Fathers' Perception, Practice, and Challenges in Young Child Care and Feeding in Ethiopia

Indian fathers' perceptions of young childcare and feeding - A qualitative study

The role of parents in fostering children's healthy habits is a robust area of research. However, most of the existing literature predominantly focuses on mothers' parenting practices. Given the emergence of nuclear, dual earning families and the recent surge in maternal employment in urban India, fathers' engagement in child rearing and feeding warrants attention. The purpose of this research was to document the views of Indian fathers about paternal parenting practices, with an emphasis on children's diet among other health behaviors. Thirty-three fathers of children aged 6-59 months from Kolkata, India took part in semi-structured interviews conducted either face-to-face or over Zoom/telephone in Hindi, Bengali, and English. The interviews were audio recorded, transcribed verbatim, and translated to English. The transcribed data were subjected to thematic analysis informed by the Template Analysis technique. Themes were detected using the NVivo software program. Overall, these Indian fathers played an important role in early childhood care and feeding as reflected in the following seven themes: (i) Involvement of fathers in various childcare activities; (ii) Implementation of responsive and non-responsive feeding practices; (iii) Concerns regarding fussy and slow eating; (iv) Concerns regarding excessive screen time; (v) Paternal vs maternal parenting; (vi) Barriers to routine engagement of fathers in childcare; (vii) Desire for more nutrition and health knowledge. This enhanced understanding of paternal parenting behavior supports the inclusion of fathers in future family-focused lifestyle interventions aimed at improving children's health outcomes, including their dietary habits.

"Good fathers": Community perceptions of idealized fatherhood and reported fathering behaviors in Mwanza, Tanzania

Globally, perceptions of idealized fatherhood have been expanding beyond men's breadwinning roles to also value men's engagement in nurturing care. While fathers' caregiving behaviors are increasing, most childcare activities are still largely performed by mothers. In this study, we unpacked community members' beliefs about the meaning of "good fathers" and explored the degree to which these values aligned with the main caregiving behaviors reported about fathers with young children under age 2 years in Mwanza, Tanzania. Qualitative data were collected as part of a broader formative research study for which we conducted in-depth interviews with 29 fathers, 23 mothers, 4 village leaders and 4 community health workers as well as 3 focus group discussions with fathers, 2 with mothers, and 6 with both fathers and mothers combined. For this secondary data analysis, we used a grounded theory approach combined with thematic content analysis to investigate the nature of fatherhood. We discovered four key ideals associated with "good fathers": fathers as providers, nurturers, supportive partners, and authoritarians. The primary ideal of fathers as breadwinners was strongly aligned with the main reported practice of fathers trying hard to financially providing for their families. However, paternal behaviors reflecting ideals of fathers as nurturers and supportive partners were less practiced. Although ideals towards good fathers as authoritarian were least explicitly valued, many fathers were reported as engaging in controlling behaviors and using violence. The links between fatherhood ideals and behaviors was influenced by various factors, including poverty, men's limited time availability at home, and restrictive gender norms. Overall, our results reveal some alignment but also inconsistencies between the ideal version of fatherhood and commonly reported paternal practices. These discrepancies highlight the need for further investigation into the underlying factors that both enable and constrain the links between fatherhood ideals and behaviors. Our study results have important implications for the design of interventions that seek to enhance fatherhood to improve the development and wellbeing of children and families.

Behaviour change communication to improve complementary feeding practices in Ethiopia: Couples' beliefs concerning paternal involvement in childcare

An important cause of stunting is limited consumption of complementary foods, in terms of both quantities and nutrients. Although existing studies show a positive association between fathers' engagement and children's diet, programmes designed to improve complementary feeding practices often only target mothers. In response to this, maternal behaviour change communication (BCC), paternal BCC and food voucher programmes were designed and implemented in Ethiopia using a clustered randomized controlled trial design. The paternal BCC programme included gender-equal messages to increase fathers' participation in childcare, household labour and decision making. The research reported in this paper is an examination of the BCC programmes, characterizing the behavioural, normative and control beliefs of both mothers and fathers in BCC households compared to those in control households. In this study, a total of 40 participants were included, with 13 mother-father pairs in the BCC + food voucher group, and seven pairs in the control group. Each participant was interviewed separately. We found that BCC mothers showed more gender-equal tendencies than the control mothers despite being more rural in location. By contrast, the beliefs of BCC and control fathers were similar overall, suggesting men are more resistant to gender-equal BCC. More work is needed to develop and test effective methods for changing fathers' beliefs and practices.

