Infant And Young Child Feeding Knowledge Research Articles

Paternal Participation in Optimal Infant and Young Child Feeding Practice and Associated Factors: A Community-Based Analytical Cross-Sectional Study from Chronically Food-Insecure Communities, Ethiopia

Evidence shows that paternal participation helps to improve the utilization of optimal infant and young child feeding (IYCF) practices. However, little has been known about chronically food-insecure (CFI) communities. The aim of this study to assess paternal participation in optimal IYCF practice and associated factors in the Dodota district of the Arsi zone, Ethiopia, 2022. A community-based cross-sectional study involving 1152 fathers was conducted after ethical clearance was obtained. Measures of optimal IYCF are based on criteria established by the World Health Organization. We analyzed the data using bivariate and multivariate logistic regression models. Results indicated that paternal participation in optimal IYCF practice was 26.2%. The percentages of early initiation of breastfeeding (EIBF), exclusive breastfeeding (EBF), and minimum acceptable diet (MAD) were respectively 72.9%, 66.1%, and 37.3%. Paternal knowledge of IYCF (AOR:3.2, P <0.01), education (AOR:2.1, P<0.05), income (AOR:1.8, P<0.05), child's age (AOR 1.7, P<0.05), and the number of children (AOR:2.1, P<0.05) were the predictors of the outcome. Large-scale, in-depth studies should be required to justify the result unequivocally.

Do improvements in infant and young child feeding (IYCF) practices endure the test of time?

BackgroundReducing malnutrition is a key priority for governments in low- and middle-income countries given its lasting effects on child development, health, income, and economic growth. Strategies to improve recommended infant and young child feeding (IYCF) practices, especially during the first two years of life, are considered among the most effective.MethodsIn this paper, we evaluate the long-run impacts of an innovative education strategy based on interactive play and performing arts implemented in El Alto, Bolivia on caregivers’ IYCF knowledge and practices. Two thousand and fifteen households were randomly assigned to intervention and control groups. Two rounds of data were collected approximately 30 and 42 months after baseline. We estimate short-term (30 month) and longer-term (42 month) intent-to-treat effects using multivariate linear regression analysis, with and without controlling for covariates.ResultsThe program significantly increased caregiver IYCF knowledge by 0.13 SDs in the short run, and this effect grew over time. The program also improved adherence to recommended IYCF practices by 0.23 standard deviations (SDs) in the short term, but the effect on practices dissipated over time, and no longer-term impacts were detected. Caregivers with above median baseline knowledge, number of children, and age appear to have benefited most from the program.ConclusionsOur findings suggest that entertainment-education interventions are a promising model for improving and maintaining IYCF knowledge. However, their ability to sustain more permanent changes in IYCF practices is less certain. Further evidence is needed to identify other avenues for producing long-term, sustainable behavior change, especially among indigenous populations in Latin America, where literature on education and behavior-change interventions related to IYCF practices is limited.

Development and validation of the Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa

BackgroundIn Sub-Saharan Africa, the nutritional status of children born to teenage mothers deserves critical attention. Maternal knowledge and attitudes concerning infant and young child feeding (IYCF) may predict actual practices and child nutritional status. This study created and validated the Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa.MethodsA literature search on IYCF knowledge and attitude gaps in teenage mothers generated scale items. Ten nutrition experts and six teenage mothers assessed content validity and comprehensibility, respectively. Construct validation was conducted by item response theory (IRT) and confirmatory factor analysis (CFA), in 150 teenage mothers in rural communities of Abuja, Nigeria. Model fit parameters were estimated by standardized chi-square tests. Internal consistency reliability was determined by marginal reliability and Cronbach’s alpha. In a sub-sample of 40 women who completed the questionnaire two weeks later, test–retest reliability was assessed via intraclass correlations.ResultsThe IRT analysis retained 23 knowledge items on infant food type, breastfeeding and complementary feeding, with acceptable discrimination and difficulty. CFA produced a six-factor solution (exclusive breastfeeding, breast milk expression, meal frequency, responsive feeding, dietary diversity, and barriers) with 17 attitude items. Confirmatory fit and Tucker Lewis indices > 0.9; Root Mean Square Errors of Approximation and Standardized Root Mean Square Residuals < 0.08, showed good model fit. Overall Cronbach’s alpha of the attitude scale (0.843), subscales (≥ 0.6) and high intraclass correlation coefficients (> 0.75) indicated reliability.ConclusionThe Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa is a valid assessment tool for IYCF knowledge and attitudes of teenage mothers.

