A Comparative Analysis of Maternal Nutrition Decision-Making Autonomy During Pregnancy-An Application of the Food Choice Process Model in Burkina Faso and Madagascar.

BACKGROUND: Adequate nutrition has been cited as one of the most critical components for optimal health outcomes during pregnancy. Women in Burkina Faso and Madagascar experience high rates of undernutrition due to lack of knowledge, finances, cultural norms, and autonomy. Therefore, this study aimed (1) to describe typical maternal diets during pregnancy in Burkina Faso and Madagascar, (2) to understand the multilevel factors that influence women's nutrition decision-making, and (3) to explore the extent to which women have nutrition decision-making autonomy during pregnancy. METHODS: This study was conducted between October 2020 and February 2021 in Burkina Faso and Madagascar. Semi-structured interviews, focus group interviews, and free lists were conducted among women of reproductive age and pregnant and lactating women. Textual data from interviews were recorded and translated verbatim from local languages into French. The Food Choice Process Model guided textual content analysis using Dedoose software. Free list data were analyzed using cultural domain analysis approaches. RESULTS: In Burkina Faso and Madagascar, women primarily consumed staple foods such as rice and tô during pregnancy. Participants cited eating fruits and vegetables when available, while the animal source foods were rarely consumed. Across both contexts, nutrition during pregnancy was influenced by factors that impact food choices, such as social factors, resources, ideals, and personal factors. While women and men in Madagascar had more shared decision-making on critical domains such as finances, men were the primary decision-makers in most areas of inquiry (eg, finances) in Burkina Faso. CONCLUSIONS: The lack of adequate diverse diet consumed during pregnancy is primarily due to important factors including social factors and resources. Understanding the ability for women to consume optimal diets during pregnancy is needed to target behavioral change in maternal nutrition programming.

Plain language titleA comparison of How Pregnant Women Make Decisions About What to Eat in Burkina Faso and Madagascar Using a Model Called the Food Choice Process ModelPlain language summaryHaving a proper diet is very important for the health of pregnant women. In Burkina Faso and Madagascar, many women do not get enough nutritious food due to lack of knowledge on what to eat, lack of money, cultural traditions, and not having control over their own choices. This study wants to find out (1) what women eat during pregnancy in Burkina Faso and Madagascar, (2) what influences the decisions women make about what to eat during pregnancy, and (3) explore how women had decision-making autonomy during pregnancy. The study took place in Burkina Faso and Madagascar. The researchers talked to women who could have babies and women who were already pregnant or breastfeeding. They used different methods like focus group discussions and semi-structured interviews to gather information. They recorded and translated everything that was said from the local languages to French. They used special software to analyze the information from the interviews. They also used a free list to understand the things women mentioned most often when talking about food. In Burkina Faso and Madagascar, women mostly ate basic foods like rice and tô during pregnancy. Sometimes they ate fruits and vegetables when they were available, but they did not eat much meat or other foods from animals. In both places, the women's food choices during pregnancy were influenced by different things like what their friends and family thought, how much money they had, their personal preferences, and other factors. In Madagascar, men and women made decisions together about important things like money, but in Burkina Faso, men were usually the ones making the decisions. The lack of a proper diverse diet during pregnancy in Burkina Faso and Madagascar is primarily caused by social factors and resources. To help women make better food choices during pregnancy, it's important to understand what affects their ability to have a healthy diet. This can help programs that aim to improve the nutrition of pregnant women by encouraging them to change their behavior.

Promising trends and influencing factors of complementary feeding practices in Côte d'Ivoire: An analysis of nationally representative survey data between 1994 and 2016.

Poor complementary feeding (CF) challenges early childhood growth. We examined the trends and influencing factors of CF practices among children aged 6-23 months in Côte d'Ivoire. Using data from Demographic and Health Surveys (DHS, 1994-2011) and Multiple Indicator Cluster Surveys (MICS, 2000-2016), the trends and predictors of World Health Organization-United Nations International Children's Emergency Fund CF indicators including the timely introduction of complementary foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD) and minimum acceptable diet (MAD) were determined. Using 2016 MICS data, we applied multivariate logistic regression models to identify factors associated with CF indicators. Between 1994 and 2016, the mean proportion of children aged 6-8 months achieving INTRO was 56.9% and increased by about 25% points since 2006. Over 2011-2016, the proportion of children aged 6-23 months meeting MMF, MDD and MAD increased from 40.2% to 47.7%, 11.3% to 26.0% and 4.6% to 12.5%, respectively. Older children and those from urban households had higher odds of meeting MDD and MAD. Maternal TV watching was associated with higher odds of meeting MDD. The secondary or higher education levels of mothers significantly predicted higher odds of meeting INTRO and MDD. Currently, breastfeeding was also positively associated with odds of meeting MMF and MAD. Children from poorer households had lower odds of meeting MMF, MDD and MAD. Despite the improvements, CF practices remain suboptimal in Côte d'Ivoire. Influencing factors associated with CF were distributed across individual, household and community levels, calling for future programmes and policies to implement multi-level strategies to improve young children's diet in Côte d'Ivoire.