Infant and young child feeding practices and stunting in two highland provinces in Ecuador

The first two years of life are critical for growth and development. Little is known about infant and young child feeding (IYCF) practices in the Ecuadorian highlands and how they contribute to stunting. With the objective of understanding nutritional status and the influencing factors to design an intervention, we assessed the nutritional status of 293 infants and children between 0 and 24 months of age, living in 14 communities in the provinces of Tungurahua and Chimborazo using a cross‐sectional study design. We used the WHO IYCF indicators to assess feeding practices; estimated dietary intake with 24‐h recalls; and identified nutritious local foods by food frequency questionnaires. Multiple regression modelling was performed to identify correlates of nutritional status. Stunting was found in 56.2% of children. Mean protein, vitamin A and vitamin C intakes were above recommendations for all ages. Only infants 6.0 to 8.9 months of age and non‐breastfed children 12–23.9 months of age consumed energy intakes below recommendations. Younger age groups had below recommended intakes for iron and calcium. While mean complementary food densities met recommendations for protein, vitamin A, vitamin C and energy, those for zinc, iron and calcium were lower than recommended. Older age, respiratory infections and being male were predictors of lower HAZ, whereas early initiation of breastfeeding, higher socioeconomic status, consumption of iron‐rich foods and higher dietary protein density were protective. Interventions that promote and support optimal breastfeeding practices and enable increased consumption of nutritious local foods have potential to contribute to reducing stunting in this vulnerable population. © 2016 John Wiley & Sons Ltd     

Infant and young child feeding in the Peruvian Amazon: the need to promote exclusive breastfeeding and nutrient-dense traditional complementary foods

The study objective was to understand the role of traditional Awajún foods in dietary quality and the potential impacts on growth of Awajún infants and young children 0-23 months of age. Research took place in April and May of 2004, along the Cenepa River in six Awajún communities. Anthropometry estimated nutritional status for 32 infants (0-23 months). Repeat dietary recalls and infant feeding histories were completed with 32 mothers. Adequacy of the complementary foods was compared with World Health Organization guidelines. Anthropometry indicated a high prevalence of stunting (39.4% of infants and young children), with nutritional status declining with age. Half of the Awajún mothers practised exclusive breastfeeding. Dietary recalls and infant food histories suggested that many of the infants were getting adequate nutrition from complementary foods and breastfeeding; however, there was variation in breastfeeding and complementary feeding practices among the mothers. Complementary feeding for young children 12-23 months generally met nutrient recommendations, but mean intakes for iron, zinc, calcium and vitamin A were inadequate in infants 6-11 months. Traditional foods provided 85% of energy and were more nutrient dense than market foods. Appropriate infant and complementary feeding was found among some women; however, given the range of feeding practices and introduction of market foods, health promotion targeting infant and young child feeding is warranted.     

Dairy intensification,mothers and children: an exploration of infant and young child feeding practices among rural dairy farmers in Kenya

Agricultural strategies such as dairy intensification have potential to improve human nutrition through increased household food security. Increasing dairy productivity could also adversely affect infant and young child feeding (IYCF) practices because of increased maternal stress, demands on maternal time, and beliefs about the timing and appropriate types of complementary foods. Yet, few studies have looked rigorously at how interventions can affect young children (0–60 months). The study explores, within the context of rural dairy farming in Kenya, the relationship between level of household dairy production and selected IYCF practices using a mixed‐methods approach. Six focus group discussions with women involved in dairy farming investigated their attitudes towards breastfeeding, introduction of complementary foods and child diets. Ninety‐two households involved in three levels of dairy production with at least one child 0–60 months participated in a household survey. Quantitative results indicated that women from higher dairy producing households were more likely to introduce cow's milk to infants before they reached 6 months than women from households not producing any dairy. Themes from the focus group discussions demonstrated that women were familiar with exclusive breastfeeding recommendations, but indicated a preference for mixed feeding of infants. Evidence from this study can inform nutrition education programmes targeted to farmers participating in dairy interventions in rural, low‐income settings to minimise potential harm to the nutritional status of children.     

