What influences child feeding in the Northern Triangle? A mixed‐methods systematic review

Abstract

Optimising child feeding behaviours could improve child health in Guatemala, Honduras and El Salvador, where undernutrition rates remain high. However, the design of interventions to improve child feeding behaviours is limited by piecemeal, theoretically underdeveloped evidence on factors that may influence these behaviours. Between July 2018 and January 2020, we systematically searched Cochrane, Medline, EMBASE, Global Health and LILACS databases, grey literature websites and reference lists, for evidence of region‐specific causes of child feeding behaviours and the effectiveness of related interventions and policies. The Behaviour Change Wheel was used as a framework to synthesise and map the resulting literature. We identified 2,905 records and included 68 relevant studies of mixed quality, published between 1964 and 2019. Most (n = 50) were quantitative, 15 were qualitative and three used mixed methods. A total of 39 studies described causes of child feeding behaviour; 29 evaluated interventions or policies. Frequently cited barriers to breastfeeding included mothers' beliefs and perceptions of colostrum and breast milk sufficiency; fears around child illness; and familial and societal pressures, particularly from paternal grandmothers. Child diets were influenced by similar beliefs and mothers' lack of money, time and control over household finances and decisions. Interventions (n = 22) primarily provided foods or supplements with education, resulting in mixed effects on breastfeeding and child diets. Policy evaluations (n = 7) showed positive and null effects on child feeding practices. We conclude that interventions should address context‐specific barriers to optimal feeding behaviours, use behaviour change theory to apply appropriate techniques and evaluate impact using robust research methods.

Engaging family members in maternal, infant and young child nutrition activities in low‐ and middle‐income countries: A systematic scoping review

“…Very few studies are from Latin America and the Caribbean. A recent systematic review examining factors that influence infant feeding practices in Guatemala, Honduras, and El Salvador described the considerable evidence of the influence grandmothers and fathers, and the lack of interventions that engage them (Deeney & Harris-Fry, 2020). and involve more than one intervention component (e.g.…”

Global lessons for strengthening breastfeeding as a key pillar of food security

“…This meant additional strain on families trying to meet their basic nutritional needs. Such challenges always place pressure on breastfeeding because women often have to prioritize seeking work to generate income and provide adequate food for their families and face limited ability to continue breastfeeding in many of these work settings, particularly in the informal sector, where most people are employed in Honduras (10,(14)(15)(16). Even when women can take advantage of maternity leave in the formal sector, leave costs are only partially born by the employer.…”

“…Honduras was the site of several key trials for programs that successfully increased breastfeeding, reduced the routine use of commercial milk formula (CMF) at hospitals, and reduced malnutrition during the 1980s through 2012 ( 10 ). Significant progress was made in the implementation of breastfeeding training and breastfeeding-friendly policies, leading to increased breastfeeding indicators in the country ( 10 ).…”

“…Honduras was the site of several key trials for programs that successfully increased breastfeeding, reduced the routine use of commercial milk formula (CMF) at hospitals, and reduced malnutrition during the 1980s through 2012 ( 10 ). Significant progress was made in the implementation of breastfeeding training and breastfeeding-friendly policies, leading to increased breastfeeding indicators in the country ( 10 ). Demographic Health Survey (DHS) data from 2011 shows that breastfeeding initiation was high at 96%, although timely initiation (within first hour) was much lower at 64, and 44% received prelacteal feeds ( 11 ).…”

Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 4. Nutrition-related activities and changes in childhood stunting, wasting, and underweight

“…A 2013 survey conducted by the Western Highlands Integrated Project (WHIP) in 20 rural municipalities of the predominantly Maya Western Highlands, which includes the Department of Huehuetenango as well as other departments in western Guatemala, revealed similar findings: 67.4% of under-5 children were stunted [ 18 ]. Contributing to this situation have been household food insecurity; large family size; history of diarrhea; lack of knowledge about proper nutrition for infants and children; endemic poverty; an over-dependence on maize (corn); a cultural belief that maize alone is sufficient nutrition; poor maternal nutrition during pregnancy; and mothers’ lack of money, time, and control over household finances and decisions [ 19 – 22 ].…”