Engaging Fathers for Effective Child Nutrition and Development in Tanzania (EFFECTS): study protocol for a five-arm, cluster-randomized trial

BACKGROUND

Globally, 144 million children under 5 years are undernourished and 250 million do not meet their developmental potential. Multi-input interventions, such as bundled nutrition and parenting interventions, are designed to mitigate risks for multiple child outcomes. There is limited evidence that bundled interventions have additive benefits to nutrition, growth, or development outcomes. These outcomes share common risks; therefore, designing interventions to tackle these risks using a common theory of change may optimize effectiveness. Emerging evidence suggests explicit engagement of fathers may benefit child outcomes, but few trials have tested this or included data collected from fathers.

METHODS

Engaging Fathers for Effective Child Nutrition and Development in Tanzania (EFFECTS) is a community-based cluster-randomized controlled trial that will be implemented in the rural Mara Region, Tanzania. The trial aims (1) to test a bundled nutrition and parenting program delivered to mothers' groups, with or without fathers' groups, over 12 months on child and caregiving outcomes compared to a nutrition program alone, and (2) to test nutrition or bundled nutrition and parenting programs delivered to mothers' and fathers' groups over 12 months on child and caregiving outcomes compared to programs delivered to mothers alone. The trial comprises five arms: (1) mothers' groups receiving a nutrition program, (2) mothers' groups receiving a bundled nutrition and parenting program, (3) mothers' and fathers' groups receiving a nutrition program, (4) mothers' and fathers' groups receiving a bundled nutrition and parenting program, and (5) control receiving standard of care health services. The primary outcomes are child dietary diversity and early child development (mental and motor development). Parents with a child under 18 months will be enrolled in peer groups and receive twice monthly intervention by trained community health workers. Data will be collected from mothers, fathers, and children at baseline (pre-intervention), midline, and endline (post-intervention).

DISCUSSION

EFFECTS will generate evidence on the effects of bundled nutrition and parenting interventions on child nutrition, growth, and development outcomes; determine the benefits of engaging fathers on child, caregiving, and caregiver outcomes; and investigate common and unique pathways between treatments and child outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03759821. Registered on November 30, 2018.

Indian fathers are involved in nurturing healthy behaviours in adolescents: A qualitative inquiry

BACKGROUND

Indian adolescents exhibit unhealthy food behaviours and inactive lifestyles which increase their risk of developing obesity and associated negative health consequences. The family food environment represents a vital setting to nurture healthy lifestyle behaviours in adolescents, with parents influencing their adolescents' dietary and physical activity behaviours. Yet, much of the existing evidence exploring parental influences predominantly focuses on mothers while fathers' engagement in instilling healthy dietary and physical activity behaviours is understudied, more so in the context of developing economies like India. Therefore, this qualitative study was designed to understand Indian fathers' views on instilling healthy behaviours in their children.

METHODS

Convenience sampling along with snowball sampling techniques were employed to recruit fathers of adolescents aged 10-19 years from Kolkata city, India. Informed by the research aim and review of literature, an interview guide was developed and pre-tested. Interviews were carried out either in person or virtually (Zoom/telephone) in English/Hindi/Bengali as per the preference of the participants. All interactions were audio recorded, transcribed verbatim, and translated to English for the purpose of data analysis. The transcripts were analysed thematically using NVivo software program. Themes were identified using both inductive and deductive approaches.