Infant feeding practices among patients of pediatricians and general practitioners

In an attempt to document the infant feeding practices among patients of pediatricians and general practitioners, a study was carried over a period of one month and data of 10,374 infants were recorded using a pre-printed proforma marked by a simple ‘tick’ for each patient. The results showed: (i) initiation of breastfeeding was delayed in nearly half of the cases beyond 24 hours; (ii) introduction of bottle feeding in more than half of infants by the age of 4 months and (iii) introduction of solid foods later than eight months in almost half of infants. While breastfeeding is practised by 78% of women, only one in five practice exclusive breastfeeding till 4–6 months, and very few avoid bottle feeds. Much education and change in behaviour is needed if optimal benefit of breastfeeding in India is to be realised.     

Infant feeding practices in a South African birth cohort—A longitudinal study

Childhood malnutrition is highly prevalent in low‐ and middle‐income countries. The choices of complementary foods, which are important in infant nutrition, are poorly described in this setting. We investigated infant feeding practices in a South African birth cohort, the Drakenstein Child Health Study. Longitudinal feeding data were collected from March 2012 to March 2015. Feeding practices at birth, 6–10 and 14 weeks and 6, 9, and 12 months, were investigated using food frequency questionnaires. Anthropometry was measured at birth and 12 months. The quality of the diet was analyzed using the World Health Organization infant and young child feeding indicators. Regression models were used to explore associations between feeding and growth outcomes at 1 year. Exclusive breastfeeding for 6 months was low (13%), and 19% of infants were introduced to solid foods before 4 months. There was high daily consumption of processed meat (56%) and inappropriate foods such as fruit juice (82%), soft drinks (54%), and refined sugary foods (51%) at 1 year. Dietary diversity and consumption of iron rich foods were low at 6 months (5% and 3%, respectively) but higher by 12 months (75% and 78%). Longer duration of exclusive breastfeeding was associated with a lower height‐for‐age z‐score at 1 year. Several dietary deficits and a rising trend in the consumption of inappropriate nutritionally poor foods were identified. These findings raise concern about poor dietary practices and the impact on child and long‐term health.     

Knowledge,attitudes and perceptions on infant and young child nutrition and feeding among adolescent girls and young mothers in rural Bangladesh

Improved infant and young child feeding (IYCF) practices have the potential to improve child health and development outcomes in poorly resourced communities. In Bangladesh, approximately 60% of rural girls become mothers before the age of 18, but most interventions to improve IYCF practices target older mothers. We investigated the knowledge, attitudes and perceptions regarding IYCF among adolescent girls and young women aged 15–23 years old in two rural regions in north‐west Bangladesh and identified the main points of concordance with, or mismatch to, key international IYCF recommendations. We compared qualitative data collected during interviews and focus groups with participants who were unmarried, married without a child and married with at least one child, and stratified by region. Qualitative indicators of concordance with international recommendations suggest that IYCF knowledge of participants was limited, irrespective of marriage or maternity. Young mothers in our study were no more knowledgeable about feeding practices than their nulliparous peers. Some participants were well aware of an IYCF recommendation (e.g. to exclusively breastfeed for 6 months), but their interpretation of the recommendation deviated from the intended public health message. Notions of insufficient or ‘spoiled’ breast milk, gender‐based biases in feeding intentions and understandings of infant needs, and generational shifts in feeding practices were commonly reported. Conclusions are that female adolescence is a window of opportunity for improving health outcomes among future children, and increased investment in early education of adolescent girls regarding safe IYCF may be an effective strategy to promote and support improved infant feeding practices.     

