Optimal Infant Feeding Practices Research Articles

Barriers to exclusive breastfeeding practice among HIV-positive mothers in Tanzania. An exploratory qualitative study.

Ensuring optimal nutrition through early breastfeeding is vital for infant mental development and overall health. HIV infections complicate decisions regarding exclusive breastfeeding, jeopardizing effective infant and young child feeding, which affects nutrition and health outcomes. Recognizing the lack of evidence on barriers to infant feeding in the context of HIV in Tanzania, this study was conducted to explore individual, household, and community obstacles in the Ilala district, Dar es Salaam. A case study design employing a qualitative approach was used. The study was executed at the Reproductive and Child Health (RCH) Clinic within Amana Regional Referral Hospital, Mnazi Mmoja Health Centre, and Buguruni Health Centre. Data collection ensued through the purposive sampling of healthcare providers and HIV-positive mothers, utilizing in-depth interview techniques. The textual data accrued were analyzed using inductive and deductive content analysis strategies, thereby enabling the delineation and formulation of principal thematic constructs. The study involved interviews with twenty-seven key informants, encompassing HIV-positive mothers, nurses, clinicians, and community-based healthcare workers. The analysis of these interviews resulted in the identification of three major themes. Firstly, individual barriers to exclusive breastfeeding were delineated, encompassing sub-themes such as occupation-related hectic schedules, early motherhood-related non-compliance to safe infant feeding directives, postpartum depression, and issues related to breast sores and abscesses. Secondly, household-level barriers were identified, highlighting challenges like food insecurity and inaccessibility to key resources, the influence of male partners and family members on decision-making, and barriers arising from non-disclosure of HIV status affecting Exclusive Breastfeeding (EBF) support. Lastly, community-level barriers were explored, revealing a sub-theme related to the low retentivity of HIV-positive women in the Prevention of Mother-to-Child Transmission (PMTCT) programs. Individual barriers encompass practical, psychological, and physical challenges, while household-level obstacles include food insecurity, limited resources, and family dynamics influencing decisions. At the community level, there's a concern about the low retentivity of HIV-positive women in PMTCT programs, indicating broader societal challenges in supporting exclusive breastfeeding. There is a need for tailored interventions at individual, household, and community levels to promote and support optimal infant feeding practices among HIV-positive women.

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.

The relationships between optimal infant feeding practices and child development and attained height at age 2 years and 6-7 years.

Limited evidence exists on the long-term effects of early feeding practices on child growth and development. We examined the relationships between infant feeding practices and child height and development at ages 2 and 6-7 years. We studied 885 mother-child dyads from a randomized controlled trial of preconception supplementation in Vietnam. Early initiation of breastfeeding (EIBF), exclusive breastfeeding (EBF), breastfeeding (BF) duration and minimum dietary diversity (MDD) were assessed using World Health Organization(WHO) guidelines. Child development was assessed by the Bayley Scales of Infant Development-III at 2 years and the Wechsler Intelligence Scale for Children®-IV at 6-7years. Child height-for-age z-score (HAZ) was calculated from child height and age. Multivariable regression and structural equation models were used in analyses that controlled for confounding. EIBF and EBF at 6monthsoccurred in 52% and 62% of children, respectively. Mean breastfeeding duration was 18 monthsand 83% achieved MDD at 1year. EIBF was associated with motor (β = 0.13, 95% confidence interval [CI]: 0.00, 0.28) and cognitive development at 2years(β = 0.12, 95%CI: -0.01, 0.26), which in turn were positively associated with cognitive development at 6-7years. EBF was directly associated with development at 6-7years (β = 0.21, 95% CI:0.08, 0.34) whereas motor and cognitive development at 2years explained 41%-75% of the relationship between EIBF and development at 6-7years. HAZ at 2years also mediated 70% of the association between MDD at 1year and HAZ at 6-7years. BF duration was not associated with child development and HAZ. Early infant feeding practices, especially EIBF and EBF, have important long-term implications for optimizing child linear growth and cognition as they begin school.

