Child Nutritional Status, Feeding Practices and Women's Autonomy in Rural Andhra Pradesh, India

Childhood under-nutrition is a prevalent public health issue through out the developing world. In recent surveys, such as the one carried out by the National Nutrition Monitoring Bureau, India, poor dietary intakes (energy, protein and micro-nutrients) and nutrition status was evident among 0-3 year old children, even in families where the adults meet their daily dietary requirements (NNMB, 2001). This indicates that availability of food may not be the only necessarily cause of under-nutrition among the under three-year-olds in such families. Further, recent research postulates the linkage between women's autonomy and child health, particularly in countries such as India where mothers play a vital role in childcare. This dissertation investigates the influence of maternal autonomy on child feeding and child nutritional status in a sequence of three essays. In the first essay, using logistic regression, we examine the overall effect of mother's autonomy on child stunting using a secondary dataset from the state of Andhra Pradesh (AP) in India. In particular we examine the influence of indicators of autonomy on child stunting. Our results show financial independence and not needing permission to go to the local market have a positive impact in reducing child stunting. In the second essay, we further investigate the role of woman's autonomy on feeding behavior through a set of qualitative interviews, conducted among a sample of 43 mothers in 3 rural villages of Andhra Pradesh, India. In particular, we explored the perception and beliefs regarding women's autonomy and environmental factors such as income and family structure and their influence on infant feeding practices. We find that not only does mother's autonomy play a role in the woman seeking information through formal health care system for a her to introduce foods and liquids to the infant, but the family structure and the cultural norms surrounding the mother-child environment also plays an important role in child feeding practices. In our third essay, using structural equation modeling approach, we examine the impact of seven latent dimensions of maternal autonomy on infant feeding practice. Our results indicate that mothers with higher autonomy [indicated by financial autonomy and decrease experience of domestic violence] are more likely to breastfeed 3-5 month old infants. Mothers in joint family households are more likely to have infants with poor growth. Overall, these results suggest that improving certain dimensions of maternal autonomy will have a positive impact on infant care and growth outcomes in rural settings of India. Future research should consider autonomy as a multi-dimensional concept to examine the influence of individual dimension of autonomy on health behaviors and health outcomes

Does maternal autonomy influence feeding practices and infant growth in rural India?

The high prevalence of child under-nutrition remains a profound challenge in the developing world. Maternal autonomy was examined as a determinant of breast feeding and infant growth in children 3 to 5 months of age. Cross-sectional baseline data on 600 mother-infant pairs were collected in 60 villages in rural Andhra Pradesh, India. The mothers were enrolled in a longitudinal randomized behavioral intervention trial. In addition to anthropometric and demographic measures, an autonomy questionnaire was administered to measure different dimensions of autonomy (e.g. decision-making, freedom of movement, financial autonomy, and acceptance of domestic violence). We conducted confirmatory factor analysis on maternal autonomy items and regression analyses on infant breast feeding and growth after adjusting for socioeconomic and demographic variables, and accounting for infant birth weight, infant morbidity, and maternal nutritional status. Results indicated that mothers with higher financial autonomy were more likely to breastfeed 3–5 month old infants. Mothers with higher participation in decision-making in households had infants that were less underweight and less wasted. These results suggest that improving maternal financial and decision-making autonomy could have a positive impact on infant feeding and growth outcomes

Does maternal autonomy influence feeding practices and infant growth in rural India?

The high prevalence of child under-nutrition remains a profound challenge in the developing world. Maternal autonomy was examined as a determinant of breast feeding and infant growth in children 3-5 months of age. Cross-sectional baseline data on 600 mother-infant pairs were collected in 60 villages in rural Andhra Pradesh, India. The mothers were enrolled in a longitudinal randomized behavioral intervention trial. In addition to anthropometric and demographic measures, an autonomy questionnaire was administered to measure different dimensions of autonomy (e.g. decision-making, freedom of movement, financial autonomy, and acceptance of domestic violence). We conducted confirmatory factor analysis on maternal autonomy items and regression analyses on infant breast feeding and growth after adjusting for socioeconomic and demographic variables, and accounting for infant birth weight, infant morbidity, and maternal nutritional status. Results indicated that mothers with higher financial autonomy were more likely to breastfeed 3-5 month old infants. Mothers with higher participation in decision-making in households had infants that were less underweight and less wasted. These results suggest that improving maternal financial and decision-making autonomy could have a positive impact on infant feeding and growth outcomes.Infant feeding Infant growth Maternal autonomy Confirmatory factor analysis India Nutrition Mothers

Does maternal autonomy influence feeding practices and infant growth in rural India?

