Complementary Feeding Behavior Research Articles

Feeding Premasticated Food to Breastfeeding and Weaned Infants among Sudanese Women, Khartoum North

Premasticated of solid food, when an individual partially breaks down food by chewing and feeding it to another person, usually children, from mouth to mouth, using the hand or by other tools e.g. spoon is common various societies in the world. We also did not know whether Sudanese women practice the premasticated feeding. So, we conducted this study to assess breastfeeding, complementary feeding behavior, presence or absence and rates of premasticated food transfer and infant age, and assessed the food species and part used. The study was conducted in Khartoum North locality, Khartoum State, Sudan. We used descriptive cross-sectional design to complete the study. The study targeted nursing mother with a child less than 24 months of age. The sample size was calculated to be 800. Two thirds of surveyed nursing mothers have had heard of premastication of food. Most heard of it from older generations. Yet, 94 (11.9%) premasticated food for the current young children. They claimed that they start premastication of food after the sixth month of the infant age, and stop the practice before the 24th month. Although many scientists around the world have recognized the possibility of transmitting infection by premasticated food from the mother to the infant, the practice is not without significant benefits. Some authors believe that premastication of food by senior person and deliver it to the infant can help stimulating the immune system in infants. The study was reviewed and approved by the Research Ethics Committee at Alzaiem Alazhari University. Written informed consent was obtained from each individual participant.

Dominant Factors in Complementary Food Feeding in Babies and Toddlers

52.8% of all Indonesian children, or those between the ages of 6 and 23 months, do not obtain the nourishment they require throughout the first two years of life in order to grow and develop as they should. One of Lampung province's areas, Tulang Bawang Regency, has the highest rate of children under five who are very thin (BB/TB), at 7.7%. The purpose of the research was to determine the important element in supplemental feeding of babies and toddlers in Tulang Bawang Regency in 2021. Analytic correlation using a cross-sectional design characterized this sort of study. A sample of 132 women who have children between the ages of 6 and 24 months was acquired by sampling utilizing stratified random sampling. Chi Square analysis in bivariate form and Logistics Regression Analysis in multivariate form. According to statistical analyses, complementary feeding behavior is significantly influenced by a number of internal and external factors, including type of food, frequency of feeding, amount of feeding, and community culture, as well as internal factors like age of knowledge of food, child's activities, and child's health history. Babies and toddlers at the Banjar Baru Community Health Center in the Tulang Bawang Regency in 2021 (p = 0.05). Based on the OR values of these factors, Child Health (OR=8,449) is the most important factor in providing complementary feeding to babies and toddlers in the Banjar Baru Health Center region of the Tulang Bawang Regency in 2021. For families with young children, there is a need for socialization over how to feed newborns and toddlers complementary feeding that are healthy and appropriate, as well as to revive the role of the posyandu in neighborhood events.

STUDI FENOMENOLOGI PERILAKU PEMBERIAN MPASI DINI PADA BAYI USIA 0-5 BULAN DI WILAYAH KERJA PUSKESMAS JAGIR KECAMATAN WONOKROMO KOTA SURABAYA

Objective: Smart and healthy children can be realized by their growth and development during the Golden Age which is a critical period because children are at risk of experiencing disorders that can occur due to insufficient or excessive nutritional intake such as lack of exclusive breastfeeding. One of the causes of the lack of exclusive breastfeeding is due to the behavior of early complementary feeding which has a negative impact on infants such as being more susceptible to diarrhea, constipation, coughs, colds, and heat due to the baby's imperfect immune system. To determine the behavior of early complementary feeding in infants aged 0-5 months in the working area of Jagir Health Center, Wonokromo District, Surabaya City. Methods: Qualitative research with a phenomenological approach. The research was conducted at several posyandu in the working area of Jagir Community Health Center, Wonokromo Subdistrict, Surabaya City. The research subjects were mothers who had babies aged 0-5 months who were given early solids in the working area of the Jagir Health Center, Wonokromo Subdistrict, Surabaya City. The sampling technique used snowball sampling with the number of informants known after the research was completed, which amounted to 10 informants. Data analysis using Miles and Hubberman which goes through three stages, namely data reduction, data presentation and conclusion drawing. Results: All informants had low-level thinking skills because their knowledge of complementary feeding was limited to the know category. Informants' attitudes about complementary feeding affect early complementary feeding behavior because mothers who have a positive attitude towards early complementary feeding are likely to practice inappropriate complementary feeding for their babies. Informant’s actions in early complementary feeding were based on several reasons such as fussy children, perceived inadequacy of breast milk and work. Conclusion: The lower the level of knowledge, attitude and action about complementary feeding, the more inclined the informant's behavior will be to provide early complementary feeding