Attitudes, beliefs and social norms regarding infant and young child feeding among Nigerian mothers, fathers and grandmothers across time.

Infant and young child feeding (IYCF) interventions in low-resource countries mainly target pregnant women and mothers of young children; however, fathers and grandmothers also influence IYCF practices. We conducted focus group discussions with mothers, fathers and grandmothers of young children across three time points in areas where an IYCF social and behaviour change intervention was implemented in Nigeria to explore differences by participant type and shifts over time in attitudes, beliefs and social norms related to breastfeeding and dietary diversity (DD). Overall, across time points, we found more discrepancies in attitudes, beliefs and social norms for early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) among different participant types than for DD. Although most participants agreed EIBF and EBF are good practices, mothers believed this more strongly than fathers and grandmothers; however, at endline, a shift towards acceptance of EIBF and EBF appeared among fathers and grandmothers. Across time points, all participant types acknowledged the nutritional and health benefits of green leafy vegetables and animal-source foods but described various barriers to feeding them to children. Across time points, all participant types also highlighted the importance of health workers and antenatal visits as important sources of IYCF knowledge and facilitators to following recommended practices. Insights from this study highlight the importance of including key influencers of IYCF practices in qualitative research.

Infant and Young Child Feeding Knowledge among Caregivers of Children Aged between 0 and 24 Months in Seshego Township, Limpopo Province, South Africa

Appropriate infant and young child feeding (IYCF) involves the initiation of breastfeeding within an hour of delivery, exclusive breastfeeding for 6 months, introduction of complementary feeding at 6 months while continuing breastfeeding for 2 years or beyond. Adequate IYCF knowledge among caregivers is associated with improved practices, lowers risk of kids developing malnutrition, infection, morbidity, and mortality. Early introduction of solid foods, mixed feeding, inadequate breastfeeding, and complementary feeding are all prevalent in South Africa. These are related to caregivers' lack of IYCF knowledge. Hence, this study aims to determine the IYCF knowledge level of caregivers of children under 24 months in the semiurban Seshego Township, South Africa. Quantitative and cross-sectional design was applied. A total of 86 caregivers were selected using simple random sampling, which is representative of a target population of 110. Structured questionnaire was utilised to gather data, and analysed through statistical software, using descriptive and inferential statistics. Chi-square test was used to calculate associations at 95% confidence interval, where a p-value of < 0.05 was considered statistically significant. Findings show that 67% of participants had good IYCF knowledge (a score of 81 to 100%) and there was a significant relationship between knowledge and education (p = 0.001). Moreover, 40.7% did not know that exclusive breastfeeding should be up to 6 months, and 90% mentioned that breastmilk protects the child against diseases. Most participants (82.6%) know that complementary feeding should be introduced at 6 months with continuation of breastfeeding. Caregivers know that breastfeeding should begin immediately after birth, and that it protects against diseases. Moreover, they know that solid food should be introduced at 6 months. However, there is still a need to strengthen IYCF education, particularly on exclusive breastfeeding. Interventions to improve IYCF knowledge should be intertwined with improving educational and health literacy on breastfeeding and complementary feeding.

Development of the generic Community Infant and Young Child Feeding Counselling Package.

Infant and young child feeding (IYCF) promotion is a key component in the set of high impact interventions to improve nutrition. The literature provides evidence of the positive impact of IYCF promotion through various platforms, including communities. In 2009, UNICEF and WHO agreed that a global, "generic" IYCF package of resources and tools to plan, implement, and monitor community-based IYCF programmes and to build skills of community-based workers was needed. In 2010, the UNICEF Community Infant and Young Child Feeding Counselling Package was finalized and field tested under a strategic collaboration between UNICEF New York and Nutrition Policy and Practice and the Center for Human Services/University Research Company. The Package includes 11 tools to guide adaptation of the materials, the design, planning, and implementation of IYCF programmes and the training, monitoring, supervision, and mentoring of community workers, using an interactive and experiential adult learning approach. The Package was rolled out from 2011 onwards and by 2017 was implemented in 87 countries. In 2013, UNICEF and the United States Agency for International Development-funded Strengthening Partnerships, Results, and Innovations in Nutrition Globally project started planning the evaluation, and a study site was selected in Nigeria to assess the efficacy and effectiveness of the Package on IYCF practices, knowledge, and worker skills. This article describes the need for and development of the Package, its content and approach to skills building, as well as its current implementation. Finally, it makes the case for the evaluation of the Package, which is covered in the other papers in the Supplement in relation to the Nigeria evaluation.

