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Kyei-Arthur F, Aballo J, Mahama AB, Adu-Afarwuah S. Infant and young child feeding practices among mothers in the pilot Micronutrient Powder Initiative in four geographically and ethnically diverse districts in Ghana. PLoS One 2024; 19:e0307961. [PMID: 39088512 PMCID: PMC11293642 DOI: 10.1371/journal.pone.0307961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 07/15/2024] [Indexed: 08/03/2024] Open
Abstract
In Ghana, breastfeeding and complementary feeding counselling have been used as a nutritional intervention to promote optimal Infant and Young Child Feeding (IYCF) and nutrition. This study examined IYCF practices in four geographically and ethnically diverse districts (Ho West, Tain, Talensi and Tolon). A qualitative study involving key informant interviews (KIIs) and focus group discussions (FGDs) was conducted between November and December 2019 among women who participated in a pilot micronutrient powder intervention for children 6-23 months of age. The KIIs and FGDs were audio-taped, transcribed verbatim, and analyzed thematically using NVivo 10. Three themes emerging from the KIIs and FGDs were: level of adherence to IYCF recommendations among mothers and caregivers; IYCF recommendations perceived as the hardest to follow; and perceived motivators, facilitators, and barriers to IYCF practices. Mothers in the four districts generally followed the eight IYCF recommendations. Mothers in the Tolon district demonstrated adherence to IYCF practices, often citing the need for early initiation of breastfeeding, timely introduction of complementary feeding, and feeding children aged 9-23 months 3 times daily in addition to breastfeeding. In contrast, mothers in other districts faced challenges that hindered adherence. Giving children 4 or more food groups and timely introduction of complementary feeding were perceived as the hardest practices to follow. The main facilitators of IYCF practices include midwives and frontline nurses teaching mothers how to breastfeed, and midwives ensuring mothers initiate breastfeeding immediately after delivery. The main barriers to IYCF practices identified were insufficient breastmilk; mothers-in-law giving water to children before six months; resumption of work; and lack of financial means. Mothers in the Ho West district reported more barriers to IYCF practices, followed by mothers in the Tain, Talensi, and Tolon districts. Health practitioners, stakeholders, and policymakers should design targeted interventions that address the contextual barriers to improve IYCF practices in the various districts.
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Affiliation(s)
- Frank Kyei-Arthur
- Department of Environment and Public Health, University of Environment and Sustainable Development, Somanya, Ghana
| | | | | | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
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Piperata BA, Scaggs SA, Dufour DL, Adams IK. Measuring food insecurity: An introduction to tools for human biologists and ecologists. Am J Hum Biol 2023; 35:e23821. [PMID: 36256611 DOI: 10.1002/ajhb.23821] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 08/20/2022] [Accepted: 09/29/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Food insecurity is a significant and growing concern undermining the wellbeing of 30% of the global population. Food in/security is a complex construct consisting of four dimensions: availability, access, utilization, and stability, making it challenging to measure. We provide a toolkit human biologists/ecologists can use to advance research on this topic. METHODS We review the strengths and limitations of common tools used to measure food access and utilization, the two dimensions most proximate to people's lived experience, and emphasize tools that provide data needed to best link food security with human biological outcomes. We also discuss methods that provide contextual data human biologists/ecologists will find useful for study design, ensuring instrument validity, and improving data quality. RESULTS Food access is principally measured using experience-based instruments that emphasize economic access. Social access, such as food sharing, is under-studied and we recommend using social network analysis to explore this dimension. In terms of utilization, emphasis has been on food choice measured as dietary diversity. Food preparation and intrahousehold distribution, also part of the utilization dimension, are less studied and standardized instruments for measuring both are lacking. The embodiment of food insecurity has focused on child growth, although a growing literature addresses adult mental wellbeing and chronic and infectious disease risk. CONCLUSIONS We see the potential to expand outcomes to include reproductive and immune function, physical activity, and the gut microbiome. Human biologists/ecologists are well-positioned to advance understanding of the human health impacts of food insecurity and provide data to support intervention efforts.
