Linking agriculture and nutrition education to improve infant and young child feeding: Lessons for future programmes (original) (raw)
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The British journal of nutrition, 2016
Poor infant and young child feeding (IYCF) practices are major determinants of chronic malnutrition. The main objective of this study was to assess the impact of a nutrition education (NE) programme aimed at promoting improved IYCF behaviours in combination with an agriculture intervention on children's dietary diversity and nutritional status. From 2012 to 2014, a cluster randomised trial was rolled out in Cambodia in the context of an agriculture and nutrition project of the FAO of the UN. The cross-sectional baseline study was carried out in sixteen pre-selected communes in 2012. Restricted randomisation allotted the communes to either intervention (NE and agriculture intervention) or comparison arms (agriculture intervention only). The impact survey was conducted as a census in all FAO project villages in 2014. Caregivers of children aged 0-23 months were interviewed using standardised questions on socio-economic status and dietary diversity (24-h recall). Anthropometric mea...
Improving child nutrition and development through community based childcare centres in Malawi
http://isrctn.com/, 2016
Background: The Nutrition Embedded Evaluation Programme Impact Evaluation (NEEP-IE) study is a cluster randomised controlled trial designed to evaluate the impact of a childcare centre-based integrated nutritional and agricultural intervention on the diets, nutrition and development of young children in Malawi. The intervention includes activities to improve nutritious food production and training/behaviour-change communication to improve food intake, care and hygiene practices. This paper presents the rationale and study design for this randomised control trial. Methods: Sixty community-based childcare centres (CBCCs) in rural communities around Zomba district, Malawi, were randomised to either (1) a control group where children were attending CBCCs supported by Save the Children's Early Childhood Health and Development (ECD) programme, or (2) an intervention group where nutritional and agricultural support activities were provided alongside the routine provision of the Save the Children's ECD programme. Primary outcomes at child level include dietary intake (measured through 24-h recall), whilst secondary outcomes include child development (Malawi Development Assessment Tool (MDAT)) and nutritional status (anthropometric measurements). At household level, primary outcomes include smallholder farmer production output and crop-mix (recall of last production season). Intermediate outcomes along theorised agricultural and nutritional pathways were measured. During this trial, we will follow a mixed-methods approach and undertake child-, household-, CBCC-and market-level surveys and assessments as well as in-depth interviews and focus group discussions with project stakeholders. Discussion: Assessing the simultaneous impact of preschool meals on diets, nutrition, child development and agriculture is a complex undertaking. This study is the first to explicitly examine, from a food systems perspective, the impact of a preschool meals programme on dietary choices, alongside outcomes in the nutritional, child development and agricultural domains. The findings of this evaluation will provide evidence to support policymakers in the scale-up of national programmes.
Ecology of Food and Nutrition, 2017
This study assessed caregivers' knowledge and practices and factors that influence the adoption of improved infant and young child feeding (IYCF) practices after nutrition education in Kasungu and Mzimba districts among 198 caregivers. Mixedmethods convergent-parallel design, including knowledge tests, focus group discussions, and in-depth interviews in the intervention areas, was used to collect quantitative and qualitative data. Data were analyzed using count regression and content analysis, which showed that knowledge increased among caregivers after nutrition education. The knowledge about diet diversification for young children as well as about hygienic practices when preparing food and during feeding improved in addition. Enhanced health among children motivated caregivers to apply improved IYCF practices. The study was based on the caregivers' reports. Long-term effects of exposure to nutrition education are unknown. However, the nutrition education that focused on the child's health benefits motivated mothers to adopt improved IYCF practices.
The Lancet, 2013
Alderman, and the Maternal and Child Nutrition Study Group* Acceleration of progress in nutrition will require eff ective, large-scale nutrition-sensitive programmes that address key underlying determinants of nutrition and enhance the coverage and eff ectiveness of nutrition-specifi c interventions. We reviewed evidence of nutritional eff ects of programmes in four sectors-agriculture, social safety nets, early child development, and schooling. The need for investments to boost agricultural production, keep prices low, and increase incomes is undisputable; targeted agricultural programmes can complement these investments by supporting livelihoods, enhancing access to diverse diets in poor populations, and fostering women's empowerment. However, evidence of the nutritional eff ect of agricultural programmes is inconclusive-except for vitamin A from biofortifi cation of orange sweet potatoes-largely because of poor quality evaluations. Social safety nets currently provide cash or food transfers to a billion poor people and victims of shocks (eg, natural disasters). Individual studies show some eff ects on younger children exposed for longer durations, but weaknesses in nutrition goals and actions, and poor service quality probably explain the scarcity of overall nutritional benefi ts. Combined early child development and nutrition interventions show promising additive or synergistic eff ects on child development-and in some cases nutrition-and could lead to substantial gains in cost, effi ciency, and eff ectiveness, but these programmes have yet to be tested at scale. Parental schooling is strongly associated with child nutrition, and the eff ectiveness of emerging school nutrition education programmes needs to be tested. Many of the programmes reviewed were not originally designed to improve nutrition yet have great potential to do so. Ways to enhance programme nutrition-sensitivity include: improve targeting; use conditions to stimulate participation; strengthen nutrition goals and actions; and optimise women's nutrition, time, physical and mental health, and empowerment. Nutrition-sensitive programmes can help scale up nutrition-specifi c interventions and create a stimulating environment in which young children can grow and develop to their full potential.
