Background Vitamin A deficiency remains a public health problem in Burkina Faso and elsewhere in the developing world. Dietary diversification is a promising strategy that needs to be explored to strengthen the country's ongoing supplementation program. Objective The purpose of this study was to identify locally available and acceptable (pro)vitamin A–rich foods to be included in a dietary intervention addressing vitamin A deficiency in children aged six months to three years. Methods A food ethnographic study combining recall methods, observation, and focused group discussion was conducted in the dry and rainy seasons. Thirty-five mother–child pairs were randomly selected and included in the study. Results The dietary pattern of children was characterized by low diversity with extremely low energy and vitamin A intake in both seasons. The study identified the availability of numerous (pro)vitamin A–rich foods, but these foods are either not consumed or consumed by few in low amounts and/or in low frequencies. The main constraining factors identified are related to financial accessibility (for liver), seasonal availability (for egg, milk, mango, papaya, and green leafy vegetables), and beliefs related to consumption and preparation (for green leafy vegetables). However, the study also revealed that the study population associated all identified (pro)vitamin A–rich foods with positive attributes such as health, strength, and vitamin richness, which might offer an entry point for designing and implementing dietary interventions. Conclusions Based on the findings of this formative research, intervention strategies with mango and liver are proposed to improve the vitamin A intake and status of children in the rural areas of Burkina Faso.

In many countries, water is provided to children under 6 months of age (CU6M) in addition to breast milk (BM), hence increasing the risk of child mortality and morbidity. Factors related to this practice have not been thoroughly investigated either a tool to assess them. Based on the extended theory of planned behaviour (eTPB), we aim to develop and validate a questionnaire to assess psychosocial and environmental factors that may contribute/limit the water provision in addition to BM by mothers of CU6M in the Republic of Guinea. A three‐step process was used. Ten focus group discussions (FGDs) were held to identify salient beliefs related to each of the four constructs of the eTPB. Data from FGDs were used to develop a questionnaire composed of 88 items administered to 428 mothers. Exploratory factor analyses were conducted to identify latent factors for each construct. A shorter version of the questionnaire was administered to another sample of 300 mothers. Confirmatory factor analyses (CFAs) were performed. Hancock and Mueller's H reliability indices were computed on final models to assess the tool's validity and reliability. The final questionnaire included 57 items. For all four final models, most criteria for fit indices of CFA were generally met. Reliability coefficients were all equal to or above 0.90 for each construct. This research offers a tool that could be used to investigate determinants of water provision besides BM among mothers of CU6M. Further validation in other contexts is warranted.

Water provision to infants under six months of age (IU6M) can hamper exclusive breastfeeding (EBF). Understanding factors and their relationships influencing this practice is needed to tailor EBF promotion programs. Using a validated questionnaire, this study aims to identify pathways in which individual factors and the environment interact to affect the provision of water in addition to breast milk among 300 mothers of IU6M. Our finding shows that 75% of mothers intended to provide water in addition to breast milk to their IU6M and that about 60% reported doing it. Results of the final path show that the subjective norm/SN (β = 0.432, p < 0.001), the attitude (β = 0.349, p < 0.001), and to a lesser extent the perceived control/PC (β = 0.141, p = 0.005) predict the intention of mothers to provide water in addition to breast milk to their IU6M. The environment scores predict the attitude (β = 0.210, p = 0.001) and the SN (β = 0.284, p < 0.001). Having the mother practicing early breastfeeding initiation at birth positively predicted the PC score (β = 0.157, p = 0.017) and predicted an increasing score of SN (β = 0.221, p = 0.003). Even though predicting the final behavior is complex, this research provides directions to nutrition education programs to tailor their content to the context and be more efficient in reducing the proportion of women providing water to their IU6M, hence contributing to the improvement of EBF.

Objective: In many countries, the provision of water in the early months of a baby’s life jeopardizes exclusive breastfeeding (EBF). Using a behavioral theory, this study assessed the impact of a behavior change intervention on mothers’ intention to act and, in turn, on the water provision in addition to breast milk to their infant under six months of age (IU6M) in two regions of Guinea. Design: A quasi-experimental design. Data on individual and environmental factors of the theoretical framework, sociodemographic, and outcomes were collected using validated questionnaires before and after the intervention. The outcomes examined were the intention to provide water to IU6M, the provision of water, and EBF. Path analyses were performed to investigate pathways by which psychosocial and environmental factors influenced the water provision in addition to breast milk. Setting: Four health centers were assigned randomly to each study’s arm (one control/CG and one intervention group/IG per region). Participants: The sample included 300 mothers of IU6M: 150 per group. Results: In IG, the proportion of mothers providing water decreased from 61% to 29% before and after the intervention (P <0•001), while no difference was observed in CG (P = 0•097). The EBF rate increased in IG (from 24•0% to 53•8%, P <0•001) as opposed to CG (36•7% to 45•9%, P = 0•107). An association (P <0•001) between the intention and the behavior was observed in both groups. Conclusions: An intervention developed using a sound framework reduces the provision of water among IU6M and improves EBF.