A comparison of observed feeding practices of infants and young children aged 6-23 months to national responsive feeding recommendations in Sri Lanka.

To describe the extent to which Sri Lankan caregivers follow current national responsive feeding recommendations and the factors limiting and enabling those behaviours. Study design. This ethnographic substudy was conducted using a four-phase, mixed methods formative research design across rural, estate and urban sectors of Sri Lanka. Data collection methods. Data were collected using direct meal observations and semistructured interviews. Participants including infants and young children aged 6-23 months (n = 72), community leaders (n = 10), caregivers (n = 58) and community members (n = 37) were purposefully sampled to participate in this study. Data analysis. Observational data were summarized using descriptive statistics while textual data were analysed thematically using Dedoose. Findings were then interpreted vis-à-vis six national responsive feeding recommendations. During observed feeding episodes, caregivers were responsive to nearly all food requests (87.2% [34/39]) made by infants and young children. Many caregivers (61.1% [44/72]) also positively encouraged their infant and young child during feeding. Despite some responsive feeding practices being observed, 36.1% (22/61) of caregivers across sectors used forceful feeding practices if their infant or young child refused to eat. Interviews data indicated that force-feeding practices were used because caregivers wanted their infants and young children to maintain adequate weight gain for fear of reprimand from Public Health Midwives. Despite overall high caregiver knowledge of national responsive feeding recommendations in Sri Lanka, direct observations revealed suboptimal responsive feeding practices, suggesting that other factors in the knowledge-behaviour gap may need to be addressed.

"Then you raise them with Shirchoy or cookies": Understanding influences on delayed dietary diversity among children in Tajikistan.

Dietary diversity is a key component of infant and young child feeding (IYCF) as well as adult health. In Tajikistan, a predominantly rural, former Soviet country in Central Asia, we conducted formative research to identify barriers to dietary diversity and strategies for nutrition behaviour change. In Spring, 2016, mixed-methods data collection took place across 13 villages in all five regions, collecting collaborative mapping; structured assessments of stores and markets; home visits for dietary recalls; food storage, preparation, and meal observations; focus groups with pregnant women, mothers of young children, fathers, and mothers-in-law; and in-depth expert interviews with local nutrition and health influentials. Overall, maternal diet was adequate in terms of diversity (only 13% reported <5/10 food groups in the past 24 hr); however, only 42% of index children 6-24 months met WHO guidelines for diversity, and only 34% met minimum acceptable diet criteria. In addition to issues of poverty and food scarcity, qualitative data reveal many behavioural barriers to timely introduction of diverse complementary foods. Women's strategies focused on gradual introduction of household diet components, without regard for diversity or nutrition. Foods such as meat were seen as costly and thus inappropriate for IYCF, and food taboos (i.e., fresh vegetables) further reduced diversity. Infant food preparation methods such as grinding were seen as impractical, and many foods were withheld until children develop teeth. Possible nutrition education strategies include point-of-purchase campaigns to improve availability and appeal of IYCF-friendly foods, as well as influencing other key household members through mosques, schools, and health care providers.

Barriers and Incentives to Rural Health Department Accreditation.

CONTEXT: Accreditation of local health departments has been identified as a crucial strategy for strengthening the public health infrastructure. Rural local health departments (RLHDs) face many challenges including lower levels of staffing and funding than local health departments serving metropolitan or urban areas; simultaneously their populations experience health disparities related to risky health behaviors, health outcomes, and access to medical care. Through accreditation, rural local health departments can become better equipped to meet the needs of their communities. OBJECTIVE: To better understand the needs of communities by assessing barriers and incentives to state-level accreditation in Missouri from the RLHD perspective. DESIGN: Qualitative analysis of semistructured key informant interviews with Missouri local health departments serving rural communities. PARTICIPANTS: Eleven administrators of RLHDs, 7 from accredited and 4 from unaccredited departments, were interviewed. Population size served ranged from 6400 to 52,000 for accredited RLHDs and from 7200 to 73,000 for unaccredited RLHDs. RESULTS: Unaccredited RLHDs identified more barriers to accreditation than accredited RLHDs. Time was a major barrier to seeking accreditation. Unaccredited RLHDs overall did not see accreditation as a priority for their agency and failed to the see value of accreditation. Accredited RLHDs listed more incentives than their unaccredited counterparts. Unaccredited RLHDs identified accountability, becoming more effective and efficient, staff development, and eventual funding as incentives to accreditation. CONCLUSIONS: There is a need for better documentation of measurable benefits in order for an RLHD to pursue voluntary accreditation. Those who pursue accreditation are likely to see benefits after the fact, but those who do not pursue do not see the immediate and direct benefits of voluntary accreditation. The finding from this study of state-level accreditation in Missouri provides insight that can be translated to national accreditation.

Policies on worksite lactation support within states and organizations.

BACKGROUND: The issue of workplace lactation support has intensified due to the Affordable Care Act of 2010 (ACA) amendment of the Fair Labor Standards Act (FLSA) obliging employers to provide a reasonable break time for nursing mothers. OBJECTIVES: This objective of this study is to examine organizational policies on worksite lactation support as they relate to the new federal standards in state employees and within large state public and private universities. METHODS: State laws were collected from National Conference of State Legislators. Policies for state employees and large public and private universities were collected via human resource or personnel administration websites. The policies were coded for content and compared to FLSA requirements. The presence of state law on lactation support and extent to which the organizational policies encompass FSLA were compared with state breastfeeding rates at 6 months. RESULTS: After the ACA became effective in 2010, 33 state organizations, 36 state public universities, and 13 private universities issued the administrative notice and aligned their organizational policies with the federal requirements. Twenty-four states enacted worksite breastfeeding law prior to the 2010 federal law. Nineteen states with enacted worksite breastfeeding state laws also have lactation policies for state employees. CONCLUSION: States and universities vary in the presence of a formal, written lactation support policy for state employees. There was a significant correlation between State law and 6 months exclusive breastfeeding rates. Future research should investigate whether the federal law serves as stronger catalyst for organizational policies than does state law. Additionally, other policies such as paid maternity leave may also contribute to achieving the desired breastfeeding rates.