The objective of this study was to explore Somali mothers’ beliefs and practices around infant feeding and education, towards developing a culturally informed infant nutrition curriculum for health providers. Four focus groups were conducted to explore: (1) beliefs about infant feeding, hunger and ideal weight; (2) feeding practices; (3) nutrition education approaches; and (4) provider/mother interactions. Thirty-seven Somali mother participants identified the following themes within these topics: (1) strategies for assessing hunger, satiety and when to feed; shared beliefs that plump babies are healthy, leading to worry about infant weight; (2) context of breast milk adequacy, difficulties breastfeeding and environmental and cultural barriers to breastfeeding, leading to nearly universal early supplementation with formula; (3) preferred education approaches include provider visits with interpreters, Somali language educational materials and advice from older, experienced family members; and (4) desired health provider skills include: listening, explaining, empathy, addressing specific concerns, repeating important information, offering preventive advice and sufficient visit time. This study presents knowledge about Somali beliefs and practices that can directly guide discussions with these families. Given that these infants appear on a trajectory towards obesity, influencing infant feeding practices in the Somali community is a good upstream approach to preventing obesity. These findings will underpin a new infant nutrition curriculum for health providers.

GH-training opportunities are important to pediatric residents when selecting a program, and many are graduating with intentions to volunteer/work in a developing country after residency. The low exposure to GH topics among a broad cross-section of pediatric residents suggests that additional work is needed to adequately prepare pediatricians for work in GH after residency.

Child mortality remains a global health challenge and has resulted in demand for expanding the global child health (GCH) workforce over the last 3 decades. Institutional partnerships are the cornerstone of sustainable education, research, clinical service, and advocacy for GCH. When successful, partnerships can become self-sustaining and support development of much-needed training programs in resource-constrained settings. Conversely, poorly conceptualized, constructed, or maintained partnerships may inadvertently contribute to the deterioration of health systems. In this comprehensive, literature-based, expert consensus review we present a definition of partnerships for GCH, review their genesis, evolution, and scope, describe participating organizations, and highlight benefits and challenges associated with GCH partnerships. Additionally, we suggest a framework for applying sound ethical and public health principles for GCH that includes 7 guiding principles and 4 core practices along with a structure for evaluating GCH partnerships. Finally, we highlight current knowledge gaps to stimulate further work in these areas. With awareness of the potential benefits and challenges of GCH partnerships, as well as shared dedication to guiding principles and core practices, GCH partnerships hold vast potential to positively impact child health.

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Objectives After completing this article, readers should be able to: 1. Provide examples of specific cultural beliefs and traditions that affect infant feeding practices. 2. Describe the influence of acculturation in the United States (US) on infant feeding practices among immigrant mothers. 3. Recognize the problem of infant overfeeding among particular groups. 4. Outline a culturally sensitive approach to elicit personal and cultural beliefs regarding infant feeding and to provide effective infant feeding counseling for mothers from different cultural backgrounds. ".. . all different cultures, whether in a tropical village or in a highly urbanized and technologically sophisticated community, contain some practices and customs which are beneficial to the health and nutrition of the group, and some which are harmful. No culture has a monopoly on wisdom or absurdity." Jellife D.

IntroductionThe extent that the dual burden of undernutrition and overnutrition affects refugee children before resettlement in the US is not well described.ObjectiveTo describe the prevalence of wasting, stunting, overweight, and obesity among refugee children ages 0–10 years at their overseas medical screening examination prior to resettlement in Washington State (WA), and to compare the nutritional status of refugee children with that of low-income children in WA.MethodsWe analyzed anthropometric measurements of 1047 refugee children ages 0–10 years old to assess their nutritional status at the overseas medical screening examination prior to resettlement in WA from July 2012—June 2014. The prevalence estimates of the nutritional status categories were compared by country of origin. In addition, the nutritional status of refugee children age 0–5 years old were compared to that of low-income children in WA from the Center for Disease Control and Prevention’s Pediatric Nutrition Surveillance System.ResultsA total of 982 children were eligible for the study, with the majority (65%) from Somalia, Iraq and Burma. Overall, nearly one-half of all refugee children had at least one form of malnutrition (44.9%). Refugee children ages 0–10 years were affected by wasting (17.3%), stunting (20.1%), overweight (7.6%) and obesity (5.9%). Among children 0–5 years old, refugee children had a significantly higher prevalence of wasting (14.3% versus 1.9%, p<0.001) and stunting (21.3% versus 5.5%, p<0.001), and a lower prevalence of obesity (6.2% versus 12.9%, p<0.001) than low-income children in WA.ConclusionThe dual burden of under- and over-nutrition among incoming refugee children as well as their overall difference in prevalence of nutritional status categories compared to low-income children in WA provides evidence for the importance of tailored interventions to address the nutritional needs of refugee children.

BACKGROUND AND OBJECTIVES: Limited data examine longitudinal nutrition outcomes of refugee children after United States resettlement. Among refugee children, our aims were to (1) assess the changes in weight-based nutritional status between baseline (0-3 months) and 10-24 months after arrival and (2) compare the BMI (BMIz) or weight-for-length z score (WFLz) trajectories to nonrefugee children for up to 36 months after arrival.

This paper provides information on optimal breastfeeding practices in the People's Democratic Republic of Lao from data collected in the 2011 Lao Social Indicator Survey. Results: Early initiation of breastfeeding within the first hour of life occurred among 39.6% of Laotian infants. After controlling for the effects of wealth, early initiation of breastfeeding was found to be most prevalent among mothers with higher education, those who received antenatal services, and those who delivered in a health facility. Avoidance of prelacteal feeds within the first three days of life occurred among 65% of Laotian infants, and was highest among ethnic Hmong and Khmer infants, and among those born in public versus private health facilities. Avoidance of prelacteal feeds was lowest after deliveries in which a traditional birth attendant was present. Exclusive breastfeeding through the first 5 months of age was reported among 40.8% of infants nationally. Ethnicity again played a role with the highest levels of exclusive breastfeeding found to occur among ethnic Khmer infants (69.4%, OR 2.8, CI: 1.5-5.1). Discussion: These results highlight the role that health care workers can have on early breastfeeding practices at the point of both antenatal counseling and in the delivery setting. Strengthening the quality of counseling on infant feeding can have a significant impact on early initiation of breastfeeding. Ethnic differences significantly impact both early and exclusive breastfeeding practices. Conclusion: A complexity of factors at different levels of care impact breastfeeding practices. A synergy of strategic approaches are needed to target antenatal counseling as well as post-delivery practices, all which account for the unique social and cultural attitudes towards infant feeding. Stronger community-based interventions that account for cultural attitudes and practices are most likely to be successful in promoting exclusive and continued breastfeeding practices.