Antenatal care utilization and nutrition counseling are strongly associated with infant and young child feeding knowledge among rural/semi-urban women in Harari region, Eastern Ethiopia.

There is a gap in evidence linking antenatal care (ANC) utilization, nutrition counseling, and knowledge of pregnant women about infant and young child feeding (IYCF), particularly in low-income settings. Therefore, this study aimed to identify the association between ANC follow-up and nutrition counseling with IYCF knowledge. A cross-sectional study was conducted among 390 pregnant women in the rural kebeles of the Harari region from January to June 2019. Data were collected using face-to-face interviews on tablet computers. Bivariate and multivariate logistic regression were employed. An adjusted odds ratio (with 95% CI) was used to determine the strength of association between IYCF knowledge with ANC follow-up and nutrition counseling by adjusting for educational status, occupation, gravida, and distance to the nearest health center. Overall, 54.4% [95% CI 49.2, 59.2] of currently pregnant women were knowledgeable about IYCF of which only 20% started ANC follow-up and 24.4% received nutrition counseling. Out of 288 multigravida women, only 51.4% had ANC follow-up during their last pregnancy. In the adjusted model, ANC follow-up during the current pregnancy (AOR 1.85, 95% CI 1.07–3.22), those who received nutrition counseling (AOR 1.92, 95% CI 1.09–3.38), literate in education (AOR 1.71, 95% CI 1.07–2.73), multigravida (AOR 1.96, 95% CI 1.12–3.43), and far from the nearest health center (AOR 0.95, 95% CI 0.93–0.97) were significantly associated with the mothers IYCF knowledge. Thus, health care providers should encourage mothers to attend ANC during pregnancy and provide nutrition counseling about the IYCF.

Barriers and Facilitators to Optimal Infant and Young Child Feeding Practices in the Central Region of Ghana: Perceptions of Heath Care Providers

ObjectivesThis qualitative study sought to describe provider’s perspectives on barriers and facilitators to optimal infant and young child feeding (IYCF) practices (primarily exclusive breastfeeding (EBF), meal frequency, and diet diversity) among caregivers in Central Region of Ghana. MethodsQualitative data were collected through audiotaped in-depth interviews with care providers from three districts within the Central Region of Ghana: Gomoa East, KEEA, and Assin South (N = 18). Interviews were conducted in English, were audio taped, and transcribed. Transcripts were read and coded independently by two authors, consensus was reached about emerging domains and themes, and a final codebook was developed. The socioecological model was used to map barriers and facilitators for EBF and complementary feeding (CF) practices. ResultsPreliminary findings showed that several barriers and facilitators were similar for EBF and CF within each level. Individual level barriers included returning to work, poor maternal hygiene and ill health, limited maternal IYCF knowledge. Additional EBF barriers included not recognizing early hunger signs, breast problems, perceived breastmilk insufficiency while additional CF barriers were related to food access, time for preparation, and food safety. Interpersonal barriers/facilitators included family/provider support, family cultural beliefs/practices, family influence on practices, provider IYCF knowledge/education delivery, role modeling. Community level barriers/facilitators were related to the built environment including access to health facility and sanitation as well as community-level characteristics such as illiteracy and traditional beliefs. Societal barriers/facilitators included industry advertising, and IYCF policies/guidelines. Poverty was identified as a cross-cutting barrier. Providers recommended intensifying IYCF counseling, home visits to address barriers and training IYCF counseling. ConclusionsProviders were aware of challenges caregivers face when trying to practice optimal IYCF. Multi-level interventions are needed, including IYCF counseling to address identified barriers. Funding SourcesThis study was funded by UNICEF-Ghana.

HUBUNGAN PENGETAHUAN DAN PRAKTIK PEMBERIAN MAKAN BAYI DAN ANAK (PMBA) SERTA PENGGUNAAN GARAM BERYODIUM DENGAN KEJADIAN STUNTING

Stunting problems often arise as a result of a lack of knowledge and skills in meeting the nutritional needs of toddlers. Infant and Young Child Feeding (IYCF) is an effort aimed at increasing the knowledge and skills of the community to deal with nutritional problems independently. In addition to feeding patterns, adequate intake of iodine is required for normal physical growth during pregnancy and early life. This study aims to analyze the relationship between knowledge and practice of IYCF and consumption of iodized salt with the case of stunting in toddlers aged 12-24 months.This research is an analytic observational study using a cross sectional design. 87 samples were selected using random sampling technique. The data was collection on the level of knowledge and practice of PMBA carried out interviews with respondents using a questionnaire, collecting data on the use of iodized salt by testing for iodine levels using Lugol's solution (iodine test), measuring body length using an Infantometer and determining nutritional status processed with the WHO anthro application and analyzing data using the test. Continuity Correction stats. IYCF knowledge of the respondents at 76.0% is classified as good, IYCF practice of the respondents at 69% is classified as good and the use of Iodized Salt is at 35.6%. The Continuity Correction ”test showed that there was” a significant association between IYCF“knowledge (p=0.001; PR =14.9), IYCF practice (p=0.001; PR =10.6) and ”the use of iodized salt” (p=0.017; PR =3.7) and the incidence of stunting in children aged 12-24 months.There is an,.association between IYCF practice and knowledge and the use of iodized salt and ”the”incidence”” of stunting in ”children ”aged 12-24 months.

