Improve Infant Feeding Research Articles

Dietary Diversity and Meal Frequency Practices among Infant and Young Children Aged 6–23 Months in Ethiopia: A Secondary Analysis of Ethiopian Demographic and Health Survey 2011

Background. Appropriate complementary feeding practice is essential for growth and development of children. This study aimed to assess dietary diversity and meal frequency practice of infants and young children in Ethiopia. Methods. Data collected in the Ethiopian Demographic and Health Survey (EDHS) from December 2010 to June 2011 were used for this study. Data collected were extracted, arranged, recoded, and analyzed by using SPSS version 17. A total of 2836 children aged 6–23 months were used for final analysis. Both bivariate and multivariate analysis were done to identify predictors of feeding practices. Result. Children with adequate dietary diversity score and meal frequency were 10.8% and 44.7%, respectively. Children born from the richest households showed better dietary diversity score (OR = 0.256). Number of children whose age less than five years was important predictor of dietary diversity (OR = 0.690). Mothers who had exposure to media were more likely to give adequate meal frequency to their children (OR = 0.707). Conclusion. Dietary diversity and meal frequency practices were inadequate in Ethiopia. Wealth quintile, exposure to media, and number of children were affecting feeding practices. Improving economic status, a habit of eating together, and exposure to media are important to improve infant feeding practices in Ethiopia.

Knowledge, attitudes and perceptions on infant and young child nutrition and feeding among adolescent girls and young mothers in rural Bangladesh

Improved infant and young child feeding (IYCF) practices have the potential to improve child health and development outcomes in poorly resourced communities. In Bangladesh, approximately 60% of rural girls become mothers before the age of 18, but most interventions to improve IYCF practices target older mothers. We investigated the knowledge, attitudes and perceptions regarding IYCF among adolescent girls and young women aged 15-23 years old in two rural regions in north-west Bangladesh and identified the main points of concordance with, or mismatch to, key international IYCF recommendations. We compared qualitative data collected during interviews and focus groups with participants who were unmarried, married without a child and married with at least one child, and stratified by region. Qualitative indicators of concordance with international recommendations suggest that IYCF knowledge of participants was limited, irrespective of marriage or maternity. Young mothers in our study were no more knowledgeable about feeding practices than their nulliparous peers. Some participants were well aware of an IYCF recommendation (e.g. to exclusively breastfeed for 6 months), but their interpretation of the recommendation deviated from the intended public health message. Notions of insufficient or 'spoiled' breast milk, gender-based biases in feeding intentions and understandings of infant needs, and generational shifts in feeding practices were commonly reported. Conclusions are that female adolescence is a window of opportunity for improving health outcomes among future children, and increased investment in early education of adolescent girls regarding safe IYCF may be an effective strategy to promote and support improved infant feeding practices.

Effect of the Mahatma Gandhi National Rural Employment Guarantee Act on malnutrition of children aged between 1 and 12 months in Rajasthan, India: a mixed methods study