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Affiliation(s)
- Barbara A Piperata
- Department of Anthropology, The Ohio State University, Columbus, Ohio, USA
| | - Shane A Scaggs
- Department of Anthropology, The Ohio State University, Columbus, Ohio, USA
| | | | - Ingrid K Adams
- Department of Extension and School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
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Robert RC, Feijoo BL. Beneficiary and Local Stakeholder Participation in Community-Based Nutrition Interventions. Curr Dev Nutr 2022; 6:nzac131. [PMID: 36157848 PMCID: PMC9492256 DOI: 10.1093/cdn/nzac131] [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: 10/01/2021] [Revised: 08/03/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Rebecca C Robert
- Conway School of Nursing, The Catholic University of America, Washington, DC, USA
| | - Brittany L Feijoo
- Conway School of Nursing, The Catholic University of America, Washington, DC, USA
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Sandow A, Tice M, Pérez-Escamilla R, Aryeetey R, Hromi-Fiedler AJ. Strengthening Maternal, Infant, and Young Child Nutrition Training and Counseling in Ghana: A Community-Based Approach. Curr Dev Nutr 2022; 6:nzac127. [PMID: 36157847 PMCID: PMC9492258 DOI: 10.1093/cdn/nzac127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 04/19/2022] [Accepted: 07/29/2022] [Indexed: 11/24/2022] Open
Abstract
Background Evidence-based maternal, infant, and young child nutrition (MIYCN) counseling provides caregivers essential nutrition education to optimize infant and young child feeding practices and subsequently improve child growth and development. Effective integration of responsive feeding (RF) into current MIYCN training requires working with priority communities. Objectives Study objectives were to 1) assess MIYCN knowledge and practices among Ghanaian caregivers, 2) identify factors influencing RF/responsive parenting (RP) among Ghanaian caregivers, 3) identify barriers and facilitators influencing MIYCN training and counseling among Ghanaian health care providers, and 4) document recommendations for integrating an RF curriculum into the existing MIYCN training. Methods This was a qualitative study, conducted within the Central Region of Ghana, based on 1) 6 focus groups with caregivers of young children (<36 mo; n = 44) and 2) in-depth interviews with health care providers (n = 14). Focus group transcripts were coded independently, consensus was reached, and a final codebook developed. The same coding process and thematic analysis were applied to the in-depth interviews. Results Caregivers identified 3 domains influencing the primary outcome of RF/RP knowledge and practices and the secondary outcome of MIYCN: 1) health care provider counseling; 2) support from family, friends, and community members; and 3) food safety knowledge and practice. Providers identified barriers to MIYCN provider training as well as caregiver counseling which included limited access to financial and counseling resources and limited qualified staff to deliver infant and young child feeding counseling. Identified facilitators included availability of funding and counseling staff with adequate resources. Health care providers strongly endorsed integrating an RF curriculum into MIYCN training and counseling along with providing RF training and distribution of RF materials/tools to facilities. Conclusions Health care providers directly influenced RF/RP practices through MIYCN counseling. Strengthening MIYCN counseling through the integration of an RF curriculum into MIYCN training is desired by the community.
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Affiliation(s)
- Adam Sandow
- Point Hope Ghana, Central Region, Awutu Senya East District, Ghana
| | - Madelynn Tice
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | | | - Amber J Hromi-Fiedler
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Wanda D, Astuti A, Utami AR, Lita BFF. Community lifestyle influences feeding practices among Indonesian infants and young children. ENFERMERIA CLINICA (ENGLISH EDITION) 2022; 32 Suppl 1:S46-S53. [PMID: 35688567 DOI: 10.1016/j.enfcle.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/30/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To analyze the feeding practices of malnourished infants and young children aged 6-24 months old in Bogor, West Java, Indonesia. METHOD Fourteen mothers or caregivers who had malnourished infants and young children aged 6-24 months were interviewed, focusing on their feeding practices. Informants came from sub-districts in Bogor Regency, Indonesia, which had a higher incidence of malnutrition. The interview process was recorded. Verbatim transcripts of recorded interviews were analyzed using thematic analysis. RESULTS Five major themes were identified: (1) Inappropriate practice of early initiation of breastfeeding, (2) Challenges in decision making to maintain breastfeeding, (3) Lack of complementary feeding practices, (4) Failing to follow feeding recommendations, and (5) Infant and young child feeding constraints. CONCLUSION The feeding practice for malnourished infants and young children is not entirely based on the recommended standards. This situation is caused by several factors such as economic conditions, culture, parental knowledge, family and community health workers' support. Health workers need to provide comprehensive intervention for mothers and families intensively by taking into account the culture and conditions of the related family.
