1
|
Schneider L, Korhonen K, Ollila S, Mutanen M. Social realities in remote villages: Infant and young child feeding in Kirewa, Uganda. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003016. [PMID: 39255291 PMCID: PMC11386423 DOI: 10.1371/journal.pgph.0003016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 08/09/2024] [Indexed: 09/12/2024]
Abstract
Understanding infant and young child feeding (IYCF) practices in Africa requires an examination of the social context. Social relationships influence people through mechanisms such as social support, social influence, social engagement, access to resources and negative social interactions. This study explores how these mechanisms manifest in IYCF in remote villages in Uganda. In 2018, we conducted two focus group discussions each with mothers, fathers and grandparents, ande interviews with two clan leaders, six village health teamers (VHT) and four healthcare workers (HCW). We deductively searched the data for any indications of elements that could influence child feeding and health using the psychosocial mechanisms of social support, social influence, social engagement, access to resources and negative social interactions as the broader themes. The manifestation of social support involved practical help from mothers-in-law (MIL), financial contributions from fathers, and informational, instrumental, emotional and appraisal support from VHTs. Social influence by MILs mainly concerned the transmission of food-related beliefs and pressure to have many children. The social engagement of young mothers was restricted. Access to resources was stratified and affected by poverty, patriarchy, and knowledge of HCWs and VHTs. Negative social interactions included physical abuse, alcoholism, and fear-based relationships. We found the different psychosocial mechanisms to construct a useful framework for describing the social reality surrounding IYCF. Changing attitudes towards family planning, involving fathers in IYCF, and strengthening the position of VHTs as family advisers can potentially improve IYCF in rural Uganda.
Collapse
Affiliation(s)
- Lauriina Schneider
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Katja Korhonen
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Sari Ollila
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Marja Mutanen
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| |
Collapse
|
2
|
Jeong J, McCann JK, Bhojani A, Kim Y, Uyehara M, Maguet Z, Ochuka W, Ochieng M. Process evaluation of the initial implementation of the Moments that Matter parenting program in Kenya. Ann N Y Acad Sci 2024. [PMID: 39217503 DOI: 10.1111/nyas.15212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
The Moments that Matter® parenting program aims to promote nurturing care and healthy early childhood development (ECD) through monthly home visits and monthly community group meetings that are delivered by ECD promoters and coordinated with faith leaders in rural Western Kenya. We designed a process evaluation in August 2023 during the first quarter of program implementation. We conducted in-depth interviews and focus group discussions with caregivers, ECD promoters, faith leaders, and program staff to capture their program experiences, assess program quality, and explore the implementation barriers and facilitators during this early stage of program roll-out. Although ECD promoters delivered the program with fidelity, the roles and responsibilities of faith leaders were relatively weaker and inconsistent. Key facilitators of quality implementation included visual aids of key messages and supportive supervision. Barriers included a lack of clarity about faith leaders' roles and relatively long group session duration. We highlight several key recommendations for improving fidelity, quality, and eventual program effects with respect to enhancing nurturing care and early child development. Overall, our study showcases how a process evaluation conducted during the early phase of program implementation can reveal practical insights that can be used to inform program adaptations and quality improvement.
Collapse
Affiliation(s)
- Joshua Jeong
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Juliet K McCann
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Alina Bhojani
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Yuri Kim
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Malia Uyehara
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Zane Maguet
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | | |
Collapse
|
3
|
Fletcher R, Forbes F, Dadi AF, Kassa GM, Regan C, Galle A, Beyene A, Liackman R, Temmerman M. Effect of male partners' involvement and support on reproductive, maternal and child health and well-being in East Africa: A scoping review. Health Sci Rep 2024; 7:e2269. [PMID: 39086507 PMCID: PMC11286546 DOI: 10.1002/hsr2.2269] [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: 11/17/2023] [Revised: 06/23/2024] [Accepted: 07/16/2024] [Indexed: 08/02/2024] Open
Abstract
Background and Aims East African countries have high rates of maternal and child mortality and morbidity. Studies have shown that the involvement of male partners in reproductive health can benefit maternal and child health (MCH). This scoping review aims to provide an overview of the evidence across East Africa that describes male partner involvement and its effect on maternal, reproductive, and child well-being. Methods Ten databases were searched to identify quantitative data on male's involvement in East Africa. Studies reporting qualitative data, "intention to use" data or only reporting on male partner's education or economic status were excluded. Studies were organized into five a priori categories: antenatal care (ANC), human immunodeficiency virus, breastfeeding, family planning, and intimate partner violence with further categories developed based on studies included. Results A total of 2787 records were identified; 644 full texts were reviewed, and 96 studies were included in this review. Data were reported on 118,967 mothers/pregnant women and 15,361 male partners. Most of the studies (n = 83) were reported from four countries Ethiopia (n = 49), Kenya (n = 14), Tanzania (n = 12) and Uganda (n = 10). The evidence indicates that male partner involvement and support is associated with improved reproductive, MCH across a wide range of outcomes. However, the studies were heterogeneous, using diverse exposure and outcome measures. Also, male partners' lack of practical and emotional support, and engagement in violent behaviors towards partners, were associated with profound negative impacts on MCH and well-being. Conclusions The body of evidence, although heterogeneous, provides compelling support for male involvement in reproductive health programs designed to support MCH. To advance research in this field, an agreement is needed on a measure of male partner "involvement." To optimize benefits of male partners' involvement, developing core outcome sets and regional coordination are recommended.
Collapse
Affiliation(s)
- Richard Fletcher
- College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNew South WalesAustralia
| | - Faye Forbes
- College of Health SciencesDebre Markos UniversityDebre MarkosEthiopia
- Global and Women's Health Unit, School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Abel Fekadu Dadi
- Menzies School of Health ResearchCharles Darwin University, NT, Australia & Addis Continental Institute of Public HealthAddis AbabaEthiopia
| | | | - Casey Regan
- College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNew South WalesAustralia
| | - Anna Galle
- Department Public Health and Primary CareInternational Centre for Reproductive Health, Ghent UniversityGhentBelgium
| | - Addisu Beyene
- School of Public Health, College of Health and Medical SciencesHaramaya UniversityHararEthiopia
- Centre for Women's Health Research, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleAustralia
| | - Rebecca Liackman
- College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNew South WalesAustralia
| | - Marleen Temmerman
- Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
- Centre of Excellence in Women and Child HealthAga Khan UniversityNairobiKenya
| |
Collapse
|
4
|
Tewodros T, Escobar CX, Berra LS, Webb Girard A. Effectiveness of Elements of Social Behavior Change Activities in Nutrition-Sensitive Agriculture Programs: A Systematic Review. Curr Dev Nutr 2024; 8:104420. [PMID: 39224142 PMCID: PMC11367542 DOI: 10.1016/j.cdnut.2024.104420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 06/28/2024] [Accepted: 07/17/2024] [Indexed: 09/04/2024] Open
Abstract
Background Limited research exists on the specific approaches and behavior change techniques (BCT) used in nutrition-sensitive agriculture (NSA) programs and their effects on diet diversity. Objectives We aimed to describe nutrition-related social behavior change (SBC) in the context of NSA and quantify the effectiveness of different SBC components of NSA programs in improving diet diversity. Methods We searched PubMed, Embase, Web of Science, the International Food Policy and Research Institute repository, and Agricola for articles published between 2000 and 2023. We identified the agricultural activities each project used as a pathway to improved nutrition (ag-nutrition pathways), identified SBC approaches used by each project, and coded BCTs using validated coding protocols. Effectiveness ratios (ERs) were calculated to assess pathways, approaches, and BCTs in relation to dietary diversity outcomes (minimum diet diversity for children, child dietary diversity score, and women's dietary diversity). Results Of 65 included NSA interventions, the most used agriculture-to-nutrition pathways included 1) agricultural production for home consumption (n = 61); 2) women's empowerment (n = 36); and 3) agricultural income (n = 37) pathways. The most used SBC approaches were interpersonal communication (IPC, n = 59) and community-based approaches (n = 53). Frequently used BCTs included "instructions on how to perform the behavior" (n = 65), "social support (unspecified)" (n = 43), and using a "credible source" (n = 43). The increased production for the home consumption pathway, IPC approach, and the BCT "behavioral practice" had high ERs for diet diversity outcomes. Conclusions Although the agricultural production for home consumption pathway to improved nutrition had the highest ERs for diet diversity, other pathways, such as income generation and reducing wastage, hold promise and require additional investigation. The most commonly applied BCTs focused on information dissemination; however, participatory BCTs related to behavioral demonstration, and behavioral practice had higher ERs. Findings indicate a need to test less frequently utilized SBC components to determine effectiveness.This trial was registered at PROSPERO (=https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=179016) as CRD42020179016.
Collapse
Affiliation(s)
- Tsedenia Tewodros
- Hubert Department of Global Health, Rollins School of Public Health at Emory University, Atlanta, GA, United States
| | - Carolina X Escobar
- Hubert Department of Global Health, Rollins School of Public Health at Emory University, Atlanta, GA, United States
| | - Liris S Berra
- Hubert Department of Global Health, Rollins School of Public Health at Emory University, Atlanta, GA, United States
| | - Amy Webb Girard
- Hubert Department of Global Health, Rollins School of Public Health at Emory University, Atlanta, GA, United States
- Nutrition and Health Sciences, Emory University, Atlanta, GA, United States
| |
Collapse
|
5
|
Gale NK, Ahmed K, Diarra NH, Manaseki-Holland S, Asamane E, Sidibé CS, Touré O, Wilson M, Griffiths P. Coproduced, arts interventions for nurturing care (0-5 years) in low-income and middle-income countries (LMICs): a realist review. BMJ Open 2024; 14:e083093. [PMID: 38762222 PMCID: PMC11103195 DOI: 10.1136/bmjopen-2023-083093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/23/2024] [Indexed: 05/20/2024] Open
Abstract
OBJECTIVES Community-based arts interventions have the potential to support contextually relevant nurturing care programmes and policies that adapt to different settings. Understanding the distinctive features of using the arts in local, culturally specific ways in low/middle-income countries (LMICs); how this varies by context; and gaining a better understanding of the perspectives on desirable outcomes for communities is important evidence that this review generates. DESIGN We conducted a realist review of papers that covered outcomes related to child health or development (0-5 years) AND arts-based approaches AND community-based, participatory approaches AND based in LMICs using a range of databases and other networks. A coding framework was developed covering context, intervention, outcomes, mechanisms, study, sustainability, transferability and scalability. RESULTS The included papers reported 18 unique interventions. Interventions covered 14 countries, with evidence lacking for South America, Arab countries and parts of Africa. Lead authors came from mostly clinical science-based disciplines and from institutions in a different country to the country/countries studied. Intended outcomes from interventions included clinical, health systems/organisation, changes in practices/behaviours/knowledge/attitudes, and wider social and educational goals. We identified three demi-regularities (semi-predictable patterns or pathways of programme functioning): participatory design based on valuing different sources of expertise; dynamic adaptation of intervention to context; and community participation in arts-based approaches. CONCLUSIONS Our findings suggest that arts-based, nurturing care interventions have greater potential when they include local knowledge, embed into existing infrastructures and there is a clear plan for ongoing resourcing of the intervention. Studies with better documentation of the lessons learnt, regarding the intervention delivery process and the power dynamics involved, are needed to better understand what works, for whom and in which contexts.
Collapse
|
6
|
Dougherty L, Dadi C. Application of the integrated gateway model on child nutrition behaviors in Niger: An exploratory analysis. PLoS One 2024; 19:e0297466. [PMID: 38558005 PMCID: PMC10984541 DOI: 10.1371/journal.pone.0297466] [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: 08/26/2023] [Accepted: 01/05/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE To identify potential gateway factors and behaviors that are associated with infant and young child feeding (IYCF) practices in the Maradi and Zinder regions of Niger through application of the Integrated Gateway Model. METHODS We analyzed data from 2,727 married women of reproductive age including details on child feeding practices for their 2,551 children between the ages of 0 to 23 months. We assessed the association of three gateway behaviors (i.e., any antenatal care, facility delivery, and communication on nutrition practices) and gateway factors (i.e., behavioral determinants, exposure to information, decision-making agency, and woman's group participation) on four IYCF practices (i.e., early initiation of breastfeeding, exclusive breastfeeding, minimum meal frequency, and minimum dietary diversity) while controlling for age, parity, educational attainment, and household wealth. RESULTS We found antenatal care was associated with exclusive breastfeeding of children 0-5 months [adjusted odds ratio (aOR): 1.17 (95% confidence interval (CI): 1.03-1.33)], and minimum meal frequency of children 6-23 months [aOR: 1.10 (95% CI: 1.03-1.17)], and facility delivery was associated with early initiation of breastfeeding among children 0-5 months [aOR: 2.08 (95% CI: 1.39-3.12)]. We found negative associations with exclusive breastfeeding and communication on nutrition practices with husbands, family/friends, and health workers. Exposure to nutrition messages through radio, women's groups participation, and with health workers was positively associated with minimum dietary diversity. Self-efficacy was positively associated with both early initiation of breastfeeding, exclusive breastfeeding among children 0-5 months and minimum dietary diversity among children 6-23 months. Women's agency was positively associated with early initiation of breastfeeding. CONCLUSION The association of antenatal care and facility delivery with child nutrition outcomes suggest intervening before a woman becomes pregnant or early in her pregnancy could improve nutrition outcomes. Programs strengthening the continuum of care should identify gateway behaviors to maximize adoption of priority health behaviors.