RESULTS

A total 36 fathers participated in the interviews. Seven main themes were identified: (i) Involvement of fathers in adolescent upbringing (i.e. engagement in meal preparation, food shopping, educational activities, physical activity); (ii) Family food environment (i.e. setting food rules, having meals with children, making food available); (iii) Challenges to instilling healthy behaviours in adolescents (i.e. adolescents' sedentary lifestyle and liking for unhealthy foods); (iv) Barriers to routine involvement in adolescent upbringing (i.e. time constraints due to paid employment, poor socio-economic status); (v) Adolescent nutrition education: (vi) Dual burden of malnutrition (i.e. awareness of malnutrition, no knowledge about government-led health programs for adolescents); (vii) Paternal knowledge.

CONCLUSIONS

The emerging themes reveal that Indian fathers played a crucial role in instilling healthy dietary and physical activity behaviour in their adolescents through various parenting practices such as purchasing nutritious food, enforcing food rules, disseminating nutrition-related knowledge, and encouraging adolescents to participate in moderate-to-vigorous intensity outdoor sports. This provides strong support for the inclusion of fathers in sustainable family-focused lifestyle interventions to maximise the nurturing care required by adolescents as well as assist in normalising the representation of fathers in health and welfare policies designed for adolescents.

Fathers' experiences of childcare and feeding: A photo-elicitation study in a low resource setting in urban Addis Ababa, Ethiopia

Children's health and wellbeing studies focus mainly on mothers' roles while very little is known about the experiences/challenges that fathers face in fulfilling their responsibilities. Therefore, this study aims to explore the fathers' lived experiences of childcare and feeding in an urban low-income setting. This qualitative study was conducted in Addis Ababa, Ethiopia. Photo-elicitation was used to facilitate the in-depth interviews with fathers of children below the age of five years. All interviews were audio-recorded, transcribed and translated verbatim, followed by a thematic analysis approach. The overarching theme of this study was "Fatherhood as an enduring identity", which comprised of three sub-themes: 1) Blessings of fatherhood, 2) Adjusting to fathering roles, and 3) Struggles/demands of fatherhood in a low-resource setting. Fathers expressed that having children or becoming parents was a blessing. They expressed their love, devotion, and attachment to their children. Some used the term "my second chance in life" underscoring the importance. Although fathers strived relentlessly to spend time and care for their children, they faced challenges such as internal struggles adjusting to and fatherhood whilst maintaining a sense of their former self. As well, providing for their families amidst added pressures imposed by the external environment, such as poor housing conditions, a lack of employment opportunities, the then COVID-19 pandemic, further increased their stressors. Most fathers were engaged in child care and feeding, suggesting that like mothers, fathers should be viewed as potential agents for implementing nutrition interventions in this setting. However, if interventions are to be successful, they need to incorporate components that boost fathers' livelihoods and general wellbeing.

Does Raising Livestock Improve Household Food Security and Child Dietary Diversity in a Rural Region of Madagascar?

Madagascar is one of the poorest countries and has an alarming prevalence of food insecurity and child undernutrition. Most of the Malagasy population live from agricultural activities making livestock a livelihood asset and a source of animal-source foods, especially for smallholder farmers. This study aimed to examine the association between livestock ownership, household food security, and children's dietary diversity in a rural region of Madagascar. Data from a cross-sectional survey of 344 respondents were used to assess the association between household tropical livestock units (TLU) per capita, Household Food Insecurity Access Scale (HFIAS) scores, and dietary diversity scores (DDSs) among children aged 6-23 months. The estimation results from the ordered probit model showed that household TLU per capita is negatively associated with HFIAS scores and positively associated with DDSs among children. Additionally, households with mothers who received information on childcare and nutrition from health facilities and community nutrition agents were more likely to be food secure and have better dietary diversity. Therefore, promoting livestock ownership and strengthening nutrition-sensitive messages focusing on the benefits of raising livestock to mothers from rural Madagascar will likely be effective in improving household food security and nutrition for children.