Time to death and its predictors among Ethiopian under-five children: cluster-level shared frailty survival analysis using the 2019 Ethiopian mini demographic health survey

Introduction: Reducing under-five mortality to less than 25 per 1000 live births by 2030 is one of the Sustainable Development Goals introduced in 2016. However, several countries are still falling short of their targets. In Ethiopia, one out of every 19 children dies before reaching the age of five. Thus, this study aims to identify the time to death and its predictors among under-five children in Ethiopia. Methods: The data were retrieved from the 2019 Ethiopian Mini Demographic and Health Survey data set. Descriptive statistics and survival curves were applied. Shared frailty survival analysis was employed to determine the predictors of under-five mortality. Statistical significance was declared at p-value <0.05. Result: The under-five mortality rate was found to be 59 deaths per 1000 live births with an estimated mean survival time of 57.6 months (95%CI: 57.38, 57.85). A child born into a family of seven or more had an 85% lowered risk of dying (AHR = 0.15, 95% CI: 0.05, 0.44). The risk of mortality among children born in the birth order of five or above was 3 times higher (AHR = 3.00, 95%CI: 1.70, 5.21) compared to those born in the birth order of one to four. The estimated risk of death among under-five children born less than 24 months interval was 2.68 times higher (AHR=2.68, 95%CI: 1.71, 4.21). Never breastfed was also a significant predictor of under-five child death (AHR = 2.76, 95%CI: 1.46, 5.23). Conclusion: Birth order, family size, preceding birth interval, and never breastfed history were significant predictors of under-five child mortality. Health policies should focus on keeping the spirit of a continuum of care to improve the health of the child and the health of the family as a whole. Health care providers should intervene in the community to maximize optimal infant and young child feeding practices.

Level of completion of a continuum of age-appropriate infant feeding practices and barriers among breastfeeding mothers in Ethiopia: a mixed methods study

BackgroundEthiopia has committed to ending undernutrition by implementing nutrition intervention strategies, including promoting optimal feeding and care practices. To monitor and evaluate optimal infant feeding practices, it is crucial to have reliable and quality data on infant feeding indicators. Therefore, this study aimed to evaluate the extent to which breastfeeding mothers in Ethiopia have completed the continuum of age-appropriate infant feeding practices and the barriers they face.MethodsIn this study, a sequential explanatory mixed method design was used. First, using datasets from performance monitoring for action (PMA) in Ethiopia, we estimated the level of the outcome and associated factors. In the quantitative (QUAN) analysis, 1755 mothers of infants were included to generate estimates. A generalized estimating equations logistic regression model was used to identify factors associated with the outcome by accounting for the clustering nature of the data by enumeration area. Then, a qualitative (QUAL) study was conducted with 14 mothers to explore their infant feeding practices using an in-depth interview guide and analyzed using a thematic approach. Results from both quantitative and qualitative data were integrated, described under the identified thematic areas, and interpreted concurrently.ResultsThis study showed that 13.96% (95% CI: 12.4 to 15.6%) of mothers practiced a complete continuum of age-appropriate infant feeding. Over 8% of mothers did not practice any optimal feeding. Nearly 47% of mothers practiced optimal breastfeeding, and one-fifth of mothers practiced optimal complementary feeding. Results from both quantitative and qualitative data showed that mothers’ complete continuum of age-appropriate infant feeding practice was affected by their level of income, knowledge, and attitude towards optimal infant feeding, as well as by important others, including husbands, grandmothers, and health workers.ConclusionThe level of a complete continuum of age-appropriate infant feeding practice is low among breastfeeding mothers in Ethiopia. Mothers’ optimal feeding practices in Ethiopia are affected by their level of knowledge and attitude towards infant feeding, income or access to food, and health workers or family members. Therefore, collaborative efforts are needed to strengthen mothers’ education on the health benefits of optimal infant feeding and design and promote strategies to improve household income or access to diverse food.

A study on relationship between protein-energy malnutrition and other morbidities among under-five children in a rural area of Hooghly district, West Bengal

Background: Malnutrition affects physical growth, morbidity, and mortality of the under-five children. It is an underlying factor in many diseases for children and is particularly prevalent in developing countries, where it affects one out of every three preschool-age children. Aims and Objectives: The aims of this study were to find out the relationship between protein-energy malnutrition and other morbidities among under-five children. Materials and Methods: Community-based prospective longitudinal study was conducted in 1 year duration in a rural area of Hooghly District, West Bengal. By adopting sample size calculation formula 4 pq/L2, total 108 children were participated in the study. With the help of pre-design, pre-tested schedule data were collected by interviewing the care giver, by clinical and anthropometry examination of the children and by record review. Results: Among the study population under-weight, stunted, and wasted were 52%, 37%, and 28%, respectively, whereas malnutrition by all types of classification was 61%. Episode of diarrhea, acute respiratory infections (ARI), and worm infestation were 3.50, 4.12, and 1.38/child/year, respectively. Study shows that rate of total morbidities and prevalence of malnutrition was very much interrelated. Conclusion: Prevalence of malnutrition along with diarrhea, ARI, and worm infestations is common ailments among rural population. Special emphasis should be given for provision of health-care services and promotion and protection of optimal infant feeding practices for the improvement of nutritional as well as health status of the children.

