with knowledge of ORS packet or pre-packaged liquids. Besides, knowledge of ORS packet or pre-packaged liquids for the management of diarrhea was not random in Ethiopia (with Moran’s Index = 0.46 and p-value <0.001), and the primary clusters spatial window was located in SNNPR, most parts of the Oromia region, and eastern parts of the Gambela region.

Conclusion

In this study knowledge of ORS packet or pre-packaged liquids was not random across the country. Lack of formal education, lack of media exposure, being from a rural area, and being from communities with a higher illiteracy level was associated with lower odds of knowledge of ORS packet or pre-packaged liquids. Therefore, special emphasis should be given to these high-risk groups and the hot spot regions (SNNPR, most parts of the Oromia region, and eastern parts of the Gambela region). Moreover, distributing information through different media regarding ORS packet or pre-packaged liquids is necessary.

Breastfeeding Practices among Adolescent Mothers and Associated Factors in Bangladesh (2004-2014)

Optimal breastfeeding practices among mothers have been proven to have health and economic benefits, but evidence on breastfeeding practices among adolescent mothers in Bangladesh is limited. Hence, this study aims to estimate breastfeeding indicators and factors associated with selected feeding practices. The sample included 2554 children aged 0-23 months of adolescent mothers aged 12-19 years from four Bangladesh Demographic and Health Surveys collected between 2004 and 2014. Breastfeeding indicators were estimated using World Health Organization (WHO) indicators. Selected feeding indicators were examined against potential confounding factors using univariate and multivariate analyses. Only 42.2% of adolescent mothers initiated breastfeeding within the first hour of birth, 53% exclusively breastfed their infants, predominant breastfeeding was 17.3%, and 15.7% bottle-fed their children. Parity (2-3 children), older infants, and adolescent mothers who made postnatal check-up after two days were associated with increased exclusive breastfeeding (EBF) rates. Adolescent mothers aged 12-18 years and who watched television were less likely to delay breastfeeding initiation within the first hour of birth. Adolescent mothers who delivered at home (adjusted OR = 2.63, 95% CI:1.86, 3.74) and made postnatal check-up after two days (adjusted OR = 1.67, 95% CI: 1.21, 2.30) were significantly more likely to delay initiation breastfeeding within the first hour of birth. Adolescent mothers living in the Barisal region and who listened to the radio reported increased odds of predominant breastfeeding, and increased odds for bottle-feeding included male infants, infants aged 0-5 months, adolescent mothers who had eight or more antenatal clinic visits, and the highest wealth quintiles. In order for Bangladesh to meet the Sustainable Development Goals (SDGs) 2 and 3 by 2030, breastfeeding promotion programmes should discourage bottle-feeding among adolescent mothers from the richest households and promote early initiation of breastfeeding especially among adolescent mothers who delivered at home and had a late postnatal check-up after delivery.

Trends and Determinants of EBF among Adolescent Children Born to Adolescent Mothers in Rural Bangladesh

Exclusive breastfeeding (EBF) has proven benefits for both mothers and infants; however, adolescent mothers have poor EBF practices globally. In Bangladesh, the practice of EBF among adolescent mothers remains unexplored. The aim of our study was to understand the EBF practices among adolescent mothers and their determinants in both the Health and Demographic Surveillance (HDSS) system areas of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) service area (ISA) and government service area (GSA) in rural Matlab, Bangladesh. For the purpose of our study, we collected relevant information from the database of the Health and Demographic Surveillance System (HDSS) of icddr,b and performed analysis to understand the trends and identify the determinants of EBF and identify the determinants of EBF among adolescent mothers living in two areas between 2007 and 2015. In total, 2947 children born to adolescent mothers were included in our final analysis. We used the Kaplan–Meier and the Cox-proportional hazards models to determine the differences in EBF practices in the two areas. We noted a lower trends of EBF in the ISA compared to the GSA in bivariate analysis. However, after adjusting for confounding variables, EBF status was 15% lower in the GSA than the ISA (HR: 0.85, 95% CI: 0.72–0.99). The father’s education was significantly different among the two populations. In both study areas, the coverage of EBF among adolescent mothers was lower than the national average (42% vs. 65%). Ensuring that adolescent mothers receive optimal care may improve EBF behavior.

Evidence from 2016 Ethiopian Demographic and Health Survey Data: Maternal Practice in Managing Childhood Diarrhea at Home

PURPOSE

The aim of this study was to assess the prevalence and associations of maternal practice in managing diarrheal diseases at home among Ethiopian mothers whose children were younger than five years of age.

METHODS

This study was a secondary analysis of the 2016 Ethiopian Demographic and Health Survey (EDHS) data. The 2016 EDHS data were collected using stratified two-stage sampling method. Nine hundred and sixty-two mothers who had children who experienced diarrhea two weeks prior to the survey were included. A logistic regression model was used to assess the associations with maternal practice.

RESULTS

In this study, 672 (69.9%) of mothers had limited understanding of home-based diarrheal disease management. Poorest wealth index (AOR, (95%CI), ((3.33), (1.38, 8.02), poorer wealth index ((3.55), (1.43, 8.80), medium wealth index ((3.10), (1.24, 7.72), and low level maternal education ((1.60), (1.51, 4.10) increased the odds of inadequate maternal practice.

CONCLUSIONS

The prevalence of inadequate maternal practice was high. Lowest wealth quantities and low level maternal education increased the likelihood of inadequate maternal practice. Health facilities should emphasize teaching mothers about home based diarrheal management.

