Is Feeding Style Associated With Dietary Intake And Nutritional Status In Ghanaian Children 1 3 Years Of Age

A study was conducted in the Manya Krobo district of Ghana with the objective of studying young child feeding practices and child nutrition situation in the area. The study was a cross-sectional survey involving 400 mothers with young children between 0 and 18 months. A combination of methods, including structured interviews using questionnaire, dietary assessment and anthropometry, was used to collect data for the study. The data obtained were analysed using spss version 10 in Windows. Means and standard deviations were generated for continuous variables and frequency distribution for categorical variables. The results revealed that although breastfeeding rates were high (97%), complementary feeding practices were less than ideal with as many as 14% of the children being introduced to complementary foods below the age of 3 months. The nutritional quality of complementary foods were poor and the prevalence of stunting among the children was high (20%). For adequate complementary feeding and improved child nutrition in this population, nutrition education intervention programmes aimed at improving nutrient intake among young children, through improved diet diversity and increased use of local foods rich in iron and other nutrients, need to be undertaken.

"Inappropriate complementary feeding (CF) practices and inadequate nutrient intakes contribute to the high level of malnutrition among children 6-24 months of age in Ghana. In communities where the economy is agricultural-based, interventions aimed at addressing malnutrition among infants and young children may need to focus on both food production and caregivers' nutrition knowledge. The aim of this study was to assess the effectiveness of a combined nutrition and agricultural education intervention, delivered through community health workers and agricultural extension agents, to improve infant and young child diet and growth in the Upper Manya Krobo district of Ghana. The current CF practices, and facilitators and barriers of CF education were identified through in-depth interviews of community health workers (n = 28) and staff of the Ministry of Food and Agriculture (n = 3), as well as three focus group discussions with caregivers (n = 22) of children 6-24 months of age. The Trials of Improved Practices method was used to test the feasibility of potential nutrition education messages. This process guided the development of the subsequent intervention. A cluster-randomised study design was used to compare the feeding practices, nutrient intakes, and growth of infants and young children (n = 367) in two intervention groups (combined nutrition and agricultural education [IE], nutrition education only [NE]), and a control group [CT]. Each child's diet and anthropometric data, and household demographic and agricultural production information were collected at baseline and at three-month intervals for nine months. Food insecurity can influence the types and amounts of food that young children consume, which may then affect their nutritional status and health. Therefore, the level of household food insecurity during the pre-harvest season and its relation with infant morbidity and growth were also assessed (n = 333). The results indicate that in this rural setting, 21.6% of households experienced food insecurity in the previous month. Household food insecurity was associated with respiratory infections in the second half of infancy, but not with diarrhea or stunting. Inclusion of animal source products, fruits, and vegetables in young children's diet was not common in the area. Poverty and maternal time constraints, and lack of teaching materials and language barrier, were identified as challenges to optimal CF practices and provision of CF education, respectively. Almost half of intervention mothers (45%) never attended an education session. Children in the IE were twice as likely to meet the minimum meal frequency compared to the CT children (aOR = 2.62; 95% CI; 1.11, 6.16), but energy, vitamin A, calcium, and iron intakes from complementary foods, and growth indicators did not differ among the three groups. Additionally, children of mothers who attended at least one nutrition education session in the IE group tended to receive the minimum acceptable diet (aOR = 2.30, 95% CI; 0.98, 5.39, p = 0.055) compared to children in the CT group at the end of the study. There were no differences between the two intervention groups, and feeding practices among children in the NE group did not improve at the end of the study. Future education interventions will need to increase the involvement of participants at the development phase of interventions, as a way of improving participation among caregivers of infants and young children." --

