Influence of childcare practices on nutritional status of Ghanaian children: a regression analysis of the Ghana Demographic and Health Surveys.

OBJECTIVES: Guided by the UNICEF framework for childcare, this study examined the association of childcare practices (CCP) with infant and young children's growth (height-for-age Z-scores, HAZ), and investigated whether care practices are more important to growth in some sociodemographic subgroups of children. DESIGN: Cross-sectional survey. SETTING: Urban and rural Ghana. PARTICIPANTS: The study sample comprised 1187 dyads of mothers aged 15-49 years and their youngest child (aged 6-36 months). RESULTS: The results showed that CCP was a significant predictor of HAZ, after controlling for covariates/confounders at child, maternal and household levels. Children with higher CCP scores had higher HAZ. A 1-unit increase in the CCP score was associated with a 0.17-unit increase in HAZ. Child's and mother's age, number of children under 5 years, place of residence, maternal weight and wealth index were also significantly associated with HAZ. Statistical interaction analyses revealed no subgroup differences in the CCP/HAZ relationship. CONCLUSIONS: This study found a significant, positive association between CCP and child growth, after accounting for other important determinants of child growth at maternal and household levels. This calls for research into the effects on growth of various CCP components, with longitudinal cohort study designs that can disentangle causal relationships.

Reliability of demographic and socioeconomic variables in predicting early initiation of breastfeeding: a replication analysis using the Kenya Demographic and Health Survey data.

OBJECTIVES: Examine the reliability of sociodemographic variables in predicting initiation of breastfeeding within an hour of birth (EarlyBF), using data from 1998, 2003 and 2008-2009. STUDY DESIGN: A replication analysis using the Kenya Demographic and Health Survey (KDHS) data collected in 1998, 2003 and 2008-2009. The candidate predictor variables were child's gender, home or health facility place of birth, vaginal or caesarean mode of birth, urban or rural setting, province of residence, Wealth Index and maternal education, occupation, literacy and media exposure. SETTING: Kenya. PARTICIPANTS: 6375 dyads of mothers aged 15-49 and their children aged 0-23 months (2125 dyads in each of the survey years). RESULTS: Mode of birth and province were statistically significant predictors of EarlyBF in 1998, 2003 and 2008-2009. Children delivered through caesarean section were non-EarlyBF in 1998 (OR 2.63, 95% CI 1.72 to 4.04), 2003 (OR 3.36, 95% CI 1.83 to 6.16) and 2008 (OR 3.51, 95% CI 2.17 to 5.69). The same was true of those living in the Western province in 1998 (OR 2.67, 95% CI 1.61 to 4.43), 2003 (OR 4.92, 95% CI 3.01 to 8.04) and 2008 (OR 6.07, 95% CI 3.54 to 10.39). CONCLUSIONS: The 1998 KDHS data do not provide the basis for reliable prediction of EarlyBF, with reliability conceptualised as replicability of findings using highly similar data sets from 2003 and 2008-2009. Most of the demographic and socioeconomic variables were unreliable predictors of EarlyBF. We speculate that activities in parts or all of Kenya changed the analysis context in the period between 1998 and 2008-2009, and these changes were of a sufficient magnitude to affect the relationships under investigation. The degree to which this is a general problem in child health research is not known, calling for further research to investigate this methodological issue with other health end points and other data.

Child diet and healthy growth in the context of rural poverty in the peruvian andes: what influences primary caregivers' opportunities and choices?

This study explored opportunities and choices related to child feeding among women living in a remote and low-income district in the Andean highlands. Data were collected through in-depth interviews with mothers (N = 7) with reputations for providing good child care, and who participated in an NGO-run social and health programme. The aim of this study was to learn about women's positive experience with child feeding, in the context of living in low-income communities. Such knowledge could be of substantial practical value to health promotion practitioners, in illuminating existing local circumstances and practices that produce good child nutrition. The women who were most knowledgeable about child health and diet were better educated and had relatively higher social positions in the community. Regarding contextual factors related to child feeding, numerous references were made to the extensive use of own crops and food stuffs, seen to provide a better diet than that available in cities where people buy their food. In discussing food and meal preparation habits, there were clear references to child welfare and health as motivating factors in the choices that were made. The NGO programme was not mentioned by the interviewer, to avoid prompting, yet the respondents referred to it explicitly, and attributed improved health-related knowledge and skills to the NGO education interventions (e.g. education about nutritious meal preparation, child care skills, and sanitation practices). It is concluded that the women were concerned about providing a good diet to their children, they were aware of the impact of feeding practices on child health, and that education about health and diet helped them to improved feeding practices.

Socioeconomic status and chronic child malnutrition: Wealth and maternal education matter more in the Peruvian Andes than nationally.

This study investigated the association of parents' socioeconomic status (SES) with child stunting in the Peruvian Andes and in Peru nationally. It was hypothesized that the relationship of SES to child stunting would be weaker in the Andean compared with the national sample. This is consistent with earlier research indicating that the relationship of SES to health may be weak in poor regions. The data were from the Demographic and Health Survey 2004 to 2006. Two samples of children 3 to 60 months old were compared: a national sample (n = 1426) and an Andean sample (n = 543). Malnutrition was measured using the indicator "stunting," which is small stature for age. Socioeconomic status was measured using parental education, occupation, and household wealth index (WI). In both samples, SES was significantly related to stunting. The odds of stunting in the poorest WI quintile were significantly higher than in the richest quintile. The same pattern was observed in children of mothers having incomplete primary education compared with children of mothers having complete secondary or higher education. The odds of stunting were significantly lower in children of mothers working at home compared with mothers in professional occupations. The associations of WI and maternal education with stunting were significantly stronger in the Andean compared with the national sample; the study did not find support for the hypothesis. Even in very poor regions such as the Andes, SES may be associated with child health, suggesting the importance of public health measures to overcome the health disadvantages experienced by children living in low SES households.