STUDI FENOMENOLOGI PERILAKU PEMBERIAN MPASI DINI PADA BAYI USIA 0-5 BULAN DI WILAYAH KERJA PUSKESMAS JAGIR KECAMATAN WONOKROMO KOTA SURABAYA

Objective: Smart and healthy children can be realized by their growth and development during the Golden Age which is a critical period because children are at risk of experiencing disorders that can occur due to insufficient or excessive nutritional intake such as lack of exclusive breastfeeding. One of the causes of the lack of exclusive breastfeeding is due to the behavior of early complementary feeding which has a negative impact on infants such as being more susceptible to diarrhea, constipation, coughs, colds, and heat due to the baby's imperfect immune system. To determine the behavior of early complementary feeding in infants aged 0-5 months in the working area of Jagir Health Center, Wonokromo District, Surabaya City. Methods: Qualitative research with a phenomenological approach. The research was conducted at several posyandu in the working area of Jagir Community Health Center, Wonokromo Subdistrict, Surabaya City. The research subjects were mothers who had babies aged 0-5 months who were given early solids in the working area of the Jagir Health Center, Wonokromo Subdistrict, Surabaya City. The sampling technique used snowball sampling with the number of informants known after the research was completed, which amounted to 10 informants. Data analysis using Miles and Hubberman which goes through three stages, namely data reduction, data presentation and conclusion drawing. Results: All informants had low-level thinking skills because their knowledge of complementary feeding was limited to the know category. Informants' attitudes about complementary feeding affect early complementary feeding behavior because mothers who have a positive attitude towards early complementary feeding are likely to practice inappropriate complementary feeding for their babies. Informant’s actions in early complementary feeding were based on several reasons such as fussy children, perceived inadequacy of breast milk and work. Conclusion: The lower the level of knowledge, attitude and action about complementary feeding, the more inclined the informant's behavior will be to provide early complementary feeding

Breastfeeding/ Complementary Feeding Behavior and Food Diversity of Stunting Toddlers in North Sumatra

SSGI (Nutritional Status Study of Indonesia) survey in 2021 found that prevalence of stunted infants in Sumatera Utara province is still higher (25.8%) than the national limit. It is known that stunting is multifactorial condition with breastmilk/weaning food feeding behavior as one of the contributing factor. Furthermore, family’s attitude toward consuming wide variety diets is also considered as factors related to stunting. Secondary data from SSGI 2021 involving 10,755 households was used in this study. STATA application was used to help analyzing the data. Statistical analysis was conducted by using Chi Square and showed that breastmilk/weaning food feeding behavior, and varied diets in family were not contributing factors of stunting in Sumatera Utara province. However, we found that educational background was significant contributing factor to stunting (p = 0.000). We suggest that other approach, such as qualitative measure may be used in future study to investigate factors attributable to stunting.

Improving healthcare for children in rural China: commentary on WeChat-based self-assessment with tailored feedback

Improving healthcare for children in rural China: commentary on WeChat-based self-assessment with tailored feedback

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

ABSTRACTBackgroundFathers 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.ObjectivesThe 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).MethodsThe 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).ResultsChildren'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.ConclusionsA 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.

Estimated causal effects of complementary feeding behaviors on early childhood diet quality in a US cohort