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The prevalence of stunting (30%) and wasting (9%) among children under the age of five years (U5) in Guinea have seen little decline in the past decade. One contributor to the high prevalence of stunting and wasting among children U5 is poor diet quality. In 2018, less than half of children 6 -- 23 months consumed the recommended food groups (15%) and meals (25%) per day to meet their nutrient requirements. However, there has been little qualitative or quantitative research conducted over the past decade to explore the multilevel determinants of infant and young child (IYC) diets and growth outcomes in Guinea. The United Nations Children's Fund (UNICEF) conceptual framework theorizes the immediate (diet, care), underlying (food, practices, services), and enabling determinants (resources, norms, governance) determinants of maternal, infant, and young and child nutrition (MIYCN). However, the UNICEF framework does not provide a robust model for exploring the factors shaping IYC diets, an immediate determinant of nutritional status. However, the Ecological Model of Food and Nutrition (EMFN) has been used for over 50 years to explore the various factors influencing diets across contexts. In addition to immediate determinants such as diet, caregiver feeding style is an underlying determinant of IYC diets and nutritional status. However, there has been little work conducted across low-and-middle income-countries including Guinea to understand the relationship between caregiver feeding styles and IYC dietary quality. Finally, enabling determinants including programs and policies are upstream factors that shape IYC diets and nutritional status. UNICEF recommends intervening through water, sanitation, and hygiene (WASH), social protection, food, and health systems to improve IYC diets and growth outcomes. However, to our knowledge, no study has systematically explored what evidence-based program modalities across systems are being supported by policies or programs in Guinea. To better understand key immediate, underlying, and enabling determinants of IYC nutritional status, this study sought to explore the infant feeding practices and inform strategies to improve MIYCN in Guinea. To fill this research gap, our first study sought to understand what factors are associated with infant dietary diversity score (DDS) in Forécariah, Guinea. To assess and define factors that shape infant DDS, a dietary assessment and survey were administered to caregivers of indexed infants (6 -- 9 months). Then, to understand the factors shaping infant diets, 3-hour observations were conducted among indexed infants (n = 81) and interviews were conducted with caregivers (n = 34) and community leaders (n = 13). A stepwise linear regression was used to understand what factors were significantly associated with infant DDS. Textual data were then analyzed deductively using the EMFN to understand how different factors shape the feeding practices of caregivers who fed infants a more diverse diet from those who did not. Findings from our study revealed that food insecurity, maternal time, and feeding advice received through various channels (i.e., radio, interpersonal) shape caregiver feeding behaviors and infant diet. Factors found to be positively associated with infant dietary diversity scores include having access to water in the household, feeding infants the same foods as primary caregivers weekly, owning land for homestead food production, and infant age. Conversely, adhering to food taboos was negatively associated with infant dietary diversity score. Imported foods were symbolized as 'clean' and locally sourced foods were symbolized as 'unclean' caregivers who fed less diverse diets. Our second study sought to understand what caregiver feeding styles are being employed by indexed caregivers and how they relate to infant DDS in Forécariah, Guinea. To define caregiver feeding styles we carried out 3-hr observations of indexed infants (n = 81), Then, to understand how and why caregivers were employing these feeding styles we carried out interviews among a subset of indexed caregivers (n = 34). Quantitative data from direct observations were subjected to k-medoid cluster analysis and textual data were analyzed using content analysis. Findings from our study revealed that three distinct feeding styles were being employed in Forécariah, Guinea including responsive, forceful, and uninvolved. Most caregivers in our sample carried out responsive feeding behaviors but fed their infants the least diverse diets. Drivers of responsive, forceful, and uninvolved feeding styles included maternal time, caregiver trust in the infant's hunger and satiety cues, and cues associated with an infant being developmentally ready to self-feed, respectively. Our third study sought to understand how current policies and programs can be leveraged to improve MIYCN in Guinea. To understand the current policy and program environment, we conducted a narrative literature review of operating programs (i.e., 2019-2022) and policies across systems. Then, to understand what factors shape program implementation, we conducted semi-structured interviews with stakeholders (n = 20) across systems. Textual data were analyzed using a content analysis approach guided by the UNICEF systems framework and a nutrition implementation science framework. Findings revealed that most evidence-based program modalities across systems were being cited in policy (25/32) and program documents (28/32). Salient factors identified to be shaping programs during interviews included poor policy development, suboptimal funding, variable stakeholder technical knowledge, low provider-to-beneficiary ratios, substandard program planning, scale-up, and resources at the community level. However, the most salient factor discussed across domains was programming planning and scale-up which was namely due to duplication of activities, poor supply chains, funding-related constraints, and suboptimal integration of activities across systems and within systems. Findings from our study suggest that multilevel determinants shape infant diets in Forécariah but also MIYCN in Guinea at large. Food taboos identified in this study and intervention approaches that have been successful in shifting social norms in other contexts could be used to dismantle food taboos and improve infant DDS in Forécariah, Guinea. Findings from this research also indicate that policymakers in Guinea may also consider introducing guidelines against advertising of IYC foods in line with WHO guidance to improve infant DDS. Findings from our second study could be used to generate tailored messaging to encourage caregivers to feed responsively during mealtimes. Finally, findings from our third study could be used as a guide for stakeholders across systems in Guinea to leverage the integration of currently operating programs to improve MIYCN using a multisectoral approach.

