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Mukanu MM, Thow AM, Delobelle P, Mchiza ZJR. Mapping of food environment policies in Zambia: a qualitative document analysis. BMC Nutr 2023; 9:112. [PMID: 37784146 PMCID: PMC10544488 DOI: 10.1186/s40795-023-00766-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/08/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND The food environment in which people exercise food choices significantly impacts their dietary patterns. Policies that limit the availability, affordability, and access to unhealthy food while increasing that of healthier alternatives help build healthy food environments, which are required to address the double burden of malnutrition. This study aimed to assess the availability of food environment policies in Zambia. METHOD We applied a two-step qualitative document analysis to identify policy content relating to healthy food environments from global and Zambia-specific nutrition-related policy documents. In the first step, global policy documents were analyzed to develop a reference point for globally recommended policies for healthy food environments. In the second step, Zambia's nutrition-related policies were analyzed to identify content relating to healthy food environments. The identified policy content was then mapped against the global reference point to identify food environment policy gaps. RESULTS Our analysis of global policy recommendations identified five broad categories of policy provisions: information and education based; regulatory and legislative tools; strategies to promote production and access to healthy food production; social protection-based strategies and guiding principles for governments relating to multisectoral collaboration and governance. Our analysis found that Zambian Government policy documents in the health, agriculture, education, and national planning and development sectors have policy provisions for healthy food environments. While these policy provisions generally covered all five reference categories, we found policy gaps in the regulatory and legislative tools category relative to global recommendations. CONCLUSION Zambia's food environment policy landscape must include globally recommended regulatory and legislative policy measures like restricting the marketing of unhealthy foods and non-alcoholic beverages to children. Nutrition policy reforms are required to facilitate the introduction of regulatory and legislative policy measures that effectively address the double burden of malnutrition in Zambia.
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Affiliation(s)
- Mulenga Mary Mukanu
- School of Public Health, University of the Western Cape, Bellville, 7535, South Africa.
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Peter Delobelle
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, 7700, South Africa
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Zandile June-Rose Mchiza
- School of Public Health, University of the Western Cape, Bellville, 7535, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, 7505, South Africa
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Bably MB, Laditka SB, Mehta A, Ghosh-Jerath S, Racine EF. Timing and factors associated with complementary feeding in India. Health Care Women Int 2023; 44:220-233. [PMID: 34156920 DOI: 10.1080/07399332.2021.1924176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introducing complementary feeding at 6 months can reduce premature death. We examined timing and factors associated with complementary feeding using the Indian Human Development Survey II (n = 11,218 women). Only 21% of mothers initiated complementary feeding at 6 months, 42% at 7-9 months, 33% at ≥10 months. In adjusted results, we found mothers with low income, with no formal education, and who had never formally worked were less likely to introduce complementary feeding at 6 months (p > 0.05). Our results indicate women in less advantaged groups are less likely to initiate complementary feeding at recommended age than women in more advantaged groups.
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Affiliation(s)
- Morium B Bably
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Sarah B Laditka
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | | | - Suparna Ghosh-Jerath
- Indian Institute of Public Health Delhi, Public Health Foundation of India, Gurgaon, India
| | - Elizabeth F Racine
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, 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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4
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Invisibility of nurses and midwives in the public health response to child abuse and neglect: A policy review. Collegian 2022. [DOI: 10.1016/j.colegn.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Key Challenges to Optimal Therapeutic Coverage and Maternal Utilization of CMAM Program in Rural Southern Pakistan: A Qualitative Exploratory Study. Nutrients 2022; 14:nu14132612. [PMID: 35807795 PMCID: PMC9268698 DOI: 10.3390/nu14132612] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 01/10/2023] Open
Abstract
Severe Acute Malnutrition (SAM) is a serious public health problem in many low- and middle-income countries (LMICs). Therapeutic programs are often considered the most effective solution to this problem. However, multiple social and structural factors challenge the social inclusion, sustainability, and effectiveness of such programs. In this article, we aim to explore how poor and remote households face structural inequities and social exclusion in accessing nutrition-specific programs in Pakistan. The study specifically highlights significant reasons for the low coverage of the Community Management of Acute Malnutrition (CMAM) program in one of the most marginalized districts of south Punjab. Qualitative data are collected using in-depth interviews and FGDs with mothers and health and nutrition officials. The study reveals that mothers’ access to the program is restricted by multiple structural, logistical, social, and behavioral causes. At the district level, certain populations are served, while illiterate, and poor mothers with lower cultural capital from rural and remote areas are neglected. The lack of funding for nutrition causes the deprioritization of nutrition by the health bureaucracy. The subsequent work burden on Lady Health Workers (LHWs) and the lack of proper training of field staff impact the screening of SAM cases. Moreover, medical corruption in the distribution of therapeutic food, long distances, traveling or staying difficulties, the lack of social capital, and the stigmatization of mothers are other prominent difficulties. The study concludes that nutrition governance in Pakistan must address these critical challenges so that optimal therapeutic coverage can be achieved.
