Infant And Young Child Feeding Practices Research Articles

Promoting Breastfeeding in Workplaces: Experiences with the Crèche at the University of Port Harcourt Teaching Hospital, Southern Nigeria

Background: The Baby Friendly Hospital Initiative (BFHI) aims to promote, protect and support optimal infant and young child feeding (IYCF) practices among all women, irrespective of their employment status. Consequently the University of Port Harcourt Teaching Hospital (UPTH), a Baby Friendly Hospital, has provided free Crèche services since 1996 to enable working mothers breastfeed their babies while at work, as they resume after 4 months of maternity leave.
 Aims: To appraise attendance and use of the Crèche by health workers for the promotion, protection and support of breastfeeding at the UPTH.
 Study Design: Retrospective study.
 Place and Duration of Study: Department of Paediatrics, UPTH, Nigeria.
 Methodology: Personal data and data on Crèche attendance were extracted from the Registers of children cared for at the Crèche between November 2006 and October 2016, entered into Excel Spreadsheet and analysed with SPSS version 20. Simple statistics were used to analyse and present data.
 Results: One thousand and sixty-two children utilised the Crèche during the 10 years review period with total of 10,490 attendances. The children consisted of 604(57%) males and 458(43%) females, aged 6 weeks to 48 months (mean-6.44±2.54 months). An average of 93.6 children were cared for each month, with attendance showing a declining trend and they spent 2 to 9.5(mean-4.68) hours daily. The children attended the Crèche for 1 to 22(mean-7.35) days each month, while 32% of them attended only 1-3 days a month. Mothers from all clinical and non-clinical departments utilised the Crèche with nurses constituting 37%.
 Conclusion: Utilisation of the Crèche services was sub-optimal. Its provision alone is insufficient to promote and support optimal IYCF practices among working women. User education and support for optimal IYCF practices are required. Access to Crèche services in all shifts and on all days should be guaranteed. Improved record keeping is required.

A Multilevel and Spatial Analysis of the Infant and Young Child Feeding Practices and Associated Factors among the Under-2 Aged Children in Bangladesh

ABSTRACT Infant and young child feeding (IYCF) is crucial for the growth, development, and survival of a child. This study aims to examine the factors associated with IYCF practices among the under-2 aged children in Bangladesh and spatial variability. A total of 2336 children aged 6–23 months were selected from the 2014 Bangladesh Demographic and Health Survey (BDHS). A multi-level logistic regression was used to determine the association between socio-demographic and health-related factors accounting for the cluster effects. An adaptive bandwidth kernel density estimator (KDE) was used to investigate the spatial variability of IYCF practices in Bangladesh. The prevalence of minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) were 29%, 47%, and 19% respectively, where the suboptimal IYCF practice was 96% among them. The study findings show that higher maternal age at childbirth and maternal education level are positively associated with MDD, MMF, and MAD. The likelihood of MMF and MAD was higher for children whose mothers had the decision-making abilities (adjusted odds ratio, [AOR] 1.23 and 1.26, respectively) and had exposure to media (AOR 1.43 and 1.38, respectively). Four or more antenatal care (ANC) visits positively associated with the MDD (AOR 1.47; 95% confidence interval [CI] 1.07–2.02) and ICFI (AOR 3.06; 95% CI 1.24–7.54). The heatmap shows Northern parts of Bangladesh performed better than South-West parts in child feeding practices. Overall, age-appropriate IYCF practices are not satisfactory, and many maternal characteristics contribute significantly to this. Geospatial inequalities are also notable across Bangladesh. The current scenario reinforces the need for programmes and interventions that address the spectrum of IYCF practices and help reduce spatial disparities.

