Browsing by Author "Pilditch, Kerry"
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- ItemComplementary feeding practices and behaviours of positive deviants among caregivers of young children at risk of stunting in Harrismith, Free State Province, South Africa(Stellenbosch : Stellenbosch University, 2020-03) Pilditch, Kerry; Du Plessis Lisanne, Drimie Scott; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.ENGLISH SUMMARY: Aim: To identify strategies present among positive deviant (PD) caregivers of non-stunted children that influence complementary feeding (CF)1 practices and allow them to function within individual, household and community-level factors to succeed in raising well-nourished children. Design: A mixed-method design using a PD model. Setting: Intabazwe Informal Settlement, Harrismith, Free State, South Africa. Subjects: Caregivers of stunted (non-positive deviant) and non-stunted (positive deviant) children aged 6-18 months. Of the caregivers selected for the quantitative population (n=28), 16 were non-positive deviants (NPD) and 12 were PDs. Six from each category additionally formed the qualitative population. Methodology: Caregivers were purposively selected according to selection criteria. Height-for-age (HAZ) and weight-for-height (WHZ) Z-scores were used to classify children as PDs or NPDs. Quantitative questionnaires were administered to obtain data regarding demographic information, socioeconomic scores and World Health Organisation (WHO) Infant and Young Child Feeding (IYCF) indicators. Caregivers with similar socioeconomic scores, from both NPD and PD categories, were selected for qualitative interviews. The semi-structured interview aimed to gain further insight into feeding behaviours that were not captured by the WHO IYCF tool, various other components related to behaviour (attitude, subjective norms and self-efficacy) and barriers and enablers to intended behaviour. Analysis of both data sets were performed with the aim of identifying possible adaptive and emphasis growth-promoting behaviours of PD caregivers. Results: IYCF Practices: In general, IYCF practices were similar among the two categories with poor exclusive and continued breastfeeding (BF) practices and the early introduction of solids reported. Only 40% (n=10) of the children obtained a minimum acceptable diet. Sixty percent (n=16) of children obtained minimum dietary diversity. The inclusion of gravy or “soup of meat” (instead of ‘flesh’ of meat) was more common among NPDs. Consumption of non-recommended foods and liquids was high and more common amongst NPD children. Responsive feeding (RF) practices were more commonly reported among PD caregivers. Child level: PDs tended to be younger, more likely female and had fewer hospital admissions. NPDs were more likely to have a low birth weight (LBW) and be premature. A strong theme identified amongst NPD caregivers was a child’s preference, often resulting in the exclusion of certain foods. Caregiver Level: Caregivers of PDs were older, more educated and more likely to be living with a partner. NPD caregivers ascribed higher value to foods that provided satiety and to infant foods. PDs more often explicitly expressed value for health care workers (HCWs). The most common advice received by both groups of caregivers pertained to the introduction of solids at six months and discontinuation of BF due to barriers or the mothers’ HIV status. PD caregivers were more likely to report taking action in response to a lack of food or finance or poor appetite. Action was typically in the form of health seeking behaviours or financial strategy. Household/ Community Level: PDs had better living conditions and higher socioeconomic scores. Support was more often expressed by PD caregivers with a warmth and appreciation for the support provided helping to create the perception of truly supportive households. The practice of eating and sharing meals as a family was a common occurrence in PD households. NPDs expressed experiencing isolation and instability in support structures. Discussion: The multifactorial and complex nature of stunting is highlighted by the lack of superior IYCF practices among PDs. Consideration needs to be given to the ability of indicators used to capture IYCF in the context of stunting and the effect of other risk factors, such as the prevalence of prematurity in the population, on nutritional status. Despite these results, adaptive and emphasis growth-promoting behaviours of PD caregivers were identified. Emphasis PD behaviours identified included: more frequent inclusion of proteins, less frequent inclusion of non-recommended liquids and foods, RF practices and health seeking behaviours by caregivers. Adaptive PD strategies encompassed the inclusion of the ‘flesh’ of meats, financial strategies as a coping mechanism of caregivers, and family eating. The presence of social capital among PD caregivers was deemed a ‘true but useless’ behaviour due to the lack of replicability. Conclusion: The poor feeding practices revealed by this study highlight the need for continued advocacy and promotion of BF and CF in South Africa. The presence of risk factors and non-nutritional PD behaviours within the study highlights the need for a multi-sectoral response, beyond the domain of HCWs and the health sector, in order to address stunting risk factors and improve IYCF practices. The identification of these risk factors will aid in identifying and supporting at-risk caregivers. Key health promotional messages based on identified PD IYCF behaviours, such as RF practices and limiting intake of non-recommended foods, should be developed to be used within the community where the research was conducted. These messages are inherent to the South Africa Paediatric Food Based Dietary Guidelines (PFBDG) which should be disseminated to the broader population. Further research is needed to investigate the role of child’s preference and caregivers’ interpretation of feeding cues, and how these impact feeding practices; the influence of improving a caregiver’s financial literacy on stunting; and gain a better understanding of the role of social capital and how it is developed.