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Torlesse H, Murira Z, Hoogendoorn A. Complementary feeding in South Asia: a multi-system analysis of the enabling environment and programme context. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01709-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Abstract
Aim
The links between poor complementary feeding and child malnutrition in South Asia argue for greater attention to improving young children’s diets. This study examined the status of policy and programme actions to support complementary feeding across four systems in South Asia: food, health, social protection, and water, sanitation, and hygiene (WASH).
Methods
We conducted a review to assess the status of national policy and programme actions to improve complementary feeding in children aged 6–23 months in eight South Asian countries across four systems, including the comprehensiveness of the enabling environment and the geographic scale of programmes.
Results
All countries have policy and programme commitments to improving complementary feeding; however, no country has a comprehensive set of legislation, policies, strategies, and plans that fully incorporate relevant global recommendations and guidance. The health system has the strongest enabling environment for complementary feeding, but the lack of supportive legislation, policies, strategies, and plans in other systems may hinder multisystem action. There are few examples of nationwide programmes to improve complementary feeding beyond the health system.
Conclusion
Governments should mobilize their institutions and resources to enable a coherent and multisystem response to complementary feeding that addresses the gaps in legislation, policies, and programmes and the barriers and bottlenecks to implementation at scale, with a focus on the food, health, social protection, and WASH systems. Further operational research is needed on the factors and processes that enable multisystem action to secure nutritious, safe, affordable, and sustainable diets for young children in South Asia.
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Payán DD, Zahid N, Glenn J, Tran HTT, Huong TTT, Moucheraud C. Implementation of two policies to extend maternity leave and further restrict marketing of breast milk substitutes in Vietnam: a qualitative study. Health Policy Plan 2021; 37:472-482. [PMID: 34536274 PMCID: PMC9006067 DOI: 10.1093/heapol/czab116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 02/03/2023] Open
Abstract
Policy research can reveal gaps and opportunities to enhance policy impact and implementation. In this study, we use a theoretically informed qualitative approach to investigate the implementation of two policies to promote breastfeeding in Vietnam. We conducted semi-structured interviews with national and local policy stakeholders (n = 26) in 2017. Interviews were audio-recorded, transcribed verbatim and then translated to English by certified translators. Transcript data were analysed using an integrated conceptual framework of policy implementation. Respondents identified several positive outcomes resulting from implementation of an extended maternity leave policy (Labour Code No. 10/2012/QH13) and further restrictions on marketing of breast milk substitutes (Decree No. 100/2014/ND-CP). Decree No. 100, in particular, was said to have reduced advertising of breast milk substitutes in mass media outlets and healthcare settings. Key implementation actors were national-level bureaucratic actors, local organizations and international partners. Findings reveal the importance of policy precedence and a broader set of policies to promote the rights of women and children to support implementation. Other facilitators were involvement from national-level implementing agencies and healthcare personnel and strength of government relationships and coordination with non-governmental and international organizations. Implementation challenges included insufficient funding, limited training to report violations, a cumbersome reporting process and pervasive misinformation about breast milk and breast milk substitutes. Limited reach for women employed in the informal labour sector and in rural communities was said to be a compatibility issue for the extended maternity leave policy in addition to the lack of impact on non-parental guardians and caretakers. Recommendations to improve policy implementation include designating a role for international organizations in supporting implementation, expanding maternity protections for all working women, building local-level policy knowledge to support enforcement, simplifying Decree No. 100 violation reporting processes and continuing to invest in interventions to facilitate a supportive policy environment in Vietnam.