Collapse
Affiliation(s)
| | - Chaibou Dadi
- Conception Etudes Suivi Evaluation Appuis Formation, Niamey, Niger
| |
Collapse
|
7
|
Komakech JJ, Emerson SR, Cole KL, Walters CN, Rakotomanana H, Kabahenda MK, Hildebrand DA, Stoecker BJ. Care groups in an integrated nutrition education intervention improved infant growth among South Sudanese refugees in Uganda's West Nile post-emergency settlements: A cluster randomized trial. PLoS One 2024; 19:e0300334. [PMID: 38489346 PMCID: PMC10942045 DOI: 10.1371/journal.pone.0300334] [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: 05/24/2023] [Accepted: 02/21/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE This study examined the effects of a peer-led integrated nutrition education intervention with maternal social support using Care Groups on infant growth among South Sudanese refugees in Uganda. METHODS A community-based cluster-randomized trial (RCT) was conducted among 390 pregnant women (third trimester). Two intervention study arms were Mothers-only(n = 131) and Parents-combined (n = 142) with a Control (n = 117). WHO infant growth standards defined length-for-age z-scores (LAZ) for stunting, weight-for-age z-scores (WAZ) for underweight and weight-for-length z-scores (WLZ) for wasting. The Medical Outcomes Study (MOS) social support index was a proxy measure for social support. A split-plot ANOVA tested the interaction effects of social support, intervention, and time on infant growth after adjusting for covariates. Further, pairwise comparisons explained mean differences in infant growth among the study arms. RESULTS The mean infant birth weight was 3.1 ± 0.5 kg. Over the study period, infant stunting was most prevalent in the Control (≥ 14%) compared to Mothers-only (< 9.5%) and Parents-combined (< 7.4%) arms. There were significant interaction effects of the Care Group intervention and social support by time on infant mean LAZ (F (6, 560) = 28.91, p < 0.001), WAZ (F (5.8, 539.4) = 12.70, p = < 0.001) and WLZ (F (5.3, 492.5) = 3.38, p = 0.004). Simple main effects by the end of the study showed that the intervention improved infant mean LAZ (Mothers-only vs. Control (mean difference, MD) = 2.05, p < 0.001; Parents-combined vs. Control, MD = 2.00, p < 0.001) and WAZ (Mothers-only vs. Control, MD = 1.27, p < 0.001; Parents-combined vs. Control, MD = 1.28, p < 0.001). CONCLUSION Maternal social support with an integrated nutrition education intervention significantly improved infant stunting and underweight. Nutrition-sensitive approaches focused on reducing child undernutrition among post-emergency refugees may benefit from using Care Groups in programs. TRIAL REGISTRATION Clinicaltrials.gov, NCT05584969.
Collapse
Affiliation(s)
- Joel J. Komakech
- Department of Food Science, Nutrition, and Health Promotion, Mississippi State University, Starkville, Mississippi, United States of America
| | - Sam R. Emerson
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, United States of America
| | - Ki L. Cole
- Research, Evaluation, Measurement, and Statistics Department, Oklahoma State University, Stillwater, OK, United States of America
| | - Christine N. Walters
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, United States of America
| | - Hasina Rakotomanana
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, United States of America
| | | | - Deana A. Hildebrand
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, United States of America
| | - Barbara J. Stoecker
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, United States of America
| |
Collapse
|
8
|
Melnick EM, Doom JR. "Associations between maternal perceptions of social support and adolescent weight status: A longitudinal analysis". SSM Popul Health 2024; 25:101647. [PMID: 38495803 PMCID: PMC10943960 DOI: 10.1016/j.ssmph.2024.101647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/12/2024] [Accepted: 02/27/2024] [Indexed: 03/19/2024] Open
Abstract
Social support is a well-established predictor of improved physical health outcomes among adults. Establishing whether maternal social support may have an inter-generational positive impact on their child's physical health will provide important information for developing potential interventions and policies. Elevated body mass index (BMI) is one indicator of child health that is linked to increased risk for cardiovascular disease and other morbidities later in life. There is some evidence that maternal social support is associated with improved child and adolescent weight status; however, no studies have examined whether specific aspects of social support are more impactful than others or whether support availability is differentially impactful across developmental stages. The present study examined whether maternal perceptions of specific types of social support (i.e., financial support, non-monetary instrumental support, partner emotional support, and having a close supportive contact) were associated with lower adolescent BMI z-scores using longitudinal data collected over a 15-year period from the Future of Families and Child Wellbeing Study (n = 3146), which includes a high proportion of families experiencing socioeconomic disadvantage. Findings from linear regression models using specific types of social support measured across six waves of data collected over a 15-year period indicated that maternal perceptions of greater financial support were associated with lower adolescent BMI z-scores at 15 years (B = -0.05, 95% CI: -0.10, -0.004, P = 0.04), while the other types of support were not. Additional timing analyses demonstrated that perceived financial support during late childhood to adolescence was associated with lower adolescent BMI z-scores (B = -0.06, 95% CI: -0.11, -0.01, P = 0.01), whereas associations between support during infancy and early childhood were not detected. Study findings provide important insights for developing interventions and policies that improve maternal social supports to benefit child health.
Collapse
Affiliation(s)
- Emily M. Melnick
- Department of Psychiatry, University of Colorado Anschutz, 13001 E 17th Pl, Aurora, CO, 80045, USA
- Department of Psychology, University of Denver, 2155 S. Race St., Denver, CO, 80210, USA
| | - Jenalee R. Doom
- Department of Psychology, University of Denver, 2155 S. Race St., Denver, CO, 80210, USA
| |
Collapse
|
9
|
Kimiywe J, Craig H, Agyapong A, Thorne‐Lyman A, Matsisa P, Kiige L, Codjia P, Rudert C, Katua S, Wambu R, Samburu B, Kamudoni P, Chimanya K, Nordhagen S. Diets of infants and young children in two counties of Kenya: Key drivers and barriers to improvement. MATERNAL & CHILD NUTRITION 2024; 20 Suppl 3:e13334. [PMID: 36468358 PMCID: PMC10782136 DOI: 10.1111/mcn.13334] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/28/2022] [Accepted: 02/04/2022] [Indexed: 12/11/2022]
Abstract
Infant and young child feeding (IYCF) practices are influenced by many context-specific factors related to local food systems as well as social and cultural practices. Understanding these local contextual perspectives is essential for designing effective programs and policies. This paper uses focused ethnographic study methods to examine challenges experienced by mothers related to IYCF in two counties in Kenya, a country with considerable heterogeneity in agriculture, food systems, and cultures. A two-phase qualitative study was undertaken in each of Kilifi County and West Pokot County, entailing interviews and rating activities with mothers, health workers, and vendors. Interviews were audio-recorded, transcribed, translated into English, coded, and analysed by topic. Results show low levels of dietary diversity in both counties; in West Pokot, the level of adequate meal frequency is also low. Core foods in young child diets included maize porridge and family foods such as ugali (stiff maize porridge), vegetables, beans, fish, and plantains. Food safety, acceptability, and acquisition ease were the main drivers of food choice. Mothers generally felt that all core foods fed to young children are healthy and safe, but there was more variability regarding child acceptance, acquisition ease, cost, and convenience. Common barriers to feeding nutrient-dense foods to children included child illness, economic constraints, and limited knowledge of modification strategies, skills, or tools to make the foods suitable for young children. Potential actions to address these barriers include sharing information on child-appropriate recipes; raising awareness on local, affordable nutrient-dense foods; and improving WASH practices to reduce illness frequency.
Collapse
Affiliation(s)
- Judith Kimiywe
- Department of Food, Nutrition and DieteticsKenyatta University School of Public Health and Applied Human SciencesNairobiKenya
| | - Hope Craig
- Department of International HealthCenter for Human Nutrition, Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Abigail Agyapong
- College of Agriculture and Life SciencesCornell UniversityIthacaNew YorkUSA
| | - Andrew Thorne‐Lyman
- Department of International HealthCenter for Human Nutrition, Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of International HealthCenter for a Livable Future, Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Patrick Matsisa
- Department of Mathematics and StatisticsJomo Kenyatta University of Agriculture and TechnologyNairobiKenya
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Lowe A, Callis A, DiGirolamo A, Girard AW, Boakye A, Ogutu E, Omosa E, Okeyo F, Odollo L, Samburu B, Arimi C, Kamudoni P, Gonzalez W, Codjia P, Kiige L. Evidence-based complementary feeding recipe book for Kenyan caregivers: A novel approach. MATERNAL & CHILD NUTRITION 2024; 20 Suppl 3:e13475. [PMID: 37789710 PMCID: PMC10782138 DOI: 10.1111/mcn.13475] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/28/2022] [Accepted: 01/05/2023] [Indexed: 10/05/2023]
Abstract
The Kenyan Ministry of Health (MOH) and a consortium of nutritionists, researchers and communication, and design specialists developed a novel approach to create an evidence-based recipe book promoting complementary feeding (CF) in Kenya. The ADAPT approach includes five steps: applied research (A), dialogue with stakeholders (D), adapted behaviour change communication (BCC) theories (A), purpose-driven visual communication (P), and tailoring to priority audiences (T). Through this approach, the recipe book addresses key knowledge gaps using behaviour change theories and visual communication best practice to increase accessibility, acceptability, retention and motivation for behaviour change. The book addresses barriers to CF identified through formative applied research. Dialogue with stakeholders helped ensure cultural appropriateness and the book's alignment with MOH recommendations and key messages. The book uses behaviour change theories to approach the reader in a respectful way that motivates behaviour change. The use of consistent, purpose-driven visuals helps ensure key messages are easily understood and accessible to all caregivers regardless of literacy level. The book's tone and content are tailored to its audiences' attributes, needs and preferences. This five-step process inspired the development of ADAPT, a novel approach that integrates behaviour change and visual communication for greater impact. This paper outlines how the consortium used the ADAPT approach to develop an evidence-based book that thoughtfully and holistically addresses a wide range of barriers, provides practical solutions and increases self-efficacy around CF. It offers a blueprint for public health practitioners from any field who are interested in using visual behaviour change communication to promote healthy behaviour.
Collapse
Affiliation(s)
- Alyssa Lowe
- Georgia Health Policy CenterGeorgia State UniversityAtlantaGeorgiaUSA
| | | | - Ann DiGirolamo
- Georgia Health Policy CenterGeorgia State UniversityAtlantaGeorgiaUSA
| | - Amy W. Girard
- Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
| | - Amma Boakye
- Georgia Health Policy CenterGeorgia State UniversityAtlantaGeorgiaUSA
| | - Emily Ogutu
- Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
| | - Esther Omosa
- International Livestock Research InstituteNairobiKenya
| | - Frida Okeyo
- Department of Community Health and Development, School of Public HealthGreat Lakes University of KisumuNairobiKenya
| | - Lawrence Odollo
- Department of Community Health and Development, School of Public HealthGreat Lakes University of KisumuNairobiKenya
| | - Betty Samburu
- United Nations Children's Fund Kenya Country OfficeNairobiKenya
| | | | | | | | - Patrick Codjia
- United Nations Children's Fund Kenya Country OfficeNairobiKenya
| | - Laura Kiige
- United Nations Children's Fund Kenya Country OfficeNairobiKenya
| |
Collapse
|
11
|
Ajike SO, Oloyede BL. Determinants of child survival practice among caregivers in internally displaced persons' camps in Abuja Municipal Area Council, Nigeria. Child Care Health Dev 2024; 50:e13201. [PMID: 37950536 DOI: 10.1111/cch.13201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/23/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Child survival remains a major public health challenge in the sub-Saharan region of Africa, especially Nigeria. The Boko Haram crisis, which has aggravated this, has led to the displacement of many people in the north-eastern region, including children under five. This study investigated the determinants of child survival practice among caregivers in internally displaced persons' (IDP) camps in Abuja Municipal Area Council (AMAC), Nigeria. METHODOLOGY A cross-sectional design was used to collect data on determinants of child survival practice from 312 caregivers in five purposively selected IDP camps in AMAC using the snowball sampling technique. Data were analysed using univariate, bivariate, and multivariate statistics at 5% level of significance. RESULTS The mean age of respondents was 29.6 ± 6.72 years. There was a significant (p < 0.05) relationship between the predisposing, reinforcing, enabling and environmental factors studied and child survival practice. Findings also indicated that all factors were significant (p < 0.05) predictors of child survival practice with the reinforcing factor being the major predictor (ß = 0.38; t = 6.08). CONCLUSION Attention needs to be paid to all factors, particularly the reinforcing factor of social support in order to promote optimal child survival practice among caregivers in AMAC IDP camps. Collaboration with social work professionals would be an added benefit to enhance social support.
Collapse
Affiliation(s)
- Saratu Omagbemi Ajike
- Department of Public Health, School of Public and Allied Health, Babcock University, Ilishan-Remo, Ogun State, Nigeria
| | - Busola Loveall Oloyede
- Department of Public Health, School of Public and Allied Health, Babcock University, Ilishan-Remo, Ogun State, Nigeria
| |
Collapse
|
12
|
Schnefke CH, Flax VL, Ubanmhen F, Alayon S, Bose S, Daniel O, Grimes KEL, Allotey D, Seiger ER, Arije O. Attitudes, beliefs and social norms regarding infant and young child feeding among Nigerian mothers, fathers and grandmothers across time. MATERNAL & CHILD NUTRITION 2023; 19:e13524. [PMID: 37173816 PMCID: PMC10483957 DOI: 10.1111/mcn.13524] [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: 09/19/2022] [Revised: 03/27/2023] [Accepted: 04/12/2023] [Indexed: 05/15/2023]
Abstract
Infant and young child feeding (IYCF) interventions in low-resource countries mainly target pregnant women and mothers of young children; however, fathers and grandmothers also influence IYCF practices. We conducted focus group discussions with mothers, fathers and grandmothers of young children across three time points in areas where an IYCF social and behaviour change intervention was implemented in Nigeria to explore differences by participant type and shifts over time in attitudes, beliefs and social norms related to breastfeeding and dietary diversity (DD). Overall, across time points, we found more discrepancies in attitudes, beliefs and social norms for early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) among different participant types than for DD. Although most participants agreed EIBF and EBF are good practices, mothers believed this more strongly than fathers and grandmothers; however, at endline, a shift towards acceptance of EIBF and EBF appeared among fathers and grandmothers. Across time points, all participant types acknowledged the nutritional and health benefits of green leafy vegetables and animal-source foods but described various barriers to feeding them to children. Across time points, all participant types also highlighted the importance of health workers and antenatal visits as important sources of IYCF knowledge and facilitators to following recommended practices. Insights from this study highlight the importance of including key influencers of IYCF practices in qualitative research.
