Factors influencing feeding practices of extreme poor infants and young children in families of working mothers in Dhaka slums: A qualitative study

BackgroundNutritional status differs between infants and young children living in slum and non-slum conditions—infants and young children living in City Corporation slums are likely to have worse nutritional status compared to those from non-slums. Furthermore, families in slums tend to engage female labor in cash-earning activities as a survival strategy; hence, a higher percentage of mothers stay at work. However, little is known about feeding practices for infants and young children in families with working mothers in slums. This study aims to understand the factors that determine feeding practices for infants and young children living in families with working mothers in Dhaka slums.MethodsThis study adopted a qualitative approach. Sixteen In-depth Interviews, five Key Informant Interviews, and Focused Group Discussions were conducted with family members, community leaders, and program staff. Method triangulation and thematic analyses were conducted.ResultsFeeding practices for infants and young children in families with working mothers are broadly determined by mothers’ occupation, basis civic facilities, and limited family buying capacity. Although mothers have good nutritional knowledge, they negotiate between work and feeding their infants and young children. Household composition, access to cooking facilities, and poverty level were also found to be significant determining factors.ConclusionThe results suggest a trade-off between mothers’ work and childcare. The absence of alternative care support in homes and/or work places along with societal factors outweighs full benefits of project interventions. Improving alternative childcare support could reduce the burden of feeding practice experienced by working mothers and may improve nutritional outcomes

Mother's positive attitude and familiarity towards formula milk may contribute to low dietary diversity amongst Indonesia urban young children

Background and Objectives: Indonesia is one of the countries facing nutrition transition with an increased proportion of the middle-class population. Few studies explored young child feeding practice amongst middle class families in developing countries. This study aims to assess child feeding practices and their associations with child nutritional status in urban area of Indonesia. Methods: The study was designed as a mixed-method study in an urban middle-class community, comprising of a qualitative study amongst 26 families of young children and a case-control study involving 288 (109 cases and 179 controls) children aged 12-36 months. Cases were mild to moderately underweight children, while controls were normal weight children. The data collection methods consisted of in-depth interview for the qualitative phase and anthropometry measurements, structured interviews pertaining to child feeding practices and 24-hours recall for the quantitative phase. Results: The qualitative study suggested that mothers appeared to have positive attitude and were familiar with many brands of toddler formula milk. Mothers reported challenges in encouraging their children to eat and relied on formula milk to increase child’s food intake.The results of the case-control study showed that only 10.4% children received six-month exclusive breastfeeding and there was a significantly higher proportion of control than case children who were offered formula milk within their first month of life. Almost all children (91.7%, CI = 87.7 – 94.5) had low dietary diversity (consumed 1-3 food groups) in the last 24 hours. Formula milk was the largest contributor to child’s energy intake amongst the control children. Conclusions: The low dietary diversity warn potential problems for the health of Indonesian children. A large government strategy on complementary feeding practices including controlling the marketing activities of formula milk need to be enhanced

Mother's positive attitude and familiarity towards formula milk may contribute to low dietary diversity amongst Indonesia urban young children

Background and Objectives: Indonesia is one of the countries facing nutrition transition with an increased proportion of the middle-class population. Few studies explored young child feeding practice amongst middle class families in developing countries. This study aims to assess child feeding practices and their associations with child nutritional status in urban area of Indonesia. Methods: The study was designed as a mixed-method study in an urban middle-class community, comprising of a qualitative study amongst 26 families of young children and a case-control study involving 288 (109 cases and 179 controls) children aged 12-36 months. Cases were mild to moderately underweight children, while controls were normal weight children. The data collection methods consisted of in-depth interview for the qualitative phase and anthropometry measurements, structured interviews pertaining to child feeding practices and 24-hours recall for the quantitative phase. Results: The qualitative study suggested that mothers appeared to have positive attitude and were familiar with many brands of toddler formula milk. Mothers reported challenges in encouraging their children to eat and relied on formula milk to increase child’s food intake.The results of the case-control study showed that only 10.4% children received six-month exclusive breastfeeding and there was a significantly higher proportion of control than case children who were offered formula milk within their first month of life. Almost all children (91.7%, CI = 87.7 – 94.5) had low dietary diversity (consumed 1-3 food groups) in the last 24 hours. Formula milk was the largest contributor to child’s energy intake amongst the control children. Conclusions: The low dietary diversity warn potential problems for the health of Indonesian children. A large government strategy on complementary feeding practices including controlling the marketing activities of formula milk need to be enhanced