Association of Stunting with Socio-Demographic Factors and Feeding Practices among Children under Two Years in Informal Settlements in Gauteng, South Africa.

Despite improvements in childhood undernutrition through integrated nutritional programs in South Africa, stunting among children remains persistent, and is attributed to poor socio-demographic status. This context has been implicated in disrupting mothers' decisions regarding effective infant feeding, ultimately meaning that children's nutritional demands remain unmet. In view of this, we conducted a cross-sectional study to determine the association between socio-demographic factors and infant and young child feeding (IYCF) practices and stunting among children under two years receiving primary health care in informal settlements in Gauteng, South Africa. A validated questionnaire was used to assess mothers' socio-demographic status and feeding practices using WHO core indicators. Stunting was defined as length-for age z-scores (LAZ) below -2 standard deviation, computed using WHO Anthro software version 3.2.2.1 using age, sex, and anthropometric measurements of children. Univariate and multivariate analyses were stratified by stunting to determine the relationship with socio-demographic, infant, and IYCF factors using STATA 17. The prevalence of stunting was 16% among surveyed children under two years (with a mean age of 8 ± 5 months) living in poor socio-demographic households. Poor feeding practices were characterized by delayed initiation of breastfeeding (58%), sub-optimal exclusive breastfeeding (29%), discontinued breastfeeding (44%), early introduction of solid foods (41%), and low dietary diversity (97%). Significant differences in terms of child's age, monthly household income, and ever being breastfed were observed (Chi square test and univariate analysis). After controlling for potential confounders, stunting was significantly associated with child's age [12-23 months: AOR = 0.35, 95% CI: 0.16-0.76], and monthly household income [ZAR 3000-ZAR 5000: AOR = 0.47, 95% CI: 0.26-0.86]. Despite the few aforementioned socio-demographic and IYCF factors associated with stunting, this study reiterates stunting as the commonest poor nutritional status indicator among children under two years, suggesting the presence of chronic undernutrition in these poverty-stricken informal settlements. A multisectoral approach to address stunting should be context-specific and incorporate tailor-made interventions to promote optimal infant-feeding practices. Conducting future nutrient assessments focusing on children is imperative.

Determinants Of Under-Nutrition Among Under Five Children in The Urban Slum of Ahmedabad, India

Background: Optimal infant and young child feeding practices (IYCF) are effective public health intervention to enhance child survival, nutrition and development. There is also documented evidence regarding the protective effect of optimal IYCF practices against diarrhoea and ARTI. The objective is to assess knowledge and practices regarding IYCF among study participants & to explore the association of feeding practices of mothers with the morbidities (infections) in their children. Methodology: The present study was a hospital based cross-sectional study, carried out during September 2019 to March 2021. A total of 380 mothers of children less than two years attending OPD of Institute of child health, Nirmal hospital private limited, a tertiary care multi-specialty hospital was interviewed using pre-designed and pretested questionnaire. Results: Feeding practices during early days of life to be reasonably good among study participants with almost 2/3rd of the study participants practicing them. Mean number of morbidity episodes requiring consultation were significantly lower in the children whose mothers practiced optimal IYCF practices. Conclusion: Poor feeding practices in children had significant association with morbidity episodes of diarrhoea and ARTI in children.

Infant And Young Child Feeding Practices and Infections Pattern in Children Up To 24 Months Age Attending Outdoor Patient Department of a Tertiary Care Hospital of South Gujarat

Background: Optimal infant and young child feeding practices (IYCF) are effective public health intervention to enhance child survival, nutrition and development. There is also documented evidence regarding the protective effect of optimal IYCF practices against diarrhea and ARTI. Objectives: 1) To assess knowledge and practices regarding IYCF among study participants. 2) To explore the association of feeding practices of mothers with the morbidities (infections) in their children. Methodology: The present study was a hospital based cross-sectional study, carried out during September 2019 to March 2021. A total of 380 mothers of children less than two years attending OPD of Institute of child health, Nirmal hospital private limited, a tertiary care multi-specialty hospital were interviewed using pre-designed and pretested questionnaire. Results: Feeding practices during early days of life to be reasonably good among study participants with almost 2/3rd of the study participants practicing them. Mean number of morbidity episodes requiring consultation were significantly lower in the children whose mothers practiced optimal IYCF practices. Conclusion: Satisfactory knowledge and practices were observed among study participants regarding various infant and young child feeding practices. Poor feeding practices in children had significant association with morbidity episodes of diarrhea and ARTI in children.