Collapse
Affiliation(s)
- Courtney H. Schnefke
- Public Health Research DivisionRTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | - Valerie L. Flax
- Public Health Research DivisionRTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | | | - Silvia Alayon
- Department of Global HealthSave the ChildrenWashingtonDistrict of ColumbiaUSA
| | - Sujata Bose
- FHI Solutions, MonitoringLearning and EvaluationDurhamNorth CarolinaUSA
| | - Obinna Daniel
- Public Health Research DivisionRTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | | | - Diana Allotey
- Department of NutritionUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Emily R. Seiger
- Department of NutritionUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Olujide Arije
- Institute of Public HealthObafemi Awolowo UniversityIle‐IfeOsun StateNigeria
| |
Collapse
|
13
|
Gulema H, Demissie M, Worku A, Assebe Yadeta T, Berhane Y. Influence of engaging female caregivers in households with adolescent girls on adopting equitable family eating practices: a quasi-experimental study. PeerJ 2023; 11:e16099. [PMID: 37750079 PMCID: PMC10518164 DOI: 10.7717/peerj.16099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/25/2023] [Indexed: 09/27/2023] Open
Abstract
Background In patriarchal societies, female caregivers decide on food allocation within a family based on prevailing gender and age norms, which may lead to inequality that does not favor young adolescent girls. This study evaluated the effect of a community-based social norm intervention involving female caregivers in West Hararghe, Ethiopia. The intervention was engaging female caregivers along with other adult influential community members to deliberate and act on food allocation social norms in a process referred to as Social Analysis and Action (SAA). Method We used data from a large quasi-experimental study to compare family eating practices between those who participated in the Social Analyses and Action intervention and those who did not. The respondents were female caregivers in households with young adolescent girls (ages 13 and 14 years). The study's outcome was the practice of family eating together from the same dish. The difference in difference (DID) analysis with the mixed effect logistic regression model was used to examine the effect of the intervention. Result The results showed improved family eating practices in both groups, but the improvement was greater in the intervention group. The DID analysis showed an 11.99 percentage points greater improvement in the intervention arm than in the control arm. The mixed-effect regression produced an adjusted odds ratio of 2.08 (95% CI [1.06-4.09]) after controlling selected covariates, p-value 0.033. Conclusions The involvement of influential adult community members significantly improves the family practice of eating together in households where adolescent girls are present in our study. The intervention has great potential to minimize household food allocation inequalities and thus improve the nutritional status of young adolescents. Further studies are necessary to evaluate the effectiveness of the intervention in different social norm contexts to formulate policy and guidelines for scale-up.
Collapse
Affiliation(s)
- Hanna Gulema
- Department of Global Health and Health Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Meaza Demissie
- Department of Global Health and Health Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Yemane Berhane
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| |
Collapse
|
14
|
Jeong J, McCann JK, Alsager A, Bhojani A, Andrew N, Joseph J, Ahun MN, Kabati M, Joachim D. Formative research to inform the future design of a multicomponent fatherhood intervention to improve early child development in Mwanza, Tanzania. Soc Sci Med 2023; 331:116072. [PMID: 37459822 PMCID: PMC10753856 DOI: 10.1016/j.socscimed.2023.116072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/27/2023] [Accepted: 07/02/2023] [Indexed: 07/29/2023]
Abstract
Fathers can influence child development through various pathways, such as via their caregiving behaviors, marital relationships, and their psychosocial wellbeing. However, few parenting interventions have been designed to target these multiple dimensions among fathers with young children in low- and middle-income countries. In June 2022, we conducted qualitative formative research to explore the perceptions surrounding fatherhood and the underlying barriers and enablers to engaged fathering in Mwanza, Tanzania. We completed individual in-depth interviews with 29 fathers and 23 mothers of children under aged 2 years along with 5 community leaders and 3 community health workers. We also completed 10 focus group discussions: 4 with fathers, 2 with mothers, and 4 mixed groups that combined both fathers and mothers. In total, the sample included 120 respondents stratified from across 4 study communities. Data were analyzed using thematic content analysis. Respondents highlighted that poor couples' relationships (e.g., limited male partner support, male dominance in decision-making) and fathers' mental health problems (e.g., parenting stress) were major priorities affecting fathers. Father involvement in parenting, childcare, and household activities were generally low. These dimensions of fatherhood were interlinked (e.g., poor paternal mental health constrained marital relationships and parenting). A constellation of determinants impacted engaged fathering. Common barriers included poverty, restrictive gender attitudes and norms, men's limited time at home, and inadequate knowledge about caregiving. Key enablers included mutual respect in marital relationships and men's desires to show their love for their families. Our results highlight the cultural relevance and the need for multicomponent strategies that jointly target fathers' caregiving, marital relationships, and psychosocial wellbeing for enhancing nurturing care and promoting early child development in Tanzania. Study findings can be used to inform the design of a future father-inclusive, gender-transformative parenting intervention for engaging and supporting fathers with young children in the local cultural context.
Collapse
Affiliation(s)
- Joshua Jeong
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Juliet K McCann
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alya Alsager
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alina Bhojani
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ngusa Andrew
- Tanzania Home Economics Organization, Mwanza, Tanzania
| | | | - Marilyn N Ahun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mary Kabati
- Tanzania Home Economics Organization, Mwanza, Tanzania
| | - Damas Joachim
- Tanzania Home Economics Organization, Mwanza, Tanzania
| |
Collapse
|
15
|
Jeong J, Sullivan EF, McCann JK. Effectiveness of father-inclusive interventions on maternal, paternal, couples, and early child outcomes in low- and middle-income countries: A systematic review. Soc Sci Med 2023; 328:115971. [PMID: 37224703 PMCID: PMC10330563 DOI: 10.1016/j.socscimed.2023.115971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/17/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023]
Abstract
Most caregiving interventions for young children are directed to female caregivers. Relatively few have included male caregivers as program participants especially in low- and middle-income countries (LMICs). The range of potential benefits that can be achieved through the engagement of fathers and male caregivers has not been adequately explored from a family systems perspective. We reviewed interventions that engaged male caregivers to support young children in LMICs and summarized impacts on maternal, paternal, couples, and child outcomes. We searched MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Global Health Library for quantitative evaluation studies of social and behavioral interventions that included fathers or other male caregivers to improve nurturing care for young children under 5 years of age in LMICs. Three authors independently extracted data using a structured form. Forty-four articles, representing 33 intervention evaluations, were included. The most common type of intervention targeted fathers along with their female partners and primarily to address child nutrition and health. Across interventions, maternal outcomes were the most evaluated outcomes (82%), followed by paternal (58%), couple's relationship (48%) and child-level outcomes (45%). Overall, father-inclusive interventions had positive impacts on maternal, paternal and couples' relationship outcomes. Although there was greater variation in the degree of supportive evidence for child outcomes compared to maternal, paternal, and couples outcomes, findings suggested mostly positive effects across all outcomes. Limitations included relatively weak study designs and heterogeneity across interventions, outcome types, and measurement tools. Interventions that include fathers and other male caregivers have potential to improve maternal and paternal caregiving, couple's relationships dynamics, and early child outcomes in LMICs. More evaluation studies, using rigorous methods and robust measurement frameworks, is needed to bolster this evidence-base about the effect of fathers' engagement for young children, caregivers, and families in LMICs.
Collapse
Affiliation(s)
- Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | | | - Juliet K McCann
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
16
|
Rothstein JD, Klemm RDW, Kang Y, Niyeha D, Smith E, Nordhagen S. Engaging men in maternal, infant and young child nutrition in rural Tanzania: Outcomes from a cluster randomized control trial and qualitative study. MATERNAL & CHILD NUTRITION 2023; 19:e13460. [PMID: 36482813 PMCID: PMC10019044 DOI: 10.1111/mcn.13460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 10/02/2022] [Accepted: 10/26/2022] [Indexed: 12/13/2022]
Abstract
There is growing recognition that engaging men in maternal, infant and young child nutrition (MIYCN) interventions can benefit child health and disrupt harmful gender norms. We conducted a cluster-randomized controlled trial in Tanzania, which engaged men and women in behaviour change via mobile messaging (short message service [SMS]) and traditional interpersonal communication (IPC), separately and in combination. Here, we evaluate intervention effects on individual-level men's MIYCN knowledge and discuss barriers to male engagement. Eligible clusters were dispensary catchment areas with >3000 residents. Forty clusters were stratified by population size and randomly allocated to the four study arms, with 10 clusters per arm. Data on knowledge and intervention exposure were collected from 1394 men through baseline and endline surveys (March-April 2018 and July-September 2019). A process evaluation conducted partway through the 15-18-month intervention period included focus group discussions and interviews. Data were analysed for key trends and themes using Stata and ATLAS.ti software. Male participants in the short message service + interpersonal communication (SMS + IPC) group reported higher exposure to IPC discussions than IPC-only men (43.8% and 21.9%, respectively). Knowledge scores increased significantly across all three intervention groups, with the greatest impact in the SMS + IPC group. Qualitative findings indicated that the main barriers to male participation were a lack of interest in health/nutrition and perceptions that these topics were a woman's responsibility. Other challenges included meeting logistics, prioritizing income-earning activities and insufficient efforts to engage men. The use of a combined approach fusing IPC with SMS is promising, yet countering gender norms and encouraging stronger male engagement may require additional strategies.
Collapse
Affiliation(s)
- Jessica D. Rothstein
- Headquarters Nutrition DivisionHelen Keller InternationalWashingtonDistrict of ColumbiaUSA
- Division of Community Health SciencesUniversity of Illinois at Chicago School of Public HealthChicagoIllinoisUSA
| | - Rolf D. W. Klemm
- Headquarters Nutrition DivisionHelen Keller InternationalWashingtonDistrict of ColumbiaUSA
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Yunhee Kang
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Debora Niyeha
- Tanzania Country OfficeHelen Keller InternationalDar es SalaamTanzania
| | - Erin Smith
- Nepal Country OfficeHelen Keller InternationalKathmanduNepal
| | | |
Collapse
|
17
|
Watson D, Mushamiri P, Beeri P, Rouamba T, Jenner S, Proebstl S, Kehoe SH, Ward KA, Barker M, Lawrence W. Behaviour change interventions improve maternal and child nutrition in sub-Saharan Africa: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000401. [PMID: 36996036 PMCID: PMC10062616 DOI: 10.1371/journal.pgph.0000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 02/28/2023] [Indexed: 03/31/2023]
Abstract
Evidence that nutrition-specific and nutrition-sensitive interventions can improve maternal and child nutrition status in sub-Saharan Africa is inconclusive. Using behaviour change theory and techniques in intervention design may increase effectiveness and make outcomes more predictable. This systematic review aimed to determine whether interventions that included behaviour change functions were effective. Six databases were searched systematically, using MeSH and free-text terms, for articles describing nutrition-specific and nutrition-sensitive behaviour change interventions published in English until January 2022. Titles, abstracts and full-text papers were double-screened. Data extraction and quality assessments followed Centre for Reviews and Dissemination guidelines. Behaviour change functions of interventions were mapped onto the COM-B model and Behaviour Change Wheel. PROSPERO registered (135054). The search yielded 1193 articles: 79 articles met inclusion criteria, ranging from low (n = 30) to high (n = 11) risk of bias. Many that applied behaviour change theory, communication or counselling resulted in significant improvements in infant stunting and wasting, household dietary intake and maternal psychosocial measures. Interventions with >2 behaviour change functions (including persuasion, incentivisation, environmental restructuring) were the most effective. We recommend incorporating behaviour change functions in nutrition interventions to improve maternal and child outcomes, specifically drawing on the Behaviour Change Wheel, COM-B model (SORT B recommendation). To enhance the designs of these interventions, and ultimately improve the nutritional and psychosocial outcomes for mothers and infants in sub-Saharan Africa, collaborations are recommended between behaviour change and nutrition experts, intervention designers, policy makers and commissioners to fund and roll-out multicomponent behaviour change interventions.
Collapse
Affiliation(s)
- Daniella Watson
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom
- SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Patience Mushamiri
- SAMRC Centre for Health Economics and Decision Science, PRICELESS, University of the Witwatersrand, School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa
| | - Paula Beeri
- Navrongo Health Research Centre, Ghana Health Service, Accra, Ghana
| | - Toussaint Rouamba
- Clinical Research Unit of Nanoro, Institute for Research in Health Sciences, National Center for Scientific and Technological Research, Ouagadougou, Burkina Faso
| | - Sarah Jenner
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Simone Proebstl
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- Institute for Medical Information Processing, Biometry, and Epidemiology-IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Sarah H Kehoe
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Kate A Ward
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary Barker
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Cambridge, United Kingdom
- School of Health Sciences, Faculty of Life and Environmental Sciences, University of Southampton, Southampton, United Kingdom
| | - Wendy Lawrence
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Cambridge, United Kingdom
| |
Collapse
|
18
|
Komakech JJ, Emerson SR, Cole KL, Walters CN, Rakotomanana H, Kabahenda MK, Hildebrand DA, Stoecker BJ. A Peer-Led Integrated Nutrition Education Intervention through Care Groups Improved Complementary Feeding of Infants in Postemergency Settlements in the West-Nile Region in Uganda: A Cluster Randomized Trial. Curr Dev Nutr 2023; 7:100042. [PMID: 37181933 PMCID: PMC10111604 DOI: 10.1016/j.cdnut.2023.100042] [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: 10/18/2022] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
Background Complementary feeding of infants in refugee settlements remains inadequate. Furthermore, there has been limited evaluation of interventions addressing these nutrition challenges. Objective This study examined the effects of a peer-led integrated nutrition education intervention on infant complementary feeding by South Sudanese refugee mothers in the West-Nile region in Uganda. Methods A community-based randomized trial enrolled 390 pregnant women (during third trimester) as the baseline. Two arms [mothers-only and parents-combined (both mothers and fathers)] comprised treatments with a control. Infant feeding was assessed using WHO and UNICEF guidelines. Data were collected at Midline-II and Endline. The medical outcomes study (MOS) social support index was used to measure social support. An overall mean score of >4 was considered optimal social support, a score of ≤2 was none or little support. Adjusted multivariable logistic regression models determined the effects of the intervention on infant complementary feeding. Results At the end of the study, infant complementary feeding improved significantly in both mothers-only and parents-combined arms. There was a positive effect on the introduction of solid, semisolid, and soft foods (ISSSF) in the mothers-only arm at both Midline-II {adjusted odds ratio (AOR) = 4.0]} and Endline (AOR = 3.8). Likewise, ISSSF was better for the parents-combined arm at both Midline-II (AOR = 4.5) and Endline (AOR = 3.4). Minimum dietary diversity (MDD) was significantly better at the Endline for the parents-combined arm (AOR = 3.0). Minimum acceptable diet (MAD) was significantly better at Endline for both mothers-only (AOR = 2.3) and parents-combined arms (AOR = 2.7). Infant consumption of eggs and flesh foods (EFF) was improved only in the parents-combined arm at both Midline-II (AOR = 3.3) and Endline (AOR = 2.4). Higher maternal social support was associated with better infant MDD (AOR = 3.3), MAD (AOR = 3.6), and EFF (AOR = 4.7). Conclusion Engaging both fathers and mothers in care groups benefited complementary feeding of infants. Overall, this peer-led integrated nutrition education intervention through care groups improved infant complementary feeding in the West-Nile postemergency settlements in Uganda.This trial was registered at clinicaltrials.gov as NCT05584969.
