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Mphamba PN, Chirwa GC, Mazalale J. An evolution of inequality of opportunity in the nutritional outcomes of under-five children in Malawi. SSM Popul Health 2024; 25:101606. [PMID: 38292048 PMCID: PMC10825516 DOI: 10.1016/j.ssmph.2024.101606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 02/01/2024] Open
Abstract
Background Malnutrition among children is a significant public health and development issue, especially in low- and middle-income countries, Malawi inclusive, which contributes to preventable diseases and deaths. Significant socioeconomic disparities persist, which affect access to and equal distribution of basic nutrition. This study analyzed the extent and trends of Inequality of Opportunity (IOP) in the nutritional outcomes of children aged 0-59 months. Methods The study used nationally representative data from the 2006, 2013-14, and 2019-20 Malawi Multiple Indicator Cluster Survey. In terms of method, we examined IOP in stunting, wasting, and underweight indicators, using the Human Opportunity Index and the Dissimilarity Index in 55,723 children. The Shapley-value technique decomposed the relative IOP. Results We find the largest share of circumstance-driven inequality in stunting (8.96 percent), followed by underweight (1.91 percent), and then wasting (0.90 percent). The Shapley-value decomposition results indicate the child's age (29.15 percent for stunting, 12.42 percent for underweight, and 52.36 percent for wasting) and gender (8.28 percent, 18.36 percent and 8.87 percent), wealth (6.36 percent, 22.87 percent and 8.54 percent), and mother's education (6.28 percent, 11.29 percent and 5.51 percent) as the dominant contributors to IOP for all three nutritional outcome indicators; stunting, underweight and wasting, respectively. Conclusion The findings suggest that policies aimed at narrowing the wealth and education inequality gap could help equalize nutrition opportunities for children in Malawi.
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Martin SL, Zongrone AA, Craig HC, Litvin K, Fort P, Cooper S, Haller M, Dickin KL. Measuring the intangible resources caregivers need to provide nurturing care during the complementary feeding period: a scoping review in low- and lower-middle-income countries. Public Health Nutr 2024; 27:e78. [PMID: 38223942 DOI: 10.1017/s1368980024000065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Caregivers require tangible (e.g. food and financial) and intangible resources to provide care to ensure child health, nutrition and development. Intangible resources include beliefs and knowledge, education, self-efficacy, perceived physical health, mental health, healthy stress levels, social support, empowerment, equitable gender attitudes, safety and security and time sufficiency. These intangible caregiver resources are included as intermediate outcomes in nutrition conceptual frameworks yet are rarely measured as part of maternal and child nutrition research or evaluations. To facilitate their measurement, this scoping review focused on understudied caregiver resources that have been measured during the complementary feeding period in low- and lower-middle-income countries. DESIGN We screened 9,232 abstracts, reviewed 277 full-text articles and included 163 articles that measured caregiver resources related to complementary feeding or the nutritional status of children 6 months to 2 years of age. RESULTS We identified measures of each caregiver resource, though the number of measures and quality of descriptions varied widely. Most articles (77 %) measured only one caregiver resource, mental health (n 83) and social support (n 54) most frequently. Psychometric properties were often reported for mental health measures, but less commonly for other constructs. Few studies reported adapting measures for specific contexts. Existing measures for mental health, equitable gender attitudes, safety and security and time sufficiency were commonly used; other constructs lacked standardised measures. CONCLUSIONS Measurement of caregiver resources during the complementary feeding period is limited. Measuring caregiver resources is essential for prioritising caregivers and understanding how resources influence child care, feeding and nutrition.
