Exclusive breastfeeding duration during the first 6 months of life is positively associated with length-for-age among infants 6-12 months old, in Mangochi district, Malawi.

OBJECTIVES: To examine the association between breastfeeding pattern and growth in the first year of life. METHODS: A cross-sectional survey was carried out on 349 mothers with infants <12 months in a rural and a semi-urban community in Mangochi district, Malawi. Data on socio-demographic characteristics, infant weight, length and feeding patterns since birth were collected. Multivariate linear regression was performed to test the association between feeding pattern and infant anthropometric status. RESULTS: Exclusive breastfeeding (EBF) until 6 months was practised by 13.1% semi-urban and 1.3% rural mothers. No infant was exclusively breastfed beyond 6 months. Breastfeeding was continued among all infants who had stopped EBF. Among infants 6-12 months of age, duration of EBF during the first 6 months was positively associated with length-for-age Z-score (LAZ) (regression coefficient=0.19, 95% confidence interval: 0.06, 0.31) in a model adjusted for socio-demographic factors. Urban residence and female gender yielded positive associations in the same model. The model explained 27% of the variation in LAZ. Among infants <6 months, duration of EBF was not significantly associated with LAZ, but being female and urban residence yielded positive associations. Breastfeeding patterns were not associated with weight-for-age Z-score (WAZ) or weight-for-height Z-score (WLZ) either in the 0-6-month or in the 6-12-month group. Birth outside a health facility was negatively associated with WAZ and WLZ in the older group. CONCLUSION: EBF in the first 6 months of life was associated with increased linear growth, but not weight gain, in later infancy. Promotion of EBF could reduce the prevalence of chronic child undernutrition in the study area.

Does the "stages of change" construct predict cross-sectional and temporal variations in dietary behavior and selected indicators of diabetes risk among Norwegian-Pakistani women?

UNLABELLED: The aim of this study is to explore the association between motivational "stage" and intake of selected foods, and risk factors for diabetes; and what degree of attendance in an intervention that was necessary to show movements across the motivational "stages of change". Participants (n = 198, aged 25-62 years) were randomly assigned into intervention and control. DATA COLLECTION: Interviews with a structured questionnaire, anthropometric and biochemical assessments. Intake of several food items and blood parameters at baseline differed according to motivational stage. Those who participated in at least four group sessions in the intervention were more likely to show a positive move through the "stages of change". Those in low motivational stages at baseline had benefitted just as much from the intervention as those in higher stages. Intake of several food items corresponded to the motivational "stage". High attendance in the intervention was necessary for a positive move through "stages of change".

Anaemia prevalence and associated sociodemographic and dietary factors among Palestinian adolescents in the West Bank.

Anaemia still persists among children and women of childbearing age in Palestine. We investigated the prevalence of anaemia and associated factors among Palestinian school adolescents (aged 13-15 years) in Ramallah and Hebron governorates. Haemoglobin levels were measured to assess the prevalence of anaemia. The prevalence of anaemia was significantly higher in Hebron than in Ramallah among boys (22.5% versus 6.0% respectively), while among girls the figures were similar (9.2% and 9.3% respectively). Linear binomial regression analysis showed that among boys, anaemia was independently associated with residence in Hebron and higher standard of living, while among girls, anaemia was associated with higher father's education. Consumption of iron-rich foods, as recorded in food frequency questionnaires, had no significant effects on anaemia prevalence in both boys and girls.

Diet, nutritional status and school performance among adolescents in Gaza Strip.

The associations between dietary intake, nutritional status and school performance among 932 adolescents aged 12-15 years were examined in a cross-sectional survey in 2002 in north Gaza Strip. School performance was obtained from school records and height and weight were measured for body mass index (BMI). Self-administered questionnaires included sociodemographic characteristics and food frequency intakes. Adolescents consuming fruit and vegetables more than 3 times per week were more likely to have good school performance (72.6% versus 59.9%). When adjusting for sociodemographic variables and BMI, fruit and vegetables intake was positively associated with school performance (OR = 1.61, 95% CI: 1.11-2.32) and stunting was negatively associated (OR = 0.53, 95% CI: 0.31-0.90). The findings support a broader implementation of school nutrition programmes.

Intention to change dietary habits, and weight loss among Norwegian-Pakistani women participating in a culturally adapted intervention.