Collapse
Affiliation(s)
- Joel J. Komakech
- Department of Food Science, Nutrition, and Health Promotion, Mississippi State University, United States
| | - Sam R. Emerson
- Department of Nutritional Sciences, Oklahoma State University, United States
| | - Ki L. Cole
- Research, Evaluation, Measurement, and Statistics Department, Oklahoma State University, United States
| | | | | | | | - Deana A. Hildebrand
- Department of Nutritional Sciences, Oklahoma State University, United States
| | - Barbara J. Stoecker
- Department of Nutritional Sciences, Oklahoma State University, United States
| |
Collapse
|
19
|
Jeong J, Sullivan EF, McCann JK, McCoy DC, Yousafzai AK. Implementation characteristics of father-inclusive interventions in low- and middle-income countries: A systematic review. Ann N Y Acad Sci 2023; 1520:34-52. [PMID: 36482863 PMCID: PMC9974925 DOI: 10.1111/nyas.14941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although prior reviews have documented the effectiveness of engaging male caregivers in early childhood interventions, little is known about how these interventions have been designed and implemented to reach, engage, and support male caregivers in low-resource global settings. We searched five bibliographic databases for intervention studies that engaged male caregivers to improve nurturing care for children under 5 years of age in low- and middle-income countries. Forty-four articles met the inclusion criteria, which represented 33 interventions. Fathers specifically were the most common type of male caregivers targeted in these interventions. The majority of interventions invited fathers to participate alongside their female partners. Community-based peer-groups were the most common delivery model. Most interventions used the same program structure for fathers as applied to mothers, with few considering whether implementation adaptations were needed for men. Intervention curricula were multicomponent and largely targeted child nutrition, health, and couples' relationships. A minority of programs addressed parenting, psychosocial wellbeing, violence prevention, gender attitudes, or economic support. Behavior change techniques were limited to interactive counseling and peer learning. Male caregivers remain missing from caregiving interventions for young children. A greater focus on implementation research can inform better inclusion, engagement, and support for male caregivers in nurturing care interventions.
Collapse
Affiliation(s)
- Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Juliet K McCann
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Dana C McCoy
- Harvard Graduate School of Education, Cambridge, Massachusetts, USA
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
20
|
Chen Y, Wu Y, Dill SE, Guo Y, Westgard CM, Medina A, Weber AM, Darmstadt GL, Zhou H, Rozelle S, Sylvia S. Effect of the mHealth-supported Healthy Future programme delivered by community health workers on maternal and child health in rural China: study protocol for a cluster randomised controlled trial. BMJ Open 2023; 13:e065403. [PMID: 36669837 PMCID: PMC9872510 DOI: 10.1136/bmjopen-2022-065403] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 01/04/2023] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Millions of young rural children in China still suffer from poor health and malnutrition, partly due to a lack of knowledge about optimal perinatal and child care among rural mothers and caregivers. Meanwhile, there is an urgent need to improve maternal mental health in rural communities. Comprehensive home visiting programmes delivered by community health workers (CHWs) can bridge the caregiver knowledge gap and improve child health and maternal well-being in low-resource settings, but the effectiveness of this approach is unknown in rural China. Additionally, grandmothers play important roles in child care and family decision-making in rural China, suggesting the importance of engaging multiple caregivers in interventions. The Healthy Future programme seeks to improve child health and maternal well-being by developing a staged-based curriculum that CHWs deliver to mothers and caregivers of young children through home visits with the assistance of a tablet-based mHealth system. This protocol describes the design and evaluation plan for this programme. METHODS AND ANALYSIS We designed a cluster-randomised controlled trial among 119 rural townships in four nationally designated poverty counties in Southwestern China. We will compare the outcomes between three arms: one standard arm with only primary caregivers participating in the intervention, one encouragement arm engaging primary and secondary caregivers and one control arm with no intervention. Families with pregnant women or infants under 6 months of age are invited to enrol in the 12-month study. Primary outcomes include children's haemoglobin levels, exclusive breastfeeding rates and dietary diversity in complementary feeding. Secondary outcomes include a combination of health, behavioural and intermediate outcomes. ETHICS AND DISSEMINATION Ethical approval has been provided by Stanford University, Sichuan University and the University of Nevada, Reno. Trial findings will be disseminated through national and international peer-reviewed publications and conferences. TRIAL REGISTRATION NUMBER ISRCTN16800789.
Collapse
Affiliation(s)
- Yunwei Chen
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yuju Wu
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Sarah-Eve Dill
- Stanford Center on China's Economy and Institutions, Stanford University, Stanford, CA, USA
| | - Yian Guo
- Stanford Center on China's Economy and Institutions, Stanford University, Stanford, CA, USA
| | - Christopher Michael Westgard
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alexis Medina
- Stanford Center on China's Economy and Institutions, Stanford University, Stanford, CA, USA
| | - Ann M Weber
- Department of Biostatistics, Epidemiology and Environmental Health, School of Public Health, University of Nevada, Reno, Reno, NV, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Huan Zhou
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Scott Rozelle
- Stanford Center on China's Economy and Institutions, Stanford University, Stanford, CA, USA
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
21
|
Wemakor A, Awuni V, Issah S. Maternal autonomy but not social support is a predictor of child feeding indicators in the Northern Region, Ghana. BMC Nutr 2022; 8:135. [PMID: 36401277 PMCID: PMC9673434 DOI: 10.1186/s40795-022-00630-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
Abstract
Background Child malnutrition may be mediated by poor infant and young child feeding (IYCF) practices. This study sought to explore if maternal social support or autonomy was related to IYCF indicators in Northern Region, Ghana. Methods An analytical cross-sectional study was conducted with 395 randomly sampled mother–child pairs from 8 health facilities. Data were collected on socio-demographic characteristics, social support and autonomy statuses of mothers, and dietary intake and anthropometry of children. Maternal social support and autonomy statuses were derived and classified into tertiles and IYCF and child growth indicators were derived based on WHO protocol. Logistic regression analysis was used to explore the association of maternal social support and autonomy statuses to IYCF indicators and child nutritional status. Results The mean age of the women was 27 (± 5.10) years and most belonged to the lowest tertile of social support (52.4%), and autonomy (44.1%). About half of the children, 53.2% and 44.6%, received Minimum Dietary Diversity (MDD) and Minimum Acceptable Diet (MAD) respectively but the majority (72.9%) received Minimum Meal Frequency (MMF). About a fifth of the children, 21.0%, 24.1%, and 20.5%, were wasted, stunted, and underweight respectively. Maternal autonomy was associated with IYCF but not growth indicators of young children. Compared to children of mothers of richest autonomy tertile, children of women of middle autonomy tertile were 67% less likely to receive MDD [Adjusted Odds Ratio (AOR): 0.33; 95% Confidence Interval (CI): 0.18–0.59], and 56% less likely to receive MAD (AOR: 0.44; 95% CI: 0.24–0.77). Also, children belonging to mothers of poorest autonomy tertile were 56% less likely to receive MMF compared to children of richest maternal autonomy tertile (AOR: 0.44; 95% CI: 0.23–0.84). Conclusion Maternal autonomy and not social support is associated with IYCF indicators of children in Northern Ghana; child survival programmes should incorporate or strengthen women empowerment interventions to improve child nutrition. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-022-00630-8.
Collapse
|
22
|
Saaka M, Awini S, Kizito F, Hoeschle-Zeledon I. Fathers' level of involvement in childcare activities and its association with the diet quality of children in Northern Ghana. Public Health Nutr 2022; 26:1-8. [PMID: 36210797 PMCID: PMC10131150 DOI: 10.1017/s1368980022002142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 09/07/2022] [Accepted: 09/21/2022] [Indexed: 11/07/2022]
Abstract
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.
Collapse
Affiliation(s)
- Mahama Saaka
- University for Development Studies, School of Allied Health Sciences, PO Box 1883, Tamale, Ghana
| | - Simon Awini
- Ghana Health Service, Wa West District Health Directorate, Wechau, Ghana
| | - Fred Kizito
- International Institute of Tropical Agriculture (IITA), Tamale, Ghana
| | | |
Collapse
|
23
|
Ogutu EA, Ellis A, Rodriguez KC, Caruso BA, McClintic EE, Ventura SG, Arriola KRJ, Kowalski AJ, Linabarger M, Wodnik BK, Webb-Girard A, Muga R, Freeman MC. Determinants of food preparation and hygiene practices among caregivers of children under two in Western Kenya: a formative research study. BMC Public Health 2022; 22:1865. [PMID: 36203140 PMCID: PMC9535979 DOI: 10.1186/s12889-022-14259-6] [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: 10/12/2021] [Accepted: 09/19/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Diarrhea is a leading cause of child morbidity and mortality worldwide and is linked to early childhood stunting. Food contamination from improper preparation and hygiene practices is an important transmission pathway for exposure to enteric pathogens. Understanding the barriers and facilitators to hygienic food preparation can inform interventions to improve food hygiene. We explored food preparation and hygiene determinants including food-related handwashing habits, meal preparation, cooking practices, and food storage among caregivers of children under age two in Western Kenya. METHODS We used the Capabilities, Opportunities, and Motivations model for Behavior Change (COM-B) framework in tool development and analysis. We conducted 24 focus group discussions with mothers (N = 12), fathers (N = 6), and grandmothers (N = 6); 29 key informant interviews with community stakeholders including implementing partners and religious and community leaders; and 24 household observations. We mapped the qualitative and observational data onto the COM-B framework to understand caregivers' facilitators and barriers to food preparation and hygiene practices. RESULTS Facilitators and barriers to food hygiene and preparation practices were found across the COM-B domains. Caregivers had the capability to wash their hands at critical times; wash, cook, and cover food; and clean and dry utensils. Barriers to food hygiene and preparation practices included lack of psychological capability, for instance, caregivers' lack of knowledge of critical times for handwashing, lack of perceived importance of washing some foods before eating, and not knowing the risks of storing food for more than four hours without refrigerating and reheating. Other barriers were opportunity-related, including lack of resources (soap, water, firewood) and an enabling environment (monetary decision-making power, social support). Competing priorities, socio-cultural norms, religion, and time constraints due to work hindered the practice of optimal food hygiene and preparation behaviors. CONCLUSION Food hygiene is an underexplored, but potentially critical, behavior to mitigate fecal pathogen exposure for young children. Our study revealed several knowledge and opportunity barriers that could be integrated into interventions to enhance food hygiene.
Collapse
Affiliation(s)
- Emily A. Ogutu
- grid.189967.80000 0001 0941 6502Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322 USA
| | - Anna Ellis
- grid.189967.80000 0001 0941 6502Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322 USA
| | - Katie C. Rodriguez
- grid.189967.80000 0001 0941 6502Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322 USA
| | - Bethany A. Caruso
- grid.189967.80000 0001 0941 6502Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Emilie E. McClintic
- grid.189967.80000 0001 0941 6502Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Sandra Gómez Ventura
- grid.189967.80000 0001 0941 6502Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Kimberly R. J. Arriola
- grid.189967.80000 0001 0941 6502Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502James T. Laney School of Graduate Studies, Emory University, Atlanta, GA USA
| | - Alysse J. Kowalski
- grid.189967.80000 0001 0941 6502James T. Laney School of Graduate Studies, Emory University, Atlanta, GA USA
| | - Molly Linabarger
- grid.189967.80000 0001 0941 6502Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Breanna K. Wodnik
- grid.189967.80000 0001 0941 6502Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Amy Webb-Girard
- grid.189967.80000 0001 0941 6502Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502James T. Laney School of Graduate Studies, Emory University, Atlanta, GA USA
| | - Richard Muga
- grid.472446.7Uzima University College, Kisumu, Kenya
| | - Matthew C. Freeman
- grid.189967.80000 0001 0941 6502Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322 USA
| |
Collapse
|
24
|
Irenso AA, Zheng M, Campbell KJ, Chamberlain D, Laws R. The influence of household structure and composition on the introduction of solid, semisolid and soft foods among children aged 6-8 months: An analysis based on Ethiopia Demographic and Health Surveys. MATERNAL & CHILD NUTRITION 2022; 19:e13429. [PMID: 36148628 PMCID: PMC9749599 DOI: 10.1111/mcn.13429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/13/2022] [Accepted: 08/20/2022] [Indexed: 12/15/2022]
Abstract
The early and late introduction of complementary food, both prevalent in Ethiopia, are associated with morbidities, growth faltering and developmental risks in children. The interhousehold network around the primary caregiver's intrahousehold network is critical in influencing the age of introducing complementary foods. This study examined the influence of household composition and structures on complementary food introduction. This is a secondary data analysis of four Ethiopian Demographic and Health Surveys conducted between 2000 and 2016. The household structure and composition variables were calculated from household members' kinship status and attribute, respectively. The introduction of solid, semisolid or soft foods was dichotomised as whether the children within 6 to 8 months have been given complementary foods. Multivariable logistic regression with adjustment for the primary caregiver and household characteristics was run to examine the associations between household structure and composition variables and the introduction of complementary foods. The marginal effects (ME) were calculated to facilitate the practical interpretation of the study findings. Large households (>3 nonredundant contacts) with extended family or unrelated people (high effective size, ME = 6.01%, 95% confidence interval [CI]: -8.53, -3.49) lowered the proportion of children starting food within the recommended 6-8 months. Households with close kins (high constraint) (ME = 7.22%, 95% CI: -13.65, 28.09) and greater age diversity (ME = 0.65%, 95% CI: 0.15, 1.15) increased the proportion of children receiving complementary food at an appropriate age. This study revealed that interhousehold structure and composition influence the age of introduction of complementary foods. These factors, therefore, need to be considered in designing interventions to improve age at the introduction of complementary foods.
