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Abstract
Background: Undernutrition in children is a leading underlying cause of child death globally. Previous research has shown that inappropriate or suboptimal infant and young child feeding practices (IYCF) play an essential role in the development of undernutrition. Implementing the IYCF correctly significantly decreases the likelihood of a child being malnourished. However, many low and middle-income countries fall short in implementing these nutrition recommendations. One theory as to why IYCF practices are not being implemented appropriately is related to caregiver capabilities. The purpose of this study is to investigate the relationship between caregiver capabilities and IYCF practices and nutrition outcomes in children across the East and Southern Africa region. We hypothesize that greater presence of caregiver capabilities—measured as a decision-making domain, bodily integrity domain, and overall capability index— will be associated with a decreased stunting and wasting incidence and will be positively associated with mother’s IYCF practices.
Methods: We used cross-sectional data from the 13 nationally-representative Demographic and Health Surveys (DHS) from the East and Southern regions of Africa that met inclusion criteria. Nutrition status was assessed by indicators of stunting (length-for-age Z-score < -2) and wasting (weight-for-length Z-score < -2) using the 2006 WHO Multicentre Growth References Study values . IYCF dependent indicators included exclusive breastfeeding (EBF), minimum meal frequency (MMF), minimum diet diversity (MDD), and minimum acceptable diet (MAD). Two domain-specific scales, bodily integrity and decision-making, as well as an overall caregiver capabilities scale were developed by a multi-step approach. We explored the country-specific association between each independent variable (bodily integrity, decision making, and overall capability scales) and each dependent variable (IYCF and nutrition outcomes) using separate adjusted logistic regression models. After obtaining disaggregated estimates for each country, and each domain, the beta coefficients were entered into separate meta-analyses to obtain odds ratios pooled across countries for the associations between bodily integrity, decision making, and overall capability scales and IYCF and nutrition outcomes.
Results: Among individual countries, decision-making was found to be the domain with the most significant associations with IYCF practices. When all countries were combined, we discovered a positive association between the bodily integrity domain, decision-making domain, and overall caregiver capabilities index with all measured indices of IYCF. Greater presence of caregiver capabilities was also negatively associated with stunting incidence between all countries.
Conclusion: Based upon our results, greater presence of caregiver capabilities positively influences child health. Efforts to strengthen capabilities among mothers may result in the implementation of recommended IYCF practices and reduction in undernutrition. Our findings contribute to the understanding of previously under measured social variables identified as influencers of caregiver capabilities. The continued enrichment of this particular field of maternal health provides opportunities for further research, programs, policies, and other intervention strategies.