BackgroundMalnutrition is a major risk factor for mortality in children aged 1–12 months in India. Macroeconomic and social policies are determinants of both health and health inequalities. Therefore, policies targeting poverty and food insecurity might reduce infant malnutrition. The Mahatma Gandhi National Rural Employment Guarantee Act, a wage-for-employment policy of the Indian Government, targets deprivation and food insecurity in rural households. The Act could prevent malnutrition in children by improving household food security or increase the risk of malnutrition by reducing the time devoted to infant care or feeding if mothers are employed. We analysed the effect of household's and mother's participation in the scheme on malnutrition of children aged 1–12 months and studied how this effect occurred. MethodsWe did a quantitative cross-sectional study (single-stage cluster sampling) and qualitative focus group discussions (nested sampling) in Dungarpur district in Rajasthan, India. We randomly selected (with Stata; version 10.1) 44 villages from the five administrative blocks of the district. All households with infants aged 1–12 months (identified with records of the local village nurse and community health worker) in each of these villages were asked to participate in the study. We measured three indicators of malnutrition: underweight, stunting, and wasting (WHO criteria). We used multivariable logistic regression modelling with a hierarchical approach. We analysed focus group discussions to generate themes, and quantified theoretical pathways by path analysis. FindingsWe included 528 households with 1056 participants. Between August, 2010, and September, 2011, 281 households took part in the scheme, and 247 did not. Mothers were employed in 51 (18%) households in the scheme. Prevalence of wasting was 39% (n=206), stunting 24% (n=129), and underweight 50% (n=266). Households in the scheme were less likely to have wasted infants (odds ratio [OR] 0·58, 95% CI 0·38–0·90; p=0·016) and less likely to have underweight infants (OR 0·47, 95% CI 0·30–0·74; p=0·002) than were households not in the scheme. Stunting did not differ significantly between groups (OR 0·79, 95% CI 0·54–1·16; p=0·222). We did 11 focus group discussions with 65 mothers. Although the scheme reduced starvation, it did not provide the amount of benefit claimed by the programme because of lower than standard wages and delayed payments. Participants generally agreed that mother's employment was detrimental to infant care and feeding because of a lack of facilities at worksites for child care and breastfeeding. Results from path analysis did not support existence of an effect through household food security and infant feeding but did suggest a pathway of effect through low birthweight. The probability of being born with low birthweight (<2·5 kg) was lower in participating households than in non-participating households, which reduced the risk of infant malnutrition in the participating households. The probability coefficients of the Act's effect on each indicator were for wasting: indirect path −0·21 (p=0·074), direct path −0·23 (p=0·216), total −0·44 (p=0·016); for underweight: indirect −0·25 (p=0·051), direct −0·43 (p=0·061), total −0·68 (p=0·007); for stunting: indirect −0·06 (p=0·204), direct −0·26 (p=0·065), total −0·32 (p=0·047). Path analysis and logistic regression did not show a significant effect of mother's employment on the outcomes. InterpretationParticipation in the wage-for-employment programme was associated with reduced malnutrition, possibly mediated indirectly by improved birthweight rather than by improved infant feeding. Provision of child-care facilities at worksites could mitigate the negative effects of mother's participation in the scheme. Although the scheme seems to reduce risk of low birthweight, ensuring timely and adequate payment could improve food security, and augment the protective effect of the programme against infant malnutrition. FundingWeidenfeld Scholarship and Leadership programme, University of Oxford.

Global trends in exclusive breastfeeding

BackgroundInfant and young child feeding is critical for child health and survival. Proportion of infants 0–5 months who are fed exclusively with breast milk is a common indicator used for monitoring and evaluating infant and young child feeding in a given country and region. Despite progress made since 1990, a previous review in 2006 of global and regional trends found improvement to be modest. The current study provides an update in global and regional trends in exclusive breastfeeding from 1995 to 2010, taking advantage of the wealth of data from recent household surveys.MethodsUsing the global database of infant and young child feeding maintained by the United Nations Children’s Fund, the authors examined estimates from 440 household surveys in 140 countries over the period between 1995 and 2010 and calculated global and regional averages of the rate of exclusive breastfeeding among infants 0–5 months for the two time points to assess the trends.ResultsTrend data suggest the prevalence of exclusive breastfeeding among infants younger than six months in developing countries increased from 33% in 1995 to 39% in 2010. The prevalence increased in almost all regions in the developing world, with the biggest improvement seen in West and Central Africa.ConclusionsIn spite of the well-recognized importance of exclusive breastfeeding, the practice is not widespread in the developing world and increase on the global level is still very modest with much room for improvement. Child nutrition programmes worldwide continue to require investments and commitments to improve infant feeding practices in order to have maximum impact on children’s lives.

