Introduction Since 2003, the World Health Organization has recommended exclusive breastfeeding for the first 6 months of life. In the Northwest region of Cameroon approximately 90% of women initiate breastfeeding, yet only 34% of these women exclusively breastfeed for the recommended six months. Aim To determine influences on women’s exclusive breastfeeding practices. Methods Semi-structured interviews were conducted with six women and six men followed by focus group discussions with three groups of women and three groups of men in the Kumbo West Health District, Northwest region, Cameroon. All participants were selected using theoretical sampling to assure triangulation. Results Three themes emerged that influence exclusive breastfeeding practices: woman’s readiness to exclusively breastfeed; cultural influences towards exclusive breastfeeding; and perceived constraints to exclusive breastfeeding. Conclusion These emergent themes were used to create a theoretical framework that is useful for developing a breastfeeding health education intervention in non-Western settings.

Background Sub-optimal infant and young child feeding (IYCF) practices contribute to child undernutrition. Sierra Leone Demographic and Health Survey data show that IYCF practices remain poor despite modest improvements. Recent studies have identified the role of grandmothers as critical to child nutrition, however in Sierra Leone to date, the potential for grandmothers to influence IYCF practices has not been investigated. Objectives We examine how an innovative grandmother-inclusive approach (GMIA) can be used to address sub-optimal IYCF practices. Methods Using a quasi-experimental design, we compared IYCF beliefs and practices between GMIA intervention communities (receiving monthly dialogue sessions on nutrition, quarterly community praise sessions, and intergenerational forums) and comparison communities (receiving standard nutrition education) in Bum chiefdom from 2013 and 2016. The quantitative endline survey targeted 101 pregnant women, 291 women with children < 2 y of age, and 219 grandmothers. Statistical analyses utilized t-tests and chi square to examine differences between intervention and comparison communities at endline. Multivariate regression was used to determine the intervention's effect on IYCF outcomes of interest. Results Awareness of and participation in the GMIA was high among mothers and grandmothers in intervention communities. The percentage of infants and young children 0–23 mo (n = 291) exclusively breastfed during the first week of life was significantly higher in the intervention group (90.2% vs. 79.4%, p = 0.01). Among infants 6–23 mo (n = 219), the percentage achieving minimum dietary diversity and minimum acceptable diet was significantly higher in the intervention group (77.2% vs. 51.8%, p < 0.001 and 53.8% vs. 22.6%, p < 0.001, respectively). Differences in percentages achieving minimum meal frequency (MMF) were only significant for infants 9–23 mo, with intervention group achieving higher MMF (54.6% vs. 36.9%, p = 0.02). Conclusions Results suggest that a GMIA that recognizes grandmothers’ roles and strengthens their knowledge may contribute to improved IYCF practices.

Child undernutrition in Cambodia is a persistent public health problem requiring lowcost and scalable solutions. Rising cellphone use in low-resource settings represents an opportunity to replace in-person counselling visits with phone calls; however, questions remain on relative effectiveness. Our objective was to evaluate the impact of two options for delivering a World Vision infant and young child feeding (IYCF) counselling programme: (1) traditional Positive Deviance/Hearth (PDH) programme with in-person visits or (2) PDH with Interactive Voice Calling (PDH-IVC) which integrates phone calls to replace 62.5% of face-to-face interaction between caregivers and volunteers, compared to the standard of care (SOC). We conducted a longitudinal cluster-randomised controlled trial in 361 children 6-23 months. We used an adjusted difference-in-difference approach using baseline, midline (3 months) and endline (12 months) surveys to evaluate the impact on child growth among the three groups. At baseline, nearly a third of children were underweight, and over half were food insecure. At midline the PDH group and the PDH-IVC groups had improved weight-for-age z-scores (0.13 DID, p = 0.011; 0.13 DID, p = 0.02, respectively) and weight-for-height z-score (0.16 DID, p = 0.038; 0.24 DID, p = 0.002), relative to SOC. There were no differences in child height-for-age z-scores. At endline, the impact was sustained only in the PDH-IVC group for weight-for-age z-score (0.14 DID, p = 0.049), and the prevalence of underweight declined by 12.8 percentage points (p = 0.036), relative to SOC. Integration of phone-based IYCF counselling is a potentially promising solution to reduce the burden of in-person visits; however, the modest improvements suggest the need to combine it with other strategies to improve child nutrition.

Objective: To examine the difference in the rehabilitation rate from underweight by child age at enrolment in the Positive Deviance (PD)/Hearth programme. Design: This secondary data analysis used programme monitoring records of underweight children aged 6–60 months attending a 2-week PD/Hearth session and followed up for 6 months in Sep. 2018–Mar. 2019. Data were analysed using multi-level mixed-effect regression and poisson regression with robust variance. Setting: Rajshahi Division, Bangladesh Participants: A total of 5,227 underweight (weight-for-age z-score [WAZ]<-2) children who attended the PD/Hearth sessions. Results: From enrolment to six months follow-up, the mean WAZ improved from −2.80 to −2.09, and the percentage of underweight children decreased to 54.5%. Compared to the enrolment age of 6-11 months, the estimated monthly change in WAZ at six months of follow-up were 0.05 lower for 12-23 months, 0.06 lower for 24-35 months, and 0.09 lower for 36-60 months of the enrolment age (all p<0.001). The probability of rehabilitation at six months of follow-up were lower by 16.7% for 12-23 months (RR=0.83; 95% CI: 0.77, 0.91), 15.5% for 24-35 months (RR=0.84; 95% CI: 0.78, 0.92), and 34.9% for 36-60 months of the enrolment age (RR=0.65; 95% CI: 0.59, 0.72), compared to the enrolment age of 6-11 months. Conclusions: Enrolment in the PD/Hearth programme at a younger age had the advantage of greater rehabilitation from underweight than older age. Our findings provide a better understanding of the successes and failures of the PD/Hearth programme to achieve more sustainable and cost-effective impacts.

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