The aim was to explore the relationships between degree of participation in a culturally adapted lifestyle intervention and stages of change for healthy eating and weight loss among Pakistani immigrant women in Norway. The intervention lasted 7 months and included 198 women, randomized into control and intervention groups. The odds of losing weight from baseline to follow-up, and being in action stages of change (compared to pre-action stages) with regard to intake of amount and type of fat, sugar and white flour at follow-up, increased significantly with number of group sessions attended. Those in action stage of reducing intake of fat and increasing intake of vegetables, as well as of reducing weight, were significantly more likely than others to have experienced weight loss at follow-up. Participation in the culturally adapted intervention was related to increase in intentions to change dietary behaviours and to weight loss.

Diet, nutritional status and school performance t among adolescents in Gaza Strip

The associations between dietary intake, nutritional status and school performance among 932 adolescents aged 12-15 years were examined in a cross-sectional survey in 2002 in north Gaza Strip. School performance was obtained from school records and height and weight were measured for body mass index [BMI]. Self-administered questionnaires included sociodemographic characteristics and food frequency intakes. Adolescents consuming fruit and vegetables more than 3 times per week were more likely to have good school performance [72.6% versus 59.9%]. When adjusting for sociodemographic variables and BMI, fruit and vegetables intake was positively associated with school performance [OR = 1.61, 95% Cl: 1.11-2.32] and stunting was negatively associated [OR = 0.53, 95% Cl: 0.31-0.90]. The findings support a broader implementation of school nutrition programmes

Anaemia prevalence and associated sociodemographic and dietary factors among Palestinian adolescents in the West Bank

Anaemia still persists among children and women of childbearing age in Palestine. We investigated the prevalence of anaemia and associated factors among Palestinian school adolescents [aged 13-15 years] in Ramallah and Hebron governorates. Haemoglobin levels were measured to assess the prevalence of anaemia. The prevalence of anaemia was significantly higher in Hebron than in Ramallah among boys [22.5% versus 6.0% respectively], while among girls the figures were similar [9.2% and 9.3% respectively]. Linear binomial regression analysis showed that among boys, anaemia was independently associated with residence in Hebron and higher standard of living, while among girls, anaemia was associated with higher father's education. Consumption of iron-rich foods, as recorded in food frequency questionnaires, had no significant effects on anaemia prevalence in both boys and girls

Associations between food patterns, socioeconomic position and working situation among adult, working women and men in Oslo.

BACKGROUND/OBJECTIVES: Socioeconomic disparities in diet are well documented, but the relative importance of different indicators of socioeconomic position (SEP) is not well known. The aim of this study was to explore relationships between food patterns, SEP (occupation, education and income) and degree of work control. SUBJECTS/METHODS: A cross-sectional population-based study 2000-2001, using three self-administered questionnaires including food frequency questions (FFQs). Factor analysis was used to explore food patterns. Participants include 9762 working Oslo citizens, 30-60 years of age, having answered the questionnaires with <20% of the FFQ missing. RESULTS: Four food patterns were found: Western, prudent, traditional and sweet. In multivariate analyses, the likelihood of having a high intake of the Western pattern was lowest in the two highest educational groups (women: odds ratio (OR)=0.54/OR=0.75; men: OR=0.51/OR=0.76), and in the two highest occupational groups for men (OR=0.73/OR=0.78). The odds of having a high intake of the prudent pattern was highest in the two highest educational groups (women: OR=2.50/OR=1.84; men: OR=2.23/OR=1.37), and among the self-employed (women OR=1.61, men OR=1.68), as well as in the highest occupational group for men (OR=1.33). Women always having work control were least likely to have high intake of the Western pattern (OR=0.78) and most likely to have high intake of the prudent pattern (OR=1.39). CONCLUSIONS: The SEP indicators were in different ways related to the food patterns, but the effect of occupation and income was partly explained by education, especially among women. Women's work control and men's occupation were important for their eating habits.

Breastfeeding perceptions in communities in Mangochi district in Malawi.

AIM: To investigate mothers' perceptions of breastfeeding and influences from their social network. METHODS: A cross-sectional survey was carried out in Mangochi district, Malawi where questionnaire data from 157 rural and 192 semi-urban mother-infant pairs were obtained. RESULTS: The proportion of mothers who thought that exclusive breastfeeding should last for 6 months and those who reported to have actually exclusively breastfed were 40.1% and 7.5% respectively. Of those who reported practising exclusive breastfeeding for 6 months, 77.5% stated that exclusive breastfeeding should last for 6 months. This opinion was independently associated with giving birth in a Baby-Friendly facility, OR = 5.22; 95% CI (1.92-14.16). Among the mothers who thought that exclusive breastfeeding should last for less than 6 months, 43.9% reported having been influenced in their opinion by health workers. Infant crying was the most common (62.4%) reason for stopping exclusive breastfeeding. CONCLUSION: The findings illustrate the positive impact health workers can have, as well as the need to raise awareness of the benefits of exclusive breastfeeding among both health workers and mothers. Furthermore, continued counselling of mothers on how to deal with stressful infant behaviour such as crying may assist to prolong exclusive breastfeeding.

