Role of sociocultural perceptions in malnutrition of children under the age of 5 years in a semi-urban community of Pakistan

OBJECTIVE

To assess the impact of sociocultural perception on the nutritional status of children under five years of age.

METHODS

This cross-sectional study using a self-constructed questionnaire was conducted at the Shifa Rotary Clinic, Nurpur Shahan, Pakistan, from February to October 2016, and comprised mothers and children. Mothers age 18-45years having a child less than 5 years old were included. SPSS 21 was used for data analysis. .

RESULTS

Of the 564 participants, 526(93.3%) were housewives and 38(6.5%) were working mothers. The overall mean age was 27.49±5.197 years. Mother was the decision-maker for child nutrition in 344(61.0%) cases while the father was the decision-maker for child nutrition in 106(18.8%) cases. About 64(11.3%) wasted colostrums, of which 18(28.1%) acted on their own accord 46(71.9%) on others' advice. Mother as the decision-maker for child nutrition was found to be significantly associated with normal child nutritional status (p<0.05).In our study male child was 2.29 times likely to have a normal nutritional status as compared to a female child (p<0.05).

CONCLUSIONS

Sociocultural perceptions were found to have a significant impact on nutritional status of children under the age of 5 years.

'Both parents should care for babies': A cross-sectional, cross-cultural comparison of adolescents' breastfeeding intentions, and the influence of shared-parenting beliefs

BACKGROUND

Many young men and women expect to co-parent their newborn infant. This may have a positive or negative impact on decisions to breastfeed, which is an important health behaviour, influenced by cultural and psycho-social norms. We investigated the relationship between shared parenting, infant feeding beliefs and intentions in male and female (non-parent) adolescents, comparing Nordic countries (Sweden, Norway, Finland) with high breastfeeding rates with others with low rates (Scotland, USA).

METHODS

We utilised cross-sectional surveys of male and female adolescents (n = 1064, age 12-18) administered directly in schools or via the internet. We assessed attitudes to breast and formula feeding and shared parenting, using a Theory of Planned Behaviour framework, assessing beliefs, attitudes, norms and control as predictors of intention.

RESULTS

Male and female adolescents' breastfeeding intentions varied in line with national cultural norms. Young people from Nordic countries (high breastfeeding rates) were significantly more likely to intend to breastfeed than those from Scotland or the USA (low breastfeeding rates). Positive beliefs about breastfeeding, norms and 'exposure' to breastfeeding and feeding confidence were consistently stronger in Nordic countries, whereas young people in Scotland had more positive beliefs, norms and 'exposure' to formula feeding. Differences in parenting beliefs, norms and confidence were less consistent. In logistic regression, cultural group, positive breastfeeding beliefs and exposure, norms, and shared parenting beliefs were significant predictors of breastfeeding feeding intention.

CONCLUSIONS

Positive beliefs about shared parenting and equal gender norms were related to future breastfeeding intentions for female and male adolescents. Health education programmes for young people could encourage positive breastfeeding choices by considering how this would fit with young people's ideal parenting roles, and by emphasising benefits of complementary maternal and paternal roles in breastfeeding newborn infants.

Infant-feeding practices and American Indian infants' gut microbiome: Rationale of the pilot study

This study aims to examine the relationship between infant-feeding practices and American Indian infants' gut microbiome--laying the foundation of a research program aimed at identifying potential aetiologies of childhood obesity in this population. Previous studies have emphasised the high prevalence of obesity in American Indian infants, but its underlying causes remain unclear. We received funding from the University of Washington to examine attitudes towards breastfeeding and formula feeding in American Indian mothers, their dietary and physical activity habits and the yield, quality and diversity of their infants' gut microbiome. Our study combines the strengths of qualitative and quantitative data with DNA sequencing. Results will be used to propose a larger study aimed at clarifying aetiologies of childhood obesity in this population and to identify prevention strategies. This protocol describes the theoretical basis of the study, rationale for the target population, study design, participant recruitment and data analysis plan.

Complementary feeding practices and associated factors among HIV positive mothers in Southern Ethiopia

