Complementary feeding —Reasons for inappropriateness in timing,quantity and consistency

Objective  To assess the practice of complementary feeding (CF) in infants 6 month to 2 year, knowledge of mothers regarding CF, and reasons for inappropriate CF practices. Methods  CF practices were assessed in children aged 6 months to 2 years using semi-structured questionnaire. Demographic profile and mother’s knowledge regarding CF was recorded. Cause of inappropriate CF was ascertained by open-ended questions. Results  Among the 200 children studied, 32(16%) were not started on CF at all, and only 35 (17.5%) received CF from 6 months. Of the 168 who were started CF, mean age of starting feeds was 13.37 months. Quantity was adequate in 42(25%) and consistency of food was thick in 64(38%) cases. Only 7(3.5%) mothers started CF at proper time, in adequate quantity and with proper consistency. Knowledge of proper timing was present in 46% of children, adequate quantity in 46.5% and thick consistency in 25.5%. Only 16(8%) mothers had proper knowledge of all three aspects of CF. Knowledge regarding appropriate timing and consistency varied significantly with maternal education and paternal education (Chisquare P<0.05). On multiple logistic regression only maternal education of graduate level corelated with knowledge of timing of CF (P=0.089. OR-3.5, Cl 0.826–15.2). Most common reason for inappropriate practice in 154 mothers who delayed feeds was “tried but did not eat, vomits everything” (52%). Conclusion  CF practices were inappropriate and knowledge inadequate in majority of the children studied.     

Perspectives on maternal,infant, and young child nutrition and family planning: Considerations for rollout of integrated services in Mara and Kagera,Tanzania

In Lake Zone, Tanzania, low contraceptive prevalence, closely spaced births, and child stunting are common. Synergies exist between postpartum family planning (PPFP) and maternal, infant, and young child nutrition (MIYCN), yet health services are often provided in silos. This qualitative formative research study aimed to identify barriers and facilitating factors for optimal nutrition and PPFP practices in Mara and Kagera, Tanzania. Results informed the program design of an integrated nutrition and family planning (FP) implementation approach. The study involved in‐depth interviews with mothers of infants under 1 year (n = 24), grandmothers (n = 12), health providers (n = 6), and traditional birth attendants (n = 12), and 14 focus group discussions with community health workers, fathers, and community leaders. Findings reveal that breastfeeding initiation was often delayed, and prelacteal feeding was common. Respondents linked insufficient breast milk to inadequate maternal nutrition—in terms of the quality of the diet and small quantities of food consumed by mothers. Breast milk insufficiency was addressed through early introduction of foods and liquids. Mothers believed that breastfeeding prevents pregnancy, regardless of the frequency or duration of breastfeeding, yet were generally not aware of the lactational amenorrhea method (LAM) of FP. Joint decision‐making on FP was viewed as important, and women often discussed it with their partner. Future programming should address misconceptions about return to fecundity 1 1 Return to fecundity refers here to a woman's ability to become pregnant after childbirth
knowledge gaps and concerns about FP methods including LAM; and perceptions regarding insufficient breast milk and early introduction of foods which are impediments to optimal MIYCN and FP practices.     

Breastfeeding practices of HIV-positive and HIV-negative women in Kabarole district, Uganda

Ugandan policy regarding infant feeding for HIV-positive mothers is replacement feeding (RF), if feasible; otherwise, exclusive breastfeeding (EBF) for 3 months is advised (or EBF for 6 months, if RF is still not feasible). HIV-negative mothers should practise EBF for 6 months. The study objective was to explore the association between maternal HIV status and breastfeeding practices in Kabarole, Uganda. Data were collected from questionnaires administered at home to 182 women (44 HIV-positive and 138 HIV-negative) 3 months post-partum and from medical charts. The HIV-negative women were matched on delivery date to HIV-positive women at a ratio of 3:1. Interviewers were blinded to HIV status. There was no statistically significant association between adherence to Ugandan national feeding guidelines and maternal HIV status in bivariate analysis [odds ratio (OR) = 1.52; confidence interval (CI): 0.76-3.04]. Multivariate analyses showed a significant association between adherence to feeding guidelines and child illness (OR = 0.40; CI: 0.21-0.79) and between adherence to feeding guidelines and rural residence in Burahya county (OR = 2.43; CI: 1.15-5.13). Many mothers do not follow the feeding guidelines for HIV infection. This region-specific information on breastfeeding practice determinants will be used to inform local Prevention of Mother-to-Child Transmission (PMTCT) programmes. The nature of the association between child illness and EBF should be further explored.     