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Affiliation(s)
- Denise Diaz Payán
- *Corresponding author. Department of Public Health, Social Sciences, Humanities and Arts (SSHA), University of California Merced, 5200 N Lake Road, Merced, CA 95343, USA. E-mail:
| | - Neha Zahid
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California Merced, 5200 N Lake Road, Merced, CA 95343, USA
| | - Jeffrey Glenn
- Department of Public Health, College of Life Sciences, Brigham Young University, 4103 LSB, Provo, UT 84602, USA
| | - Ha TT Tran
- Research and Training Centre for Community Development (RTCCD), No 39 Lane 255, Vong Street, Hai Ba Trung District, Hanoi, Vietnam
| | - Tran Thi Thu Huong
- Research and Training Centre for Community Development (RTCCD), No 39 Lane 255, Vong Street, Hai Ba Trung District, Hanoi, Vietnam
| | - Corrina Moucheraud
- Department of Health Policy and Management, University of California Los Angeles, Fielding School of Public Health, 650 Charles E. Young Dr. South, Los Angeles, CA 90095-1772, USA
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Hanley-Cook G, Argaw A, Dahal P, Chitekwe S, Kolsteren P. Infant and young child feeding practices and child linear growth in Nepal: Regression-decomposition analysis of national survey data, 1996-2016. MATERNAL AND CHILD NUTRITION 2020; 18 Suppl 1:e12911. [PMID: 31922348 PMCID: PMC8770650 DOI: 10.1111/mcn.12911] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/09/2019] [Accepted: 10/17/2019] [Indexed: 11/30/2022]
Abstract
Suboptimal infant and young child feeding (IYCF) practices have profound implications on child survival, health, growth, and development. First, our study analysed trends in 18 IYCF indicators and height‐for‐age z‐score (HAZ) and stunting prevalence across Nepal's Family Health Survey 1996 and four rounds of Nepal Demographic and Health Surveys from 2001–2016. Second, we constructed multivariable regression models and decomposed the contribution of optimal IYCF practices on HAZ and stunting prevalence over the 1996–2016 period. Our findings indicate that most age‐appropriate IYCF practices and child linear growth outcomes improved over the past two decades. At present, according to the World Health Organization's tool for national assessment of IYCF practices, duration of breastfeeding is rated very good, early initiation of breastfeeding and exclusive breastfeeding (EBF) are rated good, whereas minimal bottle‐feeding and introduction of solid, semi‐solid or soft foods are rated fair. Our study also reports that a paucity of age‐appropriate IYCF practices—in particular complementary feeding—are significantly associated with increased HAZ and decreased probability of stunting (p < .05). Moreover, age‐appropriate IYCF practices—in isolation—made modest statistical contributions to the rapid and sustained reduction in age‐specific child linear growth faltering from 1996–2016. Nevertheless, our findings indicate that comprehensive multisectoral nutrition strategies—integrating and advocating optimal IYCF—are critical to further accelerate the progress against child linear growth faltering. Furthermore, specific focus is needed to improve IYCF practices that have shown no significant development over the past two decades in Nepal: EBF, minimum acceptable diet, and minimal bottle‐feeding.
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Affiliation(s)
- Giles Hanley-Cook
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Alemayehu Argaw
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium.,Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Pradiumna Dahal
- Nutrition Section, United Nations Children's Fund (UNICEF), Kathmandu, Nepal
| | - Stanley Chitekwe
- Nutrition Section, United Nations Children's Fund (UNICEF), Kathmandu, Nepal
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
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Benedict RK, Craig HC, Torlesse H, Stoltzfus RJ. Trends and predictors of optimal breastfeeding among children 0-23 months, South Asia: Analysis of national survey data. MATERNAL AND CHILD NUTRITION 2019; 14 Suppl 4:e12698. [PMID: 30499250 PMCID: PMC6519202 DOI: 10.1111/mcn.12698] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Optimal breastfeeding practices, including early initiation of breastfeeding (EIBF) within 1 hr of birth, exclusive breastfeeding (EBF) for the first 6 months of age, and continued breastfeeding (CBF) for 2 years of age or beyond with appropriate complementary foods, are essential for child survival, growth, and development. Breastfeeding norms differ within and between countries in South Asia, and evidence is needed to inform actions to protect, promote, and support optimal practices. This study examines time trends and predictors of EIBF, avoidance of prelacteal feeding (APF), EBF, and CBF to 2 years using survey data from Afghanistan, Bangladesh, India, Nepal, and Pakistan since 1990. EIBF, APF, and EBF increased in Bangladesh, India, and Nepal from 1990 to 2016. EIBF and EBF increased in Pakistan from 1990 to 2013, but both EIBF and APF decreased in recent years. In Afghanistan, EIBF, APF, and EBF decreased from 2010 to 2015. CBF remained fairly constant across the region although prevalence varied by country. Significant (p < 0.05) predictors of suboptimal practices included caesarian delivery (4-25%), home delivery, small size at birth, and low women's empowerment. Wealth, ethnic group, and caste had varied associations with breastfeeding. Progress towards optimal breastfeeding practices is uneven across the region and is of particular concern in Afghanistan and Pakistan. There are some common predictors of breastfeeding practices across the region, however country-specific predictors also exist. Policies, programs, and research should focus on improving breastfeeding in the context of women's low empowerment and strategies to support breastfeeding of infants born small or by caesarian section, in addition to country-specific actions.
