Life course learning experiences and infant feeding practices in rural Rwanda

Determinants of early interruption of exclusive breastfeeding at Dollo Ado refugee camps, Dollo Ado district, Ethiopia

Introduction

nearly three-quarters of infants younger than six months were not exclusively breastfed globally. Despite some research indicating what factors influence early exclusive breastfeeding interruption in Ethiopia's stable population, there is little evidence indicating what factors influence exclusive breastfeeding interruption in vulnerable populations such as refugee camps. Therefore, this study aimed to determine the factors that contributed to the early termination of exclusive breastfeeding in Ethiopian refugee camps in the Dollo Ado district.

Methods

a case-control study was conducted at the Dollo Ado refugee camps from April 05th to 25th, 2017. The eligible 112 cases and 224 controls were identified using the 24-hour recall method. The information was gathered using an interviewer-administered questionnaire that was pretested and organized. Logistic regression analysis was computed to assess the effect of independent variables.

Results

the determinants for early interruption of exclusive breastfeeding were not counseled about infant feeding during antenatal care follow-up (adjusted odds ratio (AOR =5.87, 95% CI [2.61-13.1]), not counseled about infant feeding during postnatal care service use (AOR= 4.33, 95% CI [2.71-10.8), breastfeeding problem (AOR= 5.62, 95% CI [4.55-15.2]) and late initiation of breastfeeding (AOR= 4.79, 95% CI [28-10.1]).

Conclusion

in this study, early termination of exclusive breastfeeding was caused by breastfeeding problems and late commencement of breastfeeding, as well as not receiving infant feeding advice during antenatal care or postnatal care. The results of this study highlight the significance of concentrating on newborn and young child feeding counseling during prenatal and postnatal care services in order to promote exclusive breastfeeding. In addition, health providers should educate parents on the significance of starting exclusive breastfeeding on time and obtaining help right away if there is a problem, such as breast soreness or the infant refusing to eat due to oral trash, to avoid early exclusive breastfeeding interruption.

Beneficiary and Local Stakeholder Participation in Community-Based Nutrition Interventions

Beneficiary and local stakeholder participation is an essential element to the success of community-based nutrition interventions. We sought to define active participation and review the available evidence on beneficiary and local stakeholder participation in community-based nutrition interventions in Africa. From reviewing the literature, we provide a reflective assessment on the process and findings. Participation falls on a continuum of community involvement from passive (no real involvement) to empowerment and community ownership (full active involvement). However, we found a clear gap in the research on defining active participation and identifying what constitutes active participation on behalf of beneficiaries and local stakeholders. However, progress was found; evidence included the use of participatory methods to engage beneficiaries and local stakeholders in the assessment and design phase. Beneficiary and local stakeholder participation in delivering interventions has moved forward with quantitative measures from process evaluation and implementation science. Research has started on the extent of beneficiary engagement (as recipients) and connecting this to outcomes. Evaluation has benefited from qualitative inquiry with insights from participants on engagement itself, and the barriers and facilitators to engagement. Yet questions remain in each study phase around defining and quantifying active participation and in understanding the personal, social, and motivational elements of active participation. We offer a simple framework to stimulate thought and commitment to research on participation in community-based nutrition interventions.

Does maternal grandmother's support improve maternal and child nutritional health outcomes? Evidence from Merida, Yucatan, Mexico

In humans, high levels of investment are required to raise offspring, because of the prolonged developmental period and short interbirth intervals. The costs borne by individual mothers may be mitigated by obtaining social support from others. This strategy could be particularly valuable for first-time mothers, who lack first-hand experience and whose offspring have higher mortality risk than later-born siblings. As raising children is potentially stressful, mothers may gain from others sharing their experience, providing knowledge/information and emotional support. Being genetically related to both mother and grandchild, maternal grandmothers may be especially well placed to provide such support, while also gaining fitness benefits. We tested the over-arching hypothesis that first-time mothers and their young children supported by the maternal grandmother would have lower levels of stress and better health outcomes, compared to mother-infant dyads lacking such grandmaternal support. A cohort of 90 mother-infant dyads (52 with grandmaternal support, 38 without) was recruited in Merida, Mexico. We assessed anthropometry and body composition in both mother and child, along with maternally perceived stress and child temperament, and documented maternal social relationships. No differences were found in perceived stress/temperament or anthropometry of either mothers or children, according to the presence/absence of grandmaternal support. However, a composite score of whether grandmothers provided advice on infant feeding was positively associated with child nutritional status. Mothers without grandmaternal support reported seeking more informational and emotional support from other female relatives for childcare, potentially compensating for limited/absent grandmaternal support. Our findings may help develop interventions to improve maternal and child health by targeting the dynamics of maternal social networks. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.

Life course learning experiences and infant feeding practices in rural Rwanda

Most studies about infant and young child feeding (IYCF) practices are often perceived as an individual choice depending on mothers' or caregivers' knowledge or attitudes and are focused on mothers' failure rather than successes in adequately feeding their children. However, the role of life course experiences in IYCF is less investigated. Applying a Salutogenic Model of Health, this study on 14 mothers looks at women's life course learning experiences shaping appropriate IYCF practices during the first year of child's life in a rural district of Rwanda. Transcripts from in‐depth interviews were analysed using thematic analysis. Results indicate that positive social interaction with parents or grandmothers during childhood such as sharing meals, parental role models for dietary choices and cooking skills gained by participating in household food preparation played a role in shaping appropriate IYCF practices. Negative experiences during childhood also had a positive influence on IYCF practices for some participants by converting life course constraints into learning opportunities. Motherhood increased mothers' sense of responsibility over their children's health and nutrition. Moreover, mothers' participation in community cooking classes and role modelling approach were strong avenues that enabled their learning through positive interactions and encouragement. Nutrition promotion interventions should consider tailoring nutrition advice to the complexity of mothers' life course experiences by creating opportunities for positive learning experiences of appropriate IYCF practices.