Stunting and Infant and Young Child Feeding Practices in Madagascar: Analysis of the Demographic and Health Survey

Madagascar is among the countries with a dramatically high prevalence of stunting in children under 5 years old. This study used the latest Demographic and Health Survey (2009) to investigate determinants of child stunting according to the United Nations Children�s Fund (UNICEF) framework on the causes of malnutrition and to evaluate infant and young child feeding (IYCF) practices using the World Health Organization (WHO) indicators. Logistic regressions were performed to determine the variables associated with stunting and with inappropriate feeding practices. A cut-off at 24 months was used to separate the population into two groups. In 2009, 40.1% of the 1863 children aged 0-23 months and 53.9% of the 2911 children aged 24-59 months were stunted contributing to the 48.5% overall prevalence. In the younger group, boys (AOR=0.69 for girls), severely anemic children (AOR=3.50), children living in households that used non-iodized salt (AOR=0.76 for iodine content more than 15 ppm) and children living in rural areas (AOR=0.66 for urban) were more likely to be stunted. In the 24-59 months group, boys (AOR=0.84 for girls), moderately anemic children (AOR=1.79), children with incomplete immunization coverage (AOR=0.84 for full coverage), children whose mothers were breastfeeding (AOR=1.29), children who were perceived as small at birth (AOR=1.55) and children living in limited-resource households (AOR=3.13) were more likely to be stunted. Increased maternal height was associated with lower risks of stunting in both age groups (AORs=0.77 and 0.69). Region of residence was also a significant factor for stunting. The results also confirmed poor complementary feeding practices as only 17.4% of the children 6-23 months received the minimum diet diversity and 1.8% ate iron-rich food the day before the survey. No association was found between the IYCF indicators and stunting with logistic regression. Inappropriate feeding practices were associated with lower media exposure, lower family wealth and lower maternal education. This study contributes to the understanding of the determinants of child undernutrition and feeding practices in Madagascar.Nutritional Scienc

Investigating the causes of child undernutrition and poor development in Vakinankaratra, Madagascar: A mixed-methods study

The Vakinankaratra region of Madagascar has the highest burden of child undernutrition in the country. The purpose of this study was to investigate the factors associated with child undernutrition and to assess child development among children aged 6 to 23 months using a mixed-methods approach. Individual interviews (n = 8) and focus group discussions among fathers and mothers (10 with 63 total participants) were conducted. A sample of 391 mother-child dyads were included in the surveys and anthropometric measurements. Stunting rates were very high (69.4%) and 23.4% were underweight. Proportions of children achieving minimum dietary diversity (MDD) (35.8%) and consuming iron-rich foods (14.1%) were very low. Maternal knowledge of child feeding was associated with better feeding practices [Adjusted odds ratio: 1.2 (1.1 - 1.4)] for MDD. Consumption of iron-rich foods was significantly associated with lower odds of underweight [AOR: 0.3 (0.1 - 0.7)]. Barriers to optimal feeding practices included beliefs regarding certain foods considered as heavy, food insecurity, and heavy workload. Enablers include perceived benefits of appropriate complementary foods and positive relationships between the mothers and the community nutrition agents. Strong traditional gender roles around child care were a salient theme throughout the qualitative data as mothers were considered the primary child care providers. Fathers actively involved in child care activities would be ridiculed by the community and their wives would be considered lazy or unable to take care of their children. Besides providing for their families, fathers were also involved in home stimulation activities and support their wives with household chores when they were unavailable. Work conditions, separation and distance and reluctance prevented fathers from being more involved. Both fathers and mothers expressed interest in engaging fathers more in child care. Higher birthweight predicted increased length (B = 0.11), weight (B = 0.18), and weight-for-length (B = 0.13). Higher maternal height predicted increased both length (B = 0.17) and weight (B = 0.16), while larger household size was associated with lower length (B = -0.10) and weight (B = -0.16). Using the Bayley's scale, children aged 11 - 13 months had low cognitive, motor, language, and socioemotional development scores

Situation and determinants of the infant and young child feeding (IYCF) indicators in Madagascar: analysis of the 2009 Demographic and Health Survey

