Challenges and responses to infant and young child feeding in rural Rwanda: A qualitative study
Ahishakiye, Jeanine ; Bouwman, Laura ; Brouwer, Inge D. ; Matsiko, Eric ; Armar-Klemesu, Margaret ; Koelen, Maria - \ 2019
Journal of Health, Population and Nutrition 38 (2019)1. - ISSN 1606-0997
Breastfeeding - Complementary feeding - Infant and young child feeding - Qualitative - Rwanda
Background: Despite different interventions to improve child nutrition conditions, chronic malnutrition is still a public health concern in Rwanda, with a high stunting prevalence of 38% among under 5-year-olds children. In Rwanda, only 18% of children aged 6-23 months are fed in accordance with the recommendations for infant and young child feeding practices. The aim of this study was to explore challenges to infant and young child feeding practices and the responses applied to overcome these challenges in Muhanga District, Southern province of Rwanda. Methods: Sixteen (16) focus group discussions were held with mothers, fathers, grandmothers, and community health workers from 4 rural sectors of Muhanga District. The discussions were recorded, transcribed verbatim, and thematically analyzed using qualitative data analysis software, Atlas.ti. Results: Two main themes emerged from the data. Firstly, there was a discourse on optimal infant and young child feeding (IYCF) practices that reflects the knowledge and efforts to align with early initiation of breastfeeding, exclusive breastfeeding for the first 6 months, as well as initiation of complementary foods at 6 months recommendations. Secondly, challenging situations against optimal practices and coping responses applied were presented in a discourse on struggling with everyday reality. The challenging situations that emerged as impeding appropriate IYCF practices included perceived lack of breast milk, infant cues, women's heavy workload, partner relations and living in poverty. Family and social support from community health workers and health facility staff, financial support through casual labor, and mothers saving and lending groups, as well as kitchen gardens, were used to cope with challenges. Conclusion: Factors influencing IYCF practices are multifaceted. Hence, intervention strategies to improve child nutrition should acknowledge the socially embedded nature of IYCF and address economic and social environmental constraints and opportunities, in addition and above knowledge only.
Baby's first bites: a randomized controlled trial to assess the effects of vegetable-exposure and sensitive feeding on vegetable acceptance, eating behavior and weight gain in infants and toddlers
Veek, S.M.C. van der; Graaf, C. de; Vries, J.H.M. de; Jager, G. ; Vereijken, C.M.J.L. ; Weenen, H. ; Winden, N. van; Vliet, M.S. van; Schultink, J.M. ; Wild, V.W.T. de; Janssen, S. ; Mesman, J. - \ 2019
BMC Pediatrics 19 (2019)1. - ISSN 1471-2431 - 1 p.
Complementary feeding - Infant - Responsive feeding - Self-regulation of energy intake - Toddler - Vegetable exposure - Vegetables
BACKGROUND: The start of complementary feeding in infancy plays an essential role in promoting healthy eating habits. Evidence shows that it is important what infants are offered during this first introduction of solid foods: e.g. starting exclusively with vegetables is more successful for vegetable acceptance than starting with fruits. How infants are introduced to solid foods also matters: if parents are sensitive and responsive to infant cues during feeding, this may promote self-regulation of energy intake and a healthy weight. However, the effectiveness of the what and the how of complementary feeding has never been experimentally tested in the same study. In the current project the what and how (and their combination) are tested in one study to determine their relative importance for fostering vegetable acceptance and self-regulation of energy intake in infants. METHODS: A four-arm randomized controlled trial (Baby's First Bites (BFB)) was designed for 240 first-time Dutch mothers and their infants, 60 per arm. In this trial, we compare the effectiveness of (a) a vegetable-exposure intervention focusing on the what in complementary feeding; (b) a sensitive feeding intervention focusing on the how in complementary feeding, (c) a combined intervention focusing on the what and how in complementary feeding; (d) an attention-control group. All mothers participate in five sessions spread over the first year of eating solid foods (child age 4-16 months). Primary outcomes are vegetable consumption, vegetable liking and self-regulation of energy intake. Secondary outcomes are child eating behaviors, child anthropometrics and maternal feeding behavior. Outcomes are assessed before, during and directly after the interventions (child age 18 months), and when children are 24 and 36 months old. DISCUSSION: The outcomes are expected to assess the impact of the interventions and provide new insights into the mechanisms underlying the development of vegetable acceptance, self-regulation and healthy eating patterns in infants and toddlers, as well as the prevention of overweight. The results may be used to improve current dietary advice given to parents of their young children on complementary feeding. TRIAL REGISTRATION: The trial was retrospectively registered during inclusion of participants at the Netherlands National Trial Register (identifier NTR6572 ) and at ClinicalTrials.gov ( NCT03348176 ). Protocol issue date: 1 April 2018; version number 1.
Application and validation of the Feeding Infants : Behaviour and Facial Expression Coding System (FIBFECS) to assess liking and wanting in infants at the time of complementary feeding
Nekitsing, C. ; Madrelle, J. ; Barends, C. ; Graaf, C. de; Parrott, H. ; Morgan, S. ; Weenen, H. ; Hetherington, M.M. - \ 2016
Food Quality and Preference 48 (2016)Part A. - ISSN 0950-3293 - p. 228 - 237.