Knowledge, Attitude and Involvement of First-Time Fathers in Infant and Young Child Feeding and Care Practices

Father’s role is as important as a mother’s in the early years of life to ensure optimum growth and development of the baby. But in most societies, it is often linked with just earning money for the child and the entire family. The present study was undertaken to assess the knowledge, attitude and involvement of first-time fathers in infant and young child feeding and care practices, and their relationship with each other. The influence of select personal and family factors of the fathers was also studied on these aspects. A total of 60 first-time fathers having only one child in the age group of 6 months to 3 years residing in the National Capital Region of India constituted the study sample. A questionnaire schedule was administered to gather information on general and family characteristics, child’s profile, and knowledge, attitudes and involvement of the fathers in infant and young child feeding and care practices. Findings revealed that the total knowledge scores of maximum fathers (43%) were ‘average’. Nearly 60% and 38% fathers respectively had ‘very good’ and ‘good’ total attitude scores. High percentage of fathers had ‘good’ (43%) and ‘very good’ (30%) total involvement scores related to their infant/young child feeding and care practices. A weak but significant positive correlation was found only between knowledge and involvement scores of the fathers (r=0.277, p<0.05). Attitude scores of the fathers were found to be influenced by their occupation while their involvement scores were influenced by their age, and monthly family income. The study indicated that even though the knowledge of the first-time fathers regarding infant and young child feeding practices was average, their attitude regarding these aspects was good, and they also showed a good involvement in these practices. The existing knowledge gaps need to be catered to through suitable timely interventions in order to ensure that fathers can also proactively contribute towards the feeding and care of their infants and young children.

Fathers' level of involvement in childcare activities and its association with the diet quality of children in Northern Ghana

OBJECTIVE

This study assessed the level of fathers' involvement in childcare activities and its association with the diet quality of their children in Northern Ghana.

SETTING

The study was carried out in the Northern, Upper East and Upper West regions of Ghana. The people in the study area mostly depend on agriculture as their main occupation.

DESIGN

A community-based comparative analytical cross-sectional study.

PARTICIPANTS

A sample of 422 rural mother-father pairs who had at least one child aged 6-36 months.

RESULTS

The overall level of fathers' involvement in childcare and feeding activities was high among 63·5 % of the respondents in the 6 months prior to the study. The most common childcare activity men were involved in was providing money for the purchase of food for the child. Minimum acceptable diet was higher for children with a higher level of paternal involvement in childcare activities (adjusted OR = 3·33 (95 % CI: 1·41, 7·90)), compared to their counterparts whose father's involvement was poor. Fathers who had a positive attitude to childcare and feeding were 2·9 more likely to get involved in childcare activities (adjusted OR = 2·90 (95 % CI: 1·87, 4·48)).

CONCLUSIONS

The findings confirm earlier studies that show that fathers' involvement in childcare activities including feeding is positively associated with improved child feeding practices. The findings point to the need to have a policy shift in which both men and women are key actors in interventions designed to improve child nutritional status in rural settings of Northern Ghana.

Caregivers Systematically Overestimate Their Child's Height-for-Age Relative to Other Children in Rural Ethiopia

BACKGROUND

Stunting affects one-quarter of children <5 y of age, yet little is known about the accuracy of caregivers' perceptions regarding their child's linear growth. Most existing quantitative research on this topic has been conducted in high-income countries and has examined perceptions of children's weight rather than height.

OBJECTIVES

In rural Ethiopia where linear growth faltering is highly prevalent, this study aimed to better understand how caregivers perceive their child's growth. The objectives of this analysis were to 1) assess caregivers' perceptions of their child's height; 2) investigate whether there is a discrepancy between a child's actual height and caregivers' perceptions of their child's height; and 3) examine the factors that influence discrepancies in estimating a child's height (secondary outcomes), including the role of the average height in the community (primary outcome).

METHODS

We conducted a cross-sectional analysis using data from 808 woman caregivers of children ages 6-35 mo in the Oromia region of Ethiopia. We assessed caregivers' rankings (from 1 to 10) of their child's height relative to other children their age in their village. We then converted these rankings to z scores based on an age- and region-specific distribution in order to calculate their difference with the child's actual height-for-age z score and to determine the degree of overestimation. Lastly, we used multivariate log Poisson regressions to determine factors associated with overestimating a child's height.