Knowledge and Practices Regarding Infant and Young Child Feeding among Mothers Working in Readymade Garments Sector in Bangladesh: A Cross-Sectional Survey

Optimum is. Adequate Infant and young child feeding (IYCF), critical for child’s growth and development, requires a significant amount of time andcan be challenging for working mothers. In Bangladesh, about four million women work long-hours in Readymade Garment (RMG) factories without proper maternity benefits which raises concern regarding optimum IYCF practice. We conducted a descriptive cross-sectional study in Dhaka, Bangladesh to identify the knowledge and common practices of IYCF among mothers working in Readymade Garment sector. Ninety-three women of reproductive age (15-49 years), working in Readymade Garment sector, with children aged 6-23 months, were interviewed. Our study revealed- majority knew about exclusive breast feeding (EBF) (76%), duration to continue breast feeding (73%) and early initiation of breast feeding (53%). The exclusive breast-feeding practice in mothers employed in RMG sector was 44%. Three-fourths of the mothers knew and initiated complementary feeding timely. Both knowledge regarding age-adjusted minimum meal frequency (MMF) (19.4%) and minimum quantity (8.6%) were low; compared to actual practices. Nearly two-fifth of the mothers (40%) had to start working before their child reached six months of age enabling them to provide their baby with breastmilk substitutes. Mothers employed in Readymade Garment sector had better IYCF practice than general population. Proper workplace environment with mandatory breast-feeding corners, daycare facilities and ensuring maternity benefits in these mothers could help achieve an even better IYCF practices for their children.

Community-Based Nutrition Education Improves Caregivers’ Knowledge of Complementary Feeding in Southern Ethiopia

Abstract Objectives Quality Diets for Better Health (QDBH) is a nutrition-sensitive agriculture project in southern Ethiopia that promotes vitamin A-rich orange-fleshed sweetpotato (OFSP) and community-based nutrition education to improve the quality of young child diets. The objective of this research is to examine the impact of the project and other predictors on caregiver knowledge of infant and young child feeding (IYCF) over time. Methods Communities were randomized to a control group and intervention groups receiving OFSP planting materials and community-based nutrition education. Households with infants &amp;lt;6 months completed a baseline survey in January 2018, and follow-up surveys 7 and 13 months later. Knowledge of IYCF recommendations and vitamin A was assessed at each visit; a knowledge score (range 0–100) was calculated by assigning points for accurate responses. If a caregiver was missing not more than two responses, we imputed her score with the community-mean to retain sample size and minimize bias. We used mixed effects modeling to examine the effect of QDBH and other factors, such as education and prenatal counseling, on knowledge scores over time, while controlling for covariates. Results Of the 605 households who completed the baseline survey, 548 (90.6%) and 523 (86.4%) completed the follow-up surveys. Baseline characteristics of the group lost to follow-up did not differ from those retained in the sample. Knowledge scores were highest at baseline (65.3 ± 14.4), and lower at 7 months (48.4 ± 13.8) and 13 months follow-up (46.9 ± 14.0). Baseline scores were higher among caregivers with higher education (P &amp;lt; 0.05) and who reported receiving prenatal IYCF counseling (P &amp;lt; 0.0001), but also declined faster among those who had prenatal counseling (β = −1.6, P = 0.04). Knowledge scores in intervention and control groups were similar at baseline (P = 0.49), but scores of those in the intervention group declined less rapidly than those in the control group (β = 4.0, P &amp;lt; 0.0001). Conclusions Caregivers’ knowledge of IYCF decreased in the postnatal period; decreases were fastest among those who received prenatal IYCF counseling and among those in the control group. Postnatal community-based nutrition education can help maintain knowledge of IYCF recommendations. Funding Sources This research is funded by the European Union in partnership with the International Potato Center.