Collapse
Affiliation(s)
- Asnake Ararsa Irenso
- School of Public HealthAmbo UniversityAmboEthiopia,School of Exercise and Nutrition Science, Institute for Physical Activity and Nutrition (IPAN)Deakin UniversityBurwoodVictoriaAustralia
| | - Miaobing Zheng
- School of Exercise and Nutrition Science, Institute for Physical Activity and Nutrition (IPAN)Deakin UniversityBurwoodVictoriaAustralia
| | - Karen J. Campbell
- School of Exercise and Nutrition Science, Institute for Physical Activity and Nutrition (IPAN)Deakin UniversityBurwoodVictoriaAustralia
| | - Dan Chamberlain
- Centre for Social Impact UNSWUniversity of New South WalesSydneyNew South WalesAustralia
| | - Rachel Laws
- School of Exercise and Nutrition Science, Institute for Physical Activity and Nutrition (IPAN)Deakin UniversityBurwoodVictoriaAustralia
| |
Collapse
|
25
|
Allotey D, Flax VL, Ipadeola AF, Kwasu S, Adair LS, Valle CG, Bose S, Martin SL. Fathers' Complementary Feeding Support Strengthens the Association Between Mothers' Decision-Making Autonomy and Optimal Complementary Feeding in Nigeria. Curr Dev Nutr 2022; 6:nzac098. [PMID: 35854939 PMCID: PMC9283102 DOI: 10.1093/cdn/nzac098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Evidence about the effects of mothers' decision-making autonomy on complementary feeding is not consistent, generating hypotheses about whether complementary feeding social support moderates the relation between mothers' decision-making autonomy and the practice of complementary feeding. Objectives This study examined the moderation effect of fathers' complementary feeding support on the association of mothers' decision-making autonomy with the WHO complementary feeding indicators of minimum dietary diversity, minimum meal frequency, and minimum acceptable diet, and post hoc secondary outcomes of feeding eggs or fish the previous day. The study also examined the concordance between mothers' and fathers' perspectives of mothers' autonomy and fathers' complementary feeding support. Methods Data were from cross-sectional surveys of 495 cohabiting parents of children aged 6-23 mo enrolled in an Alive & Thrive initiative implementation research study in Kaduna State, Nigeria. Logistic regression models were used to examine moderation, and κ statistics and 95% CIs were used to assess the concordance in reported perspectives of the parents. Results The moderation results show that the simple slopes for decision-making were significant for minimum meal frequency, minimum acceptable diet, and feeding children fish the previous day when fathers offered ≥2 complementary feeding support actions. There were no significant findings in the moderation models for minimum dietary diversity or feeding children eggs the previous day. The findings from the concordance tests show moderate to substantial agreement (ranging from 57.6% to 76.0%) between parents' perspectives of mothers' autonomy, and moderate to excellent agreement (ranging from 52.1% to 89.1%) between parents' perspectives of fathers' complementary feeding support. Conclusions In Nigeria, high levels of fathers' complementary feeding support strengthen the association of mothers' decision-making autonomy with minimum meal frequency, minimum acceptable diet, and feeding children fish the previous day.This study was registered with clinicaltrials.gov (NCT04835662).
Collapse
Affiliation(s)
- Diana Allotey
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Valerie L Flax
- RTI International, Research Triangle Park, Durham, NC, USA
| | | | - Sarah Kwasu
- Alive & Thrive, Kaduna State, Kauna, Nigeria
| | - Linda S Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carmina G Valle
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Stephanie L Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
26
|
McClintic EE, Ellis A, Ogutu EA, Caruso BA, Ventura SG, Arriola KRJ, Kowalski AJ, Linabarger M, Wodnik BK, Muga R, Freeman MC, Girard AW. Application of the Capabilities, Opportunities, Motivations, and Behavior (COM-B) Change Model to Formative Research for Child Nutrition in Western Kenya. Curr Dev Nutr 2022; 6:nzac104. [PMID: 35898312 PMCID: PMC9314706 DOI: 10.1093/cdn/nzac104] [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: 12/13/2021] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023] Open
Abstract
Background Interventions aimed at improving dietary intake and feeding practices have alone proven insufficient for combatting stunting resulting from poor nutrition and repeated infections. Objectives To support the development of an integrated water, sanitation, and hygiene (WASH) and nutrition, social, and behavior change strategy aimed at reducing stunting, formative research was conducted in 2 program sites in western Kenya. Methods Twenty-nine key informant interviews were conducted with community leaders, health workers, and project staff, and 24 focus group discussions with caregivers of children under 2 y on topics related to feeding, sanitation, and hygiene behaviors. Three frameworks informed the study design and analysis of our formative research: the Capabilities, Opportunities, and Motivations model for behavior change, which identifies what needs to change in order for behavior change interventions to be effective; the Grandmother Project's Change Through Culture Approach, which values the important role of influential household and community members in producing household health; and Starr and Fornoff's approach to Theory of Change development. Results Caregivers exhibited sufficient psychological capabilities (knowledge and skills) for many of the key maternal and infant nutrition behaviors. However, reflective motivation to perform optimal behaviors was undermined by limitations in physical and social opportunities, including limited time and competing priorities for mothers, limited accessibility and availability of diverse foods, low self-efficacy for exclusive breastfeeding, and fears of negative consequences related to specific foods and recommended practices. Conclusions Interventions that aim to improve maternal and child diets should address the underlying social, cultural, and environmental determinants that contribute to motivations and opportunities to perform recommended practices.
Collapse
Affiliation(s)
- Emilie Ewart McClintic
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anna Ellis
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Emily A Ogutu
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Bethany A Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sandra Gomez Ventura
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kimberly R Jacob Arriola
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alysse J Kowalski
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA USA
| | - Molly Linabarger
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Breanna K Wodnik
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Matthew C Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Amy Webb Girard
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA USA
| |
Collapse
|
27
|
Choi S, Kiriya J, Shibanuma A, Jimba M. Mediating role of social capital in the association between socioeconomic status and childcare practices in rural Malawi: a cross-sectional study. BMJ Open 2022; 12:e054134. [PMID: 35534073 PMCID: PMC9086639 DOI: 10.1136/bmjopen-2021-054134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Childcare practices determine the child nutritional outcomes, but resources for good practices are unequally distributed across socioeconomic status (SES). This study first examined the associations between social capital and childcare practices separately across SES groups. It then investigated the mediation effect of social capital between SES and childcare practices. DESIGN This cross-sectional study used the Short Version of the Adapted Social Capital Assessment Tool to measure structural social capital (group membership, social support and citizenship activities) and cognitive social capital of mothers. Data were analysed using multilevel logistic regressions with random intercepts and mediation modellings. SETTING Rural Lilongwe, Malawi. PARTICIPANTS A total of 320 mothers with a child aged between 12 months and 23 months. PRIMARY OUTCOME MEASURES Childcare practice outcomes included were minimum dietary diversity, handwashing and complete vaccination. RESULTS Among structural social capital dimensions, social support was found to be positively associated with minimum dietary diversity (adjusted OR (AOR)=1.44, 95% CI 1.22 to 1.71; p<0.001) and handwashing for all mothers (AOR=1.42, 95% CI 1.23 to 1.64; p<0.001). In the subgroup analysis, the higher SES group had higher odds of meeting the minimum dietary diversity (AOR=1.63, 95% CI 1.18 to 2.26; p=0.01) and handwashing with increased social support (AOR=1.53, 95% CI 1.13 to 2.08; p=0.01) than the lower SES. The mediation effect of social support accounted for 27.3% of the total effect between SES and minimum dietary diversity. Cognitive social capital was negatively associated with vaccination for the lower SES group (AOR=0.07, 95% CI 0.01 to 0.68; p=0.03). CONCLUSIONS To improve feeding and handwashing practices and to reduce health inequalities in rural Malawi, governments and organisations should consider promoting the value of social support and health. Future research is needed to explain the negative association between cognitive social capital and vaccination among the lower SES group.
Collapse
Affiliation(s)
- Suhyoon Choi
- Department of Community and Global Health, The University of Tokyo, Bunkyo-ku, Japan
| | - Junko Kiriya
- Department of Community and Global Health, The University of Tokyo, Bunkyo-ku, Japan
| | - Akira Shibanuma
- Department of Community and Global Health, The University of Tokyo, Bunkyo-ku, Japan
| | - Masamine Jimba
- Department of Community and Global Health, The University of Tokyo, Bunkyo-ku, Japan
| |
Collapse
|
28
|
Flax VL, Ipadeola A, Schnefke CH, Ralph-Opara U, Adeola O, Edwards S, Bose S, Brower AO. Breastfeeding Interpersonal Communication, Mobile Phone Support, and Mass Media Messaging Increase Exclusive Breastfeeding at 6 and 24 Weeks Among Clients of Private Health Facilities in Lagos, Nigeria. J Nutr 2022; 152:1316-1326. [PMID: 35015869 PMCID: PMC9071272 DOI: 10.1093/jn/nxab450] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/23/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although most health facilities in urban Nigeria are privately owned, interventions to promote optimal breastfeeding practices in private facilities have not previously been implemented. OBJECTIVES We tested the impact of a breastfeeding promotion intervention on early initiation of breastfeeding and exclusive breastfeeding among clients of private facilities in Lagos, Nigeria. METHODS The intervention included training for health-care providers on the Baby-Friendly Hospital Initiative and breastfeeding counseling skills, provision of interpersonal communication and support to women at facilities and on WhatsApp, distribution of behavior change communication materials, and mobile phone and mass media messaging. We used logistic regression models adjusted for clustering to measure intervention impact in a cohort of women (n = 1200) at 10 intervention and 10 comparison facilities interviewed during their third trimester and at 6 and 24 weeks postpartum. RESULTS The intervention significantly increased the percentage of infants who were exclusively breastfed at 6 weeks (83% intervention; 76% comparison; P = 0.02) and 24 weeks (66% intervention; 52% comparison; P < 0.001), but had no impact on early initiation of breastfeeding (35% intervention; 33% comparison; P = 0.65). Among infants who were exclusively breastfed at 6 weeks, the odds of continued exclusive breastfeeding at 24 weeks were higher in the intervention arm than in the comparison arm (OR, 1.6; 95% CI: 1.2-2.1). Infants had increased odds of being exclusively breastfed at 6 weeks if their mothers discussed breastfeeding with a private health provider (OR, 2.3; 95% CI: 1.5-3.4), received text or WhatsApp messages about breastfeeding (OR, 1.7; 95% CI: 1.0-2.7), or heard breastfeeding radio spots (OR, 4.2; 95% CI: 1.2-14.7). Infants had increased odds of exclusive breastfeeding at 24 weeks if their mothers participated in a WhatsApp breastfeeding support group (OR, 1.5; 95% CI: 1.0-2.2). CONCLUSIONS A breastfeeding intervention in private health facilities in Lagos increased exclusive breastfeeding. Implementation of breastfeeding interventions in private facilities could extend the reach of breastfeeding promotion programs in urban Nigeria. This trial was registered at clinicaltrials.gov as NCT04835051.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Sujata Bose
- Alive & Thrive, FHI Solutions, Washington, DC, USA
| | | |
Collapse
|
29
|
Boulom S, Bon DM, Essink D, Kounnavong S, Broerse JEW. Understanding Discrepancies in Nutritional Outcomes Among Under-Fives in Laos: A Mixed-Methods Study Using the Positive Deviance Approach. Food Nutr Bull 2022; 43:303-322. [PMID: 35506170 PMCID: PMC9403390 DOI: 10.1177/03795721221096187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Stunting is one of the main contributing factors in the under-five mortality rate worldwide. In Laos, the prevalence of stunting remains high, particularly in mountainous rural areas. To prevent stunting, insight into positive deviant behaviors can help understand how people can cope or adapt in resource-poor settings. OBJECTIVE This study aims to analyze the practices and underlying factors that explain discrepancies in nutritional outcomes in children under the age of 5 in remote mountainous areas in Laos. METHODS This mixed-methods study included all children under the age of 5 living in 6 selected villages. Anthropometric measurements were taken, and a Z-score for stunting was calculated to select the positive and negative deviant children. To identify the causes of discrepancies in childhood stunting, household questionnaires, focus group discussions, observations, and individual interviews with family members and health workers were conducted. RESULTS Fifty-five percent of children were stunted. Inappropriate care and feeding practices were observed such as providing unbalanced diets and not attending health facilities. Positive deviant mothers were less likely to follow inappropriate practices, experienced less food insecurity, and had higher motivation and autonomy, which resulted in prioritizing their children's health. An active role of fathers seemed to benefit positive practices within households. CONCLUSIONS The combination of many different practices in which positive deviant families are doing slightly better resulted in less stunting of children. Those practices are related to the household resources, such as access to food and social support; and the mother's motivation, autonomy, and perspectives on child health.