Influences on infant feeding decisions of first-time mothers in five European countries

Infant feeding decisions made by new parents have significant health implications. The study aimed to investigate: influences on infant feeding decisions; characteristics of mothers reporting reliance on alternative information sources; associations between reliance on different sources and intentions to exclusively breastfeed and introduce complementary foods later; and subsequent breastfeeding and weaning behaviours. First-time mothers in five European countries (England, Finland, Germany, Hungary, Spain) completed questionnaires about the importance of 17 influences on infant feeding choices at birth and 8 months later, during 2007-2008. Use of individual sources and reliance on four categories (family and friends, health professionals, written materials, audio-visual media) were compared between countries. Associations between information sources used and mother characteristics, feeding intentions and behaviours were investigated using appropriate statistical tests. In all, 2071 first-time mothers provided baseline data; 78% at 8 months. Variation exists between countries in the influence of different sources on feeding decisions of first-time mothers. Across all countries, the most important influences at both time points were books, partner and antenatal midwife. Mothers in higher income quintiles and remaining at school beyond age 16 years reported greater reliance on written sources (P<0.0005). Mothers relying most on written sources reported longer exclusive breastfeeding (P=0.002), and a tendency to introduce foods other than milk later (P=0.079) than mothers relying most on personal or professional contacts. Further research is required about which dissemination strategies are most effective at improving infant feeding behaviours in varied cultural settings, and for different socio-economic groups.

Health effects of infant feeding: Information for parents in leaflets and magazines in five European countries

Parents' decisions about whether to breastfeed their infant, and when to introduce complementary foods, are important public health issues. Breastfeeding has beneficial health effects and is widely promoted. Leaflets and magazine articles on infant feeding were collected in 2005, in five European countries (England, Finland, Germany, Hungary, Spain), and screened for statements that link feeding behaviours to infant health outcomes. A total of 127 leaflets contained 512 statements (0.38 / published page). Magazines contained approximately 1 article / month. Health outcomes were more intensively covered in England and Germany. Most statements referred to short term health implications. Lack of scientific agreement may underlie lack of cover of longer term health effects. Scope may exist to promote improved infant feeding practices by increasing the quantity and specificity of messages about health effects. Further research is required to evaluate the impact of alternative means of providing information on infant feeding practices.

Primary prevention of childhood obesity: views from primary care

IntroductionChildhood obesity prevalence has increased significantly, yet primary risk factors are known and early prevention is possible. This study (a) explored parents' beliefs concerning their infant's size, growth and feeding...

Impact of CARE‐India's Integrated Nutrition and Health Program (INHP II) on infant feeding practices and growth in rural Uttar Pradesh, India

Despite some success of nutrition education in improving infant feeding practices, such interventions have had little impact on growth. We evaluated CARE-India's INHP II program that aimed to improve breastfeeding (BF) and complementary feeding (CF) practices and nutritional status of children under 2 yr in the Uttar Pradesh. A CARE program district was the intervention (Int) and a non-CARE district with the Government of India's Integrated Child Development Services program was selected as the comparison (C) area. Through multi-stage cluster random sampling, 81-Int and 84-C villages were selected. A cohort of 942 mother-child pairs from birth to 18 mo of age was followed. Percentages of women initiating BF within 1 hr of delivery (17.4 vs 2.7, p<0.001), feeding colostrum (34.7 vs 8.4, p<0.001), avoiding pre-lacteals (19.6 vs 2.1, p<0.001) and exclusively BF at 6 mo (24.1 vs 15.3, p=0.001) were higher in the intervention district. There were also differences in CF practices across the two areas but not consistently in favor of intervention districts. The mean weight for age z score was better at 9 mo (−2.1 vs −2.4, p=0.0026) and prevalence of underweight lower among intervention children (58.5 vs 69.3%, p=0.047) at 12 mo of age but there were no differences at 18 mo. No effect on stunting was observed. Despite early more complete BF achieved, sustained reductions in nutritional status were not found.

First steps for mommy and me: a pilot intervention to improve nutrition and physical activity behaviors of postpartum mothers and their infants.

