Home stimulation, development, and nutritional status of children under 2 years of age in the highlands of Madagascar.

BACKGROUND: The Vakinankaratra region of Madagascar has a high burden of child undernutrition which, in addition to poor psychosocial stimulation, is a strong risk factor of poor child development. However, there are limited studies evaluating the relations between developmental deficits, child nutrition outcomes, and home stimulation in the region. The purpose of this study was to assess the development of children aged 11-13 months in relation to their nutritional status and to examine parental home stimulation attitudes and practices in the Vakinankaratra region. METHODS: Cognitive (n = 36), language (n = 36), motor (n = 36), and socioemotional (n = 76) development were assessed using the Bayley Scales of Infant and Toddler Development III. Household stimulation environment was evaluated using the family care indicators survey. Stunting (length-for-age z-score < - 2) and underweight (weight-for-age z-score < - 2) were determined using the 2006 WHO growth standards. Perceptions of and barriers to greater home stimulation for children were collected using focus group discussions among parents and in-depth interviews with community nutrition agents. RESULTS: Almost all mothers reported that parent-child interaction with talk and play was very important. Alarmingly high stunting rates (> 69%) were observed in this subsample. Limited time and tiredness were the major barriers to home stimulation mentioned by parents and confirmed by key informants. Children had a very limited variety of play materials, and most of the mothers used household objects (75%) and materials from outside the house (71%) as children's toys. Composite cognitive [mean (SD): 60 (10.3)], motor [61.9 (13.4)], language [62 (13.2)], and socioemotional [85.1 (17.9]) scores were low. Fine motor, cognitive, and receptive and expressive language scores were correlated [0.4 < r < 0.7, p < 0.05]. CONCLUSIONS: The very high stunting rates and very low performance on cognitive, motor, language, and socioemotional development assessments of children in the Vakinankaratra region require urgent attention.

Fathers' involvement in child care activities: Qualitative findings from the highlands of Madagascar.

Few studies have investigated fathers' roles in child care in Madagascar. This study explored the perceptions, attitudes, and practices regarding fathers' involvement in child care using qualitative methods. Ten focus group discussions were conducted among parents of children aged 6-23 months; seven were among mothers, and three among fathers. In-depth semi-structured interviews (n = 8) were also conducted with key informants. Discussions and interviews were audio-recorded and the verbatim transcripts in Malagasy were translated into English. Data were analyzed using the thematic analysis approach. Provision of financial and material support as well as teaching and playing with the child were the main perceived roles of fathers. In practice, fathers spent their time alone with their children playing and holding them when the mother was unavailable. Busy schedules and separation due to work were major barriers to fathers' involvement. Traditional gender roles for child care in which the mother is seen as primarily responsible for the child were salient across the data. Consequently, men involved in child care activities and their wives were often criticized by the community. Nevertheless, there was self-reported interest from both mothers and fathers in involving men more in child care. Interventions aimed to increase fathers' involvement in child care may be more successful when they focus on shifting the community perceptions on the division of responsibilities between fathers and mothers.

Maternal Knowledge, Attitudes, and Practices of Complementary Feeding and Child Undernutrition in the Vakinankaratra Region of Madagascar: A Mixed-Methods Study.