RESULTS

Forty-three percent of caregivers scored their child's height as the median; 37% overestimated their child's height relative to other children. Regression results showed caregivers who were poorer, and had children who were female, older, and stunted, were more likely to overestimate.

CONCLUSIONS

Our findings suggest that caregivers of young children in Oromia systematically overestimated their children's height, which could adversely affect child health if these misperceptions translate to insufficient care-seeking behavior or feeding choices for 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.

Barriers and facilitators to father involvement in early child health services: A qualitative study in rural Mozambique

Engaging men and increasing their involvement as partners and parents can improve child health and development. Despite the increasing global evidence and advocacy around father involvement and caregiving, there remain few father-inclusive interventions for promoting early child health, especially within primary health systems in low- and middle-income countries. In this study, we explored community perspectives regarding fathers' roles in early child health services during the first three years of life to identify the barriers and facilitators to father involvement in Monapo District in northern, rural Mozambique. A qualitative sub-study was embedded within a qualitative intervention implementation evaluation conducted in October-November 2020. In-depth interviews were conducted with 36 caregivers, 15 health facility providers, 12 community health providers, 4 government officials, and 7 non-governmental partner organizations. Data were analyzed using inductive thematic content analysis. Results revealed that fathers were generally uninvolved in early child healthcare services. Primary barriers to fathers' involvement included the absence of fathers in many households; opportunity costs associated with fathers' accompanying children to health facilities; long waiting times at facilities; negative health provider attitudes towards fathers; and patriarchal gender norms. Respondents also highlighted facilitators of father involvement, which included fathers' broader engagement with their child at home; fathers' desires to support their partners; parental awareness about the importance of father involvement in child healthcare; and community outreach and sensitization campaigns targeting fathers directly. Our study highlights opportunities for enhancing the focus, design, and delivery of child health services so that they are more inclusive and responsive to fathers. Future research should assess the feasibility, acceptability, and effectiveness of father-focused child health interventions on caregiving and early child health and development outcomes. These strategies should holistically address not only individual and household factors, but also broader structural and sociocultural determinants at the health system and community levels.

Engaging fathers to improve complementary feeding is acceptable and feasible in the Lake Zone, Tanzania

In Tanzania, suboptimal complementary feeding practices contribute to high stunting rates. Fathers influence complementary feeding practices, and effective strategies are needed to engage them. The objectives of this research were to examine the acceptability and feasibility of (1) tailored complementary feeding recommendations and (2) engaging fathers in complementary feeding. We conducted trials of improved practices with 50 mothers and 40 fathers with children 6-18 months. At visit 1, mothers reported current feeding practices and fathers participated in focus group discussions. At visit 2, mothers and fathers received individual, tailored counselling and chose new practices to try. After 2 weeks, at visit 3, parents were interviewed individually about their experiences. Interview transcripts were analysed thematically. The most frequent feeding issues at visit 1 were the need to thicken porridge, increase dietary diversity, replace sugary snacks and drinks and feed responsively. After counselling, most mothers agreed to try practices to improve diets and fathers agreed to provide informational and instrumental support for complementary feeding, but few agreed to try feeding the child. At follow-up, mothers reported improved child feeding and confirmed fathers' reports of increased involvement. Most fathers purchased or provided funds for recommended foods; some helped with domestic tasks or fed children. Many participants reported improved spousal communication and cooperation. Families were able to practice recommendations to feed family foods, but high food costs and seasonal unavailability were challenges. It was feasible and acceptable to engage fathers in complementary feeding, but additional strategies are needed to address economic and environmental barriers.