To assess the feasibility of a pediatric primary care based intervention to promote healthful behaviors among 0-6 month old infants and their mothers. We enrolled two intervention practices (60 mother-infant pairs) and one usual care control practice (24 pairs) in a non-randomized controlled trial. We completed visits and interviews with 80 (95%) pairs at birth and 6 months. The intervention included (1) brief focused negotiation by pediatricians, (2) motivational counseling by a health educator, and (3) group parenting workshops. We evaluated the intervention effects on infant feeding, sleep duration, TV viewing, and mothers' responsiveness to satiety cues. Maternal behavioral targets included postpartum diet, physical activity, TV and sleep. At 6 months, fewer intervention than control infants had been introduced to solid foods (57% vs. 82%; P=0.04), and intervention infants viewed less TV (mean 1.2 vs. 1.5 h/d; P=0.07). Compared to control infants, intervention infants had larger increases in their nocturnal sleep duration from baseline to follow up (mean increase 1.9 vs. 1.3 h/d; P=0.05); larger reductions in settling time (mean reduction -0.70 vs. -0.10 h/d; P=0.02); and larger reductions in hours/day of nighttime wakefulness (mean reduction -2.9 vs. -1.5 h/d; P=0.08). There were no differences in breastfeeding, response to satiety cues, or maternal health behaviors. A program of brief focused negotiation by pediatricians, individual coaching by health educators using motivational interviewing, and group parenting workshops tended to improve infant feeding, sleep and media exposure, but had less impact on mothers' own health-related behaviors.

Four-year follow-up of a randomized controlled trial of a social support intervention on infant feeding practices

In a 4-year follow-up of a randomized controlled trial, this study aimed to evaluate the longer-term effects of a peer-led infant feeding intervention that was delivered during the first year of life. The original intervention used monthly home visits from trained volunteers to improve infant feeding practices among a sample of low-income mothers in two disadvantaged London boroughs. Outcome measures at follow-up included children's eating and drinking habits, general and dental health, and BMI. Data were collected via structured face-to-face interviews and postal questionnaires. Of 212 women who completed the original trial, 101 took part in the follow-up (55 intervention, 46 control). Children's mean age at follow-up was 4 years 7 months. There is little evidence that the intervention had an important effect on children's current BMI, caries levels or consumption of fruit and vegetables. However, mothers from the intervention group had better nutritional knowledge and confidence. Intervention group children also consumed more pure fruit juice [relative risk (RR) = 1.57; 95% confidence interval (CI) 0.99, 2.49] and were more likely to never drink squash (RR = 1.76; 95% CI 1.20, 2.58). The data suggest that the original peer support intervention had a small number of positive long-term effects.

Infant and Young Child Feeding Indicators and Determinants of Poor Feeding Practices in India: Secondary Data Analysis of National Family Health Survey 2005–06

In India, poor feeding practices in early childhood contribute to the burden of malnutrition and infant and child mortality. To estimate infant and young child feeding indicators and determinants of selected feeding practices in India. The sample consisted of 20,108 children aged 0 to 23 months from the National Family Health Survey India 2005-06. Selected indicators were examined against a set of variables using univariate and multivariate analyses. Only 23.5% of mothers initiated breastfeeding within the first hour after birth, 99.2% had ever breastfed their infant, 89.8% were currently breastfeeding, and 14.8% were currently bottle-feeding. Among infants under 6 months of age, 46.4% were exclusively breastfed, and 56.7% of those aged 6 to 9 months received complementary foods. The risk factors for not exclusively breastfeeding were higher household wealth index quintiles (OR for richest = 2.03), delivery in a health facility (OR = 1.35), and living in the Northern region. Higher numbers of antenatal care visits were associated with increased rates of exclusive breastfeeding (OR for 2 7 antenatal visits = 0.58). The rates of timely initiation of breastfeeding were higher among women who were better educated (OR for secondary education or above = 0.79), were working (OR = 0.79), made more antenatal clinic visits (OR for 2 7 antenatal visits = 0.48), and were exposed to the radio (OR = 0.76). The rates were lower in women who were delivered by cesarean section (OR = 2.52). The risk factors for bottle-feeding included cesarean delivery (OR = 1.44), higher household wealth index quintiles (OR = 3.06), working by the mother (OR = 1.29), higher maternal education level (OR = 1.32), urban residence (OR = 1.46), and absence of postnatal examination (OR = 1.24). The rates of timely complementary feeding were higher for mothers who had more antenatal visits (OR = 0.57), and for those who watched television (OR = 0.75). Revitalization of the Baby Friendly Hospital Initiative in health facilities is recommended. Targeted interventions may be necessary to improve infant feeding practices in mothers who reside in urban areas, are more educated, and are from wealthier households.

