Figures & Tables
Figures
- FIGURE 1.
Conceptual Model of Social Support Provided to Mothers Affecting Maternal, Infant, and Young Child Nutrition Practices
Cultural beliefs are mitigated by information and education on optimal nutrition practices. Provision of social support along with improved information and education of influencers (i.e., fathers and grandmothers) can impact maternal, infant, and young child feeding practices both indirectly by supporting mothers and directly by the influencers implementing optimal feeding practices themselves.
- FIGURE 2.
Study Timeline
Source: Thuita et al., 2015 31
A father in western Kenya feeds his child. Household members such as fathers and grandmothers often exert social influences on a mother’s adoption of optimal infant feeding practices.
Tables
Grandmother Dialogue Groups Father Dialogue Groups Role of grandmothers in infant and young child feeding and maternal nutrition
Overview of maternal and infant and young child nutrition and the local health situation
Eating during pregnancy and breastfeeding
Early initiation of breastfeeding
Exclusive breastfeeding
Complementary feeding
Preparing food safely
Responsive feeding
What to do when a child falls ill
Mother‐to‐child transmission of HIV
Infant feeding and HIV
Supporting mothers with HIV and their families (including referrals and promoting health seeking)
Facilitation skills
Effective family communication
Infant feeding beliefs and myths
Understanding gender
Gender roles: behaviors and division of labor and child care in the home
Healthy and unhealthy relationships
Effective communication
Thinking about fatherhood
Family care
Poor child health “problem tree”
What your family eats
Understanding maternal and child nutrition
Supporting good infant feeding practices during the first 6 months of life
Complementary feeding
What to do when your child falls ill
Mother‐to‐child transmission of HIV
Infant feeding and HIV
Disclosure of HIV status (role plays)
Men, women, and caregiving
Men’s role in health promotion
Study Areas No. of Participants Mothers Grandmothers Fathers Total Baseline Endline Baseline Endline Baseline Endline Baseline Endline Father intervention area (Kitagwa) 92 70 NA NA 85 75 177 145 Grandmother intervention area (Viguru) 77 71 79 81 NA NA 156 152 Comparison area (Mambai) 89 76 86 73 46 63 221 212 Total 258 217 165 154 131 138 554 509 Expected sample (69 participants/group) 207 138 138 483 Father Intervention Area (Kitagwa) n = 92 Grandmother Intervention Area (Viguru) n = 77 Comparison Area (Mambai) n = 89 P Value Age of mother, mean, years 27.2 27.5 26.5 .63 Sex of child is male, % 48.9 53.2 53.9 .77 Age of child, % 6 months 37.0 31.2 29.5 .27 7 months 15.2 18.2 22.7 8 months 26.1 16.9 15.9 9 months 21.7 33.8 31.8 Parity, % 1 25.0 15.6 33.0 .14 2–3 39.1 40.3 34.8 4+ 35.9 44.2 32.9 Marital status, % Married (ever) 100.0 88.2 78.7 .001 Single/never married 0.0 11.8 21.4 Mother’s education, % Primary completed 38.5 48.1 55.1 .001 Secondary completed 11.0 7.8 21.4 Mother’s occupation, % Subsistence farmer 34.8 46.1 30.6 .32 Homemaker (no outside work) 33.7 30.3 38.8 Outside work 31.5 23.7 30.6 Spouse’s age, mean, years 32.9 33.2 33.4 .57 Spouse’s education, % Primary completed 31.3 47.1 48.6 .03 Secondary completed 21.7 16.2 27.1 Spouse’s occupation, % Subsistence farmer 18.7 30.9 16.9 .09 Employed 81.3 69.1 83.1 Socioeconomic status, % Lowest quartile 31.5 36.4 32.6 .83 Middle quartile 31.5 31.2 37.1 Highest quartile 37.0 32.5 30.3 - TABLE 3 Changes in Mothers’ Reported Infant Feeding Practices, by Intervention Area: Difference-in-Difference Analysis
Father Intervention Area (Kitagwa) Grandmother Intervention Area (Viguru) Comparison Area (Mambai) Father vs. Comparison Area Grandmother vs. Comparison Area DiD OR P Value DiD OR P Value Adequate consistency of food consumed, No. (%) Baseline 92 (32.2) 77 (30.3) 89 (31.4) Endline 70 (68.1) 71 (88.7) 76 (45.8) 21.5 2.4 .06 44.0 9.8 .001 Minimum no. of meals provided in past 24 hours, No. (%) Baseline 92 (71.7) 77 (77.9) 89 (64.0) Endline 70 (70.0) 71 (77.5) 76 (64.5) -2.2 1.3 .59 -0.9 1.5 .47 Dietary diversity (≥4 food groups), No. (%) Baseline 92 (44.6) 77 (48.1) 89 (44.9) Endline 70 (85.7) 71 (81.7) 76 (72.4) 13.6 2.3 .11 6.1 1.5 .42 Minimum acceptable diet, No. (%) Baseline 92 (39.1) 77 (40.3) 89 (31.5) Endline 70 (58.6) 71 (60.6) 76 (46.1) 4.9 1.2 .71 5.7 1.2 .66 Animal-source foods consumed on ≥3 days in past 7 days, No. (%) Baseline 92 (9.8) 77 (14.3) 89 (11.2) Endline 70 (41.4) 71 (42.3) 76 (11.8) 31.0 6.1 .005 27.4 4.1 .03 Abbreviations: DiD, difference-in-difference; OR, odds ratio.