Challenges and responses to infant and young child feeding in rural Rwanda: a qualitative study

BackgroundDespite different interventions to improve child nutrition conditions, chronic malnutrition is still a public health concern in Rwanda, with a high stunting prevalence of 38% among under 5-year-olds children. In Rwanda, only 18% of children aged 6–23 months are fed in accordance with the recommendations for infant and young child feeding practices. The aim of this study was to explore challenges to infant and young child feeding practices and the responses applied to overcome these challenges in Muhanga District, Southern province of Rwanda.MethodsSixteen (16) focus group discussions were held with mothers, fathers, grandmothers, and community health workers from 4 rural sectors of Muhanga District. The discussions were recorded, transcribed verbatim, and thematically analyzed using qualitative data analysis software, Atlas.ti.ResultsTwo main themes emerged from the data. Firstly, there was a discourse on optimal infant and young child feeding (IYCF) practices that reflects the knowledge and efforts to align with early initiation of breastfeeding, exclusive breastfeeding for the first 6 months, as well as initiation of complementary foods at 6 months recommendations. Secondly, challenging situations against optimal practices and coping responses applied were presented in a discourse on struggling with everyday reality. The challenging situations that emerged as impeding appropriate IYCF practices included perceived lack of breast milk, infant cues, women’s heavy workload, partner relations and living in poverty. Family and social support from community health workers and health facility staff, financial support through casual labor, and mothers saving and lending groups, as well as kitchen gardens, were used to cope with challenges.ConclusionFactors influencing IYCF practices are multifaceted. Hence, intervention strategies to improve child nutrition should acknowledge the socially embedded nature of IYCF and address economic and social environmental constraints and opportunities, in addition and above knowledge only.

Knowledge and Hygiene Practices among Mothers While Infant and Young Child Feeding in Raichur, Karnataka:A Cross Sectional Study

Introduction: With the adoption of the 2030 Agenda for Sustainable Development, improving infantand young child feeding practices has never been more urgent. While breastfeeding provides optimal nutrition to the child and prevent infections, the timely initiation and age appropriate complementary feeding can substantially reduce stunting and related burden of disease. Poor hygiene and subsequent diarrhea may also contribute to stunting through chronic gut inflammation. Objective : To study the knowledge and hygiene practices among mothers during infant and young child feeding. Methodology: A cross-sectional study was conducted in the urban field practice area of Navodaya Medical College. A study population of 375 mothers having children of less than two years age were selected by systematic random sampling method. Data was collected after informed consent regarding socio-demographic factors, knowledge and hygiene practices during child feedingfrom mothers. Data was analyzed using EPI Info 7 and expressed in terms of percentages, proportions. Results: The study showed 50.1% of mothers had correct knowledge on duration of exclusive breastfeeding and 42.7% on appropriate time of initiating complementary feeding. 28.35% of mothers had the habit of washing hands with soap and water before feeding the child. Only 12.8% of mothers had given safe water for drinking to child. Conclusion: In our study half of the mothers had the right knowledge on appropriate duration of exclusive breastfeeding while knowledge on initiation of complementary feeding is much less. Hygiene practices are very low and needs more attention.

Suboptimal infant and young child feeding practices in rural Boucle du Mouhoun, Burkina Faso: Findings from a cross-sectional population-based survey.

In Burkina Faso in 2016, 27% and 8% of children under-5 were estimated to suffer from stunting and wasting respectively. Here, we report on infant and young child feeding (IYCF) practices in rural areas of the Boucle du Mouhoun region. A cross-sectional population-based survey was performed in 2017 in a representative sample of mothers of children aged 6 to 23 months. IYCF practices were assessed using 24-hour dietary recall. Logistic regression was used to identify predictors of IYCF practices. All analyses accounted for sampling stratification by child's age group and for data clustering. According to mothers' reports, 60% (95%CI 55, 65%) of children received the minimum meal frequency, but only 18% (95%CI 15, 22%) and 13% (95%CI 10, 16%) benefited from the minimum dietary diversity and the minimum acceptable diet respectively. Only 16% (95%CI 13, 20%) of mothers reported increasing breastfeeding or liquids and continued feeding during an episode of child illness. Knowledge of timely introduction of complementary foods and recommended feeding practices during an illness were low. Despite positive attitudes towards the introduction of key food groups, mother's perceived self-efficacy to provide children with these food groups every day was relatively low. Our findings highlight the need for interventions to improve mothers' knowledge and practices in relation to IYCF in the Boucle du Mouhoun region. Behaviour change communication strategies have the potential to improve IYCF indicators but should be tailored to the local context. The high attendance of health facilities for preventive well-baby consultations represents an opportunity for contact with caretakers that should be exploited for promotion and child growth monitoring.

