Exploring Infant and Young Child Feeding Practices in the Royal Borough of Greenwich, London, to Improve Health and Nutrition Outcomes in Children Under 2 Years of Age

Introduction: The UK, like many other countries, is struggling to achieve two of the Global Nutrition Targets, namely increasing exclusive breastfeeding and halting the rise of childhood obesity. Identifying the infant feeding interventions that are having an impact could increase the effectiveness of cash strapped public health services in London. Improving infant feeding practices could also help halt the dangerous rise in childhood obesity. Study Aim: This study explored the Infant and Young Child Feeding (IYCF) practices and support in place to improve health and nutrition outcomes of children under 2 years of age in the Royal Borough of Greenwich, London Methodology: The study applied a qualitative methodology, supplemented with data on demographic characteristics of participants, collected via standardised questionnaires prior to the qualitative data collection. Categorical data are presented as absolute (n) and relative frequency (%). Qualitative data were collected using focus group discussions, semi structured interviews and key informant interviews and analysed using a thematic approach. Participants: The total sample included 35 participants: four focus groups with fifteen mothers, nine semi structured interviews, six with mothers and three fathers--all with at least one child in the target age group--and 11 key informants. Findings: Five main themes and twenty-five subthemes emerged from the qualitative data including a high level of awareness on the importance of infant feeding practices. However, only six of the key informants were aware of the borough IYCF Policy. Key informants felt that they personally would benefit from more training and resources, while more support from health workers, family and friends was very important for the other participants. Support services offered at the Children’s Centres appeared to be the most effective, in comparison to support at hospital and at home. There was a lack of cohesion among messages given at the different points of care of breastfeeding moms. Respondents reported that the Borough was implementing some aspects of its infant feeding support programmes effectively, especially through the breastfeeding support groups. Conclusions: Continuous monitoring and evaluation of current programmes and creation of sustainable links between all points of care from antenatal to postnatal period will help the Borough in achieving improved breastfeeding rates. This should improve health and nutrition outcomes for children under 2 years of age in the borough

The Use of Dietary Supplements Among African and Caribbean Women Living in the UK: A Cross-Sectional Study

Previous studies have shown that the use of dietary supplements is associated with the prevention of birth defects, negative pregnancy outcomes and cardiovascular diseases. However, there might be some ethnic disparities in supplement usage suggesting that women who could benefit from it are not frequent users. This study aimed to characterise the use of dietary supplement among Black African and Black Caribbean women living in the United Kingdom (UK). Furthermore, it evaluated possible associations between the use of dietary supplements and health and diet awareness. A total of 262 women self-ascribed as Black African and Black Caribbean living in the UK completed a comprehensive questionnaire on socio-demographic factors, diet, use of supplements and cultural factors. The main outcome variable was the regular use of any type of dietary supplement. Use of vitamin D and/or calcium was also explored. A stepwise logistic regression analysis was applied to identify predictors of regular use of dietary supplements. A total of 33.2% of women reported regular use of any dietary supplements and 16.8% reported use of vitamin D and/or calcium. There were no significant ethnic differences in the use of dietary supplements. Reporting use of the back of food packaging label (odds ratio (OR) 2.21; 95% CI 1.07–4.55); a self-rated healthy diet (OR 2.86; 95% CI 1.19–6.91) and having cardiovascular disease (CVD), hypertension and/or high cholesterol (OR 3.81; 95% CI 1.53–9.49) increased the likelihood of using any dietary supplement. However, having poorer awareness decreased the likelihood (OR 0.94; 95% CI 0.88–0.99) of using any dietary supplement. For the use of vitamin D and/or calcium supplements, the main predictor was having CVD, hypertension and/or high cholesterol (OR 4.43; 95% CI 1.90–10.35). The prevalence of dietary supplement use was low among African and Caribbean women. Thus, awareness of potential benefits of some dietary supplements (e.g., vitamin D) among the Black population should be promoted

Attitudinal Determinants of diet and lifestyle among African and Caribbean women living in the UK : study design and rationale

The aim of this article is to describe the rationale and design of a cross-sectional study that investigated the influence of attitudinal factors on diet and lifestyle of African and Caribbean women living in the UK. The results of the study will be presented elsewhere. African and Caribbean women are at high risk of obesity which exacerbates health inequalities. In the UK, little work has been carried out to better understand attitudinal factors that contribute towards obesity, lifestyle and health practice amongst this group. Methods: The study applied a comprehensive questionnaire to capture socio-demographic data and explore general attitudes towards diet and lifestyle of African and Caribbean women. Dietary data were collected using triple-pass 24-hour recalls. In addition, all participants had anthropometric measures, blood pressure and biochemical indices assessed using standardised methods. Discussion: Potential strengths and limitations of the current study design, exploring health, diet, and lifestyle habits and the contextual influence on these practices among African and Caribbean in the UK are discussed. Findings from this study will contribute to the understanding of food and health practices, the role of socio-cultural factors and potential barriers and facilitators to the adoption of a healthy lifestyle, which could reduce the risk of cardiovascular disease, obesity, and type 2 diabetes, all of which have increased prevalence in these communities

Nutritional factors and cardiovascular disease risk in Black African and Black Caribbean women: a cross-sectional study