BACKGROUND: Data are limited on how feeding knowledge and practices relate to child undernutrition in the highlands of Madagascar. OBJECTIVES: This study assessed maternal knowledge and practices of complementary feeding and their associations with anthropometrics of children aged 6-23 mo in the Vakinankaratra region of Madagascar. METHODS: Knowledge was assessed using WHO recommendations on child feeding, and WHO infant and young child feeding (IYCF) indicators were used to evaluate feeding practices. Child growth was measured as length-for-age, weight-for-age, and weight-for-length z-scores using the 2006 WHO growth standards. A z-score less than -2 was classified as child undernutrition. Logistic regression models were used to determine associations between independent variables and outcomes. Focus group discussions among mothers and in-depth interviews with key informants were conducted; barriers and facilitators of optimal feeding practices were identified using a thematic analysis approach. RESULTS: Maternal knowledge scores regarding child feeding averaged 6.4 of 11. Better knowledge scores were associated with higher odds of appropriate complementary feeding practices before and after covariate adjustments. The proportions of children achieving the minimum dietary diversity (35.8%), minimum acceptable diet (30.2%), and consuming meat, fish, and poultry (14.1%) were low. Only consumption of iron-rich foods was associated with lower odds of underweight (adjusted OR = 0.3; 95% CI: 0.1, 0.7; P < 0.05). None of the IYCF indicators were associated significantly with stunting or wasting. Maternal attitudes about complementary foods, as well as mothers' workload and very low income, were identified as barriers to optimal feeding practices. Maternal perceived benefits of giving appropriate complementary foods as well as their positive relationship with the community health workers were the main facilitators of optimal child feeding. CONCLUSIONS: Integrated nutrition-sensitive interventions addressing these barriers while enhancing the facilitators are critical in promoting better feeding practices in the Vakinankaratra region.

Parents' Perceptions of Childhood Obesity and Support of the School Wellness Policy.

OBJECTIVE: Investigate differences in familiarity of parents of school-aged children with school wellness polices (SWP) and perceptions of the problem of childhood obesity related to support for the SWP and school's role in providing a healthy environment. METHODS: Descriptive, cross-sectional study using telephone surveys conducted in spring, 2016. T test statistics compared differences between parents with high vs low SWP familiarity and agreement vs disagreement of childhood obesity as problematic. RESULTS: Nearly half of parents (49.5%) had low familiarity with SWP. Overall, fewer parents agreed that obesity was a local school problem compared with a statewide problem (P < .001). Differences in agreement about childhood obesity explained some differences in SWP support. CONCLUSIONS AND IMPLICATIONS: Greater awareness is needed among parents of schoolchildren regarding the SWP as well as the prevalence of childhood obesity. This could be achieved through increased development, implementation, and evaluation of communication efforts between schools and families regarding health-promoting environments.

Situation and determinants of the infant and young child feeding (IYCF) indicators in Madagascar: analysis of the 2009 Demographic and Health Survey.

BACKGROUND: Studies evaluating child feeding in Madagascar are scarce despite its importance in child growth during the first two years of life. This study assessed the associations between the WHO infant and young child feeding (IYCF) indicators and stunting and identified determinants of inappropriate child feeding practices. METHODS: The most recent Demographic and Health Survey was used including a total of 1956 infants aged 0-23 months. Logistic regressions were performed for the association between IYCF indicators and stunting and for the determination of risk factors for inappropriate feeding practices. RESULTS: The rates of initiation of breastfeeding within one hour after birth (77.2%), continued breastfeeding at one year (99.6%) and timely introduction of solid, semi-solid or soft foods at 6-8 months (88.3%) were high. Exclusive breastfeeding under 6 months (48.8%), attaining minimum dietary diversity (22.2%) and consumption of iron-rich foods (19.6%) were relatively low. Higher length-for-age was associated with achieving minimum dietary diversity (p<0.01). The other indicators assessed (early initiation of breastfeeding, exclusive breastfeeding under 6 months, timely introduction of complementary foods and consumption of iron-rich foods) were not associated with stunting. Infants born to mothers who had first given birth at an age younger than 19 were more likely not to be breastfed within one hour after birth, not to be exclusively breastfed and not to have the recommended dietary diversity. Infants whose mothers had low media exposure were at increased risk of being inappropriately fed. Low household wealth also was associated with higher odds of not meeting the minimum dietary diversity. CONCLUSIONS: Despite almost total continued breastfeeding at one year and early initiation of breastfeeding by more than three-quarter of mothers, minimum dietary diversity scores were still low, confirming the need for more effective programs for improving child feeding practices in Madagascar. Improving dietary diversity in children aged 6-23 months may help reduce stunting. The identified risk factors for inappropriate feeding practices could be used in directing future nutrition sensitive interventions.

Determinants of stunting in children under 5 years in Madagascar.