Information Diffusion and Social Norms Are Associated with Infant and Young Child Feeding Practices in Bangladesh

BackgroundInteraction within mothers’ social networks can theoretically diffuse messages from interventions and campaigns into norms and practices for infant and young child feeding (IYCF).ObjectivesWe hypothesized that mothers’ social networks, diffusion of information, and social norms differed in intensive [intensive interpersonal counseling (IPC), community mobilization (CM), and mass media (MM)] compared with nonintensive (standard IPC and less-intensive CM and MM) intervention areas, were associated with IYCF practices, and partly explained practice improvement.MethodsWe conducted household surveys at endline in 2014 and follow-up in 2016 (n = ∼2000 each round). We used multiple regression to test differences and changes in networks, diffusion, and norms within intervention areas. We analyzed paths from intervention exposure to IYCF practices through networks, diffusion, and norms.ResultsMothers’ networks were larger in intensive than in nonintensive areas in 2014 and increased in both areas over time [25–38 percentage points (pp)]. The prevalence of receipt of IYCF information was high, with no changes over time in intensive areas but an increase in nonintensive areas (8–16 pp). In both areas, more family members and health workers provided IYCF information over time. Sharing of information increased 17–23 pp in intensive and 11–41 pp in nonintensive areas over time. Perceived descriptive norms improved 8–16 pp in intensive and 17–28 pp in nonintensive areas. Perceived injunctive norms were high in both areas. Breastfeeding practices were associated with networks, diffusion, and norms (OR: 1.6–4.4 times larger comparing highest with lowest quartile). Minimum dietary diversity was associated with larger networks and diffusion (OR: 1.5–2.2) but not with social norms. Indirect paths from intervention exposure to practices explained 34–78% of total effects.ConclusionsDiffusion of IYCF information through social networks, reinforced by positive social norms for messages promoted over time, will contribute to positive changes in IYCF practices that may be achieved and sustained through large-scale social and behavior change interventions. This trial was registered at clinicaltrials.gov as NCT0274084.

Women's bargaining power and child feeding in Nepal: Linkages through nutrition information.

Women's intra‐household bargaining power is an important determinant of child nutritional status, but there is limited evidence on how it relates to infant and young child feeding (IYCF) practices. We conducted a cross‐sectional analysis using 2012 baseline data from the impact evaluation of Suaahara, a multisectoral programme in Nepal, focusing on households with children 0–23 months (n = 1787). We examined if women's bargaining power was related to exposure to IYCF information and if exposure to IYCF information was in turn associated with improved IYCF practices: early initiation of breastfeeding, exclusive breastfeeding, minimum meal frequency and dietary diversity. Bargaining power consisted of four domains: (i) ownership and control of assets; (ii) social participation; (iii) workload; and (iv) household decision‐making control and were primarily measured using additive scales. We used generalized structural equation modelling to examine if exposure to IYCF information mediated the relationship between the bargaining domains and the four IYCF practices, separately. Social participation was positively associated with exposure to IYCF information (β = 0.266, P < .001), which in turn was related to early initiation (β = 0.241, P = .001). We obtained similar results for the relationship between social participation and dietary diversity. Decision‐making control was directly associated with exclusive breastfeeding (β = 0.350, P = .036). No domains were associated with minimum meal frequency. Different domains of women's bargaining power may relate to exposure to nutrition information and IYCF behaviours. Understanding specific domains of bargaining power is critical to developing interventions that can effectively address gender‐related issues that underlie child nutrition outcomes.

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.