The objective of this study was to assess complementary feeding practices and associated factors among HIV exposed infants in Sidama Zone, Southern Ethiopia. An institutional based cross-sectional study with cluster random sampling technique was employed and all HIV exposed infants aged 6-17 months found in randomly selected health institutions in Sidama zone, Southern Ethiopia were included. A 24-hour dietary recall and 7-day quasi-food group frequency was used to assess complementary feeding practices. The prevalence of timely initiation of complementary feeding (6-8 months) was 42% [95% CI: (30-54%)]. Of all the HIV exposed infants aged 6-17 months, 40.7% had practiced bottle-feeding. About 65.6% and 53.3% of HIV exposed infants did not receive the recommended number of food groups and frequency of complementary feeding in the last 24 hours respectively. Pulse (plant protein) was consumed by only 22.5% of the infants while only 9.9% of the infants consumed animal source food in the last 24 hours. Presence of infant food prohibition (β = -0.342, P = 0.001) and age of the infant (β = 0.311, P = 0.001) were found to be an independent predictors of dietary diversity. Presence of infant food prohibition (β = -0.181, P = 0.02) and age of infant (β = 0.388, P < 0.001) were also the predictors of 24 hour meal frequency. Having lower educational status [AOR = (0.21, 95% CI (0.062-0.71)] was an independent negative predictor of bottle-feeding practice. Many of the complementary feeding practices like meal frequency; dietary diversity and bottle-feeding were sub-optimal. Nutrition education should be designed for improving complementary feeding practices of HIV exposed infants in Sidama Zone, Southern Ethiopia. Mothers with higher educational status should be also targeted for nutrition education especially on bottle feeding practice.

Impact of breastfeeding self-efficacy and sociocultural factors on early breastfeeding in an urban, predominantly Dominican community

BACKGROUND

Latinas have high breastfeeding initiation rates that decrease significantly in the first postpartum months. Little is known about the effects of self-efficacy and sociocultural factors on early breastfeeding among low-income Latinas. This study quantifies early breastfeeding rates and identifies factors associated with breastfeeding at 4-6 weeks postpartum in our community.

SUBJECTS AND METHODS

Mothers were recruited from a newborn clinic (NBC) in the first postpartum week. Questionnaires in the NBC and 4-6 weeks later assessed feeding practices, breastfeeding self-efficacy, and sociocultural factors. Feeding practices in the well baby nursery (WBN) were obtained by chart review. A scale from "1" (exclusive formula feeding) to "5" (exclusive breastfeeding) characterized feeding practices. Paired-sample t tests assessed change in feeding practices, and regression analysis assessed the impact of factors on breastfeeding at 4-6 weeks.

RESULTS

We interviewed 209 women: 86.1% Latina, 47.3% foreign-born, and 94.2% Medicaid-recipients. Breastfeeding increased from WBN to NBC (2.6±1.2 to 2.9±1.4; p<0.05) and then decreased by 4-6 weeks (2.9±1.4 to 2.5±1.44; p<0.05), without significant change between WBN and 4-6 weeks. Higher levels of education [β=0.21 (0.08, 0.56)], breastfeeding a previous child for ≥6 months [β=0.35 (0.57, 1.8)], foreign birth [β=0.2 (0.06, 1.07)], and higher breastfeeding self-efficacy scores [β=0.38 (0.02, 0.05)] were associated with more breastfeeding. Higher breastfeeding self-efficacy scores were associated with exclusive breastfeeding [adjusted odds ratio=1.18 (1.05, 1.32)].

CONCLUSIONS

Breastfeeding self-efficacy was the sole, modifiable factor associated with exclusive breastfeeding. Efforts to improve breastfeeding self-efficacy may serve to support breastfeeding in this population.

Factors contributing to infant overfeeding with Hispanic mothers

OBJECTIVE

To evaluate existing evidence on factors potentially contributing to infant overfeeding among Hispanic mothers that may explain the high infant overweight rates often seen among this ethnic group.

DATA SOURCES

Electronic databases including CINHAL and MEDLINE were searched for relevant studies published from 1998 to January 2012. Related article searches and reference list searches were completed on all included studies.

STUDY SELECTION

Thirty-five studies (nine qualitative, 15 cross-sectional, nine cohort, and two longitudinal) were identified that met the following inclusion criteria: (a) studies of Hispanic-only or multiethnic mothers, (b) studies of healthy full-term infants or toddlers, (c) studies in which a majority of the sample included children within the target age group (0-24 months of age), and (d) studies conducted in the United States. The methodological quality of the studies ranged from fair to excellent.

DATA EXTRACTION

Data extraction included content related to Hispanic infant feeding and weight gain.

DATA SYNTHESIS

Reviewed research fell into three main foci of inquiry: breastfeeding and formula-feeding beliefs, attitudes, and practices; family and cultural influences of maternal feeding beliefs and practices; and maternal perceptions of infant feeding satiety and weight gain. The Preferred Reporting Items of Systematic Reviews Meta-Analysis (PRISMA) guidelines were followed for data extraction and reporting the results of this integrative review.

CONCLUSION

Three major feeding practices and beliefs among Hispanic mothers potentially contribute to infant overfeeding. Hispanic mothers are more likely to practice nonexclusive breastfeeding, initiate early introduction of solid foods including ethnic foods, and perceive chubbier infants as healthy infants. Cultural norms driving family influences and socioeconomic factors play a role in the feeding tendencies of Hispanics. Empirical research is needed to further define the primary factors that influence Hispanic mothers feeding decisions and practices that contribute to excessive weight gain in their infants.