Fathers' involvement in child care activities: Qualitative findings from the highlands of Madagascar

Few studies have investigated fathers’ roles in child care in Madagascar. This study explored the perceptions, attitudes, and practices regarding fathers’ involvement in child care using qualitative methods. Ten focus group discussions were conducted among parents of children aged 6–23 months; seven were among mothers, and three among fathers. In-depth semi-structured interviews (n = 8) were also conducted with key informants. Discussions and interviews were audio-recorded and the verbatim transcripts in Malagasy were translated into English. Data were analyzed using the thematic analysis approach. Provision of financial and material support as well as teaching and playing with the child were the main perceived roles of fathers. In practice, fathers spent their time alone with their children playing and holding them when the mother was unavailable. Busy schedules and separation due to work were major barriers to fathers’ involvement. Traditional gender roles for child care in which the mother is seen as primarily responsible for the child were salient across the data. Consequently, men involved in child care activities and their wives were often criticized by the community. Nevertheless, there was self-reported interest from both mothers and fathers in involving men more in child care. Interventions aimed to increase fathers’ involvement in child care may be more successful when they focus on shifting the community perceptions on the division of responsibilities between fathers and mothers.

'I also take part in caring for the sick child': a qualitative study on fathers' roles and responsibilities in seeking care for children in Southwest Ethiopia

OBJECTIVES

Fathers play an important role in household decision-making processes and child health development. Nevertheless, they are under-represented in child health research, especially in low-income settings. Little is known about what roles fathers play in the care-seeking processes or how they interact with the health system when their child is sick. This study aimed to understand Ethiopian fathers' roles and responsibilities in caring for their children when they are or become ill.

DESIGN

Qualitative study using semistructured interviews with fathers.

SETTING

This study was conducted in three rural districts of the Southern Nations, Nationalities and People's Region of Ethiopia.

PARTICIPANTS

Twenty-four fathers who had at least one child between 2 and 59 months who visited a health extension worker with fever.

RESULTS

The overarching theme of this study was 'changing perceptions of paternal responsibilities during children's ill health'. It constituted three subthemes, namely, 'fathers' burden of earning money for care', 'fatherhood entails advocating children's healthcare needs' and 'investing in children's health can benefit the family in the future'. Fathers described that they were the ones mainly responsible for the financial arrangement of care and that this financial responsibility can involve stress when resources are scarce. Fathers knew what health services were available and accessible to them and were involved in different ways in the care seeking of the child. Changes in the importance ascribed to child health were expressed by fathers who described being more alert to children's ill-health.

CONCLUSION

Fathers play various roles in the care-seeking process during children's illness episodes. This included, for instance, arranging resources to seek care, (co)-deciding where to seek care as well as accompanying the child to the health facility. The inability to organise necessary resources for care can lead to involuntary delays in care seeking for the child. This demonstrates the importance of including fathers in future interventions on maternal and child health.

Exploring the challenges and opportunities towards optimal breastfeeding in Ethiopia: a formative qualitative study

Background

Breastfeeding, particularly exclusive breastfeeding, is essential to ensure the short- and long-term health of infants and mothers. Sub-optimal breastfeeding practices currently take place in low income countries contributing to morbidity and mortality. This research explored the challenges and opportunities around exclusive breastfeeding in a large city in Ethiopia to inform a larger breastfeeding intervention.

Methods

Fathers and mothers who had children less than 2 years of age, and who could speak, and understand Tigrigna were recruited from two health centres located in Mekelle, Ethiopia. Two focus group discussions (FGDs) with fathers and two FGDs with mothers (n = 42) were conducted using a semi-structured interview guide to explore the challenges and opportunities related to breastfeeding. Discussions were audio-recorded and transcribed in Tigrigna and translated to English. The data were manually analysed using thematic analysis, generating open codes which were grouped to form themes.

Results

Four themes with 11 sub-themes emerged. The themes identifies were: conflicted emotions on the birth of baby (feeling happy and feeling worried); perspectives on intergenerational approaches (old-fashioned beliefs of grandparents and the power of science, breastfeeding in public, breastfeeding knowledge); gender roles as barriers and enablers (the burden on women, changes in men’s roles and the financial status of the household); the role of healthcare (delivery of health information to parents, the role of health care providers and perceptions of inadequate milk supply).

Conclusion

Parents reported a range of opportunities with respect to breastfeeding, including the power of a scientific approach, the positive role of healthcare, and shifts within gender roles that maximized the potential support from fathers. However, there remains a tension between the beliefs of older generations and current best-practice. Parents continue to need ongoing support in order to practice optimal breastfeeding.