Assessment of infant and young child feeding practices among mothers of Paniya tribal children aged 0-23 months in Gudalur Block, Nilgiris District.

Optimal infant and young child feeding practices (IYCFPs), despite being emphasized since 2003, are yet to be met in India. This study assessed these practices and their association with various factors among mothers of children aged 0-23 months in Paniya tribes in Nilgiris, Tamil Nadu. About 89.1% of the infants below six months were timely breastfed and 77.9% of them were exclusively breastfed, respectively. Complementary food was introduced to 25% of infants aged six to eight months. About 27.8% of them received a diverse diet. About 91.7% of them were fed egg and/or flesh food and 37% of them were fed vegetables and fruits. Illiterate mothers and mothers who had a vaginal delivery fed the infant optimally. The adherence to these practices was found to decrease gradually with an increase in the infant's age. The prevalence of IYCFP is higher in the study population compared to the corresponding indicators for the district according to the National Family Health Survey-5.

Engaging Fathers Through Nutrition Behavior Communication Change Does Not Increase Child Dietary Diversity in a Cluster Randomized Control Trial in Rural Ethiopia

BackgroundAdding food vouchers or paternal nutrition behavior change communication (BCC) activities to maternal BCC may improve child diets and household food security but their effect is unknown. ObjectivesWe assessed whether maternal BCC, maternal and paternal BCC, maternal BCC and a food voucher, or maternal and paternal BCC and a food voucher improved nutrition knowledge, child diet diversity scores (CDDS), and household food security. MethodsWe implemented a cluster randomized control trial in 92 Ethiopian villages. Treatments were as follows: maternal (M) BCC only; maternal BCC and paternal BCC (M+P); maternal BCC and food vouchers (M+V); and maternal BCC, food vouchers, and paternal BCC (M+V+P). Effects were assessed using generalized estimating equations. ResultsMaternal BCC and paternal BCC increased the maternal and paternal knowledge of optimal infant and young child feeding practices by 4.2–6.8 percentage points (P < 0.05) and by 8.3–8.4 percentage points (P < 0.01), respectively. Combining maternal BCC with either paternal BCC or the food voucher increased CDDS by 21.0%–23.1% (P < 0.05). The treatments M, M+V, and M+P increased the proportion of children who met minimum acceptable diet standards by 14.5, 12.8, and 20.1 percentage points, respectively (P < 0.01). Adding paternal BCC to the maternal BCC treatment or to the maternal BCC and voucher treatment did not lead to a larger increase in CDDS. ConclusionsIncreased paternal involvement does not necessarily translate into improvements in child feeding outcomes. Understanding the intrahousehold decision-making dynamics that underlie this is an important area for future research.This study was registered at clinicaltrials.gov as NCT 03229629.

A cross sectional study on infant and young child feeding practices: a keep for successful nutrition in under-five children attending rural Anganwadi centres, Mysuru

Background: Optimal infant and young child feeding practices (IYCF) are crucial for nutritional status, growth, development, health, and ultimately the survival of children. Even with several national schemes and programs in place, India’s progress in tackling the problem of child malnutrition is slow. This study aims to estimate the prevalence of undernutrition and infant and young child feeding factors determining undernutrition among under five children in rural Mysuru.Methods: A cross sectional study was conducted among under five children who are registered in Anganwadi centres in the rural field practice area of JSS Medical College. 261 children were chosen as per population proportionate to the size sampling technique.Results: The mean age of the children was 2.8±1.2 years and 86.6% belonged to Below Poverty Line households.70.1% received breastfeeding within an hour of birth. Exclusive breastfeeding for 6 months was provided for 67.4% of the children. The prevalence of underweight, stunting, and wasting was 13.8%, 16.5%, and 5.7% respectively. The undernutrition among children was associated with the type of economic card and birth weight of the child.Conclusion: IYCF is a key area to improve child survival and promote healthy growth and development. The study calls for attention to be placed on improving and promoting participatory nutrition education to raise awareness, health literacy, and foster behavioural change communication for improved child feeding and caring practices. Additionally, sociocultural determinants of feeding practices should be addressed in the design of nutritional interventions.

Sociocultural Determinants of Nutritional Status Among Children Under Five Years of Age: An Ethnographic Study From Gujarat.