Australian early childhood educators and infant feeding: a qualitative analysis using social cognitive theory

ABSTRACT Early Childhood Education and Care (ECEC) services are vital in the establishment of optimal infant and young child feeding (IYCF) practices and long-term health. This qualitative study, informed by Social Cognitive Theory, aimed to describe ECEC infant feeding environments. Nineteen formal long day care and family day care ECEC services and 124 educators in metropolitan and regional Queensland, Australia participated in interviews and professional conversations. Inductive and deductive analysis identified three key themes: ‘agency’, ‘IYCF environment’, and ‘monitoring/surveillance’. This research has identified the key environmental, behavioural and cognitive factors that contribute to optimal IYCF practices in Australian ECEC. Tensions and negotiation between educators, parents, infants and the regulatory framework operate to develop collective agency. Key recommendations are: increasing the visibility of infants in ECEC policy frameworks and building educator and parent self-efficacy in supporting infant agency in order to meet shared goals related to optimal infant health and well-being.

Infant and young child feeding practice, dietary diversity, associated predictors, and child health outcomes in Bangladesh.

The aim of this study was to explore the association of Infant and Young Child Feeding (IYCF) practices with health and nutritional status among children aged 0-23 months and to investigate the predictors of minimum acceptable diets (MADs) using Bangladesh Demographic and Health Survey (BDHS) data. Binary logistic regression models were performed to assess the association between IYCF and child health and to determine the influential predictors for MAD. About 55% mothers reported exclusive breastfeeding; 65% introduced solid, semisolid, or soft foods for their child; and 27% maintained minimum dietary diversity (MDD). About 64% children received recommended minimum meal frequency (MMF) and 23% received recommended MAD. The likelihood of having wasting was .22 times lower for the child who received MDD and MMF, respectively. MDD and MAD were associated with lower probability of experiencing underweight among children (Adjusted odds ratio [AOR] = .73 and AOR= .81, respectively). Early initiation and continuation of breastfeeding were significantly associated with reduction in diarrhea prevalence among young children. The findings of the study generated imperative evidence related to dietary diversity, associated factors, and child health outcomes. Policy should focus on the improvement of IYCF practices and complimentary food diversity by taking initiatives for designing and implementing effective interventions to tackle childhood morbidity.

The effectiveness education of counseling of infant and young child feeding as intensive to improve counseling performance of Posyandu cadres in Bogor, Indonesia

Background: Cadres have an essential role in providing counseling in integrated health service post (Posyandu). Poor capacity cadres may affect information delivery to the mothers/caregivers of under-five children. This study aimed is to assess the effect education of counseling of infant and young child feeding (IYCF) as intensive on the performance of the cadres in providing IYCF counseling.Methods: The study was a quasi-experimental with a pre-post test controlled group. The subjects were 55 Posyandu cadres in Ciomas sub-district Bogor. The intervention was training for cadres using education of counseling of IYCF as intensive carried out in the classroom and the field. Data on knowledge, attitude, motivation and counseling performance of cadres before and after the training were collected using a validated structured questionnaire. The paired and independent T-test was applied to analyze the difference before and after the intervention, and analysis of covariance (ANCOVA) was applied to analyze the factors that influence cadre counseling performance.Results: Mean score of knowledge (p=0.00), attitude (p=0.00), motivation (p=0.04), and counseling performance (p=0.00) of cadres in intervention group significantly increased. There is an increase in the score of performance counseling indicators for cadre in the quantity and quality after the education of counseling of IYCF as intensive. All of the indicators of the counseling performance of cadres influenced by educational models, knowledge, attitudes and attended training (p&lt;0.05).Conclusions: Training of cadres using the education of counseling of IYCF as intensive effectively improved the knowledge, attitude, motivation and counseling performance of IYCF practice with indicators of quantity, quality, concern, and character. The capacity building of the cadres should improve continuously through the development of various methods which are more specific and applicable.