Effects of processing method and blend on some physicochemical properties and digestibility of flours made from selected cereals and legumes

In the way to set up an appropriate weaning food, the effect of various treatments such as germination, fermentation and supplementation with legumes on millet flour quality was investigated. Untreated and treatedsamples of flours were monitored for their nutritional properties and in vitro digestibility. Results showed an important effect of treatment on flour proximate composition and digestion. In fact, proteins, lipids, ash, minerals (Ca, Mg) contents and energy density were well-enhanced when millet flour was supplemented by soybean. Values were respectively 24.5%, 12.1%, 2.66%, 0.23 and 0.15 mg/100 g and 408,98 kcal/100 g. Values for the untreated flour were 9.63%, 3.6%, 2.5%, 0.067 and 0.093 mg/100 g and 403.98 kcal/100 g respectively for the same parameters. Total tocopherols with contents of 820.71 and 799.1 mg/kg were highest in germinated and soybean supplemented flours. But soybean supplemented flour had the lowest digestibility rate contrarily to the germinated one. However, this formulation appears as the best treatment for improving infant feeding.© 2009 International Formulae Group. All rights reservedKey words: Composite flours, cowpeas, digestibility, fermentation, germination, millet flour, soybean.

Evaluating a Bilingual Video to Improve Infant Feeding Knowledge and Behavior Among Immigrant Latina Mothers

Childhood obesity is recognized as a major health problem in the United States and is occurring at ever younger ages. While most prevention efforts are aimed at school-age children, this project focuses on the caregivers of children from 0 to 24 months of age. This study is an evaluation of an educational English/Spanish infant feeding video, distributed for home viewing at one New York City Special Supplemental Food Program for Women, Infants and Children (WIC) center (video group) but not at three others (comparison group). Baseline, 3 and 6 month infant feeding knowledge and behavior surveys were conducted. For this report, analyses are restricted to Latina immigrant mothers. The video and comparison group mothers were similar in age, education, and parity. The video group was more likely to speak Spanish at home, and had lower knowledge scores at baseline. At the 6 month follow-up, knowledge increased for both groups, but the video group showed a greater increase in knowledge between baseline and 6 months: in ordered logistic regression analyses the video group had a 1.7 times greater score increase at each outcome level. The video group also showed positive changes in behavior-later age at first solid feeding was observed in the video group. We found that an inexpensive, low-intensity video intervention can positively impact maternal knowledge and behavior related to infant feeding among immigrant Latinas. Attention should be given to intervening early with high-risk populations.

Infant feeding choices and experiences of HIV-positive mothers from two Ghanaian districts

Documentation of the feeding choices and experiences of HIV-positive mothers is needed to improve infant feeding counselling. The feeding behaviour and experiences of mothers receiving infant feeding counselling at two Ghanaian districts were explored. A postpartum survey involving 128 HIV-positive mothers, and in-depth interviews involving a purposively selected sample of 10 HIV-positive mothers were conducted. Exclusive breastfeeding rate was 62%. About six percent of the infants were given breast milk and infant formula, while 33% received breast milk and other feeds. Perceived stigma of formula feeding (odds ratio [OR] 7.50; p < 0.05), and perceived cost of infant formula (OR 0.37; p < 0.05) were significantly associated with exclusive breastfeeding for three months. In our multiple regression analysis, perceived stigma of formula feeding (OR 15.62; p < 0.05), and perceived cost of infant formula (OR 4.60; p < 0.05) were significantly associated with exclusive breastfeeding. Social pressure to mix-feed, local norms and “the baby friendly hospital initiative” also influenced infant feeding implementation efforts of mothers. Mothers face various barriers in implementing their feeding intentions. Policy makers and service providers in these districts need to address these issues in order to improve feeding practice. Key words: Infant feed choices, infant feeding experiences, HIV-positive mothers, Ghana.