List of tables; Education of caregiver; Knowledge, attitudes, and beliefs of caregiver; Physical health and nutritional status of caregiver; Mental health, self-confidence, and lack of stress of caregiver; Autonomy and control of resources in the household by caregiver; Workload and time availability of caregiver; Social support for caregiver; Estimates of time spent on child care from observation and recall; Feeding practices: caregiver-child interactions; Feeding practices: child variables; Psychosocial care: child and caregiver interactions; Psychosocial care: child variables; Illustrations; The unicef conceptual model; The extended model of care; The transactional model of care; Pathways of interaction of education with caregiving; Possible pathways of interaction of maternal health and caregiving; Summary; Introduction; Developments in conceptualizing care; Resources for care; Care practices.

Product Description The Ghanaian Woman's Guide to Feeding Babies and Toddlers, written and reviewed by a team of maternal and child nutrition experts -- is a complete nutrition guide to breastfeeding, formula feeding, complementary feeding, handling picky eaters and food allergies. Overview Get the know-how to prepare healthy foods for your child. Everything you need to make the most of your breastfeeding experience. Helpful information & support for mothers who opt for infant formula. Stage-by-stage guide of what to feed and how to feed your baby. Packed with easy-to-follow homemade Ghanaian recipes. Practical advice to solve feeding problems such as colic, gastrointestinal challenges, fussy eaters and expand your child's diet. Review ''Having started reading this book, leaving it for long became difficult until I read to the last page. This is really a great informative handbook for all mothers feeding their toddlers and infants. I wish I had read it before now, but since there is always a second chance, I am making the best nutrition choices for my toddlers from now on. I strongly recommend this book for all mums of toddlers, pregnant women and especially first-time mums. It is one of the best gifts you can bless yourself or a loved one with.'' --Agbele Olusola, Mother ''This guide to feeding babies and toddlers is a number one go-to resource and a must-have book not only for mothers but for health professionals and dad's as well. It is a comprehensive guide with well organised content. With this book, every woman or caregiver can now give a sigh of relief on matters related to feeding their babies and children.'' --Eunice Nortey, Dietician Authors Asare Emmanuel Domfeh, RD, PhD Dr. A E Domfeh is a specialist in maternal and infant nutrition. He is a graduate of University of Ghana and King's College London, UK. He has served as a dietician at Ridge Hospital, Princess Marie Louise Children's Hospital and the Volta River Authority Clinic in Accra, Ghana. He also worked with the 37 Military Hospital, Ghana, as a dietician and as an instructor for students on clinical placement. Emmanuel has also served as a community nutrition officer for the World Food Programme and with UNICEF Ghana, where he was involved in projects aimed at improving maternal and child nutrition. Gladys Peprah Boateng, RD, PhD Dr. G P Boateng is graduated of Howard University, USA and University of Ghana. She worked as a dietitian with the Department of Human Services, Children's Hospital, and Anacostia Health Centre, USA. She is the former president of the Ghana Dietetics Association. She is a retired Chief Dietitian, 37 Military Hospital Diet Therapy Unit. She has participated and published several research and manuals on nutrition. She taught at the Nursing and Midwifery College of the 37 Military Hospital and was a preceptor for medical, dietetics, nutrition and catering students. She is a member of the Professions Specific Committee of Allied Health Professional Council. Dr. Peprah Boateng currently serves as a part-time lecturer at the Department of Nutrition and Dietetics, University of Ghana. Eunice Berko Nartey, RD, MPhil Eunice Berko Nartey is a lecturer with the Department of Nutrition and Dietetics, UHAS, Ho, Ghana. She has worked as a dietitian with a number of private hospitals and organisations in Accra and Tema, Ghana. She has also presented scientific papers at a number of seminars and conferences organised both locally and internationally on infant feeding. She is currently pursuing her PhD in Nutrition from the University of Ghana where she had her MPhil. and BSc. degrees.