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Affiliation(s)
- Stephanie L Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, CB 7461, Chapel Hill, NC, 27599-7461, USA
| | | | - Hope C Craig
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Kate Litvin
- USAID Advancing Nutrition, Arlington, Virginia, USA
| | - Peyton Fort
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Stephanie Cooper
- Global Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mia Haller
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katherine L Dickin
- USAID Advancing Nutrition, Arlington, Virginia, USA
- Department of Public and Ecosystem Health, Cornell University, Ithaca, New York, USA
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Gizaw AT, Sopory P, Sudhakar M. Barriers and coping responses towards infant and young child feeding practices in rural Ethiopia: a descriptive qualitative study. BMJ Open 2023; 13:e077008. [PMID: 37821129 PMCID: PMC10582866 DOI: 10.1136/bmjopen-2023-077008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE To explore barriers and coping responses toward infant and young child practices (IYCFP) in rural Ethiopia. METHODS A descriptive qualitative study using semi-structured in-depth interviews and focus group discussions was conducted with 98 mothers having infants and young children aged 0-24 months in rural Ethiopia. The mothers were selected purposively by stratifying into four age groups of infants and young children in months: 0-5, 6-8, 9-12 and 13-24. Thematic analysis was performed to elucidate the main ideas regarding the barriers and coping responses to IYCFP across the participant stratum using ATLAS.ti analytical software (V.7.5.18). RESULTS Two main themes emerged from the data. First, there was a discourse on optimal IYCFP that reflects the knowledge and efforts to adhere to recommendations for early breastfeeding initiation, exclusive breast feeding for the first 6 months and introduction of complementary foods at 6 months. Second, in a discourse on struggling with everyday realities, barriers against optimal feeding practices and coping responses were presented. Mothers' responses in the four age strata as barriers to IYCFP were inadequate knowledge towards breast milk, perceived insufficiency of breast milk, beliefs, mothers' excessive workload, limited partner support, food price inflation and shortage, gender roles, dowry demand and cultural understanding of marriage. Relying on cheaper food items and backyard garden was used to cope with the barriers. CONCLUSIONS Barriers towards IYCFP are numerous which extend from intrapersonal to sociocultural factors. Therefore, reducing mothers' work burden to enable appropriate IYCFP by empowering women economically and addressing gender inequalities through collective societal approaches for promoting appropriate feeding is vital in rural communities.
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Affiliation(s)
| | - Pradeep Sopory
- Department of Communication, Wayne State University, Detroit, Michigan, USA
| | - Morankar Sudhakar
- Department of Health, Behavior Society, Jimma University, Jimma, Ethiopia
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Wasti SP, Shrestha A, Dhakal P, Gc VS. The prevalence of exclusive breastfeeding practice in the first six months of life and its associated factors in Nepal: A systematic review and meta-analysis. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100863. [PMID: 37269619 DOI: 10.1016/j.srhc.2023.100863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 05/12/2023] [Accepted: 05/24/2023] [Indexed: 06/05/2023]
Abstract
Despite the global emphasis on breastfeeding, exclusive breastfeeding (EBF) in the first six months of life still lag behind the global recommendations in low- and middle-income countries, such as Nepal. This systematic review aims to determine the prevalence of EBF in the first six months of life and the associated factors determining EBF practices in Nepal. The databases PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, MIDIRS, DOAJ, and the NepJOL were searched for peer-reviewed literature published up to December 2021. The JBI quality appraisal checklist was used to assess the quality of studies. Analyses were performed by pooling together studies using the random-effect model, and the I2 test was used to assess the heterogeneity of the included studies. A total of 340 records were found, out of which 59 full-text were screened. Finally, 28 studies met the inclusion criteria and were selected for analysis. The pooled prevalence of EBF was 43 % (95 % confidence interval: 34-53). The odds ratio for the type of delivery was 1.59 (1.24-2.05), for ethnic minority groups 1.33 (1.02-1.75) and for first-birth order 1.89 (1.33-2.67). We found a lower prevalence of exclusive breastfeeding practice in Nepal compared to the national target. Multifaceted, effective, evidence-based interventions would encourage individuals in the exclusive breastfeeding journey. Incorporating the BEF counselling component into Nepal's existing maternal health counselling package may help promote exclusive breastfeeding practice. Further research to explore the reasons for the suboptimal level of EBF practice would help develop the targeted interventions pragmatically.
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Affiliation(s)
- Sharada P Wasti
- School of Human Sciences, University of Greenwich, London, UK
| | | | - Pushpa Dhakal
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Vijay S Gc
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK.
