The acceptability and utility of an innovative feeding bowl and sieved spoon to improve maternal and child nutrition practices in Bihar, India Open Access

Abstract

Introduction: Dietary practices in India often fail to provide adequate nutrition during the first 1000 days of life. Behaviour change theory suggests that effective cues to action can influence positive uptake of optimal recommendations. We explored the utility and benefit of low-cost and easy-to use demarcated feeding bowl and slotted spoon designed as a cue to action for the dietary practices in the first 1000 days. Methodology: In Samastipur district, Bihar India we conducted 16 focus group discussions and 8 key informant interviews to identify community acceptability and obtain feedback on design and delivery of the bowl and spoon. We conducted user testing with 20 pregnant women and 20 breastfeeding women 0-6 months postpartum and 20 mothers with infants 6-18 months. Results: The tools were well accepted by the community, though communities recommended manufacturing them in steel. The proportion of pregnant and breastfeeding women taking an extra portion of food per day increased from 0% to 100%; number of meals increased from 2-3 to 3-4 / day. For children 6-18 months, meal frequency, quantity of food consumed during meals and thickness of the foods increased for all age groups. Children 6-8 months who had not yet initiated complementary feeding all initiated during the testing period. Conclusion: Simple feeding tools are culturally acceptable and can be appropriately used by families in Bihar India to improve dietary practices during the first 1000 days of life. Research is needed to assess whether the tools promote dietary and nutrition improvements over and above counseling alone.

Table of Contents

Table of Contents

CHAPTER I: Introduction............................................................................................................ 1

Objectives................................................................................................................................... 4

Significance............................................................................................................................... 5

CHAPTER II: Literature Review................................................................................................. 6

Problem and Consequences of Maternal and Child Malnutrition..................................... 6

Assessment of Current Maternal and Child Nutrition Interventions................................ 7

Maternal Nutrient Regulation and Child Outcomes................................................................. 8

Maternal Knowledge, Nutrition Counseling and Education..................................................... 9

Infant and Young Child Feeding Practices.............................................................................. 11

Potential Opportunities in Improving Current Maternal and Child Malnutrition Intervention 14

CHAPTER III: Manuscript......................................................................................................... 20

Title Page................................................................................................................................. 21

Contribution of Student [required for Rollins thesis only; not for publication]............ 22

Abstract..................................................................................................................................... 23

Keywords:................................................................................................................................. 23

Research Highlights [requirement of Social Science & Medicine]................................. 24

Introduction.............................................................................................................................. 25

Methods.................................................................................................................................... 28

Design, Study Setting and Participant Recruitment............................................................... 28

Tool Development................................................................................................................. 29

Data Collection:...................................................................................................................... 29

Data Preparation and Management........................................................................................ 31

Data analysis.......................................................................................................................... 32

Research Ethics:..................................................................................................................... 32

3.0 Results................................................................................................................................ 33

1.0 Community Norms and Current Maternal and Child Nutrition Practices....................... 33

2. Potential of the Bowls and Spoon to Shift Dietary Practices- Findings from Trials of Improved Practices User testing 35

3. Recommendations for tools: design modifications and delivery platforms........................ 40

Discussions and Conclusion.................................................................................................. 43

References................................................................................................................................ 47

Tables and Figures.................................................................................................................. 49

Table 2: The Assessment of Nutritional Practices by Pregnant and Breastfeeding Women in the 14 day Pilot Study 50

Table 3: The Assessment of Nutritional Practices of 6-24 months old children in the 14 day Pilot Study 51

CHAPTER IV: Conclusion and Recommendations................................................................. 54

References.................................................................................................................................... 57

Appendix....................................................................................................................................... 60

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Nutrition
Keyword	Dietary Practices Feeding Bowl and Slotted Spoon Nutrition Acceptability Cues to action Bihar, India
Committee Chair / Thesis Advisor	Girard, Amy Webb, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs International Non-governmental organization (e.g., CARE, Inc.) University, college or educational institution (other than Emory)

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