Comparative Study of Growth Monitoring & Promotion of Children with Special Care (IYCF Counseling) and without Special Care

This comparative study was conducted to see the challenges and impact of counselling of Infant and Young Child Feeding (IYCF) to the mother’s knowledge and the practices of the mother from case group and control on best IYCF interventions, mainly targeted the behavioral change of the mother and to see the effect on the nutritional status of the children under 2 years. A total of 353; 177 mother of case group for counselling and 176 of control group for non-counselling, eligible mothers having children 0-11 months were approached with the purpose of study and informed consent was obtained from the mothers. Then all 177 mothers from case group received IYCF counseling according to the need of mothers as well as on key IYCF messages. At the same time the 176 mothers from control group didn’t receive any kind of IYCF support and counselling, they received only regular health services counselling and messages on IYCF. IYCF practices have a great impact on the physical and mental development of the child. The objective of this study was the lactating mothers with the children in the age group 0-11 months were studied and delivered IYCF counseling according to their need basis as well as key IYCF messages from case group and at the same time mothers from control group would not receive any kind of message from study and they would receive only regular health program messaging. Low percentage of mothers from the case group had knowledge on early initiation of breast feeding within one hour after birth, the exclusive breast-feeding up to 6 months. Timely initiation of complementary feeding after 6 months (61,0%, 58.7%, 61.6% & 55.4% respectively) before IYCF counselling to mothers. After IYCF counselling to the mothers of case group, they motivated and learnt to early initiation of breast feeding within one hour after birth, the exclusive breast-feeding up to 6 months. Timely initiation of complementary feeding after 6 months (79.1%, 75.7%, 75.2% & 65.5% respectively). For control group the results were 61.9%, 65.3%, 65.9% & 63.6% respectively before study and 66.5%, 67.7%, 66.8% & 64.1% after the study. The study result showed that the impact of IYCF counselling and messaging on the mother knowledge was great and it changed the knowledge level of the mother in dramatic way. The percentage of mothers from the case group & the control group those had children over 6 months practiced the exclusive breast-feeding were (60.2% & 73.5%) before study. After IYCF counselling to the mothers of case group, they motivated and changed their attitude to ensure the exclusive breast feeding for their children (73.5% and 73.9% from case and control group respectively). Before the study Minimum Dietary Diversity (MDD) was observed in only 30.3% & 36.6% respectively from case and control group for the children between 6- and 11months age group and after IYCF counselling mothers from the case group improved their practice for MDD for their children aged 6-23 months and increased to 39.0% in case group and in control group improved to 37.3%. Minimum Meal Frequency (MMF) was observed in the majority (63.6%) of children aged 6–23 months before the study and after IYCF intervention it increased to 74.6% in case group. But in Control group it changed from 72.6% to 73.1%. The indirect effect of IYCF counselling on the nutritional status of the children who are benefited from the improved mother knowledge and practices to good practices. Before the controlled comparative study, the GAM rate of the children was 21.1% & 20.3% respectively for case & control group of wasting (WHZ) and after study it was 20.1% & 20.3% respectively for case & control group. The same happened for underweight (WAZ) & stunting (HAZ). They also changed from 36.9% to 35.4% and 45.4% to 43.8% for underweight & stunting respectively. The IYCF practices are strongly influenced by what people know, think and believe and also affected by social circumstances and economic factors. Effective communication for behavioral change is necessary for ensuring optimal infant and young child feeding. Awareness regarding IYCF practices and their benefits in Maternal and Child Health (MCH) is poor leading to poor compliance. It is important to educate mothers during the antenatal visits. This study showed same impact as stated above.

Determinants of infant nutrition status in rural farming households before and after harvest.

