An Innovative Grandmother-Inclusive Approach for Addressing Suboptimal Infant and Young Child Feeding Practices in Sierra Leone

Abstract

Background Sub-optimal infant and young child feeding (IYCF) practices contribute to child undernutrition. Sierra Leone Demographic and Health Survey data show that IYCF practices remain poor despite modest improvements. Recent studies have identified the role of grandmothers as critical to child nutrition, however in Sierra Leone to date, the potential for grandmothers to influence IYCF practices has not been investigated. Objectives We examine how an innovative grandmother-inclusive approach (GMIA) can be used to address sub-optimal IYCF practices. Methods Using a quasi-experimental design, we compared IYCF beliefs and practices between GMIA intervention communities (receiving monthly dialogue sessions on nutrition, quarterly community praise sessions, and intergenerational forums) and comparison communities (receiving standard nutrition education) in Bum chiefdom from 2013 and 2016. The quantitative endline survey targeted 101 pregnant women, 291 women with children < 2 y of age, and 219 grandmothers. Statistical analyses utilized t-tests and chi square to examine differences between intervention and comparison communities at endline. Multivariate regression was used to determine the intervention's effect on IYCF outcomes of interest. Results Awareness of and participation in the GMIA was high among mothers and grandmothers in intervention communities. The percentage of infants and young children 0–23 mo (n = 291) exclusively breastfed during the first week of life was significantly higher in the intervention group (90.2% vs. 79.4%, p = 0.01). Among infants 6–23 mo (n = 219), the percentage achieving minimum dietary diversity and minimum acceptable diet was significantly higher in the intervention group (77.2% vs. 51.8%, p < 0.001 and 53.8% vs. 22.6%, p < 0.001, respectively). Differences in percentages achieving minimum meal frequency (MMF) were only significant for infants 9–23 mo, with intervention group achieving higher MMF (54.6% vs. 36.9%, p = 0.02). Conclusions Results suggest that a GMIA that recognizes grandmothers’ roles and strengthens their knowledge may contribute to improved IYCF practices.

Engaging family members in maternal, infant and young child nutrition activities in low‐ and middle‐income countries: A systematic scoping review

“…Four used the Theory of Planned Behaviour (Ajike et al, 2020; Downs et al, 2019; Gu et al, 2016; Rempel et al, 2017), two used the Theory of Reasoned Action (Hoddinott et al, 2018; Nguyen et al, 2018), two used Social Cognitive Theory (Rabiepoor et al, 2019; Singla et al, 2015), two used the socioecological model (DeLorme et al, 2018; Mukuria et al, 2016), two used theoretical concepts related to social support and social networks (Bootsri & Taneepanichskul, 2017; Martin et al, 2017), one used the transtheoretical model (Salasibew et al, 2019), and one used the Beliefs, Attitudes, Subjective Norms and Enabling Factors (BASNEF) model (Akbarzadeh et al, 2015). Four studies based intervention design on multiple theories and constructs (Aidam et al, 2020; Aubel, 2012; Hoddinott et al, 2018; H. S. Kim et al, 2016; Nguyen et al, 2019). Two studies did not explicitly state a theoretical orientation, but described designing their intervention in response to multiple levels of influence consistent with a socio‐ecological framework (Brasington et al, 2016; Cresswell et al, 2019).…”

“…Support groups or similar types of community groups were used in 19 studies. Occasionally groups included mothers, fathers and grandmothers and met together with other members of their community (DeLorme et al, 2018), but separate groups for fathers (Tall et al, 2018; Thuita et al, 2015) or grandmothers (Aidam et al, 2020; Aubel et al, 2004; Tall et al, 2018; Thuita et al, 2015) were more common. In Malawi, father or grandmother groups met separately and then came together with other family members during occasional meetings (Bezner Kerr et al, 2011).…”

“…Activities that reached the entire community, or targeted community leaders, often covered multiple nutrition topics and sought to influence social and gender norms and increase support for maternal and child nutrition (Aubel et al, 2004; Kumar et al, 2018; Nguyen et al, 2018; Rosenberg et al, 2018). Songs, dances and skits were also used as part of community‐based interventions (Aidam et al, 2020; Aubel et al, 2004; Kumar et al, 2018; Thuita et al, 2015).…”

“…F I G U R E 3 Intervention approaches used to engage each category of family member Songs, dances and skits were also used as part of community-based interventions (Aidam et al, 2020;Aubel et al, 2004;Kumar et al, 2018;Thuita et al, 2015).…”

The male breadwinner nuclear family is not the ‘traditional’ human family, and promotion of this myth may have adverse health consequences

“…But even if older women's advice does contradict that of public health professionals, they are typically very influential in decisions around maternal and child health, which suggests it is even more important to incorporate older women into public health interventions [31]. The positive results in the handful of studies that have incorporated grandmothers and older women in public health initiatives suggest this would be a fruitful avenue for improving maternal and child health [93][94][95][96], and mental health (Dixon Chibanda's 'Friendship Bench' is perhaps the best known example of a successful intervention employing 'grandmothers' [97,98]).…”