Vegetable-rich food pattern is related to obesity in China.

OBJECTIVE: To investigate the association between a vegetable-rich food pattern and obesity among Chinese adults. DESIGN: A food pattern rich in vegetables is associated with lower risk of obesity and non-communicable chronic disease in Western countries. A similar food pattern is found in the Chinese population but the cooking method is different. A cross-sectional household survey of 2849 men and women aged 20 years and over was undertaken in 2002 in Jiangsu Province (response rate, 89.0%). Food intake was assessed by food frequency questionnaire. Factor analysis was used to identify food patterns. Nutrient intake was measured by food weighing plus consecutive individual 3-day food records. Height, weight and waist circumference were measured. RESULTS: The prevalence of general obesity (BMI > or =28 kg m(-2)) was 8.0% in men and 12.7% in women, central obesity was 19.5% (> or =90 cm) and 38.2% (> or =80 cm), respectively. A four-factor solution explained 28.5% of the total variance in food frequency intake. The vegetable-rich food pattern (whole grains, fruits and vegetables) was positively associated with vegetable oil and energy intake. Prevalence of obesity/central obesity increased across the quartiles of vegetable-rich food pattern. After adjusting for sociodemographic factors and four distinct food patterns, the vegetable-rich pattern was independently associated with obesity. Compared with the lowest quartile of vegetable-rich pattern, the highest quartile had higher risk of general obesity (men, prevalence ratio (PR): 1.82, 95% confidence interval (CI): 1.05-3.14; women, PR: 2.25, 95% CI: 1.45-3.49). CONCLUSION: The vegetable-rich food pattern was associated with higher risk of obesity/central obesity in Chinese adults in both genders. This association can be linked to the high intake of energy due to generous use of oil for stir-frying the vegetables.

Assessing social differences in overweight among 15- to 16-year-old ethnic Norwegians from Oslo by register data and adolescent self-reported measures of socio-economic status.

OBJECTIVE: To determine to what extent self-reported and objective data on socio-economic status (SES) are associated with overweight/obesity among 15 to 16-year-old ethnic Norwegians. DESIGN: A cross-sectional questionnaire study on health and health-related behaviors. SUBJECTS: All school children aged 15-16 years old in 2000 and 2001 in Oslo, Norway. Response rate 88% (n=7343). This article is based on the data from the 5498 ethnic Norwegians. MEASUREMENTS: Self-reported height and weight were used to measure overweight (including obesity) as defined by the International Obesity Task Force cutoffs at the nearest half-year intervals. SES was determined by register data from Statistics Norway on residential area, parental education and income and by adolescent self-reported measures on parental occupation and adolescents' educational plans. RESULTS: The prevalence of overweight/obesity was low, but higher among boys (11%) than among girls (6%). Parental education (four levels) showed the clearest inverse gradients with overweight/obesity (boys: 18, 13, 10 and 7%; girls: 11, 6, 6 and 4%). Parental education remained significantly associated with overweight/obesity when adding occupation and income to the model for the boys, whereas there were no significant associations in the final model for the girls. Overweight/obesity was associated with a lower odds ratio of planning for higher education (college/university) among boys only. CONCLUSION: For the boys, parental education was most strongly associated with overweight/obesity, and the association between overweight/obesity and educational plans appears to imply downward social mobility. The relationships between the various SES measures and overweight/obesity appeared more interrelated for the girls.

Nutritional status, tobacco use and alcohol consumption of older persons in Botswana.