Infant and young child feeding (IYCF) practices determine infant growth, development and health. Despite global recommendations for exclusive breastfeeding until 6months, adherence rates are low worldwide for different reasons, largely dependent on environment. In low-income countries, inappropriate IYCF leads to poor nutrition status. This study examined IYCF practices and nutrition outcomes in rural farming households in Tanzania before and after harvest. Mothers and their infants were recruited from two regions in Tanzania. Demographics, health status, IYCF practices, anthropometrics and haemoglobin were measured; preharvest and postharvest. Regression analysis modelled the relationship between IYCF and nutrition outcomes. Despite high rates of breastfeeding a large proportion did not meet early initiation of breastfeeding and minimum acceptable diet standards. Undernutrition was high with 30-40% of infants classified as stunted depending on season, and the majority (81%) were anaemic. Early initiation of breastfeeding was associated with higher Length-for-age z-score and weight-for-age z-score and lower risk of stunting and underweight (p<0.05). The introduction of fluids other than breast milk in the first 3days after birth was associated with lower weight-for-age z-score and increased underweight (p<0.05). Maternal age and height were strongly and positively associated with child anthropometrics. Findings confirm the importance of early infant feeding practices for growth and development and emphasize the significance of mother's nutrition status in relation to infant health. Future interventions should focus on improving maternal nutrition status before, during and after pregnancy as well as educating and supporting mothers to adopt appropriate infant feeding including breastfeeding practices for the prevention of undernutrition.

Evaluation of a social network intervention on child feeding practices and caregiver knowledge.

Food insecurity and poor infant and young child feeding (IYCF) practices contribute to undernutrition. The Kanyakla Nutrition Program was developed in rural Kenya to provide knowledge alongside social support for recommended IYCF practices. Utilizing a social network approach, the Kanyakla Nutrition Program trained community health workers (CHWs) to engage mothers, fathers, and grandparents in nutrition education and discussions about strategies to provide instrumental, emotional, and information support within their community. The 12-week programme included six sessions and was implemented on Mfangano Island, Kenya, in 2014-2015. We analysed intervention effects on (a) nutrition knowledge among community members or CHWs and (2) IYCF practices among children 1-3years. Nutrition knowledge was assessed using a postintervention comparison among intervention (community, n=43; CHW, n=22) and comparison groups (community, n=149; CHW, n=64). We used a quasi-experimental design and difference-in-difference to assess IYCF indicators using dietary recall data from an ongoing cohort study among intervention participants (n=48) with individuals living on Mfangano Island where the intervention was not implemented (n=178) before the intervention, within 1month postintervention, and 6months postintervention. Findings showed no effect of the intervention on IYCF indicators (e.g., dietary diversity and meal frequency), and less than 15% of children met minimum acceptable diet criteria at any time point. However, knowledge and confidence among community members and CHWs were significantly higher 2years postintervention. Thus, a social network approach had an enduring effect on nutrition knowledge, but no effects on improved IYCF practices.

Determinants of Stunting Children (0-59 Months) in Some Countries in Southeast Asia

Stunting is one of the main nutritional problems caused by malnutrition in children under 5 years old. Risk factors of stunting influenced by socio-economic, Infant and Young Child Feeding (IYCF), child illnesses, Water Sanitaon and Hygiene (WASH). These factors vary considerably accros the nation in southeast asia. The aim of this study was to determine the factors affecting in stunting of children (0-59 months) in Southeast Asia. It is needed to identified the right intervention. This systematic review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Articles were searched by using pubMed database. The literature search outline in the methods indentified 14.790 arcles discuss stunting. We identified 60 articles potentially met all criteria using PubMed advanced search strategy. A total of 60 articles were retrieved from one database (PubMed), 11 articles met the inclusion criteria for stunting in Southeast Asia countries. In our review socio-economic status was reported as one of consistent factors associated with stunting in Cambodia, Myanmar, Indonesia, Laos, Thailand, and Malaysia. Low household income and lack education of mother influenced inappropriate IYCF practice, poor hygiene and sanitation, and care of child illnesses. Improving like income and maternal exposure to nutrition and health information especially for the topics of growth and development, appropriated IYCF, hygiene, sanitation, and child illnesses are required for continuous improvement in a specific strategy that involves many factors.

Infant and young child feeding learning sessions during savings groups are feasible and acceptable for HIV-positive and HIV-negative women in Malawi.

