Using formative research to design a context‐specific behaviour change strategy to improve infant and young child feeding practices and nutrition in Nepal

Abstract

Global recommendations on strategies to improve infant feeding, care and nutrition are clear; however, there is limited literature that explains methods for tailoring these recommendations to the local context where programmes are implemented. This paper aims to: (1) highlight the individual, cultural and environmental factors revealed by formative research to affect infant and young child feeding and care practices in Baitadi district of Far Western Nepal; and (2) outline how both quantitative and qualitative research methods were used to design a context-specific behaviour change strategy to improve child nutrition. Quantitative data on 750 children aged 12-23 months and their families were collected via surveys administered to mothers. The participants were selected using a multistage cluster sampling technique. The survey asked about knowledge, attitude and behaviours relating to infant and young child feeding. Qualitative data on breastfeeding and complementary feeding beliefs and practices were also collected from a separate sample via focus group discussions with mothers, and key informant interviews with mothers-in-law and husbands. Key findings revealed gaps in knowledge among many informants resulting in suboptimal infant and young child feeding practices - particularly with relation to duration of exclusive breastfeeding and dietary diversity of complementary foods. The findings from this research were then incorporated into a context-specific nutrition behaviour change communication strategy.

Trends and predictors of appropriate complementary feeding practices in Nepal: An analysis of national household survey data collected between 2001 and 2014

“…First, there is a widespread cultural belief that cereal foods are enough for children, with less emphasis on the importance of diet diversity for healthy growth and development (Gautam, Adhikari, Khatri, & Devkota, ). Second, cultural taboos relating to eggs and flesh foods are common, and children are usually fed such foods only after they have teeth, at about 1 year of age (Locks et al, ).…”

Factors associated with the introduction of prelacteal feeds in Nepal: findings from the Nepal Demographic and Health Survey 2011

“…Mothers from the Far western region of Nepal were less likely to provide prelacteal feeds. The Far western development region of Nepal has some of the poorest areas in the country and is characterised by a harsh terrain with less access to driveable roads, greater reliance on an animal based transport system, and a lower density of the health facilities with the highest child mortality rates [34,35]. The current findings could be a reflection of a large number of mothers from poorest socio-economic groups and a lack of access to expensive prelacteal feeds such as ghee, honey or glucose solution.…”

Eggs: the uncracked potential for improving maternal and young child nutrition among the world's poor

“…In Nepal, cultural and religious beliefs about whether foods are “hot,” “cold,” or “pollution” or have “strengthening” or “weakening” properties can play strong roles in food choices during certain stages of the life cycle, such as pregnancy and early childhood, or during recovery from illness . Within the Baitadi, Brahmin, and Chhetri castes, poultry are not reared because they are believed to be unclean . Among some religions, vegetarianism is held as an ideal, with the consumption of meat, eggs, and seafood strictly prohibited.…”

“…Among pregnant women in Nepal, “religious reasons” have been reported as the most frequently cited reason for not consuming eggs . Mothers from multiple castes reported that they thought meat and eggs should be avoided in children under the age of 1 year because they are “difficult to digest.” On the other hand, eggs are considered “hot” and strength giving, particularly good to eat during times of illness …”