Complementary feeding (CF) provides an opportunity to shape children's future dietary habits, setting the foundation for good nutrition and health. We estimated effects of 3 CF behaviors on early childhood diet quality using inverse probability (IP) weighting of marginal structural models (MSMs). Among 1041 children from the Boston-area Project Viva cohort, we estimated effects on the mean Youth Healthy Eating Index (YHEI) score in early childhood of 1) delayed (≥12 mo) compared with early (<12 mo) introduction of sweets and fruit juice; 2) continued compared with ceased offering of initially refused foods; and 3) early (<12 mo) compared with late (≥12 mo) introduction of flavor/texture variety. Mothers reported CF behaviors at 1 y and completed FFQs for children in early childhood (median age: 3.1 y). We estimated average treatment effects (ATEs) using IP weighting of MSMs to adjust for both confounding and selection bias due to censored outcomes and examined effect modification by child sex and breastfeeding compared with formula feeding at 6 mo. Twelve percent of mothers delayed introducing sweets/fruit juice, 93% continued offering initially refused foods, and 32% introduced flavor/texture variety early. The mean ± SD YHEI score was 52.8 ± 9.2 points. In adjusted models, we estimated a higher mean YHEI score with delayed (compared with early) sweets and fruit juice among breastfeeding children (ATE: 4.5 points; 95% CI: 1.0, 7.4 points), as well as with continued (compared with ceased) offering of refused foods among females (ATE: 5.4 points; 95% CI: 0.8, 9.1 points). The ATE for early (compared with late) flavor/texture variety was 1.7 points (95% CI: 0.3, 3.2 points) overall and stronger (2.8 points; 95% CI: 0.7, 5.1 points) among the formula-fed group. Delayed introduction of sweets/juice, continued offering of refused foods, and early flavor/texture variety may all result in higher childhood diet quality. Effects may depend on child sex and infant breastfeeding status.

Development and Validation of a Tool to Assess Responsive Complementary Feeding: Sri Lanka’s Responsive Feeding Practices Assessment Tool (RFPAT)

ObjectivesTo develop and validate a scale to assess responsive feeding practices among mothers and infants between 6 and 12 months of age in Sri Lanka. MethodsThe Responsive Feeding Practices Assessment Tool (RFPAT) was developed and validated using standard scale development techniques using a three step approach. A comprehensive review was conducted in PubMed and Scopus to identify possible items for assessing responsive feeding (RF) practices. Then, an in-depth qualitative study explored RF practices in the Sri Lankan context. Finally, RFPAT was validated through a cross-sectional study. The study was conducted in Anuradhapura district, Sri Lanka in a purposeful sample of 170 mother-infant pairs. The initial tool had 17 items. All items had responses in an adjectival scale; i.e., always, often, sometimes, rarely and not at all that were scored as 4, 3, 2, 1 and 0, respectively. Content validation was performed among experts using standard techniques, followed by cognitive interviews among mothers. The revised 15-items tool was pretested on 30 mothers. Principal Component Analysis (PCA) and Parallel Analysis were carried out for Structural validation. Test-retest reliability was done with a sample of 50 mothers. Ethical clearance was obtained from the Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka (ERC/2014/060). ResultsCognitive validation with mothers confirmed the applicability and comprehensiveness of a 15-item tool. The tool possessed good reliability with an intra-class correlation of 0.80 and internal consistency of 0.79. The PCA showed a clear 3-factor solution. The results of Parallel Analysis supported with the PCA results. The 3-factors were interpreted as responsive communication during feeding, appropriate feeding attentive to child’s signals and pro-active preparation of the feeding environment. An additive composite score was generated with a range of 0 to 60 (quartiles scores ranges: Poor 0–34, Moderate 35–36, Good 37–40, and Very Good 41–60 RF practices). ConclusionsRFPAT is a valid tool to assess RF. The tool can help assess complementary feeding behaviors and design and program evaluation of Infant and Young Child Feeding in order to influence policies across low- and middle- income countries. Funding SourcesNo funding source

Effect of complementary feeding behavior change communication delivered through community-level actors on the time of initiation of complementary foods in rural communities of West Gojjam zone, Northwest Ethiopia: a cluster-randomized controlled trial