PRACTICAL IMPLICATION

Inadequate personal and environmental hygiene are the major cause of diarrheal disease, which is common among children under five years of age. Diarrhea is not fatal by itself, but it causes dehydration, which can ultimately result in child mortality if not treated. Fortunately, dehydration can be managed at home, which is an opportunity for nurses and health professionals to address this public health problem.

Awareness and attitude towards dehydration and its management amongst mothers and factors influence on in under-five children of Omdurman locality, Sudan

Dehydration is a significant depletion of body water and electrolytes. The awareness of dehydration signs is essential, and in-home mothers' practice and responses towards professional medical help are crucial. The study is a cross-sectional study enrolled 222 mothers with children under 5 years, and 198 of them participate in a semi-structured questionnaire that involves information of dehydration signs, oral rehydration solution and preparation and in-home practice and remedies used by mothers in the management of dehydration. Fifty-eight participants (29.3%) were found in the age group of 26-30 years, 78 participants (39.4%) received primary school education and 92 (46.5%) had one child under 5 years, whereas 17.7% received educational workshop or counselling. Main management practices performed by the mothers were over-the-counter medications (36.4%) and rice water (33.8%). The majority (88%) of the participants were aware about dehydration signs, which were significantly associated with educational levels, and workshop or counselling received from professional.

Factors associated with unmet fertility desire and perceptions of ideal family size among women in Bangladesh: Insights from a nationwide Demographic and Health Survey

Introduction

Along with the developing world, Bangladesh has made a tremendous improvement in declining total fertility rate, however, this declining trend is not uniform to all the socio-demographic stratum. Incongruities exist between the numbers of children that women bearing and what they actually desired which refers to unmet fertility desire. This study aims to elicit women’s perception of ideal number of children and predictors of unmet fertility desire in Bangladesh.

Method

This study analyzed nationally representative cross-sectional Bangladesh Demographic and Health Survey 2014 data. A two-stage stratified random sampling technique was used while a total of 17,863 ever-married women were interviewed between June and November 2014. A total of 10,912 eligible women were included in the analysis. Poisson regression analysis and logistic regression models were used to measure women’s perception of the ideal number of children and to determine the influencing factors of unmet fertility desires.

Result

The mean value of the perceived ideal number of children was 2.22 (SD ± 0.73) and the majority of women (71.2%) expect to have two children in their lifetime. Approximately 46% of mothers reported bearing more children than they desired. The perceived ideal number of children was significantly higher among women who were living in rural areas, from Sylhet division, Muslim, unemployed, and experienced child death and those who justified beating. Findings revealed that several factors such as place of residence, geographic location, religion, wealth index, maternal age and education, partners’ education, experiencing child death, and other empowerment-related indicators were significantly associated with unmet fertility desires.

Conclusion

Perceived ideal number of children differs among women’s socioeconomic and demographic strata. Unmet fertility desire was also found which indicates that reproductive knowledge and health care services are still necessary for some socio-demographically disadvantaged/vulnerable people and this group should be regularly monitored to control population growth.

A Qualitative Exploration of the Determinants of Exclusive Breastfeeding (EBF) Practices in Wajir County, Kenya

Background

The World Health Organization recommends exclusive breastfeeding for the first six months of life. A qualitative study was conducted to assess the factors that influence the practice of exclusive breastfeeding amongst mothers attending Wajir County Hospital, Kenya.

Method

This study was part of a cross-sectional study to compare the exclusive breastfeeding rates amongst primiparous and multiparous mothers with infants under 6 months old attending Wajir County Hospital. Focus group discussions and key informant interviews were conducted to collect information on exclusive breastfeeding and related factors. Four focus group discussions were conducted with mothers who exclusively breastfed and the same number with mothers who did not exclusively breastfeed their babies. Key informant interviews were conducted with nine healthcare providers. The data were transcribed, and a content analysis identified common themes and inferences.

Results

The exclusive breastfeeding rate among the mothers in the larger study was 45.5%. There was no disparity between the practice of exclusive breastfeeding between primiparous and multiparous mothers. Despite the high knowledge and positive attitudes towards exclusive breastfeeding of most mothers, the practice of exclusive breastfeeding was unsatisfactory. The major hindrances identified were cultural barriers propagated by mothers-in-law and traditional birth attendants; the belief that babies cannot live without water; and a few unsupportive health workers. The uptake of exclusive breastfeeding was enhanced by Islamic teaching on breastfeeding, education from a few supportive healthcare providers; support from husbands; and positive deviance among some lactating mothers who practiced exclusive breastfeeding.

Conclusions

Deeply rooted cultural factors were the major hindrance to the practice of exclusive breastfeeding. Most of the mothers did not practice exclusive breastfeeding, despite the majority being knowledgeable and having positive attitudes towards the practice. The influence of mother-in-law’s and traditional birth assistants were major barriers. Strengthening the Community Health Strategy through training traditional birth attendants on Infant Young Child Nutrition practices, designing mechanisms linking traditional birth assistants to existing health facilities for support, and capacity building and monitoring is critical in promoting exclusive breastfeeding. Behavior change and communication through multiple channels within the community should be utilized to maximize promotion of exclusive breastfeeding among all stakeholders.