Facilitators of Responsive Feeding/Parenting Knowledge and Practices Among Parents in the Central Region of Ghana

Abstract Objectives Identify facilitators of the practice of Responsive Feeding/Parenting (RF/P) among parents of children under 3 years of age in the Central Region of Ghana. Methods Qualitative data was collected through six audiotaped focus group discussions with mothers (n = 27) and fathers (n = 18) living in the Central Region of Ghana who a) were 18 years of age or older; b) had a child under 3 years of age; c) were involved in feeding the child. Transcripts were read and coded independently by three authors, consensus was reached about emerging domains and themes, and a final codebook was developed. Results Three factors were identified as direct facilitators of the practice of RF/P: support, health care providers infant and young child feeding (IYCF) education delivery, and IYCF practice. Family, friends and the community gave parents informational, instrumental and emotional support including education/counseling on childcaring practices, doing chores for parents, giving parents the time off to respond to their children's needs. This support enabled parents to learn and adopt some RF/P behaviours. Health care providers delivered education on IYCF, food safety and, in some instances, provided some RF/P counselling/guidance. This then enabled parents to identify the nutritional and the psychosocial needs of their children and to recognize they should attend to these needs using RF/P knowledge and practice. Non-responsive feeding/parenting practices also emerged within IYCF practices demonstrating the need for more high-quality RF/P education. Conclusions Health care providers as well as family/friends facilitate parent's IYCF practices, which in turn influences their RF/P practices. Strengthening IYCF knowledge delivery through enhanced antenatal and postnatal counselling targeting parents as well as family/friends can promote RF/P knowledge and practices among Ghanaian parents. Funding Sources Hecht-Albert Leadership Award to Dr. Hromi-Fiedler through the Global Health Leadership Institute, Yale University.

Counselling skills of Accredited Social Health Activists for promotion of optimal Infant and Young Child Feeding practices

Background: Accredited Social Health Activists (ASHAs) play an important role in communicating messages related to infant and young child feeding (IYCF) practices. Adequate knowledge and counselling skills are crucial for effective behavior change among mothers. Objective: To assess counselling skills of ASHAs for promotion of optimal IYCF practices among mothers of young children. Material &amp; Methods: ASHAs (n=190) were selected randomly from 21 primary health centres in Delhi. Their knowledge and counselling skills for promotion of optimal IYCF practices were assessed using a questionnaire and simulated counselling sessions based on WHO IYCF counselling course (2006) and IYCF guidelines by WHO (2009), GOI (2006) and IAP (2016). Results: Mean scores of ASHAs on optimal IYCF knowledge and counselling skills were 65.2±11.8% (n=190) and 41.8±9.4% (n=182) respectively. Less than half (45%) of the appropriate key messages were correctly communicated by ASHAs during the simulated counselling sessions. Majority of ASHAs (&gt;75%) used helpful non-verbal communication, simple language and tried solving problems while counselling. Inability to empathise with caregivers, praising good practices and assessing their understanding were the communication skills which most ASHAs (&gt;95%) lacked. Conclusion: There is need to focus on improving their counselling skills for effective promotion of optimal IYCF practices.

Dietary Diversity among Children Aged 6-23 Months in Aleta Wondo District, Southern Ethiopia.

Background Dietary diversity (DD) is among the core infant and young child feeding (IYCF) indicators. However, in many developing countries, meeting the minimum standards of DD is challenging and information concerning its determinants is limited. Objective To assess the level and predictors of DD among children aged 6–23 months in rural communities of Aleta Wondo district, Sidama zone, Southern Ethiopia. Method A community-based cross-sectional study was conducted in rural Aleta Wondo in February 2016. Multistage sampling was employed to recruit 502 children aged 6–23 months. DD was assessed by asking the mother whether the index child had received food from the standard seven food groups in the previous day, without setting minimum intake restrictions. Ultimately, the dietary diversity score (DDS) was rated on a 7-point scale, and it was modeled using linear regression analysis. The outputs are presented using adjusted regression coefficients (β). Results Only 12.0% (95% confidence interval: 9.0–15.0%) of the children met the minimum recommended DD, receiving from four or more from seven food groups. The analysis identified eleven significant predictors of DDS. As the maternal knowledge of IYCF increases by a unit, DDS raised by 0.21 units (p = 0.004). Unit increment in the husband's involvement in the IYCF score was linked with 0.32 units improvement in DDS (p = 0.016). One unit change in the ordinal category of household food insecurity was associated with 0.13 reduction in DDS (p = 0.001). Similarly, household wealth index (β = 0.54, p = 0.041), father's literacy (β = 0.48, p = 0.002), ownership of home garden (β = 0.38, p = 0.01), mother's participation in cooking demonstrations (β = 0.19, p = 0.036), and child age in months (β = 0.04, p = 0.001) were all positively associated with DDS. Furthermore, receiving IYCF information via mass media (β = 0.04, p = 0.001) and during antenatal (β = 0.91, p = 0.022) and postnatal checkups (β = 0.21, p = 0.043) were positive predictors of DDS. Conclusions Promoting the socioeconomic status of the community, strengthening of home gardening, involving husbands in IYCF, and enhancing maternal knowledge of IYCF may advance DD.