The high prevalence of child under-nutrition remains a profound challenge in the developing world. Maternal autonomy was examined as a determinant of breast feeding and infant growth in children 3 to 5 months of age. Cross-sectional baseline data on 600 mother-infant pairs were collected in 60 villages in rural Andhra Pradesh, India. The mothers were enrolled in a longitudinal randomized behavioral intervention trial. In addition to anthropometric and demographic measures, an autonomy questionnaire was administered to measure different dimensions of autonomy (e.g. decision-making, freedom of movement, financial autonomy, and acceptance of domestic violence). We conducted confirmatory factor analysis on maternal autonomy items and regression analyses on infant breast feeding and growth after adjusting for socioeconomic and demographic variables, and accounting for infant birth weight, infant morbidity, and maternal nutritional status. Results indicated that mothers with higher financial autonomy were more likely to breastfeed 3–5 month old infants. Mothers with higher participation in decision-making in households had infants that were less underweight and less wasted. These results suggest that improving maternal financial and decision-making autonomy could have a positive impact on infant feeding and growth outcomes

The Sex-Specific Role of Plasma Folate in Mediating the Association of Dietary Quality with Depressive Symptoms1–3

Folate deficiency has been implicated in the etiology of unipolar depression. In this study, we attempted to cross-link plasma folate, depressive symptoms, and dietary quality (or dietary intake of folate) together in a comprehensive framework, while examining effect modification of those associations by sex. This was a cross-sectional, population-based study of 1681 participants aged 30–64 y (Healthy Aging in Neighborhoods of Diversity across the Lifespan Study). Participants were administered the Center for Epidemiologic Studies Depression scale (CES-D). Measures of plasma folate and dietary intakes (2 24-h recalls) from which the 2005-Healthy Eating Index (HEI) was computed were available. Multivariate logistic regression and structural equation modeling (SM) were conducted. Compared with the lowest tertile, the middle and uppermost tertiles of plasma folate were associated with a 39–40% reduced odds of elevated CES-D (≥16) among women [adjusted odds ratio (T3 vs. T1) = 0.60 (95% CI = 0.42–0.86); P = 0.006]. Confounding of this association by HEItotal was noted among both men and women, although dietary folate did not confound this association appreciably. In SM, plasma folate completely mediated the inverse HEItotal-CES-D association among men only, specifically for HEI2 (higher intakes of whole fruits), HEI3 (total vegetables), HEI5 (total grains), HEI6 (whole grains), HEI7 (milk), and HEI12 (lower discretionary energy). Among women, HEItotal and 4 components had an inverse direct effect on CES-D score, suggesting a mechanism that is independent of plasma folate. Depressive symptoms in our study may be alleviated by improving overall dietary quality, with plasma folate playing a potential mediating role only among men

Serum Antioxidant Status Is Associated with Metabolic Syndrome among U.S. Adults in Recent National Surveys123

Potential antiinflammatory and antioxidant effects were recently ascribed to naturally occurring micronutrients. The extent and magnitudes of their differential effects on the metabolic syndrome (MetS) are still unknown. We examined the association between serum antioxidant status and MetS. NHANES 2001–2006 cross-sectional data among adults aged 20–85 y were analyzed (n = 3008–9099). MetS was defined with the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) and also by elevated homeostatic model assessment insulin resistance (HOMA-IR), C-reactive protein (CRP) and hyperuricemia. Serum antioxidants included retinol, retinyl esters, carotenoids [α-carotene, β-carotene (cis+trans), β-cryptoxanthin, lutein+zeaxanthin, total lycopene], vitamin E, and vitamin C. MetS (NCEP ATP III) prevalence in U.S. adults was 32.0% among men and 29.5% among women. Adults with MetS had consistently lower serum carotenoid concentrations compared with those without MetS, even after controlling for total cholesterol and TG among other potential confounders. Vitamin E had no significant relationship with MetS in the full multiple logistic regression model, whereas retinol+retinyl esters were inversely related to MetS among men only. The latter were also inversely related to elevated CRP and positively associated with hyperuricemia. Vitamin C exhibited a similar pattern to serum carotenoids with an inverse linear association with MetS (binary), HOMA-IR, and hyperuricemia. Future intervention studies of dietary and lifestyle change must be conducted to assess the utility of modifying serum antioxidant concentrations, especially carotenoids, given their suboptimal levels among U.S. adults with MetS, for the prevention of type 2 diabetes and various cardiovascular endpoints