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Berhanu H, Gebremichael B, Roba KT, Moges S, Gebremedhin M. Drivers of Food Choice Among College Students in Addis Ababa, Ethiopia: A Structural Equation Model. NUTRITION AND DIETARY SUPPLEMENTS 2023. [DOI: 10.2147/nds.s379563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Nsiah-Asamoah C, Adjei G, Agblorti S, Doku DT. Association of maternal characteristics with child feeding indicators and nutritional status of children under-two years in Rural Ghana. BMC Pediatr 2022; 22:581. [PMID: 36207712 PMCID: PMC9540729 DOI: 10.1186/s12887-022-03651-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 09/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Optimal nutrition during the first two years of a child’s life is critical for the reduction of morbidity and mortality. In Ghana, majority of children miss out on optimal nutrition and only few (13%) of children receive a Minimum Acceptable Diet (MAD). Several studies have investigated the influence of community-level factors on infants and young children feeding (IYCF) practices. However, little is known about the influence of maternal factors on IYCF practices in rural settings. Therefore, this study assessed the influence of maternal factors on the feeding indicators and nutritional status of children aged 6–23 months in two administrative districts in Ghana. Methods Data were collected among 935 mothers who had children aged 6–23 months and accessed 21 Child Welfare Clinics within the study area. The study involved a face- to-face interview using structured questionnaires to capture maternal characteristics, dietary intake and anthropometric measurements of children. Multivariate logistic regression was used to study the association between maternal factors and child nutrition outcomes (MAD, dietary diversity score (DDS) and anthropometric indicators) using Stata 16.0 software. Results Being employed (AOR = 3.07, 95% CI: 1.71—5.49, p < 0.001) and attaining secondary or higher education (AOR = 2.86, 95% CI: 1.42—5.78, p = 0.003) were significant predictors of children receiving MAD. Similarly, having an average decision-making autonomy increased the child’s odds of receiving MAD (AOR = 1.68, 95% CI: 1.02—2.76, p = 0.040). Children of mothers who attained secondary or a higher level of education (AOR = 0.59, 95% CI: 0.36 -0.97, p = 0.040) and those whose mothers were employed (AOR = 0.71, 95% CI: 0.47—1.07, p = 0.043) were associated with a reduced risk of underweight and stunting respectively. Children of mothers with average financial independence status were more likely to receive diversified meals (AOR = 1.55, 95% CI: 1.01–2.38, p = 0.045). Conclusions High educational level and being employed have positive influence on MAD, stunting and underweight of children. High decision-making power and average financial independence of mothers are good predictors of children receiving MAD. Family planning, women empowerment in decision-making, providing employment opportunities for mothers and promoting girl-child education are recommended.
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Affiliation(s)
| | - George Adjei
- Department of Community Medicine, University of Cape Coast, Cape Coast, Ghana
| | - Samuel Agblorti
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - David Teye Doku
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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Allotey D, Flax VL, Ipadeola A, Kwasu S, Bentley ME, Worku B, Kalluru K, Valle CG, Bose S, Martin SL. Maternal and paternal involvement in complementary feeding in Kaduna State, Nigeria: The continuum of gender roles in urban and rural settings. MATERNAL & CHILD NUTRITION 2022; 18:e13325. [PMID: 35080111 PMCID: PMC8932823 DOI: 10.1111/mcn.13325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 01/11/2023]
Abstract
Household gender roles influence infant and young child feeding behaviours and may contribute to suboptimal complementary feeding practices through inequitable household decision‐making, intra‐household food allocation and limited paternal support for resources and caregiving. In Igabi local government area of Kaduna State, Nigeria, the Alive & Thrive (A&T) initiative implemented an intervention to improve complementary feeding practices through father engagement. This study describes household gender roles among A&T participants and how they influence maternal and paternal involvement in complementary feeding. We conducted 16 focus group discussions with mothers and fathers of children aged 6–23 months in urban and rural administrative wards and analysed them using qualitative thematic analysis methods. Most mothers and fathers have traditional roles with fathers as ‘providers’ and ‘supervisors’ and mothers as ‘caregivers’. Traditional normative roles of fathers limit their involvement in ‘hands‐on’ activities, which support feeding and caring for children. Less traditional normative roles, whereby some mothers contributed to the provision of resources and some fathers contributed to caregiving, were also described by some participants and were more salient in the urban wards. In the rural wards, more fathers expressed resistance to fathers playing less traditional roles. Fathers who participated in caregiving tasks reported respect from their children, strong family relationships and had healthy home environments. Our research findings point to the need for more context‐specific approaches that address prevalent gender normative roles in complementary feeding in a variety of settings. Some mothers and fathers still hold traditional attitudes about their roles in feeding and caring for children. Traditional gender normative roles of fathers limit their involvement in the ‘hands‐on’ activities that support feeding and caring for children. Some mothers and fathers are performing ‘non‐traditional’ gender normative roles despite social disapproval. The shifts from the traditional roles of mothers and fathers are more salient in urban compared with rural wards.