Infant and young child feeding learning sessions during savings groups are feasible and acceptable for HIV‐positive and HIV‐negative women in Malawi

Based on formative research, HIV‐positive women in Lilongwe District, Malawi receive little infant and young child feeding (IYCF) counselling postpartum and want more support for IYCF from their husbands. To address these gaps, we implemented a behaviour change communication intervention promoting IYCF in village savings and loan associations (VSLAs) that included HIV‐positive and HIV‐negative women. The intervention consisted of 15 IYCF learning sessions facilitated by VSLA volunteers during regular VSLA meetings and included four sessions to which husbands were invited. We assessed the feasibility and acceptability of the intervention through learning session participation logs, structured observations of learning sessions, and in‐depth interviews with HIV‐positive and HIV‐negative VSLA members, husbands of members, and VSLA volunteers. Nine VSLA volunteers conducted learning sessions with approximately 300–400 women, about one quarter of whom were lactating, and 25–35 men. VSLA volunteers consistently communicated technical information correctly, followed the learning session steps, and used visual aids. Sessions averaged 46 min, with <20% of observed sessions completed within the recommended time (20–25 min). Key themes from interviews were the following: (a) learning sessions were useful; (b) including HIV‐positive and HIV‐negative women in the sessions was acceptable; (c) information learned during sessions encouraged families to change IYCF practices; (d) IYCF messages were shared with others in the community; and (e) male participation was low because men considered VSLAs and IYCF to be women's activities. In conclusion, integrating IYCF learning sessions into VLSAs was feasible and acceptable for mixed groups of HIV‐positive and HIV‐negative women. Future research should test other strategies for involving men in IYCF.     

Characterising infant and young child feeding practices and the consumption of poultry products in rural Tanzania: A mixed methods approach

Suboptimal breastfeeding practices, early initiation of complementary feeding, and monotonous cereal‐based diets have been implicated as contributors to continuing high rates of child undernutrition in sub‐Saharan Africa. Nutrition‐sensitive interventions, including agricultural programs that increase access to nutrient‐rich vegetables, legumes, and animal‐source foods, have the potential to achieve sustainable improvements in children's diets. In the quest to evaluate the efficacy of such programs in improving growth and development in the first 2 years of life, there is a role for mixed methods research to better understand existing infant and young child feeding practices. This analysis forms part of a longitudinal study assessing the impact of improvements to poultry health and crop production on diets and growth of 503 randomly selected children from eight rural communities in Manyoni District in central Tanzania. Using an explanatory sequential design, the quantitative phase of data collection was conducted between May 2014 and May 2016, comprising six monthly structured questionnaires, four monthly household‐level documentation of chicken and egg consumption, and fortnightly records of children's breastfeeding status. The subsequent qualitative phase involved in‐depth interviews with a subset of 39 mothers in October 2016. Breastfeeding was almost universal (96.8%) and of long duration (mean = 21.7 months, SD = 3.6), but early initiation of complementary feeding was also common (74.4%; mean = 4.0 months, SD = 1.8), overwhelmingly driven by maternal perceptions of insufficient milk supply (95.0%). Chicken and eggs were infrequently eaten, but close associations between maternal and child consumption patterns (p < .001) suggest the potential for strategies that increase household‐level consumption to bring nutritional benefits to young children.     

Infant and young child feeding in emergencies: Organisational policies and activities during the refugee crisis in Lebanon

Appropriate infant and young child feeding (IYCF) is key to reducing mortality amongst children aged under 2. Facilitating adherence to recommended IYCF practices during emergencies includes having relevant policies to support breastfeeding and complementary feeding as well as regulating the distribution of breast milk substitutes. In the current crisis, more than 1.2 million Syrian refugees are in Lebanon and it is timely to examine organisational IYCF policies and programmes. One hundred and thirty‐five non‐governmental organisations providing humanitarian aid in Lebanon were invited to participate in an online survey about organisational policies and programmatic activities on IYCF. Responses were obtained from 54 organisations: 29 International Non‐Governmental Organisations (INGOs) and 25 Local Non‐Governmental Organisations (LNGOs). In total, 8 (15%) reported having a written policy on IYCF, but only 1 policy (in draft format) was available for inspection. Twelve (8 INGOs and 4 LNGOs) indicated endorsing an external IYCF policy, but only 6 listed a valid policy. Four organisations (3 INGOs and 1 LNGO) had programme objectives that indicate protection, promotion, and support of IYCF. Three LNGOs reported receiving infant formula donations and 5 organisations (2 INGOs and 3 LNGOs) indicated distributing infant formula; 2 (1 INGO and 1 LNGO) did so in accordance with international and national policies. Few organisations violated IYCF guidance but organisational policies and activities on IYCF are not well established. In order to improve response in the current refugee crisis in Lebanon, there is a need to ensure policies are in place and implemented so that interventions support, promote, and protect IYCF.     