BackgroundAttaining the recommended level of complementary feeding practices remains a serious challenge in many developing countries. Complementary foods are usually untimely initiated, which has adverse consequences on the growth, development, and survival of infants. The focus of most studies conducted worldwide seemed to be on the effect of behavior change interventions on the adequacy of complementary diets; but not on the timing of initiations. Moreover, many of the interventions targeted only mothers/caregivers of infants, and studies that engaged the family members are scarce. This study aimed to evaluate the effectiveness of complementary feeding behavior change communication delivered through women development army leaderson the time of initiation of complementary foods.MethodsWe conducted a cluster-randomized controlled trial in rural communities of West Gojjam Zone, Northwest Ethiopia from February 2017 to March 2018. A total of 16 geographic clusters were selected. Trial participants in the intervention group received complementary feeding behavior change intervention for 9 months whereas those in the control group received only the usual health care. Trained women development army leaders delivered the intervention. A pre-tested, structured interviewer-administered questionnaire was used for data collection. Generalized estimated equation (GEE) regression and survival analyses were used to test differences in time of initiation of complementary food between the study groups.ResultsThe intervention significantly improved the likelihood of timely initiation of complementary food by 22 percentage points [RR: 2.6; 95% CI: 1.78–5.86], and reduced the risk of late initiations by 19 percentage points [RR: 2.8; 95% CI: 1.83–4.37]. The complementary food initiation survival curve for the control group after 6 months was constantly above the curve than for the intervention group. The median age at the introduction of complementary food for infants was 6 months in the intervention group, and 6.7 months in the control group and the difference was statistically significant (P-value < 0.001).ConclusionsComplementary feeding behavior change communication improved the rate of timely initiation of complementary foods and reduced the risk of late initiations.Trial registrationClinicalTrials.gov, NCT03488680. Registered 5 April 2018-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03488680.

Effect of complementary feeding behavior change communication delivered through community-level actors on dietary adequacy of infantsin rural communities of West Gojjam Zone, Northwest Ethiopia: A cluster-randomized controlled trial.

BackgroundAttaining the recommended level of adequacy of the infant’s diet remains a serious challenge in most developing countries. Complementary foods, particularly in developing countries, are inadequate in quality and quantity that can result in adverse health and nutrition consequences in infants. This could be not only because of lack of food but also associated with caregiver’s poor knowledge, harmful cultural norms and behaviors on infant feeding. The promotion of optimal complementary feeding through behavior change interventions is a global health priority. However, many of the interventions targeted only mothers/caregivers of infants, and studies that engaged other family members are limited worldwide. Moreover, such interventions are scarce in developing countries, including Ethiopia. This trial aimed to evaluate the effectiveness of complementary feeding behavior change communication delivered through community-level actors on the dietary adequacy of infants.MethodsWe conducted a cluster-randomized controlled trial in rural communities of West Gojjam Zone, Northwest Ethiopia. Trial participants in the intervention clusters received complementary feeding behavior change communication for 9 months whereas those in the control clusters received only the usual care. Trained women development army leaders delivered the intervention. A pre-tested, structured interviewer-administered questionnaire was used for data collection. Generalized estimating equations regression analyses adjusted for baseline covariates and clustering were used to test the intervention effects.ResultsThe intervention showed positive statistically significant effects on the consumption of dairy products [RR = 1.8; 95% CI: 1.04–3.13], eggs [RR = 3; 95% CI: 1.35–6.56], vitamin A-rich fruits and vegetables [RR = 2.7; 95% CI: 1.17–6.1], other fruits and vegetables [RR = 5; 95% CI: 2.49–10.58] and animal-source foods [RR = 2; 95% CI: 1.39–2.87]. The proportions of infants who achieved minimum dietary diversity [RR = 3; 95% CI: 1.34, 7.39], minimum meal frequency [RR = 2.4; 95% CI: 1.37–4.29], and minimum acceptable diet [RR = 2.7; 95% CI: 1.13–7.23] were significantly higher in the intervention as compared to control groups.ConclusionsComplementary feeding behavior change communication delivered through community-level actors significantly improved the dietary adequacy of infants.Trial registrationClinicalTrials.gov, NCT03488680. Registered 5 April 2018- Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03488680.

Estimated Causal Effects of Complementary Feeding Behaviors on Diet Quality in Early Childhood Using Birth Cohort Data