Three Months of Positive Deviance Approach Integrated with Posyandu TKA Increased Development Performance and Decreased Morbidity of Underweight Children (659 Months)

Positive Deviance Approach integrated with Posyandu TKA (Centre for Growth and Development) offered an excellent opportunity to alleviate the health and malnutrition problem. The study aimed to measure the effectiveness of 3-month Positive Deviance Approach (PDA) integrated with posyandu TKA on growth, development and morbidity of underweight children under five in Pandeglang Assessment of growth used anthropometrics measurement; KPSP test for development, feeding practice used 24-hour food recall, and morbidity record on diarrhea and ARI (Acute Respiratory Infection). Results showed that after 3 months of intervention there were no significant changes on growth of the children in term of WAZ, HAZ and WHZ, but prevalence of underweight among intervention children reduced up to 27.5%, whereas amongcontrol children 18.2%. No significant changes in energy and protein intake of the children. However feeding frequency, food diversity and good feeding practices of intervention children were significantly improved. The morbidity was significantly reduced in the intervention group by 1025%. The development score of the intervention group was about 1.9 better than control group. The posyandu TKA was an alternative model in educating mothers for a better feeding practices, and stimulating the children for improving development and prevention from nutritional status deterioration. This should make an ideal model for posyandu in Indonesia.Key words: malnutrition, intervention, positive deviance approach (PDA), posyandu, growth, developmen

Improving policies to combat micronutrient deficiencies in Southeast Asia : the SMILING experience

Background Despite scientific evidence on the potential impact or importance of specific interventions to improve micronutrient status of vulnerable groups, political commitment and extensive support from national stakeholders is paramount to support introduction and implementation of these interventions at national level. In order to develop efficient nutritional strategies to improve the micronutrient status of children < 5 years of age and women of reproductive age that will be supported by a wide range of stakeholders, a better understanding of viewpoints on the nutrition politics and strategies is necessary. Multi-criteria mapping (MCM) was successfully used to assess the stakeholder's viewpoint in a wide variety of contexts since the late 1990s. Objective The objective of the present study was to assess the viewpoints of stakeholders on a wide range of potential nutritional interventions in the five Southeast Asian countries participating in the SMILING project. Method MCM methodology was used to appraise the stakeholder's viewpoints in five countries. Results The results show that the overall stakeholders' preference was for actions already implemented in their country rather than for new, innovative options, even for supplementation. Indirect interventions such like food fortification (except in Indonesia), delayed cord clamping or food-based approaches were generally less favored by the stakeholders. However, the majority of stakeholders agreed that new approaches should be considered and put in place in the future provided that evidence of their impact was demonstrated, that they received adequate technical support for their implementation and their monitoring, and that they will be accompanied by strong advocacy among decision-makers, civil society and beneficiaries. Conclusions for practice To conclude, for the introduction of new, innovative strategies to reduce micronutrient deficiencies in South-East Asia, convincing stakeholders appears to be the first hurdle to be taken

Child feeding practices in families of working and nonworking mothers of Indonesian middle class urban families: what are the problems?

This study aims to explore the feeding practices in families of working and nonworking mothers with children (aged 12-36 months) of different nutritional status and types of domestic caregiver in Indonesian urban middle class families. It was designed as a qualitative multiple case study. Mothers and caregivers from 26 families were interviewed in depth, and caregivers were categorized as family and domestic-paid caregivers. The result suggested that offering formula milk to young children was a common practice, and there was a high recognition and familiarity toward a range of formula milk brands. Mothers reported challenges in encouraging their children to eat, and in some cases they appeared to lack knowledge on overcoming their child's feeding problem. The findings suggested the need to address the child feeding problems experienced by mothers in order to overcome the double burden of child nutrition in Indonesia