AIM: To describe body mass index (BMI) distribution according to patterns of tobacco use, alcohol consumption and sociodemographic factors of older persons in Botswana. MATERIAL AND METHODS: Data were collected in 1998 as part of a national household survey of 1085 subjects aged 60 years and older. For the purpose of this analysis, data are utilised from a representative 50 % sub-sample (n=393; response rate = 72 %), in which weight and height were measured as part of a medical examination in the subjects' homes. RESULTS: A high prevalence of underweight (BMI < 18.5) was found in men (20.1 %), while overweight (BMI = 25-29.9) and obesity (BMI > or = 30) were common in women (21.3 % and 27.9 %, respectively). Thirty-four percent of the subjects reported alcohol consumption and 39 % reported tobacco use. Half of the sample used either one or both of the stimulants. Underweight was significantly associated with low socioeconomic status (OR=3.3; 95 % CI=1.3-8.2) and the use of a combination of alcohol and tobacco (OR=2.2; 95 % CI=1.1-4.4). Obesity was significantly associated with female gender (OR=4.9; 95 % CI=2.5-9.7) and younger age (60-69 years, compared to older groups; OR=3.2; 95 % CI=1.3-7.7). A higher than expected clustering of the three health-related risk factors (underweight, tobacco use and alcohol consumption) was found at 6.7 % (observed:expected ratio = 2.9). CONCLUSION: A double burden of undernutrition and overnutrition was found in this sample of older persons in an African country. A clustering of the three risk factors for increased morbidity (tobacco use, alcohol consumption and underweight) was evident. These findings indicate a need for health education to effect lifestyle behavioural change in older adults in the subregion.

Ethnic differences in obesity among immigrants from developing countries, in Oslo, Norway.

OBJECTIVES: To compare ethnic and gender differences in generalized and central obesity and to investigate whether these differences persisted after adjusting for socio-demographic and lifestyle factors. DESIGN: In 2002, the population-based cross-sectional, Oslo Immigrant Health study was conducted. SUBJECTS: A total of 7890 Oslo residents, born between 1942 and 1971 in Turkey, Iran, Pakistan, Sri Lanka and Vietnam, were invited and 3019 attended. MEASUREMENTS: Participants completed a health questionnaire and attended a clinical screening that included height, weight, waist and hip measurements. RESULTS: Generalized obesity (BMI> or =30 kg/m2) was greatest among women from Turkey (51.0%) and least among men from Vietnam (2.7%). The highest proportions of central obesity (waist hip ratio (WHR)>or =0.85) were observed among women from Sri Lanka (54.3%) and Pakistan (52.4%). For any given value of BMI, Sri Lankans and Pakistanis had higher WHR compared to the other groups. Despite a high mean BMI, Turkish men (27.9 kg/m2) and women (30.7 kg/m2) did not have a corresponding high WHR. Ethnic differences in BMI, waist circumference and WHR persisted despite adjusting for socio-demographic and lifestyle factors. CONCLUSION: We found large differences in generalized and central obesity between immigrant groups from developing countries. Our data find high proportions of overweight and obese subjects from Pakistan and Turkey, but low proportions among those from Vietnam. Subjects from Sri Lanka and Pakistan had the highest WHR for any given value of BMI. Our findings, in light of the burgeoning obesity epidemic, warrant close monitoring of these groups.

Socio-demographic differences in food habits and preferences of school adolescents in Jiangsu Province, China.

OBJECTIVE: To identify the differences in food habits and preferences among the adolescents according to socio-demographic characteristics. DESIGN: Cross-sectional, cluster design survey in 2002. SETTING: Eight middle schools in two distinct socio-economic areas of the Jiangsu province, China. SUBJECTS: Some 824 young adolescents (12-14 y) attending public schools with a response rate of 99%. METHODS: A self-administered questionnaire containing questions on food and meal frequencies, food preferences and socio-demographic characteristics was used. RESULTS: High socio-economic status (SES) and urban residence was positively associated with intake of high-energy foods, such as foods of animal origin, Western style foods and dairy products. In all, 76% of the students had three meals a day regularly , but 8.1% urban students vs 3.4% rural students had breakfast only 1-3 times per week or less often. Daily fruit consumption was fairly common, but with clear differences by SES. Only about 42% of the boys and 55% of the girls from low SES families ate fruit daily, compared with 66% and 72%, respectively in the high SES families. Urban boys had the lowest proportion of daily consumers of vegetables (67.0%). More urban students drank milk daily than the rural students (68.7 vs 38.5%). The frequency of milk drinking also showed a strong positive association with SES. About 10% of the high SES boys consumed hamburgers daily compared with 2.8% of the low SES boys. More than half of the students reported a liking for Western style fast foods including hamburgers, soft drinks and chocolate. Among high SES boys, 21.5% consumed soft drinks on a daily basis; however, as many as 72.3% wanted to drink soft drinks more often if they could afford it. CONCLUSIONS: SES and urban location were positively associated with frequency of intake of high-energy foods. Reported food preferences may enforce this trend. Nutrition education for adolescents and parents is needed to promote healthy eating. Health Authorities should strengthen the monitoring of food intake and its association with overweight/obesity. SPONSORSHIP: This study was funded by the Norwegian Directorate of Health and Social affairs under the auspices of the Norway-China Health Agreement.