Knowledge and practices of exclusive breastfeeding among mothers in rural areas of Rajshahi district in Bangladesh: A community clinic based study

BACKGROUND

World Health Organization (WHO) suggests that exclusive breastfeeding (EBF) is the best nutrition for the neonate. Still, it remains a big challenge to establish EBF not only in Bangladesh but also in any developing countries.

OBJECTIVE

The aim of this study was to determine the level of knowledge and practices on EBF and its relationship between different socioeconomic and demographic factors among mothers having at least one child of aged 6-12 months in the rural area of Rajshahi District, Bangladesh.

METHODOLOGY

A community clinic (CC) based study has been conducted by using semi-structured questionnaire. A total of 513 mothers having at least one child aged 6-12 months from 32 different CC in the rural area of Rajshahi District, Bangladesh during September to December 2015. A composite index, chi-square test, and logistic regression model were utilized in this study.

RESULTS

The prevalence of knowledge and practices on EBF were 34.5% and 27.9% among mothers having at least one child aged 6-12 months. From the analyses, mothers age of ≥21 years were (adjusted odds ratio (AOR) = 13.840, 95% CI: 7.394-25.904; p<0.001) times more likely to have knowledge on EBF and (AOR = 0.084, 95% CI: 0.050-0.143; p<0.05) times less likely to have practices of EBF compared to mother's age ≤20 years. Service holders mothers were (AOR = 9.992, 95% CI: 4.485-22.260, p<0.05) times more likely to have practices than that of house wife. Home delivery mothers was (AOR = 0.208, 95% CI: 0.111-0.389; p<0.05) times less likely to have practices of EBF than that of the hospital delivery mothers. Those mothers monthly family income ≥10,000 Bangladeshi taka (BDT) currency was (AOR = 0.092, 95% CI: 0.050-0.168, p<0.05) times less likely to have practices of EBF compared to their counterparts.

CONCLUSIONS

This study was found poor knowledge and practices on EBF. This study suggested that education and EBF related intervention could play an important role to increase good knowledge and practices on EBF among mothers. Malnutrition will be decreased if EBF was widely established in Bangladesh.

High confidence, yet poor knowledge of infant feeding recommendations among adults in Nova Scotia, Canada

In Canada, adherence to the national 'Nutrition for Healthy Term Infants' recommendations of infant and young child feeding (IYCF; 0-24 months) is suboptimal. While maternal knowledge of IYCF is commonly assessed, that of the general public has rarely been explored. Our objective was to assess the knowledge of, and confidence in answers to, Canadian IYCF recommendations among a diverse sample of adults in Nova Scotia, Canada. Between March and May 2018, a self-administered questionnaire examining IYCF knowledge, self-rated confidence, and sociodemographic information was conducted among Nova Scotians (≥19 years) in public locations. We surveyed 229 adults; 60% (n=134) were women. Mean (95% CI) age was 44 (41,46) years, 73% self-identified as white, 77% were born in Canada, and 69% were parents. Knowledge deficits were: age to terminate breastfeeding (18.3 (16.7,19.9) months; recommendation: ≥24 months), age to introduce solids (9.2 (8.2,10.2) months; recommendation: 6 months), vitamin D supplementation (10% correct), and optimal complementary foods (only 37% indicated iron-rich foods). Correct IYCF knowledge was lower among men, non-parents, young adults (19-29 years) and low-income adults (<$50,000/year). Mean self-rated confidence (out of 10) was high (7.2 (6.9,7.5)), and not different (p>0.05) between correct and incorrect responses for: best food for a newborn, age to terminate any breastfeeding, and age to start family meal foods. We found low knowledge of IYCF guidelines, yet high confidence in responses regardless of accuracy, among adults in Nova Scotia. General public knowledge deficits may contribute to an unsupportive culture around IYCF practices and low adherence to current recommendations.

Prenatal Interventional Program about Mothers' Behavior Related to Exclusive Breast Feeding: Findings of Planned Behavior Theory-Based Research

Background

Promotion of exclusive breast feeding is known as a savior strategy, to reduce infantile mortality. The theory of planned behavior is an appropriate theory to explain the effect of psychosocial factors on infant feeding behavior. This study aimed to evaluate impact of planned behavior theory-based education on the behavior of pregnant women related to exclusive breast feeding in Arak city, 2016–17.

Methods

This study is an interventional study that was done on 101 pregnant women with gestational age of 32–28 weeks in health centers of Arak city. All individuals were divided into experimental and control groups randomly. Valid and reliable questionnaires were completed before, on and 3 months after intervention. Experimental group received educational intervention in 3 sessions. Date was analyzed using SPSS 16 software (Chi-square, T, R.M.ANOVA Tests).

Results

The results showed that, after implementation of the intervention, mean of scores for attitudes, subjective norms, Perceived behavioral control, intention and exclusive breast feeding behavior has increased significantly in the experimental group compared with the control group.

Conclusion

The findings of this study, showed the efficiency and effectiveness of educational intervention based on the theory of planned behavior on exclusive breast feeding behavior. Designing and implementing educational programs based on the theory of planned behavior is proposed to encourage women to breast-feed exclusively to encourage women to breast-feed exclusively.