- TABLE 4 Changes in Reported Social Support, by Intervention Area: Difference-in-Difference Analysis
Father Intervention Area (Kitagwa) Grandmother Intervention Area (Viguru) Comparison Area (Mambai) Father vs. Comparison Area Grandmother vs. Comparison Area DiD OR P Value DiD OR P Value Mothers’ Reported Receipt of Social Support From Child’s Father or Grandmother No. of support actions received, median Baseline 5.0 5.0 5.0 Endline 10.0 10.0 6.0 4.0 – – 4.0 – – Any social support received, No. (%) Baseline 92 (97.8) 77 (94.8) 89 (96.6) Endline 70 (100.0) 71 (100.0) 76 (94.7) 4.1 – – 7.1 – – 5+ social support actions received, No. (%) Baseline 92 (65.2) 77 (58.4) 89 (66.3) Endline 70 (97.1) 71 (97.2) 76 (72.4) 25.8 13.6 .002 32.7 18.4 .001 Fathers’ Reported Provision of Social Support to Child’s Mother Any social support provided by fathers, No. (%) Baseline 85 (88.2) NA 46 (84.8) Endline 75 (100.0) NA 63 (90.5) 6.1 – – NA NA NA 5+ social support actions provided by fathers, No. (%) Baseline 85 (63.5) NA 46 (54.3) Endline 75 (98.7) NA 63 (52.4) 37.1 46.0 .001 NA NA NA 5+ physical support actions provided by fathers, No. (%) Baseline 85 (18.8) NA 46 (21.7) Endline 75 (96.0) NA 63 (44.4) 54.5 35.9 .001 NA NA NA 3+ material support actions provided by fathers, No. (%) Baseline 85 (38.8) NA 46 (45.7) Endline 75 (96.0) NA 63 (69.8) 33.0 13.7 .001 NA NA NA Grandmothers’ Reported Provision of Social Support to Child’s Mother Any social support provided by grandmothers, No. (%) Baseline NA 79 (86.1) 86 (94.2) Endline NA 81 (97.5) 73 (97.3) NA NA NA 8.4 2.9 .36 5+ social support actions provided by grandmothers, No. (%) Baseline NA 79 (60.8) 86 (67.4) Endline NA 81 (90.1) 73 (86.3) NA NA NA 10.4 1.9 .27 5+ physical support actions provided by grandmothers, No. (%) Baseline NA 79 (60.8) 86 (67.4) Endline NA 81 (64.2) 73 (38.4) NA NA NA 36.6 4.4 .002 3+ material support actions provided by grandmothers, No. (%) Baseline NA 79 (10.1) 86 (23.3) Endline NA 81 (72.8) 73 (57.5) NA NA NA 28.4 5.3 .003 Abbreviations: DiD, difference-in-difference; OR, odds ratio.
(–): No values reported either because the indicator is reported in terms of median or because there is 100% response; in either case, logistic regression cannot be fitted.
- TABLE 5 Influence of Reported Social Support Received by Mothers on Infant Feeding Practices
Min. No. of Meals Min. Dietary Diversity Min. Acceptable Diet OR (CI) P Value OR P Value OR (CI) P Value No. of social support actions 1.14 (1.00, 1.30) .047 1.07 (0.95, 1.21) .24 1.06 (0.94, 1.20) .32 Study site; ref: comparison area (Mambai) Father intervention area (Kitagwa) 2.94 (0.98, 8.83) .055 0.4 (0.14, 1.15) .09 0.95 (0.33, 2.71) .92 Grandmother intervention area (Viguru) 5.07 (1.56, 16.50) .007 0.38 (0.13, 1.13) .08 1.00 (0.35, 2.90) .99 Support * Father intervention area 0.85 (0.73, 1.00) .045 1.15 (0.98, 1.34) .08 1.04 (0.90, 1.21) .58 Support * Grandmother intervention area 0.82 (0.70, 0.97) .02 1.19 (1.01, 1.40) .04 1.06 (0.91, 1.23) .48 Abbreviation: OR, odds ratio.The first row (number of social support actions) indicates the effect of increasing social support in all 3 study groups on the selected infant feeding practices. The second row (study site) compares the effect on infant feeding practices of the father intervention area vs. the comparison area and the grandmother intervention area vs. the comparison area, without specifically taking into account social support. The last set of rows (support * father intervention area; support * grandmother intervention area) takes into account the interaction effects of both intervention area and social support on infant feeding practices.
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