Abstract
BackgroundThe interdisciplinary Participatory Approach for Nutrition in Children: Strengthening Health, Education, Engineering and Environment Linkages (PANChSHEEEL) study used a participatory approach to develop locally-feasible and tailored solutions to optimise Infant and Young Child Feeding (IYCF) practices at an individual, household, community, and environmental level. This paper aims to evaluate the influence of gender; migration; and Health, Education, Engineering and Environmental (HEEE) factors on IYCF practices, with the primary outcomes being three key complementary-feeding practices of Minimum Dietary Diversity (MDD), Minimum Meal Frequency (MMF) and Minimum Acceptable Diet (MAD).MethodsA cross-sectional survey of 325 households with children aged 6–23 months was conducted in nine purposively selected villages in two blocks of Banswara district, Rajasthan, India. A survey tool was developed, translated into the local language, pre-tested, and administered in a gender-sensitive manner. Data-collection processes were standardized to ensure quality measures. Association of the primary outcome with 27 variables was tested using a Chi-square test (Mantel-Haenszel method); backward stepwise regression analysis was conducted to assess the impact of effect modifiers (gender, parental migration).ResultsHalf of the surveyed children were of each gender, and fathers from half of the households were found to have migrated within the previous year to search for additional income. Parental literacy ranged from 60 to 70%. More than half of the households had access to milk-producing animals. Consumption of each of the seven food groups, eggs (4.7% vs 0.7%; p < 0.02), MDD (10.5% vs 3.2%; p < 0.02) and MAD (9.4% vs 2.6%; p < 0.02) were higher for boys than for girls. After controlling for contextual factors, a male child was 4.1 times more likely to get a diet with MDD and 3.8 times more likely to get a diet with MAD. A child from a non-migrant household was 2.0–2.1 times more likely to get a diet with MDD and MAD as compared to a child from a migrant household. However, this association was not found to be statistically significant after regression. Presence of milk-producing animals in households and consumption of milk/milk products by children in the previous 24 h were the other two strong predictors of MDD and MAD, although access to animal milk in the house did not translate to an increase in consumption of milk/milk products by a child.ConclusionGender discrimination in diet diversity and complementary-feeding practices starts early in childhood with boys having a distinct advantage over girls. In the case of parental migration, further research is required to establish if it has an adverse impact on feeding practices. Emphasis needs to be given to gender issues and other contextual factors when developing strategies to optimise complementary feeding practices.Trial registrationWith UCL ethics [Ethics ID 4032/002] in United Kingdom and with Sigma IRB [10,025/IRB/D/17–18] in India.
Highlights
The interdisciplinary Participatory Approach for Nutrition in Children: Strengthening Health, Educa‐ tion, Engineering and Environment Linkages (PANChSHEEEL) study used a participatory approach to develop locallyfeasible and tailored solutions to optimise Infant and Young Child Feeding (IYCF) practices at an individual, household, community, and environmental level
Parental migration for work in the past 1 year was nearly four times higher in the Kushalgarh block as compared to Ghatol block (74% vs. 19%), implying that migration-related differences in IYCF practices were mostly confined to Kushalgarh
After adjustment for HEEE and other background characteristics, a male child was found to be 4.1 times more likely to get a diet with Minimum Dietary Diversity (MDD) and 3.8 times more likely to get a diet with Minimum Acceptable Diet (MAD) as compared to a female child
Summary
The interdisciplinary Participatory Approach for Nutrition in Children: Strengthening Health, Educa‐ tion, Engineering and Environment Linkages (PANChSHEEEL) study used a participatory approach to develop locallyfeasible and tailored solutions to optimise Infant and Young Child Feeding (IYCF) practices at an individual, household, community, and environmental level. Appropriate feeding of 6–23-month-old children enhances their chance of survival and promotes optimal growth and cognitive development. Malnutrition is the result of a complex interplay between household factors like poverty, maternal-health literacy, diarrhoea, cooking fuel, home environment, dietary practices, and hygiene. The prevalence of these influences is a result of multiple socio-ecological factors including resources, awareness, and cultural and behavioural practices [2, 3].
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