Factors influencing the uptake of a mass media intervention to improve child feeding in Bangladesh

Production Choices and Food Security: A Review of Studies Based on a Micro-Diversity Perspective

Given the 'subsistence' character of smallholder production, agricultural production diversification is often seen as an effective strategy for smallholders to improve their diets' diversity and nutritional status, yet the existing evidence remains inadequate. The study applies bibliometric data from the "Web of Science" database to synthesize 46 papers from developing countries to explore the relationship between production diversity, dietary diversity, and nutrition in smallholder households. The study identifies the most influential journals, authors, organizations, and countries and reveals research themes related to agricultural production and food security. This data analysis can help researchers target potential collaborators and access influential literature in agricultural production diversity and dietary diversity research. In addition, the results showed that agricultural production diversity potentially influences households' dietary diversity, with mixed results: Agricultural production diversification is the primary way to improve food and nutritional security among smallholder families with low socio-economic status, inaccessible transportation, and poverty; market access and trade have more potential to improve dietary diversity among smallholder households with well-developed markets and higher income levels; the significant measures of agricultural production diversity include Crop Counts, FGPD, SI, and SWDI; the significant measures of dietary diversity include HDDS and IDDS. This paper provides a roadmap for agricultural production and food security researchers by conducting a systematic review of the literature, summarizing some research methods and perspectives applicable to local socio-economic development.

The use of mass media by mothers and its association with their children's early development: comparison between urban and rural areas

BACKGROUND

Mass media can play critical roles in influencing parents' attitudes and practice toward the healthy upbringing of children.  OBJECTIVE: This study examined the association between the use of five types of mass media among mothers living in rural and urban areas and the early childhood development (ECD) of their children.

METHODS

We analysed nationally representative and internationally standardized Multiple Indicator Cluster Survey data collected in 2013 and 2019 in Bangladesh. The ECD was calculated using four domains of development: physical health, literacy-numeracy, learning and social-emotional. Mothers' use of newspapers/magazines, radio, television, internet and mobile phones was the study factor. We used Poisson regression with robust variance. The dataset included 27,091 children aged three or four years.

RESULTS

Almost 21% of the children were living in urban and 78% in rural areas. Mothers/caretakers of 30% of the children used none, 39% used one, 25% used two, and approximately 6% used three or more of the five types of media. Mobile phones and television were the dominant types of media, both in terms of the number of users and the frequency of use. Overall, 68.87% of the children were on track in terms of their ECD and 31.13% were not. A significantly larger proportion of urban children (74.23%) than rural children (67.47%) were on track in their ECD. The prevalence of children being on track of ECD increases by 4% (aPR 1.04; 95%CI: 1.01-1.06) for each additional media use among women who lived in urban areas and increases by 7% if women live in rural areas. In terms of the individual formats of media, using newspapers, television and internet was found to be significantly associated with the children in rural areas being on track in terms of their ECD. In the urban sample, only radio use was found to be significant.

CONCLUSIONS

Targeted and well-designed child development campaigns that are delivered through popular media types are likely to help mothers to take better care of their children.

Complementary Feeding Social and Behavior Change Communication for Fathers and Mothers Improves Children's Consumption of Fish and Eggs and Minimum Meal Frequency in Kaduna State, Nigeria

Background

Fathers are key influencers of complementary feeding practices, but few studies in low- and middle-income countries have measured the effects of complementary feeding social and behavior change communication (SBCC) targeted at both fathers and mothers.

Objectives

The aims of this study were to measure the effects of an SBCC intervention on children's dietary diversity (primary outcome) and other complementary feeding indicators, fathers' and mothers' complementary feeding knowledge, and fathers' support for complementary feeding (secondary outcomes).

Methods

The 12-mo intervention in Kaduna State, Nigeria, engaged parents through community meetings, religious services, home visits from community health extension workers (CHEWs), mobile phone messages (fathers only), and mass media. Cross-sectional population-based surveys of cohabiting fathers and mothers with a child aged 6-23 mo were conducted, and regression models were used to compare results at baseline (n = 497) and endline (n = 495).

Results

Children's minimum dietary diversity did not change from baseline to endline (62% to 65%, P = 0.441). Children's consumption of fish (36% to 44%, P = 0.012) and eggs (8% to 20%, P = 0.004) and minimum meal frequency (58% to 73%, P < 0.001) increased. Fathers' and mothers' knowledge of the timing of introduction of different foods and meal frequency improved. Fathers' support for child feeding by providing money for food increased (79% to 90%, P < 0.001). Fathers' and mothers' reported intervention exposure was low (11-26% across types of SBCC). Child feeding outcomes were not associated with fathers' exposure. Children's odds of both fish and egg consumption increased significantly with mothers' exposure to community meetings, religious services, home visits, and television spots, and children's odds of minimum meal frequency increased significantly with mothers' exposure to home visits.

Conclusions

A multipronged SBCC intervention improved complementary feeding practices, fathers' and mothers' knowledge of complementary feeding, and fathers' support for complementary feeding, despite low levels of reported exposure, which may have been influenced by coronavirus disease 2019 (COVID-19) disruptions. This trial was registered at ClinicalTrials.gov as NCT04835662.