Adolescent girls' perceptions of breastfeeding in two low-income periurban communities in South Africa

In South Africa, exclusive breastfeeding rates are low, and rates of teenage pregnancy are high. Educational policy enables mothers' return to school, which conflicts with policy emphasizing exclusive breastfeeding. We elicited adolescent women's perceptions and experiences of infant feeding choices, and conducted six focus groups (N = 57) in two periurban settlements. Participants knew arguments in favor of and against breast and formula-feeding, but in practice, mixed feeding occurred early after birth. While completion of high school was emphasized, exclusive breastfeeding was viewed as impractical. Congruent education policies and infant feeding policies/guidelines must address the constraints and contexts of adolescent mothers.

Caregivers' knowledge and attitudes about childhood diarrhea among refugee and host communities in Gambella Region, Ethiopia

BACKGROUND

Maternal knowledge, attitudes, and practices related to hygiene, breastfeeding, sanitary food preparation, and appropriate weaning practices are potentially important determinants in the occurrence of diarrhea in children. However, few studies have been carried out about the knowledge and attitudes about childhood diarrhea among parents in refugee camps and host communities.

OBJECTIVE

This study aims at assessing the caregivers' knowledge and attitudes regarding acute diarrhea in under-five children among refugee and host communities in Gambella Region, Ethiopia.

METHODOLOGY

This cross-sectional study, employing multistage sampling, was carried out from September to December 2016. Data was collected by a questionnaire-based interview, and 1667 caregivers were included in this study. A composite knowledge score was calculated, and a five-point Likert type of attitude scale was developed to assess the attitudes of the caregivers towards childhood diarrhea. Appropriate descriptive statistics and logistic regression models were used. Odds ratios (ORs) are presented with their 95% confidence intervals (CIs), and all analyses were performed at the 5% significance level (p < 0.05).

RESULT

The study indicates that 633 (28.0%) of the caregivers had poor knowledge, while 393 (23.6%) of them had unfavorable attitudes towards childhood diarrhea. Knowledge of the caregivers was significantly associated with formal education (AOR, 1.3; 95% CI, 1.03-1.5) and health information obtained from a health care institution (AOR, 1.8; 95% CI, 1.28-2.3). Caregivers' knowledge is a single predictor of their attitude (p < 0.001), and Pearson's correlation coefficient revealed that there was a significant positive correlation (r = 0.2, p < 0.001) between knowledge and attitude scores.

CONCLUSION

The study indicates that significant numbers of caregivers had inadequate knowledge and unfavorable attitudes about diarrhea in under-five children. Designing and implementing an inclusive health education intervention focusing on uneducated child caregivers may be beneficial for improving knowledge and attitudes towards reducing the incidence of acute childhood diarrhea in the region.

Mothers' knowledge, attitude and practice towards the prevention and home-based management of diarrheal disease among under-five children in Diredawa, Eastern Ethiopia, 2016: a cross-sectional study

BACKGROUND

Diarrhea remains the 2nd leading cause of death among children under 5 globally. It kills more young children than AIDS. It would have been prevented by simple home management using oral rehydration therapy. Mothers play a central role in its management and prevention. So, the main objective of this study was to assess mothers' knowledge, attitude & practice in prevention & home-based management of diarrheal disease among under-five children in Dire Dawa, Eastern Ethiopia.

METHODS

Institutional based cross-sectional study was conducted from March 15-April 14, 2016, in Diredawa among 295 Mothers who had under-five child with diarrhea in the last 2 weeks using simple random sampling method. Mothers were interviewed face to face by using pretested, standard and structured questionnaire. The data quality was assured by translation, retranslation and pretesting the questionnaire. Data were checked for completeness, consistency and then entered into Epi Info v3.1 and analyzed using SPSS v20. The descriptive statistical analysis was used to compute frequency, percentages, and mean of the findings of this study. The results were presented using tables, charts, and graphs.

RESULTS

In this study, 295 participants were included with 100% response rate. From total 295 mothers, around two-thirds (65.2%) of them had good knowledge, but more than half of mothers (54.9%) had a negative attitude towards home-based management and prevention of diarrhea among under-five children. Regarding the attitude of the mothers, 58% had poor practice towards home-based management and prevention of diarrhea among under-five children.

CONCLUSION

The finding of this study showed that the attitude and practice of mothers were unsatisfactory about the prevention and home-based management of under-five diarrheal diseases. Therefore, Health education, dissemination of information, and community conversation should plan and implement to create a positive attitude and practice towards the better prevention and management of under 5 diarrheal diseases.

Socio-economic differentials in minimum dietary diversity among young children in South-East Asia: evidence from Demographic and Health Surveys

OBJECTIVE

To investigate the socio-economic differentials underlying minimum dietary diversity (MDD) among children aged 6-23 months in three economically diverse South-East Asian countries.

DESIGN

The outcome variable MDD was defined as the proportion of children aged 6-23 months who received foods from four of the seven recommended food groups within the 24 h prior to interview. The association between socio-economic factors and MDD, adjusting for relevant characteristics, was examined using logistic regression.

SETTING

We used cross-sectional population data from recent Demographic and Health Surveys from Cambodia (2014), Myanmar (2015-16) and Indonesia (2012).

SUBJECTS

Total of 8364 children aged 6-23 months.

RESULTS

Approximately half of all children met the MDD, varying from 47·7 % in Cambodia (n 1023) to 58·2 % in Indonesia (n 2907) and 24·6 % in Myanmar (n 301). The likelihood (adjusted OR; 95 % CI) of meeting MDD increased for children in the richest households (Cambodia: 2·4; 1·7, 3·4; Myanmar: 1·8; 1·1, 3·0; Indonesia: 2·0; 1·6, 2·5) and those residing in urban areas (Cambodia: 1·4; 1·1, 1·9; Myanmar: 1·7; 1·2, 2·4; Indonesia: 1·7; 1·5, 1·9). MDD deprivation was most severe among children from the poorest households in rural areas. The association between mother's labour force participation and MDD was positive in all three countries but reached significance only in Indonesia (1·3; 1·1, 1·5).