Collapse
Affiliation(s)
- Sayvisene Boulom
- VU Amsterdam University, Amsterdam, the Netherlands.,National University of Laos, Vientiane, Lao PDR
| | | | - Dirk Essink
- VU Amsterdam University, Amsterdam, the Netherlands
| | | | | |
Collapse
|
30
|
Flax VL, Ipadeola A, Schnefke CH, Kwasu S, Mikail AA, Bose S, Brower AO, Edwards S. 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. Curr Dev Nutr 2022; 6:nzac075. [PMID: 35669047 PMCID: PMC9154220 DOI: 10.1093/cdn/nzac075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/29/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
Abstract
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.
Collapse
|
31
|
Mahumud RA, Uprety S, Wali N, Renzaho AMN, Chitekwe S. The effectiveness of interventions on nutrition social behaviour change communication in improving child nutritional status within the first 1000 days: Evidence from a systematic review and meta‐analysis. MATERNAL & CHILD NUTRITION 2022; 18:e13286. [PMID: 34842341 PMCID: PMC8710127 DOI: 10.1111/mcn.13286] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/23/2021] [Accepted: 10/05/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Rashidul A. Mahumud
- NHMRC Clinical Trials Centre, School of Medicine and Health The University of Sydney Camperdown New South Wales Australia
- Centre for Health Research University of Southern Queensland Toowoomba Queensland Australia
- Department of Statistics Health Research Group Rajshahi Bangladesh
| | - Sophiya Uprety
- Former UNICEF Consultant and Public Health Nutritionist Kathmandu Nepal
| | - Nidhi Wali
- School of Social Sciences Western Sydney University Penrith New South Wales Australia
| | - Andre M. N. Renzaho
- Translational Health Research Institute School of Medicine Campbelltown New South Wales Australia
- Maternal, Child and Adolescent Health Program Burnet Institute Melbourne Victoria Australia
| | - Stanley Chitekwe
- Nutrition Section United Nations Children's Fund (UNICEF) Kathmandu Nepal
| |
Collapse
|
32
|
Irenso AA, Chamberlain D, Zheng M, Campbell KJ, Laws R. The Role of Household Structure and Composition in Influencing Complementary Feeding Practices in Ethiopia. Nutrients 2021; 14:nu14010130. [PMID: 35011004 PMCID: PMC8747051 DOI: 10.3390/nu14010130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 02/03/2023] Open
Abstract
While the household in which a child grows up is considered a critical environment that influences nutrition outcomes, there is little research examining the influence of household composition and structure on complementary feeding practices. This study examined the influence of household structure and composition on complementary feeding practices, using the Ethiopian Demographic and Health Survey (EDHS), 2000 to 2016. The composition variables were calculated from the attributes of household members (alters) and the structure variables from their kinship status. A multilevel mixed-effects regression model, specifying survey rounds as the random effect, was used to examine the association between household structure/composition and the Minimum Meal Frequency (MMF) and Minimum Dietary Diversity (MDD). The average Marginal Effects (MEs) were calculated to facilitate practical interpretation. Children of caregivers with a higher number of alters (degree), unique number of kinship category (effect size), closely related (constraint), and mixed-age alters (age diversity) seemed to increase the probability of meeting the MDD. Degree and effective size decreased the probability of meeting MMF, while constraint increased it. Overall, this study revealed some associations between household structure and composition and complementary feeding practices. Hence, complementary feeding interventions could be adapted to account for the household structure and composition variations.
Collapse
Affiliation(s)
- Asnake Ararsa Irenso
- School of Public Health, Haramaya University, Harar P.O. Box 235, Ethiopia
- Institute for Physical Activity and Nutrition (IPAN), School of Nutrition and Exercise Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia; (M.Z.); (K.J.C.); (R.L.)
- Correspondence: ; Tel.: +61-416-121-881
| | - Dan Chamberlain
- Centre for Social Impact, University of New South Wales, Kennington, NSW 2052, Australia;
| | - Miaobing Zheng
- Institute for Physical Activity and Nutrition (IPAN), School of Nutrition and Exercise Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia; (M.Z.); (K.J.C.); (R.L.)
| | - Karen J. Campbell
- Institute for Physical Activity and Nutrition (IPAN), School of Nutrition and Exercise Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia; (M.Z.); (K.J.C.); (R.L.)
| | - Rachel Laws
- Institute for Physical Activity and Nutrition (IPAN), School of Nutrition and Exercise Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia; (M.Z.); (K.J.C.); (R.L.)
| |
Collapse
|
33
|
Maleki Saghooni N, Karshki H, Esmaily H, Zaidi Feroz F, Mirzaii Najmabadi K. Mothers' Breastfeeding Experiences of Emotional Support Needs: A Qualitative Study in Iran. J Caring Sci 2021; 10:169-176. [PMID: 34849361 PMCID: PMC8609118 DOI: 10.34172/jcs.2021.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 01/06/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction: Breastfeeding is an important strategy to ensure health promotion and wellbeing. Since breastfeeding rates have consistently decreased around the world, protection, promotion, and supportive programs are considered as public health priorities. This study aims to explore breastfeeding mothers’ perceptions and experiences of emotional support needs.
Methods: This study was performed in five health centers and four hospitals affiliated to Mashhad University of Medical Sciences, Iran. Using a qualitative approach, 36 breastfeeding mothers, family members, and health providers attended individual semi-structured in-depth interviews. Data were analyzed using directed content analysis based on the Elo and Kyngas approach, with MAXQDA software version 10.
Results: Four categories of ‘need to tranquility and solace’, ‘sense of being loved and belongingness’, ‘creating hope, motivation, and confidence’, and ‘empathy and companionship’, and 12 subcategories including ‘not inducing stress’, ‘relieving the mother’s stress and worries’, ‘creating and maintaining tranquility’, ‘understanding and attention’, ‘receiving affection from significant others’, ‘being respected by others’, ‘ being inspired by significant others’, ‘being assured by family members’, ‘being motivated by significant others’, ‘interacting with others’, ‘having the companionship and presence of others’, and ‘receiving empathy from others’ were identified as the mothers’ emotional support needs.
Conclusion: Mothers need emotional support to sustain breastfeeding. Significant others, such as the husband, family members, and health providers play an important role in meeting breastfeeding mothers’ emotional support needs.
Collapse
Affiliation(s)
- Nahid Maleki Saghooni
- Students Research Committee, School of Nursing and Midwifery, Mashhad University of Medical Science, Mashhad, Iran
| | - Hossein Karshki
- Department of Psychology, Faculty of Education Sciences & Psychology, Ferdowsi University, Mashhad, Iran
| | - Habibollah Esmaily
- Department of Biostatistics, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fakhera Zaidi Feroz
- Department of Obstetrics & Gynecology, Academic Health Science Center (AHSC) for Reproductive Maternal Newborn Child Health (PMNCH), London, U.K
| | - Khadigeh Mirzaii Najmabadi
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Science, Mashhad, Iran
| |
Collapse
|
34
|
Shaker‐Berbari L, Qahoush Tyler V, Akik C, Jamaluddine Z, Ghattas H. Predictors of complementary feeding practices among children aged 6-23 months in five countries in the Middle East and North Africa region. MATERNAL & CHILD NUTRITION 2021; 17:e13223. [PMID: 34137179 PMCID: PMC8476411 DOI: 10.1111/mcn.13223] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 01/13/2023]
Abstract
Ensuring diets of children aged 6-23 months meet recommended guidance is crucial for growth and development and for the prevention of malnutrition including stunting, wasting and micronutrient deficiencies. Despite some improvement, indicators related to undernutrition and overnutrition fall short of global targets in the Middle East and North Africa (MENA) region that consist of low- and middle-income countries witnessing political and social changes and a nutrition transition. This research aims at reviewing the situation related to the diets of children aged 6-23 months in five selected countries in the MENA region, examining factors affecting complementary feeding and providing recommendations for guiding effective strategies to improve it. The study triangulated data on complementary feeding status and predictors from semistructured interviews with 30 key informants, and multivariable analysis of household surveys in Egypt, Jordan, Lebanon, State of Palestine and Sudan including data on refugees in Lebanon and Jordan. There remain considerable gaps in complementary feeding differing noticeably among geographic areas. Findings from qualitative and quantitative analyses showed that maternal factors, including maternal education and age, household level factors such as paternal education and wealth, community-level factors (culture and geographic location), and utilization of health services, were associated with minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD) at varied levels in the five countries. Interventions to improve complementary feeding practices should include actions tailored to the needs of the population at multiple levels including at the caregiver's level, household, service use, community and policy level.
Collapse
Affiliation(s)
- Linda Shaker‐Berbari
- United Nations Children's Fund (UNICEF) Regional Office for Middle East and East Africa RegionAmmanJordan
| | - Vilma Qahoush Tyler
- United Nations Children's Fund (UNICEF) Regional Office for Middle East and East Africa RegionAmmanJordan
| | - Chaza Akik
- Center for Research on Population and Health, Faculty of Health SciencesAmerican University of BeirutBeirutLebanon
| | - Zeina Jamaluddine
- Center for Research on Population and Health, Faculty of Health SciencesAmerican University of BeirutBeirutLebanon
- London School of Hygiene and Tropical MedicineLondonUK
| | - Hala Ghattas
- Center for Research on Population and Health, Faculty of Health SciencesAmerican University of BeirutBeirutLebanon
| |
Collapse
|
35
|
Chande M, Muhimbula H, Mremi R, Muzanila YC, Kumwenda NC, Msuya J, Msere H, Bekunda M, Okori P, Gichohi-Wainaina WN. Drivers of Millet Consumption Among School Aged Children in Central Tanzania. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2021. [DOI: 10.3389/fsufs.2021.694160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Iron and zinc deficiency are common public health problems in low-income countries largely due to poor consumption of iron and zinc rich foods. It has previously been observed that 57% of school aged children (SAC) in Tanzania suffer from anemia. In addition, estimates indicate that over 25% of the population have inadequate zinc intake. Pearl millet is an example of a nutrient dense, resilient cereal crop, that can be promoted to diversify diets and combat iron and zinc deficiency. This study overall aim was to increase pearl millet consumption among school aged (5 – 12 years) children. As part of the study, we investigated, the drivers of food choice relating to pearl millet consumption.Methods: The study was a cross-sectional study of randomly selected households in Kongwa district, Dodoma region of Tanzania. In total, 128 women of reproductive age (20 – 49 years) were randomly selected for the study. A study questionnaire consisting of 66 items, was developed and validated. The constructs in the questionnaire were categorized in two groups: internal and external factors. Respondents were asked to indicate their level of agreement or disagreement with statements read to them by interviewers. The scores on intention and behavior constructs were based on the number of times caregivers intended to, or had fed their school going children with pearl millet in the referent month. Intention was considered high if it was higher than the median intention score of the group, and low if it was equal to or lower than the median scores. Correlations and multiple linear regressions were performed to measure association between constructs and to identify predictive constructs. The Mann-Whitney U test was used for score comparison.Results: There was a significant difference between intention and behavior among those who did not consume pearl millet (P = 0.003), and those who consumed pearl millet two or more times a week, in the same month (P = 0.01). Knowledge was significantly correlated with behavior identity (ρ = 0.58, P = 0.001), while health behavior identity was significantly correlated with intention (ρ = 0.31, P = 0.001). Intention of caregivers was significantly and positively correlated (ρ = 0.44, P = 0.001) with and predicted consumption of pearl millet (ρ = 0.87, P = 0.067).Conclusion: Increasing knowledge or awareness on nutritional benefits of pearl millet among caregivers may increase consumption of pearl millet by children of school going age.
Collapse
|
36
|
Cunningham K, Nagle D, Gupta P, Adhikari RP, Singh S. Associations between parents' exposure to a multisectoral programme and infant and young child feeding practices in Nepal. MATERNAL & CHILD NUTRITION 2021; 17 Suppl 1:e13143. [PMID: 34241957 PMCID: PMC8269143 DOI: 10.1111/mcn.13143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/07/2020] [Accepted: 01/04/2021] [Indexed: 12/28/2022]
Abstract
In Nepal, an at-scale, multisectoral programme-Suaahara (2011-2023)-aims to improve nutrition behaviours. Suaahara II (2016-2023) transitioned from a mother/child dyad focus to explicitly targeting all family members. Evidence is scant, however, regarding how exposure by men to social and behaviour change interventions relates to nutrition outcomes. This study uses a 2019 cross-sectional monitoring dataset to test associations between maternal and male household head exposure to Suaahara II interventions (interacting with a frontline worker, participating in a community event or listening to the Bhanchhin Aama radio programme) and adoption of three infant and young child feeding practices: minimum dietary diversity, minimum acceptable diet and sick child feeding, in households with a child under 2 years (n = 1827). Maternal exposure to Suaahara II had a positive association with minimum dietary diversity (OR: 1.71, 95% CI [1.27, 2.28], P < 0.001), minimum acceptable diet (OR: 1.60, 95% CI [1.19, 2.14], P = 0.002) and increased feeding to a sick child (OR: 2.11, 95% CI [1.41, 3.17], P < 0.001). Male household head exposure was only associated with increased feeding to a sick child (OR: 2.21, 95% CI [1.27, 3.84], P = 0.005). Among households with an exposed mother, having an exposed male household head nearly tripled the odds of appropriate sick child feeding (OR: 2.90, 95% CI [1.57, 5.34], P = 0.001) but was not significantly associated with the other two outcomes. These findings suggest that the relationships between exposure to nutrition programmes and outcomes are complex and further research is needed to understand variation by family member, behavioural outcome and context.