Based on formative research, HIV-positive women in Lilongwe District, Malawi receive little infant and young child feeding (IYCF) counselling postpartum and want more support for IYCF from their husbands. To address these gaps, we implemented a behaviour change communication intervention promoting IYCF in village savings and loan associations (VSLAs) that included HIV-positive and HIV-negative women. The intervention consisted of 15 IYCF learning sessions facilitated by VSLA volunteers during regular VSLA meetings and included four sessions to which husbands were invited. We assessed the feasibility and acceptability of the intervention through learning session participation logs, structured observations of learning sessions, and in-depth interviews with HIV-positive and HIV-negative VSLA members, husbands of members, and VSLA volunteers. Nine VSLA volunteers conducted learning sessions with approximately 300-400 women, about one quarter of whom were lactating, and 25-35 men. VSLA volunteers consistently communicated technical information correctly, followed the learning session steps, and used visual aids. Sessions averaged 46min, with <20% of observed sessions completed within the recommended time (20-25min). Key themes from interviews were the following: (a) learning sessions were useful; (b) including HIV-positive and HIV-negative women in the sessions was acceptable; (c) information learned during sessions encouraged families to change IYCF practices; (d) IYCF messages were shared with others in the community; and (e) male participation was low because men considered VSLAs and IYCF to be women's activities. In conclusion, integrating IYCF learning sessions into VLSAs was feasible and acceptable for mixed groups of HIV-positive and HIV-negative women. Future research should test other strategies for involving men in IYCF.

Strengthening nutrition services within integrated community case management (iCCM) of childhood illnesses in the Democratic Republic of Congo: Evidence to guide implementation

In the Democratic Republic of Congo, 43% of children under 5 years of age suffer from stunting, and the majority (60%) of children, 6–59 months of age, are anaemic. Malaria, acute respiratory infections, and diarrheal diseases are common among children less than 5 years of age, with 31% of children 6–59 months affected by malaria. This qualitative implementation science study aimed to identify gaps and opportunities available to strengthen service delivery of nutrition within integrated community case management (iCCM) at the health facility and community level in Tshopo Province, Democratic Republic of Congo, through the following objectives: (a) examine cultural beliefs and perceptions of infant and young child feeding (IYCF) and child illness, (b) explore the perspectives and knowledge of facility‐based and community‐based health providers on nutrition and iCCM, and (c) gain an understanding of the influence of key family and community members on IYCF and care‐seeking practices. This study involved in‐depth interviews with mothers of children under 5 years of age (n = 48), grandmothers (n = 20), fathers (n = 21), facility‐based providers (n = 18), and traditional healers (n = 20) and eight focus group discussions with community health workers. Study findings reveal most mothers reported diminished quantity and quality of breastmilk linked to child/maternal illness, inadequate maternal diet, and feedings spaced too far apart. Mothers' return to work in the field led to early introduction of foods prior to 6 months of age, impeding exclusive breastfeeding. Moreover, children's diets are largely limited in frequency and diversity with small quantities of foods fed. Most families seek modern and traditional medicine to remedy child illness, dependent on type of disease, its severity, and cost. Traditional healers are the preferred source of information for families on certain child illnesses and breastmilk insufficiency. Community health workers often refer and accompany families to the health centre, yet are underutilized for nutrition counselling, which is infrequently given. Programme recommendations are to strengthen health provider capacity to counsel on IYCF and iCCM while equipping health workers with updated social and behavior change communication (SBCC) materials and continued supportive supervision. In addition, targeting key influencers to encourage optimal IYCF practices is needed through community and mother support groups. Finally, exploring innovative ways to work with traditional healers, to facilitate referrals for sick/malnourished children and provide simple nutrition advice for certain practices (i.e., breastfeeding), would aid in strengthening nutrition within iCCM.