Abstract Objectives We aimed to examine effects of 3 complementary feeding behaviors on later diet quality using a causal inference framework. Methods Using data from 1041 mother-child pairs from the Boston, MA-area Project Viva cohort, we estimated effects on the mean Youth Healthy Eating Index (YHEI) score, a measure of diet quality in early childhood, of hypothetical interventions that expose (vs. do not expose) to the following: 1) introduce sweets and fruit juice at ≥12 m and provide no daily fruit juice at age ∼1 y; 2) introduce varied, non-sweet flavors (at least 2/3 of fish, eggs and peanut butter) at &amp;lt;12 m; and 3) continue offering foods initially refused by the child. Mothers reported complementary feeding behaviors (exposures) at 1y and completed food frequency questionnaires for children in early childhood (median age 3.2 y). We estimated average treatment effects (ATEs) using inverse probability weighted linear regression analysis with stabilized weights to adjust for both confounding and selection bias due to censored outcomes. For each effect, we adjusted for child race/ethnicity, maternal socio-demographics, BMI, and diet quality, and the other 2 exposures, and examined effect modification by child sex and infant feeding mode (breastfed at 6 m [BF group] vs. not [FF group]). Results Of 1041 pairs, 12% delayed introducing sweets/fruit juice and provided no daily fruit juice at 1y, 68% introduced fish, eggs and peanut butter before 12 m, and 93% continued to offer refused foods. We estimated that mean YHEI score was higher under “delay sweets and fruit juice” (1.8 points, 95% CI: −1.0, 5.5), particularly among the BF group (ATE 5.1 points, 95% CI: 0.0, 8.7) and females (ATE 4.4 points, 95% CI: −2.0, 9.0). ATEs for the “early flavor variety” exposure were 1.7 points (95% CI: 0.2, 3.0) and similar among males and females but stronger (2.6 points, 95% CI: 0.4, 4.8) among the FF group. Mean YHEI score was also higher (2.6 points, 95% CI: −1.1, 6.5) under the “continue offering refused foods” exposure, particularly among females (ATE 5.7 points, 95% CI: 1.2, 9.6). Conclusions Delayed introduction of sweets and fruit juice, early introduction of varied, non-sweet flavors, and continued offering of initially refused foods may result in better diet quality in early childhood. Effects may differ by child sex and breastfeeding status. Funding Sources US NIH.

Are Malnourished Children Hungry? Use of the International Complementary Feeding Assessment Tool (ICFET) to Describe Diet and Eating Behavior

Abstract Objectives Undernutrition risk increases when children transition to complementary feeding in lower/middle income countries. Our newly developed ICFET assesses feeding and eating behavior (FEB); we aimed to test its performance in different countries and assess FEB in wasted and healthy infants. Methods Healthy and malnourished children aged 6–24 months were sampled from child health and malnutrition clinics in urban slums in Nairobi, Kenya (n = 157), peri-urban Lahore, Pakistan (n = 108), rural Retalhuleu, Guatemala (n = 125) and playgroups in Glasgow, United Kingdom (UK, n = 97). Children were measured and parents surveyed using the ICFET, which comprises standardized questions on meal frequency and self-feeding, and 5-point scores for enthusiasm for eating (Avidity), food refusal (Avoidance) and Force-feeding. Results Of 487 children, mean (SD) age 14.2 (5.3) months, 77 (16%) were wasted (body mass index &amp;lt; −2SD). Complementary feeding started earliest in the UK, with 91% starting before 6 m, and latest in Pakistan, where 27% started ≥ 8 m. In 336 healthy weight children, median (Q1, Q3) Avidity was higher (3.67; 2.8–4.2) than Avoidance (2.0; 1.6–2.6); Kenyan children had highest avoidance (2.4; 1.8–3.0) and Pakistani children lowest avidity (2.2; 2–2.8). Force feeding was rare in the UK (17%) and Guatemala (15%), but common in Pakistan (76%) and Kenya (82%). In LMIC children, wasted infants had lower median Avidity (2.7) than healthy (3.5; P &amp;lt; 0.001), but similar Avoidance and Force-feeding. Healthy children were offered 3 (2–3) plated meals and 1 (0–3) energy dense snacks daily. Compared to healthy, wasted children had fewer meals (2; vs 3; P = 0.006) and more milk (3 vs 2; P = 0.016). Conclusions Malnourished children were less hungry and ate fewer meals, but still refused food. The ICFET identified between country variation in complementary feeding behavior. It will be valuable for the identification of poor feeding and eating practices and informing intervention. Funding Sources Scottish Funding Council (Global Challenges Research Fund).

Perilaku Ibu pada Pemberian Makanan Pendamping ASI (MPASI) di Kelurahan Pegirian

Background: The target of exclusive breastfeeding has not been achieved because complementary feeding (MPASI) has been given earlier. Infants aged 0-6 months should only get breastfed without any complementary food. Objective: This paper aimed to analyze factors related to maternal behavior towards complementary feeding (MPASI) in Pegirian Village. Method: This study was observational and cross-sectional, involving all mothers and caregivers of under-five-year-old children in Pegirian Village. The sample size was 35 mothers and caregivers of toddlers in Neighborhood Association No. 06 Community Association 02 Pegirian Village, Surabaya City. Sampling technique in use was saturated sampling or census method because the total population was less than 100. The research variables included educational background, income, and actions in giving MPASI. Correlation test was in use to see the relationship among factors. Results: The results showed that there was a relationship between knowledge and attitude with complementary feeding behavior (P value = 0.001 and 0.015). There was no relationship between the level of education and employment status with complementary feeding behavior towards infants aged less than 6 months (P values = 0.425 and 0.134). Conclusion: Knowledge and attitude of mothers and caregivers can influence complementary feeding for infants aged less than 6 months.