Collapse
Affiliation(s)
- Kenda Cunningham
- Helen Keller InternationalNew YorkNew YorkUSA
- Department of Population Health, Faculty of Epidemiology, London School of Hygiene and Tropical MedicineLondonEngland
| | - Devin Nagle
- Heilbrunn Department of Population and Family Health, Mailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
| | - Poonam Gupta
- Department of International Health, Johns Hopkins Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | | |
Collapse
|
37
|
Martin SL, Matare CR, Kayanda RA, Owoputi I, Kazoba A, Bezner Kerr R, Nnally L, Khan M, Locklear KH, Dearden KA, Dickin KL. Engaging fathers to improve complementary feeding is acceptable and feasible in the Lake Zone, Tanzania. MATERNAL & CHILD NUTRITION 2021; 17 Suppl 1:e13144. [PMID: 34241956 PMCID: PMC8269136 DOI: 10.1111/mcn.13144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/05/2020] [Accepted: 01/04/2021] [Indexed: 11/27/2022]
Abstract
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.
Collapse
Affiliation(s)
- Stephanie L. Martin
- Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Cynthia R. Matare
- Program in International Nutrition, Division of Nutritional SciencesCornell UniversityIthacaNYUSA
| | | | - Ibukun Owoputi
- Program in International Nutrition, Division of Nutritional SciencesCornell UniversityIthacaNYUSA
| | | | | | | | - Maliha Khan
- Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Kamryn H. Locklear
- Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | | | - Katherine L. Dickin
- Program in International Nutrition, Division of Nutritional SciencesCornell UniversityIthacaNYUSA
| |
Collapse
|
38
|
Thuita F, Mukuria A, Muhomah T, Locklear K, Grounds S, Martin SL. Fathers and grandmothers experiences participating in nutrition peer dialogue groups in Vihiga County, Kenya. MATERNAL & CHILD NUTRITION 2021; 17 Suppl 1:e13184. [PMID: 34241953 PMCID: PMC8269141 DOI: 10.1111/mcn.13184] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 12/01/2022]
Abstract
Grandmothers and fathers are key influencers of maternal and child nutrition and are increasingly included in interventions. Yet, there is limited research exploring their experiences participating in interventions. This study reports on findings from a qualitative process evaluation of a quasi-experimental study that we conducted with grandmother and father peer dialogue groups to support maternal, infant and young child feeding practices in western Kenya. The aim was to explore grandmother and father experiences participating in interventions and how participation influences care and feeding practices. Grandmother and father peer educators received training to facilitate discussions about maternal and child nutrition, HIV and infant feeding, family communication, and family members' roles. Father peer educators also received training on gender inequities and power dynamics. In the original quasi-experimental study, the intervention was associated with increased social support and improvements in some complementary feeding practices. The process evaluation explored participants' experiences and how participation influenced infant care and feeding practices. We used Atlas.ti to thematically analyse data from 18 focus group discussions. The focus group discussions revealed that grandmothers and fathers valued their groups, the topics discussed and what they learned. Grandmothers reported improved infant feeding and hygiene practices, and fathers reported increased involvement in child care and feeding and helping with household tasks. Both described improved relationships with daughters-in-law or wives. This study highlights the importance of engaging influential family members to support child nutrition and identifies factors to build cohesion among group members, by building on grandmothers' roles as advisors and expanding fathers' roles in nutrition through gender transformative activities.
Collapse
Affiliation(s)
- Faith Thuita
- School of Public HealthUniversity of NairobiNairobiKenya
| | - Altrena Mukuria
- USAID Advancing Nutrition/Department of Global HealthSave the ChildrenWashingtonDCUSA
| | | | - Kamryn Locklear
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Samantha Grounds
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Stephanie L. Martin
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| |
Collapse
|
39
|
Aubel J, Martin SL, Cunningham K. Introduction: A family systems approach to promote maternal, child and adolescent nutrition. MATERNAL & CHILD NUTRITION 2021; 17 Suppl 1:e13228. [PMID: 34241950 PMCID: PMC8269145 DOI: 10.1111/mcn.13228] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/19/2021] [Indexed: 11/26/2022]
Abstract
In all cultures, women and children are embedded in family systems that determine roles, relationships, patterns of communication and authority between family members. Especially in non-western societies, maternal and child nutrition practices are determined not only by the biological parents but also by other influential family members. Most maternal and child nutrition research and interventions do not consider the constellation of family roles and influence on women and children and continue to focus on the mother-child dyad and individual knowledge, attitudes and practices. There is growing agreement on the need to adopt an ecological framework to address public health issues, including those dealing with maternal and child nutrition. This special issue presents examples of research from a variety of settings that employed an ecological, family systems approach either to investigate maternal, child or adolescent nutrition issues or to design interventions that engaged various actors within family settings. These 11 articles contribute to a growing body of evidence supporting the relevance of a wider family systems perspective for nutrition research and interventions. Key themes across studies include the limitations of using a nuclear family model for research and intervention design, the need for formative research that comprehensively explores family systems, increasing recognition of the extensive involvement and support provided by grandmothers, and the importance of engaging men in culturally appropriate ways based on community dialogue and women's perspectives. Future maternal and child nutrition research and interventions can be strengthened by systems thinking that acknowledges that individuals are situated within family and community systems.
Collapse
Affiliation(s)
- Judi Aubel
- Grandmother Project—Change through CultureRomeItaly
| | - Stephanie L. Martin
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Kenda Cunningham
- Helen Keller InternationalNew YorkNew YorkUSA
- Department of Population Health, Faculty of Epidemiology, London School of Hygiene and Tropical MedicineLondonEngland
| |
Collapse
|
40
|
Martin SL, McCann JK, Gascoigne E, Allotey D, Fundira D, Dickin KL. Engaging family members in maternal, infant and young child nutrition activities in low- and middle-income countries: A systematic scoping review. MATERNAL & CHILD NUTRITION 2021; 17 Suppl 1:e13158. [PMID: 34241961 PMCID: PMC8269148 DOI: 10.1111/mcn.13158] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 01/06/2021] [Accepted: 01/12/2021] [Indexed: 12/20/2022]
Abstract
The influence of fathers, grandmothers and other family members on maternal, infant and young child nutrition practices has been well documented for decades, yet many social and behavioural interventions continue to reach only mothers. While recent guidelines recommend involving fathers, grandmothers and other family members in maternal and child nutrition, we lack a comprehensive review of interventions that have engaged them. This scoping review aimed to address this gap by describing social and behavioural interventions to engage family members in maternal and child nutrition in low- and middle-income countries. We systematically searched PubMed, Scopus, Web of Science, Global Health and CINAHL for peer-reviewed studies meeting inclusion criteria. We screened 6,570 abstracts, evaluated 179 full-text articles, and included 87 articles from 63 studies. Studies reported a broad range of approaches to engage fathers, grandmothers and other family members to support maternal nutrition (n = 6); breastfeeding (n = 32); complementary feeding (n = 6) and multiple maternal and child nutrition practices (n = 19). Interventions were facility and community based; included individual and group-based interpersonal communication, community mobilization, mass media and mHealth; and reached mothers and family members together or separately. Most interventions were located within the health sector; rare exceptions included nutrition-sensitive agriculture, social protection, early child development and community development interventions. Few interventions addressed gender norms, decision-making, and family dynamics or described formative research or theories informing intervention design. These diverse studies can shed light on innovative programme approaches to increase family support for maternal and child nutrition.
Collapse
Affiliation(s)
- Stephanie L. Martin
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Juliet K. McCann
- Program in International Nutrition, Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | - Emily Gascoigne
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Diana Allotey
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Dadirai Fundira
- Program in International Nutrition, Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | - Katherine L. Dickin
- Program in International Nutrition, Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| |
Collapse
|
41
|
Umugwaneza M, Havemann-Nel L, Vorster HH, Wentzel-Viljoen E. Factors influencing complementary feeding practices in rural and semi-urban Rwanda: a qualitative study. J Nutr Sci 2021; 10:e45. [PMID: 34164124 PMCID: PMC8190714 DOI: 10.1017/jns.2021.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/08/2021] [Accepted: 05/18/2021] [Indexed: 11/08/2022] Open
Abstract
The aim of the present study was to identify and describe the factors influencing feeding practices of children aged 6-23 months in Rwanda. This is a cross-sectional descriptive qualitative study. A total of ten focus group discussions were conducted separately with mothers, fathers, grandmothers and community health workers (CHWs) from five different districts in Rwanda. The discussions were recorded, transcribed verbatim, and thematically analysed using qualitative data analysis software, Atlas.ti. The study participants were mothers, fathers and grandmothers of children aged 6-23 months and CHWs in charge of child health. Caregivers' knowledge and beliefs about the benefits of breast-feeding and timely introduction of complementary food were found to be the primary individual factors facilitating good infant and young child feeding practices. The common belief of caregivers that infants should be given liquids (thin gruel, fruit juices and meat broth) as first foods instead of semi-solid foods was a barrier to good feeding practices. The community-based nutrition education and counselling programmes were facilitators of good complementary practices at the group level. At the society level, poverty in rural agrarian households was a barrier to optimal feeding practices. The study shows that there is a need to empower caregivers with more specific guidelines, especially on complementary feeding.
Collapse
Affiliation(s)
- Maryse Umugwaneza
- College of Medicine and Health Sciences, University of Rwanda, P.O. Box 3286, Kigali, Rwanda
| | - Lize Havemann-Nel
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, Potchefstroom2520, South Africa
| | - Hester H. Vorster
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, Potchefstroom2520, South Africa
| | - Edelweiss Wentzel-Viljoen
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, Potchefstroom2520, South Africa
| |
Collapse
|
42
|
Etowa J, Hannan J, Etowa EB, Babatunde S, Phillips JC. Determinants of infant feeding practices among Black mothers living with HIV: a multinomial logistic regression analysis. BMC Public Health 2021; 21:663. [PMID: 33827510 PMCID: PMC8025335 DOI: 10.1186/s12889-021-10675-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infant feeding practices are imperative for babies' and mothers' health and emotional wellbeing. Although infant feeding may seem simple, the decisions surrounding it are complex and have far-reaching implications for women globally. This is an especially difficult concern among mothers living with HIV because breastfeeding can transmit HIV from mother to child. This is further complicated by cultural expectations in case of Black mothers living with HIV. This paper discusses determinants of infant feeding practices among Black mothers living with HIV who were on anti-retroviral therapy (ART) in two North American cites and one African city. METHODS A cross-sectional, multi-country survey using venue-based convenience sampling of Black mothers living with HIV was employed. The effective response rates were 89% (n = 89) in Ottawa, Canada; 67% (n = 201) in Miami, Florida, US; and 100% (n = 400) in Port Harcourt, Nigeria, equaling a total sample size of 690. Data were collected in Qualtrics and managed in Excel and SPSS. Multinomial logistic regression analyses were used to determine the factors influencing the mothers' infant feeding practices (Exclusive Formula Feeding [EFF] = 1; Mixed Feeding [MF] = 2; and Exclusive Breastfeeding [EBF while on ART] =3). RESULTS The results highlight socio-demographics, EFF determinants, and EBF determinants. The statistically significant determinants of infant feeding practices included national guideline on infant feeding, cultural beliefs and practices, healthcare systems, healthcare personnel, infant feeding attitudes, social support, and perceived stress. Mothers' mean ages were Ottawa (36.6 ± 6.4), Miami (32.4 ± 5.8), and Port Harcourt (34.7 ± 5.7). All sampled women gave birth to least one infant after their HIV diagnoses. Statistically significant (p < .05) determinants of EFF relative to MF were the national guideline of EFF (relative risk [RR] = 218.19), cultural beliefs (RR = .15), received healthcare (RR = 21.17), received healthcare through a nurse/midwife (RR = 3.1), and perceived stress (RR = .9). Statistically significant determinants of EBF relative to MF were received healthcare (RR = 20.26), received healthcare through a nurse/midwife (RR = 2.31), functional social support (RR = 1.07), and perceived stress (RR = .9). CONCLUSION While cultural beliefs and perceived stress favoured MF over EFF, advice of healthcare workers, and the care received from a nurse/midwife improved EFF over MF. Also while the mothers' perceived stress favoured MF over EBF, advice of their nurses or midwife and the social support improved EBF over MF. The providers advice was congruent with WHO and national guidelines for infant feeding among mothers living with HIV. These results have implications for nursing, healthcare practice, and policies on infant feeding practices for mothers living with HIV.
Collapse
Affiliation(s)
- Josephine Etowa
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada
| | - Jean Hannan
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, 11200 Southwest 8th Street, Miami, FL, 33199, USA
| | - Egbe B Etowa
- Department of Sociology, Anthropology & Criminology; Faculty of Arts, Humanities & Social Sciences, 401 Sunset Avenue, Windsor, Ontario, N9B 3P4, Canada.
| | - Seye Babatunde
- Centre for Health and Development, University of Port Harcourt, Port Harcourt, Nigeria
| | - J Craig Phillips
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada
| |
Collapse
|
43
|
Fathers' involvement in child care activities: Qualitative findings from the highlands of Madagascar. PLoS One 2021; 16:e0247112. [PMID: 33784340 PMCID: PMC8009407 DOI: 10.1371/journal.pone.0247112] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 02/01/2021] [Indexed: 11/19/2022] Open
Abstract
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.
