Beyond food insecurity: How context can help improve complementary feeding interventions

Abstract

Context has not been elaborated in current recommendations for complementary feeding (CF) interventions apart from a categorization of food security. We compared 2 food insecure settings in Africa to explore how context affects CF practices and nutrient intakes and in turn a suitable intervention strategy. We conducted 24‐hr recalls and interviews with mothers of 6–12 mo‐olds in rural Zimbabwe (n=32) and Pemba Island, Tanzania (n=44). In both settings, many infants had suboptimal nutrient intakes, poor dietary diversity, and hygiene. Pemba had poor breastfeeding, and Zimbabwe had low energy density. Contextual determinants were indigenous knowledge, livelihoods, family foods, agriculture, and the ecosystem. Both settings require education targeting indigenous knowledge and family eating behaviors. A home‐based fortificant is enough for Pemba because the island's ecosystem provides sufficient sources of macronutrients. However, Zimbabwe needs a fortified food‐based supplement to overcome the poor agricultural and economic context. Assessing context was essential to intervention design. A framework for formative research is proposed. Supported in part by DFID and NIH grant T32 HD007331.Grant Funding Source: NIH grant T32 HD007331