Assessing Early Childhood Nutritional Practices in Rural Uganda
Ubc Medical Journal, 2014
OBJECTIVE: According to the 2011 Uganda Nutrition Action Plan, 40 per cent of children under the age of five are malnourished. As local healthcare leaders identify childhood malnutrition as an ongoing problem in the rural village of Nakaseke, Uganda, this study aimed to assess early childhood nutritional practices in Nakaseke, and to identify barriers to healthy nutritional practices in order to create sustainable interventions. METHODS: Data was collected using seven focus groups with a total of 46 participants including community health workers, village health teams, and community members. The interviews were conducted in Luganda using a translator, and were audio recorded, transcribed, and analyzed for common themes. RESULTS: General poverty and lack of knowledge were identified as two major barriers to healthy nutritional practices in the community. Poverty left many homes unable to afford certain nutrition-rich foods, an issue compounded by the lack of family planning resulting in large families. A general lack of knowledge contributed to the inappropriate cessation of breastfeeding and the improper introduction of complementary foods, and was due in part to a lack of proper education. CONCLUSION: This study identified a continued need for education on nutrition within the community. With a better understanding of current practices and beliefs, we can now collaborate with the community to create sustainable interventions to address their specific needs while taking into account their financial restraints.
Public Health Nutrition, 2020
Objectives:To identify the drivers and challenges of successful nutrition programme implementation in a multisectoral, community-level approach to improve infant and young child feeding (IYCF) practices in northern Burkina Faso.Design:A qualitative study was conducted in 2019 through (i) individual interviews with key informants from five different sectors (health, agriculture, environment, livestock and education) and association staff, agents and community leaders and (ii) focus groups with mothers of children under the age of 2 years.Setting:Three health districts in the northern region of Burkina Faso implemented a multisectoral community nutrition programme to improve IYCF practices.Participants:Forty-seven implementing actors and twenty-four beneficiary mothers.Results:Factors influencing successful implementation include community participation; sector commitment and involvement; the existence of nutrition champions; capacity building; the integration of interventions; micron...
2017
my study supervisors, for their consistent support, encouragement and expert guidance throughout the course of this study. The Ministry of Agriculture and Water Development, Malawi, for granting me study leave to undertake my studies. The administration and staff of Mzimba-north district Agriculture Office, Malawi, for their inputs and support throughout the data collection of the study. The parents and caregivers of children, aged zero to two years, and local leaders from Mzimba-north district, Malawi, for participating in the study. Prof Piet J Becker, University of Pretoria, for the statistical analysis of all the quantitative data for the study. My colleagues, Justice Munthali, Chido Zambuko, Dr Debbie Kupolati and Temitope Bello for their moral support. Mwabi Mkandawire, Jimmy Mkwinda, Moses Phiri, Mrs Mhango and field extension workers of Mzimba-north district for assisting in the data collection; and Glory Munthali, Alinafe Msiska and Estrida Nyirenda for assisting with the data entry. Mr H Mzumala and Mr R C Lungu for their assistance in translating the questionnaires and interview guides. Mr Raphael Msyali for encouragement and moral support. Finally, my parents, Mrs N Ziba and Mr K Kumwenda, and brother, Wanangwa Kumwenda, for their love, concern, prayers, encouragement and support throughout the study. © © U Un ni iv ve er rs si it ty y o of f P Pr re et to or ri ia a iii ABSTRACT Introduction: Adequate nutrition knowledge, positive attitudes and perceptions, and good practices of parents on infant and young child feeding (IYCF), among others, are essential for the optimal growth of children. Hence, the involvement of both parents in IYCF is essential. Aim: To explore and describe the involvement of both biological parents and caregivers in IYCF in Mzimba-north district, Malawi by assessing their nutrition knowledge, attitudes, perceptions and practices, and identifying the factors that affected their involvement. Study design: A cross sectional descriptive study employing quantitative and qualitative research methodologies. Setting: Five agriculture extension planning areas in Mzimba-north district, Malawi. Sampling technique: Stratified random sampling in the quantitative domain and purposive sampling in the qualitative domain. Sample: Quantitative domain: Households [mothers (n = 154) and fathers (n = 127)] with children aged zero to 24 months and caregivers (n = 4) where the biological parents were absent. Qualitative domain: A different sample of fathers (n = 41), mothers (n = 53) and local leaders (n = 3). Methodology: Quantitative domain: Participants were stratified into three groups based on the age of their children, i.e. <six months, six to 12 and >12 to 24 months. Data were collected using modified FAO nutrition knowledge, attitudes and practices (KAP) questionnaires. Data were analysed using Stata version 14.0 and Microsoft Excel 2013 version. The Chi-square, Fisher's exact and McNemar's tests were used to compare the nutrition KAP between males and females. Testing