BackgroundThe magnitude of child malnutrition, including severe child malnutrition, is high in India, and Gujarat has a higher prevalence of child malnutrition. Prior studies have employed anthropometric measures to identify the prevalence and associated factors of children’s undernutrition. The present study explored community-level determinants of malnutrition among malnourished and well-nourished children in Devbhumi Dwarka district of Gujarat State, India.MethodsA qualitative research employing focused ethnographic methodologies was used. In-depth observations of 60 families in a home food environment were carried out. Each child was observed at their respective homes for three consecutive days. Data were analyzed using thematic analysis techniques.ResultsThe study revealed that lack of knowledge on malnutrition, inadequate feeding practices, poor socioeconomic status, insufficient hygiene and sanitation practices, lack of food variety, use of health facilities, and birth complications were the major community-based determinants of malnutrition.ConclusionThe study identified community-level determinants of malnutrition among children under five years in the Devbhumi Dwarka district. To tackle the immediate and underlying causes of malnutrition, interventions are urgently needed to create community awareness about malnutrition as a disease and optimal infant and young child feeding (IYCF) practices using behavior change communication strategies.

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.

Cohort profile: the Taicang and Wuqiang mother–child cohort study (TAWS) in China

PurposeThe Taicang and Wuqiang cohort study (TAWS) was established to examine the association between early-life nutrition and children’s health, and to explore the potential roles of maternal health, metabolites and...

Infant Feeding Practice And Associated Factors Among Breast Feeding Mothers In Udessa District, South Ethiopia

Background Malnutrition has a profound effect on a child’s growth and development, as it can lead to permanent stunting, impaired brain, predisposing the child to obesity later in life. In Africa, malnutrition contributes to half of the 9.7 million annuals under five deaths and is a leading cause of diseases and disabilities in children. Therefore, the study was to assess infant and young child feeding practice and associated with factors to identify problem and to recommend solutions for problems. Objective: To assess the practice and factors associated with infant and young child feeding among mothers of children aged 0-23 month in udassa washe weyira kebele, south Ethiopia,2020. Methodology: This community based cross-sectional study conducted on 214 participants from June 15– July 15/2020. All eligible children included in the study. Spas version 22 software used for data entry and for analysis. The association between variables was analyzed with bivariate and multi variable logistic regression. Hosmar and Lemeshow test was used for model adequacy. A statistical significance was declared at p value &lt; 0.05, with 95% confidence interval. Results: A total 214out of 217 mothers or caregivers of children less than 23 months were included in the study yielding response rate of 98.6%. Optimal infant and young child feeding practice was 10.3%.After adjusting for the possible confounders, maternal higher education [AOR= 0.40; 95%CI(.21-.72)], having ante natal care [AOR =1.46, 95% CI (1.12-3.48)], place of delivery in health facility [AOR =2.70, 95% CI (1.50-5.81)]and having post-natal care [AOR=2.79, 95%CI (1.33-8.14)]were significantly associated at P &lt; 0.05 with optimal infant and young child feeding practices. Conclusion: Education, ante natal care, place of delivery and post-natal care were found to be significant predictors for optimal infant and young child feeding practice. Scaling up educational status, antenatal care, institutional delivery and post-natal care were warranted.

Morbidity, Feeding Practices, and Immunization Status of Children 6 - 23 Months in Delhi

Optimal infant and young child feeding (IYCF) practices and immunization play a critical role in averting childhood illness and in achieving optimal growth and development among children. This was a cross-sectional study that assessed the morbidity and immunization status of children 6–23 months of age in three income groups in Delhi. The study also assessed feeding practices for children during illness. Results showed that the prevalence of diarrhea in the past 2 weeks preceding the survey was 8.6%, 18.3%, and 17.7% in urban slum, low-income group (LIG), and middle-income group (MIG), respectively. About 50% of children in LIG and MIG and about 45% in the urban slum had fever in the past 2 weeks preceding the survey. About 20% of mothers in urban slum and LIG reported that they were not washing their hands with soap before preparing food for their children. Although most of the children with diarrhea had received oral rehydration salts, they had not received zinc which is critical in the treatment of diarrhea. About 24% of mothers in the urban slum discontinued complementary feeding during illness. The immunization was complete for most of the children in all groups except for the 2nd dose of measles vaccine and booster dose of OPV and DPT vaccine whose coverage was found to be low in urban slums. There is an urgent need of counseling and support on IYCF during and after common childhood illnesses by the frontline health functionaries to reduce the high burden of undernutrition among children under 2 years.