Micronutrient sprinkles add more bioavailable iron to some Kenyan complementary foods: studies using an in vitro digestion/Caco-2 cell culture model.

Iron deficiency anaemia is arguably the most important public health problem in developing countries. In Sub-Saharan Africa, iron deficiency anaemia has largely been attributed to poor infant feeding practices where complementary foods low in iron bioavailability are offered to at-risk infants. Home fortification of complementary foods using micronutrient Sprinkles has been shown to reduce iron deficiency anaemia in many resource-poor settings. In this study, the benefit of using the micronutrient Sprinkles as a home fortificant for some Kenyan complementary foods was assessed using an in vitro Caco-2 cell model. In each case when micronutrient Sprinkles were added to the complementary food, the amount of Caco-2 cell ferritin formation increased. For example, the addition of Sprinkles to corn porridge increased ferritin formation 5-fold from 5.8 to 31.8 ng mg(-1). Therefore, as indicated by the results, micronutrient Sprinkles would be a suitable form of home fortification for Kenyan complementary foods. Their use should be encouraged so as to improve infant feeding practices in Kenya.

Effectiveness of a social support intervention on infant feeding practices: randomised controlled trial

Background:To assess whether monthly home visits from trained volunteers could improve infant feeding practices at age 12 months, a randomised controlled trial was carried out in two disadvantaged inner city...

Demotivating infant feeding counselling encounters in southern Africa: Do counsellors need more or different training?

Ethnographic research was conducted in eleven low-resource settings across Swaziland, Namibia and South Africa to explore how the perceptions and experiences of counselling health workers, pregnant women and recent mothers could be used to improve infant feeding counselling in the context of mother to child transmission (MTCT) of HIV. We found many counselling encounters to be demotivating. Mothers often reported feeling judged, stigmatised and shamed. Counsellors complained of mothers’ poor compliance and passive resistance and reported suffering from stress, depression and burnout. We observed a rift between the mothers and counselling nurses, with both parties holding opposing agendas grounded in conflicting realities, expectations, experiences and needs. While the clients framed the visit as a consultation, counsellors framed it as health education, towards one exclusive purpose; to save the baby. Two communication modes prevailed in the counselling encounter: in theory, the counselling format was non-directive and client-centred but, in practice, most encounters reverted to information-based health education. Neither counselling format enabled the counsellors to acknowledge the reality of the two opposing agendas in the conversation and manage its dynamics. In order to achieve success – which, for the health service, is framed as persuading mothers to test for HIV and disclose the result – counsellors often felt compelled to be prescriptive and authoritative and reverted at times to confronting, judging and shaming mothers. Yet to adhere to their feeding choice consistently, mothers need to be motivated towards the significant behaviour change that this implies: to change their traditional roles and identities as women. For infant feeding counselling in the context of HIV/AIDS to become effective in southern Africa, a different format is therefore required; one that can acknowledge and manage these opposing agendas and conflicting realities and also enable counsellors to motivate mothers to make significant behaviour change.

Infant feeding practices: Realities and mind sets of mothers in southern Africa

Exclusively breastfed infants in developing countries are at lower risk of HIV transmission than mixed-fed infants. Ethno-graphic research was conducted in eleven low-resource settings across South Africa, Namibia and Swaziland to understand how the perceptions and experiences of counselling health workers, pregnant women and recent mothers could be used to improve infant feeding counselling. Despite prevention of mother-to-child transmission (PMTCT) programmes, very early mixed-feeding remains the norm; traditional conceptualisations of ‘water as life’ and ‘milk as a fluid’ are holding up against current PMTCT education, with milk considered liquid ‘drink’ rather than ‘real food’. This aggravates an ‘insufficient milk syndrome’ where disempowered mothers perceive their breastmilk, and themselves, as deficient—‘not good enough’. Infant feeding is embedded within traditional relationships of intimacy; both relatives and breadwinner have influence and even authority over options and modes of infant feeding. In patriarchal and violent societies, traditional power differentials prohibit easy or complete HIV disclosure or condom negotiation; HIV status remains hidden from most partners and relatives. This context of secrecy means that the traditional advice and authority, which the mothers feel they dare not disregard, is often blind to the mother and her infant's HIV status and survival needs.