Engaging family members in maternal, infant and young child nutrition activities in low- and middle-income countries: A systematic scoping review

The influence of fathers, grandmothers and other family members on maternal, infant and young child nutrition practices has been well documented for decades, yet many social and behavioural interventions continue to reach only mothers. While recent guidelines recommend involving fathers, grandmothers and other family members in maternal and child nutrition, we lack a comprehensive review of interventions that have engaged them. This scoping review aimed to address this gap by describing social and behavioural interventions to engage family members in maternal and child nutrition in low- and middle-income countries. We systematically searched PubMed, Scopus, Web of Science, Global Health and CINAHL for peer-reviewed studies meeting inclusion criteria. We screened 6,570 abstracts, evaluated 179 full-text articles, and included 87 articles from 63 studies. Studies reported a broad range of approaches to engage fathers, grandmothers and other family members to support maternal nutrition (n = 6); breastfeeding (n = 32); complementary feeding (n = 6) and multiple maternal and child nutrition practices (n = 19). Interventions were facility and community based; included individual and group-based interpersonal communication, community mobilization, mass media and mHealth; and reached mothers and family members together or separately. Most interventions were located within the health sector; rare exceptions included nutrition-sensitive agriculture, social protection, early child development and community development interventions. Few interventions addressed gender norms, decision-making, and family dynamics or described formative research or theories informing intervention design. These diverse studies can shed light on innovative programme approaches to increase family support for maternal and child nutrition.

Mixed-Methods Systematic Review of Behavioral Interventions in Low- and Middle-Income Countries to Increase Family Support for Maternal, Infant, and Young Child Nutrition during the First 1000 Days

Fathers, grandmothers, and other family members' influence on maternal, infant, and young child nutrition (MIYCN) is widely recognized, yet synthesis of the effectiveness of engaging them to improve nutrition practices during the first 1000 d is lacking. We examined the impact of behavioral interventions to engage family members in MIYCN in low- and middle-income countries through a mixed-methods systematic review. We screened 5733 abstracts and included 35 peer-reviewed articles on 25 studies (16 with quantitative and 13 with qualitative data). Most quantitative studies focused on early breastfeeding, primarily engaging fathers or, less often, grandmothers. Most found positive impacts on exclusive breastfeeding rates and family members' knowledge and support. The few quantitative studies on complementary feeding, maternal nutrition, and multiple outcomes also suggested benefits. Qualitative themes included improved nutrition behaviors, enhanced relationships, and challenges due to social norms. Interventions engaging family members can increase awareness and build support for MIYCN, but more rigorous study designs are needed. This systematic review is registered at PROSPERO as CRD42018090273, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=90273.

Association Between Exclusive Breastfeeding and Infant Health Outcomes in Pakistan

PURPOSE

The infant mortality rate in Pakistan is one of the highest in the world with most cases attributed to diarrheal or respiratory diseases. Exclusive breastfeeding for the first 6 months of life is recommended by the World Health Organization to achieve optimal growth and health, however, in Pakistan the rate of exclusive breastfeeding by mothers is <40%. The aim of this study was to investigate the relationship of exclusive breastfeeding, diarrhea, acute respiratory infections and fever among infants under the age of 6 months.

DESIGN AND METHODS

The cross-sectional study analyzed secondary data from the 2017-18 Pakistan Demographic and Health-Survey. The sampling frame for the current study consisted of last-born children who were under the age of 6 months. The study sample consisted of 1033 infants under the age of 6 months.

RESULTS

The prevalence of exclusive breastfeeding was 53.6%. Compared to infants who were not breastfed exclusively, infants who were had lower odds of diarrhea, acute respiratory infection, and fever. The observed association was independent of potential confounders.

CONCLUSIONS

Exclusive breastfeeding reduces the odds of childhood illnesses. Plausible explanations for the observed association may be related to human milk's contents including necessary nutrients to fulfill an infant's needs within first months of life. Additionally, continued exposure to breastfeeding also reduces exposure to other contaminated foods to ensure adequate nutrition for the infant.

PRACTICE IMPLICATIONS

The findings have important implications for educating families and healthcare providers about the benefits of exclusive breastfeeding for optimal child health outcomes.

Factors influencing the uptake of a mass media intervention to improve child feeding in Bangladesh

Mass media are increasingly used to deliver health messages to promote social and behaviour change, but there has been little evidence of mass media use for improving a set of child feeding practices, other than campaigns to promote breastfeeding. This study aimed to examine the factors influencing the uptake of infant and young child feeding messages promoted in TV spots that were launched and aired nationwide in Bangladesh. We conducted a mixed‐methods study, using household surveys (n = 2,000) and semistructured interviews (n = 251) with mothers of children 0–23.9 months and other household members. Factors associated with TV spot viewing and comprehension were analysed using multivariable logistic regression models, and interview transcripts were analysed by systematic coding and iterative summaries. Exposure ranged from 36% to 62% across 6 TV spots, with comprehension ranging from 33% to 96% among those who viewed the spots. Factors associated with comprehension of TV spot messages included younger maternal age and receipt of home visits by frontline health workers. Three direct narrative spots showed correct message recall and strong believability, identification, and feasibility of practicing the recommended behaviours. Two spots that used a metaphorical and indirect narrative style were not well understood by respondents. Understanding the differences in the uptake factors may help to explain variability of impacts and ways to improve the design and implementation of mass media strategies.