Role of Religion on Knowledge, Attitude and Practices of Lactating Mothers on Infant Feeding

Infant and young child feeding (IYCF) practices directly affect the nutritional status of children under two years of age, and ultimately, impact child survival. These practices are influenced by maternal knowledge and attitudes as well as socio-demographic and cultural factors; and an understanding of such factors is important to scaling up IYCF practices. This study was designed to assess the role of religion on knowledge, attitude and infant feeding practices among Christian and Muslim lactating mothers in Ibadan North Local Government Area (LGA), Oyo State. The descriptive cross-sectional study was conducted among 320 lactating mothers in the LGA. Eight focus group discussions were carried out among Christian and Muslim lactating mothers. An adapted pre-tested questionnaire was used to collect information on socio-demographic characteristics and IYCF knowledge, attitude and practices of the respondents. Knowledge on IYCF was assessed on 14-item scale, and the scores categorised as: ˂5.60 poor, 5.60–10.88 fair, and ˃10.88 good knowledge. Attitude was assessed on 13 statements from the IOWA Infant Feeding Attitude scale with lowest and highest obtainable score of 13 and 65 respectively. A score of ˂44 was ranked as poor, and ˃44 points good. Data were analysed using descriptive statistics and one-way ANOVA. Qualitative data was analysed thematically. Mean age of respondents was 30.0±4.9 years, 55.9% were Muslims, and 63.8% had fair knowledge. There was no significant difference in fair knowledge categorisation (63.7%, 63.8%), but there existed slight difference in good (20.7%, 21.3%) and poor (15.6%, 14.9%) knowledge of the Muslim and Christian respondents respectively. Mothers with poor attitude constituted 56.0%. Muslim religion directly supports pre-lacteal feeding and duration of breastfeeding while the other indirectly supports breastfeeding. Religious practices directly and indirectly affect knowledge, attitude and practices of nursing mothers on infant feeding; hence, healthcare Professionals should pay more attention to nutrition education in religious houses using the infant and young child feeding module.

Large-Scale Social and Behavior Change Communication Interventions Have Sustained Impacts on Infant and Young Child Feeding Knowledge and Practices: Results of a 2-Year Follow-Up Study in Bangladesh

BackgroundSustained improvements in infant and young child feeding (IYCF) require continued implementation of effective interventions. From 2010–2014, Alive & Thrive (A&T) provided intensive interpersonal counseling (IPC), community mobilization (CM), and mass media (MM) in Bangladesh, demonstrating impact on IYCF practices. Since 2014, implementation has been continued and scaled up by national partners with support from other donors and with modifications such as added focus on maternal nutrition and reduced program intensity.ObjectiveWe assessed changes in intervention exposure and IYCF knowledge and practices in the intensive (IPC + CM + MM) compared with nonintensive areas (standard nutrition counseling + less intensive CM and MM) 2 y after termination of initial external donor support.MethodsWe used a cluster-randomized design with repeated cross-sectional surveys at baseline (2010, n = 2188), endline (2014, n = 2001), and follow-up (2016, n = 2400) in the same communities, among households with children 0–23.9 mo of age. Within-group differences over time and differences between groups in changes were tested.ResultsIn intensive areas, exposure to IPC decreased slightly between endline and follow-up (88.9% to 77.2%); exposure to CM activities decreased significantly (29.3% to 3.6%); and MM exposure was mostly unchanged (28.1–69.1% across 7 TV spots). Exposure to interventions did not expand in nonintensive areas. Most IYCF indicators in intensive areas declined from endline to follow-up, but remained higher than at baseline. Large differential improvements of 12–17 percentage points in intensive, compared with nonintensive areas, between baseline and follow-up remained for early initiation of and exclusive breastfeeding, timely introduction of foods, and consumption of iron-rich foods. Differential impact in breastfeeding knowledge remained between baseline and follow-up; complementary feeding knowledge increased similarly in both groups.ConclusionsContinued IPC exposure and sustained impacts on IYCF knowledge and practices in intensive areas indicated lasting benefits from A&T's interventions as they underwent major scale-up with reduced intensity. This trial was registered at clinicaltrials.gov as NCT02740842.