Attitudes,beliefs and social norms regarding infant and young child feeding among Nigerian mothers,fathers and grandmothers across time

Infant and young child feeding (IYCF) interventions in low-resource countries mainly target pregnant women and mothers of young children; however, fathers and grandmothers also influence IYCF practices. We conducted focus group discussions with mothers, fathers and grandmothers of young children across three time points in areas where an IYCF social and behaviour change intervention was implemented in Nigeria to explore differences by participant type and shifts over time in attitudes, beliefs and social norms related to breastfeeding and dietary diversity (DD). Overall, across time points, we found more discrepancies in attitudes, beliefs and social norms for early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) among different participant types than for DD. Although most participants agreed EIBF and EBF are good practices, mothers believed this more strongly than fathers and grandmothers; however, at endline, a shift towards acceptance of EIBF and EBF appeared among fathers and grandmothers. Across time points, all participant types acknowledged the nutritional and health benefits of green leafy vegetables and animal-source foods but described various barriers to feeding them to children. Across time points, all participant types also highlighted the importance of health workers and antenatal visits as important sources of IYCF knowledge and facilitators to following recommended practices. Insights from this study highlight the importance of including key influencers of IYCF practices in qualitative research.     

Informing infant and young child feeding programming in humanitarian emergencies: An evidence map of reviews including low and middle income countries

Around 200 million people were affected by conflict and natural disasters in 2015. Whereas those populations are at a particular high risk of death, optimal breastfeeding and complementary feeding practices could prevent almost 20% of deaths amongst children less than 5 years old. Yet, coverage of interventions for improving infant and young child feeding (IYCF) practices in emergencies is low, partly due to lack of evidence. Considering the paucity of data generated in emergencies to inform programming, we conducted an evidence map from reviews that included low‐ and middle‐income countries and looked at several interventions: (a) social and behavioural change interpersonal and mass communication for promoting breastfeeding and adequate complementary feeding; (b) provision of donated complementary food; (c) home‐based fortification with multiple micronutrient powder; (d) capacity building; (e) cash transfers; (f) agricultural or fresh food supply interventions; and (g) psychological support to caretakers. We looked for availability of evidence of these interventions to improve IYCF practices and nutritional status of infants and young children. We identified 1,376 records and included 28 reviews meeting the inclusion criteria. The highest number of reviews identified was for behavioural change interpersonal communication for promoting breastfeeding, whereas no review was identified for psychological support to caretakers. We conclude that any further research should focus on the mechanisms and delivery models through which effectiveness of interventions can be achieved and on the influence of contextual factors. Efforts should be renewed to generate evidence of effectiveness of IYCF interventions during humanitarian emergencies despite the challenges.     

The effect of interventions distributing home fortification products on infant and young child feeding (IYCF) practices: A systematic narrative review

Interventions distributing micronutrient powders (MNPs) and small-quantity lipid-based nutrient supplements (SQ-LNS), or home fortification products (HFPs), have the potential to improve infant and young child feeding (IYCF) practices and children's nutrition. We systematically searched for studies on the effect of interventions distributing HFP on IYCF practices. We identified 12 (8 MNP, 4 SQ-LNS) studies: seven programmes with IYCF behaviour change communications (BCC) and MNP (IYCF-MNP) and one provided MNP without IYCF BCC (MNP only). Three SQ-LNS studies came from randomised trials without an IYCF component (SQ-LNS only) and one from a programme with both IYCF BCC and SfQ-LNS (IYCF-SQ-LNS). Five IYCF-MNP programmes reported positive associations with some IYCF practices—four with minimum dietary diversity, two with minimum meal frequency, four with minimum acceptable diet, and three with the initiation of complementary foods at 6 months. Two reported no association between MNP and IYCF indicators, and one reported a decline in IYCF practices during the intervention, although it also reported significant changes to the IYCF programme during the evaluation period. Two studies from interventions that distributed SQ-LNS (one from a related set of randomised controlled trials and the sole IYCF-SQ-LNS programme) reported a positive association with IYCF practices; one trial reported no change in breast milk intake with the provision of SQ-LNS and one found no association with IYCF practices. SQ-LNS and MNP can address nutrient gaps for young children in low-resource settings; our findings indicate that programmes that combine HFP with IYCF interventions may also contribute to improved IYCF practices in some settings.     

