Infant Feeding Practices, Nutrition, and Associated Health Factors during the First Six Months of Life among Syrian Refugees in Greater Beirut, Lebanon: A Mixed Methods Study

The objective was to describe infant feeding practices, nutrition and related health aspects of infants under six months among Syrian refugees in Greater Beirut, Lebanon. A cross-sectional study was conducted among Syrian refugee mothers with infants under six months in July-October 2018 (N = 114). Additionally, eleven focus group discussions were conducted to explore supportive factors and barriers associated with early breastfeeding practices. The prevalence of pre-lacteal feeding was high (62.5%), whereas early initiation of breastfeeding was low (31%), and exclusive breastfeeding very low (24.6%). One-fifth of the infants were anemic (20.5%) and 9.6% were wasted. A significantly higher proportion of non-exclusively breastfed infants had a fever and took medicines than those who were exclusively breastfed. Supporting factors of adequate infant feeding practices comprised knowledge on maternal nutrition and exclusive breastfeeding, along with receiving support from healthcare professionals and family members. Identified barriers included preterm delivery, pre-lacteal feeding, an at-risk waist circumference and moderate to severe depression among mothers, bottle feeding, early introduction of food, maternal health reasons, breastmilk substitutes' distribution, and misinformation offered by mothers-in-law. To address sub-optimal feeding practices documented among Syrian refugees, awareness on proper breastfeeding practices, maternal nutrition, and psychosocial support should be provided to mothers and family members alike.

Linking agriculture and nutrition education to improve infant and young child feeding: Lessons for future programmes

Agriculture and food systems play a central role in nutrition by supplying nutritious, healthy and affordable foods. When integrated with nutrition education for behaviour change, agricultural interventions that supply diverse affordable foods from all food groups have great scope for improving young child and family diets. In 2014, process reviews were conducted in Cambodia and Malawi of food security projects that provided agricultural support and community-based nutrition education on improved infant and young child feeding (IYCF). In both countries, household visits were carried out with mothers/caregivers, and interviews and Focus Group Discussions (FGDs) were conducted with purposively selected project stakeholders (53 in Cambodia, 170 in Malawi), including government staff from the agriculture and health sectors. Results highlight that adoption of improved IYCF practices was facilitated by participation in nutrition education and practical cooking sessions, and supportive family and community structures. Barriers faced by families and caregivers were identified, such as women's workload and lack of access to high quality foods, namely fruits, vegetables, legumes, nuts and animal source foods. Implementation challenges regarding coordination of cross-sectoral targeting strategies and capacities of extension services to sustain community-based IYCF nutrition education need to be addressed to improve programme effectiveness and impact. The project lessons from Cambodia and Malawi are useful for integrated agriculture-IYCF nutrition education programmes to help ensure better young child nutrition outcomes.

Exclusive breastfeeding and its effect on growth of Malawian infants: results from a cross-sectional study

BACKGROUND

For the optimal nutrition of children under 2 years of age, it is considered important that they be exclusively breastfed for the first 6 months before being given complementary food.

AIMS AND OBJECTIVES

A cross-sectional nutritional baseline survey was undertaken in 2011 in the Kasungu and Mzimba Districts of Malawi to assess the nutritional status of children under 2 years of age and its determinants in order to prepare a nutrition education intervention programme. The intention of this study was to assess the nutritional status of infants aged 0-<6 months with regard to food intake.

METHODS

Interviews were conducted on randomly selected families with children under 2 years; anthropometric measurements were obtained from mothers and their children. Only infants between 0 and <6 months were selected for analysis (n  =  196). An ANCOVA test was performed on age of the infant with mothers' height and weight as covariates.

RESULTS

Prevalence of stunting (infants' length-for-age Z-score (LAZ) <-2SD) was 39%, wasting (WLZ <-2SD) 2%, and underweight (WAZ <-2SD) 13%. Of the infants under 6 months, 43% were exclusively breastfed. Predominant breastfeeding and mixed breastfeeding were less common (21% and 36%, respectively). The ANCOVA confirmed the association between exclusive breastfeeding and LAZ and WAZ: exclusively breastfed infants had a higher mean (SE) LAZ (-1.13, 0.12) and WAZ (-0.41, 0.13) than infants not being exclusively breastfed (-1.59, 0.11, and -0.97, 0.11, respectively). There was no overall significant association between breastfeeding practice and WLZ.

CONCLUSION

Exclusive breastfeeding of infants under 6 months is associated with higher mean LAZ and WAZ. Promotion of exclusive breastfeeding in low-income countries is important in preventing growth retardation.