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Affiliation(s)
- Dessie Wanda
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia.
| | - Astuti Astuti
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
| | - Ayuni Rizka Utami
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
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Kabue M, Abubakar A, Ssewanyana D, Angwenyi V, Marangu J, Njoroge E, Ombech E, Mokaya MM, Obulemire EK, Mugo C, Malti T, Moran G, Martin MC, Proulx K, Marfo K, Zhang L, Lye S. A community engagement approach for an integrated early childhood development intervention: a case study of an urban informal settlement with Kenyans and embedded refugees. BMC Public Health 2022; 22:711. [PMID: 35410147 PMCID: PMC8995906 DOI: 10.1186/s12889-022-13185-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community engagement is crucial for the design and implementation of community-based early childhood development (ECD) programmes. This paper aims to share key components and learnings of a community engagement process for an integrated ECD intervention. The lessons shared are drawn from a case study of urban informal settlement with embedded refugees in Nairobi, Kenya. METHODS We conducted three stakeholder meetings with representatives from the Ministry of Health at County and Sub-County, actors in the ECD sector, and United Nations agency in refugee management, a transect walk across five villages (Ngando, Muslim, Congo, Riruta and Kivumbini); and, six debrief meetings by staff from the implementing organization. The specific steps and key activities undertaken, the challenges faced and benefits accrued from the community engagement process are highlighted drawing from the implementation team's perspective. RESULTS Context relevant, well-planned community engagement approaches can be integrated into the five broad components of stakeholder engagement, formative research, identification of local resources, integration into local lives, and shared control/leadership with the local community. These can yield meaningful stakeholder buy-in, community support and trust, which are crucial for enabling ECD programme sustainability. CONCLUSION Our experiences underscore that intervention research on ECD programmes in urban informal settlements requires a well-planned and custom-tailored community engagement model that is sensitive to the needs of each sub-group within the community to avoid unintentionally leaving anyone out.
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Affiliation(s)
- Margaret Kabue
- Institute for Human Development, Aga Khan University, Nairobi, Kenya.
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Derrick Ssewanyana
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Toronto, Canada
| | - Vibian Angwenyi
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Joyce Marangu
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Eunice Njoroge
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Eunice Ombech
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | | | | | - Catherine Mugo
- Ministry of Health-Kenya, Nairobi Metropolitan Services, Dagoretti Sub-county, Nairobi, Kenya
| | - Tina Malti
- Centre for Child Development, Mental Health, and Policy, University of Toronto Mississauga, Toronto, Canada.,Department of Psychology University of Toronto, Toronto, Canada
| | - Greg Moran
- Academics without Borders, Toronto, Canada
| | - Marie-Claude Martin
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Toronto, Canada
| | - Kerrie Proulx
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Toronto, Canada
| | - Kofi Marfo
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Linlin Zhang
- School of Psychology, Capital Normal University, Beijing, China
| | - Stephen Lye
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Toronto, Canada
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Parkin S, Locock L, Montgomery C, Chisholm A. 'Team ethnography visual maps': Methods for identifying the ethnographic object in multiple sites of fieldwork. ETHNOGRAPHY 2021; 22:556-577. [PMID: 39040517 PMCID: PMC7616273 DOI: 10.1177/14661381211038383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Team ethnography is becoming more popular in research. However, there is currently limited understanding of how multiple ethnographers working together actually share their experiences of conducting team ethnography. There is also an associated lack of explanation regarding how evidence and conclusions are drawn from such collective endeavour. This article attempts to address this absence of detail regarding the practice and conduct of team ethnography. In the following account, the authors present details of the design, development and application of 'team ethnography visual maps' and the collaborative reflexivity that took place within 'team ethnography data sessions' that were each embedded within a mixed methods study of frontline services located in six different National Health Service Trusts throughout England (UK). After a presentation of the ethnographic methods and analyses that occurred as part of team ethnography, they are then discussed in terms of their applied and academic value from a methodological perspective.