What factors explain pregnant women's feeding intentions in Bradford, England: a multi-methods, multi-ethnic study

BACKGROUND

Using a multi-methods approach we aimed to explore the relative prediction of demographic, socioeconomic and modifiable predictors from the Theory of Planned behaviour (TPB) in explaining feeding intentions amongst a multi-ethnic sample.

METHODS

476 women completed a questionnaire at 28 weeks gestation. They were grouped into breastfeeding (N = 258), mixed-feeding (N = 50), bottle-feeding (N = 88) intenders, or a no clear intention (N = 88). Multinomial adjusted regressions explored the influence of modifiable TPB factors, along with ethnicity and socioeconomic status in predicting group membership. Free-text responses allowed women to elaborate on reasons behind their intention.

RESULTS

TPB factors were significant predictors of feeding intention. Women with high intention to breastfeed were less likely to report high attitudes in any other feeding alternative. Bottle-feeding intenders reported poorer self-efficacy regarding breastfeeding compared to breastfeeding intenders (prevalence rate ratio, PRR = 0.10). Mixed and bottle-feeding intenders reported greater self-efficacy for mixed-feeding (PRR = 1.80, 5.50 respectively). Descriptive norms for mixed (PRR = 13.77) and bottle-feeding (PRR = 10.68) were predictive of mixed-feeding intention. Reasons for breastfeeding intentions related to health considerations, whilst bottle-feeding reasons related to convenience. Mixed-feeding intenders reported both breast and bottle-related factors.

CONCLUSIONS

Understanding modifiable predictors related to feeding intentions like TPB factors can help professionals target appropriate interventions to encourage breastfeeding.

Exploration of African-American women's infant feeding choices

It is well documented in the literature that breastfeeding is more beneficial for infants and mothers than is formula feeding. Yet, African-American women are least likely to initiate and continue breastfeeding compared to other ethnic groups. Few studies have examined African-American women's infant feeding choices from the women's perspectives. Therefore, the purpose of this exploratory study was to examine African-American women's infant feeding choices with individual narrative interviews at 3 weeks postpartum. Five African-American women participated. After coding and analyzing the narrative interviews, three major themes with sub-themes emerged that identified influencing factors on participants' choices and their opinions about other women who chose formula. The women willingly shared their rationales for their infant feeding methods. In an effort to develop and implement culturally appropriate interventions and to increase breastfeeding rates in this population, further exploration of infant feeding choices from the women's perspectives is needed.

Comparing child-feeding practices of Dominican mothers

The purpose of this study was to compare similarities and differences between two samples - mothers of children under the age of 6 years living in the Dominican Republic (D.R.) and recent immigrants from the D.R. to the United States - on their (a) feeding practices for infants and young children, (b) knowledge regarding healthy size and weight and ideal diet for young children, and (c) knowledge regarding the causes and health implications of childhood obesity. An exploratory descriptive design was used, and qualitative data were collected through focus groups.

Preventing mother-to-child transmission: factors affecting mothers' choice of feeding--a case study from Cameroon

This paper reports on factors influencing the decision of mothers regarding the type of feeding method for their babies in a rural setting in Cameroon. The aim of the study was to ascertain the proportion of mothers choosing the different methods of feeding, to determine the various factors influencing their choices, and to ascertain the relationships of these factors to their respective choices. Questionnaires were used on 108 HIV-positive mothers who had delivered babies and who were administered nevirapine at least 3 months prior to the study. A focus group discussion with mothers also took place. Findings were that more mothers (84%) chose breastfeeding than artificial feeding (16%), while a minority (4%) selected mixed feeding. Factors found to militate against artificial feeding were cost (69%), stigma (64%), family pressure (44%), inconvenience in preparation/administration (38%), prior education from health workers (23%), and loss of special attention from family (8%). On the other hand, advice of health worker (44%), ill health (19.5%), free milk (12.5%),job pressure (12.5%) and loss of beauty (12.5%) were found to militate against breastfeeding. A direct relationship was also found between age, educational level, income size, marital status and choice of feeding. Policies targeting stigma reduction and socio-cultural factors affecting the choice of feeding are needed to optimise uptake of the less risky methods of feeding which could in turn contribute to a reduction in transmission.

Use of breast feeding indicators for assessment of current feeding practices

To investigate the current breast feeding practices, a survey was conducted cross sectionally on 2000 children aged less than 2 years recruited from 6 MCH centers in Alexandria governorate. The median duration of breast feeding was 19.4 months. Only one quarter of infants were exclusively breast fed for the first four months of age with a mean duration of 2.4+2.5 months. Predominantly breast feeding rate was 0.36, while timely complementary breast feeding rate(6-9 months) was 0.66. Continued breast feeding rate(one year) was 0.73 while that for two years was 0.3. Results also indicated that 40% of infants were receiving food from a bottle with a nipple/teat regardless of whether or not the infant was breast fed. These findings implicate that promotion of breast feeding should receive priority in health programs activities.