Patterns of Complementary Feeding Behaviors Predict Diet Quality in Early Childhood.

Infancy is a time of plasticity in development of taste preference. Complementary feeding (CF) may be a “sensitive period” for learning new taste preferences and establishing healthy dietary behaviors that may track later in life. Among 1162 children in the U.S. prospective cohort study Project Viva, we aimed to identify patterns of CF behaviors around 1 year and examine associations with diet quality in early childhood (median age 3.1y). We identified patterns of CF using latent class analysis (LCA) and examined later diet quality based on scores on the Youth Healthy Eating Index (YHEI). We identified four distinct CF patterns (latent classes). Later YHEI scores were highest in the class characterized by “breast milk and delayed sweets and fruit juice” and lowest in the “picky eaters” class. The classes defined as “late flavor introduction and delayed sweets” and “early flavor introduction and more fruit juice” had similar, moderate scores. Our results suggest that CF patterns that increase food acceptance and discourage the innate preference for sweetness may have persistent influences on diet quality.

Evaluation of complementary feeding knowledge and behavior of mothers with children between four-twenty four months

Aim: Complementary feeding is important for growth in infancy. In this study, we aimed to determine the knowledge of complementary feeding of mothers who take their children to our hospital and to evaluate the effects of mother’s and baby’s characteristics on complementary feeding. Material and Method: Between December 2018 and February 2019, 259 mothers who admitted to our hospital were included in the study. Mothers’ knowledge and behavior about complementary feeding were questioned. Results: The mean age of 259 mothers was 28.71 ± 5.09 years old. 94 (36.3%) of the participants introduced complementary feeding before six months. The mean time to introduce complementary feeding was 5.67 ± 0.84 months. Complementary feeding was introduced with 48.6% yoghurt, 17.8% fruit puree and 17% soup. The most frequent reason for early onset was the weight gain of the baby and the decrease in breast milk. A significant difference was found between the monthly income of the family, smoking and working of the mother, and early initiation of complementary feeding. The use of feeding bottles and/or pacifiers was also associated with early onset of complementary feeding. Conclusion: Mothers’ time to introduce complementary feeding varies. Mothers should be given more education about complementary feeding for healthy development of babies.

Translating Evidence-Based Program Recommendations into Action: The Design, Testing, and Scaling Up of the Behavior Change Strategy EsIAN in Mexico

The Integrated Strategy for Attention to Nutrition (EsIAN in Spanish) is a national strategy within Mexico's conditional cash transfer program (initially Progresa, then Oportunidades, then Prospera, CCT-POP) designed to strengthen the health and nutrition component, address the nutrition transition, and improve the health and nutritional status of its beneficiaries, through 3 main components: 1) procurement of functioning equipment to primary health care (PHC) units; 2) providing free micronutrient supplements to beneficiary women and children; 3) implementing a behavior change communication (BCC) strategy and a training system for PHC providers (PHCPs). We aim to describe the iterative process and evidence-based approach used to design and roll-out the EsIAN at scale, by focusing on the BCC component. The BCC strategy was developed by following an iterative process through the following phases: situational analysis, formative research and design of the BCC strategy (using the socioecological framework and the social marketing approach), large-scale feasibility study, redesign, and national scale-up. The review and formative research revealed several barriers and issues that limited program coverage, utilization, and acceptance. These included misconceptions about pregnancy and infant feeding, nonalignment of practices with international recommendations, and lack of knowledge on nutrition and related topics, among others. These results were used to identify priority behaviors and elaborate key messages for mothers/caregivers and providers to develop the BCC strategy. The feasibility study resulted in significant improvements in PHCPs' knowledge, counseling (breastfeeding, and supplement use and consumption), and caregivers' complementary feeding behaviors, and highlighted several design and delivery aspects that needed strengthening. Based on these findings, the BCC strategy was adapted prior to a national scale-up. The theory-based iterative approach resulted in the identification of specific actions to target, and approaches to do so, as part of the design and roll-out of the BCC strategy at scale.