Behavioural drivers of suboptimal maternal and child feeding practices in Rwanda: An anthropological study

At 33% of under‐5s, stunting rates in Rwanda remain stubbornly high, as do figures for maternal (25% of pregnant women) and childhood anaemia (37%). Intensive communication and education campaigns have provided caregivers with high levels of knowledge about best practices in Maternal, Infant and Young Child Nutrition (MIYCN), but this is not translating into the improved diets which could contribute to reducing rates of stunting. Deploying an anthropological approach via multi‐module Focused Ethnographic Studies carried out within household case studies, the research team sought to understand drivers of suboptimal feeding practices in a sample of 30 households across all of Rwanda''s districts. The sample included households with pregnant women as well as children in the 6–60 month age range. Analysed against a framework of proximal and underlying causes of under‐nutrition, our results reveal gaps in the knowledge‐capability‐practice chain resulting from decisions and prioritisations taken by caregivers and heads‐of‐household. Pregnant women and mothers of young children possess high levels of knowledge about feeding themselves and their young children, but this is not reflected in decision‐making and prioritisation around the acquisition and feeding of animal source foods, whose consumption is low among both groups. This was found to be true even in households which own and raise livestock. Turning to policy and programmes, we argue for a move towards incentivized human capital programming focusing on the ‘last mile’ behaviour change which is needed to translate knowledge and capability into better dietary choices.     

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.     

Maternal knowledge regarding breast feeding and weaning practices

The study assessed the knowledge of mothers of the high income group of urban Baroda, related to breast feeding and weaning. Forty mothers with children aged 4 to 18 months were studied. Knowledge and practices regarding breast feeding and weaning were assessed using pretested questionnaires. Results indicated that only half the mothers breast fed their babies on the first day. Breast feeding was stopped when the child was 3–6 months; top feeding and solid supplements were initiated at 4–6 months. Mainly commercial baby foods were used for weaning.Most mothers avoided ‘dals’ for the child because these were believed to be difficult to digest and produced gas in the child’s stomach. Fifty percent of the mothers were not in favour of feeding the sick child with small frequent meals.     

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.     

An mHealth voice messaging intervention to improve infant and young child feeding practices in Senegal

Mobile health (mHealth) interventions have the potential to improve infant and young child feeding (IYCF) practices; however, gaps in the literature remain regarding their design, implementation, and effectiveness. The aims of this study were to design an mHealth voice messaging intervention delivered to mothers and fathers targeting IYCF practices and examine its implementation and impact in households with children 6–23 months in three rural villages in Senegal. We conducted focus groups (n = 6) to inform the intervention development. We then conducted a pilot study (n = 47 households) to examine the impact of the intervention on IYCF practices of children 6–23 months. Voice messages were sent to the children's mothers and fathers over a period of 4 weeks (two messages per week; eight messages in total), and 24‐hr dietary recalls and food frequency questionnaires (FFQs) were conducted before and immediately after the implementation of the mHealth intervention to examine its impact on IYCF practices. Overall, three of the eight behaviours increased and one decreased. There was a significant increase in the number of children that consumed fish (60% vs. 94%; p = .008) as measured by the 24‐hr recall after the completion of the intervention. We also found significantly higher frequency of egg (p = .026), fish (p = .004), and thick porridge (p = .002) consumption in the previous 7 days measured by the FFQ. Our findings suggest that voice messaging IYCF interventions in Senegal have the potential to improve IYCF behaviours among young children in the short term. Future research should entail scaling‐up the intervention and examining its sustainability over the long‐term.     

Factors associated with the introduction of complementary feeding in the French ELFE cohort study

The objectives of this study were to estimate the age of complementary feeding introduction (CFI) and investigate the related health, demographic, and socio‐economic factors. Analyses were based on 10,931 infants from the French national birth cohort ELFE, born in 2011. Health, demographic, and socio‐economic data concerning infants and parents were collected at birth (face‐to‐face interviews and medical records) and 2 months (telephone interviews). Data on milk feeding and CFI practices were collected at birth and 2 months then monthly from 3 to 10 months using online or paper questionnaires. The associations between both health and social factors and CFI age were tested by multivariable multinomial logistic regressions. The mean CFI age was 5.2 ± 1.2 months; 26% of the infants started complementary feeding before 4 months of age (CF < 4 months), 62% between 4 and 6 months of age, and 12% after 6 months of age (CF > 6 months). CF < 4 months was more likely when mothers smoked, were overweight/obese, younger (<29 years), and used their personal experience as an information source in child caregiving and when both parents were not born in France. CF < 4 months was less likely when the infant was a girl, second‐born, when the mother breastfed longer, and had attended at least one birth preparation class. Mothers of second‐born infants and who breastfed their child longer were more likely to introduce CF > 6 months. Couples in which fathers were born in France and mothers were not born in France were less likely to introduce CF > 6 months. CF < 4 months occurred in more than 25% of the cases. It is important to continue promoting clear CFI recommendations, especially in smoking, overweight, young, not born in France, and nonbreastfeeding mothers.     