Chronic diseases and health inequalities in older persons in Botswana (southern Africa): a national survey.

OBJECTIVES: To evaluate the health status of older persons in Botswana, to report on the prevalence of common health conditions--typically chronic diseases, to assess the socio-demographic correlates of morbidity in this population, and to assess the associations between physical functioning and self-reported health and the common health problems presented. DESIGN: National, cross-sectional survey (12 rural areas, 3 urban centres), inclusive of clinical examinations. SAMPLE: 372 individuals (183 females, 189 males) aged 60-109 years. RESULTS: 68% of respondents reported musculoskeletal pain in two or more locations; 42% were found to be hypertensive; 36% reported dental problems; 32% had dermatological problems; 11% were blind (as defined); 9% had cognitive impairment; 7% were depressed. Multinomial regression analyses showed poor self reported health to be significantly associated with musculoskeletal pain (OR = 15.5), depression (OR = 9.7), incontinence (OR = 3.9), dermatological problems (OR = 3.0) and dental problems (OR = 2.3); hypertension, blindness and cognitive impairment did not show significant associations. CONCLUSION: A large number of older persons in Botswana suffer from one or more age-associated chronic diseases that may impair function and quality of life. Several of the conditions may be diagnosed and treated to optimise the individuals' functioning. Poor self reported health was associated with "painful conditions" which are commonly poorly managed or untreated.

Ethnic differences in body mass index and associated factors of adolescents from minorities in Oslo, Norway: a cross-sectional study.

OBJECTIVES: To examine ethnic differences in body mass index (BMI), food habits and physical activity, and determine the factors contributing to differences in BMI. DESIGN AND METHOD: In 2000-2001, 7343 (response rate 88%) 15- and 16-year-old students, enrolled in lower secondary schools in Oslo, participated in the cross-sectional Oslo Health Study. Of these participants, 1719 were defined as ethnic minorities. RESULTS: Significant gender and ethnic differences in mean BMI were observed. Of the ethnic minority adolescents, 5.8% were underweight (<5th percentile of the US Centers for Disease Control and Prevention (CDC)/National Center for Health Statistics (NCHS) reference distribution) and 9.1% were overweight (>85th percentile of the US CDC/NCHS reference distribution). BMI was not significantly associated with either socio-economic factors or physical activity. Food habits and physical activity differed with ethnicity but not with socio-economic factors. An ordinal regression showed that girls from East Asia (odds ratio (OR) 0.4) and boys from sub-Saharan Africa (OR 0.4) had lower BMI than the Western group. Among girls, higher BMI was associated with less frequent consumption of chocolates and sweets, full-fat milk and breakfast (OR 2.4, 1.7 and 1.7, respectively). Higher BMI, for both boys and girls, was associated with current and past dieting (OR 3.7 and 4.2, respectively). CONCLUSIONS: Adolescent food habits and physical activity varied by gender and ethnicity but not with socio-economic factors. BMI was associated with ethnicity, gender and food habits, but no significant relationship was observed with socio-economic factors or physical activity. Ethnicity, in addition to gender, should be taken into consideration when studying BMI and associated factors among adolescents.

Obesity in a rural and an urban Palestinian West Bank population.

OBJECTIVE: To compare the prevalence of obesity, household food consumption patterns, physical activity patterns and smoking between a rural and an urban community in the Palestinian West Bank and to describe the associations of the latter factors with body mass index (BMI). DESIGN: A population-based cross-sectional survey in a rural and an urban Palestinian West Bank community. SUBJECTS: A total of 549 women and 387 men aged 30-65 y, excluding pregnant women. MEASUREMENTS: Obesity was defined as BMI >/=30 kg/m(2). RESULTS: The prevalence of obesity was 36.8 and 18.1% in rural women and men, respectively, compared with 49.1 and 30.6% in urban women and men, respectively. The mean difference (s.e) in BMI levels was 1.6 (0.52) kg/m(2) between urban and rural women and 0.9 (0.46) kg/m(2) in men. At the household level, the mean energy consumption from 25 selected food items was 13.8 MJ (3310 kcal)/consumption unit/day in the rural community compared to 14.5 MJ (3474 kcal)/consumption unit/day in the urban community (P=0.021). BMI was positively associated with age in both men and women and with urban residence in women. BMI was negatively associated with smoking and physical activity in men and with educational level in women. CONCLUSION: BMI was associated with urban residence in women after adjusting for age, smoking, education, physical activity and nutrition-related variables, suggesting that the differences in the conventional determinants of obesity could not fully explain the difference in the prevalence of obesity between the two communities. Among men, the measured determinants explained the rural-urban differences in BMI.