Background: Studies evaluating child feeding in Madagascar are scarce despite its importance in child growth during the first two years of life. This study assessed the associations between the WHO infant and young child feeding (IYCF) indicators and stunting and identified determinants of inappropriate child feeding practices.Methods: The most recent Demographic and Health Survey was used including a total of 1956 infants aged 0–23 months. Logistic regressions were performed for the association between IYCF indicators and stunting and for the determination of risk factors for inappropriate feeding practices.Results: The rates of initiation of breastfeeding within one hour after birth (77.2%), continued breastfeeding at one year (99.6%) and timely introduction of solid, semi-solid or soft foods at 6–8 months (88.3%) were high. Exclusive breastfeeding under 6 months (48.8%), attaining minimum dietary diversity (22.2%) and consumption of iron-rich foods (19.6%) were relatively low. Higher length-for-age was associated with achieving minimum dietary diversity (p<0.01). The other indicators assessed (early initiation of breastfeeding, exclusive breastfeeding under 6 months, timely introduction of complementary foods and consumption of iron-rich foods) were not associated with stunting. Infants born to mothers who had first given birth at an age younger than 19 were more likely not to be breastfed within one hour after birth, not to be exclusively breastfed and not to have the recommended dietary diversity. Infants whose mothers had low media exposure were at increased risk of being inappropriately fed. Low household wealth also was associated with higher odds of not meeting the minimum dietary diversity.Conclusions: Despite almost total continued breastfeeding at one year and early initiation of breastfeeding by more than three-quarter of mothers, minimum dietary diversity scores were still low, confirming the need for more effective programs for improving child feeding practices in Madagascar. Improving dietary diversity in children aged 6–23 months may help reduce stunting. The identified risk factors for inappropriate feeding practices could be used in directing future nutrition sensitive interventions.Peer reviewedNutritional Science

Fathers' involvement in child care activities: Qualitative findings from the highlands of Madagascar.

Few studies have investigated fathers' roles in child care in Madagascar. This study explored the perceptions, attitudes, and practices regarding fathers' involvement in child care using qualitative methods. Ten focus group discussions were conducted among parents of children aged 6-23 months; seven were among mothers, and three among fathers. In-depth semi-structured interviews (n = 8) were also conducted with key informants. Discussions and interviews were audio-recorded and the verbatim transcripts in Malagasy were translated into English. Data were analyzed using the thematic analysis approach. Provision of financial and material support as well as teaching and playing with the child were the main perceived roles of fathers. In practice, fathers spent their time alone with their children playing and holding them when the mother was unavailable. Busy schedules and separation due to work were major barriers to fathers' involvement. Traditional gender roles for child care in which the mother is seen as primarily responsible for the child were salient across the data. Consequently, men involved in child care activities and their wives were often criticized by the community. Nevertheless, there was self-reported interest from both mothers and fathers in involving men more in child care. Interventions aimed to increase fathers' involvement in child care may be more successful when they focus on shifting the community perceptions on the division of responsibilities between fathers and mothers

The COVID-19 epidemic in Madagascar: clinical description and laboratory results of the first wave, march-september 2020.

BackgroundFollowing the first detection of SARS-CoV-2 in passengers arriving from Europe on 19 March 2020, Madagascar took several mitigation measures to limit the spread of the virus in the country.MethodsNasopharyngeal and/or oropharyngeal swabs were collected from travellers to Madagascar, suspected SARS-CoV-2 cases and contact of confirmed cases. Swabs were tested at the national reference laboratory using real-time RT-PCR. Data collected from patients were entered in an electronic database for subsequent statistical analysis. All distribution of laboratory-confirmed cases were mapped, and six genomes of viruses were fully sequenced.ResultsOverall, 26,415 individuals were tested for SARS-CoV-2 between 18 March and 18 September 2020, of whom 21.0% (5,553/26,145) returned positive. Among laboratory-confirmed SARS-CoV-2-positive patients, the median age was 39&nbsp;years (IQR: 28-52), and 56.6% (3,311/5,553) were asymptomatic at the time of sampling. The probability of testing positive increased with age with the highest adjusted odds ratio of 2.2 [95% CI: 1.9-2.5] for individuals aged 49&nbsp;years and more. Viral strains sequenced belong to clades 19A, 20A and 20B indicative of several independent introduction of viruses.ConclusionsOur study describes the first wave of the COVID-19 in Madagascar. Despite early strategies in place Madagascar could not avoid the introduction and spread of the virus. More studies are needed to estimate the true burden of disease and make public health recommendations for a better preparation to another wave