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Affiliation(s)
- Stephen Parkin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Catherine Montgomery
- Centre for Biomedicine, Self and Society, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Alison Chisholm
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Wanda D, Astuti A, Utami AR, Lita BFF. Community lifestyle influences feeding practices among Indonesian infants and young children. ENFERMERIA CLINICA 2021. [DOI: 10.1016/j.enfcli.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hawkes C, Fox E, Downs SM, Fanzo J, Neve K. Child-centered food systems: Reorienting food systems towards healthy diets for children. GLOBAL FOOD SECURITY 2020. [DOI: 10.1016/j.gfs.2020.100414] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Kyei-Arthur F, Situma R, Aballo J, Mahama AB, Selenje L, Amoaful E, Adu-Afarwuah S. Lessons learned from implementing the pilot Micronutrient Powder Initiative in four districts in Ghana. BMC Nutr 2020; 6:50. [PMID: 33292686 PMCID: PMC7650146 DOI: 10.1186/s40795-020-00382-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/14/2020] [Indexed: 11/16/2022] Open
Abstract
Background Micronutrient deficiencies affect many children in low-income settings due primarily to over-reliance on complementary foods low in nutrients. Home-fortification (HF) could improve children’s diet quality in these settings. The Ghana Health Service, supported by UNICEF, integrated the pilot Micronutrient Powder Initiative (MPI) into Child Welfare Clinic (CWC) services in four districts (Tain, Tolon, Talensi, and Ho West), whereby micronutrient powder (MNP) is supplied for HF for children aged 6–23 months attending CWCs. This study’s main aim was to identify the facilitators, barriers and “lessons learned” after 2 years of program implementation. Methods This was a qualitative cross-sectional study. MNP distributed and children enrolled were obtained from program records. Primary data were collected from November to December 2019 and included, by district: interviews with senior program staff; key informant interviews and focus group discussion with caregivers in each of 6 sub-districts; and discussions workshop with frontline staff from at least 10 health facilities. Besides field notes, all interactions were audio-recorded and transcribed verbatim. Qualitative data were analyzed using NVivo10. Results The MPI remains on-going, with about 2.5 million MNP sachets distributed to nearly 30,000 children within 90 district-months. Caregivers generally accept the MNP; reported positive responses in children include: “increased appetite”, “less frequent illnesses, “increased energy/strength”, “increased weight”, and “walking independently relatively early”. Main facilitators are: generally regular MNP availability; increased patronage of CWC services; various contact points for supplying MNPs; fairly strong social mobilization strategy; good integration of MPI with CWC services; “one-on-one” counselling for caregivers reporting side effects; and tracing caregivers to address concerns and monitor adherence. Main barriers are: lack of counselling materials; caregivers’ suspicions towards the program; absence of refresher training for frontline workers; and perceived MNP side-effects. Key lessons learned are: incorporating MNPs into CWC services is feasible, acceptable, and could reduce child micronutrient deficiencies in program districts; and MPI’s success requires stronger community sensitization, equipping frontline workers to advise caregivers and manage side-effects, and consciously identifying and managing logistical challenges. Conclusion Further research is needed to evaluate the effectiveness of the MPI in reducing micronutrient deficiencies among 6–23-months-olds in Ghana.
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Affiliation(s)
- Frank Kyei-Arthur
- Regional Institute for Population Studies, University of Ghana, Legon, Accra, Ghana
| | - Ruth Situma
- UNICEF Ghana, 4-8th Rangoon Close, Cantonments, Accra-North, Ghana
| | - Jevaise Aballo
- UNICEF Ghana, 4-8th Rangoon Close, Cantonments, Accra-North, Ghana
| | - Abraham B Mahama
- UNICEF Ghana, 4-8th Rangoon Close, Cantonments, Accra-North, Ghana
| | - Lilian Selenje
- UNICEF Ghana, 4-8th Rangoon Close, Cantonments, Accra-North, Ghana
| | | | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana.