Madagascar is among countries where the prevalence of stunting is dramatically high in under 5 years old children. This study investigated the determinants of child stunting based on the UNICEF framework on the causes of malnutrition. A cutoff at 24 months was used to separate the child population into two groups. By using the latest Demographic and Health Survey (2009), logistic regressions were performed to determine the variables associated with stunting. In 2009, 40.1% of the 1,863 children aged 0-23 months and 53.9% of the 2,911 children aged 24-59 months were stunted contributing to the 48.5% overall stunting prevalence in the sample. Girls were less likely to be stunted (adjusted odds ratio with confidence interval [AOR] = 0.69 [0.55-0.88] and 0.84 [0.72-0.97], p < 0.01) than boys; the risk of stunting increased with age. Regarding underlying predictors, increased maternal height was associated with lower odds of stunting in both age groups (AOR = 0.75 [0.68-0.83] and 0.69 [0.61-0.77], p < 0.001). Children living in households using iodized salt (>15 ppm) had lower risk of stunting in the younger group (AOR = 0.76 [0.61-0.94], p < 0.05). Children living in urban areas were less likely to be stunted in both age groups (AOR = 0.67 [0.51-0.88] and 0.73 [0.59-0.90] respectively, p < 0.01]. Region of residence was also a significant basic factor for stunting. This study contributes to the understanding of the determinants of child stunting in Madagascar. The results confirmed the need for specific interventions for each of the two age groups.

Differences in body dissatisfaction, weight-management practices and food choices of high-school students in the Bangkok metropolitan region by gender and school type.

OBJECTIVE: The present study aimed to compare body dissatisfaction, food choices, physical activity and weight-management practices by gender and school type. DESIGN: A questionnaire was used to obtain height, weight, body image perception using Stunkard's figure rating scale, food choices, physical activity and weight-management practices. SETTING: Nine single- and mixed-gender schools located in Bangkok Metropolitan Region, Thailand. SUBJECTS: Students in 10th-12th grade, aged 15-18 years (n 2082). RESULTS: Only 18% of females and 21% of males did not indicate body dissatisfaction. About 66% of females selected a thinner ideal figure than their current figure. Among males, 44% wanted a thinner figure, but 35% wanted a bigger figure. However, univariate analysis found differences by school type but not gender in the degree of body dissatisfaction; students in single-gender schools had more body dissatisfaction. Females reported using more weight-management practices but less physical activity, while males reported healthier food choices. Participants in single-gender schools had healthier food choices compared with those in mixed-gender schools. Adolescents who were at increased risk of a greater degree of body dissatisfaction were females, attended single-gender schools, had lower household income, higher BMI and less physical activity. CONCLUSIONS: Most participants reported being dissatisfied with their current body shape, but the type and level of dissatisfaction and use of weight-management practices differed by gender and type of school. These findings suggest that programmes to combat body dissatisfaction should address different risk factors in males and females attending single- and mixed-gender schools.

Comparison of disordered eating symptoms and emotion regulation difficulties between female college athletes and non-athletes.

The purpose of the study was to compare the prevalence of disordered eating between female college athletes and non-athletes and explore emotion regulation as a potential mediator of the link between participation in athletics and disordered eating symptoms. Data for this cross-sectional study came from 527 college students in a mid-western state of the USA in fall of 2013 (376 non-athletes and 151 athletes). Disordered eating symptoms and emotion regulation were assessed utilizing the Eating Attitudes Test and the Difficulties with Emotion Regulation Scale in a survey-based format. The prevalence of disordered eating was higher in non-athletes (16.5%, vs. 6.6%; X(2)=62.8; p<.05). Non-athletes reported more signs and symptoms of disordered eating than athletes (p<.01). A linear regression approach indicated a statistically significant indirect effect (0.63, CI95=0.18, 1.20) of athletic-status on disordered eating via emotion regulation; however, this effect did not reach practical significance. Our findings show that female athletes in our sample were somewhat protected from disordered eating compared to non-athletes, but the mechanism of this relationship is unclear. A further in-depth examination of other factors, such as self-esteem and body satisfaction, that may have contributed to this finding is warranted utilizing a large sample of female college students and athletes representing a variety of sports.

