An exploration of cultural influencing factors on dietary diversity in Malagasy children aged 6–59 months

Abstract

Background More than 1.7 million children in Madagascar are stunted, with low dietary diversity being a determinant. Although diverse crops are produced in the Vakinankaratra region, it registers the highest stunting prevalence rate nationally. While children’s diets may be influenced by region-specific cultural factors, little is known about this link so far. The aim of this study was to determine the influence of cultural habits on dietary diversity in children between 6 to 59 months in the Vakinankaratra region. Methods A mixed method design with a qualitative lead approach was used, including three transect walks, six focus group discussions and 51 semi-structured interviews with caregivers. The interviews contained a quantitative part to assess the four feeding indicators: ‘minimum meal frequency’, ‘minimum dietary diversity’, ‘minimum acceptable diet’ and the consumption of iron-rich foods. Participants were selected by convenience sampling. Data was collected in November 2019 in three communities displaying maximal possible variation. Results Subsistence farming with diverse crops and livestock was found to be a common practice. Minimum meal frequency was achieved by 78% of the sixty included children. In total, 45% attained minimum dietary diversity and 40% consumed a minimum acceptable diet. Across the three communities, the range of children attaining a minimum acceptable diet was 25–60%. Older, no longer breastfed children were prone to not achieving a minimum acceptable diet. Although caregivers had a basic idea of important foods for child development, these were often not available to or affordable for them. An effect of cultural events on diet, especially diversity, was found. Whilst for annual events this effect was short-term, the region-specific ceremony of reburying the dead (Famadihana) was found to have a long-term influence on the diet of certain families. Conclusions The dietary diversity of children under five in the Vakinankaratra region is influenced by cultural factors like agricultural practices, caregivers’ knowledge of child nutrition, food taboos and a region-specific cultural event. Cultural determinants, especially important traditions that result in significant expenditures, may thus influence the quality of children’s diet and should therefore be considered in future nutrition programmes and research on child malnutrition and stunting.

Incorrect Feeding Practices, Dietary Diversity Determinants and Nutritional Status in Children Aged 6–23 Months: An Observational Study in Rural Angola

“…Nonetheless, the qualitative analysis highlighted some religion-associated beliefs on food impurity (mainly regarding pork and fish) and other beliefs about specific foods being harmful for children (mainly regarding eggs and cow milk). These data are in line with findings from similar settings and should be considered when planning educational interventions to improve child nutrition [16].…”

Evaluation of nutritional status using the minimum dietary diversity for women of reproductive age (MDD‐W) tool in breastfeeding mothers in Madagascar

“…Government support and resources for smaller-scale improvements are scarce, and the burden of increasing DD falls primarily on the individual or family. Some of the challenges in increasing DD are directly tied to the economic status of the individual or family [35]. People with higher economic status are able to purchase a bigger variety of foods that cannot be obtained from subsistence farming alone at the market, but only if these are accessible [36].…”

“…While chickens are the most common livestock, the consumption of eggs, a nutritionally rich food, is low as almost all eggs are used for hatching [35]. Meanwhile, increasing dairy consumption could also help with DD but this is highly dependent on the ability of the individual or family to produce their own dairy products or acquire them from the markets [35]. Wild food consumption in Madagascar has been studied previously in relation to human nutrition [51][52][53][54] and was associated with increased household DD, in particular leafy greens and animal foods, and positively correlated with child anthropometric growth.…”

“…Finally, it has been suggested that special cultural events and celebrations may influence DD beyond the day of celebration [35]. During the event, DD seems to increase but in the medium and long-term these celebrations, depending on their size and the families' initial financial status, can impose financial constraints and have a negative effect on DD [55,56].…”

Food consumption, culture, and living environment's impact on stunting cases: A systematic review

“…In Latin America and the Caribbean, the prevalence of stunting has decreased to 9.6%. Meanwhile, in Madagascar, the stunting rate is 700,000 people (Ribeli and Pfister, 2022). The prevalence of stunting in Ethiopia, India, France, Pakistan, Malaysia, and Bangladesh was reported as 37 % (Tamir et al, 2022), 39.3% (Koshy et al, 2022), 12% (Castro-Bedriñana et al, 2021), 45% (Kureishy et al, 2017), 21.8% (Chew et al, 2022), and 46% (Chakraborty et al, 2020), respectively.…”