Collapse
|
44
|
Woldetensay YK, Belachew T, Ghosh S, Kantelhardt EJ, Biesalski HK, Scherbaum V. The effect of maternal depressive symptoms on infant feeding practices in rural Ethiopia: community based birth cohort study. Int Breastfeed J 2021; 16:27. [PMID: 33743775 PMCID: PMC7980325 DOI: 10.1186/s13006-021-00375-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/12/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Maternal depression and other psychosocial factors have been shown to have adverse consequences on infant feeding practices. This study explored the longitudinal relationship of maternal depressive symptoms and other selected psychosocial factors with infant feeding practices (IFPs) in rural Ethiopia using summary IFP index. METHODS This study uses existing data from the ENGINE birth cohort study, conducted from March 2014 to March 2016 in three districts in the southwest of Ethiopia. A total of 4680 pregnant women were recruited and data were collected once during pregnancy (twice for those in the first trimester), at birth, and then every 3 months until the child was 12 months old. A standardized questionnaire was used to collect data on IFPs, maternal depressive symptoms, household food insecurity, intimate partner violence (IPV), maternal social support, active social participation, and other sociodemographic variables. A composite measure of IFP index was computed using 14 WHO recommended infant and young child feeding (IYCF) practice indicators. High IFP index indicated best practice. Prenatal and postnatal maternal depressive symptoms were assessed using the patient health questionnaire (PHQ-9). Linear multilevel mixed effects model was fitted to assess longitudinal relationship of IFPs with maternal depression and other psychosocial factors. RESULTS Reports of higher postnatal depressive symptoms (ß = - 1.03, P = 0.001) and IPV (ß = - 0.21, P = 0.001) were associated with lower scores on the IFP index. Whereas, reports of better maternal social support (ß = 0.11, P = 0.002) and active social participation (ß = 0.55, P < 0.001) were associated with higher scores on the IFP index. Contrary to expectations, moderate household food insecurity (ß = 0.84, P = 0.003), severe household food insecurity (ß = 1.03, P = 0.01) and infant morbidity episodes (ß = 0.63, P = 0.013) were associated with higher scores on the IFP index. CONCLUSIONS Overall, a multitude of factors are related to IFPs and hence coordinated, multi-sectoral and multi-stakeholder interventions including maternal depressive symptoms screening and management are needed to improve infant feeding practices.
Collapse
Affiliation(s)
- Yitbarek Kidane Woldetensay
- Institute of Nutrition Science (140a), University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
| | - Tefera Belachew
- Department of Population and Family Health, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Shibani Ghosh
- Tufts University, Friedman School of Nutrition Science and Policy, Boston, USA
| | - Eva Johanna Kantelhardt
- Department of Gynecology, Faculty of Medicine, Martin-Luther University, Halle, Germany
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther University, Halle, Germany
| | - Hans Konrad Biesalski
- Institute of Nutrition Science (140a), University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
| | - Veronika Scherbaum
- Institute of Nutrition Science (140a), University of Hohenheim, Stuttgart, Germany
| |
Collapse
|
45
|
Dickin KL, Litvin K, McCann JK, Coleman FM. Exploring the Influence of Social Norms on Complementary Feeding: A Scoping Review of Observational, Intervention, and Effectiveness Studies. Curr Dev Nutr 2021; 5:nzab001. [PMID: 33718753 PMCID: PMC7937492 DOI: 10.1093/cdn/nzab001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 01/09/2023] Open
Abstract
The influence of social norms on child feeding is recognized, but guidance is lacking on how to address norms and related perceptions that hinder or support positive nutrition practices. We reviewed recent peer-reviewed and grey literature to summarize social norms relevant to complementary feeding (CF), intervention approaches that address norms, and their impacts on social norms and CF outcomes. Many reports described various norms, customs, and perceptions related to appropriate foods for young children, parenting practices, gender, and family roles, but rarely explored how they motivated behavior. Community engagement and media interventions addressed norms through facilitated discussions, challenging negative norms, portraying positive norms, engaging emotions, and correcting misperceptions. Evaluations of norms-focused interventions reported improved CF practices, but few assessed impacts on social norms. Although multiple contextual factors influence CF practices, evidence suggests the feasibility and effectiveness of addressing social norms as one component of programs to improve CF practices.
Collapse
Affiliation(s)
- Katherine L Dickin
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
- USAID Advancing Nutrition, Crystal City, VA, USA
| | - Kate Litvin
- USAID Advancing Nutrition, Crystal City, VA, USA
| | - Juliet K McCann
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Fiona M Coleman
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| |
Collapse
|
46
|
Ahishakiye J, Vaandrager L, Brouwer ID, Koelen M. Qualitative, longitudinal exploration of coping strategies and factors facilitating infant and young child feeding practices among mothers in rural Rwanda. BMC Public Health 2021; 21:103. [PMID: 33419407 PMCID: PMC7796631 DOI: 10.1186/s12889-020-10095-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 12/20/2020] [Indexed: 11/29/2022] Open
Abstract
Background Mothers in low-income countries face many challenges to appropriately feed their children in the first year such as poverty, food insecurity and high workloads. However, even in the lowest income families there are mothers who succeed to feed their children according to the recommendations. In this paper, we explored the coping strategies that facilitate appropriate breastfeeding and complementary feeding practices among rural Rwandan mothers from birth to one year of a child’s life. Methods This qualitative longitudinal study recruited a purposive sample of 17 mothers who followed the infant and young child feeding recommendations (IYCF). They were selected from a larger study of 36 mothers. In-depth interviews were conducted with mothers of the total group (36 mothers) within the first week, at 4th, 6th, 9th and 12th months postpartum. Interviews were audio-recorded, transcribed verbatim and analyzed thematically. Results Coping strategies included improving mothers’ own diet for adequate breastmilk production, prioritizing child feeding over livelihood chores, livelihood diversification and mothers’ anticipatory behaviors such as preparing child’s food in advance. Some of those coping strategies were shifting overtime depending on the development of the children. Personal factors such as breastfeeding self-efficacy, religious beliefs and perceived benefits of breastfeeding were among the facilitating factors. Additionally, social support that mothers received from family members, other mothers in the community, Community Health Workers (CHWs) and health professionals played an important role. Conclusion In challenging contextual conditions, mothers manage to follow the recommended breastfeeding and complementary feeding practices through the interplay of active coping strategies, feeling to be in control and social support. Nutrition promotion interventions that aim to improve IYCF should consider strengthening mothers’ capability in gaining greater control of their IYCF practices and the factors facilitating their appropriate IYCF practices.
Collapse
Affiliation(s)
- Jeanine Ahishakiye
- Department of Human Nutrition and Dietetics, College of Medicine and Health Sciences, University of Rwanda, P.O Box 3286, Kigali, Rwanda. .,Health and Society Chair Group, Wageningen University and Research, P.O Box 8130, 6700EW Wageningen, The Netherlands.
| | - Lenneke Vaandrager
- Health and Society Chair Group, Wageningen University and Research, P.O Box 8130, 6700EW Wageningen, The Netherlands
| | - Inge D Brouwer
- Division of Human Nutrition and Health, Wageningen University and Research, P.O Box 17, 6700AA Wageningen, The Netherlands
| | - Maria Koelen
- Health and Society Chair Group, Wageningen University and Research, P.O Box 8130, 6700EW Wageningen, The Netherlands
| |
Collapse
|
47
|
Aidam BA, MacDonald CA, Wee R, Simba J, Aubel J, Reinsma KR, Girard AW. An Innovative Grandmother-Inclusive Approach for Addressing Suboptimal Infant and Young Child Feeding Practices in Sierra Leone. Curr Dev Nutr 2020; 4:nzaa174. [PMID: 33409444 PMCID: PMC7773705 DOI: 10.1093/cdn/nzaa174] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Suboptimal infant and young child feeding (IYCF) practices contribute to child undernutrition. Sierra Leone Demographic and Health Survey data show that IYCF practices remain poor despite modest improvements. Recent studies have identified the role of grandmothers as critical to child nutrition; however, in Sierra Leone to date, the potential for grandmothers to influence IYCF practices has not been investigated. OBJECTIVES We examined how an innovative grandmother-inclusive approach (GMIA) can be used to address suboptimal IYCF practices. METHODS Using a quasi-experimental design, we compared IYCF beliefs and practices between GMIA intervention communities (receiving monthly dialogue sessions on nutrition, quarterly community praise sessions, and intergenerational forums) and comparison communities (receiving standard nutrition education) in Bum chiefdom from 2013 and 2016. The quantitative endline survey targeted 101 pregnant women, 291 women with children aged <2 y, and 219 grandmothers. Statistical analyses utilized t tests and χ2 tests to examine differences between intervention and comparison communities at endline. Multivariate regression was used to determine the intervention's effect on IYCF outcomes of interest. RESULTS Awareness of and participation in the GMIA was high among mothers and grandmothers in intervention communities. The percentage of infants and young children aged 0-23 mo (n = 291) exclusively breastfed during the first week of life was significantly higher in the intervention group (90.2% compared with 79.4%, P = 0.01). Among infants aged 6-23 mo (n = 219), the percentage achieving minimum dietary diversity and minimum acceptable diet was significantly higher in the intervention group (77.2% compared with 51.8%, P < 0.001; and 53.8% compared with 22.6%, P < 0.001, respectively). Differences in percentages achieving minimum meal frequency (MMF) were only significant for infants aged 9-23 mo, with the intervention group achieving a higher MMF (54.6% compared with 36.9%, P = 0.02). CONCLUSIONS Results suggest that a GMIA that recognizes grandmothers' roles and strengthens their knowledge can contribute to improved IYCF practices.
Collapse
Affiliation(s)
- Bridget A Aidam
- Action Against Hunger USA. Previously of Evidence and Learning Unit, World Vision International, Washington, DC, USA
| | - Carolyn A MacDonald
- World Vision International, Nutrition Centre of Expertise, Mississauga, Ontario, Canada
| | - Rebecca Wee
- Hubert Department of Global Health and Nutrition, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Joseph Simba
- World Vision Sierra Leone, Freetown, Sierra Leone
| | - Judi Aubel
- Grandmother Project: Change through Culture, Rome, Italy
| | - Kathryn R Reinsma
- World Vision International, Nutrition Centre of Expertise, Mississauga, Ontario, Canada
| | - Amy Webb Girard
- Hubert Department of Global Health and Nutrition, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| |
Collapse
|
48
|
Rakotomanana H, Hildebrand D, Gates GE, Thomas DG, Fawbush F, Stoecker BJ. Maternal Knowledge, Attitudes, and Practices of Complementary Feeding and Child Undernutrition in the Vakinankaratra Region of Madagascar: A Mixed-Methods Study. Curr Dev Nutr 2020; 4:nzaa162. [PMID: 33274306 PMCID: PMC7695809 DOI: 10.1093/cdn/nzaa162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Data are limited on how feeding knowledge and practices relate to child undernutrition in the highlands of Madagascar. OBJECTIVES This study assessed maternal knowledge and practices of complementary feeding and their associations with anthropometrics of children aged 6-23 mo in the Vakinankaratra region of Madagascar. METHODS Knowledge was assessed using WHO recommendations on child feeding, and WHO infant and young child feeding (IYCF) indicators were used to evaluate feeding practices. Child growth was measured as length-for-age, weight-for-age, and weight-for-length z-scores using the 2006 WHO growth standards. A z-score less than -2 was classified as child undernutrition. Logistic regression models were used to determine associations between independent variables and outcomes. Focus group discussions among mothers and in-depth interviews with key informants were conducted; barriers and facilitators of optimal feeding practices were identified using a thematic analysis approach. RESULTS Maternal knowledge scores regarding child feeding averaged 6.4 of 11. Better knowledge scores were associated with higher odds of appropriate complementary feeding practices before and after covariate adjustments. The proportions of children achieving the minimum dietary diversity (35.8%), minimum acceptable diet (30.2%), and consuming meat, fish, and poultry (14.1%) were low. Only consumption of iron-rich foods was associated with lower odds of underweight (adjusted OR = 0.3; 95% CI: 0.1, 0.7; P < 0.05). None of the IYCF indicators were associated significantly with stunting or wasting. Maternal attitudes about complementary foods, as well as mothers' workload and very low income, were identified as barriers to optimal feeding practices. Maternal perceived benefits of giving appropriate complementary foods as well as their positive relationship with the community health workers were the main facilitators of optimal child feeding. CONCLUSIONS Integrated nutrition-sensitive interventions addressing these barriers while enhancing the facilitators are critical in promoting better feeding practices in the Vakinankaratra region.
Collapse
Affiliation(s)
- Hasina Rakotomanana
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, USA
| | - Deana Hildebrand
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, USA
| | - Gail E Gates
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, USA
| | - David G Thomas
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Fanjaniaina Fawbush
- Department of Agricultural and Food Science and Technology, University of Antananarivo, Antananarivo, Madagascar
| | - Barbara J Stoecker
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, USA
| |
Collapse
|
49
|
Po JYT, Bukania Z, Muhammad L, Hickey GM. Associations between Maternal Participation in Agricultural Decision-Making and Child Nutrition in Semiarid Kenya. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2020. [DOI: 10.1080/19320248.2019.1617214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- June Yee Tsun Po
- Department of Natural Resource Sciences, McGill University, Sainte-Anne-de-Bellevue, Q.C., Canada
| | | | - Lutta Muhammad
- Kenya Agricultural and Livestock Research Organization, Nairobi, Kenya
| | - Gordon M. Hickey
- Department of Natural Resource Sciences, McGill University, Sainte-Anne-de-Bellevue, Q.C., Canada
| |
Collapse
|
50
|
" When I Breastfeed, It Feels as if my Soul Leaves the Body": Maternal Capabilities for Healthy Child Growth in Rural Southeastern Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176215. [PMID: 32867111 PMCID: PMC7504657 DOI: 10.3390/ijerph17176215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 11/21/2022]
Abstract
The burden of childhood stunting in Tanzania is persistently high, even in high food-producing regions. This calls for a paradigm shift in Child Growth Monitoring (CGM) to a multi-dimensional approach that also includes the contextual information of an individual child and her/his caregivers. To contribute to the further development of CGM to reflect local contexts, we engaged the Capability Framework for Child Growth (CFCG) to identify maternal capabilities for ensuring healthy child growth. Ethnographic fieldwork was conducted in Southeastern Tanzania using in-depth interviews, key informant interviews, participant observation, and focus group discussions with caregivers for under-fives. Three maternal capabilities for healthy child growth emerged: (1) being able to feed children, (2) being able to control and make decisions on farm products and income, and (3) being able to ensure access to medical care. Mothers’ capability to feed children was challenged by being overburdened by farm and domestic work, and gendered patterns in childcare. Patriarchal cultural norms restricted women’s control of farm products and decision-making on household purchases. The CFCG could give direction to the paradigm shift needed for child growth monitoring, as it goes beyond biometric measures, and considers mothers’ real opportunities for achieving healthy child growth.
Collapse
|