Low adherence to exclusive breastfeeding in Eastern Uganda: A community-based cross-sectional study comparing dietary recall since birth with 24-hour recall

BackgroundExclusive breastfeeding is recommended as the best feeding alternative for infants up to six months and has a protective effect against mortality and morbidity. It also seems to lower HIV-1 transmission compared to mixed feeding. We studied infant feeding practices comparing dietary recall since birth with 24-hour dietary recall.MethodsA cross-sectional survey on infant feeding practices was performed in Mbale District, Eastern Uganda in 2003 and 727 mother-infant (0–11 months) pairs were analysed. Four feeding categories were made based on WHO's definitions: 1) exclusive breastfeeding, 2) predominant breastfeeding, 3) complementary feeding and 4) replacement feeding. We analyzed when the infant fell into another feeding category for the first time. This was based on the recall since birth. Life-table analysis was made for the different feeding categories and Cox regression analysis was done to control for potential associated factors with the different practices. Prelacteal feeding practices were also addressed.ResultsBreastfeeding was practiced by 99% of the mothers. Dietary recall since birth showed that 7% and 0% practiced exclusive breastfeeding by 3 and 6 months, respectively, while 30% and 3% practiced predominant breastfeeding and had not started complementary feeding at the same points in time. The difference between the 24-hour recall and the recall since birth for the introduction of complementary feeds was 46 percentage points at two months and 59 percentage points at four months. Prelacteal feeding was given to 57% of the children. High education and formal marriage were protective factors against prelacteal feeding (adjusted OR 0.5, 0.2 – 1.0 and 0.5, 0.3 – 0.8, respectively).ConclusionEven if breastfeeding is practiced at a very high rate, the use of prelacteal feeding and early introduction of other food items is the norm. The 24-hour recall gives a higher estimate of exclusive breastfeeding and predominant breastfeeding than the recall since birth. The 24-hour recall also detected improper infant feeding practices especially in the second half year of life. The dietary recall since birth might be a feasible alternative to monitor infant feeding practices in resource-poor settings. Our study reemphasizes the need for improving infant feeding practices in Eastern Uganda.

Translating global recommendations on HIV and infant feeding to the local context: the development of culturally sensitive counselling tools in the Kilimanjaro Region, Tanzania.

BackgroundThis paper describes the process used to develop an integrated set of culturally sensitive, evidence-based counselling tools (job aids) by using qualitative participatory research. The aim of the intervention was to contribute to improving infant feeding counselling services for HIV positive women in the Kilimanjaro Region of Tanzania.MethodsFormative research using a combination of qualitative methods preceded the development of the intervention and mapped existing practices, perceptions and attitudes towards HIV and infant feeding (HIV/IF) among mothers, counsellors and community members. Intervention Mapping (IM) protocol guided the development of the overall intervention strategy. Theories of behaviour change, a review of the international HIV/IF guidelines and formative research findings contributed to the definition of performance and learning objectives. Key communication messages and colourful graphic illustrations related to infant feeding in the context of HIV were then developed and/or adapted from existing generic materials. Draft materials were field tested with intended audiences and subjected to stakeholder technical review.ResultsAn integrated set of infant feeding counselling tools, referred to as 'job aids', was developed and included brochures on feeding methods that were found to be socially and culturally acceptable, a Question and Answer Guide for counsellors, a counselling card on the risk of transmission of HIV, and an infant feeding toolbox for demonstration. Each brochure describes the steps to ensure safer infant feeding using simple language and images based on local ideas and resources. The brochures are meant to serve as both a reference material during infant feeding counselling in the ongoing prevention of mother to child transmission (pMTCT) of HIV programme and as take home material for the mother.ConclusionThe study underscores the importance of formative research and a systematic theory based approach to developing an intervention aimed at improving counselling and changing customary feeding practices. The identification of perceived barriers and facilitators for change contributed to developing the key counselling messages and graphics, reflecting the socio-economic reality, cultural beliefs and norms of mothers and their significant others.