TY - JOUR
T1 - Beyond food insecurity
T2 - How context can improve complementary feeding interventions
AU - Paul, Keriann H.
AU - Muti, Monica
AU - Khalfan, Sabra S.
AU - Humphrey, Jean H.
AU - Caffarella, Rosemary
AU - Stoltzfus, Rebecca J.
PY - 2011/9
Y1 - 2011/9
N2 - Background. The role of context has not been elaborated with respect to current recommendations for complementary feeding interventions, apart from a gross distinction based on food security. Objective. Our objective was to compare two foodinsecure settings in sub-Saharan Africa to determine how context (i.e., the set of local social, cultural, and physical circumstances) influences complementary feeding practices and nutrient intakes and how the results can help in the design of a suitable intervention strategy. Methods. We conducted formative research using 24-hour dietary recalls, household interviews, and focus group discussions with mothers of 6- to 12-month-old infants in rural Zimbabwe (n = 32) and Pemba Island, Zanzibar, Tanzania (n = 44). Results. In both settings, many infants had suboptimal nutrient intakes, poor dietary diversity, and poor hygiene. Breastfeeding practices were poor in Pemba, and the infants' diet had low energy density in Zimbabwe. Beyond food insecurity, contextual determinants of practices included inaccurate indigenous knowledge, time-consuming maternal livelihoods, family eating behaviors, local agriculture, and the local ecosystem. Both settings would require nutrition education, but it should target the broader indigenous ways of learning and family eating behaviors in order to achieve the necessary behavior change. A home-based fortificant would probably be enough for Pemban children, because the ecosystem of the island provides sufficient sources of macronutrients. However, Zimbabwean children appear to need a fortified food-based supplement to overcome the poor agricultural and economic context. Conclusions. Assessing context was essential to intervention design. A framework to guide future formative research is proposed.
AB - Background. The role of context has not been elaborated with respect to current recommendations for complementary feeding interventions, apart from a gross distinction based on food security. Objective. Our objective was to compare two foodinsecure settings in sub-Saharan Africa to determine how context (i.e., the set of local social, cultural, and physical circumstances) influences complementary feeding practices and nutrient intakes and how the results can help in the design of a suitable intervention strategy. Methods. We conducted formative research using 24-hour dietary recalls, household interviews, and focus group discussions with mothers of 6- to 12-month-old infants in rural Zimbabwe (n = 32) and Pemba Island, Zanzibar, Tanzania (n = 44). Results. In both settings, many infants had suboptimal nutrient intakes, poor dietary diversity, and poor hygiene. Breastfeeding practices were poor in Pemba, and the infants' diet had low energy density in Zimbabwe. Beyond food insecurity, contextual determinants of practices included inaccurate indigenous knowledge, time-consuming maternal livelihoods, family eating behaviors, local agriculture, and the local ecosystem. Both settings would require nutrition education, but it should target the broader indigenous ways of learning and family eating behaviors in order to achieve the necessary behavior change. A home-based fortificant would probably be enough for Pemban children, because the ecosystem of the island provides sufficient sources of macronutrients. However, Zimbabwean children appear to need a fortified food-based supplement to overcome the poor agricultural and economic context. Conclusions. Assessing context was essential to intervention design. A framework to guide future formative research is proposed.
KW - Complementary feeding
KW - Context
KW - Food supplementation
KW - Infant and young child feeding
KW - LiNS
UR - http://www.scopus.com/inward/record.url?scp=80052718006&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=80052718006&partnerID=8YFLogxK
U2 - 10.1177/156482651103200308
DO - 10.1177/156482651103200308
M3 - Review article
C2 - 22073798
AN - SCOPUS:80052718006
SN - 0379-5721
VL - 32
SP - 244
EP - 253
JO - Food and nutrition bulletin
JF - Food and nutrition bulletin
IS - 3
ER -