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Affiliation(s)
- Diana Allotey
- Department of Nutrition, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | | | | | | | - Margaret E. Bentley
- Department of Nutrition, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Beamlak Worku
- Department of Nutrition, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Keerti Kalluru
- Department of Nutrition, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Carmina G. Valle
- Department of Nutrition, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Sujata Bose
- Alive & Thrive Washington District of Columbia USA
| | - Stephanie L. Martin
- Department of Nutrition, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
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Constantinides SV, Turner C, Frongillo EA, Bhandari S, Reyes LI, Blake CE. Using a global food environment framework to understand relationships with food choice in diverse low- and middle-income countries. GLOBAL FOOD SECURITY 2021. [DOI: 10.1016/j.gfs.2021.100511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kulkarni S, Frongillo EA, Cunningham K, Moore S, Blake CE. Gendered Intrahousehold Bargaining Power is Associated with Child Nutritional Status in Nepal. J Nutr 2021; 151:1018-1024. [PMID: 33693922 DOI: 10.1093/jn/nxaa399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/09/2020] [Accepted: 11/18/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Women's intrahousehold bargaining power is an important determinant of child nutrition in Nepal, but a better understanding is needed on how men's bargaining power is related to child nutrition. OBJECTIVES We examined the relation of women's and men's household bargaining power with child height-for-age z score (HAZ). METHODS We analyzed cross-sectional data from 2012, collected as an impact evaluation baseline of the Suaahara 1 program. A subsample of households with data on women's and men's intrahousehold bargaining power (n = 2170) with children aged 0-59 mo across Nepal was considered for this analysis. Intrahousehold bargaining power consisted of 4 domains: 1) ownership and control of assets, 2) social participation, 3) time allocation to work activities (workload), and 4) household decision-making control. Using multilevel methods, we analyzed associations between HAZ and 1) women's bargaining power, 2) men's bargaining power, and 3) women's and men's bargaining power, adjusted for individual- and household-level confounding factors and clustering. RESULTS Women's ownership and control of assets was positively associated with HAZ when women's and men's domains were modeled together (β: 0.0597, P = 0.026). Men's social participation was positively associated with HAZ in the men's model (β: 0.233, P < 0.001) and the model with women's and men's domains (β: 0.188, P = 0.001). Women's workload was negatively associated with HAZ in the women's model (β: -0.0503, P = 0.014) and in the model with women's and men's domains (β: -0.056, P = 0.008). Household decision making for women (β: -0.0631, P = 0.007) and for men (β: -0.0546, P = 0.017) were negatively associated with HAZ in the gender-specific models. Women's social participation, men's ownership and control of assets, and men's workload were not associated with HAZ. CONCLUSIONS Women's workload and ownership and control of assets and men's social participation may be important in improving child HAZ in Nepal. Nutrition interventions should address women's intrahousehold bargaining power and promote men's social engagement.
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Affiliation(s)
- Shibani Kulkarni
- Department of Health Promotion, Education, and Behavior; Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior; Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Kenda Cunningham
- Hellen Keller International, Kathmandu, Nepal.,London School of Hygiene and Tropical Medicine, Department of Population Health, Faculty of Epidemiology, London, United Kingdom
| | - Spencer Moore
- Department of Health Promotion, Education, and Behavior; Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Christine E Blake
- Department of Health Promotion, Education, and Behavior; Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Kulkarni S, Frongillo EA, Cunningham K, Moore S, Blake CE. Women's bargaining power and child feeding in Nepal: Linkages through nutrition information. MATERNAL & CHILD NUTRITION 2020; 16:e12883. [PMID: 31386796 PMCID: PMC7038888 DOI: 10.1111/mcn.12883] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 07/29/2019] [Accepted: 08/02/2019] [Indexed: 12/05/2022]
Abstract
Women's intra-household bargaining power is an important determinant of child nutritional status, but there is limited evidence on how it relates to infant and young child feeding (IYCF) practices. We conducted a cross-sectional analysis using 2012 baseline data from the impact evaluation of Suaahara, a multisectoral programme in Nepal, focusing on households with children 0-23 months (n = 1787). We examined if women's bargaining power was related to exposure to IYCF information and if exposure to IYCF information was in turn associated with improved IYCF practices: early initiation of breastfeeding, exclusive breastfeeding, minimum meal frequency and dietary diversity. Bargaining power consisted of four domains: (i) ownership and control of assets; (ii) social participation; (iii) workload; and (iv) household decision-making control and were primarily measured using additive scales. We used generalized structural equation modelling to examine if exposure to IYCF information mediated the relationship between the bargaining domains and the four IYCF practices, separately. Social participation was positively associated with exposure to IYCF information (β = 0.266, P < .001), which in turn was related to early initiation (β = 0.241, P = .001). We obtained similar results for the relationship between social participation and dietary diversity. Decision-making control was directly associated with exclusive breastfeeding (β = 0.350, P = .036). No domains were associated with minimum meal frequency. Different domains of women's bargaining power may relate to exposure to nutrition information and IYCF behaviours. Understanding specific domains of bargaining power is critical to developing interventions that can effectively address gender-related issues that underlie child nutrition outcomes.
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Affiliation(s)
- Shibani Kulkarni
- Health Promotion, Education, and BehaviorUniversity of South CarolinaColumbiaSouth Carolina
| | - Edward A. Frongillo
- Health Promotion, Education, and BehaviorUniversity of South CarolinaColumbiaSouth Carolina
| | | | - Spencer Moore
- Health Promotion, Education, and BehaviorUniversity of South CarolinaColumbiaSouth Carolina
| | - Christine E. Blake
- Health Promotion, Education, and BehaviorUniversity of South CarolinaColumbiaSouth Carolina
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