Social and physical environmental factors and child overweight in a sample of American and Czech school-aged children: a pilot study.

OBJECTIVE: To compare environmental factors that influence body mass index for age (BMI-for-age) between a sample of American and Czech school-aged children. DESIGN: Pilot study. A parent questionnaire and school visits were used to collect data from parents and children. SETTING: Public schools in 1 American and 2 Czech cities. PARTICIPANTS: Forty-five American and 97 Czech 4(th)- through 6(th)-graders and their parents. VARIABLES MEASURED: Parenting style, food socialization and preparation practices, healthful food availability, and children's BMI-for-age were measured. ANALYSIS: Factors from the parental scales were derived using factor analysis. Independent t tests compared environmental factors between American and Czech families. A regression model was used to identify environmental variables associated with BMI-for-age. RESULTS: American parents used authoritative parenting style and positive food socialization practices more often than Czech parents (P <.001). Availability of healthful food and parental involvement in food preparation were higher (P <.001) in Czech households. Positive encouraging socialization practices, less frequent use of negative explanations, and a greater availability of vegetables were associated with lower BMI-for-age in the Czech sample of children. CONCLUSIONS AND IMPLICATIONS: A future study should focus on identifying environmental factors that influence children's BMI-for-age with a large sample of Czech and American parents and their school-aged children.

Body image perceptions in Western and post-communist countries: a cross-cultural pilot study of children and parents.

The development of an unrealistic ideal body image and body size dissatisfaction among children is common in Western countries, including the USA and many European nations. However, little is known about children's body image perceptions in post-communist countries. This pilot study evaluated body image perceptions in a sample of Czech school-aged children and their parents and compared them with the perceptions of American children and parents. Ninety-seven Czech and 45 American 4th-6th graders and their parents from eight urban schools participated in this study. A previously developed silhouette body image instrument was utilized in a parent questionnaire and during child interviews to measure perceived and ideal body image perceptions of children and parents. Descriptive statistics, independent t-tests and paired t-tests were used to compare differences between children's and parents' perceived and ideal body image perceptions. Associations between body image perceptions and other variables were explored using bivariate correlations. American children had a thinner ideal body image compared with Czech children (P < 0.05). However, a larger proportion of Czech boys desired to be thinner compared with American boys (34.2% vs. 20%). Parent's ideal body image for their children did not differ by nationality (P = 0.858). While the pressure on children to look thinner was apparent among both American and Czech children, Czech children considered a larger body size as more ideal. A future study should evaluate body image perceptions and factors influencing these perceptions in a representative sample of Czech children and parents.

Dietary intakes, physical activity, and predictors of child obesity among 4-6th graders in the Czech Republic.

The prevalence of child obesity in the Czech Republic has increased in the last several years, especially among school-aged children. While obesity trends are closely monitored in the Czech Republic, very little is known about the dietary habits and exercise behaviors of Czech children. The purpose of this study was to evaluate nutrient intakes and physical activity, as well as identify predictors of BMI-for-age in a sample of Czech school-aged children. Ninety-seven fourth, fifth and sixth graders and their parents from two large Czech cities participated in the study. Two 24-hour recalls provided total amount of energy, fat, percentage of energy derived from fat, dietary fiber, and servings of fruits and vegetables. Physical activity was measured by the Self-administered Physical Activity Checklist (SAPAC). Children consumed less energy and dietary fiber than suggested by Czech dietary recommendations. The proportion of energy that children consumed from fat was 28.5%. Children consumed 1.4 cups of fruit and 1.2 cups of vegetables. Children's physical activity levels fell within the current recommendations. Age was the only significant predictor of higher BMI-for-age. Poor dietary quality may be responsible for increasing rates of child obesity in the Czech Republic. Nutritional professionals in the Czech Republic should focus on increasing consumption of fruits, vegetables, and other high-fiber foods in order to reduce the risk for overweight among Czech children.