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Al-Jawaldeh A, Taktouk M, Nasreddine L. Food Consumption Patterns and Nutrient Intakes of Children and Adolescents in the Eastern Mediterranean Region: A Call for Policy Action. Nutrients 2020; 12:E3345. [PMID: 33143163 PMCID: PMC7693485 DOI: 10.3390/nu12113345] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/23/2020] [Accepted: 10/29/2020] [Indexed: 11/17/2022] Open
Abstract
The Eastern Mediterranean Region (EMR) has witnessed significant social and economic changes that may have influenced the diet of children and adolescents, and increased the risk for obesity and malnutrition in this age group. This review aims to characterize and assess food consumption patterns and nutrient intakes amongst school-aged children (5-10 years) and adolescents (10-19 years) in countries of the EMR. Electronic databases (MedLine, PubMed, Scopus, and Google Scholar) were searched for relevant articles published between 2005 and 2020; international organizations and governmental websites were also searched. Available studies documented low intakes of fruits, vegetables and fiber, inadequate consumption of water, milk and dairy products, coupled with high intakes of fat, saturated fat, and sugar sweetened beverages, as well as a frequent consumption of energy-dense, nutrient poor foods such as sweet and savory snacks. Micronutrient inadequacies were also observed, particularly for calcium, iron, zinc and vitamins A, D, C, and folate. Acknowledging the impact that nutrition may have on building societies and transforming the lives of children, adolescents and their families, there is a crucial need for a food system approach in developing and implementing national and regional policies and interventions aimed at improving the diet of children and adolescents.
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Affiliation(s)
- Ayoub Al-Jawaldeh
- World Health Organization (WHO), Regional Office for the Eastern Mediterranean (EMRO), Cairo 7608, Egypt;
| | - Mandy Taktouk
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon;
| | - Lara Nasreddine
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon;
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Robert RC, Bartolini RM, Creed-Kanashiro HM, Verney Sward A. Using formative research to design context-specific animal source food and multiple micronutrient powder interventions to improve the consumption of micronutrients by infants and young children in Tanzania, Kenya, Bangladesh and Pakistan. MATERNAL AND CHILD NUTRITION 2020; 17:e13084. [PMID: 33064374 PMCID: PMC7988862 DOI: 10.1111/mcn.13084] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/31/2020] [Accepted: 09/01/2020] [Indexed: 01/26/2023]
Abstract
Optimal complementary feeding practices including consumption of multiple micronutrient powders (MNP) are recommended to improve micronutrient intake by infants and young children (IYC) 6-23 months. Formative research was used to design the behaviour change strategy to improve IYC micronutrient intake for the multicountry ENRICH project in rural impoverished areas of Tanzania, Kenya, Bangladesh and Pakistan. Employing a qualitative approach with multiple methods and guided by a social ecological framework, the study was conducted in several phases: data collection in the community, household and health facilities, initial analysis and household trials (HHT). Results found limited use of animal source foods (ASF) for feeding IYC and MNP largely unavailable. Although cost constrained access to ASF, potential more affordable context-specific ASF options were identified in each setting. Caregivers associated ASF with many positive attributes for IYC, but barriers to feeding them included lack of caregiver time and knowledge of specific preparation techniques, and limited advice from health workers. Feeding practices were identified that used time-efficient, specific preparations for eggs and other ASF, and demonstrated good initial acceptability and feasibility during HHT. Testing MNP in HHT found good initial feasibility and acceptability and provided an understanding of the facilitators and constraints for preparing, feeding and promoting MNP. In conclusion, formative research led to the design of context-specific ASF and MNP complementary feeding promotion strategies to improve IYC consumption of micronutrients by identifying the practices, benefits, motivations and alternative actions to overcome the barriers in each setting.
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Affiliation(s)
- Rebecca C Robert
- Conway School of Nursing, The Catholic University of America, Washington, D.C., USA.,Instituto de Investigación Nutricional, Lima, Peru
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Hasselberg AE, Aakre I, Scholtens J, Overå R, Kolding J, Bank MS, Atter A, Kjellevold M. Fish for food and nutrition security in Ghana: Challenges and opportunities. GLOBAL FOOD SECURITY 2020. [DOI: 10.1016/j.gfs.2020.100380] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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