Consumption of highly processed snacks,sugar‐sweetened beverages and child feeding practices in a rural area of Nicaragua

Appropriate feeding behaviours are important for child growth and development. In societies undergoing nutrition transition, new food items are introduced that may be unfavourable for child health. Set in rural Nicaragua, the aim of this study was to describe the infant and young child feeding (IYCF) practices as well as the consumption of highly processed snack foods (HP snacks) and sugar‐sweetened beverages (SSBs). All households with at least one child 0‐ to 35‐month‐old (n = 1371) were visited to collect information on current IYCF practices in the youngest child as well as consumption of SSBs and HP snacks. Breastfeeding was dominant (98%) among 0‐ to 1‐month‐olds and continued to be prevalent (60%) in the second year, while only 34% of the 0‐ to 5‐month‐olds were exclusively breastfed. Complementary feeding practices were deemed acceptable for only 59% of the 6‐ to 11‐month‐old infants, with low dietary diversity reported for 50% and inadequate meal frequency reported for 30%. Consumption of HP snacks and SSBs was frequent and started early; among 6‐ to 8‐month‐olds, 42% and 32% had consumed HP snacks and SSBs, respectively. The difference between the observed IYCF behaviours and World Health Organization recommendations raises concern of increased risk of infections and insufficient intake of micronutrients that may impair linear growth. The concurrent high consumption of SSBs and HP snacks may increase the risk of displacing the recommended feeding behaviours. To promote immediate and long‐term health, growth and development, there is a need to both promote recommended IYCF practices as well as discourage unfavourable feeding behaviours.     

Regional differences in milk and complementary feeding patterns in infants participating in an international nutritional type 1 diabetes prevention trial

Differences in breastfeeding, other milk feeding and complementary feeding patterns were evaluated in infants at increased genetic risk with and without maternal type 1 diabetes (T1D). The Trial to Reduce IDDM in the Genetically at Risk is an international nutritional primary prevention double‐blinded randomized trial to test whether weaning to extensively hydrolyzed vs. intact cow's milk protein formula will decrease the development of T1D‐associated autoantibodies and T1D. Infant diet was prospectively assessed at two visits and seven telephone interviews between birth and 8 months. Countries were grouped into seven regions: Australia, Canada, Northern Europe, Southern Europe, Central Europe I, Central Europe II and the United States. Newborn infants with a first‐degree relative with T1D and increased human leukocyte antigen‐conferred susceptibility to T1D were recruited. A lower proportion of infants born to mothers with than without T1D were breastfed until 6 months of age in all regions (range, 51% to 60% vs. 70% to 80%). Complementary feeding patterns differed more by region than by maternal T1D. In Northern Europe, a higher proportion of infants consumed vegetables and fruits daily compared with other regions. Consumption of meat was more frequent in all European regions, whereas cereal consumption was most frequent in Southern Europe, Canada and the United States. Maternal T1D status was associated with breastfeeding and other milk feeding patterns similarly across regions but was unrelated to the introduction of complementary foods. Infant feeding patterns differed significantly among regions and were largely inconsistent with current recommended guidelines.     