CONCLUSIONS

MDD deprivation among young children was significantly high in socio-economically disadvantaged families in all three study settings. MDD requirements are not being met for approximately half of young children in these three South-East Asian countries.

"Then you raise them with Shirchoy or cookies": Understanding influences on delayed dietary diversity among children in Tajikistan

Dietary diversity is a key component of infant and young child feeding (IYCF) as well as adult health. In Tajikistan, a predominantly rural, former Soviet country in Central Asia, we conducted formative research to identify barriers to dietary diversity and strategies for nutrition behaviour change. In Spring, 2016, mixed‐methods data collection took place across 13 villages in all five regions, collecting collaborative mapping; structured assessments of stores and markets; home visits for dietary recalls; food storage, preparation, and meal observations; focus groups with pregnant women, mothers of young children, fathers, and mothers‐in‐law; and in‐depth expert interviews with local nutrition and health influentials. Overall, maternal diet was adequate in terms of diversity (only 13% reported <5/10 food groups in the past 24 hr); however, only 42% of index children 6–24 months met WHO guidelines for diversity, and only 34% met minimum acceptable diet criteria. In addition to issues of poverty and food scarcity, qualitative data reveal many behavioural barriers to timely introduction of diverse complementary foods. Women's strategies focused on gradual introduction of household diet components, without regard for diversity or nutrition. Foods such as meat were seen as costly and thus inappropriate for IYCF, and food taboos (i.e., fresh vegetables) further reduced diversity. Infant food preparation methods such as grinding were seen as impractical, and many foods were withheld until children develop teeth. Possible nutrition education strategies include point‐of‐purchase campaigns to improve availability and appeal of IYCF‐friendly foods, as well as influencing other key household members through mosques, schools, and health care providers.

Maternal behavioural determinants and livestock ownership are associated with animal source food consumption among young children during fasting in rural Ethiopia

Religious fasting often involves abstention from animal source foods (ASFs). Although children are exempt, their diets are influenced by the widespread fasting practices. This study investigated the factors influencing ASF consumption among young children during the Lent fasting period in western Amhara, Ethiopia. We used baseline survey data from households with children 6-23 months of age (n = 2,646). We conducted regression analysis to examine the maternal and household factors associated with ASF consumption and path analysis to examine the direct and indirect effects of maternal knowledge, beliefs, social norms, and livestock ownership on ASF consumption. Only 24% of children consumed any ASF in the previous day-18% dairy products, 5% eggs, and 2% flesh foods. Mothers with high knowledge, beliefs, and social norms about feeding children ASFs during fasting had higher odds (odds ratio: 1.3-1.4) of children who consumed them. Compared with households with no ASFs, those with ASFs available were 4.8 times more likely to have children who consumed them. Most of the association between knowledge, beliefs and social norms, and ASF consumption was explained by pathways operating through ASF availability (approximately 9, 12, and 8 pp higher availability, respectively), which in turn were associated with higher consumption. Cow ownership was directly and indirectly associated with ASF consumption, whereas having chickens was indirectly associated with consumption via the availability pathway. Our findings corroborate the importance of maternal behavioural determinants related to feeding ASFs to children during fasting on ASF consumption via household availability and the positive influence of livestock ownership.

Uncovering the barriers to exclusive breastfeeding for mothers living in Dhaka's slums: a mixed method study

Background

Despite the substantial impact on child and maternal health, breastfeeding practices for infants remain at the suboptimum level in Bangladesh. Yet the understanding of why these practices are suboptimal, especially surrounding urban slum dwelling mothers, is unclear. The purpose of this study was to assess early infant feeding practices, examine associations with maternal factors, and uncover the facilitators and barriers to early feeding practices in selected slums of Dhaka, Bangladesh.

Methods

A mixed method study was conducted from June to September 2016 using both quantitative and qualitative methods among mothers with children under the age of 6 months. The survey included 342 mother-infant pairs and 18 in-depth interviews were conducted. Univariate and multiple logistic regression was used to determine status of early infant feeding practices and factors associated with exclusive breastfeeding (EBF) within the previous 24 h. Transcripts were coded to uncover the facilitators and barriers surrounding early infant feeding practices.

Results

Sixty four percent (220/342) of mothers initiated breastfeeding within 1 h, 96.5% (330/342) reported feeding colostrum, and 36.3% (124/342) infants were EBF in the last 24 h. After adjusting for child gender, maternal age, education, diet and household income; infant’s age (adjusted odds ratio (AOR) for 61–120 days 6.42; 95% CI 3.42, 12.1; AOR for 121–180 days 45.6; 95% CI 18.33, 113.45), prelacteal feeding (AOR 2.53; 95% CI 1.14, 4.58), lack of planning for EBF during pregnancy (AOR 4.06; 95% CI 1.09, 15.12) and infants delivered by cesarean section (AOR 2.76; 95% CI 1.34, 5.67) were negatively associated with EBF. During the 18 interviews, eight mothers reported a cesarean delivery and none of these mothers initiated breastfeeding within 1 h or exclusively breastfed. Moreover, all eight mothers gave their infants prelacteal feeds.