People of Black African (BA) and Caribbean (BC) heritage form the third largest ethnic group in England and Wales. Evidence shows they experience higher rates of overweight/obesity, stroke and type 2 diabetes compared to the general population but lower risk of heart disease, which may be explained by the favourable lipid profile they exhibit (2,3). There are limited UK studies on their dietary habits and health. The aim of the current study was to assess nutritional intake and cardiovascular disease (CVD) risk factors in UK BA and BC women. A convenience sample of self-ascribed BA and BC women, aged 19-64 years, were recruited (n = 44) from the ATTITUdinal DEterminants of diet and lifestyle (ATTITUDE) study. Cholesterol was measured using a portable CardioChek Blood Analyser, blood pressure using a digital blood pressure monitor and dietary intake via triple pass 24hr recall. Ethical approval was obtained from London Metropolitan University, King’s College London and Westminster University. Percentage energy, total fat, saturated fat, carbohydrate, and fibre and salt intake were calculated and under-reporting was assessed using the Goldberg equation. A sensitivity analysis conducted on nutrient intakes with under-reporters removed. Nutritional intake and CVD risk factors are shown in Table 1. Sixty three percent of participants were overweight or obese. Analysis of the dietary data revealed higher intakes salt, free sugars, fat and saturated fat than recommendations and lower intake of carbohydrate. Sensitivity analysis was conducted to investigate the impact of under-reporting (n = 22). Reported data remained unchanged except for fibre intake, which was lower in the under-reporters (14.9g compared to 21.0g) (P = 0.004). Blood lipid profiles and blood pressure data were within recommendations. In conclusion, the anthropometric and certain dietary measures would indicate increased risk for developing CVD in BA and BC women, however, blood lipid profile and blood pressure measures were within healthy ranges

Exploring infant & young child feeding (IYCF) practices & perceptions in the London Borough of Tower Hamlets

Introduction: The aim of the research was to gain a greater understanding of infant and young child feeding perceptions and practices in the London Borough of Tower Hamlets and the role of early years’ providers in supporting healthy feeding practices. The research was used to feed into ongoing commissioning and resource allocation priorities, taking into consideration continuing budget restrictions, to achieve nutrition outcomes through effective early years’ public health interventions. Methodology: A qualitative methodology was applied. The target groups were mothers with children under five years old, early years ‘service providers and carers. The participants were selected using purposeful, convenience and snowball sampling methods. In total 18 focus group discussions, 36 interviews and 3 direct observation sessions were carried out with 144 participants across the borough. Findings: There was generally widespread knowledge that breastfeeding is best for infants, however, there was less clarity on the best time for introducing complementary food and drinks to infants. Mothers trust health providers for information, but most used the internet, family and friends for information as it was easier to access. Some mothers reported mixed messages, pain, and pressure from the media, families and friends as the main reasons for changing from exclusive breastfeeding to mixed feeding. Some mothers reported lack of support postnatally and inconsistent advice such as service providers giving mixed messages, especially regarding feeding in public, mixed feeding and when to introduce other fluids and foods. The borough’s infant and young child feeding support workers were valued, but not all mothers knew about the service. Certain groups, such as those with English as a second language, teenage mothers and mothers without childcare reported not using services routinely. Conclusions: Following presentation of the key findings, and a discussion with early years’ service providers, the Tower Hamlets Public Health Division suggested practice changes which were adopted by the LBTH council. The council committed to continue supporting the Infant Feeding & Wellbeing Service (known as the Baby Feeding Service) to continue to improve infant and young child feeding practices. Health visitors are encouraged to use their new 3-4 month contact with post-natal mothers, in addition to the five mandated universal contacts, as an opportunity to offer nutrition support to mothers. The council also approved increased nutrition capacity within the Health Visiting and Public Health team. More information is now available on the Tower Hamlets website to support mothers with clear nutrition and infant feeding information with details of the many services mothers can access in the borough

Exploration of parental perceptions and practices concerning sugar/oral health of children

Abstract: Background: The consumption of sugary foods and drinks and poor oral health practices among children is linked to the development of tooth decay. The aim of the study was to explore perceptions and practices concerning sugar consumption and oral health of young children. Methods: This qualitative study was conducted using semi-structured focus group discussions with parents (n=28) and key informant interviews with healthcare providers (n=10). All data were collected in Tower Hamlets, London. Data analysis was performed on transcribed interviews using a thematic analysis approach and NVivo Starter 11. Results: Six themes emerged related to sugar and oral health during analysis: (1) Communication: internet as a form of communication and limited communication on UK Sugar Tax to parents. In addition, influencing communicative messages on food packages and labels to parents and children. Themes related to barriers: (2) cost, (3) convenience of sugary foods and drinks, (4) fussy eaters prevent parents from giving their children healthier foods, (5) family influence makes it much harder for parents to feed their children healthier foods, and (6) family influence and mixed messages on sugar and correct oral health practices. Conclusion: Parents and healthcare providers identified many factors that influence parent’s perceptions and practices around sugar consumption and oral health. However, parents face many barriers to reduce sugar and performing correct oral health practices. Future public health policy planning should consider implementing a multifactorial approach to improve child health that includes the barriers identified in this qualitative stud