Modelling the impact of stunting on child survival in a rural Ugandan setting

BackgroundUganda ranks among the top 10 countries in the world for newborn and child mortality rates and among the top 34 for burden of stunting. This study was conducted to model the impact of stunting on child mortality in the southwest region of Uganda where the prevalence of stunting and child mortality are of great public health concern.MethodsThe study was conducted in Buhweju district in the southwest region of Uganda. The study was cross-sectional involving use of a structured household questionnaire, focus group discussions and interviews with key informants in order to gather relevant information on infant and young child feeding (IYCF) and coverage of antenatal care (ANC) and vaccination programs. The survey of stunting, vaccination and ANC services covered 221 children aged 6–59 months while the assessment of IYCF practices covered 83 children aged 0–23. The Lives Saved Tool (LiST) was used to estimate the impact of stunting on child mortality and cases of stunting averted.ResultsThe study findings indicated that only 33% of the mothers had knowledge of optimal IYCF and 39% of the sampled children were exclusively breastfed. The majority of the mothers (57%) breastfed their children for less than 2 years and only 31% of the mothers practiced appropriate introduction of complementary foods at 6 months. Only 17% of the 0–23-month-olds received a good standard of IYCF. Only 37% of the mothers reportedly attended ANC 4 times or more during pregnancy and among children aged 6–59 months, only 28% were fully vaccinated. The high impact LiST model estimated that 1297 children under 5 years would be saved and 24,850 cases of stunting averted in the study district.ConclusionsThe study concludes that IYCF practices and coverage of expanded programme on immunization (EPI) and ANC in the study population are sub-optimal thus the high prevalence of stunting and child mortality in the region. LiST demonstrated that prevention of stunting would reduce child mortality in rural Uganda. Therefore, increased investment in cost-effective child survival interventions targeting rural areas of Uganda would have a significant impact on stunting and child mortality.

Effectiveness of timed and targeted counselling about feeding and caring practices for infants and young children to mothers in West Bank: a randomised controlled trial

BackgroundRestricted access to health facilities in some Palestinian localities is believed to contribute to little knowledge and poor infant and young child feeding (IYCF) and care practices among mothers. The objective of this study was to assess the effectiveness of a community approach called Timed Targeted Counselling in improving mothers' knowledge and practices of IYCF in four remote villages surrounding Bethlehem in the West Bank. MethodsWe did a randomised controlled trial in four villages. All mothers of infants born between March 1, 2011, and April 30, 2011, were identified by community health workers (CHWs) and randomly assigned to the intervention or comparison group. Randomisation was done at the individual level, four villages who had similar characteristics were identified and all newborns during the months of March and April, 2011, were assigned randomly into intervention and comparison groups, univariate, and multivariate analysis were applied. CHWs targeted the intervention group with key messages and support for positive IYCF and caring practices during two organised home visits (sometimes three depending on their counselling) throughout 12 months. Women in the comparison group were not exposed to any messages; they were visited only for data collection. Baseline and postintervention data from a questionnaire, designed for the purpose of the study, were collected for both groups at the end of 12 months. Ethical approval was given and informed consent obtained from participants. The primary endpoint was behavioural caring practices of mothers towards their children. We did univariate and multivariate statistical analysis were planned to be done using SPSS version 17. FindingsWe enrolled 118 mothers in the study and randomly assigned them to the intervention group (n=66) or the comparison group (n=52). IYCF and caring practices improved significantly among mothers in the intervention group: exclusive breastfeeding up to 6 months increased from 27% (18 of 66 women) to 70% (46 women; OR 29, 95% CI 8·02–108); breastfeeding of children aged 1 year increased from 56% (37) to 83% (55; 2·94, 1·03–8·41); timely introduction of complementary meals increased from 38·5% (25) to 67% (44; 83·6, 17·24–40·5); rubbing of salt on infant skin and umbilical cord decreased from 54·5% (36) to 3% (3; 0·033, 0·006–0·19); recognition of danger signs increased from 15% (10) to 48% (32; 3·96, 0·17–9·2); and, bathing of newborns within 24 h after birth decreased from 68·2% (45) to 32% (21; p<0·0001 for all comparisons). No behavioural changes were recorded among mothers in the comparison group. During the study period, fewer disease episodes were reported in the intervention group than in the comparison group for diarrhoea (10 cases vs 25 cases), respiratory illness (15 vs 33), common cold (39 vs 50), fever (20 vs 31), and ear infections (7 vs 32 cases). InterpretationTimed Targeted Counselling proved very effective for improvement of a range of IYCF and caring practices. Because of contextual similarities in most Palestinian localities, scale-up for TTC is recommended for other areas in West Bank (Gaza, occupied Palestine territory). FundingWorld Vision Jerusalem.