Conclusions

The status of early infant feeding practices in Dhaka’s slums was poor. The negative impact of cesarean section on all early infant feeding practices was evident in both quantitative and qualitative analysis.

Prevalence and Determinants of Stunting Among Preschool Children and Its Urban-Rural Disparities in Bangladesh

BACKGROUND

Despite improvements in the reduction of child stunting rates over the last decade, poor nutritional status still remains a public health concern in Bangladesh, where young children are the most vulnerable.

OBJECTIVE

The objective of this study is to capture the prevalence and determinants of childhood stunting and document its urban-rural disparities in the context of Bangladesh.

METHODS

The study used data from the Bangladesh Demographic and Health Survey of 2014. A bivariate analysis was performed to find out the differentials in prevalence of stunting, and multivariate logistic regression was performed to also assess the association of stunting with potential risk factors.

RESULTS

The overall prevalence of stunting was 36.3% and was significantly higher in rural (38.1%) areas than urban (31.2%) areas. In all 3 regression models, significantly higher odds were found among children aged 36 to 47 months compared to 6 to 12 months and among the children from the poorest households. In rural areas, male children were significantly more likely to be stunted (odds ratio = 1.31; 95% confidence interval: 1.12-1.53). Other significant risk factors for childhood stunting were maternal education and body mass index, children suffering from diarrhea, initial breast-feeding, and administrative divisions.

CONCLUSIONS

Disparities exist among urban and rural areas regarding stunting among the children younger than 5 in Bangladesh, which need to be reduced. Public health policies and interventions need to consider the risk factors in urban and rural areas separately.

Perceptions of Acute Malnutrition and Its Management in Infants Under 6 Months of Age: A Qualitative Study in Rural Bangladesh

BACKGROUND

World Health Organization guidelines advise community-based care (CBC) for "uncomplicated" severe acute malnutrition (SAM) infants <6 months old (u6m), whereas current national protocols refer to inpatient care. Our aim was to inform and shape future management strategies by understanding caregivers' and different stakeholders' perceptions on malnutrition among infants u6m on barriers/facilitators to future CBC.

METHODS

The methods used in this study are as follows: in-depth interviews and focus group discussions (FGDs) in southern Bangladesh, thematic analysis of transcripts, and sample size by data saturation.

RESULTS

We conducted 5 FGDs with 29 caregivers, 4 with 29 health care workers, 4 key informant interviews each with community leaders and health supervisors. Five themes emerged. 1) Identification of SAM infants and care-seeking behavior: malnutrition was not noticed until severe, caregivers focused on clinical symptoms. Both allopathic and traditional healers were consulted. (2) Perceived causes of infant malnutrition: underlying illness, poor feeding practices, poverty, and local superstitions. (3) Views and preferences on treatment: hospitals and doctors were perceived as offering the best treatment, health care workers were also important, and respondents highlighted the need care of the caregiver/mother along with the infant. (4) Perceived benefits and risks of CBC: lower cost and greater accessibility were appreciated but worried about quality. (5) Community networks: wider family and social support networks were considered important aspects of care.

CONCLUSIONS

There is considerable potential for CBC but needs to be better and earlier identification of at-risk infants, strengthening of health systems to avoid community options being perceived as "second best," engagement with families and communities to tackle "upstream" determinants of SAM, and care for mother-infant pairs.

Comparison of knowledge, attitudes and practices on exclusive breastfeeding between primiparous and multiparous mothers attending Wajir District hospital, Wajir County, Kenya: a cross-sectional analytical study

BACKGROUND

Exclusive breastfeeding (EBF) is recommended for 6 months of age, with continued breastfeeding for 2 years of age or beyond. There is paucity of information on the disparity in Knowledge, Attitudes and Practices (KAP) on EBF between primiparous and multiparous mothers. This study compared the KAP on EBF between primiparous and multiparous mothers attending Wajir County Hospital, Wajir County, Kenya and investigated the association between maternal knowledge and attitudes and EBF.

METHODS

Information on maternal KAP on EBF was collected through structured researcher administered questionnaires for a total of 281 mothers, recruited from a maternal and child health centre in 2014; primiparous (n = 137) and multiparous (n = 144) with infants 0-5 months of age. Maternal knowledge and attitudes on various aspects of breastfeeding were determined. The knowledge and attitude scores were also calculated. The practice of EBF was determined based on a 24-h recall.

RESULTS

The prevalence of EBF among infants 0-5 months old was 45.5%. The rate of EBF among primiparous mothers was 39.4% and multiparous mothers 49.3%. The knowledge score on breastfeeding (out of a total of 10) for the primiparous mothers was 7.93 ± 2.10 and 7.49 ± 2.20 for the multiparous mothers. The mean attitude score (out of a total score of 40) for the primiparous mothers was 29.46 ± 5.65 and 28.65 ± 6.40 for the multiparous mothers. The prevalence of EBF and maternal knowledge and attitudes towards breastfeeding was similar among the two groups of mothers. Those mothers with positive attitudes towards breastfeeding were more likely to EBF (Fisher's exact test; p = 0.00) compared with those with lower scores.

CONCLUSIONS

Interventions to promote exclusive breastfeeding should be tailored to the needs of each population by identifying the factors that influence the practice in a given context. The findings of this study will be useful particularly for behavior change communication interventions by those organizations working in similar circumstances to the study area.