Infant feeding practices among macrosomic infants: A prospective cohort study

The health benefits of breastfeeding are well recognised, but breastfeeding rates worldwide remain suboptimal. Breastfeeding outcomes have yet to be explored among women who give birth to macrosomic (birthweight ≥4000 g) infants, a cohort for whom the benefits of breastfeeding may be particularly valuable, offering protection against later‐life morbidity associated with macrosomia. This longitudinal prospective cohort study aimed to identify whether women who give birth to macrosomic infants are at greater risk of breastfeeding non‐initiation or exclusive breastfeeding (EBF) cessation. A total of 328 women in their third trimester were recruited from hospital and community settings and followed to 4 months post‐partum. Women gave birth to 104 macrosomic and 224 non‐macrosomic (<4000 g) infants between 2018 and 2020. Longitudinal logistic regression models calculated odds ratios (ORs) and 95% confidence intervals (CIs) to assess likelihood of EBF at four timepoints post‐partum (birth, 2 weeks, 8 weeks, and 4 months) between women who gave birth to macrosomic and non‐macrosomic infants, adjusted for maternal risk (obesity and/or diabetes), ethnicity and mode of birth. Macrosomic infants were more likely to be exclusively breastfed at birth and 2 weeks post‐partum than non‐macrosomic infants with adjusted OR = 1.94 (95% CI: 0.90, 4.18; p = 0.089) and 2.13 (95% CI: 1.11, 4.06; p = 0.022), respectively. There were no statistically significant associations between macrosomia and EBF at 8 weeks or 4 months post‐partum. Macrosomia may act as a protective factor against early formula‐milk supplementation, increasing the likelihood of EBF in the early post‐partum period, but rates of exclusive breastfeeding continued to decline over the first 4 months post‐partum.     

喂养习惯与婴儿出生后前6个月按身长体质量增加的相关性

目的 探讨导致婴儿出生早期生长过快,尤其是按身长体质量增长过快的相关喂养习惯,包括婴儿的喂养方式、喂养环境以及喂养者的一般情况和喂养行为等,方法以上海市控江社区医疗服务中心常规健康体检的200例足月、单胎、正常出生体质量的健康5～6月龄婴儿及其主要喂养者作为研究对象.有关婴儿喂养习惯的调查问卷,包括婴儿喂养模式、喂养环境、以及喂养者的行为等,由研究小组成员在现场对婴儿的主要喂养者进行一对一调查.记录婴儿的出生体质最,并在婴儿6月龄时测量其体质量和身长.结果 200例婴儿中有70例超重(BAZ>+1),占35%.男婴超重多于女婴(40.0%对30.9%,x2=1.798,P=0.180).超重婴儿和体质量正常婴儿的出生体质量一致(3.30±0.35 kg对3.35±0.32 kg,t=1.010,P=0.314),6月龄时两组婴儿的身长也一致(67.64±2.10 cm对67.91±1.97cm,t=0.896,P=0.371).超重婴儿在出生后前6个月内按身长体质量增加速度明显快于正常体质量婴儿,6月龄时超重婴儿的体质量以及BMI显著高于正常体质量婴儿(9.16±0.67对7.94±0.64,t=12.324,P<0.01;19.86±1.24对17.41±0.80,t=14.953,P<0.01).两组婴儿中纯母乳喂养时间至少4个月,6月龄时持续母乳喂养、辅助食品稠厚度和喂养次数差异无统计学意义(x2=0.723～2.701,P均>0.05).祖父母在上海婴儿的喂养照料中扮演着重要的角色,39.0%的婴儿完全由祖父母承担喂养和照料的责任,而23.0%的婴儿则由父母与祖父母共同承担.两组婴儿的主要喂养者、喂养者学历、婴儿喂养知识掌握差异无统计学意义(x2=0.175、0.446,t=0.949,P均>0.05).超重婴儿喂养者的喂养速度明显快于正常体质量婴儿(Z=2.753,P<0.01),超重婴儿喂养者在喂养过程中与婴儿的语言交流明显较少(Z=2.932,P<0.01).在超重婴儿中,喂养者的过度喂养行为与超重婴儿的BAZ呈显著正相关(r=0.281,P<0.05).结论 上海婴儿出生早期按身长体质量增长过快与某些婴儿喂养习惯相关.婴儿出生后前6个月按身长体质量增加过快是否会增加儿章期肥胖的风险值得进一步观察和研究.     