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.     

Intimate partner violence and infant feeding practices in India: a cross‐sectional study

Intimate partner violence (IPV) is widespread; yet research is thin and equivocal regarding its potential adverse effects on infant feeding practices. With a national sample of 3552 mothers and infants aged 180 days or younger from the 2005–2006 National Family Health Survey for India, we used logistic regression to estimate the unadjusted and adjusted associations of maternal reported lifetime exposure to any IPV and to physical or sexual IPV with feeding practices at birth and in the prior 24 h. Compared with their unexposed counterparts, mothers exposed to any IPV and to any physical or sexual IPV had higher adjusted odds of giving their infant liquids [aOR 1.32, 95% confidence interval (CI) 1.04–1.66; aOR 1.37, 95% CI 1.08–1.75, respectively], and thus lower adjusted odds of exclusively breastfeeding their infant in the prior 24 h (aOR 0.78, 95% CI 0.62–0.98; aOR 0.74, 95% CI 0.58–0.95). Mothers exposed to physical or sexual IPV also had higher adjusted odds of feeding their infant solids in the prior 24 h (aOR 1.50, 95% CI 1.01–2.23). Exposure to IPV was not significantly associated with breastfeeding immediately after birth or with bottle feeding in the prior 24 h. Perinatal screening for IPV, and addressing IPV and feeding practices in exposed mothers, may improve maternal health and infant nutrition in similar settings.     

Determinants of infant nutrition status in rural farming households before and after harvest

Infant and young child feeding (IYCF) practices determine infant growth, development and health. Despite global recommendations for exclusive breastfeeding until 6 months, adherence rates are low worldwide for different reasons, largely dependent on environment. In low‐income countries, inappropriate IYCF leads to poor nutrition status. This study examined IYCF practices and nutrition outcomes in rural farming households in Tanzania before and after harvest. Mothers and their infants were recruited from two regions in Tanzania. Demographics, health status, IYCF practices, anthropometrics and haemoglobin were measured; preharvest and postharvest. Regression analysis modelled the relationship between IYCF and nutrition outcomes. Despite high rates of breastfeeding a large proportion did not meet early initiation of breastfeeding and minimum acceptable diet standards. Undernutrition was high with 30–40% of infants classified as stunted depending on season, and the majority (81%) were anaemic. Early initiation of breastfeeding was associated with higher Length‐for‐age z‐score and weight‐for‐age z‐score and lower risk of stunting and underweight (p < 0.05). The introduction of fluids other than breast milk in the first 3 days after birth was associated with lower weight‐for‐age z‐score and increased underweight (p < 0.05). Maternal age and height were strongly and positively associated with child anthropometrics. Findings confirm the importance of early infant feeding practices for growth and development and emphasize the significance of mother's nutrition status in relation to infant health. Future interventions should focus on improving maternal nutrition status before, during and after pregnancy as well as educating and supporting mothers to adopt appropriate infant feeding including breastfeeding practices for the prevention of undernutrition.     

Using formative research to design a context‐specific behaviour change strategy to improve infant and young child feeding practices and nutrition in Nepal

Global recommendations on strategies to improve infant feeding, care and nutrition are clear; however, there is limited literature that explains methods for tailoring these recommendations to the local context where programmes are implemented. This paper aims to: (1) highlight the individual, cultural and environmental factors revealed by formative research to affect infant and young child feeding and care practices in Baitadi district of Far Western Nepal; and (2) outline how both quantitative and qualitative research methods were used to design a context‐specific behaviour change strategy to improve child nutrition. Quantitative data on 750 children aged 12–23 months and their families were collected via surveys administered to mothers. The participants were selected using a multistage cluster sampling technique. The survey asked about knowledge, attitude and behaviours relating to infant and young child feeding. Qualitative data on breastfeeding and complementary feeding beliefs and practices were also collected from a separate sample via focus group discussions with mothers, and key informant interviews with mothers‐in‐law and husbands. Key findings revealed gaps in knowledge among many informants resulting in suboptimal infant and young child feeding practices – particularly with relation to duration of exclusive breastfeeding and dietary diversity of complementary foods. The findings from this research were then incorporated into a context‐specific nutrition behaviour change communication strategy.     