Indigenous food ingredients for complementary food formulations to combat infant malnutrition in Benin: a review

This paper reviews indigenous Beninese food resources as potential ingredients for complementary infant foods with the aim to develop affordable formulations for low-income households in each agro-ecological zone of the country. Potential ingredients were selected on their documented nutritional value. The selected foods encompass 347 food resources, namely 297 plant products from home gardens or collected from natural vegetation and 50 animals, either domesticated or from the wild. The compiled data reveal that the distribution of the available food resources was unbalanced between agro-ecological zones. Only a few animal ingredients are obtainable in northern Benin. Most resources are seasonal, but their availability may be extended. A high variation was observed in energy and nutrient contents. Antinutritional factors were identified in some resources, but processing techniques were reported to reduce their presence in meals. In general, ingredients from local tree foods (Adansonia digitata, Parkia biglobosa) were adequate as sources of nutrients for complementary infant foods. Based on this review, local foods for the development of complementary food formulas for Beninese infants and children may be selected for each agro-ecological zone. The approach used is exemplary for other sub-Saharan African countries in need of complementary infant foods. © 2017 Society of Chemical Industry.

A systematic review of complementary feeding practices in South Asian infants and young children: the Bangladesh perspective

BACKGROUND

Sub-optimal nutrition among children remains a problem across South Asia (SA). Appropriate complementary feeding practices (CFP) can greatly reduce this risk. The primary objective of this systematic review (SR) of CF studies was to assess timing, dietary diversity, meal frequency and influencing factors in children under two in Bangladesh.

METHODS

Searches included English-language research published between January 2000 and June 2016 within MEDLINE, EMBASE, Global Health, Web of Science, OVID Maternity & Infant Care, BanglaJOL, Cochrane Library, CINAHL, POPLINE and WHO Global Health Library. Eligibility criteria: primary research concerning the adequacy of complementary feeding practices in South Asian children aged 0-2 years and/or their families. We excluded interventional papers and those focusing exclusively on breast-feeding. In total 45,712 titles and abstracts were screened against inclusion criteria, 860 of which received independent full text review by two reviewers. 36 papers relevant to Bangladesh were identified. The 'EPPI-Centre Weight of Evidence Framework' was used to objectively assess each study's value in answering the review question. As per WHO Infant and Young Children Feeding Guidelines (IYCF), introduction of CF was assessed as the proportion of infants aged 6-8 months who received solid, semi-solid or soft foods. Search terms were: "children", "feeding" and "Asians" with their derivatives. Two researchers undertook study selection, data extraction and quality appraisal.

RESULTS

Three cohort, 30 cross-sectional and 3 mixed methods studies were included. Despite adopting the WHO IYCF Guidelines, sub-optimal CF practices were found in many studies. Timely initiation of CF practices ranged from 24 to 83%. Achieved minimum dietary diversity ranged from 25% to 44% and minimum meal frequency from 33% to 81%. Influencing factors included maternal education, poor knowledge of CF practices and socioeconomic variables.

CONCLUSIONS

This is the first systematic review to evaluate CF practices in Bangladesh. Despite adoption of the WHO IYCF guidelines, inadequate CFP remain in communities across Bangladesh.

TRIAL REGISTRATION

PROSPERO Registration No: CRD42014014025.

Mothers' education and ANC visit improved exclusive breastfeeding in Dabat Health and Demographic Surveillance System Site, northwest Ethiopia

INTRODUCTION

Despite its proven benefit in reducing child mortality and morbidity, the coverage of exclusive breastfeeding (EBF) remains sub-optimal. In Ethiopia, about 52% of infants under six months of age were exclusively breastfed, implying the need for further identification of the barriers to optimal EBF practice. Therefore, this study aimed to investigate EBF and its determinants in the predominantly rural northwest Ethiopia.

METHODS

The study was conducted at the Dabat Health and Demographic Surveillance System (HDSS) site, which is located in Dabat District, northwest Ethiopia. A total of 5,227 mothers with children under five years of age were included for analysis. Multivariable binary logistic regression analysis was employed to identify factors associated with EBF. The Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was estimated to show the strength of association. A P-value of <0.05 was used to declare statistical significance.

RESULTS

About 54.5% [95% CI: 51.9, 57.1] of the mothers practiced EBF. Mothers' education [AOR = 2.10; 95% CI: 1.63, 2.71], age (20-35 years) [AOR = 1.39; CI: 1.07, 1.80], urban residence [AOR = 1.28; 95% CI: 1.07, 1.54], at least one ANC visit [AOR = 1.41; 95% CI: 1.23,1.61], initiation of breastfeeding within one hour of birth [AOR = 1.32; 95% CI: 1.15,1.50], richer household [AOR = 1.34; 95% CI: 1.07, 1.65], and withholding prelacteal feeds [AOR = 1.34; 95% CI: 1.17, 1.53] were found important determinants of EBF.

CONCLUSION

In this study area, the prevalence of EBF is lower than the national as well as the global recommendation for universal coverage of EBF. Therefore, strengthening the implementation of Infant and Young Child Feeding strategy (IYCF) and maternal health care utilization are essential for stepping up EBF coverage. Moreover, attention should be given to uneducated, rural resident, and adolescent mothers.