Using Trials of Improved Practices to identify practices to address the double burden of malnutrition among Rwandan children

OBJECTIVE

Low- and middle-income countries (LMIC) are increasingly experiencing the double burden of malnutrition. Studies to identify 'double-duty' actions that address both undernutrition and overweight in sub-Saharan Africa are needed. We aimed to identify acceptable behaviours to achieve more optimal feeding and physical activity practices among both under- and overweight children in Rwanda, a sub-Saharan LMIC with one of the largest recent increases in child overweight.

DESIGN

We used the Trials of Improved Practices (TIPs) method. During three household visits over 1·5 weeks, we used structured interviews and unstructured observations to collect data on infant and young child feeding practices and caregivers' experiences with testing recommended practices.

SETTING

An urban district and a rural district in Rwanda.

PARTICIPANTS

Caregivers with an under- or overweight child from 6 to 59 months of age (n 136).

RESULTS

We identified twenty-five specific recommended practices that caregivers of both under- and overweight children agreed to try. The most frequently recommended practices were related to dietary diversity, food quantity, and hygiene and food handling. The most commonly cited reason for trying a new practice was its benefits to the child's health and growth. Financial constraints and limited food availability were common barriers. Nearly all caregivers said they were willing to continue the practices and recommend them to others.

CONCLUSIONS

These practices show potential for addressing the double burden as part of a broader intervention. Still, further research is needed to determine whether caregivers can maintain the behaviours and their direct impact on both under- and overweight.

What Influences Urban Mothers' Decisions on What to Feed Their Children Aged Under Five-The Case of Addis Ababa, Ethiopia

Mothers carry the prime responsibility for childcare and feeding in low-income countries. Understanding their experiences in providing food for their children is paramount to informing efforts to improve the nutritional status of children. Such information is lacking in Sub-Saharan Africa. To understand what influences urban mothers' food acquisition and their motivations for selecting food for their children, 36 in-depth interviews were carried out with mothers having children under five years of age. Interviews were conducted in the local language, audio-recorded, transcribed, and translated into English. Data were analyzed using thematic analysis which led to the identification of four major themes: mothers give-in to a child-driven diet; quick-fix versus the privilege of planning; keen awareness on food safety, nutrition, and diet diversity; and social, familial, and cultural influences. The findings indicate that child feeding practices are influenced by interlinked social and environmental factors. Hence, nutrition education campaigns should focus on targeting not only families but also their children. Attention should also be given to food safety regulations, as well as to the much-needed support of mothers who are struggling to ensure their children's survival in low-income countries.

Infant and Young Child Feeding Decision Making and Practices: Malawian Mothers' and Fathers' Roles in the Context of HIV

BACKGROUND

Few studies in low- and middle-income countries have examined the roles of couples in infant and young child feeding decision making and practices, and there is no corresponding data in the context of human immunodeficiency virus (HIV). Research aim: This study aimed to explore mothers' and fathers' perceptions of their roles in feeding decision making and practices.

METHODS

The authors conducted in-depth interviews with 15 mothers and their male partners, recruited from the catchment areas of two urban and two rural government clinics in Lilongwe District, Malawi. The mothers were ≥ 18 years of age, were HIV positive, and had a child < 24 months of age. Twelve of the 15 fathers were also HIV positive. The interviews were analyzed using content analysis.

RESULTS

Mothers were responsible for child care, including breastfeeding and complementary feeding. Fathers provided monetary support for purchasing food and offered verbal support to encourage mothers to implement recommended feeding practices. Many fathers found it difficult to support adequate complementary feeding because of household food insecurity. Mothers were advised on child feeding during prevention of mother-to-child transmission clinic visits. No fathers in this study accompanied women to clinic appointments, so they were less well-informed about feeding than mothers. Fathers usually deferred to mothers in feeding decision making. One-third of mothers wanted fathers to be more involved in child feeding.

CONCLUSION

Malawian mothers' and fathers' roles in feeding decision making in the context of HIV align with local gender norms. Strategies are needed to improve fathers' knowledge of and involvement in child feeding, as desired by mothers.