Breast feeding patterns in an urban resettlement colony of Delhi

Studies on duration and patterns of breast feeding based on recall may lead to a bias about the exact feeding status. The present study was designed to overcome the bias using the ‘current status analysis method’. Mothers of 650 infants from 0 to 12 months of age attending a Health Centre were interviewed about the current feeding patterns of the infants and other socioeconomic variables. Month-wise prevalence of feeding patterns was determined. It was observed that breast feeding was maintained at a high level (more than 90%) throughout infancy while exclusive breast feeding showed a rapid decline. At 1 month, 74% and at 4 months, 46% of infants were exclusively breast-fed. The median duration of exclusive breast feeding was 3.83 months. Mothers with lesser education and lower family income were more likely to exclusively breast feed (p < 0.05). The time interval between birth and first breast feed was 24–48 hours in most (48.9%) of the infants. Majority (76.9%) of the infants received pre-lacteal feeds. Hospital-born infants received their first feed earlier and were less likely to receive pre-lacteal feeds as compared to those bom at home (p < 0.001 ). Thus, the practice of exclusive breast feeding has to be promoted amongst pregnant and lactating mothers by health personnel. Also knowledge regarding infant feeding has to be imparted in schools and colleges.     

Infant-feeding practices and associated factors of HIV-positive mothers at Gert Sibande, South Africa

Aim: To assess knowledge, infant‐feeding education and practices, factors that affect choice of infant feeding option, determinants of mixed feeding, psychosocial challenges and attitudes of HIV‐positive women with infants between ages 3–6 months who attended prevention of mother‐to‐child transmission of HIV services in Gert Sibande district. Methods: A cross‐sectional study was conducted with 815 HIV‐positive mothers at 47 postnatal clinics. Trained field workers collected data at health facilities, using structured questionnaires. HIV‐infected women who were at least 18 years of age were interviewed. Results: The mean age was 27.7 years (SD 6.4). Seventy‐eight percent agreed that HIV could be transmitted by breastfeeding. Fifty per cent were exclusively formula feeding, 35.6% breastfed exclusively and 12.4% mixed fed. In multivariate analysis, having a vaginal delivery, infant hospital admissions, and currently pregnant were associated with mixed feeding. Being older, knowing the HIV status of the infant and higher knowledge on HIV transmission through breastfeeding were associated with formula feeding. Conclusion: The study identified gaps in prevention of mother‐to‐child transmission (PMTCT) knowledge and infant feeding policy which seem to affect appropriate infant feeding. Various determinants of mixed feeding and exclusive formula feeding in the context of PMTCT were identified that can guide infant feeding counselling and support services of PMTCT programmes.     

Do maternal perceptions of child eating and feeding help to explain the disconnect between reported and observed feeding practices?: A follow‐up study

Research demonstrates a mismatch between reported and observed maternal feeding practices. This mismatch may be explained by maternal cognitions, attitudes, and motivations relating to dyadic parent–child feeding interactions. These complex constructs may not be apparent during observations nor evidenced in self‐report questionnaire. Therefore, the aim of this study was to use a qualitative approach to gain a more nuanced and contextualized understanding of (a) maternal perceptions of children's food intake control; (b) how parent–child mealtime interactions influence maternal feeding practices; and (c) ways in which mothers may promote healthy child eating and weight outcomes. Semistructured telephone interviews were conducted with 23 mothers (M = 38.4 ± 3.7 years of age) of preschool‐aged children (M = 3.8 ± 0.6 years of age, 19 were normal weight, 14 were girls), who had previously completed child feeding questionnaire and participated in two home‐based mealtime observations, 12 months apart. Interviews were recorded, transcribed, and themes extracted to create the database. Four major themes emerged: (a) Maternal confidence in children's ability to regulate food intake is variable; (b) Implementing strategies for nurturing healthy relationships with food beyond the dining table; (c) Fostering positive mealtime interactions is valued above the content of what children eat; and (d) Situation‐specific practices and inconsistencies. Findings indicate that maternal feeding practices are shaped by both parent and child influences, and child feeding is mostly guided by controlling the family food environment, rather than by directly pressuring or restricting their child's eating. Results also highlighted the need for research to consider both parent and child influences on child feeding.     

