Acceptability of a child feeding toolkit in Mchinji district Malawi Open Access

Kedera, ELLAH (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/m039k528t?locale=en
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Abstract

Background: Over half (53.7 percent) of all children under 5 years in Mchinji district, Malawi are stunted. Among other factors, stunting is caused by inadequate young child feeding characterized by poor quality and insufficient quantities of complementary foods. Under the support for nutrition improvement component(SNIC) project, Concern Worldwide and the Mchinji District Council are conducting targeted research to assess the effectiveness of a child feeding bowl and slotted spoon ('feeding toolkit') to improve the volume and consistency of foods provided to children 6-23 months of age.

Objective: Formative research was conducted to assess the acceptability and feasibility of the feeding toolkit and cultural appropriateness of the counseling card among community members.

Methodology: We explored current infant and young child feeding (IYCF) practices and the acceptability of the feeding toolkit through 10 focus group discussions (FGDs) with pregnant mothers and care givers of children under 5 years, husbands to the care givers, Care Group Lead Mothers, community leaders, and healthcare workers. The focus group discussions were conducted in Chichewa and detailed field notes and summaries of discussions were collated for analysis of key themes.

Findings: Child feeding largely depends on the child's age, size, and behavior during feeding, and food availability. Mothers predominantly reported feeding two to three times per day regardless of child's age. All caregivers reported a preference for thin or watery foods starting at six months. The feeding toolkit was positively perceived as an aid for Lead Mothers and health care workers and a reminder to care givers and husbands about the quantity of food, timing and frequency of child feeding. Potential threats to the acceptability and feasibility of the feeding toolkit are lack of food, and insufficient community sensitization.

Conclusion: Young children in this community are not fed according to the WHO recommendations. Lack of illustrative devices to help caregivers in cuing volume, frequency and consistency of complementary feeding a major challenge. The perceived benefits of the feeding toolkit are a pointer to its acceptability despite the major challenge of poverty and food insecurity. Lead mothersknowledge on households makes them a better channel of distributing the feeding toolkit. The toolkit should be distributed at a subsidized cost of 100MK if not free.

Table of Contents

Abstract .................................................................................................................................................... iv
Acknowledgements ................................................................................................................................. vi
List of abbreviations ............................................................................................................................... ix
List of figures ........................................................................................................................................... xi
Chapter 1: Introduction. .......................................................................................................................... 1
1.0 Introduction and rationale ........................................................................................................ 1
1.1 Problem Statement .......................................................................................................................... 2
1.2 Purpose Statement.......................................................................................................................... 3
1.3 Research Objective .......................................................................................................................... 3
1.4 Significance Statement .................................................................................................................... 3
1.5 Definition of terms ........................................................................................................................... 4
Chapter 2: Literature review ................................................................................................................... 5
2.1 Introduction .................................................................................................................................... 5
2.2 Complementary feeding .................................................................................................................. 5
2.2.1 Consequences of inappropriate complementary child feeding............................................. 6
2.3 Causes of child stunting .............................................................................................................. 6
2.3.1 Consequences of child stunting ................................................................................................... 9
2.4 Determinants of complementary child feeding ............................................................................. 9
2.5 Strategies to improve complementary feeding ........................................................................... 10
2.6 Child stunting in Malawi .............................................................................................................. 15
2.6.1 Interventions promoting complementary child feeding in Malawi.................................... 17
2.6.2 Care groups in Malawi ........................................................................................................... 19
2.7 Development of the feeding bowl and spoon. .............................................................................. 19
Chapter 3: Methodology........................................................................................................................ 24
3.1 Introduction .................................................................................................................................. 24
3.2 Study sites and population. ........................................................................................................... 24
3.3 Sample size and selection .............................................................................................................. 25
3.4 Study design .................................................................................................................................. 25
3.5 Instrumentation ............................................................................................................................. 25
3.5.1 Training of research assistants .............................................................................................. 26
3.6 Data collection ............................................................................................................................... 27
3.7 Data analysis ................................................................................................................................. 28 3.8 Ethical considerations. .................................................................................................................. 28
3.9 Study limitations and delimitations ............................................................................................. 29
Findings ................................................................................................................................................... 30
4.1 Introduction .................................................................................................................................. 30
4.2 The study population .................................................................................................................... 30
4.3 Infant and young child feeding practices in Mchinji district .................................................... 30
4.3.1 Infant feeding from birth to 6 months .................................................................................. 30
4.3.2 Common complementary foods for children 6 to 23 months ............................................. 32
4.3.3 Amount of food given to children 6-23 months. ................................................................... 33
4.3.4 Frequency of feeding children 6-23 months ......................................................................... 34
4.3.5 Consistency/thickness of food given to children 6-23 months ............................................ 34
4.3.6 Sources of information on infant and young child feeding ................................................. 35
4.4 Acceptability of the feeding toolkit .............................................................................................. 35
4.4.1 Perceptions of the design of the counseling card. ................................................................ 36
4.4.2 Perceptions of the design of the feeding bowl ...................................................................... 37
4.4.3 Perceived benefits of the feeding toolkit ............................................................................... 38
4.5 Motivating factors influencing acceptability of the toolkit........................................................ 38
4.5.1 Perception of the problem. ..................................................................................................... 38
4.5.2 Perceived personal benefits. ................................................................................................... 38
4.5.3 Design of the feeding bowl ..................................................................................................... 39
4.6 Factors that may affect feasibility of the feeding toolkit ........................................................... 39
4.6.1 Challenges in utilizing the feeding toolkit ............................................................................ 39
4.7 Proposed modifications to the counseling card .......................................................................... 40
4.8 Cost and delivery platforms ......................................................................................................... 40
4.8.1 Cost of feeding toolkit ............................................................................................................. 41
Discussion................................................................................................................................................ 42
5.1 Summary of study ......................................................................................................................... 42
Conclusion and Recommendations ....................................................................................................... 47
6.1 Conclusion ..................................................................................................................................... 47
6.2 Recommendations. ........................................................................................................................ 47
References ............................................................................................................................................... 50
Appendix A Focus group discussion guides in English and Chichewa .............................................. 58

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