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Affiliation(s)
- Rukundo K Benedict
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA.,The DHS Program, ICF International, Rockville, Maryland, USA
| | - Hope C Craig
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
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10
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Torlesse H, Aguayo VM. Aiming higher for maternal and child nutrition in South Asia. MATERNAL AND CHILD NUTRITION 2019; 14 Suppl 4:e12739. [PMID: 30499249 PMCID: PMC6588023 DOI: 10.1111/mcn.12739] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 12/31/2022]
Abstract
The sustainable development of nations relies on children developing to their full potential and leading healthy, productive, and prosperous lives. Poor nutrition in early life threatens the growth and development of children, especially so in South Asia, which has the highest burdens of stunting, wasting, and anaemia in the world. Targeted actions to reduce stunting and other forms of child malnutrition in South Asia should be informed by an understanding of what drives poor nutrition in children, who is most affected, and effective programme approaches. To this end, the UNICEF Regional Office for South Asia commissioned a series of papers in 2016–2017 to fill knowledge gaps in the current body of evidence on maternal and child nutrition in South Asia, including analyses of: (a) the links between anthropometric failure in children and child development; (b) the time trends, current distribution, disparities and inequities of child stunting, wasting and anaemia, and their direct and underlying causes, including maternal anaemia, low birth weight, breastfeeding, and complementary feeding; (c) policy and programme actions to increase the coverage of nutrition interventions during pregnancy, improve breastfeeding practices, and care for severely wasted children. This overview paper summarizes the evidence from these analyses and examines the implications for the direction of future advocacy, policy, and programme actions to improve maternal and child nutrition in South Asia.
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Affiliation(s)
- Harriet Torlesse
- Nutrition Section, UNICEF Regional Office for South Asia, Kathmandu, Nepal
| | - Víctor M Aguayo
- Nutrition Section, Programme Division, UNICEF, New York, New York
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George A, LeFevre AE, Jacobs T, Kinney M, Buse K, Chopra M, Daelmans B, Haakenstad A, Huicho L, Khosla R, Rasanathan K, Sanders D, Singh NS, Tiffin N, Ved R, Zaidi SA, Schneider H. Lenses and levels: the why, what and how of measuring health system drivers of women's, children's and adolescents' health with a governance focus. BMJ Glob Health 2019; 4:e001316. [PMID: 31297255 PMCID: PMC6590975 DOI: 10.1136/bmjgh-2018-001316] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/16/2019] [Accepted: 02/15/2019] [Indexed: 11/18/2022] Open
Abstract
Health systems are critical for health outcomes as they underpin intervention coverage and quality, promote users’ rights and intervene on the social determinants of health. Governance is essential for health system endeavours as it mobilises and coordinates a multiplicity of actors and interests to realise common goals. The inherently social, political and contextualised nature of governance, and health systems more broadly, has implications for measurement, including how the health of women, children and adolescents health is viewed and assessed, and for whom. Three common lenses, each with their own views of power dynamics in policy and programme implementation, include a service delivery lens aimed at scaling effective interventions, a societal lens oriented to empowering people with rights to effect change and a systems lens concerned with creating enabling environments for adaptive learning. We illustrate the implications of each lens for the why, what and how of measuring health system drivers across micro, meso and macro health systems levels, through three examples (digital health, maternal and perinatal death surveillance and review, and multisectoral action for adolescent health). Appreciating these underpinnings of measuring health systems and governance drivers of the health of women, children and adolescents is essential for a holistic learning and action agenda that engages a wider range of stakeholders, which includes, but also goes beyond, indicator-based measurement. Without a broadening of approaches to measurement and the types of research partnerships involved, continued investments in the health of women, children and adolescents will fall short.