Association between maternal depressive symptoms in the early post‐natal period and responsiveness in feeding at child age 2 years

Maternal depression is a known risk factor for poor outcomes for children. Pathways to these poor outcomes relate to reduced maternal responsiveness or sensitivity to the child. Impaired responsiveness potentially impacts the feeding relationship and thus may be a risk factor for inappropriate feeding practices. The aim of this study was to examine the longitudinal relationships between self‐reported maternal post‐natal depressive symptoms at child age 4 months and feeding practices at child age 2 years in a community sample. Participants were Australian first‐time mothers allocated to the control group of the NOURISH randomized controlled trial when infants were 4 months old. Complete data from 211 mothers (of 346 allocated) followed up when their children were 2 years of age (51% girls) were available for analysis. The relationship between Edinburgh Postnatal Depression Scale (EPDS) score (child age 4 months) and child feeding practices (child age 2 years) was tested using hierarchical linear regression analysis adjusted for maternal and child characteristics. Higher EPDS score was associated with less responsive feeding practices at child age 2 years: greater pressure [β = 0.18, 95% confidence interval (CI): 0.04–0.32, P = 0.01], restriction (β = 0.14, 95% CI: 0.001–0.28, P = 0.05), instrumental (β = 0.14, 95% CI: 0.005–0.27, P = 0.04) and emotional (β = 0.15, 95% CI: 0.01–0.29, P = 0.03) feeding practices (ΔR² values: 0.02–0.03, P < 0.05). This study provides evidence for the proposed link between maternal post‐natal depressive symptoms and lower responsiveness in child feeding. These findings suggest that the provision of support to mothers experiencing some levels of depressive symptomatology in the early post‐natal period may improve responsiveness in the child feeding relationship.     

Maternal knowledge in complementary feeding following Baby Friendly Community Initiative in Koibatek,Kenya

The Kenyan Ministry of Health has developed a National Strategy on Infant and Young Child Feeding with the goal of improving feeding practices for infants and children. In order to promote appropriate infant feeding, the government has explored implementation of the Baby Friendly Community Initiative (BFCI). This study assessed maternal knowledge of attributes of complementary feeding following implementation of BFCI in Koibatek, Kenya. A randomized control study composed of 270 mother–infant pairs previously enrolled in a BFCI programme in Koibatek was conducted. The study found that a significantly greater number of mothers in the intervention group were more knowledgeable about proper breastfeeding and complementary feeding aspects compared with controls (P ≤ 0.001). About half (53%) of mothers in the intervention group had high knowledge scores in comparison with 20% of mothers in the control group. When the relationship between mothers' knowledge and complementary feeding practices (minimum meal frequency, minimum dietary diversity and minimum acceptable diet) was assessed, significant associations were observed (P = 0.010, P ≤ 0.001 and P ≤ 0.001, respectively). The odds of having a high knowledge score regarding complementary feeding practices were significantly higher for the intervention group compared with the control group (odds ratio [OR]: 25.98, 95% confidence interval [CI] 13.62–49.55, P ≤ 0.001). The BFCI intervention effectively improved mothers' knowledge on complementary feeding and correlated with improved feeding practices.     

Infant temperament,maternal feeding behaviours and the timing of solid food introduction

Despite guidance from the World Health Organization and the U.K. Department of Health, many mothers introduce solid food before their infant is 6 months old. The current study aimed to investigate relationships between maternal feeding behaviours (preintroduction and postintroduction to solids), infant temperament, and the timing of introduction to solid food. Eighty‐one women were recruited on low‐risk maternity units and were contacted at 1 week, 3, and 6 months postpartum. Mothers of infants (45 males, 36 females, mean birth weight 3.52 kg [SD 0.39]) completed the behaviours component of the Infant Feeding Style Questionnaire via telephone interview at 3 months. At 6 months, they were observed feeding their infant solid food at home and reported infant temperament using the Infant Behaviour Questionnaire‐Revised (short form). Partial correlations (covariates: birth weight, maternal age, breastfeeding duration, and postnatal depression) revealed negative associations between age of introduction to solid food and temperament (smiling and laughter) and laissez‐faire milk feeding behaviours; and positive associations between age of introduction to solid food and restrictive milk feeding behaviours and verbal involvement during an observed mealtime. Hierarchical multiple regression analysis revealed that an infant's birth weight and the degree to which their mothers perceive them to smile and laugh are key predictors of when they will be introduced to solid food, over and above other variables of interest (e.g., maternal milk feeding behaviours, breastfeeding duration, and postnatal depression).     

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.