Feasibility, acceptability, and preliminary impact of an mHealth supported breastfeeding peer counselor intervention in rural India.

To evaluate the feasibility of an mHealth-supported breastfeeding peer counselor intervention implemented in rural India and the preliminary impact of the intervention on maternal breastfeeding behaviors, including exclusive breastfeeding (EBF). In this quasi-experimental pilot study, participants received either the intervention plus usual care (n=110) or usual care alone (n=112). The intervention group received nine in-home visits during and after pregnancy from peer counselors who provided education about and support for EBF and other optimal infant feeding practices and were aided with an mHealth tool. The control group received routine prenatal and postnatal health education. Progress notes and surveys were used to assess feasibility. Logistic regression models were used for between-group comparisons of optimal infant feeding outcomes, including EBF for 6months. The intervention was delivered as intended, maintained over the study period, and had high acceptability ratings. There were statistically significant differences in all outcomes between groups. The intervention group had a significantly higher likelihood of EBF at 6months compared to the control group (adjusted odds ratio 3.57, 95% confidence interval 1.80-7.07). Integration of mHealth with community-based peer counselors to educate women about EBF is feasible and acceptable in rural India and impacts maternal breastfeeding behaviors.

Early Infant Feeding Practices Among Mothers of Southeast Nigeria

Background: The promotion of optimal infant feeding practices is the most cost-effective of all interventions to reduce infant mortality. In spite of the recommendation of the WHO for optimal breastfeeding practices, several studies in Nigeria on early infant feeding practices have indicated a need for continuous auditing of feeding practices among mothers to make improvements. Objective: This study evaluated the early infant feeding practices of mothers and associated factors. Methods: A cross-sectional, descriptive, multi-centre, questionnaire-based survey was conducted among 2,287 mother-infant pairs in 13 Baby Friendly Hospitals in Southeast Nigeria. Results: The rate of early initiation of breastfeeding [EIBF] within the first one hour of birth was 22.9%, while the exclusive breastfeeding [EBF] rate was 39.3%. The main deterrent to EBF was early introduction of water [94.0%], formula [40.9%] and complementary feeds [85.7%]. There was a statistically significant difference [p<0.001] between the nutritional status of the exclusively breastfed infants and those non-exclusively breastfed, with moderate underweight, and severe underweight malnutrition in the non-exclusively breastfed group. Sociodemographic factors associated with EBF were infant’s birth order [p<0.001], maternal age [p=0.010], mother’s and spouse’s education [p<0.001 and p<0.001], mother’s and spouse’s occupation [p<0.001 and p<0.001]. Conclusion: Policies and measures to promote hospital deliveries targeting all mothers, with special focus on the poor, rural, working, and primiparous mothers, should become a top priority to improve the rate of EIBF. Promotion of EBF with emphasis on the dangers of early introduction of water, formula and complementary feeding should be intensified.

Minimum Acceptable Diet and its Predictors among Children Aged 6-23 Months in Mareka District, Southern Ethiopia: Community Based Cross-Sectional Study

Background: Optimal infant and young child feeding practices are essential for normal growth, better health, and mental and physical development. Even though there are a lot of nutrition intervention programs in Ethiopia, still suboptimal feeding practices are prevalent. This study was devised to assess a level of minimum acceptable diet (MAD) and predictors among children aged 6-23 months in Mareka District, south Ethiopia. Method: A community-based cross-sectional study was employed on 662 study participants from August 15 to September 15/ 2015. They were selected by a multi-stage sampling technique. Data were collected by interviewer-administered semi-structured questionnaires. Statistical significance was declared at p-value &lt;0.05 at multivariable logistic regression. Result: The study showed that 35.5 % of the children aged 6-23 months met the recommended MAD. Maternal primary and secondary education (AOR: 1.90; 95% CI: 1.15-3.16 and AOR: 2.06, 95% CI: 1.12-3.77), Media exposure (AOR: 2.16; 95% CI: 1.46-3.29), health facility delivery (AOR:2.52; 95% CI: 1.54-4.13), child age of 9-11 and 12-23 months (AOR:2.73; 95% CI: 1.41-5.49 and AOR:2.55; 95% CI: 1.39-4.69) and GMP service utilization (AOR: 4.09; 95% CI: 2.51-6.65) were associated with MAD of children. Conclusion: The level of MAD among children was low. Maternal educational status, media exposure, institutional delivery, child age, and GMP service utilization were associated with MAD. Increasing utilization of GMP service, health facility delivery, maternal education, and media promotion was recommended to increase the level of MAD.