Maternal participation in a nutrition education program in Uganda is associated with improved infant and young child feeding practices and feeding knowledge: a post-program comparison study

BackgroundCost-effective approaches to improve feeding practices and to reduce undernutrition are needed in low-income countries. Strategies such as nutritional counseling, food supplements, and cash transfers can substantially reduce undernutrition among food-insecure populations. Lipid-based nutrient supplements (LNS) are an increasingly popular strategy for treating and preventing undernutrition and are often delivered with nutrition education. The post-program effects of participation in a LNS-supported supplemental feeding program on Infant and Young Child Feeding (IYCF) practices and caregiver child feeding knowledge are not well understood. The objective of this study was to understand whether children’s diet quality and caregiver nutrition knowledge was improved after participation in such a program.MethodsWe conducted a post-program comparison group study to compare feeding practices and caregiver nutrition knowledge among mother-child dyads who completed a nutrition education program and a community comparison group in western Uganda. We administered a feeding practices survey and two 24-h dietary recalls to 61 Post-Program (PP) caregivers and children ages 6 to 59 months (mean age = 25.1 months) who participated in a supplemental feeding program (which included growth monitoring, caregiver nutrition education, and LNS) and a Comparison Group (CG) of 61 children and caregivers. PP caregivers were recruited 4 to 8 weeks after program participation ended. We hypothesized that PP caregivers would report better IYCF practices and greater knowledge of key nutrition education messages related to IYCF.ResultsPP children had higher dietary diversity scores (3.0 vs 2.1, p =0.001) than CG children, and were more fed more frequently (3.0 vs 2.1 times per day, p = 0.001). IYCF indicators were higher in the PP group for minimum meal frequency (44.8% vs. 37.9%), minimum dietary diversity (10.3 vs. 3.4%), iron-rich complementary foods (17.2 vs. 20.7%), and minimally acceptable diet (10.3% vs 3.6%), but differences were non-significant. Caregivers in the PP group demonstrated greater knowledge of healthful IYCF practices.ConclusionsNutrition education can be effective to improve caregiver feeding practices and children’s dietary diversity and the frequency by which they are fed. A 10-week nutrition education and supplemental feeding program appears to provide some benefit to children in terms of dietary diversity and frequency of meals, and caregiver knowledge of feeding 1 to 2 months after program completion. However, children in this rural Ugandan region have diets that are still largely inadequate, highlighting the need for enhanced interventions and policies to promote diverse and appropriate diets for young children in this region. Future follow-up work in LNS-supported programs is recommended to understand how other similar approaches influence children's diet quality after program completion in other contexts.

Health Extension Workers’ Knowledge and Knowledge-Sharing Effectiveness of Optimal Infant and Young Child Feeding Are Associated With Mothers’ Knowledge and Child Stunting in Rural Ethiopia

Little is known about how the knowledge and the knowledge-sharing effectiveness (KSE) of health extension workers (HEWs) affect maternal knowledge of optimal infant and young child feeding (IYCF) and their child's nutritional status. The objective of this study was to evaluate mothers' and HEWs' knowledge of key IYCF practices and to investigate whether mothers' knowledge and HEWs' KSE are associated with stunting in young children (aged 12-23 months). This cross-sectional study used face-to-face interviews to assess the IYCF knowledge of HEWs (n = 96) and mothers of 12- to 23-month-old children (n = 122) in Mecha district, West Gojam, Ethiopia. The association between HEWs' KSE and children's length-for-age z scores (LAZ) was investigated. Stunting (50%), underweight (34%), and wasting (10%) were highly prevalent. Less than half (45%) of the mothers had access to nutrition education through the health extension program, but those who had, had better knowledge of IYCF practices and thus lower rates of stunting ( P < .001). However, key IYCF practices were not well understood by the HEWs and this affected their KSE. The gap in KSE was negatively associated with LAZ ( r = -.475, P < .001) and remained significant even after adjusting for maternal height, socioeconomic status, and maternal education ( r = -.423, P = .002). Health extension workers' KSE is associated with child stunting. Future training of HEWs would benefit from emphasis on not only the content of the IYCF messages but also the process of delivery while increasing their counseling skills.