Obesity and selected co-morbidities in an urban Palestinian population.

OBJECTIVE: To assess the prevalence of obesity and central obesity in an urban Palestinian population and their associations with selected co-morbidities, including diabetes, hypertension and dyslipidaemia. DESIGN: A population-based cross-sectional survey in an urban Palestinian community. SUBJECTS: Men and women aged 30-65 y residing in the urban community, excluding pregnant women. MEASUREMENTS: According to WHO guidelines, obesity for men and women was defined as BMI> or =30 kg x m(-2), while pre-obesity was defined as BMI 25-29.9 kg x m(-2). Central obesity was defined as a waist-to-hip ratio (WHR) of >0.90 in men and >0.85 in women. RESULTS: The prevalence of obesity in this population was high at 41% (49% and 30% in women and men, respectively). Central obesity was more prevalent among men (59% compared to 25% in women). After adjusting for the effects of age, sex, smoking and each other, obesity and central obesity were found to be significantly associated with diabetes, low HDL-cholesterol and elevated triglycerides in separate logistic regression analyses. Central obesity was also significantly associated with hypertension (OR 2.26, 95% CI 1.30-3.91). CONCLUSION: Obesity and central obesity are prevalent in the urban Palestinian population. Their associations with diabetes, hypertension, and dyslipidaemia point to a potential rise in cardiovascular disease (CVD). An understanding of the reasons behind the high prevalence of obesity is essential for its prevention as well as for the prevention of the morbidities to which it may lead.

Obesity and associated factors in a Palestinian West Bank village population.

OBJECTIVE: To describe body mass index (BMI), waist circumference and waist-hip ratio in a Palestinian West Bank village population, and to assess the associations of these variables to blood pressure and serum lipids. DESIGN: Cross-sectional study. SETTING: Community-based study in a prototypic semi-rural Palestinian village in the central West Bank. SUBJECTS: All individuals aged 30-65 y in the study village were invited for the study and 500 (85%) participated. MAIN OUTCOME MEASURES: BMI > or = 30 was used as the measure of obesity. RESULTS: The prevalence of obesity was 37.5% among women and 18.8% among men. The prevalence of abdominal obesity was 62.5% among women and 14.8% among men. BMI seemed to be the more important correlate of blood pressure whereas waist-hip ratio seemed to be the more important correlate of serum triglycerides, compared to the other obesity measures. CONCLUSIONS: The prevalence of obesity in the study population was very high compared to most other countries in the world, particularly among women. SPONSORSHIP: The study was funded by the Norwegian Universities' Committee for Development Research (NUFU). LCM Stene was supported by a grant from the Throne Holst Foundation.

Promoting breastfeeding in rural Gambia: combining traditional and modern knowledge.

Sub-optimal breastfeeding practices still prevail in many countries, especially in traditional rural communities. Despite high breastfeeding initiation rates and long total duration of breastfeeding, exclusive breastfeeding is a rare practice. In the present study, quantitative methods were used to identify current infant feeding practices in 12 rural communities in The GAMBIA: Results indicated that delayed initiation of breastfeeding, prelacteal feeding and failure to practice exclusive breastfeeding were widespread. Qualitative data further indicated that current beliefs and practices were strongly influenced by traditional beliefs and practices. These were kept very much alive by elders, both women and men, including husbands. The results also showed an unexpected support for bottle-feeding from both male and female elders who considered it part of the modernization process. A strategy for promoting early initiation of breastfeeding, feeding of colostrum and exclusive breastfeeding for 6 months in rural communities should therefore incorporate traditional beliefs and practices into modern messages on optimal breastfeeding. Traditional beliefs and practices in the study setting that could be used in this way included knowledge from the population's acquaintance with the newborns of their livestock. It also included the traditional practice of mothers taking their very young children with them when going to work in the fields. The paper suggests such a strategy by developing a matrix to establish linkages between modern and traditional knowledge on a specific practice. Such linkages facilitate the acceptance of recommendations on infant feeding by mothers in these communities. The strategy recommends an expanded target group to include elders and husbands, as the data show that these groups are highly influential in matters regarding patterns of child feeding.