Improving Children's Diet: Approach and Progress.

We highlight key findings from a recent comprehensive review of social and behavior change communication (SBCC) interventions to improve complementary feeding in low-middle-income countries and discuss 4 large-scale programs as illustrative case studies. Improving dietary diversity was the most commonly targeted practice, and interpersonal communication was the most commonly used platform for the 64 interventions included in the comprehensive review. The number of behavior change techniques used by any one intervention ranged from 2 to 13 (median 6); all provided instruction on how to perform the target behavior(s), followed by the use of a "credible" source to provide the SBCC (n = 46), demonstration of the behavior (n = 35) and providing information about health consequences of the behavior (n = 35). The key factors that contributed to the success of the large-scale programs applying SBCC alone, or in combination with point-of-use fortification or nutrition-sensitive agriculture, included the formation of alliances with key stakeholders, availability of funds, technical support from multiple donors, well-defined theory of change, and streamlined processes for monitoring and implementation. Major limitations included a lack of detailed information on (a) intervention design, (b) behavioral theories or frameworks, (c) implementation processes including adaptations to context, and (d) cost and feasibility.

A scoping review of social-behaviour change techniques applied in complementary feeding interventions.

Education and other strategies to promote optimal complementary feeding can significantly improve practices, but little is known about the specific techniques successful interventions use to achieve behaviour change. We reviewed the literature for complementary feeding interventions in low-/middle-income countries (LMIC) published since 2000. We systematically applied a validated taxonomy mapping process to code specific behaviour change techniques (BCTs) used in each intervention; effectiveness ratios for each BCT were estimated. Sixty-four interventions met inclusion criteria, were abstracted, BCTs identified, and coded. Dietary diversity was the most commonly assessed component of complementary feeding, and interpersonal communication, either individually or in groups, was the most commonly used delivery platform. Of the 93 BCTs available for mapping, the 64 interventions included in this review applied a total of 28 BCTs. Interventions used a median of six techniques (max = 13; min = 2). All interventions used "instruction on how to perform the behaviour." Other commonly applied BCTs included "use of a credible source" (n = 46), "demonstration of the behaviour" (n = 35), and "providing information about health consequences" (n = 30). Forty-three interventions reported strategies to shift the physical or social environment. Among BCTs used in >20 interventions, five had effectiveness ratios >0.8: "provision of/enabling social support"; "providing information about health consequences"; "demonstration of the behaviour"; and "adding objects to the environment" namely, food, supplements, or agricultural inputs. The limited reporting of theory-based BCTs in complementary feeding interventions may impede efforts to improve and scale effective programs and reduce the global burden of malnutrition.

Dairy intensification, mothers and children: an exploration of infant and young child feeding practices among rural dairy farmers in Kenya.

Agricultural strategies such as dairy intensification have potential to improve human nutrition through increased household food security. Increasing dairy productivity could also adversely affect infant and young child feeding (IYCF) practices because of increased maternal stress, demands on maternal time, and beliefs about the timing and appropriate types of complementary foods. Yet, few studies have looked rigorously at how interventions can affect young children (0-60 months). The study explores, within the context of rural dairy farming in Kenya, the relationship between level of household dairy production and selected IYCF practices using a mixed-methods approach. Six focus group discussions with women involved in dairy farming investigated their attitudes towards breastfeeding, introduction of complementary foods and child diets. Ninety-two households involved in three levels of dairy production with at least one child 0-60 months participated in a household survey. Quantitative results indicated that women from higher dairy producing households were more likely to introduce cow's milk to infants before they reached 6 months than women from households not producing any dairy. Themes from the focus group discussions demonstrated that women were familiar with exclusive breastfeeding recommendations, but indicated a preference for mixed feeding of infants. Evidence from this study can inform nutrition education programmes targeted to farmers participating in dairy interventions in rural, low-income settings to minimise potential harm to the nutritional status of children.

Food insecurity is associated with attitudes towards exclusive breastfeeding among women in urban Kenya.

This study aimed to document whether food insecurity was associated with beliefs and attitudes towards exclusive breastfeeding (EBF) among urban Kenyan women. We conducted structured interviews with 75 human immunodeficiency virus (HIV)-affected and 75 HIV-status unknown, low-income women who were either pregnant or with a child ≤24 months and residing in Nakuru, Kenya to generate categorical and open-ended responses on knowledge, attitudes and beliefs towards EBF and food insecurity. We facilitated six focus group discussions (FGD) with HIV-affected and HIV-status unknown mothers (n = 50 women) to assess barriers and facilitators to EBF. Of 148 women with complete interview data, 77% were moderately or severely food insecure (FIS). Women in FIS households had significantly greater odds of believing that breast milk would be insufficient for 6 months [odds ratio (OR), 2.6; 95% confidence interval (95% CI), 1.0, 6.8], that women who EBF for 6 months would experience health or social problems (OR, 2.7; 95% CI, 1.0, 7.3), that women need adequate food to support EBF for 6 months (OR, 2.6; 95% CI, 1.0, 6.7) and that they themselves would be unable to follow a counsellor's advice to EBF for 6 months (OR, 3.2; 95% CI, 1.3, 8.3). Qualitative analysis of interview and FGD transcripts indicated that the maternal experience of hunger contributes to perceived milk insufficiency, anxiety about infant hunger and a perception that access to adequate food is necessary for successful breastfeeding. The lived experience of food insecurity among a sample of low-income, commonly FIS, urban Kenyan women reduces their capacity to implement at least one key recommended infant feeding practices, that of EBF for 6 months.