Inadequate feeding practices and impaired growth among children from subsistence farming households in Sidama, Southern Ethiopia

Whether current child feeding practices and behaviours among rural households in Sidama, Southern Ethiopia conform to the World Health Organization (WHO) guiding principles for complementary feeding is uncertain. We assessed socio-demographic status, anthropometry, breastfeeding, complementary feeding practices and behaviours, and motor development milestones in a convenience sample of 97 breastfed children aged 6–23 months from three rural Sidama communities. Energy and nutrient intakes from complementary foods were also calculated from 1-day in-home weighed records. Prevalence of stunting ranged from 25% for infants aged 6–8 months to 52% for children aged 12–23 months, whereas for wasting, the corresponding prevalence was 10% and 14%, respectively. Very few children were exclusively breastfed up to 6 months of age ( n  = 2), or received solids/semi-solids for the recommended minimum number of times containing the recommended number of food groups. Responsive feeding was not practised and no cellular animal products were consumed. Median intakes of energy, and intakes and densities of micronutrients from complementary foods (but not protein) were below WHO recommendations, assuming average breast milk intakes; greatest shortfalls were for retinol, vitamin C and calcium densities. Mothers of stunted children were shorter and lighter, and from households of lower socio-economic status than non-stunted children ( P  < 0.05). Acquisition of some motor development milestones was delayed in stunted infants compared with their non-stunted counter-parts. In conclusion, interventions that address the WHO guiding principles for complementary feeding practices and behaviours, as well as prenatal influences on growth, are urgently required in this setting.     

Infant feeding,growth monitoring and the double burden of malnutrition among children aged 6 months and their mothers in KwaZulu-Natal,South Africa

South Africa has a documented high prevalence of stunting and increasing obesity in children as well as obesity in adults. The double burden of malnutrition, which can be on an individual-, household- or population level, has implications for both health and the economic development of a community and country. This paper describes a large-scale survey (N = 774) of infant feeding, growth monitoring and anthropometry among mother and child pairs aged 6 months of age in KwaZulu-Natal (KZN), South Africa, conducted between January and August 2017. Among children, a large increase in the prevalence of stunting and obesity was seen between birth and 6 months of age increasing from 9.3% to 21.7% and 4.0% to 21.0%, respectively. 32.1% of the mothers were overweight [body mass index (BMI): 25.0–29.9] and 28.4% had obesity grade 1 (BMI: 30–<40). Although most mothers (93%; 563/605) initiated breastfeeding, the introduction of other foods started early with 17.6% (56/319) of the mothers having started giving other fluids or food to their child within the first month. At 6 months 70.6% (427/605) children were still breastfed and 23.5% were exclusively breastfed. In addition, we found that length measurements were done less frequently than weight measurements between birth and 6 months, on average 2.2 (SD: 1.3) versus 5.8 (SD: 1.5) times. Moreover, there is a need for improvement of health worker training and understanding regarding anthropometric measurements when assessing malnutrition in children in the clinics. Early detection and improved infant feeding practices are key in preventing both stunting and obesity in children.     

Social and behaviour change communication to improve child feeding practices in Ethiopia

Social and behaviour change communication (SBCC) interventions can positively affect optimal nutritional practices. This study evaluated the added value of a virtual facilitator tool to an enhanced community conversation (ECC) programme to improve infant and young child feeding (IYCF) practice among children under the Growth through Nutrition Activity programme in Ethiopia. The study used a quasi‐experimental design with a control group. Pregnant and/or lactating women were the study population for both study groups. The intervention (ECC + VF) group received all the same components as the control group but had the addition of in‐person ECC meetings supplemented with audio‐recorded virtual facilitators (VF) sessions designed to complement the monthly meeting lesson or topic. A difference in difference analysis was employed using generalized linear mixed model (GLMM) in Stata version 15.0 (Stata Corporation, College Station, TX). A p‐value of less than or equal to 0.05 was considered significant for all tests. Accordingly, a 13.6% change in iron folic acid (IFA) intake for 3 months and above was observed in the intervention group. Even though not statistically significant, large to moderate positive changes in child minimum diet diversity (20%), minimum acceptable diet (18%) and women diet diversity (7.9%) were observed in the intervention group. This study identified the use of virtual facilitators as a modality to transmit standard nutrition messages during ECC programmes for optimal IYCF practices. The findings strengthen the notion that using a combination of SBCC approaches has advantage over a single method in improving important nutritional practices.