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Affiliation(s)
- Asha George
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | | | - Tanya Jacobs
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Mary Kinney
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Kent Buse
- Political Affairs and Strategy, UNAIDS, Geneva, Switzerland
| | | | | | - Annie Haakenstad
- School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Luis Huicho
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rajat Khosla
- United Nations High Commission for Human Rights, Geneva, Switzerland
| | | | - David Sanders
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Neha S Singh
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Nicki Tiffin
- Centre for Infectious Disease Research in Africa, University of Cape Town, Cape Town, South Africa.,Computational Biology, University of Cape Town, Cape Town, South Africa
| | - Rajani Ved
- National Health Systems Resource Centre, New Delhi, India
| | - Shehla Abbas Zaidi
- Community Health Sciences, Aga Khan University Faculty of Health Sciences, Karachi, Pakistan
| | - Helen Schneider
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Bhandari S, Thorne-Lyman AL, Shrestha B, Neupane S, Nonyane BAS, Manohar S, Klemm RDW, West KP. Determinants of infant breastfeeding practices in Nepal: a national study. Int Breastfeed J 2019; 14:14. [PMID: 30988689 PMCID: PMC6448244 DOI: 10.1186/s13006-019-0208-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 03/21/2019] [Indexed: 01/08/2023] Open
Abstract
Background Optimal breastfeeding practices, reflected by early initiation and feeding of colostrum, avoidance of prelacteal feeds, and continued exclusivity or predominance of breastfeeding, are critical for assuring proper infant nutrition, growth and development. Methods We used data from a nationally representative survey in 21 district sites across the Mountains, Hills and Terai (southern plains) of Nepal in 2013. Determinants of early initiation of breastfeeding, feeding of colostrum, prelacteal feeding and predominant breastfeeding were explored in 1015 infants < 12 months of age. Prelacteal feeds were defined as food/drink other than breast milk given to newborns in first 3 days. Predominant breastfeeding was defined as a child < 6 months of age is mainly breastfed, not fed solid/semi-solid foods, infant formula or non-human milk, in the past 7 days. Adjusted prevalence ratios (APR) and 95% confidence intervals (CI) were estimated, using log Poisson regression models with robust variance for clustering. Results The prevalence of breastfeeding within an hour of birth, colostrum feeding, prelacteal feeding and predominant breastfeeding was 41.8, 83.5, 32.7 and 57.2% respectively. Compared to infants not fed prelacteal feeds, infants given prelacteal feeds were 51% less likely to be breastfed within the first hour of birth (APR 0.49; 95% CI 0.36, 0.66) and 55% less likely to be predominantly breastfed (APR 0.45; 95% CI 0.32, 0.62). Infants reported to have received colostrum were more likely to have begun breastfeeding within an hour of birth (APR 1.26; 95% CI 1.04, 1.54) compared to those who did not receive colostrum. Infants born to mothers ≥ 20 years of age were less likely than adolescent mothers to initiate breastfeeding within 1 hour of birth. Infants in the Terai were 10% less likely to have received colostrum (APR 0.90; 95% CI 0.83, 0.97) and 2.72 times more likely to have received prelacteal feeds (APR 2.72; 95% CI 1.67, 4.45) than those in the Mountains. Conclusions Most infants in Nepal receive colostrum but less than half initiate breastfeeding within an hour of birth and one-third are fed prelacteal feeds, which may negatively affect breastfeeding and health throughout early infancy. Electronic supplementary material The online version of this article (10.1186/s13006-019-0208-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shiva Bhandari
- PoSHAN Study Team, Lalitpur, Nepal.,2Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Andrew L Thorne-Lyman
- 3Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | | | | | - Bareng Aletta Sanny Nonyane
- 3Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Swetha Manohar
- 3Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Rolf D W Klemm
- 3Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA.,4Helen Keller International, New York, NY USA
| | - Keith P West
- 3Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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13
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Menon P, Thow AM. Strengthening policy research on infant and young child feeding: An imperative to support countries in scaling up impact on nutrition. BMC Public Health 2017; 17:420. [PMID: 28675129 PMCID: PMC5496068 DOI: 10.1186/s12889-017-4335-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Enabling policy environments for nutrition require require evidence to support best practice and engagement with political and policy contexts, as well as leadership, resourcing, advocacy, and technical support. However, research on nutrition policy contexts is limited. The papers in this special supplement on policy contexts for infant and young child feeding (IYCF) in South Asia makes a valuable contribution to understanding the policy landscape and political dynamics in the region and the global literature. Studies included in this special supplement analyzed policy content and stakeholder influence on IYCF in Bangladesh, India, Nepal, Pakistan and Sri Lanka, and assess the role of advocacy in addressing multiple elements of the policy environment. These analyses highlight opportunities to harmonize and manage the demands and interests of multiple actors while strengthening policy to strategically support optimal IYCF as the ultimate goal. They also provide robust examples of research on policy environments and policy change. Further investments in research on policy contexts for nutrition can help to understand and support continued progress towards improved actions for nutrition.
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Affiliation(s)
- Purnima Menon
- International Food Policy Research Institute, New Delhi, India.
| | - Anne Marie Thow
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, Australia
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