Discrepancies in infant feeding recommendations between grandmothers and healthcare providers in rural Mexico.

BACKGROUND: Infant feeding practices are rapidly changing within rural areas in Mexico, including indigenous communities. The aim of this study was to compare infant feeding recommendations between grandmothers and healthcare providers, to better understand the factors that may influence these practices within these communities. This study builds on research that recognizes the legacy of colonization as an ongoing process that impacts the lives of people through many pathways, including the substandard healthcare systems available to them. METHODS: Qualitative study based on secondary data analysis from interviews and focus groups guided by a socioecological framework conducted in 2018 in two rural, Indigenous communities in Central Mexico. Participants were purposively selected mothers (n = 25), grandmothers (n = 11), and healthcare providers (n = 24) who offered care to children up to two years of age and/or their mothers. Data were coded and thematically analyzed to contrast the different perspectives of infant feeding recommendations and practices between mother, grandmothers, and healthcare providers. RESULTS: Grandmothers and healthcare providers differed in their beliefs regarding appropriate timing to introduce non-milk foods and duration of breastfeeding. Compared to grandmothers, healthcare providers tended to believe that their recommendations were superior to those from people in the communities and expressed stereotypes reflected in negative attitudes towards mothers who did not follow their recommendations. Grandmothers often passed down advice from previous generations and their own experiences with infant feeding but were also open to learning from healthcare providers through government programs and sharing their knowledge with their daughters and other women. Given the contradictory recommendations from grandmothers and healthcare providers, mothers often were unsure which advice to follow. CONCLUSIONS: There are important differences between grandmothers and healthcare providers regarding infant feeding recommendations. Healthcare providers may perceive their recommendations as superior given the neocolonial structures of the medical system. Public health policies are needed to address the different recommendations mothers receive from different sources, by harmonizing them and following an evidence-informed approach. Breastfeeding programs need to value and to seek the participation of grandmothers.

Insegurança alimentar entre adolescentes brasileiros: um estudo de validação da Escala Curta de Insegurança Alimentar / Household food insecurity in Brazilian adolescents: a validation study

Objetivo Os objetivos do trabalho foram avaliar a validade interna e a capacidade preditiva da escala de segurança alimentar de seis itens aplicada a adolescentes. Métodos Foi um estudo transversal com amostra representativa de adolescentes brasileiros (N=14.690), realizado em escolas públicas e privadas nas 26 capitais de estados brasileiros e no Distrito Federal por meio de questionário online. Resultados A maior parte dos respondentes era do sexo feminino (53,2%), com idade média de 14,4 anos, sendo 72,7% de escolas públicas. O comportamento da escala, observado pelo modelo de Rasch, foi melhor sem o item cinco, apresentando valores ótimos de Infit e nível de severidade crescente entre os itens. O alfa de Cronbach foi 0,77, e as análises do funcionamento diferencial dos itens mostraram comportamento dos itens semelhante entre os subgrupos avaliados. A análise fatorial mostrou a unidimensionalidade do instrumento. Conclusão Foi proposta a retirada do item cinco e novos pontos de corte para a escala curta de segurança alimentar. A escala curta de segurança alimentar é válida e confiável para mensurar insegurança alimentar domiciliar entre adolescentes brasileiros. .

Objective The objective of this study was to evaluate the internal and predictive validity of a six-item household food insecurity scale to measure food insecurity in Brazilian adolescents. Methods A cross-sectional study with a representative sample of Brazilian adolescents (N=14,690) was conducted in public and private schools in 26 state capitals and in the Federal District of Brazil using an online questionnaire. Results Most respondents were female (53.2%) with mean age of 14.4 years, and 72.7% of them attended public schools. The psychometric properties of the scale, assessed using the Rasch model, showed better response rates without the item five, exhibiting optimal Infit statistics and an increasing level of severity among the items. Cronbach's á was 0.767. Differential item functioning analyses showed similar behavior between the items in the subgroups evaluated. Factor analysis confirmed the unidimensionality of the scale. Conclusion This study proposes the removal of the item five and the inclusion of new cut-off points for this short form of the scale. The Household Food Security Scale (short form) is valid and reliable to measure household food insecurity in Brazilian adolescents. .