TAS2R38 bitter taste genotype is associated with complementary feeding behavior in infants

BackgroundGenetically mediated sensitivity to bitter taste has been associated with food preferences and eating behavior in adults and children. The aim of this study was to assess the association between TAS2R38 bitter taste genotype and the first complementary food acceptance in infants.Parents of healthy, breastfed, term-born infants were instructed, at discharge from the nursery, to feed their baby with a first complementary meal of 150 mL at 4 to 6 months of age. They recorded the day when the child ate the whole meal in a questionnaire. Additional data included food composition, breastfeeding duration, feeding practices, and growth at 6 months. Infants’ TAS2R38 genotypes were determined at birth, and infants were classified as “bitter-insensitive” (genotype AVI/AVI) and “bitter-sensitive” (genotypes AVI/PAV or PAV/PAV).ResultsOne hundred seventy-six infants and their mothers were enrolled; completed data were available for 131/176 (74.4%) infants (gestational age 39.3 ± 1.1 weeks, birth weight 3390 ± 430 g). Bitter-insensitive were 45/131 (34.3%), and bitter-sensitive were 86/131 (65.6%). Thirty-one percent of bitter-insensitive infants consumed the whole complementary meal at first attempt, versus 13% of bitter-sensitive ones (p = 0.006). This difference was significant independently of confounding variables such as sex, breastfeeding, or foods used in the meal. Growth at 6 months did not differ between the two groups.ConclusionsDifferences in TAS2R38 bitter taste gene were associated with acceptance of the first complementary food in infants, suggesting a possible involvement in eating behavior at weaning.

A Social Ecological Approach to Develop a Nutrition Education Program for Preventing Iron Deficiency Anemia in Young Children in Rural Pakistan

ABSTRACTInappropriate feeding practices puts infants and young children at risk of iron deficiency anemia. Maternal complementary feeding (CF) behavior is determined by influences at various levels, including knowledge and attitude about feeding, inter-personal interaction with family/friends, community norms and support. The aim of this study is to understand the various influences on maternal CF behavior in order to develop a culturally appropriate nutrition education program to improve iron status of children aged 9–24 months. Using a social ecological approach, in-depth interviews with stakeholders revealed restraining factors that prevented behavior change. Culturally appropriate nutrition education messages were developed to address these constraints.

The status of nutritional knowledge, attitude and practices associated with complementary feeding in a post-conflict development phase setting: The case of Acholi sub-region of Uganda.

Inappropriate complementary feeding is an important challenge to proper child nutrition in post‐conflict rural areas in many sub‐Saharan African countries. While in protected areas during conflict situation and soon after during recovery, communities normally receive nutrition education as part of capacity building to improve knowledge, attitude, and practices to enable them manage maternal and child nutrition issues during the post‐conflict development phase. It is largely unknown whether capacity in nutrition provided is maintained and adequately applied in the post‐conflict development situation. Using Acholi sub‐region of Uganda, an area that experienced violent armed conflict for 20 years (mid‐80s–early 2000), as a case study, we examined the status of nutritional knowledge, attitude, and practices associated with complementary feeding among caregivers of 6‐ to 23‐month‐old children in a post‐conflict development phase following return to normalcy nearly 10 years post‐conflict emergency situation. The results showed that a high proportion of caregivers had good knowledge (88%) and attitude (90.1%) toward complementary feeding. However, only a half (50%) of them practiced correct nutrition behavior. Education status of the household head and sex of the child significantly predicted caregiver knowledge on complementary feeding (p ≤ 0.05). Education status of the household head also predicted caregiver attitude toward complementary feeding (p ≤ 0.05). Poverty, food insecurity, and maternal ill health were the major factors that hindered caregivers from practicing good complementary feeding behavior. These results demonstrate that nutrition education on complementary feeding provided to the community during conflict emergency and recovery situation is largely retained in terms of knowledge and attitude but poorly translated into good child feeding practices due to poverty, food insecurity, and maternal ill health. Maternal health, food security, and poverty reduction should be prioritized if adequate complementary feeding is to be achieved among conflict‐affected communities in the post‐conflict development phase.