Complementary feeding - Facial expressions - Food refusal - Infant feeding - Like/dislike - Liking - Scale - Wanting - Weaning
Introduction: The aim of this study was to validate a novel tool developed to measure liking and wanting in infants during the weaning period. The Feeding Infants: Behaviour and Facial Expression Coding System (FIBFECS; Hetherington et al., in press) is an evidence based video coding tool, consisting of 13 items. There are 6 measures of avoidance/approach behaviours (turns head away, arches back, pushes spoon away, crying/fussy, leaning forward and rate of acceptance) to assess wanting and 7 facial expressions (brow lowered, inner brow raised, squinting, nose wrinkling, lip corners down, upper lip raised and gaping) to assess liking. Lower scores on the total scale indicated greater wanting and/or liking. The tool was applied to a recent randomized control trial (Hetherington et al., 2015). Method: 36 mother-infant dyads took part in the study and were randomised to the intervention or the control group. Infants were filmed on two occasions whilst eating a generally liked vegetable (carrots) and less preferred vegetable (green bean). 72 video extracts were coded by 4 trained researchers with adequate certification scores, each video was coded by at least two coders. Items and scales were tested for discrimination ((1) intervention vs control; (2) liked vs disliked vegetable) and construct validity (correlation with intake and liking assessed by mother and researcher). Results: Very good discrimination (p <0.001) was obtained for carrots vs green bean for the total score and total negative facial expressions and rejection behaviours (p=0.003). Discrimination for the intervention vs control groups was only obtained for the total rejections and the rate of acceptance (p <05). The FIBFECS subscales had good construct validity as these were significantly correlated with intake and liking ratings (p <0.01). Items such as crying/fussy and leaning forward were removed from the scale as well as inner brow raised, squinting and lip corners down, as these do not correlate with other variables. Their removal did not affect the integrity of the scale. The rate of acceptance parameter was found to have potential as a short method to measure wanting in infants. Conclusion: The present study has demonstrated that the FIBFECS can be used to identify liking and wanting independent of subjective ratings from mothers and researchers, therefore, this tool can be used widely in the study of infant responses to novel foods at the time of weaning. There is potential to develop the tool for infants beyond the period of complementary feeding and to assist in identifying fussy eating in the early stages of development.
Developing a novel tool to assess liking and wanting in infants at the time of complementary feeding - The Feeding Infants : Behaviour and Facial Expression Coding System (FIBFECS)
Hetherington, M.M. ; Madrelle, J. ; Nekitsing, C. ; Barends, C. ; Graaf, C. de; Morgan, S. ; Parrott, H. ; Weenen, H. - \ 2016
Food Quality and Preference 48 (2016)Part A. - ISSN 0950-3293 - p. 238 - 250.
Complementary feeding - Facial expressions - Food refusal - Infant feeding - Like/dislike - Wanting - Weaning
Introduction: Consumption of foods is determined in part by how much a food is liked. However, assessing liking in infants is difficult. Research with infants has often relied on indirect measures such as intake or subjective ratings from mothers. Therefore the aim of the present research was to devise a tool adapted from existing techniques which can directly and systematically measure liking in infants during the weaning period. Method: A tool was developed by extracting items from previous studies. In all, 13 items were generated, which included 6 behaviours reflecting avoidance and approach: turning away, arching back, pushing spoon away, crying/fussy, leaning forward and rate of acceptance; also 7 facial expressions thought to reflect affective response; brow lowered, inner brow raised, squinting, nose wrinkling, upper lip raised, lip corners down and gaping. An e-training manual was developed with a certification test to train coders. The coding tool is based on coding the first 9 spoonfuls for each infant. 63 videos were coded by 4 raters, each video was coded by at least 2 different coders. For each spoonful the absence or presence of each item was recorded; for rate of acceptance, a four point scale was used. Results: In the certification test most cues were high in agreement for all coders. Factor analysis indicated two dimensions, one which largely captured gross behaviours and the second featuring a cluster of facial expressions. Internal consistencies of the overall scale and the behaviour and facial expression subscales were acceptable as indicated by Cronbach's alpha >0.7. Intra-class correlation indicated moderate to high inter-rater reliability and test-retest reliability for most of the cues. Spearman correlations indicated significant associations of the total number of negative behaviours with rate of acceptance and overall facial expressions. Rejection behaviours corresponded with a low rate of food acceptance and a high rate of negative facial expressions. Two parameters occurred less frequently and did not appear to provide any further discriminatory ability, namely leaning forward and crying/fussiness, these can be removed from the scale for future use. Conclusions: The Feeding Infants: Behaviour and Facial Expression Coding System (FIBFECS) is structurally valid and reliable for use by trained coders and those who are researching infant eating behaviour. The two factor structure of the tool suggests that the facial expression subscale reflects liking and the behaviour subscale wanting. The tool could also be adapted for mothers and professionals to detect liking and wanting through facial expression and behavioural cues respectively.