Infant food applications of complex carbohydrates: Structure, synthesis, and function

Professional health bodies such as the World Health Organization (WHO), the American Academy of Pediatrics (AAP), and the U.S. Department of Health and Human Services (HHS) recommend breast milk as the sole source of food during the first year of life. This position recognizes human milk as being uniquely suited for infant nutrition. Nonetheless, most neonates in the West are fed alternatives by 6 months of age. Although inferior to human milk in most aspects, infant formulas are able to promote effective growth and development. However, while breast-fed infants feature a microbiota dominated by bifidobacteria, the bacterial flora of formula-fed infants is usually heterogeneous with comparatively lower levels of bifidobacteria. Thus, the objective of any infant food manufacturer is to prepare a product that results in a formula-fed infant developing a breast-fed infant-like microbiota. The goal of this focused review is to discuss the structure, synthesis, and function of carbohydrate additives that play a role in governing the composition of the infant microbiome and have other health benefits.

Determinants of perceived insufficient milk among new mothers in León, Nicaragua

Breastfeeding has been shown to improve maternal and child health. In Nicaragua, the primary risk of death and disability-adjusted life years among children under 5 years of age is suboptimal breastfeeding. Although the Nicaraguan Ministry of Health promotes exclusive breastfeeding from within the first half hour through the first 6 months of life, less than a third of children in the country under 6 months of age are exclusively breastfed. As part of a larger, mixed-methods study, 21 semi-structured, in-depth interviews were conducted with new mothers recruited from three primary health centers between June and August 2015 in order to identify the social, cultural, and structural factors that contribute to infant feeding practices and the discrepancy between recommendations and practices among mothers who delivered at an urban public hospital in León, Nicaragua. Audio recordings were transcribed verbatim, and interview transcripts were coded and analyzed by a three-member team using a grounded theory approach. Findings highlight a widespread perception of insufficient milk among mothers that influenced early cessation of exclusive breastfeeding and other infant feeding practices. This perception stemmed from anxiety about meeting infant nutritional needs and infant satiety, anxiety about maternal nutrition, advice from and role modeling of family members about mixed feeding, and perceived infant feeding norms. Results suggest that support modeled after the 10 steps of the Baby-friendly Hospital Initiative as well as strengthened policy-level support are needed. Community interventions that address cultural and structural barriers to improve breastfeeding practices may also help to increase breastfeeding rates.

Adolescent girls' infant and young child nutrition knowledge levels and sources differ among rural and urban samples in Bangladesh

In many low‐income countries, girls marry early and have children very soon after marriage. Although conveying infant and young child nutrition (IYCN) knowledge to adolescent girls in time is important to ensure the well‐being of their children, little is known about the best ways to convey these messages. This study examines the extent of, and sources from which adolescent girls derive IYCN knowledge in order to inform the design of programmes that convey such information. Data on adolescent girls aged 12–18 was collected in 2013 in 140 clusters of villages in rural areas (n = 436), and 70 clusters of slums in urban areas (n = 345) in Bangladesh. Data were analysed using multivariable Poisson regression models. In both the urban and rural samples, girls' schooling is positively and significantly associated with IYCN knowledge (P < 0.01 and P < 0.10, respectively). IYCN knowledge of adolescent girls' mothers is also associated with adolescents' IYCN knowledge in both urban and rural samples, but the magnitude of association in the urban sample is only half that of the rural sample (P < 0.01 and P < 0.10, respectively). In Bangladesh, efforts to improve knowledge regarding IYCN are typically focused on mothers of young children. Only some of this knowledge is passed onto adolescent girls living in the same household. As other messaging efforts directed towards mothers have only small, or no association with adolescent girls' knowledge of IYCN, improving adolescent girls' IYCN knowledge may require information and messaging specifically directed towards them. © 2016 John Wiley & Sons Ltd

A qualitative study exploring perceived barriers to infant feeding and caregiving among adolescent girls and young women in rural Bangladesh

BACKGROUND

Infant feeding and caregiving by adolescent girls and young women in rural Bangladesh remains relatively understudied despite high potential vulnerability of younger mothers and their children due to poverty and high rates of early marriage and childbearing. This key knowledge gap may hamper the effectiveness of maternal, infant and child health interventions not specifically tailored to teenage mothers. This study aimed to narrow this gap by documenting key barriers to optimal infant and young child feeding and caregiving perceived by adolescent girls and young women in rural Bangladesh.

METHODS

Focus group discussions and in-depth semi-structured interviews were conducted with 70 adolescent girls and young women participating in a community-based adolescent empowerment program in two rural regions of northwestern Bangladesh. Participants were stratified into three groups: unmarried, married without child, and married with child(ren). Thematic analysis was performed to elucidate dominant ideas regarding challenges with child feeding and caregiving across participant strata.

RESULTS

Participants in all three strata and in both geographical regions attributed actual and anticipated caregiving difficulties to five major contextual factors: early marriage, maternal time allocation conflicts, rural life, short birth intervals, and poverty. Indications are that many girls and young women anticipate difficulties in feeding and caring for their future children from an early age, and often prior to motherhood. Participants articulated both perceived need and unmet demand for additional education in infant and young child feeding, childcare, and family planning techniques.

CONCLUSIONS

Provision during adolescence of appropriate education, services and financial aid to support best practices for infant feeding and childcare could significantly improve maternal self-efficacy, mental health, nutrition security and young childcare, nutrition and health in rural Bangladesh. Lessons learned can be applied in future programs aimed at supporting adolescent women along a continuum of care.