Socio-Ecological Factors That Influence Infant and Young Child Nutrition in Kiribati: A Biocultural Perspective.

Stephen R Kodish,Caitlin Gomez,Stanley Gwavuya,Uma Palaniappan,Tinai Iuta,Eretii Timeon,Judy Mclean,Maryam Matean,Kelsey Grey,Wendy Erasmus,Martina Northrup-Lyons

doi:10.3390/nu11061330

Abstract

This study sought to elucidate the multi-level factors that influence behaviors underlying high childhood stunting and widespread micronutrient deficiencies in Kiribati. This two-phase formative research study had an emergent and iterative design using the socio-ecological model as the guiding theoretical framework. Phase 1 was exploratory while phase 2 was confirmatory. In phase 1, in-depth interviews, free lists, seasonal food availability calendar workshops, and household observations were conducted. In phase 2, focus group discussions, pile sorts, participatory workshops, and repeat observations of the same households were completed. Textual data were analyzed using NVivo software; ethnographic data were analyzed with Anthropac software for cultural domain analysis. We found a combination of interrelated structural, community, interpersonal, and individual-level factors contributing to the early child nutrition situation in Kiribati. Despite widespread knowledge of nutritious young child foods among community members, households make dietary decisions based not only on food availability and access, but also longstanding traditions and social norms. Diarrheal disease is the most salient young child illness, attributable to unsanitary environments and sub-optimal water, sanitation, and hygiene behaviors. This research underscores the importance of a multi-pronged approach to most effectively address the interrelated policy, community, interpersonal, and individual-level determinants of infant and young child nutrition in Kiribati.

Highlights

Maternal and child malnutrition, including both under- and overweight, are persistent global challenges that threaten child survival and development, contribute to a high disease burden, and damage the economic productivity of individuals and societies.Undernutrition, which encompasses acute and chronic undernutrition, as well as micronutrient deficiencies, is linked to more than one third of child deaths worldwide [1]
1,000 days, is recognized as one of the most substantial barriers to human development and affects approximately 156 million children under five years of age (U5) worldwide. This statistic includes about 30% of children from several Pacific Island Countries where stunting remains the foremost public health problem [3]
Despite widespread knowledge of the most nutritious and healthful locally-available foods in urban and rural Kiribati, data suggest that household decisions around food procurement and subsequent dietary patterns are primarily based on what is available and accessible across seasons

Summary

Introduction

Undernutrition, which encompasses acute and chronic undernutrition, as well as micronutrient deficiencies, is linked to more than one third of child deaths worldwide [1] For those who do survive, Nutrients 2019, 11, 1330; doi:10.3390/nu11061330 www.mdpi.com/journal/nutrients. 1,000 days, is recognized as one of the most substantial barriers to human development and affects approximately 156 million children under five years of age (U5) worldwide. This statistic includes about 30% of children from several Pacific Island Countries where stunting remains the foremost public health problem [3]. There was differential introduction of complementary foods Those caregivers who reported the timely introduction at 6 months had received a positive interpersonal influence from health workers.

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Discussion

Conclusion