Infant and Young Child-Feeding Practices in Two Local Government Areas in Southwest, Nigeria

Inadequate feeding of 0-2 years children have long been observed in our society and it is one of the global problems causing malnutrition worldwide. The study was cross sectional in design. It was conducted among consenting mothers and caregivers with 504 children 0-24 months in two local government areas (LGA) in Ekiti State, Southwest Nigeria. Respondents were selected using simple random sampling technique. Data was collected on assessment of Infant and young child feeding practice using semi-structured, interviewer administered questionnaires to obtain information on demographic characteristics, breastfeeding practices and complementary feeding practices. Data was analyzed using descriptive statistics. Analysis of categorical data between the two groups was performed with Chi-square of Fisher’s exact test. The p-values <0.05 was considered statistically significant. Statistical package for social sciences (SPSS) version 20 was used for the analysis. All the 504 children 0-24 months assessed were breastfed, 216 (42.9%) initiated breastfeeding within one hour after birth, 138 (27.4%); 78 (28.3%) in Ijero and 60 (26.3%) in Ikole LGAs infants were exclusively breastfed and only 154 (30.6%) were breastfed exclusively for a duration of 5-6 months. Of the 347 children 6-24 months, 124 (35.7%); 79 (40.7%) in Ijero and 45 (29.4%) in Ikole LGAs were fed on appropriate complementary food and 241 (69.5%) initiated complementary feeding at the age of 6 months. Infant and young child feeding (IYCF) practice was poor in this study. Therefore, it is important to strengthen the promotion on IYCF practice during child welfare clinics and via mass media.

Increasing HIV-Free Survival of Infants: Reorganizing Care Using Quality Improvement for the Optimal Health and Nutrition of HIV-Positive Women and Their Exposed Infants in Uganda.

Reorganizing service delivery to integrate nutrition and infant and young child feeding (IYCF) with prevention of mother-to-child transmission (PMTCT) is important for improving outcomes of HIV-positive mothers and HIV-exposed infants (HEIs). Quality improvement (QI) strategies were implemented at 22 health facilities. The percentage of HIV-positive pregnant women and lactating mothers who received IYCF counseling at each visit improved (45%-100%; mean = 93.1%, standard deviation [SD] = 15.5). Adherence to IYCF practices improved (70%-96%; mean = 92.4%, SD = 8.5). Mother–baby pairs receiving the standard care package improved (0%-100%; mean = 98.6%, SD = 22.6). The HEIs alive at 18 months and infected decreased (mean = 6.2%, SD = 4.8). Statistical significance of change was estimated using Fisher exact test and magnitude of change over time by calculating the odds ratio. For all indicators, improvement was rapid and significant (P < .001), especially in the first 6 months of QI implementation. Using QI to integrate nutrition and ensure consistent and comprehensive PMTCT service delivery improved IYCF adherence and decreased transmission.

ANALISIS HASIL JANGKA PENDEK PELAKSANAAN KONSELING PEMBERIAN MAKAN BAYI DAN ANAK MENGGUNAKAN PEMODELAN RASCH

The first thousand days of life is a golden period that determines the quality of life in the future . Practice of Infant and Young Child Feeding ( IYCF ) that are not appropriate during this period can cause stunt ing. One of the government’s efforts to improve IYCF practice is IYCF Counseling . IYCF counseling can improve knowledge, attitude, and encourage the occurance of IYCF behavior. This study aims to analyze the short results of IYCF counseling on the knowledge and attitude of Mothers who have and have not been given IYCF counseling in Cireunghas District , Sukabumi. The instrument was used a modified knowledge and attitude questionnaire about IYCF . Rasch modeling was used for analysis of questionnaire data, the design of this study was a survey method with a cross sectional approach in April 2018 with m aternal subjects having children aged 6-23 months totaling 90 people. The items on the instrument are found to have varying discriminat ion , which indicat es that the instrument has the ability to measure. The results show that the counseling material that needs to be emphasized during IYCF counseling is about giving breastfeeding using bottles , giving u p to 2 years of breastfeeding , the texture of food at the beginning of complementary feeding, and responsive feeding. There n eed s to be increase in the quality and frequency of IYCF counseling to achieve the expected change s of knowledge and attitude.