was done at 0.05 significance level. Qualitative domain: Eleven focus group discussions (FGDs): five with males and six with females, and three in-depth interviews with three local leaders were conducted using three interview guides (one for each group). Creswell's method of data analysis was used to identify themes and sub-themes. Ethical approval was obtained from the Ethics Committee, Faculty of Natural and Agricultural Sciences, University of Pretoria (Ref no EC151204-26) and the Ministry of Agriculture, Mzuzu Agriculture Development Division, Malawi. © © U Un ni iv ve er rs si it ty y o of f P Pr re et to or ri ia a Results: Quantitative domain: More than half of the participants knew the recommended IYCF practices. More than 80% of the participants showed positive attitudes on the appropriate IYCF practices. No significant differences were observed between the male and female participants' mean knowledge scores and their responses on the attitude statements (P > 0.05). All participants with children <six months reported having their children breastfed both during the previous day and night. Half of the children <six months were exclusively breastfed. Poor food diversity with low consumption of animal foods was observed for children aged six to 24 months. The majority of the participants reported to have given their children food from only two food groups out of seven food groups. Qualitative domain: The participants identified the roles of mothers, fathers and local leaders in IYCF; mothers had direct roles while fathers and local leaders had supporting roles. The roles and influence of grandmothers on IYCF were also discussed. The participants identified the motivating factors and the factors limiting parental involvement in IYCF, and made recommendations on improving parental involvement in IYCF. Conclusion: Findings from the qualitative study were in support of quantitative study findings. Both parents were involved in IYCF. However, mothers had direct roles while fathers had supporting roles. Good nutrition knowledge, positive attitudes and perceptions, and poor practices on IYCF were reported. Recommendations: Participants in the FGDs made recommendations on improving parental involvement in IYCF. Recommendations are also made for future research and the implementation of IYCF practices in Mzimba-north district, Malawi.
Priority interventions to improve maternal and child diets in Sub-Saharan Africa and South Asia
Maternal & child nutrition, 2017
Nutrition-sensitive interventions to improve overall diet quality are increasingly needed to improve maternal and child health. This study demonstrates feasibility of a structured process to leverage local expertise in formulating programmes tailored for current circumstances in South Asia and Africa. We assembled 41 stakeholders in 2 regional workshops and followed a prespecified protocol to elicit programme designs listing the human and other resources required, the intervention's mechanism for impact on diets, target foods and nutrients, target populations, and contact information for partners needed to implement the desired programme. Via this protocol, participants described 48 distinct interventions, which we then compared against international recommendations and global goals. Local stakeholders' priorities focused on postharvest food systems to improve access to nutrient-dense products (75% of the 48 programmes) and on production of animal sourced foods (58%), as wel...
Challenges and responses to infant and young child feeding in rural Rwanda: a qualitative study
Journal of Health, Population and Nutrition, 2019
BackgroundDespite different interventions to improve child nutrition conditions, chronic malnutrition is still a public health concern in Rwanda, with a high stunting prevalence of 38% among under 5-year-olds children. In Rwanda, only 18% of children aged 6–23 months are fed in accordance with the recommendations for infant and young child feeding practices. The aim of this study was to explore challenges to infant and young child feeding practices and the responses applied to overcome these challenges in Muhanga District, Southern province of Rwanda.MethodsSixteen (16) focus group discussions were held with mothers, fathers, grandmothers, and community health workers from 4 rural sectors of Muhanga District. The discussions were recorded, transcribed verbatim, and thematically analyzed using qualitative data analysis software, Atlas.ti.ResultsTwo main themes emerged from the data. Firstly, there was a discourse on optimal infant and young child feeding (IYCF) practices that reflects the knowledge and efforts to align with early initiation of breastfeeding, exclusive breastfeeding for the first 6 months, as well as initiation of complementary foods at 6 months recommendations. Secondly, challenging situations against optimal practices and coping responses applied were presented in a discourse on struggling with everyday reality. The challenging situations that emerged as impeding appropriate IYCF practices included perceived lack of breast milk, infant cues, women’s heavy workload, partner relations and living in poverty. Family and social support from community health workers and health facility staff, financial support through casual labor, and mothers saving and lending groups, as well as kitchen gardens, were used to cope with challenges.ConclusionFactors influencing IYCF practices are multifaceted. Hence, intervention strategies to improve child nutrition should acknowledge the socially embedded nature of IYCF and address economic and social environmental constraints and opportunities, in addition and above knowledge only.